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Physician Engagement at Houston Methodist:

Letting Doctors Be Doctors

S. Nicholas Desai, MD, CMIO, Houston Methodist

Christina Boling, Advisor, Impact Advisors

Arthur Sorrell, MD, Principal – Physician Executive, Impact Advisors

2

Why, What, and How

Why Engage Physicians?

What Should Our Approach Be?

How Do We Accomplish That?

Physician Engagement

3

“The joy of practicing medicine is gone.”

“I hate being a doctor…I can’t wait to get out.”

“I can’t tell you how defeated I feel…The feeling of being

punished for delivering good care is nerve-racking.”

“I am no longer a physician but the data manager,

data entry clerk, and steno girl…I became a doctor

to take care of patients. I have become a typist.”

Physician Dissatisfaction

4

Professional Burnout Defined:

– Loss of enthusiasm for work

– Emotional exhaustion

– Feelings of low achievement

– Feelings of decreased effectiveness

– Depersonalization

– Feelings of cynicism

Physician Burnout

5

Greater than 50% of doctors report at least one symptom of

burnout

87% of doctors said the leading cause of burnout is

administrative and clerical work

There is a 26% productivity difference between engaged

and disengaged physicians

ED doctors spend 44% of their time doing data entry

Greater than 75% of doctors report that EHR increases time

to render care

Fall 2016: 11 Health Care CEOs held a summit and

declared physician burnout a National Public Health Crisis

Concerning Statistics

6

The High Cost of Burnout

Dissatisfied doctors are associated with lower patient

satisfaction

May contribute to overuse of resources, increasing costs

Unhappy doctors are 2x–3x more likely to leave practice;

cost ranges from $250k to $1 million

Dissatisfied doctors are more likely to prescribe

inappropriate medications

Associated with reduced adherence to treatment plans

Associated with worsened clinical outcomes

Consequences of Burnout

7

The primary driver of Physician Satisfaction is

“…the ability to provide Quality Care…”

“…Physician Dissatisfaction, therefore, is an

early warning sign of a health care system

creating barriers to high-quality practice…”

Canary in a Coal Mine

8

Effects of Engagement

9

Triple Aim – 2007, IHI, Donald Berwick

1. Better Health – Improve the Health of the

Population – the PRIMARY GOAL

2. Better Care – Improve the Patient’s Experience of

Care – supports the primary goal

3. Lower Cost – Reduce the Cost of Care – supports

the primary goal

Quadruple Aim – 2014, Bodenheimer, Sinsky

4. Better Environment – Improve the worklife of

those who deliver care – supports the primary

goal

Triple to Quadruple Aim?

1

0

Evolving The Practice of Medicine:Implement But Don’t Disintegrate

S. Nicholas Desai, MD, CMIO, Houston Methodist

Christina Boling, Advisor, Impact Advisors

Arthur Sorrell, MD, Principal – Physician Executive, Impact Advisors

1

1

About Houston Methodist

Houston Methodist comprises a leading academic medical center in the Texas

Medical Center and six community hospitals serving the Greater Houston area.

Source: HoustonMethodist.org

1,983Beds in Service

$3.1B

(FY14)

Total

Revenue

467Employed Physicians

265

Residents

36

Residency

Programs

2,165

Operating Beds

557,310

Annual Pt Days

(FY16)

21,000+

Employees

500+

Employed

Physicians

$3.7B

(FY16)

Total Revenue

> 5,500

Physicians

( 24 )

( 140 )

1

2

Houston Methodist Epic

Timeline

Sites Live

Q1 16 Q2 16 Q3 16

SPG/PCG

1st wave

Go-Live

(3/1/16)

HMH

Go-Live

(5/22/16)

Q4 16 Q1 17 Q2 17

West

St Catherine

St John

Go-Lives

(2/19/17)

SPG/PCG

3rd wave

Go-Live

(11/1/16)

Willowbrook

San Jacinto

Sugar Land

Go-Live

(5/14/17)

SPG/PCG

2nd wave

Go-Live

(7/19/16)

Q3 17

The

Woodlands

Opening

(6/26/17)

LIVE LIVE LIVE LIVELIVE LIVELIVE

13

Insert Planning & Selection Process Details

• “Breakthrough results come about by a series of

good decisions, diligently executed and

accumulated one on top of another.” The Flywheel Concept / Jim Collins, Good to Great

• At HM, we strongly believe to reach physician

efficiency, one must identify “human-centric”

versus “computer-centric” workflows and

fundamentally design our tools wherever possible

to maximize adoption while minimizing variation.

Houston Methodist ApproachHow To Make Physicians Happy?

14

Synchronized CxO Goals:

Help Me Help YOU

1

5

• Maximize Adoption

• Minimize Disruption

Let Physicians Lead Physicians--- there is no one who

knows what we do better than us. I mean NO ONE.

--S. Nicholas Desai, CMIO

Change Management GoalsLet Doctors be Doctors

1

6

Physician Quotes

Epic Rocks! It’s taken

20 minutes off my

morning rounds.

I’m learning to

use Smart

phrases. It’s

kind of fun!

It’s really working well. I like the app on

my phone.

Ahh! Finally

moving into the

digital age. This

is great.

“I've never seen an implementation go this well.

This has been amazing.”

“I feel like I have my life back!”

17

*Fingersnap*

“this is easy”

The Go-Live

was like a Rolls

Royce with a

broken ashtray

…Amazing job!

Decision Making Model

Major Organizational

Impact

ModerateOrganizational

Impact

Less Organizationa

l Impact

Mid-Level Decisions

High-LevelDecisions

Detailed Decisions

~ 25% of decisions

~ 10% of decisions

~ 65% of decisions

EPACs

Subject Matter Experts

Clinical Practice Committee

Project Steering Team

System Councils/Work Groups

Project Team

Access Rev Cycle Readiness

From: Davis C, Stoots M. A Guide to EHR Adoption: Implementation Through Organizational Transformation. HIMSS Publishing. 2012.

Physician Alignment:

Know ALL of your Providers

Messaging:

Keep them informed at each step of

the way

Training;

Deconstruct It, Make it

Unique, Make it Real

Customize:

Personalize your Epic Physician

Onboarding

Maximize AdoptionWork to Meet Provider Expectations & Efficiencies

19

Stage the Go Lives:

Complexity varies but must never

leave focus on your customer

Design System Service Line Approach:

Minimize Variation

Show me the Data:

Don’t start with blank canvas, Move the relevant data, archive the rest, and build a solid documentation

strategy

Facilitate Easy Secure Access:

Mobile Tools (Haiku/Canto),My Chart, Epic Care

Link, Apps Center, Perfect Serve

Go Live Support:

At the elbow, Residents, Physician

Champions, Physician

Leadership Rounding

Minimize DisruptionStay Focused and Remain Tactical

20

Physician Engagement:Nuts and Bolts

S. Nicholas Desai, MD, CMIO, Houston Methodist

Christina Boling, Advisor, Impact Advisors

Arthur Sorrell, MD, Principal – Physician Executive, Impact Advisors

2

1

Physician Engagement: Before

2

2

CMIOCampus

leadership

Campus

leadership

Campus

leadership

Project

leadership

One trusted

source

5,000+ campus physiciansDozens of leadership

Physician Engagement: After

2

3

Campus &

physician

leadership

Office &

Administrative staff

Physician &

Resident

champions

Project leadership

& advisory team

EHR project team

Physician

Engagement

Team*

*CMIO, CQO

Physician Eng. PM

Physician Advisors

Epic Training

Epic Communications

Clinical Readiness PM

Pre-Live• Participate in Order Set Review

• Training Readiness

• Epic Preparedness– Review multidisciplinary and clinical workflows and identify critical

hospital/service line needs

During Go-Live• Participate in daily physician champion calls

• Provide updates to colleagues at service line/unit levels

• Communicate physician issues to command center in

collaboration with at-the-elbow support, including prioritization

• Assist with Go-Live issue resolution

Physician ChampionsRoles and Responsibilities

2

4

Physician ChampionsReadiness Series

2

5

6+ Months

•Review implementation timeline

•Review role, expectations

•Sign Champion contracts

•Participate in Order Set design and validation

•Participate in workflow design sessions

120 Days

•Message training expectations

•Attend physician-centric meetings to champion EHR adoption

90 Days

•Training stats

•Current state versus future state

•Drill into EHR workflows

•Web-based applications

•Mobile functionality

60 Days

•Training stats

•Dictation options

•Scheduling workflows

•Chart etiquette

•Problem list management

30 Days

•Review Go-Live logistics, scheduling

•Late-breaking clinical updates

•Physician flashcards/reference guides

Go-Live/Post-Live

•Onsite Go-Live rounding support

•De-escalate issues

•Track KPI’s

•Review Optimization requests

Physician EngagementProject Management tools

2

6

1. Messaging

calendar

- Department meetings

- MEC

- Medical Staff

meetings

- CEO Council

2. Week-By-Week

Project Plan

- Order Set build

- Training milestones

- Clinical Readiness

Physician EngagementCommunications Strategy: Tell me about IT

27

• Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Fam Medicine. 2014;12(6):573-576

• Berwick DM, Nolan TW, Whittington J. The Triple Aim: care, health, and cost. Health Aff (Milwood). 2008;27(3):759-769

• Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med.

2012;172(18):1377-1385

• Friedberg MW, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health

policy. Rand Corporation 2013. http://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_RR439.pdf.

• 2011 Physician Stress and Burnout Survey. Physician Wellness Services and Cejka Search. http://www.cejkasearch.com/wp-content/uploads/physician-stress-burnout-

survey-.pdf

• Jamoom E, Patel V, King J, Furukawa MF. Physician experience with electronic health record systems that meet meaningful use criteria: NAMCS Physician Workflow Survey,

2011. NCHS data brief, no 129. Hyattsville, MD: National Center for Health Statistics. 2013.

• McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for

patient care. Health Aff (Millwood). 2011;30(2):202-210.

• Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern

Med. 2000;15(2):122-128.

• Kushnir T, Greenberg D, Madjar N, Hadari I, Yermiahu Y, Bachner YG. Is burnout associated with referral rates among primary care physicians in community clinics? Fam

Pract. 2014;31(1):44-50.

• Bachman KH, Freeborn DK. HMO physicians’ use of referrals. Soc Sci Med. 1999;48(4):547-557.

• Sirovich BE, Woloshin S, Schwartz LM. Too little? Too much? Primary care physicians’ views on US health care: a brief report. Arch Intern Med. 2011;171(17):1582-

1585.

• Buchbinder SB, Wilson M, Melick CF, Powe NR. Primary care physicians job satisfaction and turnover. Am J Manag Care. 2001;7(7):701-713.

• Williams ES, Skinner AC. Outcomes of physician job satisfaction: a narrative review, implications, and directions for future research. Health Care Manage Rev.

2003;28(2):119-139.

• DiMatteo MR, Sherbouorne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study.

Health Psychol. 1993;12(2):93-102.

• Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359-364.

• Noseworthy J, Madara J, Cosgrove D, Edgeworth M, Ellison E, Krevans S, Rothman P, Sowers K, Strongwater S, Torchiana D, Harrison D. Physician burnout is a public health

crisis: a message to our fellow health care CEOs. Health Affairs Blog. March 28, 2017.

• Press Ganey. Hospital Check-Up Report 2007: Physician perspectives on American hospitals. 2007.

• Prins JT, et al. Burnout, Engagement, and Resident Physicians’ self-reported errors. Psychol Health and Med. 2009;14:654-666.

• Burger J, Giger A. Want to increase hospital revenues? Engage your physicians. http://www.gallup.com/businessjournal/170786/increase-hospital-revenues-engage-

physicians.aspx.

• Friedberg M. Relationships between physician professional satisfaction and patient safety. Rand Corporation in Patient Safety Network, Perspectives on Safety. 2016

February.

• Phillips D. EHR burden weighs heavily on physicians, leads to burnout. Ann Intern Med. Published online Medscape Sep 6 2016

• Davis C, Stoots M. A Guide to EHR Adoption: Implementation Through Organizational Transformation. HIMSS Publishing. 2012.

References

2

8

• Christina Boling

– christina.boling@impact-advisors.com

• S. Nicholas Desai, MD

– SDesai2@houstonmethodist.org

• Arthur Sorrell, MD

– arthur.sorrell@impact-advisors.com

Contacts

2

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