Physicians drive the majority of all quality and cost decisions, yet reimbursement pressures, competing time pressures, misaligned incentives, and a lack of credible data often make engaging clinicians in improvement work one of the biggest challenges in healthcare. David Wild, MD, MBA, and Jack Beal, JD, explore how to spread data to the edges of the organization and engage physicians in leading a continuum of improvement across an entire organization. During this webinar, our presenters: • Identify the levels of physician leadership in your organization you can engage to drive improvement. • Pinpoint the types of data and information of most interest to physician leaders. • Propose several ways data to use data to engage physicians in leading improvement work. • Help you develop at least one mechanism you can use to better engage physicians in improvement work at your organization.

1. The Doctor’s Orders for Engaging
Physicians to Drive Improvements
Jack Beal, JD
Vice President, Performance Improvement and
Deputy General Counsel,
The University of Kansas Health System
February 12, 2020
David Wild, MD, MBA
Vice President, Performance Improvement,
Assistant Professor, Department of
Anesthesiology, The University of Kansas
Hospital

2. Share background information about The
University of Kansas Health System.
Discuss the value of data to drive
improvement.
Review how to determine if a problem is
technical or adaptive.
Explore the three levels The University of
Kansas Health System
uses to engage physicians in leading
improvement work.
Share conclusions about physician
engagement.
Agenda

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Verbalize several
ways data can be
used to engage
physicians in leading
improvement work.
Identify the levels of
physician leadership
in your organization
that can be engaged
to drive improvement.
Become familiar
with the types of
data and information
of most interest to
physician leaders.
Develop at least one
mechanism that can
be used to better
engage physicians in
improvement work.
Learning Objectives
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On a scale of 1-4, how would you rate your organization’s effectiveness
in engaging physicians in improvement work?
1. Not at all effective – 10%
2. Somewhat effective – 34%
3. Moderately effective – 31%
4. Extremely effective – 2%
5. Unsure or not applicable – 23%
Poll Question #1
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Building on a legacy of patient care that began in 1906,
The University of Kansas Health System, based in Kansas City,
Kansas, is a world-class academic medical center and destination for
complex care and diagnosis.
900-bed general medical and surgical facility.
FY18 Volumes
• 41,952 discharges
• 29,073 surgeries
• 60,207 ED visits
• 1,726,674 ambulatory encounters
The University of Kansas Physicians (UKP), the largest
multi-specialty group practice in Kansas, are researchers
and educators expanding the boundaries of medical knowledge.
The University of Kansas Health System
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Our Teams
Performance
Improvement
Business
Intelligence
Solutions
Applied
Analytics
Lean
Promotion
Office
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The Problem
Clinical or Business Event
Data Collected
Analysis Complete
Action Taken
TIME
VALUE
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Improvement work is hard enough,
and doctors can be…
Different.
Challenging.
Disengaged.
Special.
The Problem Continued
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“The improvisational ability to lead adaptively relies
on responding to the present situation rather than
importing the past into the present and laying it on
the current situation like an imperfect template.”
-Ronald Heifetz
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Clinical departments vary in their support for and mechanism of improvement work.
“Us vs. them” mentality is common among physicians following the merger of the
hospital and physician practices.
Legacy medical director program is a primary mechanism for clinical improvement work.
Physician compensation is mainly based on productivity, with occasional, small
components based on quality or value.
Condition of Clinical Improvement Work,
May 2017
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Defining the Future State
Our improvement work must be aligned in all aspects.
Problems and improvement ideas must be identified at the local level, even for
physicians.
Our physicians must be engaged in improving quality and reducing cost.
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How frequently does your organization share departmental
performance information with clinical departments?
1. Annually – 3%
2. Quarterly – 27%
3. Monthly – 22%
4. Weekly or more frequently – 9%
5. Unsure or not applicable – 39%
Poll Question #2
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Enhancing Physician Engagement in
Improvement Work
Care Connections
Program.
Updated, physician-led,
local improvement
program.
Value-Based
Performance.
New department,
or division-level, gain
sharing program.
Department
Finance and
Planning Sessions.
Engagement of physician
leadership in strategy
and planning for growth
and improvement.
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Foundational support for each project with data, measurement, and analytics resources.
Care Connections Program Key Features
Move
from paying for
time, to paying for
project completion.
Encourage
practicing physicians
and their teams
to generate
improvement ideas.
Ensure
organizational alignment
by providing executive
oversight and coaching
for project, measure
and outcome
selection.
Improve
academic productivity
by requiring physicians
to present and publish
their work.
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Care Connections Program
Care Advancement
Improvement topics are suggested
by the health system in a “Request
for Proposal” announcement.
Physicians with interest in a topic
submit a proposal with the
hypothesis, proposed project,
and proposed measures.
The executive steering committee
reviews all project submissions and
approves funding for project time.
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Care Transformation
• Designed to support great ideas
from physicians, and the teams they
work with, even if the project was not
identified by leadership.
• Projects are submitted for review,
approval, and funding by the
executive steering committee.

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Departmental Finance and Planning Sessions
Information
packets
produced.
Office
hours with
analytics
leadership.
Planning
meeting
with senior
leadership.
Annual
improvement
plan
developed.
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Value-Based
Performance
Value-Based
Performance1. Find
Improvements.
2. Support the physician
department or division.
3. Remove
barriers and
support.
4. Generate and
share value.
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Departmental Finance and Planning Sessions
Internal Medicine
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Departmental Finance and Planning Sessions
Provider wRVUs and Patient Satisfaction
v
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Departmental Finance and Planning Sessions
Growth and Access
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Departmental Finance and Planning Sessions
Market Analysis
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“Your goal should be to keep the temperature
within what we call the productive zone of
disequilibrium (PZD): enough heat generated by
your intervention to gain attention, engagement,
and forward motion, but not so much that the
organization (or your part of it) explodes.”
-Ronald A. Heifetz
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Results
Care
connections
37 projects approved.
17 of 21 clinical
departments represented.
1st quarter results were
reported in November
2019.
Value-Based
Performance.
Measurable improvement
and savings in 80% of the
projects in the first month.
Savings from the first 6
months of the
measurement period were
approximately $400,000.
Process
(intervention)
outcomes
All 21 clinical departments
have annual growth and
improvement plans in place.
More than 100 additional
projects/ideas are either
complete, in the vetting
phase, or are beings
sized, all the direct result
of this work.
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Value-Based Performance COPD
Readmission Rate
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Value-Based Performance Acetaminophen
Substitution
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Value-Based Performance Average
Antibiotic Direct Cost
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Departmental Finance and Planning
Orthopedic Surgery
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Key Learnings and Recommendations
Engaging physicians
in improvement must
be done at multiple
levels, including at
the leadership,
departmental,
and individual levels.
It is worth the
investment of time to
explain and socialize
the data and information
required for prioritization
and measurement.
Physicians (and
those doing the work
every day) have good
ideas about what needs
to improve, and ideas
about how to improve.
Listen to them.
Aligned, not dictated,
improvement efforts
generate physician
engagement.
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29. Q&A
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David Wild, MD, MBA
Vice President, Performance Improvement,
Assistant Professor, Department of
Anesthesiology, The University of Kansas
Hospital
Jack Beal, JD
Vice President, Performance Improvement
and Deputy General Counsel,
The University of Kansas Health System

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New Ways to Improve Hospital Flow
with Predictive Analytics
Improving hospital-wide patient flow requires an appreciation of the hospital as an interconnected,
interdependent system of care. Learn how supervised machine learning was used at Cedars-Sinai to
create predictive models for length of stay, emergency department (ED) arrival, ED admissions,
aggregate discharges, and total bed census to reduce patient wait times, reduce staff overtime, improve
patient outcomes, and improve patient and clinician satisfaction.
Wednesday, March 18
1:00 - 2:00 PM ET
In this webinar you can expect to:
• Discover how Cedars-Sinai framed the real question that needed to be answered.
• Discuss how Cedars-Sinai engaged leaders up front – with the goal of operationalizing our analytics.
• Summarize the types of machine learning (ML) methods Cedars-Sinai employed.
• Show how Cedars-Sinai operationalized the results.
Michael Thompson, MS Predictive Analytics
Executive Director, Enterprise Data Intelligence,
Cedars-Sinai Medical Center

31. Thank you!