Barry egener org profess friday
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Barry egener org profess friday
- 1. Organizational Professionalism Friday October 19, 2012 Barry Egener, MD
- 2. External Forces • Payers • Policy makers • Specialty Societies • Consumer Orgs Environment • Uninsured • Disparities Evolution of Professionalism Physician Professionalism Patient- Physician Interactions Practice Settings Training Environment Levers for Change Individual physician and patient competencies Organizational culture and physician leadership Advocacy, system reform Adapted from Gruen, Russell, et. al., “Physician-Citizens – Public Roles and Professional Obligations,” JAMA, 2004. External Environment • Payment • Policy • Socio-economic determinants of health
- 3. External Forces • Payers • Policy makers • Specialty Societies • Consumer Orgs Environment • Uninsured • Disparities Organizational Professionalism Intra- Organizational Professionalism Inter- Organizational Interactions National Healthcare Environment Levers for Change Individual physician and patient competencies Organizational culture and physician leadership Advocacy, system reform Adapted from Gruen, Russell, et. al., “Physician-Citizens – Public Roles and Professional Obligations,” JAMA, 2004. External Environment • Payment • Policy • Socio-economic determinants of health
- 4. 2 Examples Coordinated Care Organizations “Civic Professionalism”
- 5. Values Principles Actions Beneficence (doing good, generosity, kindness) Service (to the patient and community and the profession) Promotes population health Reduces harm Promotes wellbeing Dignity (self respect, worthy of esteem) Respect (for self, patients and employees) Incorporates voice of the patient and employee Provides access to care Supports teamwork Justice (fairness, upholds the laws, impartiality) Fairness Ethical stewardship of resources Incorporates voice of community Advocates equitable payment policy Honesty (moral uprightness, fair, truthful, candor, integrity) Transparency Accountability Discloses meaningful performance information Self-discipline Mindfulness Self-motivation Collective self reflection Closes the gap between current performance and the ideal state
- 6. Today’s Topics Wellbeing Disruptive behavior Organizational transformation
- 7. Today’s Topics Wellbeing - Fulfillment Disruptive behavior Organizational transformation
- 8. Today’s Topics Wellbeing - Fulfillment Disruptive behavior – Accountability for cultural preservation Organizational transformation
Hinweis der Redaktion
- What might happen if we extended the attitude we clinicians aspire to take into the exam room, the stance toward the patient, the sense of service, the interpersonal skills, into all the interactions we have in a healthcare organization? What if we took the time to describe this ethos and teach these skills to all those who work in our organizations – the housekeeper who empties the garbage, the transportation person as well asll clinicians? It would create a new culture. This is part of what we’re talking about in “OP”. The relational aspects are key. They are key already to interprofessionalism, to functioning as a team; increasingly we hear that medicine is a team sport. Organizational Professionalism includes other content areas as well that I will allude to, although we will not talk much about them today. Why do we need a new conceptualization of professionalism for organizations? Part of the reason is that these organizations are the face of medicine to the public. I suspect that when patients think about medicine, they think about the primary contact for them with medicine, often, but not always, a physician. But when they think of medicine as a whole, they may thnk of the AMA, or their insurance company, and they may not have such warm feelings. Just as citizens may not trust politicians in general but like their senator; similarly I suspect they trust their primary practioner, but not the profession. Part of the responsibility for this resides in organizations. I’m sure it’s much more complex, but to address this disconnect, we think it is useful to think of medical organizations as entities themselves, which have certain professionalism responsibilities, just as doctors, nurses, and physical therapists do.
- Here iswhy my original thought of simply extending the doctor-patient relationship, while key to what we’re talking about, is insufficient. Organizations are complex and have many dimensions which remain untouched by the relationship issues, but are nevertheless important to address. Describe CCO’s briefly. CCO’s have yet to move from the transactional to the relational level. What I mean by that is that they have not taken the time, at least locally, to address how they would do their work. To say, upon what principles will we make our decisions? In a moment, I’m going to elaborate what some of those dimensions might be, and why the product might be very different if a different process drove it. The health care system for the most part addresses health as if the determinants of health were entirely biologic. Yet we know that health is largely related to social conditions . For example in the Whitehall British study and in America VA and other studies have demonstrated that even within these fixed insurance and delivery system, the biggest determinant of mortality are socio-economic status, for example, civil service grade in the Whitehall study was. Perhaps only 10% of premature death is addressed by the biologic systems that health care can touch. Now I’m not suggesting that health care belongs in the education, poverty, public hygiene and police business, clearly the purview of governement, but until we start to interact with those entities that address the structure of the built environment, the places people buy food, the resources for substance abuse treatment, we individual physicians will continue to be frustrated by our the minimal impact that our brief touches with patients have when something in their fragile social support system crashes and the have an acute, or perhaps lethal illness, that brings them to ur attention. My point - individual physicians have no control over these factors, and it’s a major source of burnout. However, our health care delivery systems, our medical societies might effectively partner with other agencies that affect the fabric of people’s lives.
- How does this relate to today’s program? Well, the concept of OP is quite broad and includes many domains we’re not addressing today. Many involve people not in this room, for example, the executive leadership of your organizations. Divesting an organization of conflicts of interest requires cooperation between the Bd of Dir. and the CEO. Incorporating the voice of the patient in strategic planning may occur at a Bd. Retreat. However you may be able to think of ways to incorporate that voive into your specific domain of work What you will hear today will focus on three cultural domains:The first is creating and maintaining a healthy workforce. This is important for many reaons that you will hear from John Christensen. Why should organizations care? Physician burnout leads to an increase in medical errors. Physician satisfaction leads to patient satisfaction. While we used the commonly recognized term of physician wellbeing,
- Physician fulfillment mightr be a better term. Fulfillment implies that clinicians find meaning in their work and are engaged and energetic, which prevents burnout.
- While you understand what Dr. Neff will talk about in the section on disruptive physician behavior, a more positive term might be maintaining accountability for a desirable work culture, a place where people want to come to work, because they perceive meaning in what they do, because they understand that no matter what they do, they contribute to the product of the organization. So they are vested in preserving that culture and feel permision to act when an outlier disrupts that culture. And Dr. Suchman will teach us about how to make that all happen.