This blog post is an excerpt from an article by Robin L. Rose, Vice President, Strategic Initiatives, HealthStream, in the current issue of PX Alert, HealthStream's quarterly e-newsletter devoted to the wide range of challenges, situations, and issues that have an impact on the patient experience. Subscribe to PX Alert.
Convential wisdom in healthcare tells us that the number of employed physicians is on the rise. We have researched the place of physicians in healthcare; highlights of our findings are below:
Employment of Physicians Is on the Rise
The 30-year exodus of physicians from private practice continues, according to a report released in late 2013 by the American Medical Association (AMA). In 1983, some 75.8% of physicians were in private practice, compared to only 46.8% today.
Employment Status Varies by Specialty
Preference for self-employment varies greatly by medical specialty. A whopping 71.9% of surgical subspecialists are still self-employed, while only 37.3% of pediatricians are calling their own shots.
Employed and Self-Employed Physicians Are Equally Satisfied
Although one might assume that employed physicians are less satisfied than their self-employed colleagues, recent studies indicate that overall job satisfaction levels for both groups are about the same.
Job Autonomy and Decision-Making Power Are Key
On-the-job autonomy and decision-making power have long been identified as key drivers of physician satisfaction, independent of whether the physician is employed or self-employed.
Employed Physicians Are Transitioning from Volume to Value
The next challenge facing employed physicians will be the transitioning of financial rewards from volume-based incentives to incentives that are paid to reflect improved quality of patient care. Employed physicians have traditionally received additional pay based on their ability to increase patient volumes.
Employed Physicians May Not Be Sacrificing Financial Gain
Although it has generally been thought that physicians in private practice make more money than employed physicians, Mercer cautions that this is not always the case. Competition for physicians in key specialties is forcing healthcare organizations to pay, if not top dollar, at least highly competitive rates for these providers.
Employed Physicians Value Attention from Administrators
Employed physicians highly value relationships with the healthcare administrators in their organizations, according to research conducted by HealthStream in early 2014 using its Physicians Insights survey.
Employed Physicians Have the View from the Kitchen
Additional research from HealthStream indicates that employed physicians are slightly more critical of their healthcare organizations than other physicians.
Read the entire article here.
This blog post is an excerpt from an article by Katie Owens, Vice President, BLG Practice Leader, HealthStream, in the current issue of PX Alert, HealthStream's quarterly e-newsletter devoted to the wide range of challenges, situations, and issues that have an impact on the patient experience. Subscribe to PX Alert.
If you have ever experienced the following symptoms—sweaty palms, rehearsing your talking points, anticipating how the discussion is going to go—you are in good company. This scenario is not preparation for a job interview, but the common anxiety reaction that comes with counseling staff with performance issues to create accountability. In a BLG study of over 26,000 health care leaders, staff, and physicians, the third lowest scoring item in our database is tolerance for poor performers.
Have any of the following ever happened to you?
- You overlooked or ignored incidents because you were too busy.
- You intended to give feedback and then days/weeks passed.
- You felt giving true feedback would create an overwhelming disruption or make matters worse.
- You felt you did not know what to say and avoided the matter as a result.
- You spent less time with your high-achievers because you were distracted.
In our work with clients, we consistently find that leaders spend 80% of their time with their underachievers and only 20% of their time with high achievers. Let’s face it, underachievers are exhausting. We worry, try to stop the slipperiness, and take our concerns home to the dinner table. They drain our energy. Our goal for this article is to help you change this common scenario and start on a path to spending 80% of your time with your high-achievers and 20% of the time with your underachievers.
Vital Conversations™ is the art and science a leader uses to retain, develop, or detach from leaders, employees, and physicians. To achieve and sustain outcomes, a leader must be able to communicate clear expectations, define specific behaviors, and provide feedback to direct reports on performance relative to expectations. BLG has developed Vital Conversations as a path to create and sustain systems of accountability and help organizations truly achieve patient-centered excellence.
This article includes:
- Three questions to get going with Vital Conversations
- Knowing the difference between high, solid, and underachievers
- How to conduct Vital Conversations
Link to the full article here.
This blog post excerpts an article by HealthStream's Dorothy Duncan, Product Manager, in the most recent issue of HealthStream's PX Advisor, our quarterly magazine focused on improving the patient experience.
Outdated systems of setting and assigning goals are about to be upended. As healthcare enters a new age, one that is vastly different from even just five years ago, it’s easy to see that poorly executed goal programs will lead to lackluster results as organizations work to address critical financial and patient care targets. From the rapid-fire pace of new government reforms and regulations to sophisticated cost controls and patient care mandates, hospitals and health systems are ready to adopt new ways of disseminating boardroom strategies across their workforces.
How Can Forward-Focused Organizations Ensure Their Goals Take Flight?
High performing organizations ensure that all staff members understand the vision and top objectives and make sure every employee is headed in the same direction. Through the creation of a cascading goal system, which is an efficient way to address the complexities of hospital operations, leadership can share their strategic objectives and ensure that all goals throughout the organization tie back toward achieving those key strategic goals. When implemented correctly, cascading goals systems align goals across business lines, departments, and job titles, creating accountability and leading to measurable results.
Cascading Goals Take Root in Healthcare
Cascading goal systems, or results-based goal-setting, gained credibility and became more prevalent on the healthcare stage after the Malcolm Baldrige National Quality Award added the healthcare sector to its annual competition in 1999. The awards highlighted the fact that healthcare organizations were sustaining high performance levels by focusing on outcomes throughout their goal-setting processes. This aggressive trend has now become an essential function.
The real value in cascading goal systems, however, may lie beyond simply achieving annual goals. When employees are given clear objectives, the support to excel at their job, and the opportunity to be a part of a high performing workplace, they become more self-directed, engaged, and have less strife at work. This in turn impacts everything from employee retention and patient experience scores to operating margins.
This article includes:
- Understanding and Addressing Goal-Setting Challenges in Healthcare
- Aligning Goals To Key Employee Groups
- The Rise of The Super Employee
- Leadership’s Role in Developing Goals
- Top 6 Goal-Setting Practices
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This blog post continues our series of patient experience Best Practices from BLG, a HealthStream Company. Every week we will share information from BLG that demonstrates their expansive understanding of the challenges faced by healthcare organizations and the solutions BLG has identified for improving the patient experience and patient and business outcomes.
A program for rewarding and recognizing employees is one of the most effective tools available to inspire, motivate and create excellence within your organization’s culture. Employee satisfaction is driven by a variety of factors, both tangible and intangible, from friendly work environment to good pay. In an effort to pin down exactly what matters most to individuals, behavioral science surveys have repeatedly asked employees what brings them the highest job satisfaction. And time after time, answers reveal that “full appreciation for work done” (recognition) is number one, followed by “feeling ‘in’ on things.” Good wages actually appears midway down the list.
It should be no surprise that the top driver of employee satisfaction and loyalty is recognition, because one of the most innate needs of humankind is to feel “valued.” While monetary compensation will always be a factor, being recognized for a job well-done is emotionally satisfying and generates a personal connection to the work. The positive emotions that result can spread throughout an organization, shaping its success and helping it to thrive.
What is the Value of Reward and Recognition?
Healthcare organizations that use rewards and recognition realize the following benefits:
- Promotes employee satisfaction
- Produces a more joyful, happy, upbeat place to work
- Nurtures camaraderie and boosts morale
- Raises employee self-esteem and confidence levels
- Promotes employee empowerment
- Encourages the willingness to take on new challenges
- Fosters contribution of ideas to improve productivity
- Creates loyalty and helps retain great employees
- Injects powerful stories into the culture and creates heroes!
What is the Impact of Reward and Recognition?
There is nothing more important to most individuals—the ones you want working with ou—than a sense that their contributions are valued. Ask any major, successful corporation and you’ll discover— from Wal-Mart to Disney—they have programs to reward and recognize their employees.
People are the lifeblood of your organization. When you empower your employees to be partners in your success, they begin to look at their jobs differently. They become team players. They begin to care about the overall reputation of where they work. They invest their hearts and souls into something that matters beyond a paycheck. And, consequently, they become the driving force behind change that equals success.
Can dispirited employees who are distrustful of the organization deliver the level of care that
generates high patient satisfaction scores? Usually not; instead the facts show that there is an undeniable correlation between employee contentment and patient satisfaction. Satisfied employees are happier and more fulfilled, work more productively and are committed to fulfilling the mission, vision and values of the culture. The end result is an enhanced customer experience, reflected in high patient satisfaction scores.
“I have yet to find the person, however exalted in his or her station, who did not do better work and put forth greater effort under a spirit of approval than under a spirit of criticism.” —Financier Charles Schwab
About BLG, a HealthStream Company
BLG provides Patient-Centered Excellence Consulting, where the patient is at the center of
everything we do. Our tools, tactics, and best practices are evidence-based and outcomes driven. We provide custom, individualized coaching that produces measurable, sustainable increases in patient satisfaction, employee engagement, quality outcomes, and profitability.
Learn more about BLG products and services.
Why is physician engagement so critical for a successful patient care experience in hospitals today? This discovery paper, by Beverly Begovich, Senior Director and Executive Coach, BLG/HealthStream, discusses how healthcare delivery is migrating now from a volume-based to a value-based system, which requires a physician-led, team approach. The paradox however is that many physicians are trained as sole clinicians with no leadership or team training. This creates a challenge when reimbursement is based on outcomes that are directly tied to the physician’s engagement with the organization. For example, core quality measures and several HCAHPS targets are directly related to the degree of physician engagement with the healthcare organization and to the patient-centered experience.
Over the past fifteen years of coaching healthcare organizations on the patient experience, BLG has become increasingly aware that the success of an organization in achieving organizational goals is directly related to the alignment and engagement of its physicians. The level of engagement of the medical community also is directly related to the level of personal commitment by administration towards the physicians and the leadership competencies of the physician leaders. BLG has developed an eight-step roadmap to improve physician engagement, which has demonstrated significant improvement in not only the patient experience but employee engagement, physician satisfaction, quality, and safety, as well as improved finances.
This Discovery paper Includes the following steps for improving physician engagement:
- Destination engagement – begin with physician onboarding
- Set and Communicate Standards – establish expectations that are clear
- Make it Mutual – the importance of partnership
- Incentivize Accountability – Establish a scorecard that is regularly reviewed
- Round with Peers and Leaders – Reinforce preferred behaviors and establish trust with purposeful rounding
- RELATE to Communicate – Make communication a crucial leadership competency
- Deep Dive – focus closely on what is working and what needs to be fixed
- Grow Your Own Leaders – Prepare for the future
Complete the form below to download the discovery paper.
This blog post excerpts an article by HealthStream's Brad Weeks, Director, Performance Improvement and Research, BLG,in the most recent issue of HealthStream's PX Advisor, our quarterly magazine focused on improving the patient experience.
Geoff Colvin famously debunked several myths of exceptional performance is his 2008 book Talent is Overrated: What Really Separates World-Class Performers from Everybody Else (Colvin, 2008). The essential premise of the book is that success comes not primarily from natural talent and skill, but is instead earned through deliberate practice and hard work. Whether you choose to believe LeBron James was simply born with the innate ability to play
basketball better than anyone else on the planet or that his work ethic is stronger than that of his competitors, the results cannot be argued. He is the best in the world at his craft, and the teams for which he has played have experienced tremendous success. But to what can we specifically point that differentiates his teams’ success from the rest?
What is the Secret for Success in Providing Healthcare?
The same question can be applied to any industry, but finding an answer for healthcare is particularly challenging. Despite all of the attention devoted to individual achievement in
sports, a team’s success is ultimately defined by wins and losses. That is the single measure by which one is compared to the competition. In healthcare, however, success is defined quite differently depending on whom you ask. We have found that a commonly held opinion of staff is that senior leadership team’s attention is primarily on financial success. Those responsible for quality are likely to be particularly concerned with achieving outcomes and maintaining accreditation. There are numerous measures of performance in healthcare, and even the patient experience is a comprehensive collection of data points that can be confusing for our workforce to understand.
The Importance of a Culture of Accountability
Despite the challenges we face about measuring success and the uncertain complexities of the industry, what we have found after years of research and coaching is actually quite clear—the most important and foundational aspect of success in healthcare is to create and sustain a culture of accountability. There is a significant challenge associated with the concept of accountability, namely that it can perceived as punitive or unnecessarily harsh if not executed
correctly. Like anything else, this is a function of the variability of your organization’s leadership. The extent to which they can consistently apply the best techniques that engage their people to perform will determine the amount of success they achieve.
How Do You Foster Healthcare Accountability?
It is no easy task to change an organization’s culture, particularly one as diverse and complex as what is often found in healthcare. However, what we have learned is that there are key actions leaders can take that will have a dramatically powerful effect on their teams’ success. Just as we can argue the issue of talent versus hard work, we can debate the issue of whether
results come from a shift in organizational culture or whether the culture changes after the success comes.
This article includes four practical steps to create a culture of accountability:
- Setting Clear and Aligned Goals
- Goal-based Performance Evaluations
- Transparency of Results
- Reinforce Standards of Performance
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Customer Spotlight: McLaren Health Care Strengthened Its Workforce Development Initiatives by Standardizing Online Learning
“The HealthStream Learning Center, authoring tools, and video have allowed McLaren Health Care to have a more standardized approach of providing education, training, assessments, and compliance while creating a more centralized organization.”
– Connie McFarland, RN, BSN, MSA, Corporate Supervisor, McLaren University
McLaren Health Care (MHC), headquartered in Flint, MI, is a fully integrated health network that includes 12 acute care hospitals with 2,860 beds, 21,000 employees, and more than 20,000 network physicians. Its operations and services are spread over 350 satellite facilities, located in a 56-county region that covers 67% of the state’s population. McLaren has adopted the HealthStream Learning Center (HLC) as its learning management system for the entire organization.
One benefit of using a standardized tool for online learning is strengthened, consistent training for healthcare leaders. McLaren Health Care requires a Corporate Leadership Orientation program for all newly hired or promoted leaders. The orientation is approximately 3.5 hours in length, conducted monthly, and includes overviews of corporate departments and functions by the management team. Holding the Corporate Leadership Orientation in person in a consistent and timely manner was hindered by travel distances, weather conditions, travel time, and coverage for departments while leaders were gone.
McLaren Health Care created an online orientation program using the HLC and HealthStream Video. They worked with instructional designers and speakers to update and revise the sentations, created each corporate department’s presentation as a course, and combined all courses into a curriculum. McLaren turned to HealthStream Video after exploring multiple unsuccessful options for storing and accessing videos used in the HLC courses. The organization chose video storage and bandwidth requirements that met their needs. Installation was possible in just a few weeks, and they had no issues with uploading, customizing, or storing videos.
Another benefit of standardized online learning is the ability to continually refine and improve the learning process. This solution also provided McLaren with video analytics that assisted management in understanding viewing trends and engagement. Educators have been able to fine-tune their curricula by analyzing collected data about when videos were watched and re-watched and what portions were fast-forwarded or skipped altogether.
Completed 75,370 courses and 64,185 training hours in six months
Saved $2,500 in mileage reimbursements and 100 hours of travel time in six months
Over 130 leaders completed the Corporate Leadership Orientation online over 12 months
Over 36,000 self-authored courses have been completed system-wide
- Approximately 80 percent of all employees now use HealthStream for online learning
“We have established the McLaren Leadership Academy that is required for all newly hired or promoted leaders within our system, “McLarenized” our Rapid Regulatory Courses, and most of our subsidiaries use the self-authoring feature to create department-specific as well as subsidiary-specific mandatory courses. The McLaren University Review and Development Committee ensures that selfauthored courses meet educational design as well as quality standards, and we are currently working to standardize the core Nursing Orientation courses.” – Connie McFarland, RN, BSN, MSA, Corporate Supervisor , McLaren University
Learn more about the HealthStream Learning Center and our Learning Management solution.
This blog post extends our series focused on employee engagement in healthcare, a vital component of every complete workforce development initiative. Here we are excerpting an article by HealthStream's Bo Hansen, Employee Engagement Consultant, in the current issue of PX Advisor, HealthStream's quarterly magazine devoted to the wide range of challenges, situations, and issues that have an impact on the patient experience. Subscribe to PX Advisor.
According to employee engagement survey results in HealthStream’s database, the lowest scoring category on the survey is staff’s evaluation of upper management’s effectiveness in communication, recognition, and understanding of needs. Interestingly, there is a marked gap between frontline staff’s evaluation of upper management and their managers’ perception of the same administrators’ effectiveness.
Reserve your copy of the HealthStream Employee Engagement National Benchmark Report releasing
Let’s look at the responses to our employee engagement survey questions about your upper Management/Administrators. On a four-point scale where 1=very dissatisfied and 4=very satisfied, department managers score administrators on the high end of satisfied with a mean score of 3.24, while staff score the same administrators on the low end of satisfied with a mean score of 2.73. That mean difference of 0.52 in scores is the biggest difference between the two groups on any of the higher level categories of HealthStream’s 36 survey questions.
These findings would suggest that managers/directors generally feel more connected to the leadership team than the people at the frontlines of caregiving who report to them. That awareness gap can be costly in terms of employees’ level of job and organizational engagement and consequent loyalty to the organization. This disparity suggests that managers are not diving deep enough to discover why staff’s scores are significantly lower than their own. Scores in this particular category of the employee engagement survey are statistically proven to strongly influence organizational engagement with consequences likely to manifest in high staff turnover, not recommending the organization as an employer of choice, and promulgating negative behaviors.
The article also includes:
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This blog by is William Sacks, Vice President, a co-founder of HCCS, Inc., a HealthStream company.
The Physician Payment Sunshine Act requires that all manufacturers of drugs, devices, and biological and medical supplies covered by federal health care programs report all financial relationships with physicians and teaching hospitals to the Centers for Medicare and Medicaid
Services (CMS). The goal of the law is to enhance patient safety by increasing the transparency of financial relationships between health care providers and pharmaceutical manufacturers.
Pharmaceutical and Medical Device companies are required to track and report all payments or “transfers of value” to physicians and teaching hospitals that exceed $10.00.
Unless something changes in the next month, on September 30th, 2014, CMS will make available the searchable, public-facing website displaying payment data from pharmaceutical and medical device companies to physicians and teaching hospitals. Despite some glitches in the pre-release website that physicians can use to review and dispute the data, CMS is holding to its planned publication date.
Even though this data will be incomplete (it covers only the period from August-December 2013, and as much as one third of the data gathered is being withheld temporarily due to questions of data accuracy), there will be millions of payments reported to tens of thousands of physicians from thousands of manufacturers. With just a month to go, we can begin to speculate on the likely impact be of the publication of this data. (Note: Even if the release is delayed, as ICD-10 has been several times, there is every expectation that the data will eventually be released.)
The database will receive significant publicity. The “Sunshine” database was a part of the
Affordable Care Act and it is likely that the Obama administration will want to put a positive spin on its efforts to increase transparency, reduce cost, and show that it can do something right, after the healthcare.gov website disaster. This is not to say that everything will go right, but the website will be publicized, either by proud supporters if it does go well, or gloating
detractors if it does not.
Local newspapers and other media outlets will devour this data, looking for payments they can describe as “scandalous”. Nothing sells papers like scandal, and few local outlets have the expertise, or will take the time and space to explain in detail the complexities of payments for legitimate consulting, research or continuing education.
Some hospitals will be surprised and embarrassed by what is revealed. Many hospitals will find that members of their voluntary and even their employed physician staff have been receiving tens or hundreds of thousands of dollars from industry. Hospital/Physician relationships in some cases will be tested when hospital administrators receive calls from the local press asking about payments to physicians that the hospital knew nothing about.
Some patients will begin to ask questions. Physicians who are included in the database should be prepared to explain to their patients what legitimate services these payments were for. Many patients may react favorably, happy to see that their personal physician was highly enough regarded by industry to be providing consulting to them. Others will be more skeptical, and physicians should be prepared to allay their concerns.
Direct payments from industry to physicians may be reduced in the next year. As the public becomes more aware of the influence of industry on education, training, and research, industry dollars may begin to shift from individuals to institutions, eliminating direct influence and potential embarrassment. This is, after all, what the goal of the law has been all along.
Hospitals will want to get a handle on this information going forward. Hospitals that have done a half-hearted job of managing conflicts of interest in the past may become motivated to revamp their policies and procedures and upgrade their infrastructure to identify and manage potential conflicts of interest in their medical staff.
One thing is certain, payments to physicians will be under increased scrutiny and healthcare facilities would be wise to have the detailed information needed to address that scrutiny.
Healthcare professionals should be prepared to manage the change coming, as financial relationships between industry and medicine are made available for all to see.
The HCCS COI-SMART system provides comprehensive tools for tracking and managing Conflict of Interest (COI) disclosures. COI-SMART provides for the development of multi-level branching questionnaires, automated assignment of reviewers, the development of COI management plans, and data mining tools for auditing, tracking and reporting on potential conflicts of interest.
This blog post excerpts an article by HealthStream's Karen Sorenson, Associate Vice President, Government Initiatives, in the most recent issue of HealthStream's PX Advisor, our quarterly magazine focused on improving the patient experience.
Have you noticed that CMS has escalated the pace with which they are introducing new CAHPS surveys? We at HealthStream certainly have! The passage of the Affordable Care Act is ushering in new CAHPS surveys for ACOs and group practices under Physician Quality Reporting System (PQRS) requirements, as well as for hospices, emergency departments, outpatient surgery centers, and qualified health plans. Starting this year CMS has also expanded the CAHPS survey requirements for In-Center Hemodialysis facilities. And if that isn’t enough, CMS recently announced its intention to develop a survey for inpatient psychiatric facility patients.
Attend Our Complimentary CAHPS Webinar on 9/9/14. Sign Up Here.
Patient Experience vs. Patient Satisfaction
CAHPS surveys are designed to measure patients’ perceptions of their healthcare experience, rather than their satisfaction. Never theless, patient experience surveys can be mistaken for customer satisfaction surveys. Patient experience surveys focus on asking patients whether or how often they experienced critical aspects of healthcare, including communication with their doctors and nurses, understanding their medication, and the coordination of their healthcare needs. To help illustrate the difference between the two types of surveys, consider a typical satisfaction-based question in comparison to a new patient-experience-based question that was included on the recent CMS ED-CAHPS pilot survey.
The satisfaction-based question allows the patient to determine himself if the wait time was satisfactory. In other words, the question is open for interpretation. In contrast, the CAHPS patient experience question is specific, leaving little room for subjectivity. The patient either received care within 30 minutes or he did not. The CAHPS Consortium says that patient experience surveys are more specific, actionable, understandable, and objective than general satisfaction ratings alone.
Why is measuring the patient experience important?
We asked HealthStream’s Katie Owens, Vice President and Practice Leader of BLG, to help us understand why measuring the patient experience is important. Katie said, “The patient experience is so much more than just a patient satisfaction survey. It is a call to action for healthcare leaders, staff, and physicians to strive for patient-centered excellence by placing patients at the center of their work—every patient, every time.
Setting standards to always meet and exceed patient and family expectations creates a legacy for organizations, versus simply striving to satisfy. CAHPS experience surveys help leaders create focus on what matters most, educate on the patient experience, and have meaningful discussions to elevate patient-centered behaviors.” It was this call to action that motivated HealthStream to adopt a CAHPS-aligned survey approach. Since 2007, our Patient Insights customers have benefited from the specific and actionable data that patient experience surveys are able to deliver. With the increasing number of soon-to-be required CAHPS surveys, now is the time to examine how HealthStream’s patient experience surveys can prepare your organization for what lies ahead.
The article also details:
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