This week, John describes what a great hospital quality medical director needs to know to succeed. By understanding and implementing these concepts, the medical director will be able to lead a strong QI program.

A hospital's quality improvement program is designed to ensure that medical care is undeniably effective, evidence-based, timely and error-free. The field has exploded over the past 30 years, with an increasing emphasis on measuring and reporting outcomes of care.

Though it’s unlikely anyone is building a quality program from scratch, the information presented in this episode is useful for anyone from a part-time hospital quality medical director to a full-time chief quality officer. It will help you to improve your hospital's quality and safety program. And it may help you prepare for an interview for a medical director or chief quality officer position.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country, with over 650 graduates. And, unlike other programs, which typically run 1 – 1/2 to 2 years, this program only takes a year to complete. Recently, Economist Magazine ranked the business school #1 in the world for the Most Relevant Executive MBA.

While in the program, you'll participate in a company project, thereby contributing to your organization. As a result, University of Tennessee PEMBA students bring exceptional value to their organizations.

Graduates have taken leadership positions at major healthcare organizations. And they've become entrepreneurs and business owners.

By joining the University of Tennessee physician executive MBA, you will develop the business and management skills needed to advance your career. To find out more, contact Dr. Kate Atchley’s office by calling (865) 974-6526 or go to vitalpe.net/physicianmba.

Culture and Credentialing

The foundation of a great hospital quality program is a culture that values quality and safety. The mission of the organization must include a commitment to patient care that is based on superior quality and patient safety. It’s vital that the culture values teamwork and effective communication.

The underpinning of any good program is to start with a culture of quality and safety.

Measurement

The ability to measure outcomes is the cornerstone of a quality improvement and patient safety program. The tools used to measure outcomes must use a risk-adjustment methodology in which physicians have confidence.

There are numerous systems  available to extract the data needed to provide clinical quality and safety reporting. Becoming an expert in the measurement tools will make you an invaluable asset to your organization.

Leadership and Structure

Leadership of the QI and PS program is also extremely important. Each hospital must have a knowledgeable clinical expert to lead the department or division. Physicians are best able to understand the impact of quality on the care of our patients. We can help by serving on and leading committees, and by serving as hospital quality medical director or chief medical officer.

Implementation of a great QI program depends on an organizational structure that includes a mastery of QI concepts at each level, from CQO to Pharmacy Director, Quality Improvement Director and Health Information Management Director, to Quality Nurses, Clinical Documentation Improvement Specialists, Infection Preventionists,  and Utilization Management Advisors.

The post Know This to Be a Great Hospital Quality Medical Director – 133 appeared first on NonClinical Physicians.

On this episode of the PNC podcast, Dr. Robert Applebaum joins me to discuss the transition into his nonclinical niche as a physician advisor after many years of clinical practice.

Rob’s training was in cardiovascular and thoracic surgery. He spent decades working in private practice, then as a hospital employed physician. He is the first guest I’ve had on the podcast that I have worked with in real life.

When we met, I was the chief medical officer. And he was the director of the open-heart program at our hospital. Now Rob is a physician advisor focusing on utilization management, quality improvement and clinical documentation.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country, with over 650 graduates. And, unlike other programs, which typically run 1 – 1/2 to 2 years, this program only takes a year to complete. Recently, Economist Magazine ranked the business school #1 in the world for the Most Relevant Executive MBA.

While in the program, you'll participate in a company project, thereby contributing to your organization. As a result, University of Tennessee PEMBA students bring exceptional value to their organizations.

Graduates have taken leadership positions at major healthcare organizations. And they've become entrepreneurs and business owners.

By joining the University of Tennessee physician executive MBA, you will develop the business and management skills needed to advance your career. To find out more, contact Dr. Kate Atchley’s office by calling (865) 974-6526 or go to vitalpe.net/physicianmba.

Burnout and Fatigue

Cardiac surgeons spend much of their time in an operating room. The hours-long cases were beginning to take a physical toll on Rob. So, too, were the middle-of-the-night phone calls. Clinical practice was becoming less satisfying and more stressful. Even the complicated cases he used to enjoy were becoming a stressor that began to foster feelings of burnout.

The post How This Heart Surgeon Found a Rewarding Nonclinical Niche – 132 appeared first on NonClinical Physicians.

I’ve been interviewing experts in physician career transition for over a year. So, I thought it important to discuss how to prepare financially. For many of you, loss of income is one of the big fears that stops you from even considering a change.

Much of that can be ameliorated with good planning. So, I decided to get an expert on the show to help us with that issue. My guest is a financial expert who works exclusively with physicians and their personal finances.

Ryan Inman runs Physician Wealth Services , a fee-only financial planning firm devoted to the financial well-being of physicians. He was motivated by witnessing how vulnerable his wife was to poor financial advice during residency. And, he was shocked at how many advisors tried to take advantage of her and her peers.

To meet the needs a much larger audience than those in his backyard, Ryan later created Financial Residency. It's a podcast, and associated Facebook group, that serves hundreds of attendings, residents, and their spouses frustrated with their financial challenges.

Ryan's podcast teaches financial concepts so you can protect and grow your assets. Furthermore, he teaches you to shield yourself from insurance agents, stock brokers, fee based financial planners, and lenders that attempt to sell you financial products and services you don’t need.

The University of Tennessee Physician Executive MBA Program

I'm very thankful to have the support of the University of Tennessee Physician Executive MBA Program offered by the Haslam College of Business. You’ll remember that I interviewed Dr. Kate Atchley, the Executive Director of the program, in Episode #25 of this podcast.

The UT PEMBA is the longest running, and most highly respected physician-only MBA in the country, with over 650 graduates. Unlike most other ranked programs, which typically have a duration of 18 to 24 months, this program only takes a year to complete. And, it’s offered by the business school that was recently ranked #1 in the world for the Most Relevant Executive MBA program, by Economist magazine.

University of Tennessee PEMBA students bring exceptional value to their organizations by contributing at the highest level while earning their degree. The curriculum includes a number of major assignments and a company project, both of which are structured to immediately apply to each student’s organization.

Graduates have taken leadership positions at major healthcare organizations and have become entrepreneurs and business owners. If you want to acquire the business and management skills needed to advance your nonclinical career, contact Dr. Kate Atchley’s office by calling (865) 974-6526 or going to vitalpe.net/physicianmba.

Financial Considerations When Planning a Change

It's important to be very deliberate when changing careers. Here are some basic steps to follow as you prepare:

Step 1: Consider your ideal life. What is the ultimate goal of switching careers?

Step 2: Write your plan. If it's written, you're much more likely to achieve it.

Step 3: Avoid lifestyle creep and reduce debt, if possible.

Step 4: Think about the financial implications of leaving your current position. How does leaving affect insurance policies and retirement accounts?

Common Financial Mistakes Made by Physicians

At the end of our interview, Ryan spent a few minutes listing some of the most common financial mistakes made by physicians.

Often, because of years of delayed gratification, physicians adopt a savings rate that is too low. And they don’t seem to understand the concept of compounding: as it affects growth of both savings and debt.

So, Ryan recommends that physicians prepare by saving at least 20 percent of take-home pay. And, avoiding lifestyle creep can really help mitigate long term financial disasters.

Click here to download the TRANSCRIPT of today's episode.

We didn’t discuss this at length, but I’d recommend you have a financial planner like Ryan prepare some financial projections. Compare your current salary and benefits to the new career you’re considering 5 to 10 years out, so you can see the full impact of your decision.

Ryan's podcast addresses dozens of other financial issues, particularly relevant to physicians. Check out financialresidency.com or go to your favorite podcast app and search for Financial Residency. You’ll learn a lot.

And, if you need a financial review and plan, check out the services at Physician Wealth Services. It is strictly fee-only, the most unbiased approach to financial planning. He and his team will NOT try to sell you annuities or life insurance. Ryan can really understand your unique circumstances.

Resources for Today's Episode:

Financial Residency Podcast

Physician Wealth Services

Financial Residency Facebook Group

Physician Finance Group on Facebook

Doctors Unbound Podcast with David Draghinas

Thanks to our sponsor…

We appreciate the UT Physician Executive MBA program for sponsoring the show. It’s an outstanding, highly rated, MBA program designed for working physicians. It might be just what you need to prepare for that joyful, well-paying career. You can find out more at vitalpe.net/physicianmba.

Thanks again for listening. I hope to see you next time on Physician NonClinical Careers.

As always, I welcome your comments and feedback.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton.

Disclaimers:

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life or business. 

Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counsellor, or other professional before making any major decisions about your career. 

Right click here and “Save As” to download this podcast episode to your computer.

Here are the easiest ways to listen:

vitalpe.net/itunes  or vitalpe.net/stitcher  

The post How to Prepare Financially for a Career Pivot with Ryan Inman – 071 appeared first on NonClinical Physicians.

Dr. Christian Urrea is currently working as a medical monitor for Novum Pharmaceutical Research Services, a Contract Research Organization (CRO). He graduated from Drexel University School of Medicine in 2012, then landed a job as a Specialist in QI and UM for a community hospital before moving to Novum as a Medical Monitor.

In today’s interview, Christian provides great advice as he describes his career journey. His comments are especially useful to physicians who did not complete residency and are not licensed. As he explains, with careful planning, networking, and mentoring, it's possible to find a job like his that builds on your medical education.

Christian comes from a medical family. So, he felt like he had a natural predilection toward clinical medicine. He went to Carnegie Mellon University (CMU) and majored in chemistry. He went on to get a master's degree, as well as experience as a clinical research associate (CRA) before attending Drexel University College of Medicine.

As he neared graduation from Drexel, Christian realized clinical work was not the best option for him. So, he chose not to seek a residency position. After he graduated, he became a quality improvement (QI) and utilization management (UM) specialist for a community hospital.

The University of Tennessee Physician Executive MBA Program

I'm very thankful to have the support of the University of Tennessee Physician Executive MBA Program offered by the Haslam College of Business. You’ll remember that I interviewed Dr. Kate Atchley, the Executive Director of the program, in Episode #25 of this podcast.

The UT PEMBA is the longest running, and most highly respected physician-only MBA in the country, with over 650 graduates. Unlike most other ranked programs, which typically have a duration of 18 to 24 months, this program only takes a year to complete. And, it’s offered by the business school that was recently ranked #1 in the world for the Most Relevant Executive MBA program, by Economist magazine.

University of Tennessee PEMBA students bring exceptional value to their organizations by contributing at the highest level while earning their degree. The curriculum includes a number of major assignments and a company project, both of which are structured to immediately apply to each student’s organization.

Graduates have taken leadership positions at major healthcare organizations and have become entrepreneurs and business owners. If you want to acquire the business and management skills needed to advance your nonclinical career, contact Dr. Kate Atchley’s office by calling (865) 974-6526 or going to vitalpe.net/physicianmba.

Tracking Quality and Performance

Christian used the community hospital’s system to track compliance with quality measures and reward providers who achieved better-than-average scores.

Payers provided data that showed gaps in referral and patient care patterns, such as the rate of preventive screenings (i.e. colonoscopies, mammograms, etc.).

The goal was to analyze the data and develop a provider-specific plan to achieve the Triple Aim. Also, Christian developed peer-to-peer relationships with his network providers and used those data to educate them.

Christian found that gaining physician buy-in is a critical component to success in this field. Having the medical degree certainly helped him achieve that trust.

Click here to download the FREE TRANSCRIPT

Although Christian wasn’t interested in direct patient care as a career, it didn’t mean that he wasn’t passionate about having an impact on patient care. After working for the PHO for a few years, he decided that investigating drug therapies was the best way for him to do that.

Hence, he sought a position as a medical science liaison (MSL). But at he began his search, he found that the medical monitor position would better align with his goals.

Using LinkedIn

LinkedIn is a place to network and find mentors. It also hosts a job board. And your profile can help recruiters find you. One of the first connections Christian made on LinkedIn was with Dr. Samuel Dyer, CEO of the Medical Science Liaison Society and author of Medical Science Liaison Career Guide: How to Break Into Your First Role.

Based on his experiences, Christian's advice to someone looking for a career as an MSL or a medical monitor is to find a mentor. A mentor can point you in the right direction, and provide encouragement when you become discouraged.

Being a Medical Monitor

Christian explained the positive aspects of his job as a medical monitor:

• He enjoys being a cross-functional leader, collaborator, and teacher;
• Being the primary person responsible for oversight of the safety of clinical trial subjects is fulfilling;
• Fostering collaborative relationships with principal investigators is intellectually stimulating;
• There are opportunities to work from home.

The primary downside to the position is that a sigicant amount of travel is generally required. According to Christian, you'll spend about 35% of your time travelling

Finally, he offers some tips on how to land a job as a medical monitor:

• Try to match therapeutic areas to your educational background;
• Know what the job entails before submitting an application;
• Be able to speak medical monitor language before you interview;
• Tie previous collaboration experiences into the medical monitor role;
• Be persistent and positive.

Resources for Today's Episode:

Dr. Christian Urrea on LinkedInD

Christian Urrea’s Email: urreacp@gmail.com

Novum Pharmaceutical Research Services

Drexel University – College of Medicine

Medical Science Liaison Career Guide: How to Break Into Your First Role

Dr. John Jurica on LinkedIn

Dr. John Jurica on Twitter

University of Tennessee Physician Executive MBA

Thanks to our sponsor…

We appreciate the UT Physician Executive MBA program for sponsoring the show. It’s an outstanding, highly rated, MBA program designed for working physicians. It might be just what you need to prepare for that joyful, well-paying career. You can find out more at vitalpe.net/physicianmba.

Thanks again for listening. I hope to see you next time on Physician NonClinical Careers.

As always, I welcome your comments and feedback.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton.

Disclaimers:

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life or business. 

Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counsellor, or other professional before making any major decisions about your career. 

Right click here and “Save As” to download this podcast episode to your computer.

Here are the easiest ways to listen:

vitalpe.net/itunes  or vitalpe.net/stitcher  

The post How to Get a Great Job with a CRO with Dr. Christian Urrea – 070 appeared first on NonClinical Physicians.

Opportunity

Here’s the potential opportunity: I decided to participate in Michael Hyatt’s goal setting program called 5 Days to Your Best Year Ever.

I know it is a great program, and I'm a big believer in setting annual goals. It was something our hospital management team did every year and it generated great results for our hospital. When I've prepared written goals for myself, I've always been much more effective.

My plan was to complete the program this year, and then promote it to my blog and podcast audiences as an affiliate program next year. Then we could go through the program together next year with our own private Facebook Group.

But then I got to thinking – why wait until next year? Why don’t I offer it to my listeners and readers and then go through the program with them now?

So, that’s my plan. It’s a great program. I don’t want to spend too much time describing it here. But if you want to supercharge your success and have a wildly successful 2018, you should check it out.

You can learn more about it, and get a bunch of FREE high value content, including a self-assessment and webinars about goal setting, without any obligation by going to BEST YEAR EVER

I’ll have more information for you there.

Podcast Review

I have another podcast review today. Today’s podcast by physicians for physicians is Hippocratic Hustle.

I listen to most episodes. But I’m not sure that I should be listening, given the description…

According to Dr. Carrie Reynolds, she developed the Hippocratic Hustle “to create a space where women doctors can come together and share their stories of their business, project or side-hustle… and explore ways to stretch our hard-earned dollars and be more efficient with our time and money.”

The podcast began posting weekly episodes in June of 2017. A pediatric gastroenterologist by training, Reynolds does a very good job as an interviewer.

I especially enjoyed the interviews with Rachna Patel, in episode 17, and Nilong Vyas, in episode 24. Both guests have inspirational stories for those of us seeking a career pivot.

There are plenty of episodes to enjoy. One of the recurring topics is finances, during which Reynolds is joined by dermatologist and financial expert Bonnie Koo.

I recommend you give the podcast a listen. It can be found by searching for Hippocratic Hustle on the Apple Podcast App, or by going to the website at hippocratichustle.com.

Modern Physician Advisor

OK – let’s get into our main content. Today’s interview is with Timothy Owolabi, Physician Advisor and Medical Director of the Care Management Department at Summit Health in Chambersburg, Pennsylvania.

I heard Tim speak at the annual SEAK conference on Nonclinical Careers for Physicians. He was very passionate about his career. And there was a lot of interest in this topic.

He is board certified in family medicine, a Fellow of the American Academy of Family Physicians, and a certified professional coder through the American Academy of Professional Coders (AAPC).

During the interview, we spoke about:

1. The definition of “physician advisor” and other terms used to describe a physician who works in hospital case management and utilization review.
2. His role as Medical Director of Care Management.
3. The functions of a care management department.
4. What he likes about his job as physician advisor and as medical director.
5. His specific duties and the three roles of the physician advisor.
6. The background and training of most physician advisors.
7. The best way to achieve the necessary skills, including conferences that can be attended.
8. Certifications that can be obtained for the position of physician advisor.
9. Helpful organizations physicians can join.
10. Other resources that might be helpful to review for such a position.
11. The salary and benefits of a physician advisor and medical director.

In Closing

Please subscribe to the podcast on iTunes.

Let’s close with a quote:

Please join me next time on Physician Nonclinical Careers. Until then – Take Care.

Here is a list of resources mentioned in this episode:

[table id=13 /]

If you liked today’s episode please tell your friends about it and SHARE it on Facebook, Twitter and LinkedIn.

Right click here and “Save As” to download this podcast episode to your computer.

The post Meet the Modern Physician Advisor – Interview with Dr. Timothy Owolabi – 012 appeared first on NonClinical Physicians.

A distinguished gentleman who looks to be in his 60s is asking the question. He and I are sitting across from each other at the end of a long, dark mahogany conference table.

I don’t remember how I came to be here. I probably look a bit confused.

“John. Tell me… How would you do that?”

Now I remember. I’m interviewing for the position of Chief Quality Officer (CQO). I’m ten minutes into an interview with the Chair of the Board of Directors. His name is Samuel.

That’s quite a broad question, Sam.

Clarify the question for me. You want me to describe how I would build an ideal quality improvement program? For a hospital like this? Are there any financial constraints?

“I’d just like to hear your opinion on what a really good program looks like. Let’s not worry too much about budgets. But keep it within the realm of possibility.”

A Great Hospital Quality Improvement Program

OK. I’ll tell you what I think. And I’ll try to keep it brief and fairly high level.

I’m making the following assumptions:

• We’re talking about the quality program at a stand alone general full-service hospital.
• I am going to include patient safety as part of overall quality program.
• I’m assuming that this program will need to meet all of the required reporting demands of CMS and other regulatory bodies.

“That sounds good,” Sam replies.

OK, then let me start with the basics.

First, I’ll define what I mean by quality improvement.

We’re talking about a program designed to support the hospital’s efforts to deliver medical care to patients that is:

• Undeniably effective and evidence-based,
• Timely, and
• Error free.

I’ll describe my design of a basic quality program. However, in the real world, the design process would be collaborative. It would involve multiple conversations with stakeholders from the local community, and possibly some outside experts.

Culture

The underpinnings of the program will start with the culture of the organization. Quality and safety must be built into the fabric of the culture of the hospital.

That means that the hospital mission addresses quality and safety. And the values of the organization will also include a commitment to quality.

Furthermore, the QI program itself would have its mission, values and vision. They would be defined by the hospital leadership, with input from all stakeholders, including patient representatives.

The Board of Directors will approve them. And everyone working at the hospital will need to acknowledge and sign off on the mission, vision and values. That includes the employees and non-employed medical staff members and independent contractors working at the facility.

The cultural aspects must include evidence that teamwork and effective communication are valued. We will implement the list of Safe Practices from the National Quality Forum.

Credentialing

Next, we will ensure that team members believe in quality and continuous learning. Hiring will involve an assessment of the commitment of potential hires to quality and safety.

Of course, all necessary licensing and credentialing will be followed.  An excellent quality program starts by involving motivated and engaged team members. Whether it's environmental services, phlebotomists, CNAs, lab and imaging technologists, nurses, pharmacists, or physicians, we will ensure that they all have the best credentials and a demonstrated ability to provide excellent care.

That sets the stage for building a great program.

Metrics

A great hospital quality improvement program has the ability to measure, report and improve important measures of quality and safety. So, next, I would define for the organization how quality is going to be quantified. 

We will need to implement tools to monitor our performance. In order to clearly define the tools we need, the expertise we need, and the structure to put this program in place, we need to define the metrics that will demonstrate our success or failure.

Ideally, we will track every outcome and process measure that experts agree define quality in the hospital setting. Off the top of my head, the following are generally recognized as important outcomes to track and report:

• Overall mortality rate, expressed as mortality index.
• Mortality rate for high volume conditions like heart failure, COPD and pneumonia. The top 20 by volume would be a good start.
• Complication rates for the top 20 procedures (by volume), such as total joints and other inpatient procedures.
• 30-day readmission rates for the top 20 medical, and top 20 surgical, diagnoses.
• Compliance rates for process measures (such as CMS core measures and other important lead measures).
• Selected patient safety measures (including Sentinel Events and Never Events).
• Selected AHRQ Inpatient Quality Measures.
• Length of Stay (overall, and for specific high volume diagnoses).
• Medication Errors.
• Additional measures, as indicated by comparing the Leapfrog National Measures Crosswalk and other published guidelines to what is already in place.

Measurement Tools

Given the list of measures that we must monitor, I will lead a team to identify the best measurement tools. If there are tools that can integrate with our EMR, I will focus on those. Otherwise, I will find tools(s) that will provide as much of the needed data as possible. The tools will need to provide risk-adjusted outcomes and rates for process measures. It will need to be as affordable as possible.

Such tools might include those provided by The Advisory Board, Premier, Quantros and others. Without automation of these measurements, they become very difficult to follow and compare to benchmarks.

People

In addition to leadership by the CMO or CQO, we will need an experienced, knowledgeable, clinical expert to lead the quality and safety department or division. He or she will have the appropriate attitude, experience and training to ensure success in this position.

Other expertise needed within the department will include:

• Regulatory (CMS, TJC or DNV, and state regulatory departments);
• Quality processes, including process improvement, quality improvement, and patient safety;
• Sentinel events and root cause analysis;
• Infection prevention;
• Medication safety;
• Data analysis, decision support and statistical analysis;
• Continuing medical education;
• Super-user for any measurement tools installed; and,
• Coding and documentation as it relates to quality and safety reporting.

Structure

We will need to assign the activities to the appropriate teams and create a REPORTING structure. We can start with a structure that looks like this, and adjust it to suit our needs:

In a small facility, one person might handle multiple duties. As the organization gets larger, the duties will need to be managed by a larger team.

I will place management of continuing medical education as part of the QI division. In this way, the majority of educational content for physicians will be designed to address gaps in care or patient safety.

Process

The Quality Committee, which is a subcommittee of the Board, will oversee all of the activities. So, there will need to be several scorecards that the board can review in order to easily monitor our performance.

The membership of the committee will include select board members, the CEO, COO, CQO, CMO, QI & PS Director, Pharmacy Director, Nursing Director, representatives from CME and  Infection Prevention, and members of the medical staff from each of the large departments (e.g., medicine, surgery, etc.).

Several subcommittees will report directly to the QI Committee:

• CME
• P & T/Medication Safety
• Readmissions
• Quality Team (tracking mortality, complications, core measures)
• Patient Safety
• Infection Prevention
• Code of Conduct

Each of these subcommittees will be monitoring outcomes and creating teams to address specific gaps in performance. The subcommittees might need specific teams for certain projects or for certain high risk units.

Here is how the COMMITTEE structure might look:

Reporting

Each SUBCOMMITTEE and TEAM will develop its own scorecards for reporting the ongoing performance being addressed. Minutes of each meeting and scorecards for each TEAM will be sent to its SUBCOMMITTEE. Each SUBCOMMITTEE, in turn, will report to the Quality and Safety Committee.

The CQO will present quarterly quality and safety reports to the senior executive team and the Board of Directors.

That structure ensures accountability of the organization to the community, via the Board.

Peer Review

Notice, Sam, that this model has not addressed the formal physician peer review process. But that must be included as part of the re-credentialing process for physicians.

My recommendation is that medical staff peer review be done by a multidisciplinary committee, with members from each medical staff department appointed by the chair. Cases will be reviewed, based on screening criteria for each department. Also, cases can be referred to the peer review committee as needed.

Some of those cases will also be reviewed through the sentinel event or QI process as well. The physicians will be invited to participate when their case is being discussed.

So, Sam, that’s what I consider to be a starting point for a good program.

In addition to the what I've already mentioned, we will:

• address new opportunities as they arise,
• focus on continually improving the quality of the care,
• take a multidisciplinary approach,
• integrate education into the process, and
• evaluate the culture through regular cultural surveys.

Wrapping Up a Great Hospital Quality Improvement Program

Sam replies, “That sound like a really sound plan. Thanks for taking the time to describe it.

“I think we’re out of time, so I’ll bring you to your next interview. Best of luck and thanks for coming in to meet with us today.”

I'm walking toward the door when, suddenly, I hear a distant ringing. The ringing becomes louder and louder.

Where is it coming from?

I open my eyes. The alarm on my cell phone is ringing. And I’m in my pajamas, in bed. I'm so preoccupied with my upcoming job search that I was dreaming about an interview!

Some of those ideas about a quality program were pretty good, though.

I jump out of bed to find a pen and paper to jot the ideas down!

Next Steps

What have I forgotten in my dream-induced quality plan? Let me know in the Comments.

Please share this if you found it useful – just use the links below to share on Facebook, Twitter or LinkedIn.

The post Building a Great Hospital Quality Improvement Program appeared first on NonClinical Physicians.

This is a process. Like any new realm of learning, we follow a path from awareness, to understanding, knowledge, competence, and eventually, mastery. This process may take years to complete.

The Chief Operating Officer and I asked the Director of the Laboratory, Sheila, to join us to discuss a challenge she was experiencing with her staff. I was still learning the ropes about working with directors of hospital departments like the Lab. The COO was quite good at sorting through difficult issues and building strong teams.

The director was very frustrated. She spoke about a particularly difficult employee. Peter had been working as a laboratory technician for many years. Every few months he would become the center of some drama in the department. He would be “written up” and then not be heard from for several months.

The employee had certain skills and certifications that made him difficult to replace. In spite of repeated involvement in various kerfuffles that impaired the morale of the department, he never received more than a slap on the wrist for his transgressions.

Sheila described her frustrations in detail. Several technologists and laboratory assistants had come to her with complaints about Peter’s behavior. They felt that Peter was repeatedly allowed to skirt the rules without serious consequences. The staff resented what was happening.

As Sheila described the situation to us, we mostly just listened. The COO occasionally encouraged her: “Go on, tell us more.”

Seeking a Solution

At one point he asked, “How is this behavior affecting the performance of the department?”

Sheila replied, “The turn-around times have gone up because the staff aren't working well together. And one of our new technologists resigned 2 weeks ago, probably because of Peter.”

“How is this affecting your work?” he asked.

“I'm spending much of my time putting out fires and trying to convince the other employees not to quit.”

“What have you tried so far to resolve the situation?”

She described various attempts she had made to work with Peter to improve his accountability and address his behaviors. As she paused during her description, we listened without comment. After a few moments, she continued.

“You know, it's going to be difficult to replace Peter, but I think I have to do it. For the department, and the organization. His presence is too toxic. If you agree, I'll meet with HR later this week to review the process. Then I'll meet with Peter and let him go.”

Preparing to Be a Better Physician Leader

In Part 1 of this series, I wrote about the attitudes and approaches that physician leaders should reflect upon.

In the following paragraphs, I discuss important skills we should hone if we want to be truly effective.

Project Planning

The ability to take on ever more complex projects is an important skill for the physician manager and executive. All physicians have some experience in creating plans to achieve important goals.

After all, we were able to effectively plan the process of admission to, and completion of medical school and residency, and becoming board certified.

In its simplest terms, project planning consists of starting with the desired result in mind, and working backwards, addressing each discrete step as a sub-project along the way. The planner then pieces together the steps, assigning work to involved participates and deadlines to each step.

Below is a very simple Gantt Chart that displays the process for preparing a lecture. A similar process could be used for preparing an article for publication.

On the other hand, the process for opening a 5,000 square foot physical therapy facility would be much more complex, and include dozens of separate sub-projects. Each piece of the planning puzzle would come together, ultimately resulting in the opening of the facility at some future date.

If you are just getting started in management and leadership, the best way to learn this skill is to be part of the planning of a big project and observe how all the moving pieces are coordinated.

Communication

Physicians generally excel at one-on-one communication with peers, patients and teachers and mentors.

Physician leaders must expand those skills to verbal and nonverbal communication, including lectures, group discussions, meetings, presentations and negotiations. Each of these has its own demands.

Often the best way to learn these skills is to just start doing them. Practice is the best teacher.

There are two specific communication practices that really serve leaders well:

• Listening
• Asking questions

The best leaders I have known spent much more time listening and asking questions, than making declarative statements or offering opinions.

Like the COO who allowed my laboratory director to come to her own conclusion concerning her employee, sometimes just asking questions is the best form of communication a leader can use.

Planning and Running Meetings

Meetings can be the bane of a leader's existence: too many meetings; boring meetings; meetings that take too much time and accomplish too little.

Leaders must employ several of the leadership skills already discussed to use meetings as intended: to obtain input, create action; move a project along and achieve important goals for the organization.

While many meetings are dreaded by invitees, it is possible to plan and manage a series of meetings that participants WANT to be invited to.

Such meetings are seen as exciting, challenging, inspiring and productive.

The chair of the meeting is responsible for achieving these outcomes, by following the process that I outlined in an earlier post. But it basically boils down to these steps:

1. Create an agenda that is designed to achieve the charge of the committee as quickly as possible, sharing it prior to the meeting so that everyone can come prepared;
2. Maintain control of the meeting so that EVERYONE contributes and there is respect for the participants’ time (start on time, and end early if possible);
3. End the meeting by clearly stating the next steps for the team;
4. Cancel any meeting that is not likely to produce results.

If you are not the organizer, in your next few meetings observe whether these steps have been taken. Gently encourage the team to adopt these recommendations.

Measurement

The best leaders become experts at measurement. It is only by using meaningful metrics that performance can be improved.

When I started as the Chair of the Quality Committee at the local hospice organization, I was impressed with the work that was being done. The Quality Director and her team were following infection rates, falls, and other meaningful quality indicators.

In addition to providing input and direction to the process, my role was to present updates to the Board of Trustees of this organization.

But I found that quality data were being presented as a written description of the monthly findings, with steps taken and planned improvements interspersed with the actual measurements.

Such a document would take the board hours to go through, since there were similar reports for all of the other major departments.

I asked the director if she could present the data in a way that was more concise and easy to understand. Ultimately, she was able to summarize the performance in a small number of easily understood graphs that displayed the trends in the outcomes.

Great leaders are able to identify good measures and communicate them to other stakeholders. They also use them to continually drive improvement in the performance of the department, committee or organization being led.

Measurement is key to driving improvements in quality, patient safety, employee performance, patient and employee satisfaction, and financial performance.

Teamwork

Creating effective teams is a critical skill. Like organizational culture, a strong team does not just develop by chance. I have discussed this issue before and have pointed to Peter Lencioni's book, The Five Dysfunctions of a Team,  as a good starting point to address trust and conflict.

According to Lencioni, leaders should reach of these stages in order to create a highly functioning team:

1. The members know each other at a personal level and they trust each other to NOT be judgemental or overly critical when expressing an opinion. Such team members have learned to listen carefully and provide honest, constructive comments.
2. The team engages in appropriate conflict in the form of full expression of opinions. A leader does not want a team of “yes-men.” Rather, all points of view must be freely expressed before a fully informed course of action can be developed.
3. Consensus almost never occurs. But once an issue has been discussed and debated, and a path chosen, everyone commits to supporting that decision, in spite of personal reservations. Team members will NOT undermine the plan once it is put in motion by second guessing or failing to support it.
4. Each member is accountable to the organization and its plan and holds each other accountable.
5. The team remains focused on achieving results. Each team member supports other departments and divisions, even if it means forgoing some of its own resources to achieve the overall goals of the team.

As you participate in different teams, try to observe whether the members are participating at this level. Or are they protecting their silos of responsibility and undermining others to achieve their own personal goals?

Management

To some extent, managing others involves using all of these skills to bring out the best in those that report to you. Communicating with clarity, listening well, planning well, building teams and measuring and reporting the right metrics enables us to support and encourage highly productive direct reports, committee members and colleagues.

The best CMOs, CMIOs, CQOs and medical group administrators have spent a good deal of time preparing to be a better physician leader. And, as with clinical care, such leaders are committed to lifelong learning.

In Closing

In presenting this and the previous post about preparing to be a better physician leader, I have attempted to demonstrate that:

• Physicians are natural leaders.
• The medical profession needs more leaders.
• Many of you will be drawn into leadership roles.
• You need to learn new skills to be an effective leader.

Next Steps

Observe these skills in others. See what works well and what does not.

Informally approach those with the best leadership skills for advice and counsel. Use them as mentors, as I described in Why Both a Coach and Mentor Are Vital.

I welcome your comments and questions.

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He explained that it was something they had not experienced before. They were upset that such an event could occur at their facility. He asked me to describe what I knew about hospital sentinel events and share some of my experiences.

Here is a short list of what I told him:

• In the hospital setting, a sentinel event is a specific term defined by The Joint Commission. It is a very serious, uncommon patient safety event that occurs when multiple systems break down that  results in harm to a patient.
• Not to minimize what may have happened at his facility, I told him that every hospital experiences sentinel events.
• Because they are so serious, in addition to harming a patient, they often result in upset staff and physicians, and angry patients and families. Allegations of medical negligence and potential public relations problems can occur following such an occurrrence.

I also explained that a good-sized community hospital might experience 6 to 12 sentinel events annually, in my opinion.

He seemed a bit shocked by that estimate.

I reminded him not all SEs are of the same severity. There is a difference between a “never event” such as wrong site surgery or a fire occurring in the operating room, and a medication error that causes temporary, albeit serious, harm to a patient.

Recent TJC Statistics on Hospital Sentinel Events

TJC has developed its approach to defining, identifying, analyzing and reporting sentinel events over several decades. Part of that process includes the voluntary reporting of sentinel events by accredited hospitals. When reporting the SE, most hospitals follow-up with TJC by submitting the results of its root cause analysis of the event.

We adopted a policy of reporting almost every sentinel event to TJC that we experienced. We believed that the additional support and coaching provided by TJC following our RCAs were very valuable. Also, it could be embarrassing if our board or the public discovered that there had been a serious SE that had not been reported to TJC, if and when it came to light.

This type of voluntary reporting allows TJC to track trends in SE occurrences and to promote preventive measures to reduce their occurrence. According to published TJC reports, for each of the past five years, about 900 such events were self-reported. There were another 200 or more that were reported to TJC in other ways (anonymous reports, media reports, etc.).

If we assume that as few as 5% to 10% of SEs are reported to TJC, then there are probably 9,000 to 18,000 such events annually in U.S. hospitals; more if you include less serious occurrences. With about 5,000 non-psychiatric, non-federal hospitals in the U.S., that would equate to 2 to 4 serious events per year per hospital.

There is a fairly consistent pattern to the types of events seen in hospitals.

[table id=6 /]

These numbers are probably skewed by the fact that retained FB and wrong site surgery are very obvious and easily measurable. But other events are more subjective with regard to their seriousness and reportability. For example, it is doubtful that every organization defines a “serious medication error” in the same way. Some will have a higher threshold for reporting such events than others.

There is also a fairly consistent pattern to the types of outcomes each year.

[table id=7 /]

Responding to Sentinel Events

When a sentinel event is identified, the appropriate response is to perform a root cause analysis (RCA). The RCA process was developed first in the field of engineering in the 1950s. It’s development is often attributed to Sakichi Toyoda, the founder of the Toyota Corporation.

The concept of sentinel events and RCAs were not applied to medical care until decades later. But their use is now widespread, being promoted by both TJC and the Centers for Medicare and Medicaid (CMS) as a way to learn from and prevent future patient safety breakdowns.

Most physicians do not welcome being asked to participate in an RCA, however. They are time-consuming. And the atmosphere of an RCA meeting can be intimidating and uncomfortable as participants frankly describe breakdowns leading to a patient's harm.

Why Pay Attention to Sentinel Events

Given that sentinel events have the effects mentioned above (patient harm, liability, increased costs, psychological trauma to involved professionals), it should be clear that these events must be addressed aggressively.

As a hospital leader responsible for patient quality and safety, here are some of the reasons I believe medical staff leaders and physician executives should become experts at recognizing and investigating a sentinel event:

1. Leaders Can Demystify the Process.

Because sentinel events and ensuing RCAs are, thankfully, uncommon, most healthcare workers rarely become involved. It is therefore essential that the leaders in an organisation remove the fear of being part of an RCA, and effectively communicate the need to openly, and in a blame-free manner, try to identify the root causes of an event.

While the core expertise in running an RCA may lie in Quality or Patient Safety Staff, the physician executive must feel comfortable with the process. He or she can then help to encourage others involved in an SE to provide feedback and input.

2. Leaders Promote a Culture of Safety.

The culture of an organization is often described as “how we do things around here.” Physician leaders must set the agenda AND model the behaviors that promote such a culture of patient safety. This culture has the following characteristics:

• Employees are empowered to question unsafe practices;
• Everyone understands that healthcare is prone to error;
• Lifelong learning and continuous improvement are valued; and,
• Teamwork is crucial to improving safety.

3. Leaders Enable and Support Improved Patient Care.

Identifying a sentinel event, performing a root cause analysis, and instituting corrective measures based on the RCA will reduce the likelihood of occurrence in the future. This will make your hospital a safer place for your patients.

4. Leaders Foster Downstream Benefits.

Better patient care means less rework, lower liability costs, and better staff morale. A safe high quality hospital fosters pride in caregivers, medical staff and board, and better standing in the community. By avoiding staff turnover and expensive lawsuits, there is a positive financial result in the long run.

5. Only Physician Leaders Can Fully Engage Other Physicians in the Process.

I wrote about the challenges of achieving and maintaining physician engagement in Become a Physician Leader and Save the Medical Profession. It can be quite difficult for non-physician CEOs, Quality Directors and other hospital management to speak the physician's language and enroll them in patient safety initiatives, including an RCA following a sentinel event.

None of us wants to accept the occurrence of hospital sentinel events. Hence, it should be our goal to promote the aggressive investigation of and learning from sentinel events.

How Can Leaders Help?

Here are some things we can do to help the process:

• Make time to participate in and co-lead RCAs if possible.
• Bring learnings from completed RCAs to the medical staff for discussion and feedback.
• Provide education about SEs and RCAs to your hospital board.
• Provide the board with an annual summary of RCAs that lists the nature of the events and the changes implemented to reduce or eliminate their occurrence in the future.

Next Steps

If you are not already involved with RCAs, seek out the professional at your organization that oversees identification of sentinel events. This might be the Director of Quality, or Patient Safety, or Risk Management. Then talk with them. Ask about the process if you're not already involved. And ask if you can sit through a root cause analysis or two to understand the process better.

Review These Additional Resources

Here is the TJC Sentinel Event Policy and List of Sentinel Events.

For an overview of the root cause analysis process go to Guidance for Performing Root Cause Analysis from CMS.

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The CEO and the Board of Trustees (or Directors) definitely want to see meaningful reports about hospital performance. They truly want to see that performance is improving. Along with positive financial results, nothing will make the CEO and board happier than seeing that quality can be measured, is at an acceptable level, and is improving.

There are many ways to collect, analyze and present such data. I am going to show you how to prepare quality reports that my board found useful and interesting. Several of my board members told me that they really looked forward to seeing these reports.

First, Some Basics

Anyone who works in the quality arena will take the following caveats as a “given.” But for those who are just starting, here are some things to keep in mind.

It is not easy to reliably measure quality. And for hospitals, we generally do not measure “chart-level” outcomes. Our quality measurements are limited by the fact that we use billing data to collect mortality, complications, length of stay and other quality outcome measures.

UB-04 Billing Form

However, there is more than two decades of work by universities and quality vendors validating the use of billing information to measure outcomes. These researchers have produced an approach to quantify outcomes and apply statistical methods to the process. This enables us to compare the performance of facilities across the country. These methodologies are the same as those used by CMS and private quality reporting organizations such as Truven Health Analytics and HealthGrades.

You should verify that the following requirements are in place before you try to create reports like the ones I describe:

1. Your organization has a quality measurement tool that is interfaced to all of the necessary hospital systems.
2. The tool accurately draws data such as date of admission, date of discharge or death, source of the patient, destination on discharge, length of stay, etc.
3. The system(s) have the ability to distinguish between medical conditions that were present on admission (POA) from those that arose during a hospital stay.
4. Your hospital has robust medical records, coding and billing departments that accurately assign CPT codes, ICD-10 codes, and DRGs. You must be confident that those codes comply with the definitions from CMS and other quality agencies.
5. You have staff in the quality department that is knowledgable and can pull the outcome reports you need.

Other Considerations

The systems that I’m describing perform risk-adjustment of the data. It is therefore valid to compare outcomes to other organizations. In addition to reporting risk-adjusted rates, the outcomes are also expressed in one of two ways:

1. As an index, defined as the ratio of the observed rate over expected rate. If the observed and expected rates are the same, then this ratio is 1.0. A higher ratio indicates a rate worse than expected. A lower ratio than 1.0 indicates a better than expected rate.
2. As the difference between the actual and expected rates. If the difference is a positive number, the actual rate is worse than expected. If it is less that zero (a negative number) the rate is lower/better than expected.

Finally, most systems will also indicate whether the difference or ratio is statistically significant, and at what level of significance. When considering quality comparisons, we want to know differences at the 75th and 90th percentile. In research studies a significance level of 95% is desired. But we want to err on the side of identifying opportunities for improving quality. And we ignore opportunities with a significance of less than the 75th percentile, because they are more likely a result of chance alone.

Bringing It All Together to Prepare Quality Reports

As complicated as all of that sounds, the majority of hospitals have systems that meet those requirements. They can produce risk-adjusted outcomes and deviations from expected. And they can apply statistical testing for any of the high volume diagnoses. This allows us to prepare quality reports for our medical staff, our executive team and our board.

Using these systems, the quality department can create a report for the high volume diagnoses that lists the mortality, morbidity (complications), readmissions and length of stay.

I usually break these reports into two main categories. I produce one report that focuses on the mortality and length of stay for serious medical conditions. In this way, I can show the CEO and board a report that addresses pure quality (mortality) and a combination of quality and utilization (LOS).

For the high volume surgical or procedural admissions, since the mortality rates are very low, I find it more useful to present the morbidity (complication) rates and LOS data.

Start With a Spreadsheet

I use Microsoft Excel to create the data table and the graphs. But most spreadsheet software should work as well. I copy them to Microsoft PowerPoint for my presentation. I keep the slides as simple as possible. Usually, I include a minimum of labels so the information is clear. Yet I try to be parsimonious: showing everything that is needed, but nothing that is not needed.

Creating the bar graphs is simple: just highlight two columns (the list of diagnoses and the outcomes) and select the type of bar graph from the drop down menu. I generally use 2-D graphs for simplicity. Then, I save the charts on a separate page so that I can easily copy them to my slides.

The “bubble graph” is created by highlighting the three columns to be included (LOS, mortality and volume columns in this case), then choosing the prefered style from the “Scatter or Bubble Chart” option.

An example of a table that includes all of the information needed for these graphs follows. Note that these are completely fictional data that I generated for demonstration purposes only. But the information I present will look very much like this table, but for a larger number of conditions (20 or 25).

Using the information from the table, I create a bar graph to show the spread of outcomes from best to worst (in this case, lowest to highest mortality and LOS indexes). To do so requires sorting the data (lowest to highest) before creating each chart. Here is how those graphs would look:

Preparing the Bubble Graph

Finally, in order to bring it all together when I prepare quality reports, I combine all of the information into a single graph. This graph displays a grid showing the mortality index, the LOS index and the volume of cases. That graph is shown below.

I usually add small labels for each bubble indicating which diagnosis it represents. [Those must be added manually using individual text boxes. I did not do it for this post to save time. – VPE] I should also note that most of this work was delegated to a capable quality improvement nurse once I had created the first few iterations of these reports.

When I was presenting these data regularly for our board (twice a year), I would show the previous results and the current results. And I would skip through the bar graphs quickly, since all of that information was also incorporated into the bubble graph. But I wanted the board to understand where the bubble graph information came from.

Then I would just leave that bubble graph up on the screen while I discussed the great results of conditions sitting in the bottom left quadrant. And I would point out that it is possible to have great outcomes and a short length of stay (contrary to the opinions of some of my medical staff colleagues).

I would then describe the challenges of the conditions in the top right quadrant. And I would outline the procedures we had instituted to address the excess mortality and/or LOS. I might also comment on how we would prioritize working on the largest bubbles in the top right quadrant because they represented more cases.

Other Steps

It is best to preview these presentations with your CEO and senior executive team. That way, you can better anticipate questions the board may ask. And it gives you an opportunity to engage other team members in your quality improvement efforts.

You can combine any two variables (plus the volumes) to create similar slides. In addition to mortality and LOS, I would present a bubble graph of morbidity and LOS as noted above, or incorporate readmission rates. You may want to apply this method of analysis to metrics from patient safety or infection control. Even the finance team can find a use for these types of graphics.

Next Steps

Get creative and come up with some other combinations. Once you create some charts, why don’t you include a picture in the COMMENTS below, or just describe what you have created.

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Pharmacy

Medication administration is one of the most important functions of a hospital. Safe, effective and timely administration of medications requires coordination of multiple hospital staff departments, integration of electronic medical records, implementation of pharmacy automation, and monitoring and managing drug costs.

The triad of professionals responsible for the selection and delivery of medications consists of the physician, nurse and pharmacist. These highly educated professionals each contributes critical expertise to medication delivery. The integration of the physician/nurse/pharmacist triad is the secret to safe medication delivery.

Those three professionals each work in domains with unique challenges and cultures. Thus, when they bring to bear their particular skills and tools, they optimize the patient's outcome.

Value of the Physician Executive

The physician is an expert in selecting the medication needed to treat a given patient. The nurse is the expert in safely administering the medication and monitoring the patient for intended benefits and adverse effects. The pharmacist is the expert at monitoring the process, delivering the medication to the bedside and providing needed support and advice, especially when polypharmacy is involved.

The Physician Executive is in the best position to understand the process and facilitate coordination of the stakeholders. Some of the critical aspects that must be led are:

• Developing guidelines and protocols that drive medication selection.
• Facilitating discussions needed to create a formulary that is appropriate, yet manageable in size, cost and complexity.
• Mediating between physicians and pharmacists when constraints are placed on the use of high cost medications.
• Advising about which functions can be delegated to technicians and which require direct doctorate-level pharmacists.
• Promoting the collaboration between the pharmacy and quality improvement departments.
• Balancing the costs and benefits of new pharmacy-led initiatives such as:
  • Deployment of clinical pharmacists to the emergency department and other units such as intensive care;
  • Diabetes management services to adjust insulin doses for inpatients; and
  • Anticoagulation clinics to adjust warfarin dosing.

Practical Considerations

How can the VPMA or CMO best help the pharmacy to deliver on its mission? Here are a few suggestions to consider.

1. Promote a culture of accountability, teamwork and safety within the department. This will require the selection and nurturing of a very skilled pharmacy director.
2. Lead your physician and nursing colleagues by example. Commit time and resources to measuring outcomes, participating in teams, and presenting pharmacy concerns to medical staff and executive leadership.
3. Remain current with important medication safety issues by monitoring publications from:
   • Institute for Safe Medication Practices
   • American Society of Hospital Pharmacists
   • American Hospital Association (see Quality Advisory on Medication Safety)

One-on-Ones

Finally, as with all of your direct reports, you will meet with your pharmacy director on a weekly or biweekly basis. During those meetings, the following topics should be addressed (not necessarily at every meeting):

1. Review of goals for the year. Are milestones being met? How can you facilitate them?
2. Review staffing. Is the pharmacy fully staffed? Are there open positions? How are those being addressed?
3. Budget updates. How are expenses running compared to budget, especially staffing and drug costs?
4. Medication safety reporting. What are the number and nature of medication errors for the past reporting period? Were they preventable?
5. Formulary requests. Are any pending? Review the agenda for the next Pharmacy and Therapeutics meeting. Do physicians need to be contacted prior to the next meeting?
6. Summary of cost reductions resulting from clinical pharmacy interventions.
7. Director’s performance review (at least quarterly).

Conclusion

The physician executive can have a positive impact on patient care. This will be achieved by enabling the pharmacists to fully apply their expertise and by promoting the physician/nurse/pharmacist triad.

Next Steps

If you are a VPMA or CMO and do not currently oversee the pharmacy functions, become more involved in the department.

• Attend P and T Committee meetings.
• Support the efforts of the Pharmacy Department to engage physicians.
• Promote new clinical pharmacy initiatives that will enhance medication safety.

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