As my colleague wrote last week, we must move beyond our assumptions that we all deliver high-quality care and create a formal process for data-driven physician performance improvement.
In my research on high-performance medical groups, I found they typically follow a four-step process to identify and address opportunities for practice-level improvement among employed physicians.
1. Build a comprehensive dashboard
At the root of the performance improvement process is the executive dashboard, which gives medical group leadership a bird’s-eye view into group activity and outcomes.
This dashboard provides a more comprehensive view of medical group performance than typical physician practice report cards, which primarily focus on employed physicians’ productivity and financial outcomes.
By incorporating a broader set of indicators, such as clinical outcomes, patient and peer satisfaction, or physician citizenship, executive dashboards provide a holistic view and allow the group to identify a wide range of opportunities for performance improvement.
2. Select areas for improvement
The dashboard’s role is to highlight opportunities where performance is lagging. The next step in the performance improvement process is to decide which of those opportunities are most worth pursuing.
Six physician personas every executive will recognize
For example, Marshfield Clinic conducts a three-part assessment to determine which potential improvement initiatives are most feasible, involving physicians at every step:
- Determine whether a particular initiative is feasible given the analytical and human resources available
- If so, conduct a cost-benefit analysis of the potential opportunity
- Consider the physician response and reject initiatives likely to generate too high a level of resistance
This process results in a prioritized list of physician-championed, actionable initiatives with concrete performance goals.
3. Develop standardized solutions
Once medical groups have identified a viable improvement opportunity, they next work to develop best practice solutions. Successful groups first look for best practices within their own ranks, pulling together physicians from across the organization to create "economies of intellect."
Atrius Health, a tightly knit network of standalone medical groups in Massachusetts, believes strongly that unnecessary variation leads to inefficiency and poor outcomes. As a result, Atrius works closely to identify the most effective clinical and operational practices in use by member physicians and to spread those practices across the network as standard operating protocols.
To facilitate this process, Atrius created the Quality Improvement Council, staffed by representative physicians from across the network.
Using data provided by network administrators, the council identifies the top three and bottom three performing physician practices on a metric of interest. The group next brings those physicians together to discuss what has made them successful or where they have struggled. The committee then uses that information to develop a standard that can be effectively implemented by other network physicians.
4. Roll out the standard
While physician involvement in the development of a best practice standard is critical, it's still no guarantee that the new protocol will be easily accepted by other physicians.
Even high-performance medical groups sometimes struggle to overcome physicians’ general resistance to the concept of standardization. As a result, successful groups pay careful attention to how they deploy new standards, implementing changes in a way that maximizes physician comfort.
Dashboards and Reports,
Metrics and Analytics