Interviewer (I): We are joined by my favorite guests of our show, Dr. John Showalter, Chief Health Information Officer of the University of Mississippi Medical Center and Leigh Williams, Administrator of Business Systems for UVA Health Systems. Guys welcome back to the show!
Dr. John Showalter (Dr.JS): Thanks for having us back!
Leigh Williams (LW): Yes, thank you Jeff.
I: You guys are awesome for taking the time when I'm sure everybody wants a piece of you here at HIMSS. We are going to get right to it. You guys wrote a book. What the heck? What are you writing a book about?
Dr.JS: So we are writing a book about engaging physicians, engaging physicians in shared outcomes. How to move health systems forward for both the health care of the country and for the patients that the health systems are treating.
LW: And it's a practical guide that helps you understand not only strategies behind how to deal with people, but also what tactics you can put in your toolkit to be able to get it done. Its one of the things that people ask us the most about is how do you, first of all engage them but then move physicians forward through a change initiative at that organization. So it's really focusing on approaches but then also methodology for achieving your outcomes.
I: Well that's the word and it makes perfect sense. We've been doing this show for 2 days and physician engagement has been a key topic. But why did you decide to write a book about it?
Dr.JS: I think we decided to write a book about it because as we went out and we were presenting our success stories and things that we have been doing and projects that have been successful, the number one question was, how to get your docs to do it? Did you pay them? How much money did it take to get the docs to do this? And no one was really talking about the things that we were doing that was making our physicians want to be a part of our mission and wanting to, you know, get to where we were going and buy in.
LW: And we had amazing results with the physicians that we worked with over the past few years, and it was so incredible to see them unfolding and becoming a true partner in the initiatives that we were working on. And having the stories from them, from the physicians' perspective that they normally didn't get that style of engagement and it made such a world of difference for them to be able to focus on how they wanted to do the projects. And we got so much better traction with their groups, whether it was surgeons or Family Medicine practitioners; just listening to them saying know what this is different, this is working for us and we want to be a part of this. Everyone should understand from this perspective. So, there is some of that empathy and working with the doctors saying you know there's a better way to approach this. We all want to make healthcare better. There are better ways to do it with doctors and why not share some of those best practices so that folks understand and can move their healthcare organizations forward as well.
I: Perfect! My next question seems like it just has the answer of a 'of course we would', because I have known you guys as a team for so long. But why did you team up to write this book?
Dr.JS: I think the reason we teamed up is that the frameworks, the tactics and strategies that we've developed, we developed together. And they've been very synergistic between how physicians think and how physicians are trained and what we really need to do operationally. And Leigh and I combined well to bridge that gap, and actually early on began to start putting things in framework so that Leigh and I could talk about and be on the same page because we were coming from very different directions but needed to move forward together.
LW: And we do have, and so those different directions, my background is healthcare operations and revenue cycle. John of course is a practicing physician. And so by having those conversations where we talked about my perspective and understanding of the initiatives that we were working on, and combined it with his perspective and the way that he would approach it, we did find that we influenced each other and there were insights and ways forward that alone we would not have thought of. So he's right, that these ideas came about through discussion over years of what's working and tweaking and really staying up to speed on both the clinical perspective and on the business perspective of healthcare. And it's the blending of those two things together that… that we felt was reason to write the story together.
I: We all read the Trade Rags. We know the stats. Most IT projects fail. And they fail for lots of reasons. But with most IT implementations, what's missing that leads to failed physician engagement?
Dr.JS: So, I think the two things that are missing is, one is an understanding of truly where the physicians are coming from and what their perspective is. And how their training has influenced that perspective, as well as an effort to move out of a what's in it for me or was in it for the physician's mindset to what's in it for the patient or what's in it for the health system. Because ultimately, good things for the health system are good things for the patient. And when you can get to a shared outcome where you both support the direction that you're headed in, you have a completely different story than making a doctor do something.
LW: Um–hum. No I agree with that. It's really about finding that common ground and that common mission. All week long I've been hearing people talk about start with empathy and the innovations come from really understanding your groups and that's… that's really one of those benefits of taking into those perspectives.
I: Someone I… I trust very much, talks about you have to start with a workflow.
I: You have to understand it. If you come in with this brand-new shiny piece of technology that imports some kind of crazy workflow it's never going to work no matter how shiny the technology.
LW: That's right!
I: So, I want to dig into this shared outcome approach, because I think that's probably some of the secret sauce for your success together and what's in the book. Tell us more about the approach… the approach and how it drives physician engagement.
Dr.JS: You want to start with that one Leigh? Because you know, you are the one that brought that to the table.
LW: [Laugh] So in deriving shared outcomes, if I understand your question correctly, it's like why are we trying to say that that's the thing that we are after. We found in a lot of conversations with physicians that they needed to find the meaning in the work themselves. And part of what we discussed in the book is how physicians learn and what their tactics are, and how they are a special segment of our society, and they have ways that they do business, the ways that they think and how they've been trained. And, it was very important that they individually and independently grasp onto something that was meaningful for them in the work. Because these are incredibly busy people who don't have a lot of time and energy to give to, for example, an EHR implementation or something that feels outside of their scope. I think we've all had patients… had doctors at some point they said the patients are why I'm here; I don't want to work on that. So it became just absolutely obvious that you need to find some meaning in it for them and tie it to their goals and personal mission and then you can blend in what else you're trying to do and… and accept the fact that it's not just that you're implementing an EHR, but you are transforming the way that physicians do business; you're transforming their work flows. You are providing them the most basic of tools that they use for their job. So finding a way that you can describe it in terms that make sense to them, that they want to be a part of it is incredibly important. So I think that that's where we came about and said you know its got to be not only that we're going to implement EHR or make more money or something like that, you had to find a goal that would jive with how the physicians thought about their work themselves.
Dr.JS: And one of our big examples, that we've had success with is, increasing the specificity of our documentation. And operations, revenue cycle cares about increasing the specificity because it's better billing and less denials, more revenue. The physicians, although they, you know want the health system to be financially responsible and financially viable are much more interested in the fact that… that improved specificity means the next doctor down the line knows what's going on, that when they receive a patient from another physician, they actually have a better understanding what's going on with the patient. And there's a shared outcome there of increased specificity that you can get both groups to come around and they can each take their approach from it, but we have a joint goal.
LW: That was… Actually I want to make a comment about the revenue cycle folks that we were working with on that particular example, were a little bit surprised that we were putting it in terms of what mattered for the physicians, and were a little worried that we were not going to achieve some of the revenue cycle goals that we had with that work. And John and I were like dadada… shush, stay in the background, let the physicians focus on what they think is driving this project and what they're going to get out of it and your work will flow from that. And we really found it that worked well. So if you can help everyone understand how you're achieving the goals, it doesn't have to be that you put at the beginning; it's awkward for anyone to put at the start of a healthcare project, anything other than the patients. You can't start with the money, even though that may be how your funding your business or growing your business or providing better care. It really is awkward in and sort of off-tone to be… to be putting that at the forefront. So, we even had to work with other stakeholders to understand their role, and they are side by side with the physicians and not stressing too much with saying, you know what this is about the patients.
I: One of the things I love about you guys is you introduce methodologies and models into your teaching. Is there a maturity model that you're proposing in your book, or you are showing in your book? And describe that for us.
Dr.JS: Oh absolutely! So we have a data driven maturity model that allows us to really put together a framework and say this is probably why your IT initiative or your other improvement initiative is failing with the physicians. So the model is divided up into a domain about creating actual knowledge and the domain about engaging physicians. And there are several sub-domains in each, but they then travel from a stage 1 of really no true understanding or execution in that domain, to true excellence in that domain. And what we have found through our experience is if you're not up into a stage 3, your initiative is going to fail. And if all the sub… if any of the sub-domains are less than a stage 3 your initiative is going to fail. And if you're a Stage 5 which I don't know… don't know that we've ever gotten to a stage 5, that perfect… but that three-and-a-half stage, four stage is actually where you can get really amazing returns.
I: Perfect! What is the one thing that you hope readers take away from the book? I'll give you two a chance.
LW: [Laugh] I hope they find a path forward with their own initiative. Something in there where it makes that reader a better proponent of health IT projects and that they are able to connect with their physicians in a more meaningful way to advance whatever project it is that they're working on in their organization.
Dr.JS: And whether they use exactly our methodology, or our approaches, or our strategies, or our tactics, I'm really hoping that a lot of people have an 'aha' moment in the middle of this book that says physician engagement is about how you actually approach your interaction with physicians; that you do have influence into whether or not your physicians engage. I hear so many people going - Oh they are just our physicians. We just can't… and we've been across too many campuses, too many different models, rural healthcare, community healthcare, academic medicine and had success that I don't think it's about the physicians are just anti-engagement. And whatever you can glean from the book that allows you to do that better and be more proactive, I'm going think its a win.
I: I was just thinking to myself. We made it this far and [Laugh] we haven't talked about the title of the book. What's the title of the book?
Dr.JS: The title of the book is 'Mastering Physician Engagement: A Practical Guide to Achieving Shared Outcomes'.
I: And everybody who's listening can find it?
Dr.JS: It should be available on amazon.com and just search for the title.
I: And/or Dr. Showalter and Leigh Williams as the authors.
I: Great. Good deal. Well Leigh and John, it's been so great to catch up again, to hear about your exciting book. I hope that everybody as they are listening to this goes to Amazon and either reserves a copy or buys a copy and does it right away! Thanks so much for being here.
Dr.JS: Thanks for having us again.
LW: Yes. Thank you Jeff.
I: All right. That wraps this broadcast. On behalf of our guests Leigh Williams and Dr. John Showalter, I am Joe Lavelle. Intrepid healthcare's coverage will be right back.
- Intrepid Healthcare's exclusive coverage at HIMSS16 sponsored by Jvion