Latest / Becker’s Healthcare Podcast / Healthcare Upside / Down: A Playbook for Physician Enterprise Transformation

Transcript

Healthcare Upside / Down: A Playbook for Physician Enterprise Transformation · Becker’s Healthcare Podcast

• 0:00
  - Welcome to Healthcare Upside Down, a podcast by
• 0:02
  - Becker's Healthcare and ECG Management Consultants, where we'll
• 0:05
  - explore the upsides and downsides
• 0:08
  - of healthcare and the industry's most current trends.
• 0:10
  - I'm Molly Gamble, and today I'm joined by
• 0:12
  - two guests to discuss how health care organizations
• 0:15
  - can drive effective transformation,
• 0:18
  - identifying what's not working, prioritizing the changes that
• 0:21
  - matter most, and executing at scale in today's
• 0:23
  - high pressure environment,
• 0:24
  - specifically around physician enterprises.
• 0:27
  - Joining me today, we have doctor Michael Ezzi,
• 0:29
  - president of OhioHealth Physician Group, and Frank Panzarella,
• 0:33
  - principal of ECG Management Consultants.
• 0:35
  - Doctor Ezzi and Frank, thanks so much for
• 0:37
  - joining me today.
• 0:38
  - Thank you, Molly.
• 0:39
  - Well, to get us started before we dive
• 0:41
  - in our conversation, maybe you can you both
• 0:43
  - explain more about yourselves and your background, share
• 0:45
  - a bit more about your work? Doctor Azzi,
• 0:47
  - I'm gonna turn to you first here. Sure.
• 0:49
  - Thank you. It's good to be here. I'm
• 0:52
  - a senior vice president at OhioHealth and president
• 0:54
  - of the Ohio Physician Group.
• 0:57
  - We're a health system owned group with more
• 0:59
  - than 2,000 physicians and advanced practice providers.
• 1:02
  - We have about 3,500
• 1:04
  - associates who support our practices.
• 1:07
  - I began my career as an academic pulmonary
• 1:09
  - critical care physician in,
• 1:11
  - specialized in medical education.
• 1:14
  - Spent time at hospital leadership and operations as
• 1:16
  - a vice president on medical affairs. I moved
• 1:18
  - into service line leadership,
• 1:20
  - helping to support an acute care service line,
• 1:23
  - and I've been in the role of, president
• 1:25
  - of the physician group for about three years.
• 1:28
  - I stepped away from clinical practice
• 1:31
  - about five years ago really to focus on,
• 1:33
  - helping to support complex problem solving for all
• 1:36
  - of the health care,
• 1:38
  - challenge that that we face and, support our
• 1:40
  - communities just in a different way.
• 1:42
  - Fantastic. Thank you so much, doctor Azzi. The
• 1:44
  - complex problem solving, I know we're gonna be
• 1:46
  - diving into in a bit more detail in
• 1:48
  - a moment, but, Frank, I'll turn to you
• 1:49
  - first to learn more about your background.
• 1:51
  - Well, great. Thank you so much, Molly. It's
• 1:53
  - really great to be sitting down with you
• 1:54
  - and doctor Eze for this conversation.
• 1:56
  - As mentioned, I'm principal with ECG, a firm
• 1:59
  - that for five decades has focused entirely on
• 2:01
  - the health care sector,
• 2:02
  - with expertise across all facets of the industry.
• 2:05
  - My professional career has been entirely in health
• 2:07
  - care, though my experiences kind of have ranged
• 2:10
  - from the employer self funded insurance world to
• 2:13
  - health care benefits to executive roles and health
• 2:15
  - systems and medical groups, with those last two
• 2:17
  - being where much of my time has really
• 2:19
  - been spent. So and I've been privileged to
• 2:21
  - work with and learn from many truly exceptional
• 2:23
  - people and and be a part of some
• 2:25
  - high performing teams at places like Mass General,
• 2:27
  - now Bassett Healthcare, which is anchored in the
• 2:29
  - idyllic village of Cooperstown, New York,
• 2:32
  - Dartmouth Health, and now ECG. So, I started
• 2:34
  - with ECG just over two years ago, and
• 2:37
  - I've already been deeply involved in two major
• 2:39
  - physician enterprise transformations,
• 2:41
  - including stepping into full time interim leadership roles
• 2:44
  - in both of those organizations.
• 2:46
  - Most recent, of course, being at OhioHealth where
• 2:48
  - I served in the capacity of physician group
• 2:50
  - COO for the past seven months. So,
• 2:52
  - so my work is largely focused in the
• 2:54
  - physician enterprise and integrated medical group space across
• 2:57
  - all organizational
• 2:59
  - structures and health systems and AMCs, community hospitals,
• 3:02
  - and group practices.
• 3:04
  - Terrific. You both have a a wealth of
• 3:05
  - firsthand experience on this topic.
• 3:08
  - And I I thought we could begin by
• 3:10
  - establishing the stakes here. What? Why now? Why
• 3:12
  - is this a timely topic right now? Once
• 3:15
  - we're talking about health systems
• 3:17
  - structuring and how they run their physician enterprises,
• 3:20
  - what makes it a pressure point in this
• 3:22
  - moment, and then what does it look like
• 3:24
  - when an organization
• 3:25
  - realizes something
• 3:26
  - pretty fundamental needs to change here? Frank, can
• 3:29
  - I turn to you first for your thoughts
• 3:31
  - on this one? Thanks, Molly. Yeah. That's, I
• 3:33
  - think that's a really key aspect to to
• 3:35
  - offer some context as we start the conversation.
• 3:37
  - So, you know, while, while you have some
• 3:40
  - unique health care systems out there that were
• 3:42
  - born or designed from the start to
• 3:44
  - to have integrated or employed medical groups, closed
• 3:47
  - staff models, you know, the vast majority have
• 3:49
  - really built their physician enterprise through practice acquisitions,
• 3:52
  - mergers, and building new practices out of necessity
• 3:55
  - as private practices in their communities collapsed or
• 3:57
  - became economically unable to stand on their own.
• 3:59
  - And,
• 4:00
  - in alignment, PSAs with independent medical groups, you
• 4:03
  - know, looking for support and affiliation, but not
• 4:05
  - full employment. So, so the most common scenario
• 4:07
  - is the way that health systems structure and
• 4:10
  - run their physician enterprise
• 4:12
  - has not been of intentional and strategic design
• 4:14
  - to build a high highly accountable, unified medical
• 4:18
  - group thoroughly integrated into the system,
• 4:20
  - complemented by usually, complemented by independent physician relationships
• 4:24
  - and affiliation. So so the result is a
• 4:27
  - federated group of medical practices and specialties.
• 4:30
  - You know, they don't, they don't
• 4:32
  - usually function operationally as a unified medical group
• 4:35
  - and, you know, then you hit the hospital
• 4:37
  - and the market leaders in that system. They
• 4:39
  - then see a separate and perhaps dysfunctional business
• 4:42
  - unit that has a large negative direct contribution
• 4:44
  - in the financial statements.
• 4:46
  - So, you know, that dynamic and intention, the
• 4:49
  - failure to see the medical group as an
• 4:51
  - integrated part of the whole system,
• 4:53
  - and understanding where and how it's driving value,
• 4:55
  - where it needs to drive more, and who
• 4:57
  - controls the resources. Like, that creates this underlying
• 5:00
  - condition where transformation becomes paramount.
• 5:02
  - So this core dynamic has to be acknowledged
• 5:05
  - and addressed as a part of the performance
• 5:07
  - transformation.
• 5:09
  - And it's one of the reasons too that
• 5:10
  - these efforts can be really challenging and complex.
• 5:12
  - And then ultimately, it's the underlying tension coupled
• 5:15
  - with, you know, usually a distinct catalyst event
• 5:18
  - or circumstance, which ultimately brings the need for
• 5:20
  - fundamental change front and center.
• 5:23
  - Frank, you described a pretty holistic problem there.
• 5:25
  - When you talk about that catalyst event, may
• 5:27
  - maybe you can shed more light on this
• 5:29
  - when health systems are
• 5:30
  - reacting or calling ECG saying something is not
• 5:33
  - working here. What is that catalyst event? Are
• 5:35
  - there patterns you picked up on?
• 5:38
  - Yeah. Thanks.
• 5:39
  - You know, great great kinda detailed, kinda area
• 5:42
  - to go into is that. And interestingly,
• 5:44
  - there are actually a number of different catalysts
• 5:46
  - that can generate the impetus for examining your
• 5:48
  - medical group's performance and contemplate launching a large
• 5:51
  - physician enterprise transformation initiative. I mean, it could
• 5:54
  - be provider workforce vacancies, recruitment retention challenges, which
• 5:57
  - generate, you know, large and extensive locums reliance,
• 6:00
  - access and patient wait times, ambulatory market share
• 6:03
  - stagnation
• 6:04
  - or declination,
• 6:05
  - organizing into or away from clinical service lines,
• 6:08
  - physician productivity and comp, and then financial performance.
• 6:11
  - So and of course, most commonly what we
• 6:13
  - see is this last category.
• 6:15
  - Financial performance be the primary driver. It's it's
• 6:18
  - often in the context of overall organizational
• 6:21
  - system financial performance being under pressure,
• 6:24
  - which is, you know, pretty universal issue for
• 6:26
  - nearly all health systems in the country these
• 6:28
  - days. And when they search for margin improvement
• 6:30
  - opportunities, when they start searching for those margin
• 6:33
  - improvement opportunities,
• 6:34
  - all of a sudden they look at that
• 6:35
  - net investment in the physician enterprise and quickly
• 6:38
  - gains attention. Right? For employee medical groups that
• 6:40
  - are part of a health system, median investment
• 6:43
  - per physician is now more than $300,000
• 6:45
  - and growing it every year. When even when
• 6:47
  - you look at that combined for physicians and
• 6:49
  - APPs,
• 6:50
  - the median investment is still upwards of $225,000
• 6:54
  - a year. So that naturally begs the question,
• 6:56
  - what are we getting from that investment?
• 6:58
  - We've got unrelenting cost pressures in terms of
• 7:00
  - increasing provider salaries,
• 7:02
  - recruitment and retention challenges, unsustainable welcome expenses, and
• 7:06
  - competing
• 7:07
  - competing with private equity and other health systems
• 7:08
  - for talent and market share.
• 7:10
  - So all of that leading to growth and
• 7:12
  - expense, I e the subsidy of the medical
• 7:14
  - group, and that can be really alarming to
• 7:16
  - health system and executive health system leaders and
• 7:19
  - boards.
• 7:20
  - Yeah. Frank, I I could add just really
• 7:22
  - quickly. Most of those health system leaders and
• 7:25
  - boards are used to growing up in health
• 7:27
  - system leadership at a time when there were
• 7:29
  - many, many more independent physicians.
• 7:32
  - And so the revenue that was generated by
• 7:34
  - independent
• 7:35
  - physicians didn't often come with expense loads attached
• 7:39
  - to it. Now, in The United States when
• 7:41
  - we're at or or above 80% of physicians
• 7:44
  - being employed,
• 7:46
  - that added to everything you just amounted to,
• 7:49
  - is another one of those, catalytic drivers that
• 7:52
  - that plays in.
• 7:54
  - Doctor Adzi, I'm gonna stay with you for
• 7:55
  - one moment to expand because Frank just helped
• 7:58
  - us and and laid out a list of
• 7:59
  - symptoms that a physician enterprise is not functioning
• 8:02
  - the way it it should or or possibly
• 8:04
  - could, financial
• 8:07
  - performance being the most urgent of those. But
• 8:09
  - I wanna talk about the culture and the
• 8:11
  - leadership it takes for physicians and leaders to
• 8:13
  - actually name these real problems without
• 8:16
  - fear or defensiveness.
• 8:18
  - Can you talk about this in an honest
• 8:20
  - way? Because identifying
• 8:22
  - and
• 8:23
  - confronting what's not working can be a lot
• 8:25
  - harder than it might sound.
• 8:27
  - Yeah. Thanks thanks for that question, Molly.
• 8:30
  - You know, in health care, we're really,
• 8:32
  - we're perfectionists.
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  - Most of us who go into health care
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  - do so because we have values of excellence
• 8:39
  - and integrity and compassion, and we work really,
• 8:41
  - really hard,
• 8:43
  - to get the outcomes that our patients deserve.
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  - So
• 8:46
  - admitting when something isn't going right is is
• 8:49
  - tremendously hard for,
• 8:51
  - providers specifically, physicians specifically,
• 8:54
  - but everybody really who works in health care
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  - because we we really know what's on the
• 8:58
  - line.
• 8:59
  - That change management that comes into play when
• 9:02
  - we're talking about
• 9:03
  - working through these complex problems,
• 9:06
  - where the problem
• 9:07
  - really may feel local but has system wide
• 9:10
  - implications,
• 9:11
  - adds this additional layer of friction into the
• 9:15
  - equation that it takes mature leadership to understand
• 9:18
  - and work through.
• 9:20
  - For us in OhioHealth, we try to do
• 9:22
  - that consistently through our mission, vision, and values.
• 9:26
  - That's our grounding for everything that we do.
• 9:28
  - And then come back to, one important,
• 9:31
  - principle that we've set out for our physician
• 9:33
  - group. We wanna be easy for our patients
• 9:35
  - to find our exceptional care and easier every
• 9:38
  - day for our physicians and our advanced practice
• 9:41
  - providers to deliver that exceptional care. So if
• 9:44
  - we can stay rooted and grounded in that,
• 9:47
  - vision focus, that that North Star that we're
• 9:49
  - driving toward,
• 9:51
  - that's the linchpin that we want that connects
• 9:53
  - us together to to get to the right
• 9:55
  - place that that we hope to be.
• 9:57
  - Mhmm. As you said that problems that feel
• 10:00
  - local but have system wide implications, it's a
• 10:02
  - a rich category. I'm sure our listeners are
• 10:04
  - having a a dozen examples,
• 10:06
  - flood to mind right now. But doctor Eze,
• 10:09
  - specific to your experience at OhioHealth as a
• 10:12
  - large geographically dispersed multispecialty
• 10:15
  - group, what what's been the hardest part of
• 10:19
  - leading, rolling out, and managing all that change
• 10:22
  - management, all the process there?
• 10:25
  - Where to start, really? So,
• 10:28
  - with over 2,000 physicians and and advanced practice
• 10:31
  - providers, as you mentioned,
• 10:33
  - we span thousands of square miles,
• 10:35
  - with distance apart between practices over hundreds of
• 10:38
  - miles.
• 10:39
  - And, you know, one of the first challenges
• 10:41
  - is is communication.
• 10:43
  - How do you get out and communicate
• 10:46
  - the why behind the change and the need
• 10:47
  - for the change
• 10:48
  - with all the providers at the level that
• 10:50
  - you need to for the understanding
• 10:52
  - that we want them to have,
• 10:55
  - where it's not that they're doing something wrong.
• 10:57
  - It's that we've done something wrong as a
• 10:59
  - system and how we've orchestrated and put together
• 11:02
  - this,
• 11:04
  - the the system and the processes around them
• 11:07
  - that make it more difficult for their patients
• 11:09
  - to get to us. So it's not a
• 11:12
  - you problem, it's an Us problem, and it's
• 11:14
  - really a we problem first
• 11:16
  - that, system design and the foundational system that
• 11:20
  - we built our outpatient
• 11:22
  - engine upon
• 11:23
  - needs to be reformulated.
• 11:25
  - They experience it every day. They try to
• 11:27
  - refer patients to their partners in in other
• 11:30
  - specialties,
• 11:31
  - and they experience those challenges.
• 11:33
  - So trying to get to those real world
• 11:35
  - examples to know that this is a problem
• 11:37
  - we're all in together and we need to
• 11:38
  - work on together,
• 11:40
  - and communication is the the first big challenge.
• 11:42
  - The second, then building upon that, is trust.
• 11:46
  - So
• 11:47
  - we when we're working on access specifically,
• 11:51
  - we want our physicians to see that access
• 11:53
  - redesign
• 11:54
  - isn't about getting more patients just
• 11:57
  - in through the door, and it's not about
• 11:59
  - volume. It's about reducing friction,
• 12:02
  - stabilizing their days, making their days easier, and
• 12:04
  - getting the right patient to the right clinician
• 12:07
  - in the right time and also in the
• 12:09
  - right place.
• 12:10
  - So, again, we're committed to making it easier
• 12:13
  - for our physicians and advanced practice providers to
• 12:15
  - make it through their day while improving access
• 12:18
  - at the same time, and then it's two
• 12:19
  - way accountability.
• 12:21
  - If we're improving the system to support access,
• 12:25
  - we also have to be we we also,
• 12:27
  - at the same time, have to improve their
• 12:28
  - ability to make it through their day, and
• 12:30
  - they have to hold us,
• 12:31
  - accountable to that, as well. And then lastly,
• 12:34
  - I'd say it's just the discipline to stay
• 12:36
  - focused.
• 12:37
  - Change management working through large organizations
• 12:40
  - takes a long time.
• 12:42
  - So as leaders, we have to have patience
• 12:44
  - with
• 12:45
  - the, timing around the change, with working through
• 12:48
  - the communication,
• 12:50
  - the buy in, that the results come as
• 12:52
  - further outcomes, but setting up
• 12:54
  - situations,
• 12:56
  - upfront
• 12:57
  - to allow for stakeholder input, to set up
• 12:59
  - governance over change, to ensure that people are
• 13:02
  - at the table who need to be so
• 13:04
  - that we're not going down,
• 13:06
  - the wrong path. Those have been key learnings
• 13:09
  - that, we've we've done through our access journey
• 13:11
  - and we'll continue to do moving forward.
• 13:14
  - You know, and then just to add on,
• 13:16
  - when we think about those elements,
• 13:18
  - we can also think about them. How do
• 13:20
  - we how do they,
• 13:21
  - manifest themselves in terms of measures of success?
• 13:24
  - How do we know if that position enterprise
• 13:26
  - transformation is working
• 13:28
  - with the softer measures, with things that aren't
• 13:30
  - a, a direct ROI or, a revenue or
• 13:33
  - cost measurement? And I think, you know, we
• 13:36
  - we see that
• 13:37
  - the transformation is working
• 13:39
  - when we see a a shift in the
• 13:41
  - culture and accountability.
• 13:43
  - When the work all of a sudden is
• 13:44
  - happening, not just inside the defined work streams,
• 13:47
  - but you see it start to happening
• 13:49
  - organically in other areas and people are taking
• 13:51
  - initiative. And you see that people are
• 13:56
  - bringing forward and and taking the initiative and
• 13:58
  - ownership to make changes, and improvements. They're being
• 14:01
  - self starters and, you know, really embracing that
• 14:04
  - mindset and culture of of improvement. And it
• 14:07
  - tells you that they're engaged in the work,
• 14:09
  - and it tells you that the trust is
• 14:11
  - there, that they believe that they can
• 14:13
  - take those steps and the organization
• 14:16
  - will embrace that. And even if they're not
• 14:18
  - quite the right,
• 14:19
  - step, even if it doesn't work, it's gonna
• 14:21
  - be a safe space for them because the
• 14:23
  - organization has built that trust and engagement.
• 14:27
  - So communication,
• 14:28
  - trust, accountability, and then last but not least,
• 14:31
  - discipline, staying focused one item, one goal at
• 14:34
  - a time. I'm I'm gonna go back, Frank,
• 14:36
  - to the the list you had shared of
• 14:38
  - symptoms or signs that a physician enterprises
• 14:40
  - is dysfunctional or underperforming.
• 14:43
  - Question for both of you. Once you have
• 14:45
  - some symptoms
• 14:46
  - that are known, that have been voiced,
• 14:49
  - next question is how do you decide what
• 14:50
  - to tackle first?
• 14:52
  - How do you actually organize and sequence a
• 14:54
  - transformation
• 14:55
  - so the organization
• 14:56
  - can actually absorb it? And then if if
• 14:59
  - there's metrics or indicators
• 15:01
  - that you have found in your experience
• 15:04
  - are really useful in telling you what's working
• 15:06
  - and what's not, I think those are worth
• 15:07
  - mentioning too.
• 15:09
  - So I can I can jump in on
• 15:10
  - that, and this is not my quote? I'm
• 15:12
  - sure lots of folks have heard this, but,
• 15:14
  - you know, first, you need to slow down
• 15:16
  - to speed up.
• 15:17
  - You have to start with building the foundation,
• 15:20
  - the case for change,
• 15:21
  - strong governance and physician engagement with doctor which
• 15:24
  - doctor Eze just talked about, leveraging data, baseline
• 15:28
  - understanding of performance. You gotta take the time
• 15:30
  - to build that foundation because when the earthquakes
• 15:32
  - happen, and trust me, they most certainly will
• 15:36
  - happen. You need that foundation,
• 15:38
  - and you need the group,
• 15:40
  - that built that foundation,
• 15:42
  - to be rock solid and and unwavering. When,
• 15:45
  - you know, when the powerful
• 15:47
  - physician who drives a lot of money to
• 15:49
  - the organization
• 15:50
  - doesn't like something we're doing, even though it's
• 15:53
  - the right thing to do for the patient
• 15:54
  - and the organization, and they go and they
• 15:57
  - voice that concern about it. We all need
• 15:59
  - to be standing together and say, no, you
• 16:00
  - know, this isn't about personal
• 16:03
  - personal preferences and agenda. This is about doing
• 16:05
  - the right thing for the patient. So you've
• 16:07
  - gotta start with that foundation.
• 16:09
  - You know, then the prioritization
• 16:11
  - process, you know, it's it's often political before
• 16:14
  - it's analytical. Right? So the you gotta think
• 16:16
  - about those improvement areas that require system cooperation
• 16:19
  - versus those that the medical group can control
• 16:22
  - unilaterally,
• 16:23
  - because there's there's different friction there's different types
• 16:26
  - of friction in each one of those. Right?
• 16:27
  - What you can actually drive in and accomplish,
• 16:30
  - quickly,
• 16:31
  - and we've seen that as we go after,
• 16:33
  - for example, some, some market changes in a
• 16:36
  - particular area where you've gotta have a regional
• 16:38
  - market president and an and an executive team
• 16:41
  - on board with making a change in a
• 16:42
  - community that may be unpopular in the community,
• 16:45
  - but it's the right thing to do for
• 16:46
  - the physician enterprise in the system, that can
• 16:49
  - be really difficult politically. So you've got to
• 16:51
  - decide the
• 16:52
  - first,
• 16:53
  - which which bucket do you wanna go after.
• 16:55
  - And then even harder discipline and, you know,
• 16:58
  - is is in the prior the prioritization
• 17:01
  - is actually,
• 17:02
  - you know, how do you hold the line
• 17:04
  - on not starting other initiatives?
• 17:07
  - That may be nice to do, but they're
• 17:08
  - non critical. Right? You gotta make how do
• 17:10
  - you maintain that focus so you have the
• 17:11
  - bandwidth and the sequencing
• 17:14
  - to to help the organization
• 17:15
  - and your teams through the change?
• 17:18
  - So I'll
• 17:19
  - kick it over to doctor Ezzy, and and
• 17:20
  - we'll see where else we, you know, probably
• 17:23
  - hear some more ideas on this question too
• 17:25
  - as we go through it.
• 17:26
  - So helpful, Frank. And and, doctor Razzy, if
• 17:28
  - I can, I I'd like I'd like to
• 17:29
  - sharpen this in another way for you too,
• 17:31
  - but I think hearing from Frank that you
• 17:33
  - need to slow down and speed up,
• 17:35
  - I imagine somewhere in the organization that slowness
• 17:39
  - can start to lead people to get a
• 17:41
  - little distracted or they wanna move on to
• 17:43
  - the next goal, the next win?
• 17:45
  - How do you actually keep a large organization
• 17:48
  - focused on the right priorities over a more
• 17:51
  - extended period of time?
• 17:53
  - Yeah. Really
• 17:54
  - tough challenging problem in, I think, probably every
• 17:57
  - health care organization.
• 17:58
  - And one that we as leaders have to
• 18:01
  - be really sharp on because
• 18:03
  - the change of the month, the flavor of
• 18:05
  - the month is, is the death of the
• 18:07
  - priority.
• 18:09
  - So, you know, we look at things as
• 18:11
  - three to five year goals.
• 18:13
  - We can't solve these things in six months
• 18:16
  - or a year. So if we're gonna do
• 18:18
  - this as a three to five year transformation,
• 18:21
  - then how do we use our operating system
• 18:24
  - to support that three to five year transformation
• 18:26
  - knowing that we set up the appropriate metrics
• 18:29
  - of success for the organization.
• 18:31
  - We make those metrics visible. We provide transparency
• 18:34
  - to the organization on where we're at with
• 18:37
  - each step along the way in the process,
• 18:39
  - and and this is multiple groups of stakeholders.
• 18:42
  - So in a as a leader in a
• 18:44
  - physician group,
• 18:46
  - my primary
• 18:47
  - stakeholder group are the patients that are coming
• 18:49
  - into our office. My secondary stakeholder group are
• 18:52
  - the physicians and advanced practice providers
• 18:55
  - taking care of, of our patients.
• 18:58
  - Third is our staff.
• 18:59
  - Fourth, though, is also every care site leader
• 19:02
  - who's reliant on me as a a practice
• 19:05
  - group leader to provide the support for those
• 19:07
  - hospitals and acute care sites that they need
• 19:09
  - as well. So
• 19:11
  - maintaining connection which with each of those stakeholder
• 19:14
  - groups in one way, shape, or form
• 19:16
  - through
• 19:18
  - visibility and transparency
• 19:19
  - of where we're at in our transformation journey,
• 19:21
  - the results that we've experienced now, the ones
• 19:24
  - that are coming up next, the barriers that
• 19:26
  - we're encountering,
• 19:28
  - the help needed,
• 19:30
  - the communication that we need them to,
• 19:33
  - address,
• 19:34
  - because they'll be in in in contact with
• 19:36
  - any of those stakeholders
• 19:38
  - oftentimes more often than we are. So
• 19:41
  - trying to get everybody
• 19:43
  - around that change and know that if we
• 19:46
  - stay consistent on it and put it on
• 19:47
  - our operational system as a three year project
• 19:51
  - and not a three month project,
• 19:52
  - we'll have transformational success.
• 19:55
  - Right? No transformation can really happen in in
• 19:58
  - three months at this scale. So setting those
• 20:01
  - appropriate expectations and then putting them in the
• 20:03
  - system for follow-up.
• 20:05
  - Mhmm. Makes sense. Those three to five year
• 20:07
  - goals and helping them see the it's a
• 20:09
  - it's you're you're playing the long game here
• 20:11
  - in in many ways.
• 20:13
  - To to close us out, we we've touched
• 20:15
  - on so much about transformation for physician enterprises,
• 20:18
  - the the the relationship management that goes into
• 20:20
  - it, prioritization and sequencing,
• 20:23
  - transparency,
• 20:24
  - trust building, communication.
• 20:26
  - Is Is there anything we haven't covered that
• 20:27
  - you think deserves more attention in this conversation
• 20:30
  - or you wanna make sure you leave our
• 20:31
  - listeners with?
• 20:33
  - Yeah. The the one for me is I
• 20:34
  - I really wanna stress that an employed physician
• 20:37
  - group
• 20:38
  - is by far the most important and greatest
• 20:40
  - asset for a health system.
• 20:42
  - And like everything else in health care, there's
• 20:44
  - continuous improvement opportunities
• 20:46
  - all around.
• 20:48
  - So we can't be afraid of the change
• 20:50
  - because
• 20:51
  - change with, with physicians and with a physician
• 20:54
  - group is challenging.
• 20:56
  - But build a stakeholder group that supports
• 20:59
  - that change, and then we have to accept
• 21:03
  - some small amount of disruption,
• 21:05
  - but rely on that stakeholder group to limit
• 21:08
  - any or show any signs of eruption that
• 21:11
  - may may be happening out there. Right? So
• 21:14
  - this is, you know, the this is hard
• 21:15
  - work that we have to do collectively, and
• 21:17
  - and a little disruption's okay. We don't want
• 21:20
  - any eruptions in any of our practices. We
• 21:22
  - we we wanna manage the change as well
• 21:24
  - as we can. That takes the whole organization,
• 21:27
  - not just the physician group being on that
• 21:29
  - same page.
• 21:31
  - And
• 21:31
  - the work's not easy, but our patients deserve
• 21:33
  - it. Right? Access is fundamental
• 21:36
  - to our mission.
• 21:37
  - If you don't have access, you don't you're
• 21:39
  - you're not providing value to your communities, and
• 21:41
  - we believe
• 21:42
  - that the care we deliver
• 21:44
  - is exceptional. And we want we wanna support
• 21:46
  - our communities that way, and so that's why
• 21:48
  - we're committed to the work.
• 21:50
  - Right. And add on to that as well,
• 21:52
  - you know, for for me, I think it's
• 21:54
  - important to come back and emphasize
• 21:56
  - that, you know, an initiative of this scale,
• 22:00
  - at the outset really, really has to start
• 22:02
  - with good governance design
• 22:04
  - that engages those key stakeholders that doctor Izzi
• 22:07
  - talked about from across the medical group. And
• 22:10
  - not just those informal leadership roles and administrative
• 22:13
  - positions, but, you know, also those thought leaders,
• 22:16
  - your frontline positions and APPs who can bring
• 22:18
  - critical perspectives and understanding into the conversation and
• 22:21
  - and the design set.
• 22:23
  - And then, you know, the other thing that
• 22:25
  - I'd I'd like to kinda share too is,
• 22:27
  - if you're gonna sustain the transformation, you've gotta
• 22:30
  - be thinking about
• 22:31
  - that the the long term resourcing
• 22:34
  - and
• 22:35
  - maintaining
• 22:36
  - what you've built. Right? So if you build
• 22:38
  - good governance, if you start with building the
• 22:40
  - foundation,
• 22:42
  - that's that's a great starting point. However,
• 22:45
  - don't get trapped in focusing on an initial
• 22:49
  - deliverable,
• 22:50
  - or focused on producing a report, or don't
• 22:53
  - get don't fall into the the dashboard trap
• 22:56
  - of, oh, we've got this great set of
• 22:58
  - metrics,
• 22:59
  - but they're not really tied to
• 23:01
  - sustainability or to truly what needs to change
• 23:03
  - on the ground. So be careful if if
• 23:05
  - you're gonna launch something like this. Be careful
• 23:08
  - about sort of, you know, thinking about what
• 23:10
  - the real end goal is, and then about
• 23:13
  - how you
• 23:14
  - resource that over time. It it can't just
• 23:16
  - be a single big PMO effort. You stand
• 23:19
  - up,
• 23:20
  - bunch of people come in and run it.
• 23:21
  - How are you going to
• 23:23
  - embed,
• 23:24
  - and and really inculcate that approach
• 23:27
  - into your medical group and into your,
• 23:30
  - your health care system,
• 23:31
  - so the change can persist over time. Because
• 23:34
  - it it is a long process.
• 23:36
  - It takes
• 23:37
  - persistence
• 23:38
  - and commitment to get through that and to
• 23:40
  - see the results on the other end. But
• 23:42
  - you you will see the results,
• 23:44
  - if you go through it in the right
• 23:46
  - way.
• 23:47
  - Excellent. I you both hit on something really
• 23:48
  - important there. The question is about what we
• 23:50
  - haven't covered, and I think, Frank, to your
• 23:52
  - point, so often change management, we there's not
• 23:54
  - enough time spent and expertise devoted to making
• 23:57
  - change last. And then, doctor Eze, I just
• 24:00
  - love the quote. This work is not easy,
• 24:02
  - but our patients deserve it. I mean,
• 24:04
  - pretty powerful way to to view change.
• 24:07
  - I wanna thank each of you, doctor Eze
• 24:09
  - and Frank, for your time and insights today.
• 24:11
  - We at Becker's also wanna thank our podcast
• 24:14
  - sponsor,
• 24:15
  - ECG management consultants.
• 24:17
  - You can tune in to more podcasts from
• 24:19
  - Becker's Healthcare by visiting our podcast page at
• 24:22
  - beckershospitalreview.com.