1. Learning Objectives Consider a common attribute of organizations that achieve their Vision and Strategy Discuss the development and use of a Physician Compact to support the Mission, Vision and Values of an organization Present a Case Study of the Austin Heart Physician Compact Page 1

2. 9 The Key Attribute of Positive Cultures Page 2

3. 9 Health Systems have achieved physical aggregation of previously disparate health care parts Alignment of the parts around vision, culture, and operations is lagging the physical aggregation Physicians are serving in multiple roles with unclear and unrealistic expectations The challenge is taking the aggregated parts and creating one integrated and aligned organization The Challenge Page 2

4. 9 The Barriers Physicians are being asked to change and shift from an “individual sports” to a “team sport” Organizations and physicians tend to maintain the status quo unless there is a “compelling vision” or a “burning platform” The belief that aggregation is the destination – rather than alignment Page 3

5. Poor Results Poor Results Turf issues Unclear Expectations Entitlement Autonomy Misaligned incentives Culture Issues Leadership Accountability Understand of goals Measurement of goals Weak employment agreements Lack of empowerment Many In Few Out Governance Issues The Result is Poor Performance The “JAWS” of Organizational Ineffectiveness Initiatives Vision Strategic goals Quality Initiatives Operational effectiveness Initiatives Vision Strategic goals Quality Initiatives Operational effectiveness Page 4

6. 9 Its All About Expectations In a basic form, all conflict is about the failure to meet expectations Expectations should be agreed to by the interested parties and then defined clearly in writing Conflict results when expectations are not defined, and therefore are never met Page 6

7. 9 The Key to Developing a Positive Culture Define the Expectations Culture is basically a set permissible behaviors Organizations will develop a culture with or without intentional direction Expectations must be lived out by leaders – formal and informal Effective cultures "beat strategy " every time Page 7

8. 9 Once expectations are defined, its all about ongoing communication Faulty communication is a major cause of conflict and failure to fulfill the organization Vision and Strategy Successful communication is the primary tool needed to resolve conflict and forge cultural alignment Clearly defined and communicated expectations are key contributors to successful organizations Page 5

9. 11 First Define the Expectations Most environments have stakeholders Stakeholders need to agree on a Mission, Vision and Values All stakeholders need to have defined behavioral expectations that align with and support the groups Vision Page 8

10. 19 Adults Behaving Badly-Lessons Learned What Gets Measured Gets Done Measurement tools are never perfect- do not let that stop you What you Incentivize you Achieve The “Stick” needs to be in place even if not used 20% of the people cause 80-90% of the problems Life's too short - pull the trigger fast Page 9

11. 10 Compact Formulation Bidirectional list of responsibilities that are measured The behavioral expectations align with and support the groups vision A “Charter or Compact” is an effective tool to define expectations Page 10

12. 9 Case Study: Austin Heart Page 2

13. 10 The Process Structure a series of meetings with key stakeholders Define the Vision, Mission and Values Describe those behaviors of stakeholders, that if followed, will allow the organization the best chance of achieving the vision Page 10

14. 14 AUSTIN HEART PHYSICIAN COMPACT Physician responsibilities Organization responsibilities Service Understand and meet patients’ needs Achieve and maintain optimal patient access Take ownership of each patient encounter to maximize patient continuity Maintain quality physicians and staff sufficient to provide excellent patient care Quality Achieve / maintain certification in cardiology & sub-specialty areas Practice evidence based medicine Provide timely and accurate documentation Develop, accept and adopt changes that add value to the consumer and improve the performance of the organization Provide physicians with data to show how they perform clinically against established standards Support research activities Equip the practice with the technology to promote leading edge therapies People Build positive relationships and teamwork that enhance the total patient care experience Acknowledge and appreciate each physician’s and staff member’s contribution Treat all with respect Address interpersonal issues real time and face-to-face in a collegial manner Provide appropriate input into decisions and then delegate authority to elected and appointed leaders Support organization and health system initiatives Encourage and recognize teamwork, collegiality and mutual respect Make decisions consistent with our Mission, Vision & strategic plan Empower and hold management accountable to execute practice objectives Share information regarding strategic intent, organizational priorities and business decisions Provide physicians with opportunities to have input & influence into practice decisions through dialogue and access to leadership Provides constructive performance feedback Finance Accept accountability for timely & effective execution of assigned responsibilities that support the vision and success of the whole organization Participate in outreach, referral relations and marketing activities Align compensation of physicians to individual and group performance Create a collectively efficient place to practice Provide reasonable compensation while maintaining long term financial stability Provide infrastructure to support and promote practice expansion Page 11

15. AUSTIN HEART PHYSICIAN COMPACT PHYSICIAN RESPONSIBILITIES: Service 1.Understand and meet patients’ needs 2.Achieve and maintain optimal patient access 3.Take ownership of each patient encounter to maximize patient continuity Quality 4.Achieve / maintain certification in cardiology & sub-specialty areas 5.Practice evidence based medicine 6.Provide timely and accurate documentation 7.Develop, accept and adopt changes that add value to the consumer and improve the performance of the organization Page 12

16. AUSTIN HEART PHYSICIAN COMPACT People 8. Build positive relationships and teamwork that enhance the total patient care experience 9. Acknowledge and appreciate each physician’s and staff member’s contribution 10. Treat all with respect 11. Address interpersonal issues real time and face-to-face in a collegial manner 12. Provide appropriate input into decisions and then delegate authority to elected and appointed leaders 13. Accept dual role of owner/employee. Demonstrate support for administrative actions Finance 14.Accept accountability for timely & effective execution of assigned responsibilities that support the vision and success of the whole organization Growth 15.Participate in outreach, referral relations and marketing activities Page 13

17. AUSTIN HEART PHYSICIAN COMPACT ORGANIZATION RESPONSIBILITIES: Service 1.Maintain quality physicians and staff sufficient to provide excellent patient care Quality 2.Provide physicians with data to show how they perform clinically against established standards 3.Support research activities 4.Equip the practice with the technology to promote leading edge therapies People 5.Support professional development and satisfaction 6.Encourage and recognize teamwork, collegiality and mutual respect 7.Make decisions consistent with our Mission, Vision & strategic plan Page 14

18. Austin Heart Physician Compact 8.Empower and hold management accountable to execute practice objectives 9.Share information regarding strategic intent, organizational priorities and business decisions 10.Provide physicians with opportunities to have input & influence into practice decisions through dialogue and access to leadership 11.Provides constructive performance feedback Finance 12.Align compensation of physicians to individual and group performance 13.Create a collectively efficient place to practice 14.Provide reasonable compensation while maintaining long term financial stability Growth 15.Provide infrastructure to support and promote practice expansion Organization Responsibility Page 15

19. 21 Conclusions – The Quality of an organization's communication is a attribute of an effective organization – Defining Expectations (shared understanding) is crucial to a groups success – Conflicts are minimized with effective communication and understanding Page 16