Back to the Basics: Hospital and Physician Strategies to Drive Market Share

In today’s healthcare marketplace, physicians are more time-challenged than ever, especially within the cardiovascular specialty. Patients are older, many have complex conditions and the shortage of heart and vascular doctors is affecting care delivery overall. Fewer physicians are expected to treat larger numbers of patients, while traveling to multiple hospital sites in some cases. Indeed, clinical pressures, private-practice duties and personal responsibilities make requesting additional time commitments from physicians extremely difficult. Nevertheless, engaging physicians to perform clinical duties, along with program development activities, is becoming increasingly important for hospital organizations. In fact, motivating physicians to become involved beyond the clinical scope can be invaluable to increasing procedure volumes and establishing a broader patient base through relationship-building, outreach and other means. So how can a hospital inspire physicians to focus on program growth while delivering efficient, effective, quality patient care? Corazon has worked with clients throughout the country to engage physicians and align their goals with those of the hospital. Using a collaborative approach to increase market share, both the hospital and physicians can benefit. But physicians’ practice goals must be parallel to the hospital’s goals. If a hospital wants to increase market share in a particular outreach area, it must have doctors who are willing to establish a presence there. The cardiac catheterization laboratory (CCL) is an area that can be significantly affected by physician involvement…or the lack of. CCL growth should be addressed as an integral part of the service line strategic plan. Physician involvement in deliberating and endorsing the strategic plan can be an important first step to assure that all are working toward common goals. These goals must then be turned into actionable strategies. Corazon believes the following tactics — some conventional, some creative — all have potential to result in volume growth in the CCL, while assuring that excellent patient care remains priority #1. A Focus on Operational Efficiency Assuming that the CCL operates efficiently is a serious mistake. Corazon advises our clients to take a serious look at operations through a lens that focuses on hospital efficiency and how operations affect the efficiency of the physician. Basic improvements, such as on-time case starts, the appropriate number and mix of staff, and a solid plan for emergencies, should not be overlooked as front-line managers and staff are involved with completing the day-to-day work. Also, making operational changes without considering the impact of the change on physicians can hinder instead of help. In fact, meeting the basic needs of the physician can be the root of a strong and growing relationship with this important customer. Efforts to meet one-on-one with physicians practicing in the CCL should be undertaken to query for their perspective about the lab’s efficiency. Likewise, input from managers and staff across the patient care continuum should be sought to identify opportunities for improvement. In Corazon’s experience, these areas are most commonly discussed: • Cath Lab Corazon has seen several efficiencies consistently work to streamline the CCL. For instance, block or modified-block times must be managed. Schedule management must be continually scrutinized to minimize lab downtime, minimize overtime and ensure efficiency for all. The pre-admission testing processed (including H&P) through the utilization of post-procedure recovery beds must be seamless. Shift start times for staff should be staggered during the day to allow for lunch breaks without affecting cases, and allow for extended late-day lab times to meet physician and patient needs. It is essential to establish a CCL operations committee to analyze the lab’s efficiency, perform root-cause analyses for any case delays, scrutinize overtime and regularly review lab hours. This effort can assure efficient care delivery and can be a forum where all stakeholders’ perspectives are represented. • Nursing Units Corazon advises that standardized care in a cardiac and vascular-specific unit allows the patient to receive the best possible outcomes, while helping with physician satisfaction overall. An education and skill-set gap analysis should be completed to ensure common experience levels among the staff. Likewise, frequent dialogue with physicians about their satisfaction with nursing response to care issues, clarification of treatment plans and establishment of protocols can result in a more capable, high-functioning team. • Equipment and Supplies With increasing capital and inventory costs, hospitals must control expenses whenever possible and make smart choices for costly equipment and supplies. Corazon advises the creation of a cardiac and vascular-specific technology committee where physicians discuss new technologies and options. Members of the committee then review the information and decide if the benefits outweigh the costs. Corazon believes that all equipment purchases should also be tied to an overall facility Information Technology Plan that uses physician input for budget and timeline development. Once a hospital has directed focus to ensuring efficiency, other areas to help increase volumes should be explored. Consider the following: Referral Groups Employees are among the easiest sources of referrals to tap into, and most likely the most commonly overlooked. Employees can be a hospital’s biggest marketer, as each employee has to address not only his or her own healthcare needs, but the needs of friends, families and neighbors in the community. Many hospitals produce newsletters — both internally for the staff and externally for the community — which are excellent tools to highlight a facility expansion, clinical excellence or high-profile physicians. Also, the influence of the volunteers can be significant, as they are often a powerful voice and extension of the hospital in the community. In Corazon’s experience, hosting an open house in the CCL for employees and volunteers, or a “lunch and learn” for nurses to demonstrate what occurs in the CCL, are great ways to showcase the service and the quality offered. Education and Outreach Primary care physicians (PCPs) are often the first line of communication with cath lab patients. Currently, with so many different physician specialties treating all types of heart and vascular conditions, it has become increasingly common to find that physician specialists are not interacting with one another in the care of their patients. This can be especially true as PCPs turn over inpatient care to hospitalists. Often, cardiovascular disease prevention and rehabilitation information just isn’t being shared among the cardiovascular specialists, the PCP and the patient, which in some cases may inhibit the continuum of care and negatively impact outcomes. For example, understanding how the ankle-brachial index is used to evaluate a patient’s leg circulation can be helpful in treating the patient in the most efficient and effective manner. One of the most effective ways to rectify this scenario is hospital-based physician education for PCPs related to cardiovascular disease through: • Office visits: involves a hospital representative (service line director, physician liaison and/or consultant) arriving on-site at each PCP office with information related to cardiovascular physicians, their specialties and the conditions they treat. • CME event: involves physician education and discussion about various patient care issues. Such events also help ensure that physicians are able to receive the education credits necessary, while building relationships with their colleagues. Building Relationships – Hospital and Physicians The importance of relationship-building for cardiovascular program success cannot be ignored. There are many ways that hospitals and physicians can collaborate to build trust with each other as well as with the community. Some of the areas of focus should be: • Collaboration between physicians and senior management of the hospital, including involvement in the decision-making process. Also, the importance of a service line structure cannot be underestimated, because well-defined administrative and physician leadership roles within the CCL can drive accountability. • Communication in all cases, from strategic planning initiatives to dialogue about day-to-day operational issues. Corazon knows of one hospital in the Midwest that is in danger of losing several cardiologists to a competing hospital because they feel as though they weren’t heard. Hospitals must always focus on ways to engage their physicians in order to achieve common goals, setting aside personal issues to meet objectives. • Deliver what is promised. Enough said! Building Relationships – Hospital and Practice Equally important is building regular communication forums and mechanisms with key physician practice stakeholders. • Get to know the Practice Managers: These individuals work very closely with the physicians and are sure to know their needs and expectations. They can also be helpful in communicating key messages, influencing daily physician scheduling and vacations, and communicating service issues they or their office patients experience at the hospital. Controlling or influencing these factors can be important to managing the peaks and valleys in CCL scheduling, which have a huge impact on hospital productivity, efficiency and costs. • Get to know the Physician Assistants and Nurse Practitioners: These physician extenders play a significant role in managing the physician’s workload and can be a link to the community. Whether employed by the practice or the hospital, they can be the interface for families, as they are faced with discharge instructions post procedure and/or have questions about the course of care. Often, hospitals and/or physicians recognize the need for assistance in identifying ways to increase volume, especially during times of decreasing profit margins and staffing shortages. Corazon can offer outside expertise, and help resolve issues in a timelier manner using an unbiased perspective and a wealth of experience gained from working with many organizations in many different situations. Corazon believes that efforts to increase volumes should always be top-of-mind — program growth is a never-ending pursuit to sustain a viable, high-quality cardiac program. It is imperative to be sensitive to physician time constraints, and this requires regular and consistent communication efforts to ensure their commitment to program growth. Kathy Rankin is a consultant with Corazon, a national leader in heart and vascular program consulting, recruitment and management resources. To reach Kathy, call 412-364-8200 or e-mail krankin@corazoninc.com.

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