Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Walking the Walk of a True Democratic Partnership

8/1/2016 2:47:36 PM | 1 comments

I always say that the best medical director is the one most willing to listen, has the most open mind, and empowers other people to be solution providers.
Never have I believed that more strongly than after the first few weeks of working with our newest partner, St. Mary’s General Hospital in Passaic, N.J.
Learning that the contract for the hospital’s previous ED management group would not be renewed had been unsettling for the hospital’s existing ED providers. They were dedicated to St. Mary’s; they had friends on the medical staff and felt connected to the community.
So there was understandably a lot of angst and fear around who, exactly, was going to come in next.
Luckily for CEP, St. Mary’s chose us. And while we’re not all the way there yet, we’ve managed in just a few short weeks to alleviate much of that fear.
How? By acting as a true democratic partner.
Democracy in Action
The challenges that most EDs face are remarkably similar. Regardless of whether you're in New Jersey or in Arizona, or whether you're a 50,000-visits-a-year site or a 110,000-visits-a-year site, the challenges and the issues are very similar. And they largely revolve around communication, teamwork, and culture.
All groups, however, are not the same. In particular, not all groups that claim to be democratic actually take a democratic approach. But for providers who spend years investing their careers in a hospital, it can be a case of "better the devil you know."
At CEP, we are all about transparency and autonomy, about local self-governance backed by unwavering central support. These are the principles — the pillars, really — of a great partnership.
But anybody can claim to be democratic. And with St. Mary’s, it was clear that right out of the gate we needed to do more than just tell our story.
To be sure, we've been reaching out to everybody and anybody related to the hospital in order to help them understand who we are, what we do, and what our model is. But even more than that, we’ve been visible and present.
Starting at 12:01 a.m. on Day One, the new medical director was in the emergency department handing out pens and buying pizza for people. And that on-the-floor interaction will never cease.
Indeed, it’s going to continue to require frequent touches by both senior leadership and the operations team to make sure that things are going well. 
Walking the Walk
One of the first issues we identified when we came on at St. Mary’s was around scheduling. Some of the doctors were reluctant to take night shifts, which meant a disproportionate number of nights were being shared by a smaller subset of them.
So when we started talking to them about nights and fairness, their first question was, “Well, what are you guys going to do to solve this problem?” 
Our immediate response to that was, “I don't know. You tell us. What do you guys want to do to solve this problem?”
We initially were met with no response, just a lot of blank stares. And so we said to them, “Look, this is your practice. We can tell you what other sites have done, but ultimately this is your baby. You guys get to decide how you want to do this. Decide how you want to define fairness in your group.”
It really resonated with them. And they saw that we actually walk the walk. Because we do; we’re living it. We are there to give them the tools and the resources they need to in order to make these decisions for their group themselves.
Hunger for Another Option
We’ve entered the New Jersey market at a critical juncture.
A vacuum was created when a previous democratic group was sold, which meant there was a deep hunger for another democratic option just as we were planting our flag, so to speak.
Whereas we often hear stories of how challenging it can be for new groups to bring providers on board, we experienced the exact opposite situation. We immediately had a ton of interest from physician and PA/NP providers in the region. We are therefore optimistic that we will be able to fully staff the St. Mary's ED within a few months.
Miles to Go
But it took us a while to explain to the St. Mary's ED team who we are. I think there was a fair degree of cynicism when we came in saying, “We're a democratic group too.”
But by reaching out, by giving them references, by showing them our model and telling them stories about CEP America’s culture and principles, we’ve seen their perspective change.
By no means are we there yet. We still have a lot of work to do in terms of educating them on what our expectations are of each other as a Partnership.
But we’ve already started seeing a glimmer of that sense of pride, of ownership, as it comes into formation. It’s like an ember that we will just keep fanning. It’s incredibly gratifying.
Moreover, we believe that this growing sense of ownership is going to result in a pretty dramatic culture shift at the site. And that sooner rather than later, it will become the premier ED in the area, yielding a dramatic increase in volume, and in turn, revenue for St. Mary’s.
Of course, the people who will benefit most are those in the region who need emergency care.
So by taking a truly democratic approach, this new partnership with St. Mary’s promises to be a win-win for everyone. And that’s just really exciting.

Anne Bruce
Really enjoyed this article on a true democratic partnership in healthcare. I especially liked the quote you write about—"Decide how you want to define fairness in your group"—wow, a great team concept Dr. Lin.
8/14/2016 12:48:32 AM