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HL20: David Fox—Improving Care Through Accountability

Carrie Vaughan, for HealthLeaders Media, December 13, 2011

Good Samaritan has a medical staff of about 950 physicians and —other than specialty areas like the ED and anesthesia, all are on staff at other hospitals. "While some people looked at that as a challenge, we looked at it as an opportunity," he says. The thinking was, by becoming the best place for physicians to work, maybe they would choose to move some of their patients to Good Samaritan, Fox explains.

"It may sound like a cliché but we really embraced the win-win approach where we would become a better hospital and become more successful but do that hand-in-hand with physicians as they became more successful," Fox says.

He does concede that he has an advantage over many hospitals in the nation because his parent company's PHO, Advocate Physician Partners, is an innovator on pay-for-performance clinical integration. "We are in our eighth year of the P4P clinical integration program at Good Samaritan, and our physicians actually receive additional compensation for achieving quality, efficiency, and service outcomes," Fox says.

Becoming accountable

One of the first things that Good Samaritan did to achieve its vision was create much higher levels of alignment and accountability for performance with objective and measurable goals. Good Samaritan took the organization's goals, which it has in six key areas, and cascaded those goals down to directors and frontline managers, says Fox.

It then developed report cards for each of its managers—a typical manager would have eight to 13 goals, which would cover most of the organization's six focus areas. Good Samaritan also made the goal system transparent and put it on the hospital's Intranet. "Everyone in management could actually see performance plans for each of us, and we could also see the monthly report card result for each of us," says Fox, who distributes his performance to about 300 people each month.

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