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Spring

2019

In this issue:

Presidents Message………………………….……...2

What is on My Nightstand………………………..3

Becoming Lean A Clinics Journey ….………….5

Member Toolkit……………………………………….6

Membership in the AASA………………………….8

AAMC Compensation Myth Busters…………10

Upcoming Webinars………………………….……12

Education Events…………………………………….13

CUTTING EDGE

Figure 1: Bess Wildman

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President’s Message

“If winter has the courage to turn into spring, who says I can’t do the same.”

Unknown

Greetings AASA Community.

For me, spring is an amazing time of the year. It is a refresh of the world around us. Even the somewhat dreaded budget process that most of us experience during this season is the opportunity to write a new chapter in our journey. Personally, I get excited planning for new faculty, designing new programs and having the opportunity to showcase my department to our system’s leadership.

However, as with the budget process, it is easy to focus on the obstacles or disruptors to the routine and forget about the upside. It is a

AASA Board of Directors

President

Rebecca Napier Past President

Megan Berlinger Vice-President

Lonn McDowell Secretary

Heidi Gibbs Treasurer

Dan Ott Chair of Membership Committee

Joellen Buckio Chair of Communications Committee

Bess Wildman Eastern Region Representative

Greg Kharabadze Southern Region Representative

Wendy Webster Midwest Region Representative

Tim Roach Western Region Representative

Jason Quinn Chair of Education Committee

Christal Moore

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challenge to plan for something that isn’t perfectly known. There is a risk of guessing incorrectly. It can be easy to get caught up in this. For me, that is why I rely on y’all—my AASA community—for both the joys as well as the tribulations.

You remind me how amazing the work we do really is. You provide a listening ear and encouragement when I need it. You let me know I am not alone in this change of season and remind me to appreciate the flowers that bloom! And I want to do that for you too.

I encourage you to share your triumphs with your AASA colleagues. We all want to hear about the great work your team is doing (big or small). We want to support you when you hit the bumps in the road as well.

Whether this is personally by email or a phone call, through presentations at the retreats or the annual conference, via a webinar, or by sharing an article for the newsletter*—I ask that you stay connected. This is what makes our organization special, exceptional: YOU…each of you.

We are a unique tribe and I am honored to be a member.

Rebecca Napier

*I would love for you to provide content for our newsletter, host a webinar, or lead a talk. Please email me at Rebecca.Napier@UTSouthwestern.edu if you want to learn how to do this. If you aren’t ready to take this on solo, no worries! We can find you a fantastic partner to work with. And yes—we want to hear from YOU!

What’s on my nightstand?

Katherine Stanley

Duke University

The answer to that question is a long one. I counted 16 books, 5 magazines, an (old-fashioned) digital clock, lamp, and, of course, the requisite old photos in the cracked acrylic. The books range in subject matter from parenting (2 teens!), faith, fiction, and well-intentioned self-help. From Blink to Run Shorter, Run Faster (how could one not read that one!), I would really have it all figured out if I could only find the time to read them all.

But my “nightstand” aside, the literature that I believe would be more meaningful for this audience is an article from the Harvard

Business Review. Why It’s So Hard to Be Fair by Joel Brockner is an article that resonated with me. The author defines and describes the concept of “process fairness” and how using this technique will lead to significantly better outcomes for organizations.

Why would an organization not use any technique that is basically guaranteed to produce positive results? Because it takes TIME! And if your organization is anything like mine, everything is a race to the finish. The path or process to reach the goal, seal

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the deal, or check the box does not get the same degree of attention as the end product.

My interpretation of “process fairness” after reading the author’s examples is, at its core, effective communication. Leaders who take the time to describe the “why” and other organizational rationale, which may not be obvious to all employees, will reap better results from their staff than those solely focused on crossing the finish line.

Figure 2: Photo by Azgan MjEshtri on Unsplash

The article describes and gives examples of three drivers that determine fair process: (1) how much input employees believe they have in the decision-making process; (2) how employees believe decisions are made in the organization; and (3) how managers behave. I believe the third driver can dramatically impact the first and second

drivers. Managers who actively practice an open door policy and who listen to employee’s opinions and suggestions, who are approachable, and who take the time to share information otherwise not readily apparent will be more successful in tackling challenging projects and achieving goals with their teams even during times of duress.

“Process fairness” is not equivalent to “outcome fairness.” This leadership concept involves being open to new ideas and listening to suggestions and feedback. However, the role of the leader is to make the ultimate decision and recognize that some may not like the decision, but if “process fairness” is appropriately employed, those employees will respect and understand the decision.

I encourage you to find the article and benefit from reading more examples of “process fairness” and learning how this strategy can lead to greater outcomes across an entity, with both large and small teams. Again, my takeaway is that thorough and effective communication takes time, but if structured and managed appropriately, can save money and time and generate greater results in the long-run.

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Becoming Lean: A Clinic’s Journey to Process Improvement

Heather Hubbs

Vanderbilt University Medical Center

In December of 2017, Vanderbilt University Medical Center’s Surgical Weight Loss Clinic held a Lean event. The goal of this event was simple; clinic leadership wanted to reduce waste in the clinic’s processes that led to poor patient satisfaction, experience, and volume. Over the course of three and a half days, team members ranging from patient service specialists to surgeons to administrators, and everyone in between, met to review the current state clinic flow. The result of this event was a Vanderbilt record breaking one hundred and six identified problems, or storm clouds, and sixty-eight process improvement specific solutions, or fluffy clouds.

Figure 3: Bess Wildman

Before storm clouds and fluffy clouds became routine terminology, the event, led by operational improvement engineers, began with an empathy mapping exercise. During this activity, team members were asked to relate to two people, a patient and a provider, and identify what they may be feeling, doing, saying, and thinking in their respective roles. After the stage was set to continually keep in mind the patient and clinic perspective alike, value stream

mapping occurred. During this process, sixteen different patient touch points were identified and corresponding issues, or hinderances for patients, were acknowledged. The issues were then grouped according to root cause and team members were divided into working groups to brainstorm solutions. Once this occurred, the group, in its entirety, met to discuss individual solutions and the new future state flow, assign solution owners, and establish a timeline. The event ended with a report out to the executive leadership team on progress and subsequent report outs were scheduled for thirty, sixty, ninety, and one hundred and twenty days post event for accountability.

Now, a little over a year out, the clinic can boast of increased volume, higher patient satisfaction scores, and improved patient access. More than twenty standard operating procedures were created in the process and a cultural shift occurred leading to higher team engagement and overall morale. More specifically, patient access improved by 94%, visit volume increased by 55%, and patient satisfaction rose by 9%. Additionally, market share increased by 46% and we are now the leader for bariatric surgery in Nashville.

Figure 4: Vanderbilt Lean Coordinator

As you can see, Lean events can occur in any space and are adaptable to meet the specific needs of your organization. As you embark

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upon this journey yourself, here are six lessons we learned along the way:

1. Involve representatives from every area

of the space for input from the

beginning. Front-line leaders are integral

and much needed subject-matter experts

2. To ensure engagement and participation,

plan ahead adequately to have a reduced

clinic volume during this time and allow

staff to rotate coverage responsibilities, if

necessary to attend

3. Enlist a project manager, or someone

performing in a similar function, to keep

track of all solution efforts, create

working groups as road blocks arise, and

hold the team accountable for deadlines

4. Visually track activities and progress. A

Lean event can be mentally taxing and

having visual aids will prove to be

immensely helpful in remembering

material

5. Enlist an outside moderator to conduct

the event. This person should help create

an open and safe atmosphere and level

set the room if tensions arise.

6. Provide snacks 😊

Member Toolkit Megan Berlinger

Wake Forest Baptist Medical Center

One of the many benefits to being an AASA member is information sharing. Our member toolkit is an online resource available to members only. To access the member toolkit login to the AASA website (www.aasa1.org). Under Resources, select Member Toolkit. If you are already logged in you can access directly at: https://www.aasa1.org/page/MemberToolkit#. Within the toolkit members have access to best practices and example documents that can save time, share ideas, and inspire. Also within the Member Toolkit you can find AASA resources such as past meeting presentations, past webinars, and Cutting Edge newsletters.

As an update we are refreshing the toolkit this year to improve ease in finding tools that are applicable to your practice. You will see new categories during March as well as a search functionality. We need your help in the last piece of the refresh... the content. Check out this month's new content and send documents to Megan.Berlinger@wakehealth.edu. Thank you in advance for contributing to our

mission by sharing documents for the AASA Member Toolkit.

Figure 5: © Creative Commons Zero (CC0)

New Documents within the AASA Member Toolkit:

• Yale Medicine year in Review: Example annual report

• Yale Virtual Work Space: Example Project Roll Out PowerPoint

• Example Resumes: Fred Borrelli, Jamie Meyer, Rebecca Napier

• Responsibilities of Department Chairs in the School of Medicine

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• Coat of Arms: Team Building Idea (Power Point Document)

• MUSC: Example Strategic Manpower Proforma

Figure 6: 2013 AASA Meeting

Do you have a document that could serve as an idea generator or serve as a best practice?

What recent models, curriculum, or other projects have you completed that you can share? Some areas to consider

• Coding E&M model • Revenue cycle reporting / dashboards • Model to determine whether to hire

another APP • Example Access Dashboard • Example Monthly Reporting Dashboard • Annual Faculty Review Form and

Supporting Data • Resident Professional Development or

other topic Curriculum • Department Newsletter • Employee / MD Engagement Plan • Mentoring Program

Within the area of professional development for our own careers do you have documents you can share to help others grow? Some areas to consider

• Your own resume as an example resume • Project Templates • Time Management Templates or tools • Goal documents • Personal Assessments

Bryan Carrigan UCLA Plastic Surgery

Lisa Bailey UT Southwestern Medical Center

Nicole Jennings

University of Wisconsin

Sandy Willett USF Health

Martha Noll University of Utah

Kathrine Munoz University of California – Irvine

Alejandro Lleras University of Colorado

Mandy Bucy University of Kentucky

Laura Duran

University of Arizona

Saqib Sufi Baylor College of Medicine

John Stillerman Wake Forest Baptist University

NEW MEMBERS

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Membership in the AASA

Why do we join and then stay members?

Joellen Buckio

University of North Carolina

The answers are as different as the membership in the AASA. Members usually join when they have just begun a new career and are looking for assistance with that new role. They are looking to socialize and network with other professionals for developmental purposes.

There has been a shift in organizational membership similar to what we have seen in the general workforce. As you can see in the graphic below, each age grouping sees not only their need in an organization, but also the role they will play, vary in the hierarchy of need.

Younger members of AASA might have joined to keep in touch with job opportunities or socializing while AASA might be planning more networking and conference content. Considering a large majority of members join early in their careers, it’s essential to understand the motivation for joining. Just having an awareness of this shift in the

makeup of our organization will keep us vibrant and growing.

As an organization, we should also guard against a one size fits all communication plan. The younger base may want to know everything that is going on, and the more seasoned members might not appreciate the constant interruption into their busy life. I believe our current social media communications plan has adapted this very well. For example, we can follow all the twitter feeds from AASA or simply turn it off!

Professional memberships give us a place to call home, share ideas, get advice and become a community of like-minded individuals. Let’s keep engaged and engage others to ensure we are meeting the needs of our members and making the AASA become even more attractive to new professionals joining our field. Let us know what we can do to help make this organization continue to grow and prosper.

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Figure 7: https://www.abila.com/resource-library/#topic=Member%20Engagement

We are working to improve the AASA Website. If you have suggestions for

improvements, content or a passion to help, please email Georgia Smith

(Georgia.smith@utsouthwestern.edu) or Susan Marx (smarx@uw.edu).

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Academic Medical Center Compensation

Myth Busters: Setting Base Salary Neelam Patel, Senior Manager in ECG’s academic healthcare practice

Matt Johnson, Senior Manager in ECG’s compensation services practice

Many academic medical centers (AMCs) use compensation models that include base and variable payment components. Most compensation discussions focus on variable pay and incentives, however, base salary comprises a majority of total faculty compensation and is a critical piece of the compensation equation. When structured correctly, base salary can be equally as meaningful in driving physician performance as variable salary and incentives. Take a look at the common AMC myths of faculty base salary and gain insights about how to use base compensation more effectively.

Myth #1 High levels of base salary will result in mediocre faculty performance.

Research indicates that professionals do not require large incentives to be motivated. While they do want to be recognized for their performance, intrinsic motivation is much more powerful in driving achievement among professionals.

Myth #2 Incentives recognize clinical work, and base salary pays for “everything else.”

Base salary is not payment for merely showing up. To be effective, there should be a direct connection between base salary and minimum performance standards and expectations for citizenship as well as clinical and academic work.

Myth #3 World-renowned medical centers pay their physicians entirely on salary. It seems like that would be easier.

Fixed compensation plans require a performance-driven culture, highly effective governance and management, and clear and consequential performance standards. These develop over time and are not easily achieved through a redesign of the compensation plan.

From a terminology perspective, we define “base salary” as the fixed amount of money paid to faculty in return for an agreed-to level and scope of work performed—exclusive of benefits, bonuses, or any other potential compensation. This component of compensation is paid, most frequently, in a biweekly or semimonthly paycheck resulting in 26 or 24 even paychecks over the course of the year. In the academic setting, base salary is often determined by university or institutional policy and may have distinct academic and clinical components—each with its own rules around academic rank, tenure, appointment, or track. In most cases, the base component is supported by institutional funds (e.g., tuition, state funds) as well as clinical funds.

Many faculty members (particularly those who are newly trained) covet stable compensation arrangements that are clear and that minimize risk. The base salary provides that stable platform. We recommend that base salary levels are set relative to the specialty-specific market data—as either a targeted percentile or percentage of median.

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This ensures that the base salary is responsive to the market and does not result in salary compression and other anomalies over time.

Although common in private practice, pure production models are rare in academic settings largely because faculty members are asked to perform more types of work that are difficult to quantify. Day-to-day administrative and teaching are commonplace in the academic setting, and including them in the base salary makes payment for these routine activities less transactional. Details of the arrangement, including expected activities, should be outlined in an employment agreement. Often these documents are boilerplate contracts and fail to clearly establish minimum work standards. An effective employment agreement includes not only activities that are assumed to be part of the base, but also expected levels of performance. Minimum work standards should include both time- and performance-

based elements, as described in figure 1 below.

Balancing time-based and performance-based expectations is particularly important from the clinical perspective. Clinical time has direct expense implications for the allocation of staffing and other patient care resources. By having minimum performance expectations, we can make certain efforts are directed toward covering these expenses.

While organizations are often tempted when considering plan revisions to jump into incentive compensation, base salary is a necessary foundation to a stable and effective academic compensation plan. Establishing a clear baseline for performance also defines where performance exceeds expectations and warrants incentive compensation as well as where performance falls short and management intervention is needed.

Time-Based

Considerations

» Hours of direct and/or indirect patient

care per clinical shift

» Clinical shifts per week

» Hours of direct and/or indirect patient

care activities per week

» Clinical weeks worked per year

» Hours spent on monthly committee work or organizational meetings

» Hours protected for teaching and other

scholarly activities

Performance-Based

Considerations

» Citizenship

» Minimum patient care activity targets (e.g., WRVUs)

» Chart completion threshold or

percentage

» Quality metrics achieved

» Access metrics achieved

» Day-to-day resident and student teaching

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UPCOMING WEBINARS

Bess Wildman Book Club: When Breath Becomes Air

March 26, 2019 at 3 pm EST

Kurt Mosely Merritt Hawkins

Generational Issues in Physician Recruitment

April 22, 2019 at 3 PM EST

Register online now at http://www.aasa1.org

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Getting Ready for Our Annual Meeting Christal Moore

Johns Hopkins University - Bayview

Happy Spring Everyone!

I wanted to give a quick update on the great plans we have underway for the Annual Conference in San Francisco. Please mark your calendars for October 26th-29th, 2019. The hotel and room blocks will become available in July. We will begin posting conference presentation topics starting this summer until the schedule is complete.

Figure 8: Photo by Amogh Manjunath on Unsplash

The Education Committee kicked off in February, and we have already set up subcommittee groups to help with planning. We have the following subcommittees: Program, Pre-Conference Workshop,

Attendee Engagement, #SurgeryGives, Celia King Dinner, Welcome Reception, and Posters. Joining one of these committees is a great way to meet some additional members and friends in the organization. Also, you get to hear about all the surprises we are adding in this year. We have the subcommittee structure in place so that we get feedback from anyone interested in participating in making the conference better every year.

Figure 9: Photo by The Climate Reality Project on Unsplash

This year, Susan Marx will be leading the Pre-Conference Workshop planning. Tina Hamlett will be leading Attendee Engagement, and Jonathan Radin will lead the Celia King Dinner Subcommittees.

If you are interested in working with any of these awesome individuals or any of the other committees, please feel free to contact the leader of that group or contact me at cmoore62@jhmi.edu.

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Top Reasons to Come to Buffalo! Wendy Webster

Who: Stellar Surgery Leaders What: AASA Summer Retreat When: Aug 8th – 9th Where: Buffalo, NY Why: Offerings: 1. CIO Game Plan to Impact Work Culture2. MD Compensation Work Groups3. Hot Topics

A. Navigating change w/ your faculty &staffB. Data analytics - Clin Ops &ResearchC. Growing partnerships acrossdepartments

Or a topic that is important to you. The Speaker Request for Proposal is now available online here.

Seeing the Sites!

There is a lot more in New York's second biggest city than snow and chicken wings. The city has undergone a remarkable transformation in recent years, from a redeveloped waterfront and revitalized neighborhoods to a burgeoning craft beer scene and over $1 billion in new investment. If you are into architecture or the arts, you can visit seven Frank Lloyd Wright structures, spend the morning with Andy Warhol at the Albright-Knox Art Gallery or see a Shakespeare play in the evening in Delaware Park. Sports fan? A Buffalo Bison’s game is a great way to spend the afternoon or evening. With a firework show at the end of each game you will be entertained throughout the entire game!

Looking for something more casual? Take in the scene at Canalside. Whether you choose to visit Canalside during the day or in the evening, you will always be able to find something to do! During the day, Canalside offers various activities including shopping,

paddleboat rides, water bikes, ice cream shops and a handful of new restaurants to have lunch to fulfill your afternoon. While during the evening, Canalside offers free concerts every Thursday night. Or taking a stroll down Elmwood village is key when you visit Buffalo. Imagine a neighborhood where visitors linger at open-air cafes and browse farmer’s market vendors on a tree-lined parkway in the summer. In addition, The Buffalo Zoo is one of the biggest zoos in New York State. Home to hundreds of different animals, the zoo is

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the perfect way to spend a sunny summer afternoon in Buffalo.

Want to explore a bit outside of the city? Since 1820, the Erie County Fair has entertained millions upon millions of visitors at the Fairgrounds in Hamburg. The Fair is classic

Americana fun featuring loads of family-friendly events including a petting zoo and animal shows, an expansive midway, amusement park rides and, of course, tasty treats like deep-fried Oreos and kettle corn. The fair runs August 7-18. Or take a ride to Chestnut Ridge Park in Orchard Park. If you love exploring nature and going on adventures the Eternal Flame is a must on your bucket list! Hiking to the Eternal Flame will be your favorite way to explore Buffalo. Or, check out Niagara Falls, a natural wonder of the world!

A Buffalonian’s favorite thing to do is eat! Buffalo is the home to hundreds of trendy restaurants and family owned diners that will give you the opportunity to eat somewhere new every time you go out! Why not try a food that is a classic Buffalo staple? Grab a beef on weck sandwich at Charlie the Butcher, indulge in a spaghetti parm dish at Chef’s restaurant, or satisfy your sweet tooth by trying Sponge Candy at Watson’s Chocolates. And, of course, eat as many chicken wings as you can! A visit to Gabriel’s Gate in Allentown ranks as one of the city’s best wing spots for many Buffalonians.

Want an easy way to get involved with the AASA?

How about telling members about what is on your nightstand? Or maybe giving some advice about career or personal development? Maybe you would rather share the results of your last query to one of our forums or to the members at large. Writing an article for the Cutting Edge is an easy way to contribute and set the time you invest to fit your busy schedule. Cutting Edge publishes in March, June, September and December. Please let Bess know if you are interested in sharing your knowledge with your peers for one of the upcoming publications.

Figure 10: Photo by Miriam Duran on Unsplash