August 11, 2000

James J. Mongan, MD

Peter Slavin, MD

This fall, the MGH and the Massachusetts General Physicians Organization (MGPO) will launch a management initiative to address clinical performance improvement throughout the institution. Called Clinical Performance Management (CPM), the initiative is designed to increase the efficiency of the patient care process, optimize the hospital's inpatient capacity and improve the quality of patient care.

"We'd like to accomplish these goals while ensuring that we are providing effective management support and clear priorities to our physicians," says Peter Slavin, MD, chief executive officer of the MGPO.

Slavin presented the CPM structure to many audiences in July, including the General Executive Committee, the MGPO Executive Committee and the Operations Improvement leadership. According to Slavin, the rationale behind the initiative is to enhance collaboration between the hospital and the MGPO. During the past five years, the MGH and MGPO have developed several institutional programs and initiatives, including Operations Improvement, Primary Care Medical Management, Specialty Care Management, and most recently, the Length of Stay Task Force. Over time, the work of these initiatives began to overlap. The new management structure will replace these existing programs with a more comprehensive and coordinated program.

"We found that physicians working with MGH and MGPO staff were doing similar work to improve patient care," says James J. Mongan, MD, president of the MGH. "As a result, we decided that a more coordinated management structure would eliminate redundancy and improve the efficiency of our efforts to enhance the institution's ability to stay ahead of the wave of challenges we face as the health care environment continues to change. This new structure by no means implies that we have gone about this the wrong way. The MGH and the MGPO have made significant strides in medical management during the last five years. For example, we've made tremendous progress in reducing length of stay for patients in the hospital, and we have been able to better control our expenditures for blood products. We're also making progress in utilizing our pharmaceutical agents and lab tests more efficiently."

Slavin adds: "We have seen improvements in performance with our managed care contracts through the primary and specialty care medical management efforts as well."

The CPM structure will feature interdisciplinary, physician-led teams. These teams will be established in key areas defined by need and strategic opportunity. There will be close collaboration between clinical and operational areas in the design and structuring of these new teams.

CPM will be coordinated by an executive committee chaired by Slavin and co-chaired by Mongan. Britain Nicholson, MD, senior vice president and chief medical officer, and James Richter, MD, medical director of the MGPO, will serve as vice chairs. The executive committee will be comprised of clinical and administrative leadership from the MGPO and the MGH, including service chiefs and practicing physicians. CPM restructuring also will include a staff support group, led by Elizabeth Mort, MD, director of the Decision Support and Quality Management Unit.

"We will be fine-tuning the CPM structure over the next two months through a transition team," says Slavin. "Jim Mongan and I encourage those individuals involved in utilization management activities, ancillary management and medical management initiatives to continue their work over the summer. Currently, we are experiencing higher-than-budgeted admissions, and it's important to stay on top of our clinical resource management activities. We will have a more defined picture by the end of September. It is likely that many of the individuals currently involved in key clinical resource management initiatives will have important roles in the new structure, and we certainly do not want to start from ground zero."

The membership of the Length of Stay Task Force has been expanded to work on the CPM restructuring as a transition team. The team will focus on developing the team structure, refining the goals and establishing a process for selection of the executive committee members and team leaders.

Members of the transition team: James J. Mongan, MD and Peter Slavin, MD, Co-chairs; William Abbot, MD; Dennis Ausiello, MD; W. Gerald Austen, MD; Hasan Bazari, MD; Steven Calderwood, MD; Mary Chin, RN; Alasdair Conn, MD; Nancy Gagliano, MD; Mary Ellen Heike, RN; Cyrus Hopkins, MD; Jeanette Ives Erickson, RN; Michael Jellinek, MD; Elizabeth Mort, MD; Britain Nicholson, MD; Ann Prestipino; James Richter, MD; Lawrence Ronan, MD; Nancy Sullivan; Andrew Warshaw, MD; and Jeffrey Weilburg, MD.