The Global Mission of CHRISTUS Health

JEFFREY PUCKETT, MBA

n June 18, 2018, a cardiac surgical team spent 12 hours saving a 9-year-old girl’s life by performing a heart transplant. On display were the skills and faith that such a com- Oplex operation requires from patient, family and surgical team. This scene could have occurred in one of hundreds of operating rooms across the United States, but it was taking place in Santiago, Chile, at Hospital Clínico UC CHRISTUS, and it’s just one example of what it looks like to work together as an international health care system.

Closer to the world’s equator, in Colombia, CHRISTUS Health system and will likely become the cities of Cali and Palmira recently became a best practice as we look to manage a serious the first two cities in that country to experience a national opioid crisis in the U.S. new choice in health care called Nexo Vital. In the “Think global, act local” is more than just a U.S., we call this care model “population health,” bumper sticker to CHRISTUS Health; it’s a defin- but it is a new concept there. With its own opera- ing feature of who we are. A third of our organiza- tional center of medical and administration per- tion’s associates are international — 15,000 of our sonnel, Nexo Vital currently coordinates services 45,000 associates live and work in Mexico, Chile for 110,000 patients. A significant percentage of or Colombia. With more than 15 years of experi- them are chronically ill. The team begins with a ence in global health care, we know that impres- patient’s initial diagnosis, then works with the sive work is done at each of our international patient’s physician as well as other clinicians and facilities every day. We are following in the foot- services to guide the patient through all needed steps of our sponsoring congregations, learning care, monitoring him or her continually along what it truly means to answer the call for all those the way. It is such an effective system that family in need in the U.S. and Latin America. members of patients enrolled in Nexo Vital have But just because we can understand the impor- begun asking to be included, even though they do tance of global health care doesn’t mean that not have a chronic disease. learning to be an international health system In Mexico, CHRISTUS Muguerza is now the came easy. In fact, we have learned many lessons third largest private health care provider. What the hard way, such as the challenges of recruiting doctors and nurses are doing to manage a patient’s experienced health care leaders in Latin America, pain in the mountains of Nuevo Leon, at CHRIS- navigating novel insurance markets and dealing TUS Muguerza Saltillo, one of our smaller hospi- with cash flow challenges. tals, has gained the attention of all of us across the The difficulty of these shifts, though, has given

HEALTH PROGRESS www.chausa.org NOVEMBER - DECEMBER 2018 33 Cap Pannell way to the beauty of enhanced opportunities to Over the past two years, CHRISTUS Health serve those who need us and combine our skill has hired 16 international executives and pro- sets, experience and knowledge both in Latin vided them with customized plans, including America and the United States to work for all we 253 internal stakeholder meetings and 78 facility serve in creative and innovative ways. visits, to orient them to the business and culture. Years of experience in Latin America have been EYES ON THE EXPERIENCE AND GROWING OUR OWN vital to recruiting prepared international leaders, In the U.S., it seems like common sense to hire and as CHRISTUS’ international presence has committed health care executives who hold a grown, the system has developed leaders from master’s degree in the specialized field of hospital within as well. Both CEOs of CHRISTUS minis- administration. The American Col- lege of Healthcare Executives and It has been much more difficult a plethora of master of health care administration programs ensure to recruit top executives in Latin that we have a large and deep pool America who, from the first day, of prepared executives to pull from in the U.S. understand the intricacies of health We learned early on, however, that universities in Latin America care management. don’t widely offer these specialized higher education programs. For some reason, tries in Colombia and Chile, Alejandro Canavati health care is not considered a common career and Yul Garces respectively, began their tenures path; instead, fields of advanced study like bank- at CHRISTUS Muguerza in Mexico, where each ing and hospitality are much more commonplace. served as chief financial officer at various times. Not only that, but leaders in Latin America move Both also came from industries outside health more easily between industries, while American care. Canavati spent nine years with General executives often gain experience in health care Electric, gaining experience in sourcing, opera- and make their moves within that industry. tions, quality, business development and finance. As a result, it has been much more difficult Garces, a native of Peru, earned his undergraduate to recruit top executives in Latin America who, degree in the U.S. and began his career in inter- from the first day, understand the intricacies of national automotive manufacturing before he health care management. Addressing the issue moved into health care and operational finance. has forced us to get creative, recruiting Spanish- The programs and structures built to recruit speaking talent from other industries or growing and prepare high quality executives to lead our them within our organization. ministries in Mexico, Chile and Colombia are vital That’s why CHRISTUS created an interna- to the ability to carry out the CHRISTUS mission tional executive-in-residence program to attract in Latin America. and prepare international health care leaders for development and acculturation to CHRISTUS PRICE TRANSPARENCY Health. The exposure to different CHRISTUS Health care providers in the U.S. have been ministries and to the system office allows the new warned for years of increasing price sensitivity leader to identify resources, build lasting relation- and the need for “consumer-driven health care.” ships and build bridges across the organization. In Latin America, that day already has come. The executive can then leverage this knowledge Ten years ago, CHRISTUS ambulatory centers and these experiences when starting to work in Mexico posted price lists that were as long as abroad, to the mutual benefit of the international the buildings are high. In Chile, not only does the ministry and the executive. We soften the learn- law require health care providers to give patients ing curve for leaders coming to our Latin Ameri- a quote for the full cost of their health care ser- can ministries from outside health care or who are vices, but consumers use that information to shop joining an international organization for the first around. Patients will visit a surgeon, receive a time, providing them with resources and contacts diagnosis, ask for a quote on the necessary pro- in order to make the assimilation process easier cedures and then gather and compare prices from and achievement of goals faster. other surgeons and hospitals. Often, they will

34 NOVEMBER - DECEMBER 2018 www.chausa.org HEALTH PROGRESS choose the facility and physician who provide the istry’s experience in both the United States and lowest quote. Because consumers shop for and Latin America to benefit the entire ministry. often choose the lowest cost option, the approach Make no mistake, the prevalence of extreme to pricing and negotiations with insurers differs poverty and inequality are visible in Latin Amer- greatly from practices in the United States. ica just as it is in the U.S. This great need calls us Most U.S. health systems are preparing for to respond and provides endless opportunities to a similar reality ushered in by the Centers for fulfill the CHRISTUS Health mission of extend- Medicare and Medicaid Services’ Fiscal Year 2019 ing the healing ministry of Jesus Christ while car- Inpatient Prospective Payment System, which ing for those who are the most vulnerable and in requires hospitals within the U.S. to make cur- need. rent standard charges available online. The fact In Mexico and Chile, CHRISTUS Health oper- remains, however, that the ability to provide an ates clinics for people who are poor and vulner- accurate cost estimate remains a serious strug- able, some of whom live in remote areas where gle today for most U.S. hospitals. Meanwhile, the they struggle to access needed health care ser- website of the CHRISTUS Health system in Chile vices. We also have programs in place to allow prominently displays the option to “request your CHRISTUS associates to give back to their com- surgical budget.” munities, providing surgical assistance for con- The price sensitivities of the patients and com- genital heart defects, cleft lips and palate, scolio- munity members CHRISTUS Health serves in sis, hand deformities, hip and knee replacements, Mexico, Chile and Colombia also speak to another lung and thoracic diseases, high complexity gyne- fundamental difference in Latin America — the cologic laparoscopic procedures, high complexity varying structures of the health care systems, their relationships with payers The truth is that some governments and the many issues that can affect payment for services. in Latin America, like some states Examinations of other countries’ health care systems can fail to include in the U.S. on Medicaid, are the daily realities of navigating unfa- inconsistent in their processing of miliar, varied and diverse structures, especially those closely tied to the payments. This can mean payments operations of foreign governments. The truth is that some governments in Latin are delayed for long periods of time. America, like some states in the U.S. on Medicaid, are inconsistent in their timely pro- brain surgery and eye surgery. This changes lives cessing of payments. This can mean payments and aligns with our values and sponsoring con- are delayed for long periods of time. We always gregations’ directions to CHRISTUS Health strive to continue seamless operations and serve Those directions also help us embrace the patients while waiting for the resources needed to rich heritage, culture, industry, agency and spirit compensate staff and our vendor partners and to of our neighbors in Mexico, Chile and Colombia. purchase our supplies. This falls in line with our heritage since we are sponsored by three congregations with interna- MAKING A DIFFERENCE tional origin stories. People often make assumptions about the health Although we focus on those in need, we also care experience in Latin America. The CHRIS- recognize a growing middle class that demands TUS health delivery model is designed to achieve better access and more personalized health care. high quality outcomes for all of those we serve. Latin American countries have advanced eco- To do this, we work hard to operate with similar nomically and, with increased globalization, standards in both the U.S. and Latin America. For the lives of the people have changed. There is example, nearly all our clinical quality standards a demand for health care services that include are the same between the U.S. and Latin America. important preventive and chronic care manage- CHRISTUS Health’s ministries in Latin Amer- ment. We are able to simultaneously benefit from ica offer opportunities to simultaneously expand this and improve the health of these communities its mission, diversify its portfolio and use the min- by offering our services.

HEALTH PROGRESS www.chausa.org NOVEMBER - DECEMBER 2018 35 The growth of the middle class in Mexico, important patient survey scores jumped by almost Chile and Colombia also points to the maturing 10 percent. For the nurses, it was an opportunity of local health care systems that, together with to rediscover their call to nursing, bringing back American experience and expertise, can be used not just the science, but also the art and compas- as they grow. This is easily visible when one com- sion of nursing. pares how the U.S. health care system has trans- formed to its current state of health care systems NO QUICK FIXES with multiple geographic locations and many CHRISTUS Health has learned many difficult ambulatory services. but important lessons in more than 15 years as an Historically, most health care providers in the international health care organization. Success in U.S. were independent; physicians and hospitals these endeavors does not come from short-term had not yet learned the value of integrated net- orientation, nor does it offer a quick “get in and works that provide administrative support, best get out” option. practices and rapid quality improvement oppor- We keep our number one focus on our mis- tunities. Today, however, mergers and acquisi- sion and our call to serve those in need. We also tions continue at a heightened pace, and fewer have made a point of growing in a deliberate and and fewer providers remain completely uncon- measured way. We spent 10 years in our first part- nected to some system or network. nership in Mexico before expanding to Chile and In the same way, today in Latin America there then, three years later, to Colombia. CHRISTUS are countless individual physicians and hospitals never enters a new country alone, but relies heav- that are not incorporated with bigger health sys- ily on partners to guide it toward the best way to tems or joint ventures. Broader health care net- create new systems and serve more people than works that connect providers across the contin- would be possible alone. uum of care are not as common as in the U.S., and These partnerships have helped CHRISTUS hospitals remain the center of the system. navigate some difficult circumstances: the avail- The things CHRISTUS has learned making a ability of fewer experienced executives than were similar transition to becoming a more integrated anticipated; the learning curves surrounding new health care system lends priceless experience to market structures; and a maturing health care its facilities and providers abroad, helping with market that sometimes challenges the availability everything from emergency department through- of the resources we needed. put (thus allowing us to serve more patients in But when CHRISTUS steps back to examine need) to the most effective structures for partner- its experiences as an international health care sys- ships and joint ventures with like-minded provid- tem, the case for meeting international health care ers. It also allows CHRISTUS Health to rapidly needs beyond short-term mission trips is clearly improve quality of outcomes in many areas. compelling. For CHRISTUS, it makes sense from the perspective of its call to extend the healing CLINICAL CHALLENGE ACCEPTED ministry of Jesus Christ and its need to ensure it A few years ago, CHRISTUS introduced the safety has the resources to do so in the communities it experience triad (nurse leader rounding, bedside serves. shift report and hourly rounding) to each of its And it makes sense for the patients CHRISTUS hospitals, including those in Latin America. The serves as well — from the vulnerable to the mid- nursing staff in Chile accepted the challenge to dle class to a 9-year-old girl who needed a new execute this triad practice, and they did so quickly heart and new hope. It is an honor for CHRISTUS and successfully, making the changes look almost Health to work alongside its international health easy. care partners to extend the healing ministry of The nursing staff set a goal of 100 percent Jesus Christ. implementation in six months for all CHRIS- TUS medical units in Chile. Using smartphones JEFFREY PUCKETT is executive vice president and and computers, the nursing teams documented chief operating officer, CHRISTUS Health, Irving, their work through an electronic report. Within Texas. four months, nursing communication and other

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