Physician Satisfaction

HEALTHCARE The Magazine for Healthcare Leaders JULY/AUG 2020

V35 | N4 EXECUTIVE

18 Behavioral Healthcare: Integrating Telemental Health Services 30 Healthcare’s Emerging Reality Post-COVID-19

44 CEO Focus: Leading in Crisis

TOP Approaches to Physician CLINICAL INTEGRATIONCLINICAL Satisfaction Advice for times of crisis and for every day

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Cover Story Departments

8 Top 5 Approaches to Physician Satisfaction: 2 Web Extras Advice for Times of Crisis and for Every Day 4 Take Note 6 Perspectives Creating a Healthier, More Equitable Future 28 Healthcare Management Ethics Empathy’s Role in Improving Resiliency 30 Satisfying Your Customers Healthcare’s Emerging Reality Post COVID-19 © shutterstock.com 34 Operational Advancements Even during an unprecedented event like the COVID-19 pandemic, healthcare executives Improving Operations Through Efficiency may wonder how to best preserve their valued 36 Public Policy Update relationships with physicians as they cope with COVID-19 Reveals Silver Linings the ramifications of the global emergency. 38 Careers Feature Leading by Greatness During Crisis 42 Governance Insights 18 Behavioral Healthcare Now and COVID-19 and Executive Succession Post COVID-19: Integrating Telemental Management Health Services 44 CEO Focus Leading in Crisis Inside ACHE

46 Executive News 48 CEO Survey 50 On the Move © shutterstock.com

The pandemic thrust telemental health into the 54 Member Accolades spotlight. Now that many organizations have 56 Chapter News made the transition, early signs are that this option will last. 58 Ethics Self-Assessment 64 Policy Statement 68 Professional Pointers WEB EXTRAS

Recent Healthcare Executive Podcasts You can find the following interviews at HealthcareExecutive.org/Podcast or search for “Healthcare Executive” in Apple Podcasts or iTunes: Healthcare Executive (ISSN 0883-5381) is published bimonthly by the Warner Thomas, FACHE, CEO, Ochsner American College of Healthcare Executives, 300 S. Riverside Plaza, Suite 1900, Chicago, IL 60606-6698. The subscription cost is $120 Health, discusses the impact of the COVID-19 per year (add $10 for postage outside the United States). Healthcare pandemic on operations, staff, patients and the community. Executive is paid for by members of the American College of Health- care Executives as part of their membership dues. Periodicals postage paid at Chicago, IL, and additional mailing offices. Printed in the Banner Health’s senior director of digital marketing, Chris Pace, USA. POSTMASTER: Send address changes to Healthcare Executive, 300 S. Riverside Plaza, Suite 1900, Chicago, IL 60606-6698. talks about the “digital front door” and how it drives growth, loyalty and better care. To subscribe, make checks payable to the American College of Healthcare Executives and send to: Subscription Services, Health Administration Press/Foundation of the American College of Health- Georges C. Benjamin, MD, executive director of the American care Executives, 300 S. Riverside Plaza, Suite 1900, Chicago, IL 60606-6698. Single copy is $30.00 plus shipping and handling. Public Health Association, explains how healthcare leaders can help patients navigate the pandemic and the skills executives need to lead REPRINT REQUESTS For information regarding reprints of articles, please contact through a crisis. (312) 424-9432.

ALL OTHER REQUESTS Contact the Customer Service Center: Fresh, Exclusive Content Phone: (312) 424-9400 Fax: (312) 424-9405 Read the following recent articles only at HealthcareExecutive.org/ Email: [email protected] WebExtras: All material in Healthcare Executive magazine is provided solely for the information and education of its readers. The statements “Helping Physicians During the COVID-19 Pandemic.” and opinions expressed by authors do not necessarily reflect the policy of the American College of Healthcare Executives. Authors Healthcare executives can do a lot to support their physicians on are exclusively responsible for the accuracy of their published the front line of the COVID-19 crisis. Experts recommend several materials. Advertisements appearing in Healthcare Executive do not constitute endorsement, support or approval of ACHE. strategies for helping physicians manage the physical, emotional and financial toll of battling the virus. ADVERTISING SALES AdBoom Advertising Phone: (404) 347-4170 “Tiered Staffing Strategy for Pandemics.” The need to staff new Fax: (404) 347-9771 Email: [email protected] inpatient and ICU beds has encouraged the creative use of the existing workforce supplemented by clinicians working in new roles, students TOPIC SUBMISSIONS Healthcare Executive does not accept unsolicited manuscripts. stepping in and retirees returning to work. Topic suggestions may be directed to the Managing Editor: Email: [email protected] Mail: ACHE, Attn: Managing Editor COVID-19 Member News 300 S. Riverside Plaza, Suite 1900 As this unprecedented event continues to impact our communities, Chicago, IL 60606-6698 ACHE will regularly share news about our members on the front SUBMISSIONS OF ACHE MEMBER ANNOUNCEMENTS lines. These news stories are intended to highlight the amazing work Please submit announcements for “Member Accolades” or “On the Move” to the Managing Editor: our leaders are doing as they confront the novel coronavirus and the Email: [email protected] disease caused by it, COVID-19. Mail: ACHE, Attn: Managing Editor 300 S. Riverside Plaza, Suite 1900 Chicago, IL 60606-6698

GETTING PATIENTS BACK

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As our country plans to slowly reopen and begin staging a recovery from COVID-19, healthcare providers are faced with new challenges in ramping back up their clinical and business operations.

BRG is working with healthcare providers to navigate today’s complex environment successfully and rapidly implement a thoughtful business plan for how to operate within the new normal.

WE TAKE CARE OF people TAKING CARE OF people TAKE NOTE

Clinical Integration in Challenging Times BOARD OF GOVERNORS CHAIRMAN Michael J. Fosina, FACHE CHAIRMAN-ELECT Frank W. Austin Carrie Owen Plietz, FACHE IMMEDIATE PAST CHAIRMAN Heather J. Rohan, FACHE The theme of the two features in this issue is clinical integration. The PRESIDENT/CHIEF EXECUTIVE OFFICER cover story explores a key ingredient to success: physician satisfaction. Deborah J. Bowen, FACHE, CAE The second feature looks at how the care of behavioral health patients GOVERNORS is integrated with telemental health services. Both topics are explored Kurt A. Barwis, FACHE Laura Robertson, FACHE Joanne Carrocino, FACHE William P. Santulli, FACHE in the wake of COVID-19. Brian C. Doheny, FACHE Col Gigi A. Simko, FACHE Delvecchio S. Finley, FACHE Mary C. Starmann-Harrison, FACHE Teri G. Fontenot, FACHE Michele K. Sutton, FACHE In our cover story “Top 5 Approaches to Physician Satisfaction: Michael A. Mayo, FACHE Nizar K. Wehbi, MD, FACHE Advice for Times of Crisis and for Every Day” (Page 8), we discuss PUBLISHER how despite COVID-19 disrupting most if not all organizations’ oper- Frank W. Austin MANAGING EDITOR ations, it’s imperative that healthcare executives stay focused on physi- John M. Buell cian satisfaction, engagement and well-being. “Caring about WRITER professional well-being is the way that organizations are going to best Lea E. Radick achieve the other outcomes that they are working toward,” says ART DIRECTOR Christine A. Sinsky, MD, a general internist and vice president of pro- Carla M. Nessa fessional satisfaction at the American Medical Association. EDITORIAL BOARD James C. Hite, FACHE, Chair Juana Diaz Rafael S. Alvarado John H. Everett, FACHE In the feature article “Behavioral Healthcare Now and Post Josue Arvayza Alfred D. Faulk III, FACHE L. Hillary Basden John H. Goodnow, FACHE COVID-19: Integrating Telemental Health Services” (Page 18), we LTC Jeffery K. Blackwell, FACHE Shelley Harris, DNP, FACHE examine how hospitals and health systems moved quickly to a virtual Noe Del Bosque, FACHE Col Vivian T. Hutson, FACHE Tiffany Capeles, FACHE Unhee Kim, RN, FACHE model to continue psychotherapy and psychiatric management for Alexander Choi, MD Bren T. Lowe, FACHE patients. Now that many organizations have made the transition, early Melissa Mooney, RN signs are that this option will last. Authorization to photocopy items for internal or personal use, or the internal or personal use for specific clients, is granted by the American College of Healthcare Executives for libraries and In addition, you’ll find the Ethics Self-Assessment (Page 58), used to other users registered with the Copyright Clearance Center (CCC), evaluate leadership and ethics-related actions, and to address potential provided that the appropriate fee is paid directly to CCC. Visit copyright.com for detailed pricing. ISSN 0883-5381. No unsolicited red flags identified in the process. Each year, ACHE’s Ethics manuscripts are accepted. Please query first.Healthcare Executive Committee reviews and revises the Ethics Self-Assessment. There were is indexed in PubMed by the National Library of Medicine. no changes made this year. © 2020 by the American College of Healthcare Executives. I hope you enjoy this issue of Healthcare Executive. Please share your All rights reserved. feedback with me at [email protected]. s

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Creating a Healthier, and massive. For many organizations, this meant creating new intensive care More Equitable Future units in a matter of days. It meant halting elective surgeries to expand capacity. It meant examining our sup- Building a more just “new normal” after ply chains to ensure there were enough COVID-19. protective equipment, ventilators and Deborah J. Bowen, other vital supplies. It meant activat- FACHE, CAE ing command centers to help ensure communication and transparency both inside and outside the For many weeks, the healthcare com- To help move forward, we must solve organization. munity has been immersed in taking for what we can influence. Leaders care of patients and families and get- across the country will benefit from We know now that we can rise to ting through the pandemic. While lessons learned from the pandemic, these challenges, as hard as it is. We we are slowly emerging and the rise but we must also take hold of the fun- can leverage systemness to increase of COVID-19 incidences lessens for damental values that differentiate capacity for critical patients. We can many, we have a more enduring toll healthcare organizations. How can we create advanced field hospitals and to face in racial injustice. best integrate these two priorities to deploy the might of the U.S. military provide meaningful change—to serve to reinforce our ranks. We can lever- As a white leader, I don’t profess to all patients while taking advantage of age partnerships and navigate sup- understand the depth of pain others what we now know in managing the plier networks to creatively source have faced, but I do know that leaders pandemic? What lessons have we critical materials. can play powerful and influential roles learned—about our institutions, our in driving change. I also know that as workforce and our communities— Emergency preparedness plans must a professional community, healthcare that can propel us to a new future? include mitigation of harm against leaders are adept at achieving what we vulnerable communities. Many set our hearts and minds to achieve. Enhanced Planning experts are predicting a second wave as So I wonder, as we consider what we Preparedness is a staple in healthcare the country re-opens, or a combined have learned during COVID-19, how management, but the scope of this COVID-19/influenza season that may we might devise a “new normal” that pandemic exceeded the imagination of again take a heavy toll on those mar- helps ensure equity for all in our plans even the most stringent plan or best ginalized. While we will not be able to and actions. simulation. The response was swift remedy generations of disparities in a matter of months, we can consider what education, outreach and Diversity and Inclusion Resources resources can be deployed to reduce infection and death rates. As “leaders For more data and resources on addressing inequities in health outcomes and the who care” we have both moral and healthcare management field, please visit: business imperatives to increase access to information, testing and treatment. ACHE Asian Healthcare Leaders Forum: ache.org/AHLF Performing analyses now of how and ACHE LGBTQ Forum: ache.org/LGBTQ why different populations were most ACHE research studies: ache.org/Workplace impacted—minority communities, Executive Diversity Career Navigator: edcnavigator.org low-income neighborhoods, individu- Institute for Diversity and Health Equity: ifdhe.aha.org als with disabilities and pre-existing National Association of Health Services Executives: nahse.org conditions, homeless or housing vul- National Association of Latino Healthcare Executives: nalhe.org nerable—will help us develop appropriate pre-emptive actions.

6 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. Learning and research from across As we look to hardwire telemedicine start and stop at the hospital walls. the field can and must be used to cre- practices, we need to be mindful that COVID-19 has shined a harsh light ate, rehearse and codify stronger ensuring access for all may also on long-standing health disparities plans. As we reevaluate, we can take require alternate approaches. With that have persisted for too long. Many stock of our successes and opportuni- many people balancing the struggle of our employees return to families ties for improvement. And we can to care for their loved ones while fac- and communities that are suffering celebrate the breadth of contribu- ing disruptions in income, some may from the acute situation of the pan- tors—C-suite executives, front-line have limited access to technology. We demic but also from legacies of disin- care providers, first responders, com- must practice intentional inclusion to vestment and injustice. The “full munity leaders, public health offi- ensure that the accelerated pace picture” of health is as equally impor- cials, patients and families, and so doesn’t leave already-underserved tant to consider for our employees as it many others—who helped expand populations even farther behind. is for the patients in our beds and our resources and lift our spirits. exam rooms. Workforce Support Accelerated Innovation The physical health of our workforce This is particularly important, as we Many leaders have emphasized the is paramount to our ability to persist know that the financial fallout of speed at which the situation on the in tackling this pandemic. COVID-19 may result in difficult ground developed and intensified. As Healthcare leaders have developed and painful decisions with regard to a result, organizations accelerated new ways to help reduce exposure our workforce. Moving forward, we decision-making, adapting to a new and keep care providers from con- must think carefully about how to cadence to ensure the best care possi- tracting or transferring the virus. cultivate and maintain holistic health ble. Implementation that might pre- for employees as part of the broader viously have taken weeks or months Amid this, we’ve discovered a new communities we serve. has been happening in days or even depth to our talent pools by creatively hours. Assessments and adjustments realigning talent with need. Staff Thank You are also happening on a more rapid reassignments are occurring across Throughout the tumult of the past few and continual basis. We’ve also seen the board, from medical office nurses months, we have reached inside our- ingenuity play out through commu- and PAs performing drive-through selves and mobilized our teams to do nity partnerships, from universities to testing, to administrators and prac- what seemed to be the impossible. hotels to manufacturers, to increase tice managers undertaking ED triage, While I have always known that the access to vital resources. As we to social workers running a daycare DNA of great leaders is a unique com- deepen and formalize these relation- for children of essential employees. bination of talent, ambition and a pas- ships, we can gain the benefit of our sion to do what’s right, I have never collective actions. In addition, we’ve recognized how witnessed such a persuasive display. My critical it is to preserve psychological hope for our patients and field is that Agility and innovation have created a health and prevent burnout. with our newfound knowledge and the momentum, while rapid evolution Organizations activated a host of will to make progress in reducing dis- has occurred in parallel. For instance, options during the height of the pan- parities, we will make even greater the massive uptake of telemedicine demic to create space and time for progress to advance not only our capac- and virtual visits has opened the door staff to decompress and recharge. ity to lead, but the care we provide to to a range of possibilities, including We’ve offered mental health training those who need us most. What you do advancements in triaging people and digital tools to help reduce stress, inspires me and gives me great hope for showing symptoms of COVID-19 or and provided mental health check-ins. our future. Thank you. s monitoring patients with chronic conditions. In many places, nurses Though the number of COVID-19 Deborah J. Bowen, FACHE, CAE, is and doctors are leveraging technology cases may vary in different areas, we president and CEO of the American to connect hospitalized patients with should hold on to the realization that College of Healthcare Executives their loved ones. mental health and burnout do not ([email protected]).

By Laura Hegwer

Healthcare executives cannot let their guard down on physician satisfaction even during an unprecedented event like the COVID-19 pandemic. Even in areas that have been less devastated by COVID-19, healthcare executives may wonder how to best preserve their valued relationships with physicians as they cope with the ramifications of the global emergency.

Whether hospital operations are business as usual or upended because of a crisis, it’s imperative that healthcare executives stay focused on physician satisfaction, engagement and well-being, according to experts. “Caring about professional well-being is the way that organizations are going to best achieve the other outcomes that they are working toward, including safety, patient satisfaction, quality of care and the financial stability of the organization,” says Christine A. Sinsky, MD, a general internist and vice president of professional satisfaction at the American Medical Association.

As affiliations between physician practices and health systems continue, focusing on physician satisfaction and engagement may help executives address financial challenges and staff shortages that threaten patient care and their organizations’ sustainability, according to a 2017 study, “Executive Leadership and Physician Well-Being,” published in Mayo Clinic Proceedings.

physician concerns, leaders should adopt a more proac- tive—even strategic—approach. “The CEO has to create a supportive culture for physicians, not just keep Following are strategies for improving physician satis- them from getting upset,” says Thomas H. Lee, MD, faction, even during challenging times. CMO, Press Ganey.

Create a culture that respects In its “Joy in Medicine” resources, the AMA refers to physicians and their well-being. the ideal workplace environment as having a “culture 1 Prior to the pandemic, only half of physicians of wellness,” which values self-care, personal and pro- said they had a positive relationship with fessional growth, and compassion. In organizations administrators, according to a 2019 survey of with such cultures, leaders have shared accountability more than 5,000 physicians from multiple specialties for physician wellness. They include physician satis- by the American Academy of Family Physicians and faction as part of their strategic plan. They also may the staffing company CompHealth. In the same study, make a portion of top executives’ annual compensa- only 31% of physicians reported that their organization dependent on the well-being, satisfaction or tions prioritized physician well-being. At the time of engagement scores of their physician workforce, this writing, no large surveys of physician satisfaction Sinsky says. with hospital leaders had been completed during the COVID-19 crisis. In organizations that have embraced this kind of culture, leaders and physicians also share the same val- To improve physician relationships, healthcare execu- ues and work in concert to deliver safe, coordinated tives should create the kind of workplace in which all and empathic care, Lee says. When leaders and physi- leaders make physician satisfaction and well-being a cians are aligned this way, organizations tend to have priority, experts say. Rather than being reactive to lower turnover and better health outcomes, including fewer readmissions and a shorter length of stay, he adds. (That said, he thinks it is a mistake to use financial incentives to “Caring about professional well-being is the way align physicians to the organization’s that organizations are going to best achieve the quality improvement goals. “It can send the wrong message by suggesting that other outcomes that they are working toward, there’s a threshold and if physicians just including safety, patient satisfaction, quality of get there, that’s good enough,” he says.)

care and the financial stability of the The AAFP/CompHealth survey also organization.” found that only one-third of physicians felt appreciated for their work, suggesting —Christine A. Sinsky, MD that even during normal operations, AMA many healthcare executives may miss opportunities to show their respect and gratitude to the medical staff.

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For some physicians, working with an organization that has a culture that respects its professional staff is just as important as compensation, says Clif Resources to Improve Knight, MD, FAAFP, senior vice presi- Physician Satisfaction dent of education, AAFP. “Sometimes, compensation becomes a proxy if physi- Healthcare Executive Magazine (HealthcareExecutive.org) cians don’t feel appreciated or respected, “Sustaining Performance With Nudges,” January/February and they focus on how much they get 2020 Healthcare Executive. paid,” he says. “But if physicians feel “Battling Clinician Burnout: Fighting the Epidemic From appreciated and respected by the organiza- Within,” January/February 2019 Healthcare Executive. tion, that goes a long way in helping them “Retaining Your Most Valued Resource: Appreciated High- feel a sense of satisfaction and connection Value Staff Improve Patient Care,” January/February 2019 Healthcare Executive. to the organization.”

Health Administration Press Books (ache.org/HAP) Reduce the inefficiencies Developing Physician Leaders for Successful Clinical that irk physicians. Integration 2 According to the AAFP/Comp Inside the Physician Mind Health study, clerical duties and administrative issues are ACHE Assessments (ache.org/CareerResources) the top tasks that hinder physician happi- Emotional Intelligence Assessment ness at work. Change Management Leadership “The physician workforce in this country Additional Resources AAFP’s Physician Health First portal provides resources to is not working at full power,” AMA’s help physicians boost their practice efficiency, build leadership Sinsky says. “Physicians are working skills, practice self-care and more. extensively, but we are misusing a lot of AMA’s “Creating the Organizational Foundation for Joy in those hours on work that does not require Medicine” module, co-authored by Christine A. Sinsky, MD, a medical school education.” She believes offers guidance on implementing a culture of wellness and efficiency. that in most organizations, physicians could save three to four hours per day by AMA’s “Getting Rid of Stupid Stuff” module helps physicians reduce inefficient EHR tasks and regain control of their day. redistributing clerical and lower-level clinical tasks to other members of the The Institute for Healthcare Improvement’s “Framework for Improving Joy in Work” white paper provides ideas for patient care team. Strategically delegating improving clinician satisfaction and engagement. tasks also would decrease the amount of work that physicians need to do at home after normal business hours—what Sinsky refers to as “pajama time”—that is a major contributor to burnout and dissatisfaction.

12 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. EHRs are another major source of physician dissatisfac- At Memorial Hospital in Jacksonville, Fla., Bradley tion. Sinsky co-authored a March 2020 study, “The (Brad) S. Talbert, FACHE, president and CEO, rounds Association Between Perceived Electronic Health frequently with his leadership team. “I want to be visi- Record Usability and Professional Burnout Among US ble,” he says. “I want the physicians to see my face and Physicians,” published in Mayo Clinic Proceedings, that the faces of our executive team and be able to interact, found a strong dose-response relationship between share ideas and collaborate.” He even provides physi- EHR usability and physician burnout. In terms of cians with his cell phone number and encourages them usability, EHRs ranked below common technologies to reach out to him directly. like Excel spreadsheets and global positioning systems, according to physicians surveyed. With most of the 800 providers on his medical staff still in private practice, Talbert acknowledges that Many EHRs include redundancies that can make their needs may be different from the hospital’s needs. the day-to-day practice of medicine maddening. For “It’s important that we listen and have an open dia- example, Sinsky found that it took 32 clicks in her own logue so we can try to find those common-ground EHR to order and record giving a patient a flu shot. areas on which to collaborate,” he says.

Some healthcare organizations are actively working to Even during difficult times like the pandemic, he aims address such issues. For example, leaders at Hawaii to be as open as possible with his medical staff. “We Pacific Health in Honolulu implemented a “Getting Rid want to be as transparent as we possibly can at all times of Stupid Stuff” program, in which employees submit because that ultimately builds trust,” he says, “and their ideas to reduce inefficient documentation practices. when you have trust, you can have really strong Their early successes were described in a November 2018 relationships.” article in The New England Journal of Medicine. Talbert credits these relationships for helping improve Leaders can also consider technology investments like physician engagement. In his hospital’s most recent larger monitors, which reduce physicians’ cognitive survey, 85% of the medical staff identified as “highly workload because they can see more information on a single screen. Using badge logins, rather than requiring user- names and passwords, also helps save “I want to be visible. I want the physicians to time and eases the burden of technology, according to Sinsky. see my face and the faces of our executive team and be able to interact, share ideas and Be an accessible and transparent leader. collaborate.” Whether leaders are in the 3 —Bradley (Brad) S. Talbert, FACHE midst of a crisis or managing Memorial Hospital business as usual, they need to make themselves available to physicians, says AAFP’s Knight.

After speaking with the surgeons, Talbert and his team invested in two new surgical robots and made engaged” or “very engaged.” Since he joined the orga- expanding the program an organizational priority. nization in 2017, the hospital also has improved how Since then, the hospital has seen a rapid growth in many physicians believe the hospital is an excellent robotic procedures, from about 15 cases per month to place to practice medicine, moving from the bottom nearly 100 cases per month. “We’ve had numerous 10th percentile to the 67th percentile nationally. physicians join the medical staff to take advantage of that,” Talbert says. “It’s been a real strong success story “We’re not satisfied with that number, but it’s a tre- for the physicians, for the hospital and, ultimately, the mendous improvement,” he says. patients.”

Give physicians a voice in capital Turn survey results into action. allocations for new services and “The redesign of healthcare delivery has been 4 technology. 5 accelerating for a long time, and the pandemic Healthcare leaders can improve physician satis- just makes it that much more dramatic,” says faction by working collaboratively with their Lee of Press Ganey. In times of rapid change, medical staff to shape the organization’s investments and like the industry is currently experiencing, Lee believes capital strategies, Talbert says. healthcare executives should survey their physicians more frequently than once every two or three years. A few years ago, some surgeons on staff at Memorial Hospital were disappointed by the hospital’s lack of While more frequent surveys can provide valuable sustained investment in robotic surgery. Although it insights, it’s important for leaders to remember that was one of the first hospitals in the area to offer robotic physicians suffer from survey fatigue, says AAFP’s surgery, leaders had failed to continue investing in and Knight. “The most important thing about surveying promoting the technology. physicians is that you have a plan for what you’re going to do with that information,” he says.

During normal operations, and especially in times of crisis, it is critical for “The most important thing about surveying healthcare executives to acknowledge physicians is that you have a plan for and address physicians’ concerns if they want to build trust. Experts say doing what you’re going to do with that this and following other physician satis- information.” faction practices can drive better outcomes—particularly when organizations —Clif Knight, MD, FAAFP need it most. AAFP

Laura Hegwer is a freelance writer and editor based in Lake Bluff, Ill.

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Leading organizations to success through a systems approach.

“ It’s one of the hardest professions on the and experience managing difficult situations, they are still climb that mountain—it makes it 10 times harder than it needs colleagues. Training for the first 300 identified Wellness planet—to be all in with their minds and their human and are not devoid of emotion or immune to stress. to be.” In the program, Wellness Champions solicit feedback Champions was underway. Then, COVID-19 hit. hearts, with all of the other pressures that are from their clinician colleagues via a Pain Points Survey about any swirling around them. As a society, we owe it With Simmons leading the way, Envision, a national medical obstacles. Wellness Champions then analyze the survey results COVID-19 Initiatives to clinicians to look out for them.” group, put in place several wellness initiatives to support the and collaborate with leaders across Envision on solutions. Regardless of their specialty, COVID-19 has disrupted clinicians’ health and well-being of more than 27,000 clinicians who are normal practices. As the public health crisis evolved, Envision rap- —Bonnie O’Meara on the front lines of patient care. Practicing What They Preach idly adjusted and expanded its wellness efforts, providing resources Vice President, Talent Management The Wellness Champions Program is a natural extension of and a structured approach to support all employees—both clini- Envision Physician Services Wellness Champions Program one of the medical group’s core values: to create an environ- cians and nonclinical team members—to help them navigate the Ann Arbor, Mich. Among the many initiatives established is the Wellness ment of engagement in which clinicians are valued and feel disruption caused by the coronavirus. These efforts include: Champions Program, which provides clinician peer-to-peer passion and joy for what they do. “This program is practicing With our current environment of increased uncertainty due to support. The program provides an opportunity for clinicians to what we preach,” says Bonnie O’Meara, vice president, Talent • Daily wellness coaching and stress management support for COVID-19, today’s healthcare organizations must fulfill their connect with colleagues who understand the many demands Management, Envision Physician Services. “We want clini- clinicians and support team members that focus on com- duty to take care of their providers so they, in turn, can take care of practicing in today’s healthcare system and want to pro- cians to know we have their backs.” munity support and conclude with a five-minute guided of the patients at the heart of the healthcare system. A compre- mote the personal and professional growth of their peers. meditation. hensive, systems approach to addressing clinician well-being Simmons and O’Meara believe a “systems approach” to • Peer crisis support training designed to train clinicians, clin- may be the key for healthcare organizations to achieve real, pos- Wellness Champions receive four hours of mental health addressing clinician wellness is essential for success. The idea ical leaders and clinician supporters on crisis resources, itive change that reverberates throughout their clinician popula- training so they are more adept at identifying, supporting aligns with a 2019 report by the National Academy of Medicine, peer support and signs a colleague may be struggling. tions and improves patient care and outcomes. and referring colleagues who may be going through a diffi- Taking Action Against Clinician Burnout: A Systems Approach • Counseling and follow-up sessions for clinicians who have cult time. They then receive four additional hours on how to to Professional Well-Being, which calls upon healthcare been deployed to or work in COVID-19 hot spots to help As an emergency medicine physician, Stefanie Simmons, MD, execute the wellness program, which encompasses smaller leaders to emphasize training and clinician support to improve them debrief and prepare for reintegration back home. vice president of Patient and Clinician Experience at Envision programs tailored to different topics. Following the training, professional well-being for the benefit and overall health of Physician Services and an ACHE Member, knows from first- Wellness Champions choose a specific subprogram to sup- clinicians, patients and communities around the nation. As the COVID-19 pandemic progresses, Simmons says hand experience and through her studies the stressors associ- port at their worksite and implement it. The goal is to have (Recommendations from the report are available at nam.edu.) Envision will continue to support clinicians, care for patients ated with providing care in today’s healthcare system. The one Wellness Champion at each of Envision’s sites. and work to mitigate the spread of the virus. clinical environment changes rapidly, from heightened admin- Working collaboratively across departments, and by leverag- istrative responsibilities to new clinical challenges—as seen “We didn’t just want a top-down, impersonal program; we ing resources they have within their own systems, healthcare For more information, please contact Stefanie Simmons, MD, with COVID-19—and clinicians’ ability to maintain their per- really wanted to involve clinicians’ peers,” Simmons says. organizations can set the stage to improve clinician wellness. vice president, Patient and Clinician Experience, Envision sonal and professional well-being is paramount for their per- Physician Services, at [email protected]. sonal health and their ability to care for patients. One way the Wellness Champions have done this is through “It’s one of the hardest professions on the planet—to be all a specific communications subprogram that engages a team in with their minds and their hearts, with all of the other COVID-19 Resources “Keeping clinicians safe and healthy is critical to treating all of clinical and nonclinical experts who work together to pressures that are swirling around them,” O’Meara says. “As During this unprecedented and challenging time in patients and ensuring clinicians’ long-term ability to deliver develop solutions that remove barriers to patient care. a society, we owe it to clinicians to look out for them.” healthcare, clinicians need even more wellness patient care in the communities they serve,” Simmons says. resources and support than ever. For a collection of “Every day our clinicians go to work in our complex medical sys- The Wellness Champions Program’s support extends beyond resources related to caring for patients with COVID-19, In the practice of medicine, clinicians are consistently exposed tem, they are climbing up a mountain,” Simmons says. “Now its 27,000 Envision colleagues, as many are sharing visit envisionhealth.com/covid-19ACHE. to trauma and stressors on the job. While they have training imagine you have a pebble in your shoe, and you’re trying to the benefits of the program with their hospital partner

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irk By Susan B The soaring incidence of mental health problems triggered by COVID-19 and the resulting precipitous economic downturn, combined with the social distancing required to curb the coronavirus’ spread, have thrust telemental health into the spotlight.

When the pandemic hit, hospitals “We hope the temporary regulatory and health systems had to move changes ensuring telehealth access within days or weeks to a virtual due to COVID-19 will remain in model to continue psychotherapy and place,” says Ann M. Schumacher, psychiatric management for patients RN, FACHE, president, CHI and reduce the risk of suicide Health Immanuel and Lasting Hope attempts, ED visits and hospitaliza- Recovery Center, and CHI Mercy tions. Now that many organizations Council Bluffs, Iowa. “Behavioral have made the transition, early signs health translates well to the virtual are that this option will last. platform and eliminates many of the barriers, including stigma, that An encouraging example can be seen may stop patients from following at CHI Health Immanuel, Mercy up with treatment. Patients appreci- and Lasting Hope Recovery Center, ate their ability to access timely and Omaha, part of a 14-hospital net- safe services.” work serving Nebraska and south- western Iowa. It saw virtual Not surprisingly, telehealth, already behavioral health visits during the on the rise in many specialties, has first month of the pandemic rise to shown value as a delivery tool for 85% (from 2%) of encounters and emerging behavioral health models. the no-show rate drop to less than It offers convenience for patients, 10% (from 23%). brings services to people in remote

JULY/AUG 2020 Healthcare Executive 19 Reprinted with permission. All rights reserved. Providence St. Joseph Health: Optimizing Resources With Telecare With 51 hospitals in seven states, and as the parent organization for 100,000 caregivers, Providence St. areas or for whom travel is difficult, “Behavioral health Joseph Health is large. But it faces and allows clinicians to transport the same high demand for mental themselves remotely, on demand, to translates well to health services and shortage of psy- emergency rooms and inpatient the virtual platform chiatrists seen across the U.S. The units for consultations. system has responded with a model and eliminates many built around the judicious use of “When it comes to integrating psychiatrists as members of a col- behavioral health into service offer- of the barriers, laborative care team that is inte- ings, telehealth also provides a including stigma, that grated into primary care practices. pathway for organizations that Virtual visits are the foundational want to develop more robust behav- may stop patients mode of delivery. ioral health programs but lack the from following up staff to do so,” says Howard J. Telebehavioral health was intro- Gershon, LFACHE, founding prin- with treatment.” duced as an option 10 years ago at a cipal of New Heights Group, handful of the system’s suburban Santa Fe., N.M. “Telehealth allows —Ann M. Schumacher, RN, FACHE and rural hospitals, where need was CHI Health Immanuel and organizations to expand their treat- Lasting Hope Recovery Center, greatest. Since 2016, the system has ment capacity.” and CHI Mercy Council Bluffs been offering virtual services at 35 hospitals, and further expansion is Jay H. Shore, MD, director of tele- planned. medicine at the Helen and Arthur system and practitioner will go E. Johnson Depression Center, through their own process of figur- “We’ve headed decidedly away from University of Colorado Anschutz ing out the optimal blend.” a traditional one doctor, one patient Medical Campus, and chair of the relationship to a multidisciplinary American Psychiatric Association’s A silver lining with COVID-19 is approach that includes on-demand Committee on Telepsychiatry, the fact that mental health is receiv- service with a counselor or nurse notes that, “like anything in medi- ing heightened attention, Gershon practitioner with psychiatrist cine, there are complexities observes. “People are learning that backup,” says Todd Czartoski, MD, involved in implementing telepsy- telesolutions in mental health ser- chief medical technology officer for chiatry, but as a field, it has vices are readily available and work telehealth. “We use social workers matured, and especially since well. This shot in the arm will help and other allied health professionals COVID, it is coming to the main- us use these options to treat more to spread the expertise. The impor- stream. My assumption is that we’ll people,” he says. tant part is connecting patients to have more virtual options once the ecosystem so that if someone COVID ends—hybrid care that Following are profiles of three orga- does need a psychiatrist, we can will include in-person visits as well nizations that have used virtual tech- seamlessly make that referral.” as videoconferencing, phone, nology to broaden their behavioral patient portal and email communi- health services in some innovative Embedding psychiatrists into pri- cation. We’ll see more technology ways, both before and during the mary care practices via virtual care in care going forward, and each pandemic. works well because “primary care is

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WF76131-C KHRS Results Innovation Ad 8.375 x 10.875 Bleed 8.25 x 11.indd 1 5/18/20 3:15 PM involvement in telepsychiatry revolved around the use of a third- party service to cover the nonprofit five-hospital system’s EDs and floors. The behavioral health division at Willowbrooke at Tanner, where most behavioral healthcare “Like anything in the system’s inpatient behavioral really occurs,” Czartoski notes. “The health facility, provided telepsychi- best ER visit for a mental health issue medicine, there are atry for the system’s more remote is the one that never happens. It’s the complexities involved in campuses. one you can prevent by seeing people before they go into crisis.” implementing tele- When COVID-19 hit, Layered in with these ambulatory psychiatry, but as a field, Willowbrooke moved its psychia- offerings are self-service digital trists from in-person inpatient care tools that help patients monitor it has matured, and to daily teleporting from home. The their condition. The apps drive especially since COVID, reduced “windshield time” afforded additional cost efficiencies. “We’re by the shift allowed the psychiatrists not eliminating psychiatrists; we’re it is coming to the to assume responsibility for the con- adding digital resources to free psy- mainstream.” sult service that was being handled chiatrists to care for larger popula- by the outside vendor, reports tions,” Czartoski says. Wayne Senfeld, EdS, senior vice —Jay H. Shore, MD president for behavioral health. Helen and Arthur E. Johnson A second major initiative at Depression Center Providence St. Joseph is a service for University of Colorado While the use of telepsychiatry dur- employees and their families called Anschutz Medical Campus ing the COVID-19 crisis “hasn’t Behavioral Health Concierge, an on- been optimal for every patient, it demand help line with a record of Providence St. Joseph for telemental has provided a very good alternative responding quickly to employees’ health have consistently been higher and enabled us to manage our needs since its rollout a year ago. than in-person visits. patients effectively,” he says. Czartoski reports that 65% of people are seen within 24 hours. Virtual care has been particularly Senfeld, who chairs the Psychiatry meaningful during the pandemic. Committee of the Georgia Hospital Developed partly in response to some “For patients in a COVID isolation Association, notes that Willowbrooke physician suicides within the organi- unit who haven’t seen a person with is the only behavioral health hospi- zation, the service sees 400 individu- an unmasked face in 10 days, a tal in the state he knows of that als monthly and continues to fill a remote visit with a psychiatrist dur- continued providing both inpatient vital need during the pandemic. ing which masks are not required and outpatient services without “Physicians are notoriously reticent to can be a more intimate experience interruption during COVID-19 ask for help, but 21% of the people than if the psychiatrist were in the using telehealth. using the concierge are physicians,” room,” Czartoski says. he says. The wider utilization of virtual care Tanner Health System: catalyzed by COVID-19 has also had Czartoski says virtual visits enhance Virtual Continuity Lowers the unanticipated benefit of allowing the patient experience rather than Recidivism the same psychiatrist that treated a detract from it. He reports that Before COVID-19, Carrollton, patient remotely during their inpatient satisfaction scores at Ga.-based Tanner Health System’s patient stay to continue seeing that

22 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. patient remotely after discharge with- “We’ve headed decidedly Communications Commission’s out a break in continuity of care, COVID-19 Telehealth Program. notes Kenneth Genova, MD, away from a traditional Willowbrooke’s executive medical one doctor, one patient The program is distributing $200 director. million appropriated under the relationship to a Coronavirus Aid, Relief, and Because the hospital serves as a multidisciplinary approach Economic Security Act to help non- behavioral health services provider profit and public eligible healthcare for a large swathe of Georgia, that includes on-demand providers address care access issues including a sizeable share of the service with a counselor or related to the pandemic by develop- state’s indigent people, some of ing new or expanded telehealth capa- whom might live two or more hours nurse practitioner with bilities. As of mid-May 2020, when away, it hadn’t been practical for psychiatrist backup.” Genesis PrimeCare was announced the same providers who’d treated a as a recipient along with 32 other patient during their hospitalization organizations, the program had dis- to continue seeing them for outpa- —Todd Czartoski, MD tributed $33 million in funding. Providence St. Joseph Health tient care. an established, well-staffed behav- Genesis PrimeCare received That changed with the pandemic. ioral health program from tele- $990,000 to expand telehealth “Until the world gets to a calm porting practitioners to a smaller and remote patient monitor- place where local psychiatric ser- or even a larger hospital that ing services for primary, vices can be accessed more readily, doesn’t have the same depth of pediatric and we’re taking care of everybody expertise?” he says. behavioral health- that we see from the moment they care for low- hit the ERs all the way back to Genesis PrimeCare: Remote income their communities,” Genova says. Therapy for Underserved and 46.6 “The change to virtual delivery Populations during COVID has reduced recidi- Genesis PrimeCare, Marshall, Texas, MILLION vism by enabling our inpatient level a seven-site network of primary and Americans in 2017 of care to be extended to more specialty care clinics, is among the experienced mental patients on an outpatient basis.” 82 healthcare organizations illness in a given that have received fund- year (one in five). Though Willowbrooke’s practitio- ing so far under the Source: National Institute ners all transitioned successfully to Federal of Mental Health telehealth, some adapted exception- ally well. Their ease with virtual medicine will be tapped to help 13.5 MILLION the hospital build a full-scale telepsychiatry service, Genova says. adults had an unmet need for mental health services, and 20% encountered Genova sees potential for organi- a roadblock to accessing care. zations that eliminated their Source: Association of American Medical Colleges behavioral health programs years ago to begin offering mental health services again through telepsychiatry. “What’s to stop

JULY/AUG 2020 Healthcare Executive 23 Reprinted with permission. All rights reserved. by having educational conversations with the patients, followed by brief teletalks—informal chats, not therapy sessions—so patients could get a taste of videoconferencing. “All of underserved communities in rural “The virtual visits have our patients were pleased with this northeast Texas. option once they tried it,” Roadcap helped many people says. “And their transportation issues In the behavioral health space, that feel less isolated are gone.” funding has been used to support the during the pandemic. Patients whose children were a dis- organization’s journey from all on-site Telehealth allows us to traction during therapy appoint- therapy and counseling services to an ments were encouraged to let their environment in which 90% of visits continue encouraging children watch a movie or engage are now done remotely. patients to practice in an activity to free their parents to focus on their session. “Many “While we’re eager to get some their healthy coping patients have indicated they would patients back into the clinic when it mechanisms. It’s like to continue with virtual ther- is safe for certain types of therapy apy because they no longer have to that are more conducive to being working.” arrange and pay for childcare for on-site—such as eye movement their appointments,” Roadcap says. desensitization and reprocessing —Carla Roadcap therapy for post-traumatic stress Genesis PrimeCare Dedicated patient service representa- disorder—our patients love the tives at three of Genesis PrimeCare’s televisits, and our providers feel locations handle telehealth appoint- they’re able to meet their patients’ The organization faced some chal- ment scheduling and help patients needs,” says Carla Roadcap, CEO. lenges during the transition. Many of work through any technical glitches the behavioral health patients were before their therapy sessions begin. initially uncomfortable with the idea The organization’s IT department of not being in the same room with steps in occasionally to assist some their therapist. To gently raise their patients who lack sufficient internet comfort level, the practitioners began connectivity.

Despite some patients’ initial hesi- tation, “the virtual visits have helped many people feel less isolated during the pandemic,” says Roadcap. “Telehealth allows us to continue encouraging patients to practice their healthy coping mechanisms. It’s working.”

Susan Birk is a Chicago-based freelance writer specializing in healthcare. Lea Radick, writer, Healthcare Executive, contributed to this article.

roche.com/strongertogether On the Horizon: Precision Medicine’s Wider Reach

Valuable partnerships can help organizations achieve benefits and mitigate challenges.

“ My hope is that 10 years from now, we will we’re trying to improve survival,” says Milan Radovich, PhD, “We think in terms of all diagnostic and monitoring modali- in my opinion, is not the community centers trying to do look at precision medicine just as we did associate professor of surgery, medical/molecular genetics, ties and how can we incorporate that together to take the what academia does. It’s bringing the expertise and distribut- when imaging and other technologies first and vice president of oncology genomics, Indiana University best care of the patient,” says Alan Wright, MD, CMO. “It’s ing the technology to them so there is a blend.” became mainstage—that it becomes a Health. “Data show that genomic technology improves out- really about the patient’s journey, from health into sickness ubiquitous thing that we do.” comes. It also helps us understand some of the etiology of and back to health.” One of the numerous benefits of these collaborations is where the disease came from, particularly in those patients expanding patient access to new drugs and clinical trials, —Milan Radovich, PhD who are born with mutations that they inherited that pre- With precision medicine, each phase of a patient’s treatment which community healthcare sites often cannot access. “To Associate Professor of Surgery, Medical/Molecular dispose them to developing the disease in the first place. journey is customized to that patient, from diagnosis to treat- me, one of the most disheartening things is to give hope to a Genetics/Vice President of Oncology Genomics We want to be able to help those patients’ relatives, for ment selection and risk stratification, all the way through to patient by applying this cutting-edge technology, getting a Indiana University Health example, if cancer runs in the family.” relapse detection. “There’s a lot of data points there, and a result and then saying, ‘To get this, you have to drive five Indianapolis lot of information to coordinate,” Wright says. hours away,’” says Radovich. Enthusiasm for this type of care is high among patients as it Precision medicine is one of medicine’s most promising areas. becomes more popular. “It’s not uncommon these days for Having access to the latest, most reliable testing technologies Are there barriers to making precision medicine more widely But though the strategy—tailoring medical treatment to an patients to come into clinics to see oncologists and say, ‘I’ve and being able to pull it all together based on a patient’s available? Yes. But are those hurdles insurmountable? For individual patient’s needs rather than using a one-treatment- read about it in the news—how do I get access to this tech- unique needs is vital to advancing patient care, research and Schneider and Radovich, the answer is a hopeful “No.” fits-all approach—has been around for many years, success- nology?’” Radovich says. clinical implementation. “The partnership with vendors ful implementation has so far only been achieved by a always starts with having incredibly impeccable testing capa- “I think there are some definite hurdles, but I think they can handful of large health systems. This can all change, however, Seek Out Partnerships bilities that we can be comfortable with because when we be overcome,” Schneider says. in the coming years if today’s healthcare organizations can There are steps organizations of all sizes can begin to take think about the results of these tests, they’re going to impact overcome obstacles to adopting precision medicine, including toward developing a precision medicine strategy and making ultimately what drug a patient gets, and in many ways that’s Adds Radovich, “My hope is that 10 years from now, we will by seeking innovative collaborations. this care approach more widely available. One such step is a life or death decision,” says Schneider. “In addition, part- look at precision medicine just as we did when imaging and partnering with cutting-edge technology vendors. nerships are really what allow us to push technology and the other technologies first became mainstage—that it becomes Precision Medicine’s Rise clinical implementation of that technology to the next level.” a ubiquitous thing that we do.” An emergence of cutting-edge technology has thrust preci- “The technology is advancing at breakneck speed, so work- sion medicine more into the spotlight in recent years, according with vendors that supply particular technologies to a Form Community Collaborations For more information, please contact Cari Nicholson, ing to Bryan Schneider, MD, Vera Bradley Chair of Oncology, wide swath of users and who themselves are keeping that Another path to expanding precision medicine is for smaller, marketing manager, Roche Diagnostics Corporation, professor of medicine and medical/molecular genetics, and technology up to date is very beneficial,” Schneider says. community-based healthcare provider organizations to part- Indianapolis, at [email protected]. co-leader of the Indiana University Precision Health Initiative Because of its relationship with supplier partners, Indiana ner with existing precision medicine programs. Indiana at Indiana University Health, Indianapolis. “We’ve tried for University Health’s precision medicine program is able to University Health’s program includes four clinics across the many years to get the right drugs to the right patients while deploy a vast array of technologies in its diagnosis and state, with three in rural areas. The university’s staff members COVID-19 Resources minimizing side effects,” Schneider says. “But there has been treatment of patients, including genomic sequencing, liquid work with clinic staff on interpretation, database matching, Roche Diagnostics has resources available to healthcare providers for navigating the evolving challenges of an evolution of technology that has allowed us to now do biopsies, cloud-based IT and more. bioinformatics and more. COVID-19. Please visit https://diagnostics.roche.com for this at a markedly greater depth.” more information. Tailoring care to individual patients—the heart of precision “This model allows us to distribute our university expertise Use of cutting-edge technology, such as genomic sequenc- medicine—requires a broad portfolio of testing and monitor- and to provide an unprecedented level of access, as most Note: This advertorial was developed prior to the ing, can have innumerable benefits for patients. “When we ing techniques, something Roche Diagnostics Corporation patients are seen within a week of referral at the expansion unfolding COVID-19 crisis. can match a patient’s tumor genome to the right drug, knows well. sites,” Radovich says. “The future state of precision medicine,

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JA20_Advert_roche.indd All Pages 6/15/20 1:46 PM HEALTHCARE MANAGEMENT ETHICS

Empathy’s Role in During an extended phone conver- sation I had with Riess early this Improving Resiliency year, she emphasized that the quali- ties of empathy are teachable and, eventually, lead to an improvement Genuine compassion can help heal staff in staff attitudes and behavior. members and patients. Paul B. Hofmann, DrPH, More recently, she told me, “During LFACHE the COVID-19 pandemic, empathy is needed more than ever at every level of healthcare organizations. Given the unprecedented impact of Helen Riess, MD, provides several Our patients need greater empathy the coronavirus pandemic, accelerat- breathtaking examples of human because of the increased threats to ing steps needed to elevate empathetic empathy (see sidebar below). their safety, and our colleagues need behavior is especially important. A During the talk Riess says, “The support and permission to ask for psychologically safe and just culture good news about empathy is that help that may be difficult for them.” will assist staff and patients in coping when it declines, it can also be more effectively when uncertainty and learned. Employers who want to Riess created the acronym E-M-P-A- fear are so ubiquitous. There is no have an engaged and productive T-H-Y to help us remember the key panacea, but each incremental effort workforce need to get tuned into pieces of how we connect to people. will be worth the investment. the people. Patients who don’t In the TED Talk, she describes: feel cared about have longer recov- In her notable 2013 TED Talk, ery rates and poor immune • The “E” represents eye contact. Harvard professor and psychiatrist function.” Every human being, Riess says, “has a longing to be seen, under- stood and appreciated.” The Power of Empathy • The “M” represents facial expres- sion muscles. Riess suggests our Harvard professor and psychiatrist Helen Riess, MD, works at Massachusetts General faces are actually a road map of Hospital and is the co-founder, chief scientist and chair of Empathetics Inc. Her remark- human emotion that can rarely able 2013 TED Talk, “The Power of Empathy,” has been viewed over 500,000 times. be completely hidden. During the talk, Riess mentions having received a request from one of her students who wanted to determine if, when there is empathy between people, their heart • The “P” represents posture. rates and other physiological tracers become concordant. The student also wanted to Riess indicates “posture is recruit doctor-patient pairs who were willing to have their sessions videotaped and be another powerful conveyor of hooked up to monitoring devices during those sessions. Riess approved the project, connection.” She cites a widely participated in it and, in the TED Talk, explains how she became a more effective publicized study (Journal of Pain therapist as a result of analyzing the videos. According to Riess, the familiar state- and Symptom Management, May ment, “I feel your pain,” is actually validated by neuron studies of the brain. 2005) in which researchers at MD Anderson Cancer Center in This experience led her to learn everything she could about the neuroscience of Houston found that physicians empathy which, in turn, motivated her to develop empathy training grounded in the who were asked to sit down neurobiology of emotions and empathy. The training was evaluated in a random- when making rounds in a ized control trial where those doctors trained in empathy were reported by patients patient’s room were rated as as being better listeners, showing more compassion and better understanding being much warmer and more patient concerns. caring and were estimated to have spent three to five times

28 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. longer with their patients than “To enable unhurried conversations, Executive, we recommended several doctors who remained standing, whether face-to-face, via telemedicine, steps that should be taken to pro- even though both sets of physi- asynchronous or virtual, participants mote a culture of empathy. At least cians spent the same amount of need to make themselves cognitively three deserve re-emphasis: time with patients. and emotionally available.” • Establish objective performance • The “A” represents affect. indicators, standards and goals Physicians are trained to evaluate Any program that promotes regarding patient-centered care; a patient’s affect as a way of assess- empathy and benefits monitor results; and routinely ing the person’s emotional state. report findings to senior manage- patients as well as staff by ment, medical staff leadership • The “T” represents tone of voice. increasing their resiliency and board members. According to Riess, the nuclei for tone of voice and facial expres- in the face of pandemics, • Create opportunities for patients sion reside in the same area of illness, trauma or and family members to promote our brain stems. “This means quality healthcare and improve that when we are emotionally occupational stress should be workflow processes by serving on activated, our tone of voice and pursued vigorously. hospital advisory committees. our facial expressions change without our even trying,” Riess • Insist that senior executives make says. With practice, Riess notes, It is true that the term “unhurried regular patient rounds to remind we can become more capable of conversations” implies that such dis- them of the value of interacting hearing and seeing what these cussions will take more time than directly with patients and staff emotions are. perhaps is desired when there are on clinical units. intense pressures on clinicians to • The “H” represents hearing the increase productivity, see more Given our experience with COVID- whole person. “Far more than the patients and become more efficient. 19, we know resources and time are words that people say, hearing However, reality and perception are going to be insufficient to meet the the whole person means under- not always aligned. This familiar needs of every clinician. Consequently, standing the context in which adage was confirmed by five notewor- any program that promotes empathy other people live,” Riess says. thy articles: the previously cited 2005 and benefits patients as well as staff issue of the Journal of Pain and by increasing their resiliency in the • The “Y” represents one’s Symptom Management; a 2011 issue of face of pandemics, illness, trauma or response to others’ feelings. “We Patient Education and Counseling; a occupational stress should be pursued respond to other people’s feel- 2016 issue of the Patient Experience vigorously. s ings all the time,” Riess says. Journal; a 2016 issue of the Journal of “We might think that we only Hospital Medicine; and a 2017 issue of Paul B. Hofmann, DrPH, LFACHE, experience our own emotions, the Journal of Nursing Care Quality. is president of the Hofmann but we’re constantly absorbing Each article reported the results of Healthcare Group, Moraga, Calif., the feelings of others.” studies that consistently demonstrated and co-editor of Management that patients perceived doctors and Mistakes in Healthcare: The Importance of Unhurried nurses spending more time with them Identification, Correction and Conversations than other clinicians when the staff Prevention, published by Cambridge The article “Careful and Kind Care member simply sat down. University Press and Managing Requires Unhurried Conversations,” Healthcare Ethically: An Executive’s published in the Oct. 29, 2019, issue In an article I co-authored with Guide, published by Health of NEJM Catalyst, highlights a simi- Jeffrey Selberg in the January/ Administration Press (hofmann@ lar theme. According to the authors, February 2006 issue of Healthcare hofmannhealth.com).

Healthcare’s Emerging urged staff who felt sick to stay home, entire schools were shut down and Reality Post COVID-19 universities made plans to teach via online platforms. As frame breaking as that was at the time, “it would have Changes will be seen across many areas, been incomprehensible if local hospi- including patient experience. tals were to employ the same strategy,” K. Joanne McGlown, Friedman says. During the swine flu PhD, RN, FACHE outbreak, the question was asked: What do hospitals need to do to prepare for the next pandemic? As this article went to press, there and become more prevalent in our were still many unknowns. Predictions future, according to Steve Nadeau, Foreseeing the future, Friedman pro- of potential new waves of the former executive vice president, posed using alternative treatment COVID-19 virus into 2021 seemed Gwinnett Medical Center, sites for routine or nonpandemic- likely to come true, compounded Lawrenceville, Ga. related care, freeing hospitals to treat by interaction with the normal flu the most critically ill patients only. season. Here is a generalized indus- He also suggested allowing nurses try assessment of the emerging real- Patient experience and and paraprofessionals control over ity and what our altered health satisfaction, however, may certain treatment areas. system might look like in light of COVID-19. not have the emphasis We have now, during the current they previously did prior pandemic, experienced some of Changing Patient Expectations these changes. According to Though some have predicted this to the pandemic. Patients Fredrick “Skip” Burkle Jr., MD, crisis will crush the hospital indus- and families will still expect senior fellow and scientist, Harvard try in the short term, few would Humanitarian Initiative, the argue that it will not change the a certain level of healthcare field has learned two field drastically in the future. “The personalized care. strategies from the 1918–1920 reported demise of hospitals is on Spanish flu pandemic—social dis- hold for the time being. COVID-19 tancing and vaccines; however, has taught us that hospitals are Changing Approaches to Burkle cautions, “Social distancing essential to respond to important Preparedness will only work if it is done environmental jolts,” says Leonard The COVID-19 situation will have completely.” Friedman, PhD, FACHE, professor, lasting effects on hospitals’ and Department of Health Policy and health systems’ disaster planning and Rise of Technology, Failure of the Management, and director, preparedness strategies. “The infra- Medical Supply Chain Executive Master of Health Services structure and processes that we cre- In an April 21, 2020, article in the Administration, George ated over the years, primarily to Prehospital and Disaster Medicine Washington University. respond to natural disasters that have journal addressing failures in the a more defined start and finish, need medical supply chain, Greg Burel, Patient experience and satisfaction, to be modified for pandemic situa- prior director of the Strategic however, may not have the empha- tions,” says Phillip D. Robinson, National Stockpile for Assistant sis they previously did prior to the FACHE, president, Lankenau Secretary for Preparedness and pandemic. Patients and families Medical Center, Wynnewood, Pa. Response, wrote: “There are limita- will still expect a certain level of tions on all products … The medical personalized care. However, visits In 2009, when planning for the possi- supply chain is very fragile … There with nurses may satisfy that need ble swine flu outbreak, employers is never more than about 30 days of

We’re passionate about innovations that have impact. Which is why we’re bringing consumer technologies into the digital patient experience. For example, by working with Change Healthcare, providers can improve eﬃ ciency and revenue capture while oﬀ ering patients self-serve tools that match their familiar, everyday digital experience. It’s one more way we’re helping change healthcare for the better.

projected need for the entire market about the importance of this issue is “EQ is more important than IQ. available … There is no safety stock critical. Some institutions have been Emotional intelligence is going to … Coming out of this on the other using PPE in ways inconsistent with be one of the most important attri- side, we’re going to have to really standards of care, and patient treat- butes for highly effective health rethink the entire healthcare supply ment and provider protection is suf- sector leaders,” says Friedman. chain.” fering as a result, according to Strong leadership, trusted commu- Burkle. Whether it be in hospitals, nication based in science and coor- Throughout the COVID-19 crisis, or in the prehospital setting, there dination among all levels of of all the healthcare-related tech- will be increased emphasis on thor- government, public health and the nologies, the EHR has made the ough disinfection and airborne pro- entire healthcare continuum are— tracking of patient demographics, tection and use of PPE as a standard and will be—imperative. trends and outcomes amazingly of care for all. sophisticated, and “there is a gold Positive Futures? mine of information available both Rise of Telemedicine and The emergence of public health driv- to manage through the situation Telehealth ing the medical response of our and in analyzing and learning from The rapid growth in telemedicine nation has arrived. The response of it after the fact,” says Robinson. begs the questions: How does this get individual healthcare workers and “Also, adding process engineers in paid for, and how do we deal with the public has been positive. The the command centers, and with our the interstate practice of medicine? Federal Emergency Management key work teams, added a new level George Washington University’s Agency has been granted authority of sophistication for modeling surge Friedman believes these two ques- to respond to pandemic events, plans, tracking utilization and clin- tions will come into focus in the which is new, and is also seen as a ical data, and allowing us to man- coming months. positive. age and adjust our plans, almost real time. This will continue in the Telemedicine will continue to expand Global public health is also show- future.” and may become the norm for physi- ing its value. And, in our future, cian offices, especially for follow-up wearable technology, combined Protection of Workers’ Mental and visits, suggests Nadeau. However, with big data and analytics, will Physical Health provider-initiated refusals (under allow patients and clinicians to The mental and physical toll of this medical direction and in conjunction better manage chronic conditions, pandemic on the front-line work- with telemedicine) will see greater suggests Friedman. Adds force seems to be much greater, and acceptance in prehospital care, Woodworth, “COVID-19, while may be much longer lasting, than as according to Fifer. tragic, may help us change ways we seen with even some of the major set standards and force needed disasters of the past because it is Crisis Leadership changes in the way healthcare busi- nationwide and global in scope. A Healthcare administrators have nesses are run.” s whole generation of healthcare work- reported that the lack of coordina- ers will be permanently impacted by tion at all levels caused delays and K. Joanne McGlown, PhD, RN, this experience, especially if it lin- confusion during the early COVID- FACHE, is assistant professor, gers over a year or two. Others may 19 outbreak. James Phillips, MD, of Disaster Management, Homeland decide to leave the field as a result, the George Washington University Security, Eastern Kentucky Robinson suggests. School of Medicine and Health University, and CEO, McGlown-Self Sciences, states that at the highest Consulting LLC, both in Richmond, In addition, there most likely will be levels, responding to this crisis can- Ky., and co-author of Anticipate, a continued demand for personal pro- not be about politics—it’s about cri- Respond, Recover: Healthcare tective equipment in the workplace. sis leadership. The ability to Leadership and Catastrophic Events The global lack of PPE during this communicate the issues at hand is (Health Administration Press, 2011) pandemic and misunderstanding critical. ([email protected]).

32 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. Thank you for your work behind the scenes to tame the crisis, putting patient needs first and adapting quickly to changing guidelines. We are grateful for your perseverance and dedication.

JA20_HealthcareAppreciation.indd 1 6/5/20 8:33 AM OPERATIONAL ADVANCEMENTS

Improving Operations Through Efficiency

Multifront energy savings plan increases patient comfort, reduces costs. John P. Duraes Kim N. Hollon, FACHE

Healthcare organizations today are system leadership and the board $400,000 per year but the actual seeking energy efficiency solutions to with details about the age of the savings are only $380,000, the sup- improve patient comfort, help them facilities’ systems, including which plier will pay Signature Healthcare act as good environmental stewards ones were beyond life expectancy, the difference. Overall, by May and reduce costs. For a health sys- were no longer supported by their 2020, when the initiatives have tem containing facilities that are up manufacturers, or did not meet been in place for a full year, the to 100 years old, such infrastructure revised codes and standards. Using health system is projected to upgrades are even more important. this information to form their deci- achieve more than $380,000 in With that in mind, Signature sion-making process, system leader- operational savings and more than Healthcare, Brockton, Mass., under- ship approved entering into a $470,000 in energy savings for the took several initiatives in 2018 to 12-year contract with the supplier first year. update old equipment and bring new that focused on several key initia- efficiencies to the health system. tives (see “Key Energy In addition to financial savings, the Improvements” on Page 35). energy efficiency measures imple- A Multipronged Plan mented will greatly reduce the health In 2018, Signature Healthcare’s Significant Savings system’s annual greenhouse gas emis- leadership was interested in pursu- Signature Healthcare’s plan to sions, with a projected 22% reduction ing energy efficiency solutions but reduce energy consumption and of electricity use and natural gas had limited capital funding to reduce overall costs has resulted in reduction of 24%. address the needs of its facilities’ significant benefits to patients and outdated infrastructure. An oppor- staff. In addition to making Lessons Learned tunity came when a supplier part- patients more comfortable through- There have been several lessons learned ner approached Signature to out the facilities, installation of by the health system’s leadership: participate in a guaranteed savings newer, more reliable equipment will program to upgrade a 40-plus-year- help eliminate vulnerabilities asso- Plan for the unexpected. When old boiler and address several other ciated with equipment downtime or upgrading old equipment and infra- energy efficiency needs. failures. structure, organizations often discover other, related upgrades that Working with the supplier, The improvements are projected to need to be made. When Signature Signature Healthcare conducted a result in substantial financial sav- 120-day assessment that identified ings as well. The health system esti- This column is made possible in part several energy-efficiency improve- mates that the savings will pay for by BRG Prism. ments throughout the system, the $9 million expense of installing which encompasses seven locations, the new equipment and systems. In including the 124-year-old addition, the supplier has guaran- Brockton (Mass.) Hospital. The teed that savings. For example, if assessment also provided health the savings are projected to be

34 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. Healthcare updated its boilers, it many schedule considerations, after any improvement projects. discovered the electrical panel that Signature’s leadership had to take The end users can predict whether supported its old boiler room would into account: the date for new a certain design will help—or not support the newly improved equipment delivery; a date for tem- hinder—their work. one. The health system had to porary boiler connections; duration invest an additional $80,000 to of the demolition of the original Finally, leaders must create a cul- upgrade the electrical system. system; duration of the new system ture of communication and caring, installation; and consideration for and build positive working relation- Have a well-defined schedule. time of the year, with particular ships with the staff whose work is Installing the new equipment took regard for weather conditions. affected by major projects. Everyone place during two phases and Leaders should keep in mind that feels better about their work when required a great deal of coordina- projects such as these could poten- they have buy-in and understand the tion. First, a temporary boiler sys- tially affect an organization’s fiscal goals of new organizational initia- tem had to be connected to the budget for two years. tives. And that pride shows in the building during the removal of the day-to-day operations of facilities old plant and the construction of Involve end users in planning and old or new. s the new plant. Upon completion design. After the new equipment and testing of the new plant, the is installed, it is the mechanical John P. Duraes is former director, connection was made from the tem- engineers and other related staff facilities and engineering (jduraes@ porary boiler to the boiler’s plant. who will be charged with operating signature-healthcare.org), and Kim N. With so many steps involved with the new equipment throughout the Hollon, FACHE, is president/CEO both phases, the project schedule facility. It is crucial to seek input ([email protected]), had to be well-defined. Among the from the staff initially, during and Signature Healthcare, Brockton, Mass.

Key Energy Improvements

Working with a supplier through a guaranteed savings $400,000 annually due to this automation and elimination program, in 2018, Signature Healthcare embarked on several of wages paid to full-time engineers. solutions to improve energy efficiency. The updates included: Reduced water use, including installing flushometers in all Installation of five new 8.5-horsepower high-efficiency, urinals and toilets at the hospital and in all off-site locations. high-pressure boilers that replaced boilers that were over 30 years old. The boilers are primarily used in the sterilization Updated lighting system, including changing all lamps process of surgical and other instruments, and the new ones throughout the hospital and in the parking lots to LEDs were relocated closer so that less steam was lost. The health from traditional incandescent lightbulbs. Newly installed system also installed three new low-pressure, 250-horse- lamps are warrantied for up to 10 years, resulting in energy power boilers, used for heating and hot water, which replaced and cost savings on labor, as the bulbs will not have to be older 500- and 300-horsepower boilers. changed as frequently.

Automation of the health system’s infrastructure. Upgraded HVAC system, including improved temperature The boilers were placed on electronic controls, which elimi- and humidity controls in operating rooms. nated the need to have full-time standing engineers watch- Installation of a cogeneration unit in the hospital. This ing the boilers (licensed boiler operators mandated by state type of generator runs on natural gas, which is clean burn- and county regulatory agencies to be present 24/7, 365 days ing. It generates electricity for the building and produces per year). The health system estimates it will save close to hot water, which helps reduce wear and tear on the boilers.

COVID-19 Reveals Economic Security Act is an emphasis on and increase in the use Silver Linings of telehealth in patient care. Studies show that virtual visits could effectively replace office visits, but physi- Hospital policies and procedures will improve cians pushed back citing three in the wake of the new coronavirus. concerns: 1. the potential for Paul H. Keckley, PhD breaches of patient privacy, 2. the inadequacy of virtual interactions in capturing vital patient information (e.g., signs, symptoms, risk fac- The long-term impact of the corona- outbreaks at home and abroad under tors, comorbidities) and 3. low virus pandemic on the U.S. economy the umbrella of the Centers for reimbursement by private insurers. and the health delivery system is still Disease Control and Prevention. A 2019 survey of physicians con- being assessed. What’s clear is that it ducted by a telehealth company has thrust hospitals to the forefront Infectious diseases and social deter- reports physicians’ willingness to of public consciousness. minants of health that heighten a use telemedicine increased from community’s susceptibility to infec- 57% to 69% between 2015 and As the surge progressed, attention tion are not a primary focus for most 2018, but only 22% were actual focused on the adequacy of beds and hospitals, medical practitioners and users. Physician reluctance was the supplies and the heroism of front-line insurers. Epidemiology and disease major deterrent to wider use of tele- caregivers. Administrators transitioned prevention are typically out of scope health before the pandemic. to crisis mode: The immediate avail- until they require treatment. Often, ability of N95 masks, ventilators and that’s too late. Public acceptance of telehealth is ICU beds displaced all other concerns. not an issue. A study published in The COVID-19 pandemic was pre- JAMA in 2018 found that from dictable: it’s the fifth global coronavi- 2005 to 2017, there were 383,565 OF FRONT-LINE rus pandemic in 20 years. Warnings telemedicine visits by 217,851 were sounded as early as April 2019. patients growing at a rate of 52% 20% CAREGIVERS However, CDC guidance about the annually. The mean age of users was treating COVID-19 patients got infected. COVID-19 pandemic was slow, leav- 38.3 years; 63% were female, ing some hospitals and physicians ill- 83.3% resided in urban areas and It’s clear the pandemic has had a equipped to respond to the eventual telemental health (53%) or primary profound negative impact on hospi- deluge of patients. care telemedicine (39%) were the tals. Operating margins have disap- major reasons for use. peared. Debt covenants are being Ultimately, this inadequate level of renegotiated. Uncompensated care is preparation will bolster public aware- Insurers support increased use of tele- up, and workforces are stretched ness about disease surveillance, medicine. Legislators in 32 states thin. However, there are silver linings investments in public health pro- have passed parity laws to advance its to be found for hospitals from the grams will grow, and closer collabora- use. Thus, barriers to telehealth were COVID-19 pandemic. tion between public health agencies lowering as the pandemic hit the U.S. and local hospitals will be a top prior- health system. The CARES Act Elevated Strategic Imperatives: ity in every community. pushed it into mainstream delivery Public Health and Emergency by requiring insurers to cover it and Preparedness Accelerating Technology-Enabled waiving physician culpability for The U.S. public health system is a Virtual Care HIPAA violations. As social distanc- network of federal, state and local One of the key provisions of the ing was implemented, clinicians used agencies that monitor disease Coronavirus Aid, Relief and telemedicine out of necessity.

36 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. Consequently, the use of telemedicine coronavirus. That meant 50% to in patient care will accelerate as phy- 80% of a hospital’s revenues disap- sician resistance shrinks, insurer cov- peared for two months in most com- erage increases and consumers adopt munities. Treatment of COVID-19 it more widely. patients resulted in as many as 20% of front-line caregivers being infected. Rationalizing Acute Resources Furthermore, uncompensated care The biggest and potentially most con- skyrocketed as the ranks of the unin- sequential result of the coronavirus is sured increased by 15 million. IS IT TIME FOR likely a fresh discussion about the A FRESH LOOK AT role, scope and optimal arrangement What’s ahead for hospitals? As a ACCREDITATION? of hospital services in our system. It’s direct result of the pandemic and its a delicate but inevitable deliberation aftereffect on the U.S. economy, hos- HFAP is celebrating pital consolidation will accelerate, we’re destined to have. 75 years as: and approval by state and federal reg- • A trusted, recognized Today, there are 6,142 hospitals in ulators will weigh public health pre- partner in quality. the United States: 5,197 (85%) of paredness more heavily. In all • A practical, solutions- these are community hospitals oper- likelihood, that means hospitals will oriented accreditor. ated as private for-profit (2,937), consolidate operations, reallocate investor-owned (1,295) or public hos- capital to preventive and primary • A smart, responsive, resource. pitals (965). Some are big; most are care, and rationalize investments in small. Some are very profitable; many traditional acute programs. • A cost-effective one-stop alternative. are not. Some offer a full range of Therein lies the third silver lining: preventive, chronic, acute and long- HFAP accredits: term care services; most don’t. It’s a The pandemic will require hospitals Acute Care Hospitals highly regulated sector where local to rationalize traditional acute care competition is intense and operating programs to fund investments in pri- Clinical Laboratories margins are shrinking. mary care and public health services. Critical Access Hospitals Ambulatory Surgery The COVID-19 pandemic represents As hospital leaders settle into the Centers the single biggest threat to the viabil- post-COVID-19 new normal, day-to- ity of hospitals in a generation. “We day operations will be modified based HFAP certifies: believe the pandemic will result in on lessons learned. All will refresh Stroke Centers sizeable increases in operating costs, policies and procedures for infection Wound Care particularly for labor and supplies, controls, procurement, ED triage, Joint Replacement reduced volume and revenues related formulary design, surge staffing, crisis to elective and nonessential healthcare communications, patient transporta- Compounding Pharmacies needs, reliance on working capital tion, security and much more. lines of credit, and material declines in Lithotripsy providers unrestricted reserves and nonoperating How fast and in what forms these revenue as the investment markets changes occur is hard to predict, but weaken,” S&P Global Ratings states all are inevitable. What’s also inevita- in a March 25 report. ble are the silver linings that are likely LEARN MORE: results of the coronavirus. s WWW.HFAP.ORG Every hospital was required to delay CONTACT US: or cancel elective surgical and diag- Paul H. Keckley, PhD, is managing edi- 312.920.7383 [email protected] nostic procedures and nonemergency tor of The Keckley Report (pkeckley@ office visits to prepare for the paulkeckley.com).

Leading by Greatness Vulnerability Vulnerability is not the indiscrimi- During Crisis nate and uncontained bearing of your soul or revelation of your deepest feelings. Leadership vulnerability is Humility, vulnerability, generosity are keys making sure that the image you proj- to trust and career building. ect to others is aligned with your David Lapin identity. Vulnerability is knowing what your true value-drivers are (the values that are core to who you are as a human being) and allowing the people around you to experience Leading by greatness is the capacity to being part of something bigger than them. It requires that you draw on inspire your teams to extraordinary per- you. Humility is believing that you are your value-drivers when you make formance by bringing the fullness of here to serve something bigger than decisions, have conversations and act. who you are into the way you show up you and people other than you. and lead each day. In times of crisis, this Understanding that we are all here to It is natural that healthcare profession- capacity is more important than ever. serve, although we are each free to als protect themselves from emotional choose who or what we serve and how entanglement with patients by adopt- We are conditioned to behave profes- we wish to serve them, is the founda- ing a professional and somewhat sionally at work. We bring our mental tion of leadership humility. impersonal veneer. It is valuable in capacities, our skills and our training building trust to open yourself a little to work, but we tend to mask our Leaders in healthcare are particularly and share some of your own vulnera- deeper, authentic beings. And yet, our fortunate in that their vocation is obvi- bilities and those of the healthcare sys- authentic selves are the only vehicle we ous and ever-present. There are, how- tem. Show the way to your teams by have by which to inspire the trust of ever, two risks to a healthcare leader’s starting to open up to them in ways others. By hiding our deeper selves, we humility. First, there is the risk of hubris that are authentic and vulnerable. inhibit trust-building and inspiration. resulting from the loftiness of healthcare’s higher purpose. Professionals can Generosity In times of crisis more than ever your easily forget that the individual sitting Generosity is not unconditional giv- people want to know how you are feel- in front of you is the individual you are ing; such giving is not sustainable. ing, not only what you are thinking. here to serve at that moment, no matter Leadership generosity means investing When we wear our professional who he or she is. Leaders need to your time, attention and resources into “mask,” people wonder what lies inspire professionals with this ethos. people who matter to you. Investing in beneath it. Without having some level Second, as healthcare has become more them rather than donating to them of insight into your feelings and focused on efficiency-driven processes, it means you have expectations of some beliefs, it is hard for them to trust you. is too easy to lose focus of the human form of return. It is generous to let suffering and needs of the person in people know why you are investing in In the Lead by Greatness leadership front of you. Policymakers might treat them and what your expectations are. philosophy, there are three key levers healthcare as a set of data points. For the This way they know what to do to of trust: humility, vulnerability and professional, though, healthcare is about generosity. real humans, one as important as the This column is made possible in part next; a single life is as important as by BD. Humility 1,000 lives. Patients feel your energy Humility is knowing that as unique, and know the inner place from which talented and qualified as you are, you you are approaching them. As such, are also part of something much big- your care is as important for their health ger than you. But it is more than your as is your expertise.

How do you know how to focus and prioritize the pressing population health management issues impacting your community? How do you know how to interface effectively with a variety of community leaders, each with their own perspective?

The FACHE® credential is how you know. It’s how you know you are leading your team to work hand-in-hand with the people you serve. It’s also how you know how to motivate employees to contribute to community life and well-being.

Learn more at ache.org/FACHE

FACHE_5-man_8125x10875.indd 1 1/28/19 11:30 AM CAREERS

make you feel satisfied with your most immediate pressures. Being to the crisis at hand. Our reconnec- decision to invest in them. generous with your time and attention must go beyond the transactional. tion is difficult to achieve when a We need to find ways to connect with The barrier to leading with heroic professional is being measured pri- people on a deeper, existential level. greatness is the impact of fear on our marily by efficiency. A course of They need that from us, and as leaders, limbic nervous systems, triggering us action is to help the people in your we need it too. into defensive emotions and teams balance the system’s needs for responses. When we react defensively, efficiency with the patient’s need for Reconnect we tend to focus on our own survival care and attention. Through the crisis we may have been and that of our immediate family to doing a great deal of communicating the exclusion of any notion of service In times of emergency, we naturally with people using various technology to others. During crisis times, it is first respond to the immediacy of the platforms. But communicating does natural to default into survival mode, crisis; however, as soon as possible not necessarily mean connecting. We making defensive decisions that may thereafter, it is important to shift connect with others when making serve us in the short term but could gears from a defensive, fear-driven them the center of our attention dur- cause destructive harm in the longer stance to one of heroic greatness. This ing our interaction. It is hard for peo- term. This is more so for leaders in shift requires first and foremost that we ple to feel this over the phone or even healthcare who often work under reconnect with the people who matter a video conference. It is also difficult conditions of emergency and stress to us both at work and at home and to make the other person the center and can easily be triggered into impa- who may not have felt our presence of our attention when we are in crisis tience as they focus on their own while we were focused on our response mode and worried about survival.

Master the information, tools and online resources that can help you stand out, maximize your career advancement opportunities and get the most out of your healthcare job search. Now through August, save 20% off the member and nonmember price with promo code HCEXEC720.

To learn more and purchase this book online, visit ache.org/HAP. To order by phone, call the ACHE/HAP Order Fulfillment Center at (800) 888-4741 or (312) 337-0747.

MavelySapp Book.indd 1 6/10/20 12:31 PM 40 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. As with all trust-building activities, challenging. In addition, demonstrate factors weigh even more heavily than connection should contain all three genuine interest in how they are man- in other industries because leaders in ingredients of trust: humility, vulnera- aging and in how their families are healthcare depend so much more on bility and generosity. When recon- doing. Ask them what they are strug- the trust they inspire in the people necting with the people in your life gling with the most. When they share they lead, the stakeholders they engage who matter, make sure you are not this with you, don’t feel obliged to and the communities they serve. multitasking and that your attention is offer advice; giving them your atten- not split. Doing other things or think- tion is what they will value. Connection is the key to trust, and ing about other things while talking trust is the vehicle by which to to someone does not demonstrate This approach of connecting with peo- inspire extraordinary acts of both humility and service of the other. Do ple using humility, vulnerability and caring and performance. s your best to focus all your attention generosity is crucial not only in times on the person with whom you are of crisis. This approach is also a key David Lapin is CEO of Lapin engaging. Giving another your undi- component in building your career. International Inc., a consulting and vided attention is one of the most gen- Professional competence is not the coaching firm that helps individuals erous things you can do for them. only factor that drives career advance- and organizations achieve strategic Inquire about them personally, not ment. Being trusted by your peers and clarity and leadership alignment. just professionally, and expose some of a sought-after resource of wisdom, Lapin has significant experience in your own vulnerability by sharing guidance and support is important for healthcare. Please follow him on with them what you are struggling the development of a career in any LinkedIn (linkedin.com/in/davidlapin) with and what you find particularly organization. In healthcare, these or Twitter (@DavidLapin).

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COVID-19 and Executive Succession Management

The pandemic has exposed the need to improve planning for executive turnover.

The COVID-19 pandemic has Despite the many changes COVID- the CEO in leaving behind a legacy made executive succession planning 19 has wrought, every organization of having built a strong, successful even more critical for the board, should include the creation or team and an organization that did considering that only 45% have a update of a leadership succession not miss a step upon his or her plan in place for CEO (and other plan as a key board goal for the departure, no matter the senior executive) succession, accord- next six months. The board chair or circumstances. ing to The Governance Institute’s vice chair should oversee this effort 2019 Biennial Survey of Hospitals in collaboration with the CEO. Create a robust CEO succession and Healthcare Systems. This was plan. With the many disruptions true, even though 80% of survey associated with COVID-19, it is not respondents agreed that “succession The risks of not having sufficient for the CEO succession planning for the CEO and other succession or contingency plan to focus narrowly on simply senior executives is a critical board naming a designated successor or responsibility.” plans in place are far agreeing on which executive search worse than the anxiety firm to hire to identify external candi- Although some CEOs may defer dates. The CEO, working collabora- their expected retirement, how and effort involved in tively with the chair and executive many will instead lead their organi- developing them. committee, should develop a robust zations through the first wave of the plan that includes: competencies and pandemic but then decide they attributes needed in a future CEO to don’t have the stamina needed to Incorporate succession planning accomplish the organization’s strategic lead through the next wave? Faced objectives into this year’s updated vision and plan; a succession timeta- with daunting financial pressures CEO performance expectations. ble; approaches to retaining senior related to the pandemic, will tal- Many (if not most) of the perfor- leaders; potential future role(s) for the ented executives decide to leave the mance expectations that the board departing CEO, if any; a transition field of healthcare management and CEO agreed on at the start of plan; retention planning for key exec- rather than face endless rounds of fiscal year 2020 will need to be utives; a communications plan; a ratio- layoffs, furloughs and cost-cutting? adjusted to reflect the impact from nale for and/or an approach to using COVID-19. The creation and main- an external search firm (if any); and a The following six practical tips can tenance of robust CEO succession preferred timetable for a planned help organizations immediately and leadership development plans retirement or departure. take necessary steps toward ensur- should be incorporated into this ing effective leadership succession year’s expectations for the CEO, for Confirm that contingency plans are management. which he or she will be held up to date. Amid this pandemic, an accountable. Even if the CEO has unexpected CEO departure would be Establish succession planning as no plans for retirement or departure, particularly disruptive to an organiza- one of this year’s board priorities. having these plans in place benefits tion at a time when strong leadership

42 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. is most needed. It is essential that an hit the ground running. He or she, up-to-date emergency succession plan working in tandem with the board, is in place that identifies who would should quickly get up to speed on serve as interim CEO. Preferably, the the organization’s strategic direction, interim CEO would be a competent short-term priorities and culture. current senior leader who knows the The new CEO should work with the organization, its culture and its priori- board to help establish strategically ties. Alternatively, the board should or politically important connections have a firm grasp on what external within the organization and in the organizations and resources can be local and regional communities. The used to fill the interim role quickly. CEO should also expect the board to express clear year-one CEO per- Develop the next generation of formance objectives and expecta- leaders. Developing future leaders tions for which the new CEO will should be considered a necessity that be held accountable, recognizing is integral to an organization’s opera- that if COVID-19 persists or is sup- tions. This pandemic has highlighted planted by a similarly disruptive many of our health system’s vulnera- event, both the board and the CEO Providing you bilities. Somewhat less visible may be must be open to modifying these how effectively organizations have objectives. insightful developed their next generation of leaders. Thriving hospitals and health Even thinking about replacing senior commentary and systems already know who among leaders during this unprecedented developments in the their millennial and Generation X crisis may seem overwhelming. A managers are in the leadership pipe- current leader’s strength and stability world of healthcare line. These institutions conduct may lull leadership into a false sense robust annual talent reviews of mid- of security. It can be tempting to leadership. and senior-level administrative and hope for continued stable leadership physician leaders, identify who is pre- until the pandemic has passed; how- pared or might be cultivated to ever, hope is not a strategy. The risks HealthcareExecutive.org/ replace each current senior leader, of not having succession or contin- Podcast and individualize leadership develop- gency plans in place are far worse ment plans. than the anxiety and effort involved in developing them. Taking an inten- High-performing boards endorse tional approach to succession plan- LISTEN these leadership development plans ning will pay long-term dividends for and create opportunities for directors achieving the organization’s mission and trustees to interact with up-and- without interruption—regardless of coming potential C-suite leaders future pandemics, uncertainties and RATE through informal events and formal disruptions. s processes, such as presentations at board retreats or meetings, or by Marian C. Jennings serving as staff for board committees is president, M. Jennings REVIEW and task forces. Consulting Inc., and an adviser for The Ensure a successful and smooth Governance Institute SUBSCRIBE transition to the next CEO. Now Jennings (mjennings@ more than ever, a new CEO needs to mjenningsconsulting.com).

Leading in Crisis family in the event of an escalating situation, yet 99.99% of those fall into the category of certainty. A CEO’s firsthand account of the Las Vegas shooting, response to COVID-19. Imagine, however, the uncertainty the shooting victims’ families experienced when they arrived at Sunrise Todd P. Sklamberg Hospital desperately searching for answers, with no idea if their loved ones were at Sunrise Hospital or else- where in Las Vegas. Were their loved No U.S. hospital in recent history has ambulance bay. Over 100 physi- ones even still alive? Compounding cared for more gunshot victims at one cians and more than 200 nurses the situation was the fact that many time than Las Vegas’ Sunrise Hospital responded to assist over 240 were unfamiliar with the city, its & Medical Center on the night of Oct. patients arriving at Sunrise Hospital healthcare system or Sunrise 1, 2017. For its physicians, clinical and for care in a span of two hours. Hospital. nonclinical team members, first Over 80 surgeries were performed responders, and the entire Las Vegas during the first five days (58 of To alleviate this uncertainty, the hos- community, the tragedy that night was those in the first 24 hours), 516 pital organized ongoing updates for beyond all comprehension. A culture of blood products were administered the families every 30 minutes, start- preparedness would serve the organiza- and 50 crash carts were deployed ing at midnight on Oct. 2. It shared tion well, one it draws upon today dur- within one hour. information from its CEO and ing the global COVID-19 pandemic. attempted to give families some sense How does Sunrise Hospital bring of hope that their loved ones were Sunrise Hospital & Medical Center is order and stability in times of chaos alive and would be provided the best the largest acute care facility in and uncertainty? Strength, persever- medical and traumatic care available. Nevada. A 762-bed adult and chil- ance and hope. At every turn during dren’s hospital, it is a regional center its response, Sunrise Hospital staff Initially, 92 of the victims had no for tertiary care and features a Level displays these traits, benefiting its identification because clutches, purses II trauma center. It is the closest hos- teams, patients and their families. and wallets were displaced during the pital to the Las Vegas Strip. attack. Our Incident Command Communicating in a Sea of Fear Center team found answers using an On Oct. 1, 2017, Sunrise Hospital’s and Uncertainty old-fashioned approach: comparing senior leaders and staff received a Sunrise Hospital prioritized the families’ descriptions and photos to page shortly after 10 p.m. during the flow of structured communication our team’s own visual descriptors. Las Vegas Route 91 Harvest festival to families from the onset of the This process accelerated patient iden- advising of a mass casualty. The num- crisis. CEOs, physicians and nurses tification, with tattoos, piercings and ber of victims and extent of injuries are empathetic leaders who are well- even boots becoming definitive from the incident at Mandalay Bay trained to share the most difficult identifiers. Resort and Casino, just 4.8 miles of messages with families. The from Sunrise Hospital, were majority of the organization’s every- This column is made possible in part unknown at the time. What followed day family interactions are tight by Optum. tested the mettle of the Sunrise and contained. There are certain- Hospital team, but they were pre- ties: We know the identity of the pared to rise to the occasion. patient and whether the EHR is accessible. Hospital and health sys- Ambulances, cars, pickup trucks and tem staff members are prepared taxis flooded the Sunrise Hospital with appropriate responses to

44 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. The Right Team at the Right Time units housing patients requiring • CEO-led updates assured fami- at the Right Place their expertise. lies that the top leader was There are similarities between Sunrise • ED and trauma physicians took addressing their concerns. Hospital’s response to Oct. 1 and the lead on the immediate triage COVID-19. Oct. 1 was a single point of victims, directing them to From the New York City Emergency in time. One page and an hour later, appropriate areas. Preparedness team to local EMS, the 250 patients flooded the ED with an • A trauma physician took the lead Federal Emergency Management immediate crisis managed over an on surgical triage and directed Agency and multiple organizations, extended period. The global pandemic surgical strategy. we have shared our crisis response provided advanced notice of what we • ED nurses rapidly reprioritized best practices with the hope of help- might be facing and the ability to plan patients and initially engaged in ing others be crisis-ready. Sunrise for various scenarios spanning the resuscitation of multiple Hospital recently opened a new, months. patients until additional staff state-of-the-art tower, including a arrived. new, expanded trauma and adult ED Communicating and connecting • Leaders took a pause in care to and ambulance bay designed with with the Sunrise Hospital team organize a system response, a many of the lessons learned from throughout both events has been of critical factor in maintaining Oct. 1. paramount importance. Expressing control during the crisis. gratitude to our team for being there • Paramedics and flight crews on-site Today, we are seeing the same, at the right time is always mission supported Sunrise Hospital staff. unparalleled perseverance of our critical. As the pandemic continues, The Sunrise care team used entire organization as on Oct. 1. The we see a stress on the global supply intraosseous infusion to more hope for our team, patients, commu- chain, so ensuring our team has a effectively and efficiently place IVs. nity and our nation still runs deep in safe and healthy work environment • Clinical staff self-dispatched to Sunrise Hospital’s veins. After a with appropriate personal protective support the anticipated need at month or two following Oct. 1, the equipment is a top priority. Sunrise Hospital and upon vast majority of our patients were dis- arrival, took on the role or task charged and the healing process Sunrise Hospital had the right team needed at that time. began for our patients, staff and com- at the right time at the right place for • Pulmonary and critical care staff munity. In contrast, we must prepare Oct. 1. It all started with the hospital were available and engaged in for the pandemic as an ultramara- initially establishing a triage process ongoing care needs to leverage thon. We will be working with our in the ED that was similar to combat trauma team capabilities. patients and the clinical need for triage, enabling the hospital to pro- months, if not longer. The runway for vide immediate, lifesaving care for an Sunrise Hospital also demonstrated recovery will be months or years for unprecedented patient volume in the many nonclinical strengths through- our nation and Las Vegas. following ways: out the crisis: As of June 5, we discharged our • A physician experienced in tacti- • An experienced hospital team led 134th COVID-19 patient with more cal situations made an early deci- the Incident Command to come. Like Oct. 1, strength, perse- sion to designate areas in the ED Structure. verance and hope have served our for specific care. • Early in the crisis, the hospital team well. We remain forever • ED and trauma physician leaders established a family staging area #SunriseStrong. s developed a strategy for stabiliz- to separate families from the clini- ing patients in the ED before cal unit, allowing staff to ensure Todd P. Sklamberg is CEO, Sunrise immediately transferring them to care for a large volume of patients. Hospital & Medical Center and other areas in the hospital per • Ongoing updates at regular times Sunrise Children’s Hospital, Las Vegas, primary injury category. The hos- helped manage families’ anxiety and an ACHE Member (Todd. pital dispatched subspecialists to and expectations. [email protected]).

ACHE MEMBER UPDATE

Ethics Committee Update censure, one case resulted in an revisions and topics for new ACHE’s Ethics Committee is expulsion and two cases continue, statements. responsible for reviewing member pending court action. grievances and recommending Ethics Committee members are actions to the Board of Governors The Ethics Committee is also ACHE Fellows who are appointed by on allegations regarding Code of responsible for conducting annual the Board of Governors; they serve Ethics violations. During the 2019– evaluations of ACHE’s Code of confidentially, with the exception of 2020 committee year, the Ethics Ethics and Grievance Procedure the committee chairman, whose Committee considered seven griev- and recommending updates to name is made public. The Code of ances concerning ACHE members. them. In addition, the committee Ethics, Ethical Policy Statements and Of these, three cases were dis- reviews ACHE’s existing Ethical other ethics resources are available by missed, one case resulted in a Policy Statements and suggests visiting ache.org/EthicsToolkit.

PEOPLE

Wyoming Health System in Community Service. Sponsored by • Hendrick Health System, Receives 2019 AHA Rural Baxter International Foundation, the Abilene, Texas, led by Brad D. Hospital Leadership Award American Hospital Association and Holland, FACHE, president/ Cody (Wyo.) Regional Health, led AHA’s nonprofit affiliate Health CEO by ACHE Member Douglas A. Research & Educational Trust, the McMillan, CEO, was named the prize recognizes a healthcare organiza- • Mary Lanning Healthcare, recipient of the 2019 American tion that provides innovative programs Hastings, Neb., led by Eric A. Hospital Association Rural Hospital that significantly improve the health Barber, president/CEO Leadership Award. The award recog- and well-being of its community. nizes small or rural hospital leaders • Self Regional Healthcare, who guide their hospital and com- ACHE Member-Led Greenwood, S.C., led by James munity through transformational Organizations Receive Gallup A. Pfeiffer, FACHE, president/ change on the road to healthcare Exceptional Workplace Award CEO reform and display outstanding lead- Five member-led organizations ership and commitment to improv- received the 2020 Gallup Exceptional They were among 38 organizations ing health and health coverage, and Workplace Award, which recognizes in a variety of industries that making care more affordable. employee engagement. They are: received the award.

Ohio Health System • Adena Health System, Recognized for Community Chillicothe, Ohio, led by Jeffrey This column is made possible in part by Service Excellence J. Graham, president/CEO Change Healthcare. ProMedica, Toledo, Ohio, led by Randall D. Oostra, DM, FACHE, • Hawai’i Pacific Health, president/CEO, received the 2019 Honolulu, led by Raymond P. Foster G. McGaw Prize for Excellence Vara Jr., president/CEO

As the COVID-19 pandemic con- Martha A. Lewes, Del. He says his organization tinues to impact our communities, Dawson, DNP, would not have been able to accom- ACHE has been regularly sharing RN, FACHE, presi- plish a multiday event that offered news about our members on the dent, National expanded COVID-19 testing at four front lines fighting the novel coro- Black Nurses sites without the help of community navirus and the disease caused by Association, and and government partners. it, COVID-19. We would like to associate professor, thank them and all healthcare pro- Dawson nursing, University ACHE is grateful to these members fessionals who are serving and lead- of Alabama at and so many others for the coming during the pandemic. Birmingham School of Nursing, is mendable battle they have waged sharing innovations that can help against the pandemic. To read more The experience of address the disproportionate impact stories, visit “COVID-19 Member caring for COVID- of COVID-19 on minority News” at HealthcareExecutive.org/ 19 patients will have communities. WebExtras. a lasting impact on Lake Regional Community part- Health System, nerships are more Osage Beach, Mo., important than ever Henry and on healthcare in in fighting the pan- In Memoriam general, according demic, according to to Dane W. Henry, FACHE, CEO. David A. Tam, The hospital is using data and experi- MD, FACHE, pres- ACHE regretfully reports the deaths of the following ACHE members as ence with its supply chain to plan Tam ident and CEO, now for the fall and beyond, he says. Beebe Healthcare, reported by the Department of Member Services:

ACHE STAFF UPDATE Steven Badger, FACHE Centerton, Ark. Roman Corral Los Angeles ACHE Announces Staff ACHE in 1991, she returned in Sister M. Therese Gottschalk, FACHE Retirement 1992 as a consultant and was pro- Tulsa, Okla. Following is an ACHE staff member moted to associate director, Donald L. Jernigan, PhD retirement: Membership. In 1995, she was Longwood, Fla. again promoted to vice president, Benjamin M. McKibbens, FACHE Cynthia A. Membership, and in 2013 to senior Mobile, Ala. “Sinde” Hahn, vice president. During her tenure Wade Mountz, FACHE FACHE, CAE, to with ACHE, she has contributed to Louisville, Ky. retirement from the association in many ways, Robert W. Oldfield senior vice presi- including more than doubling the Richmond, Va. dent, Department number of members. We would like Kelly D. Pottorff of Member to thank Sinde for her many years St. Francis, Kan. A. Rodney Thorfinnson, FACHE Hahn Services. Sinde of service to the healthcare field. joined ACHE in Owen Sound, Ontario 1987 as assistant director of pro- grammed activities. After leaving

Table 1: Median salaries of samples of men and women healthcare Comparing Salaries of executives, 1989–2017 Women and Men Healthcare Median Salary Executives Year Men Women 1989 $69,400 $57,200

Results provided by ACHE’s Department of 1994 $85,900 $71,700 Member Services, Research. 1999 $104,300 $84,900 2005 $131,000 $107,800

In late 2018, ACHE conducted the sixth in a series 2011 $166,900 $134,100 of studies comparing career attainments of women 2017 $183,700 $155,200 and men healthcare executives. ACHE has conducted these studies every five to six years since 1990. In all, Table 2: Median 2017 salaries of samples of men and women 5,138 men and women members of ACHE received healthcare executives by position the 2018 study survey, although only about half, Median Salary 2,566, received questions about their compensation in 2017. Of those, 769 responded for an overall response Position Men Women rate of 30%. CEO $250,400 $176,300 (n)1 (50) (50)

Having attained approximately equal levels of educa- COO/Associate Administrator $214,600 $196,100 tion and experience, women healthcare executives in (n)1 (49) (38) the 2017 study on average earned about $155,200, and Other C-Suite, men earned on average about $183,700. Thus, women Senior Vice President $237,000 $224,300 earned 16% less overall than men. This represents an (n)1 (50) (48) improvement from 2012 when the gap was 20% but is Vice President $209,600 $176,800 similar to the findings from some of the earlier surveys (n)1 (See Table 1). (69) (66) Department Head, Staff $134,800 $137,300 Table 2 shows median 2017 salaries by position level (n)1 (114) (161) for men and women executives in full-time positions 1 Sample size in the study. Men at each level outearned their women counterparts, except in the category of department head and staff. For the first time since these studies the data show that women answering the survey who began, the median salary for women in department left the workforce for three months or more did not head and staff roles drew even with that of men. The incur salary penalties compared with women who relatively lower earnings of women CEOs compared did not interrupt their careers. In fact, women with with women in other senior positions may be due to career interruptions as a group earned a median salary the fact that women CEOs in the study tended to of $167,900 in 2017, slightly more than the $153,500 work in smaller organizations than women in other median salary for those who did not experience breaks senior positions. in their careers.

One possible explanation for the lower median salaries ACHE wishes to thank the men and women who for women executives is they are more likely than responded to this survey for their time, consideration their male counterparts to have interrupted their and service to their profession and to healthcare man- careers to care for children or other reasons; however, agement research.

The Fund for Healthcare Leadership Mr. and Mrs. William Schoenhard, Sara M. Johnson, FACHE LFACHE Alan N. King would like to thank these outstanding Vanda L. Scott, EdD, FACHE(R) Michael A. King, LFACHE, and Rulon F. Stacey, PhD, FACHE Catherine A. King individuals and organizations that have Starwood Hotels and Resorts James Y. Lee, FACHE, and Mamie I. Lee continued to support ACHE’s mission year Charles D. Stokes, FACHE, and Wayne M. Lerner, DrPH, LFACHE, and Judy L. Stokes Sandye Lerner after year. This list highlights lifetime Darlene Stromstad, FACHE Jerrold A. Maki, LFACHE Spencer Stuart Massachusetts Hospital Association giving amounts and recognition levels of UHC Mayo Clinic Health System this prestigious group. Michael A. Mayo, FACHE Benefactor: $5,000–$9,999 Stephen M. Merz, FACHE This list reflects lifetime gifts received as of Dec. 31, 2019. Allina Health Gary W. Mitchell, LFACHE Dale F. Alward, FACHE Samuel L. Odle, LFACHE Visionary: $100,000 and up St. Luke’s Health System Aramark Healthcare Timothy A. Ols, FACHE, and Cathy Ols PHILIPS Toshiba America Medical Systems, Inc. Texas Health Resources Anthony A. Armada, FACHE Trinity Health Association for Operations Management Carrie Owen Plietz, FACHE Valerie L. Powell-Stafford, FACHE Innovator: $50,000–$99,999 Yale New Haven Health System Paula R. Autry, FACHE Kurt A. Barwis, FACHE Thomas M. Priselac Catholic Health Initiatives (Kevin E. Sustainer: $10,000–$24,999 Jack O. Bovender Jr., LFACHE Prism Healthcare Partners, LTD Lofton, FACHE) Fred L. Brown, LFACHE, and Lawrence D. Prybil, PhD, LFACHE, and In memory of Christine Evans American Health Information Marilyn R. Prybil Management Association Shirley Brown (Charles R. Evans, FACHE) John J. Buckley Jr., FACHE, and Deborah Y. Rasper, LFACHE, and HCA ASAE and the ASAE Foundation Alan Rasper Association Forum of Chicagoland Sarah A. Buckley Memorial Hermann Health System Frank D. Byrne, MD, FACHE, and Heather J. Rohan, FACHE, and Modern Healthcare (Fawn Lopez) Foundation Joe Rohan Donald R. Avery, FACHE, and Fara H. Cindy L. Byrne NorthShore University HealthSystem California Healthcare Foundation Austin Ross, LFACHE Scripps Health (Christopher D. Avery Schneider Regional Medical Center Marie Cameron, FACHE Kyle D. Campbell, FACHE Van Gorder, FACHE) CareFusion John C. Sheehan, FACHE Christine Candio, RN, FACHE, and Diana L. Smalley, RN, FACHE Vincent Candio Julie Caturano Leader: $25,000–$49,999 Cedars-Sinai Medical Center St. Charles Health System Gayle L. Capozzalo, FACHE, and Jack K. Sullivan, Cotter and Associates, Inc. American Hospital Association James W. Connolly, LFACHE Heil, PhD (Jim Rohan) Ascension Health Michael H. Covert, FACHE Cardinal Health Michelle A. Taylor-Smith, RN, FACHE(R) Baylor Scott and White Health Christina M. Freese Decker, FACHE Chicago Convention & Tourism Tenet Healthcare Foundation Deborah J. Bowen, FACHE, CAE, and Detroit Metro Convention & Visitors Bureau, Inc. Jessie L. Tucker III, PhD, FACHE, and R. Norris Orms, FACHE, CAE Bureau In memory of Janice Cordova Patricia E. Kennedy-Tucker, PhD BrightStar Care (John Botsko Jr., FACHE) Teresa L. Edwards, FACHE (Richard D. Cordova, FACHE) J. Larry Tyler, FACHE, CMPE, FHFMA Carolinas HealthCare System Mr. and Mrs. Don Faulk Jr., LFACHE Robert R. Fanning Jr., LFACHE Christopher D. Van Gorder, FACHE Catholic Medical Center Peter S. Fine, FACHE John G. Faubion, FACHE David G. Veillette, PhD, LFACHE Children’s Hospital Los Angeles Kelly and Delvecchio Finley, FACHE Alyson Pitman Giles, FACHE, and Michael C. Waters, LFACHE Geneva A. Clymer, LFACHE Michael J. Fosina, FACHE William C. Giles Lori L. Wightman, RN, FACHE Columbus Regional Healthcare System GE Healthcare GNYHA Ventures, Inc. Christine C. Winn, FACHE Thomas C. Dolan, PhD, FACHE, FASAE, Lynne Thomas Gordon, FACHE Anne and Kenneth D. Graham, FACHE David L. Woodrum, FACHE and Georgia A. Dolan Peggy and Ray Gordon John L. Harrington Jr., LFACHE Kimber L. Wraalstad, FACHE El Camino Hospital Greater Charlotte Healthcare Executives Patrick G. Hays, LFACHE Raul H. Zambrano, MD, FACHE John M. Haupert, FACHE Mark J. Howard, LFACHE Health Care Executives of Southern Hendrick Health System California David H. Jeppson, LFACHE, and The Foundation of the American Hilton Hotels and Resorts June Jeppson Kent R. Helwig, LFACHE, and Kay Helwig College of Healthcare Executives has Hyatt Hotels Corporation Edward H. Lamb, FACHE, and Gregory L. Hudson, FACHE made every attempt to acknowledge all Indiana University Health Debra A. Lamb Iasis Healthcare of our donors who have given since Inova Health System Kevin E. Lofton, FACHE INTEGRATED Healthcare Strategies 2006. If you note a discrepancy, please call (312) 424-9305. Johnson Controls, Inc. Larry L. Mathis, LFACHE, and Diane A. David Jimenez, LFACHE Kirby Bates Associates, LLC Peterson Mathis, LFACHE (Karen K. Kirby, RN, FACHE, FAAN, NEA-BC) Cynthia A. Moore-Hardy, FACHE Ken and Linda J. Knodel, FACHE Mark R. Neaman, FACHE When you contribute to the Fund, you are investing John J. Lynch III, FACHE Mr. Philip A. Newbold, FACHE, and in the future of our profession. Your support ensures Mercy Health (Diana L. Smalley, FACHE) Mrs. Mary J. Newbold the field is rich with leaders who have the tools and Navicent Health (Ninfa M. Saunders, David A. Olson, FACHE, and DHA, FACHE) Joanne T. Alig knowledge to provide the best in healthcare delivery. NewYork-Presbyterian (Steven J. Corwin, MG (Ret.) David Rubenstein, FACHE, and Make your 2020 contribution today. MD, and Michael J. Fosina, FACHE) Pat Rubenstein Poudre Valley Health System Saint Francis Care Andrea R. Price, FACHE Larry S. Sanders, LFACHE Visit ache.org/Fund or call (312) 424-9305 to learn more.

5K and Up Donors_JA20.indd 1 5/19/20 12:25 PM ON THE MOVE

Bledsoe Briner Gordon Miller Schnabel Self

Bernie Albertini, RPh, FACHE, Pa. We would like to thank Mark for Center (now Ochsner St. Mary), to COO, East Ohio Hospital’s his many years of service to the Morgan City, La. recently acquired Martins Ferry healthcare field. property, from COO, Canyon Claudia Eisenmann, FACHE, to Vista Medical Center, Sierra Vista, Reba Celsor to CEO, LifePoint CEO of Methodist Health Union Ariz. Health’s Spring View Hospital, County, Morganfield, Ky. She will Lebanon, Ky., from CEO, West continue in her current role as presi- HMC Kevin P. Amick to director of Tennessee Healthcare Dyersburg dent/CEO, Gibson General Butler (Pa.) VA Health Care System Hospital. Hospital, Princeton, Ind. from associate medical center director, Durham (N.C.) VA Health Care Stephan Davis, DNP, FACHE, Eric Evans to CEO, Corpus System. to assistant professor/director, Christi (Texas) Medical Center, Master of Health Administration from CEO, HCA Houston LCDR Manuel H. Beltran, program, University of North Healthcare Tomball. FACHE, to medical plans officer, Texas Health Science Center, from United States Pacific Fleet, Pearl clinical assistant professor, Georgia Jared Giles, FACHE, to CEO, Harbor, Hawaii, from medical State University, Atlanta. Southwest Healthcare System, readiness analyst, The Joint Chiefs Murrieta, Calif., from COO. of Staff, The Pentagon, Washington, Kathy Donovan, RN, NE-BC, D.C. to CEO, Children’s Hospital of Andrew Goldfrach, FACHE, Michigan, Detroit, from COO to COO, Arrowhead Regional Dana Bledsoe, DHA, FACHE, and CNO, SMM Health Cardinal Medical Center, Colton, Calif., to the Strategic Advisory Board Glennon Children’s Hospital, St. from CEO, University Hospitals of Andor Health, Orlando, Fla. Louis. Avon (Ohio) Rehabilitation Bledsoe is the former president Hospital. of Nemours Children’s Hospital Mark Doyle to president and and enterprise vice president, CEO, Holy Cross Hospital, Fort Nemours Children’s Health Lauderdale, Fla., from CEO, System, Orlando, Fla. Memorial Hospital Pembroke, Pembroke Pines, Fla. Robert S. Briner, FACHE, to This column is made possible in part director, LifeGift, Houston, from Aphreikah Duhaney-West, by Cerner. CEO, Sweeny (Texas) Hospital FACHE, to COO, Shreveport District. hospital operations, Ochsner LSU Health Shreveport (La.)– Mark A. Caron, FACHE, to retire- Academic Medical Center, from ment from CEO, Geneia, Harrisburg, CEO, Teche Regional Medical

50 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. Official Notice for the 2020–2021 Council of Regents Elections This official notice serves as the beginning of the election process to select new Regents to serve on the American College of Healthcare Executives’ Council of Regents, the legislative body that represents ACHE’s more than 48,000 members. Service as an elected official is a unique opportunity to exercise your leadership ability, share innovative ideas and act on behalf of fellow members.

All Fellows who wish to run for election must submit an electronic letter of intent to [email protected] by Aug. 21, 2020. If you submit your letter of intent and you haven’t received confirmation by Aug. 28, 2020, contact Caitlin E. Stine at (312) 424-9324 or [email protected].

Please note: • New Regents will each serve a three-year term on the Council of Regents beginning at the close of the March 2021 Council of Regents meeting during ACHE’s Congress on Healthcare Leadership.

• Members are assigned to a Regent jurisdiction based on their business address.

• This official notice is the only notification for the 2020–2021 Council of Regents elections.

If you would like additional information about the responsibilities of a Regent and what to include in your letter of intent, please contact Caitlin E. Stine at (312) 424-9324 or [email protected].

ELECTIONS WILL BE HELD IN THE FOLLOWING JURISDICTIONS: Alabama Kansas Oklahoma Alaska Louisiana Oregon Colorado Maine Rhode Island Delaware Massachusetts Texas—Northern Hawaii/Pacific Mississippi Utah Idaho New Hampshire Wisconsin

Regent_Elections_2020.indd 1 4/2/20 2:13 PM ON THE MOVE

Mark M. Gordon, FACHE, to presi- Min Lee to vice president, opera- Memorial Healthcare System, and dent, Alamance Regional Medical tions, Reading Hospital, West CEO, Memorial Regional Hospital, Center, Burlington, N.C., and senior Reading, Pa., from vice president of both in Hollywood, Fla. We would vice president, Cone Health, operations, Emory Healthcare, like to thank Zeff for his many Greensboro, N.C., from CEO, Bon Emory University Hospital years of service to the healthcare Secours Memorial Regional Medical Midtown, Atlanta. field. Center, Mechanicsville, Va. Chad T. Lefteris, FACHE, to CEO, Annette D. Schnabel, DPT, Dustin A. Greene, FACHE, to UCI Health, Orange, Calif., from FACHE, to president, Parkland CEO, TriStar Skyline Medical COO. Health Center, Farmington, Mo., Center, Nashville, Tenn., from from president/CEO, Perry CEO, TriStar Horizon Medical Steven G. Littleson, FACHE, Memorial Hospital, Princeton, Ill. Center, Dickson, Tenn. to president, Central Maine Medical Center, Lewiston, Maine, Craig Self, FACHE, to chief strat- Rod Harklroad, RN, to CEO, from chief integration and operat- egy/business development officer, LifePoint Health’s Frye Regional ing officer, Lancaster (Pa.) General Roper St. Francis Healthcare, Medical Center, a Duke LifePoint Health. Charleston, S.C., from chief strat- Hospital, Hickory, N.C., from egy/business development officer, CEO, Haywood Regional Medical Patricia Luker to interim CEO, Premier Health, Dayton, Ohio. Center, Clyde, N.C., also a Duke Perry Memorial Hospital, Princeton, LifePoint facility. Ill., from retirement. Scott Smith to CEO, LifePoint Health’s National Park Medical William Holubek, MD, to CMO, James McHugh, FACHE, to man- Center, Hot Springs, Ark., from University Hospital, Newark, N.J., aging director, Impact Advisors, CEO, Western Plains Medical from vice president of medical Naperville, Ill., from partner, Complex, Dodge City, Kan. affairs and CMO, Wellstar Atlanta Guidehouse, Chicago. Medical Center. Marcela Sweeney to hospital Kimberly J. Miller, FACHE, to assistant CNO, North Shore William Scott Hurst, FACHE, to president, Baptist Health Western Medical Center, Miami, from CEO/president, Patient Physician Region, Fort Smith, Ark., from assistant CNO, Coral Gables (Fla.) Network, Plano, Texas, from execu- president/CEO, Beaver Dam (Wis.) Hospital. tive director, Texas Operations, Community Hospitals. naviHealth, Nashville, Tenn. Lt Col Edward P. Syron, PhD, Brad Neet, FACHE, to group vice FACHE, to retirement from chief, Robert Iannaccone to executive president, Southern California, Primary Care Services, Dayton vice president, University Hospital, Universal Health Services’ Acute (Ohio) VA Medical Center. He will Newark, N.J., from CEO, Saint Care Division, Murrieta, Calif., continue as adjunct associate pro- Michael’s Medical Center, a mem- from CEO, Southwest Healthcare fessor and graduate school course ber of the Prime Healthcare System, System, Murrieta, Calif. director, Wright State University Newark. Boonschoft School of Medicine, Peter Powers, FACHE, to CEO, Dayton, Ohio. David Kent to CEO, Piedmont Memorial Regional Hospital, Newton Hospital, Covington, Hollywood, Fla., from CEO, St. Ga., from senior vice president, Anthony Hospital, Lakewood, Want to submit? Send your business development, Cancer Colo. “On the Move” submission to Treatment Centers of America, [email protected] by Aug. 3 to Boca Raton, Fla. Zeff Ross, FACHE, to retirement be considered for the November/ from executive vice president, December issue.

52 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. Award of Chapter Merit ACHE—MN Chapter Chapter Award ACHE—North Florida Chapter ACHE of Iowa Winners 2020 ACHE of Middle Tennessee ACHE of Western PA Award for Chapter Excellence California Association of Healthcare Leaders ACHE—Nevada Chapter Colorado Association of Healthcare Executives ACHE of the Triad Greater Charlotte Healthcare Executives American College of Healthcare Executives of Central Florida Hawaii-Pacific Chapter of ACHE Central Texas Chapter—ACHE Health Care Management Association of Central New York Sandhills Healthcare Executives Forum Idaho Healthcare Executive Forum Triangle Healthcare Executives’ Forum Kansas Association of Health Care Executives Maryland Association of Health Care Executives Award of Chapter Distinction Midwest Chapter of the American College of Healthcare ACHE of North Texas Executives Alabama Healthcare Executives Forum Montana ACHE Chapter American College of Healthcare Executives—Rhode Island National Capital Healthcare Executives Chapter Network of Overseas Healthcare Executives Arkansas Health Executives Forum Sooner Healthcare Executives Central Illinois Chapter of ACHE South Dakota Healthcare Executive Group CT Association of Healthcare Executives Utah Healthcare Executives East Tennessee Healthcare Executive Affiliation Western Florida Chapter Georgia Association of Healthcare Executives Healthcare Executive Forum, Inc. Award for Sustained Performance Kentucky ACHE Chapter ACHE—MN Chapter Puerto Rico Chapter of the American College of Healthcare ACHE—Nevada Chapter Executives, Inc. ACHE of Middle Tennessee San Diego Organization of Healthcare Leaders Alabama Healthcare Executives Forum South Texas Chapter of the American College of Healthcare American College of Healthcare Executives of Central Florida Executives American College of Healthcare Executives—Rhode Island Texas Midwest HealthCare Executives Chapter Arkansas Health Executives Forum Central Illinois Chapter of ACHE CT Association of Healthcare Executives Georgia Association of Healthcare Executives Greater Charlotte Healthcare Executives Hawaii-Pacific Chapter of ACHE Midwest Chapter of the American College of Healthcare Executives San Diego Organization of Healthcare Leaders South Texas Chapter of the American College of Healthcare Executives Utah Healthcare Executives

Chapter Awards Winners 2020.indd 1 6/15/20 2:19 PM MEMBER ACCOLADES

The American College of Healthcare N.C., received the Early Career Executives congratulates members who Healthcare Executive Award from the recently received awards recognizing their Regent for North Carolina. contribution to healthcare management. Capt Tamiko T. Gheen, FACHE, health services administrator, U.S. Air Force, received the Junior Leadership Award from the Regent for Air Force.

Heather Jacobson, strategic service Col Wade B. Adair, FACHE, Senior-Level Healthcare Executive associate, Duke Health, Durham, administrator, 99th Medical Group Award from the Regent for North N.C., received the Early Career (Mike O’Callaghan Military Medical Carolina. Healthcare Executive Award from the Center), Nellis AFB, Nev., received Regent for North Carolina. the Senior Career–Mentor Dasha Dahdouh, business analyst, Leadership Award from the Regent Rady Children’s Hospital–San Diego, Alex Langhart received the Early for Air Force. received the Early Career Healthcare Career Healthcare Executive Award Executive Award from the Regent for from the Regent for Mississippi. Srilalitha Akurati, student, California—Southern. University of Illinois at Chicago COL Richard S. Lindsay III, Cancer Center, received the Health Pranav Dixit received the Early FACHE, chief of staff/deputy direc- Studies Student Leadership Award Career Healthcare Executive Award tor, Transitional Intermediate from the Regent for Illinois— from the Regent for Management Organization, Metropolitan Chicago. California—Southern. Bethesda, Md., received the Career Achievement Award from the Regent Nora M. Bota, community health Lt Col Jason Estes, FACHE, direc- for Army. program specialist, County of tor, operations, United States Air San Diego Health & Human Forces in Europe, received the Mid- Robert P. McDivitt, FACHE, net- Services Agency, received the Early Career Leadership Award from the work director/CEO, VA Midwest Career Healthcare Executive Award Regent for Air Force. Healthcare Network VISN 23, from the Regent for Minneapolis, received the Senior- California—Southern. Amir Farooqi, FACHE, interim Level Healthcare Executive Award director/CEO, Central Alabama from the Regent for Veterans Melissa A. Conway, FACHE, assis- Veterans Health Care System, Affairs. tant director, VA Boston Healthcare received the Senior-Level Healthcare System, received the Early Career Executive Award from the Regent for Michael Nowicki, EdD, FACHE, Healthcare Executive Award from the Navy. professor, health administration, Regent for Veterans Affairs. Texas State University, Round MAJ Jessica Forman, chief of busi- LCDR Celerina L. Cornett received ness operations, Brooke Army the Early Career Healthcare Medical Center, Fort Sam Houston, This column is made possible in part Executive Award from the Regent for Texas, received the Early Career by Envision Physician Services. California—Southern. Healthcare Executive Award from the Regent for Army. Paul S. Crews, FACHE, director/ CEO, Durham (N.C.) VA Health Meeta Gandhi, manager, operations, Care System, received the Novant Health, Winston-Salem,

54 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. Rock, Texas, received the Senior- Thomas E. Skorup, FACHE, vice Adrienne E. White-Faines, Level Healthcare Executive Award president, applied solutions, ECRI FACHE, CEO, American from the Regent for Texas— Institute, Plymouth Meeting, Pa., Osteopathic Association, Chicago, Central & South. received the Senior-Level Healthcare received the Healthcare Leadership Executive Award from the Regent Award from the Regent for Illinois— Jennifer Pawlowski, senior prac- for Pennsylvania—Southeast & Metropolitan Chicago. tice transformation coach, Southern New Jersey. Delaware Valley ACO, Villanova, Larry S. Wrobel, DHA, FACHE, Pa., received the Early Career Charles D. Stokes, FACHE, found- MHA program director/clinical assis- Healthcare Executive Award from ing partner, Relia Healthcare tant professor, Master of Healthcare the Regent for Pennsylvania— Advisors, Houston, received the Administration program, University Southeast & Southern New Jersey. Senior-Level Healthcare Executive of Illinois at Chicago, received the Award from the Regent for Career Achievement Award from the Donald M. Peace Jr., PhD, Texas—Southeast. Regent for Illinois—Metropolitan FACHE, dean, College of Health Chicago. Professions, Anderson (S.C.) Brian E. Sweeney, FACHE, divi- University, received the Senior- sional COO, Thomas Jefferson Want to submit? Send your Level Healthcare Executive Award University Hospitals, Philadelphia, “Member Accolades” submission to from the Regent for South received the Senior-Level [email protected] by Aug. 3 to be Carolina. Healthcare Executive Award from considered for the November/ the Regent for Pennsylvania— December 2020 issue. Robert Redden-Huff, operational Southeast & Southern New Jersey. lead, care standardization, ChristianaCare, Wilmington, Del., Renee Taylor, clinical director, received the Early Career Memorial Hermann Texas Medical Healthcare Executive Award from Center, Houston, received the Senior- Healthcare the Regent for Delaware. Level Healthcare Executive Award from the Regent for North Carolina. Executive Emily K. Rhine, physician rela- Is Online tions manager, Ascension LTC Joshua C. Thompson, Healthcare, St. Louis, received the FACHE, plans officer, Blanchfield For info at your Early Career Healthcare Executive Army Community Hospital, Fort fingertips, visit Award from the Regent for Texas— Campbell, Ky., received the Senior- Central & South. Level Healthcare Executive Award HealthcareExecutive.org from the Regent for Army. Maj Sean D. Rotbart, FACHE, medical service corps officer, U.S. Air Heather L. Wargo, FACHE, senior Force, received the Early Career client program manager, Lumeris Healthcare Executive Award from the Inc., St. Louis, received the Regent for Navy. Exceptional Leadership Award from the Regent for North Carolina. Christopher R. Sandles, FACHE, medical center director, South Jeanenne B. Watters, RN, FACHE, Texas Veterans Health Care System, director, medical staff services and reg- San Antonio, received the Senior- ulatory readiness, FirstHealth of the Level Healthcare Executive Award Carolinas, Pinehurst, N.C., received from the Regent for Texas— the Exceptional Leadership Award Central & South. from the Regent for North Carolina.

Programs and Services Lots of Variety in North Carolina In 2020, Sandhills Healthcare at the Local Level Executives Forum is working to add one or two Student Associates to the board—the chapter would allow them Chapters continue to be a source of value for to attend its meetings/events at no cost. members. SHEF created a new website using association management software, which is also used to more efficiently set up its meetings and store all chap- Whether you want to volunteer, person events before the COVID-19 ter documents. The chapter now has strengthen your leadership skills or pandemic flooded Connecticut. The the capability to send out notifica- become a Fellow, your local chapter is chapter quickly realized members serv- tions of any events, announcements an excellent place for networking, ing on the front lines would still need and links to its new Facebook and professional development and career support and education and pivoted to a LinkedIn accounts. SHEF is also on advancement opportunities. virtual platform to provide them. Twitter and Instagram. The chapter did not have a website or a social During today’s unprecedented events, CTAHE scheduled a series of virtual media presence prior to the board’s chapters are providing valuable services networking sessions. The first one, annual strategic planning session. and programs, including many that are Virtual After 5, was held April 1, and conducted virtually. Below are exam- there were over 30 participants, who SHEF is also pushing to enhance its ples of chapters small and large from were so excited to see, connect and role in helping its members take the across the nation that are offering their learn from each other. Everyone Board of Governors Exam by adding members exceptional experiences. noted that even though they were so an Exam workshop. The chapter’s goal busy, this hour provided a refresh to is to increase the number of members Exam Preparation in Central connect with their fellow leaders and who take and pass the Exam in 2020. New York see that they were not alone. The Health Care Management Association chapter also hosted a successful vir- Engaging, Collaborating in the of Central New York has been focus- tual coffee chat, “Leading from a Sunshine State ing on preparing its members to take Distance,” which offered coaching ACHE of South Florida has been the Board of Governors Examination tips to those who were managing focusing on rebranding, engagement in Healthcare Management. The remote workforces. and collaboration strategies. This effort chapter has developed an Exam prep began with a name change, a new logo course. The complimentary prep The chapter is partnering with and a redesigned website. Formerly course is composed of monthly, neighboring chapters in Rhode known as South Florida Healthcare 60-minute webinars that cover one Island and Massachusetts, as it was Executive Forum, Inc., the chapter section of the Exam and is facilitated determined that COVID-19 educa- wanted to better align itself with by the chapter’s volunteers. The tion, lessons learned and best prac- ACHE so the affiliation was clear to chapter’s board members developed tices via webinar were necessary. The members. The redesigned website will the program based on what they first webinar, “Digging Deep: enhance the user experience with a learned from other chapters that had Lessons Learned from the Field to more professional image and ease of successful prep courses. Care for Yourself and Your navigation. Colleagues During Times of Connecticut Association of Healthcare Prolonged Stress,” hosted by ACHE of South Florida will continue Executives Pivots to Virtual Events American College of Healthcare to collaborate with other organizations, Connecticut Association of Healthcare Executives—Rhode Island Chapter, such as the National Association of Executives had just hosted two in- had over 300 registrants. Health Services Executives, on

56 Healthcare Executive JULY/AUG 2020 Reprinted with permission. All rights reserved. appropriate educational topics and net- plans on hosting events geared toward frequency of engagement are in place working events. This collaborative specific groups, such as Fellows, spon- for mentors who wish to post their pro- effort will help achieve diversity among sors and students. files and allow mentees to engage with chapter members and the topics and them in a mentoring relationship. panelists it offers. This strategy can also Virtual Mentor Relationships in Utah Mentees must be members of ACHE to help the chapter recruit members by Utah Healthcare Executives has be considered for the program. It is up increasing its visibility in the refreshed its mentoring program so to the mentors to decide how many community. members can sign up and connect with mentees they will engage, and the pro- mentors through the chapter’s home- cess is set up to be more automated ACHE of South Florida has committed page. Prior to this development, mentor than previously. These updates to the to greater membership engagement in participation was solicited on an annual mentorship program have only been in 2020, which it plans to achieve through basis by mentoring committee mem- place since January 2020, and feedback sending monthly email communica- bers, and mentors were matched with thus far has been positive. s tions to all members, highlighting mentees via an overly cumbersome pro- important information. The chapter is cess. The new process allows for greater To find your chapter or search the chap- also enhancing its visibility on social mentor flexibility and participation and ter directory, go to ache.org/Chapters. media to better engage members and a more diverse mentor pool for mentees To discuss your ideas for chapters, con- share their stories. Additionally, its new to select from. UHE’s mentoring com- tact Jennifer L. Connelly, FACHE, website will allow members to interact mittee will engage with participating CAE, vice president, Department of with the chapter, obtain information mentors on an annual basis. Specific Regional Services, at (312) 424-9320 and register for events. The chapter also criteria related to willingness and or [email protected].

Prepare for the ACHE Board of Governors Exam With These Study Resources

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Board of Governors Exam Study Bundle For more information or Order code: 2411 to order online, visit $395 + shipping ache.org/HAP To order by phone, call the ACHE/HAP Order Fulfillment Center at (800) 888-4741 or (312) 337-0747.

Purpose of the Ethics Self-Assessment How to Use This Self-Assessment Members of the American College of Healthcare We hope you find this self-assessment thought provoking Executives agree, as a condition of membership, to abide and useful as a part of your reflection on applying the by ACHE’s Code of Ethics. The Code provides an overall ACHE Code of Ethics to your everyday activities. You are standard of conduct and includes specific standards of to be commended for taking time out of your busy sched- ethical behavior to guide healthcare executives in their ule to complete it. professional relationships. Once you have finished the self-assessment, it is suggested Based on the Code of Ethics, the Ethics Self-Assessment is that you review your responses, noting which questions intended for your personal use to assist you in thinking you answered “usually,” “occasionally” and “almost never.” about your ethics-related leadership and actions. It should You may find that in some cases an answer of “usually” is not be returned to ACHE, nor should it be used as a tool for satisfactory, but in other cases, such as when answering a evaluating the ethical behavior of others. question about protecting staff’s well-being, an answer of “usually” may raise an ethical red flag. The Ethics Self-Assessment can help you identify those areas in which you are on strong ethical ground, areas in We are confident that you will uncover few red flags which you may wish to examine the basis for your where your responses are not compatible with the ACHE responses and opportunities for further reflection. Code of Ethics. For those you may discover, you should use The Ethics Self-Assessment does not have a scoring mecha- this as an opportunity to enhance your ethical practice nism, as we do not believe that ethical behavior can or should and leadership by developing a specific action plan. For be quantified. example, you may have noted in the self-assessment that you have not used your organization’s ethics mechanism to assist you in addressing challenging ethical conflicts. As a result of this insight, you might meet with the chair of the ethics committee to better understand the committee’s functions, including case consultation activities and how you might access this resource when future ethical conflicts arise.

We also want you to consider ACHE as a resource when you and your management team are confronted with difficult ethical dilemmas. Access the Ethics Toolkit, a group of practical resources that will help you understand how to integrate ethics into your organization, at ache.org/ EthicsToolkit. In addition, you can refer to our regular “Healthcare Management Ethics” column in Healthcare Executive magazine.

Ethics_self_assessment_20.indd 2 6/15/20 2:58 PM ETHICS SELF-ASSESSMENT

Please check one answer for each of the following questions.

I. LEADERSHIP Almost Never Occasionally Usually Always Not Applicable

I take courageous, consistent and appropriate management actions to overcome barriers to achieving my organization’s mission. ● ● ● ● ● I place community/patient benefit over my personal gain. ● ● ● ● ● I strive to be a role model for ethical behavior. ● ● ● ● ● I work to ensure that decisions about access to care are based primarily on medical necessity, not only on the ability to pay. ● ● ● ● ● My statements and actions are consistent with professional ethical standards, including the ACHE Code of Ethics. ● ● ● ● ● My statements and actions are honest, even when circumstances would allow me to confuse the issues. ● ● ● ● ● I advocate ethical decision-making by the board, management team and medical staff. ● ● ● ● ● I use an ethical approach to conflict resolution. ● ● ● ● ● I initiate and encourage discussion of the ethical aspects of management/financial issues. ● ● ● ● ● I initiate and promote discussion of controversial issues affecting community/patient health (e.g., domestic and community violence and decisions near the end of life). ● ● ● ● ● I promptly and candidly explain to internal and external stakeholders negative economic trends and encourage appropriate action. ● ● ● ● ● I use my authority solely to fulfill my responsibilities and not for self-interest or to further the interests of family, friends or associates. ● ● ● ● ● When an ethical conflict confronts my organization or me, I am successful in finding an effective resolution process and ensuring it is followed. ● ● ● ● ● I demonstrate respect for my colleagues, superiors and staff. ● ● ● ● ● I demonstrate my organization’s vision, mission and value statements in my actions. ● ● ● ● ● I make timely decisions rather than delaying them to avoid difficult or politically risky choices. ● ● ● ● ●

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Almost Never Occasionally Usually Always Not Applicable

I seek the advice of the ethics committee when making ethically challenging decisions. ● ● ● ● ● My personal expense reports are accurate and are only billed to a single organization. ● ● ● ● ● I openly support establishing and monitoring internal mechanisms (e.g., an ethics committee or program) to support ethical decision-making. ● ● ● ● ● I thoughtfully consider decisions when making a promise on behalf of the organization to a person or a group of people. ● ● ● ● ● I take responsibility for understanding workplace violence and take steps to eliminate it. ● ● ● ● ●

II. RELATIONSHIPS Community I promote community health status improvement as a guiding goal of my organization and as a cornerstone of my efforts on behalf of my organization. ● ● ● ● ● I personally devote time to developing solutions to community health problems. ● ● ● ● ● I participate in and encourage my management team to devote personal time to community service. ● ● ● ● ● I engage in collaborative efforts with healthcare organizations, businesses, elected officials and others to improve the community’s well-being. ● ● ● ● ● I seek to identify, understand and eliminate health disparities in my community. ● ● ● ● ● I seek to understand and identify the social determinants of health in my community. ● ● ● ● ●

Patients and Their Families I use a patient- and family-centered approach to patient care. ● ● ● ● ● I am a patient advocate on both clinical and financial matters. ● ● ● ● ● I ensure equitable treatment of patients, regardless of their socioeconomic status, ethnicity or payer category. ● ● ● ● ● I respect the practices and customs of a diverse patient population while maintaining the organization’s mission. ● ● ● ● ●

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Almost Never Occasionally Usually Always Not Applicable

I demonstrate through organizational policies and personal actions that overtreatment and undertreatment of patients is unacceptable. ● ● ● ● ● I protect patients’ rights to autonomy through access to full, accurate information about their illnesses, treatment options, and related costs and benefits. ● ● ● ● ● I promote a patient’s right to privacy, including medical record confidentiality, and do not tolerate breaches of this confidentiality. ● ● ● ● ● I am committed to eliminating harm in the workplace. ● ● ● ● ● I am committed to helping address affordability challenges in healthcare. ● ● ● ● ●

Board I have a routine system in place for board members to make full disclosure and reveal potential conflicts of interest. ● ● ● ● ● I ensure that reports to the board, my own or others’, appropriately convey risks of decisions or proposed projects. ● ● ● ● ● I work to keep the board focused on ethical issues of importance to the organization, community and other stakeholders. ● ● ● ● ● I keep the board appropriately informed of patient safety and quality indicators. ● ● ● ● ● I promote board discussion of resource allocation issues, particularly those where organizational and community interests may appear to be incompatible. ● ● ● ● ● I keep the board appropriately informed about issues of alleged financial malfeasance, clinical malpractice and potentially litigious situations involving employees. ● ● ● ● ●

Colleagues and Staff I foster discussions about ethical concerns when they arise. ● ● ● ● ● I maintain confidences entrusted to me. ● ● ● ● ●

I demonstrate through personal actions and organizational policies zero tolerance for any form of staff harassment. ● ● ● ● ●

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Almost Never Occasionally Usually Always Not Applicable

I encourage discussions about and advocate for the implementation of the organization’s code of ethics and value statements. ● ● ● ● ● I fulfill the promises I make. ● ● ● ● ● I am respectful of views different from mine. ● ● ● ● ● I am respectful of individuals who differ from me in ethnicity, gender, education or job position. ● ● ● ● ● I convey negative news promptly and openly, not allowing employees or others to be misled. ● ● ● ● ● I expect and hold staff accountable for adherence to our organization’s ethical standards (e.g., through performance reviews). ● ● ● ● ● I demonstrate that incompetent supervision is not tolerated and make timely decisions regarding marginally performing managers. ● ● ● ● ● I ensure adherence to ethics-related policies and practices affecting patients and staff. ● ● ● ● ● I am sensitive to employees who have ethical concerns and facilitate resolution of these concerns. ● ● ● ● ● I encourage the use of organizational mechanisms (e.g., an ethics committee or program) and other ethics resources to address ethical issues. ● ● ● ● ● I act quickly and decisively when employees are not treated fairly in their relationships with other employees. ● ● ● ● ● I assign staff only to official duties and do not ask them to assist me with work on behalf of my family, friends or associates. ● ● ● ● ● I hold all staff and clinical/business partners accountable for compliance with professional standards, including ethical behavior. ● ● ● ● ● I am sensitive to the stress of the healthcare workforce (including physicians and other clinicians), and take steps to address personal wellness and professional fulfillment, such as incorporating these issues in employee and physician satisfaction/engagement surveys. ● ● ● ● ● I take steps to understand my workforce as it relates to safety, stress and burnout and consider the impact of those who are in positions of authority (including executives and physicians). ● ● ● ● ●

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Almost Never Occasionally Usually Always Not Applicable

Clinicians When problems arise with clinical care, I ensure that the problems receive prompt attention and resolution by the responsible parties. ● ● ● ● ● I insist that my organization’s clinical practice guidelines are consistent with our vision, mission and value statements and ethical standards of practice. ● ● ● ● ● When practice variations in care suggest quality of care is at stake, I encourage timely actions that serve patients’ interests. ● ● ● ● ● I insist that participating clinicians and staff live up to the terms of managed care contracts. ● ● ● ● ● I encourage clinicians to access ethics resources when ethical conflicts occur. ● ● ● ● ● I encourage resource allocation that is equitable, is based on clinical needs and appropriately balances patient needs and organizational/clinical resources. ● ● ● ● ● I expeditiously and forthrightly deal with impaired clinicians and take necessary action when I believe a clinician is not competent to perform his/her clinical duties. ● ● ● ● ● I expect and hold clinicians accountable for adhering to their professional and the organization’s ethical practices. ● ● ● ● ●

Buyers, Payers and Suppliers I negotiate and expect my management team to negotiate in good faith. ● ● ● ● ● I am mindful of the importance of avoiding even the appearance of wrongdoing, conflict of interest or interference with free competition. ● ● ● ● ● I personally disclose and expect board members, staff members and clinicians to disclose any possible conflicts of interest before pursuing or entering into relationships with potential business partners. ● ● ● ● ● I promote familiarity and compliance with organizational policies governing relationships with buyers, payers and suppliers. ● ● ● ● ● I set an example for others in my organization by not accepting personal gifts from suppliers. ● ● ● ● ●

Ethics_self_assessment_20.indd 7 6/15/20 2:58 PM

policy statement

Adopting a Systematic Approach to November 2009 Bringing Healthcare Executives Into November 2014 a New Position or Organization November 2019

Statement of the Issue Policy Position Having a strong leadership team is key for any organiza- The American College of Healthcare Executives tion. However, when leaders undertake a new role, encourages healthcare executives and their organiza- whether in their current organizations or a new one, there tions to adopt a systematic onboarding process that are potential risks to both the organization and the indi- ensures leaders undertaking new roles receive the nec- vidual’s success. Such personnel changes alter the compo- essary support to increase their potential for success. sition of a leadership team and, if unsuccessful, can Components of the process include the following negatively impact organizational effectiveness and effi- initiatives: ciency, as well as the individual’s own career. Design and implement a carefully planned and structured For the organization, the nature of risk may be dependent acculturation process that moves the leader into the new on the role and level of the newly introduced professional. role as quickly and as efficiently as possible. The goal At the departmental level, an unsuccessful transition may should be for the individual to sufficiently understand the be revealed in diminished productivity, deteriorating new role, its organizational context, goals and objectives quality of service and decreased team morale. At the orga- and key relationships in order to reach a point of effec- nizational level, unsuccessful leadership transitions have tiveness with the fewest missteps possible. The process been linked to increased external threats by competitors should be in writing and contain as much detail as neces- in the form of new marketplace initiatives and attempts sary for successful implementation, including assignment to recruit key employees and physicians. Internal threats of accountabilities for various action steps in the onboard- include instability in leadership positions and the post- ing process and a means to document progress. ponement or cessation of important initiatives such as physician recruitment, community outreach, strategic • Adopt a longitudinal, phased approach to onboard- planning and new service development. ing, including the following:

For the individual experiencing an unsuccessful transi- − Use prework in advance of the actual start date tion, associated risks include diminished prospects for in order to clarify expectations. Ideally, expecta- further career advancement, economic hardship and emotions would be delineated as measurable objec- tional distress stemming from a failure. tives that can be tracked in the first year.

In an effort to decrease the risks that occur when individ- − Provide an assessment to the individual that uals take on a new role or join a new organization, many helps him/her identify his/her skills and opportu- leading organizations have adopted onboarding systems nities for development and how well they align for executives and high-level directors. with organizational expectations.

PS_Adopting_Approach_New_Positions.indd 1 6/10/20 9:20 AM − Prepare the organization for the arrival of the provide feedback and been-there-done-that kinds of leader and aid the selected candidate in building intelligence to help the new leader navigate organiza- communication bridges with key individuals. tional dynamics that may not be evident. A key priority for the mentor could be to accelerate the new − Create a first-days-on-the-job schedule that estab- leader’s attainment of knowledge of expected leader- lishes a formal process for the new leader to ship competencies and norms within the become well acquainted with key staff members environment. and by which the new individual conveys personal values and core expectations and begins • Support opportunities for the newly installed leaders building solid relationships and trust. to achieve early substantive successes that will demonstrate effectiveness and help build personal credi- − Establish the first weeks on the job as a period of bility. At the same time, recognize that a new leader’s active listening on the part of the new leader to propensity to make fast and positive first impressions learn more about the organization, its depart- may be inappropriate; provide counsel as necessary. ments, and the associated people and systems, rather than a focus on immediate actions. • For the new leader that has relocated from another community, ensure attention is given to helping the − Ensure during the first month on the job that the spouse/significant other and family get introduced to new leader establishes and employs a system to the community and its resources. In addition, if the identify, sort and manage priorities and specific individual has relocated alone, it is equally important measurable goals, distinguishing between short- to pay attention to community introduction and term and long-term initiatives. inclusion to ensure he/she does not become isolated − Devote sufficient time during the first months to outside of work. ensure the new incumbent and the direct super- • Encourage the newly installed leader to monitor his/ visor systematically work to develop the founda- her progress in achieving onboarding goals and to tion for a productive relationship, agreeing on the consider sharing his/her assessments with his/her attainment of unambiguous mutual expectations supervisors to demonstrate accomplishments and related to the content of the individual’s job and ensure priorities remain aligned. to organizational priorities. • Establish similar acculturation processes for new clin- • Provide the new leader with knowledge and insight ical leaders who may have had limited executive expe- about the organization’s culture and heritage. rience in their earlier professional roles. Understanding culture and the social organization are as important as learning the strategy and opera- • Systematic and comprehensive onboarding has tions focus. become a routine best practice in many industries. Healthcare organizations, too, should capitalize on • Allow for the basics in educational training and do the advantages of onboarding realized by individuals not cut corners on training that is required for others. and organizations by adopting a well-structured Subordinates are aware of norms, policies and pro- process. cesses and other leadership expectations. Approved by the Board of Governors of the American College • Consider assigning a mentor—someone who is not of Healthcare Executives on Nov. 18, 2019. the individual’s direct supervisor—to be a sounding board, monitor progress on the onboarding plan and

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policy statement

Strengthening Healthcare May 1992 Employment Opportunities for May 1995 (revised) Persons With Disabilities December 1998 (revised) March 2002 (revised) November 2006 (revised) November 2009 (revised) November 2019 (revised)

Statement of the Issue members of the American College of Healthcare Despite the passage of the Americans with Disabilities Executives showed a somewhat higher rate, with an esti- Act in 1990, disability, whether actual or perceived, pres- mated 7.6% of respondents being disabled, defined as ents an ongoing employment challenge in our society. having a condition that limits full participation in work Even in the case of healthcare organizations, which face and/or having specific conditions such as learning, emo- periodic personnel shortages in administrative, clinical tional or mental disability or disease; a sensory impair- and support functions, persons with disabilities may not ment; physical handicap; pain; or chronic fatigue be sought after as willing, productive resources for syndrome. employment. The prevalence of disability in our society, and the Obstacles to including the disabled in the pool of poten- responsibility of healthcare leaders to lead by example, tial employees may be related to misperceptions about creates a particular responsibility for healthcare executives accommodation and healthcare costs, productivity losses, to be vigilant in ensuring ongoing opportunities for per- reliability of workers, how to access potential candidates, sons with disabilities while fostering an inclusive environ- and, in many communities, the lack of reliable transpor- ment with equitable workplace treatment for all. tation. There is a perception that significant infrastructure Policy Position investments and systematic process modifications may be needed to achieve organizational compliance with regula- ACHE believes healthcare executives should take the lead tions such as those included in the Americans with in their organizations to increase employment, advance- Disabilities Act. However, research suggests that the addi- ment and leadership opportunities for persons with dis- tional costs to accommodate employees with a disability abilities. Additionally, healthcare executives should may be minimal or nonexistent and that people with dis- advocate on behalf of the employment of persons with abilities have lower rates of turnover and absenteeism (Job disabilities in other organizations in their communities. Accommodation Network, 2009). ACHE encourages all healthcare executives to pursue the There is evidence that healthcare organizations may following actions: already be more likely to employ those with disabilities • Develop an organizational culture that is inclusive of than organizations in other sectors. While in 2009 4% the abilities of persons with disabilities to utilize their of all civilian workers were disabled, a 2005 survey of potential to contribute to the mission of a healthcare

PS_StrengthenOpportunities_PersonsDisabilities.indd 1 6/15/20 3:13 PM organization. Create ongoing programs to educate • Determine appropriate accommodations using an those within human resources departments/divisions, informal, interactive problem-solving process involv- supervisors and co-workers on disability awareness. ing the employer and the individual with a disability. The employer may wish to seek the assistance of a • Affirm that equal access to employment for persons third party who is knowledgeable in disability mat- with disabilities exists by recruiting governance lead- ters, such as a vocational rehabilitation counselor. ers, executives, clinicians and support staff with auxiliary aids and services (such as Braille or large-print The American College of Healthcare Executives encour- materials, telecommunication devices for deaf per- ages its members to take the lead in their organizations sons and videotext displays); through using networks and their communities in creating working environments and recruiting firms committed to accommodating that enhance the opportunities of persons with disabilities persons with disabilities; and by making auxiliary to gain and maintain employment. assistance available throughout the interview process. Approved by the Board of Governors of the American College • Reallocate or redistribute job responsibilities to of Healthcare Executives on Nov. 18, 2019. accommodate individuals with disabilities and consider reallocating responsibilities to accommodate and retain individuals already on staff who acquire a disability.

PS_StrengthenOpportunities_PersonsDisabilities.indd 2 6/15/20 3:13 PM PROFESSIONAL POINTERS

LEADERSHIP

Are You Stimulating or Stifling Your Millennials in particular like to have feedback on how they are Rising Stars? 7 Rules doing and talk about themselves and their careers—not in an In working with organizations to place mid-level execu- egotistical manner but as a means of figuring out or even tives, the expectation is that many up-and-coming course correcting their futures. In addition, they are very open leaders—the “rising stars” or “high potentials”—will to and, I believe, energized by being mentored. Creating a one day fill senior-level roles and shape the future. culture that encourages mentoring and regular feedback will pay great dividends in terms of retaining rising stars. One mistake leadership makes, at times, is that their ideas for promoting rising stars are not always in line Nudge, but don’t rush. It’s important to pro- with what those individuals actually want. There can 4. vide opportunities and encourage rising stars be a disconnect, and in some cases the initiatives to take on new challenges above and beyond their nor- meant to encourage up-and-coming executives end up mal responsibilities—new committee work or educa- discouraging them instead. tion/training opportunities, for example. Don’t expect immediate results, as it can be hard for talented pro- The following are rules for talent leaders to consider as fessionals to juggle new tasks with their core responsi- they establish effective strategies for rising stars: bilities. Take the long view, including providing resources for high potentials over many years. Define what a rising star or high potential 1. looks like in your organization. A lot of Let them call the shots. Up-and-coming companies presume that these are the most visible and 5. talent must have relative autonomy to decide vocal employees in their ranks or are simply junior ver- what works for them in terms of career progression. sions of current senior executives. That’s often not the They may have entirely different ideas about what con- case at all. Carefully consider and specify what desig- stitutes work-life balance than their seniors in the orga- nates the next-generation stars in your organization, nization. They may want to get ahead but still within a and question your assumptions about who those indi- 9-to-5 or even flex work schedule. Listen to them rather viduals are. than prescribe or layer on your own expectations.

Don’t assume everyone wants to climb the Link high-potential strategy to diversity pro- 2. ladder. Beware of conveying an “up or out” cul- 6. motion. Identifying and encouraging women, ture. Many ambitious professionals get to a point where minorities and diverse professionals as rising stars is an they are quite comfortable and impactful at their current effective way to improve leadership diversity. Dedicate employment level and pay grade. There can be great value mentors and resources to this cause, with the understand- in allowing them to achieve success in these roles long ing that diverse candidates know very well whether a com- term. Besides, realize that not all high performers are high pany is truly committed to diverse leadership. potentials. According to George Hallenbeck of the Center for Creative Leadership, high potentials “tend to be broad Accept attrition. Not all rising talent will stay. and adaptable in their learning and skills,” which is not 7. This will always be true, so know that you are necessarily true of all high performers, many of whom investing in high potentials for their personal gain and that may have “narrow but deep” expertise. some will leave the fold to pursue other opportunities.

Communicate and mentor. Tease out rising lead- Adapted from an article by David Boggs, senior partner and practice 3. ers’ aspirations in regular meetings with supervisors. leader, mid-level executive search, Witt/Kieffer. Visit wittkieffer.com.

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1910004772 USR COVID Appreciation ACHE print ad.indd 3 5/13/20 12:17 PM HE_JA20_cover_spread.indd 2 6/22/20 2:26 PM HEALTHCARE The Magazine for Healthcare Leaders JULY/AUG 2020

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18 Behavioral Healthcare: Integrating Telemental Health Services 30 Healthcare’s Emerging Reality Post-COVID-19

44 CEO Focus: Leading in Crisis

TOP Approaches to Physician CLINICAL INTEGRATIONCLINICAL Satisfaction Advice for times of crisis and for every day

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