Using Technology to Map out a Population Health Strategy VOLUME 30,NUMBER 5 • SEPTEMBER/OCTOBER 2015 SEPTEMBER/OCTOBER

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HE_SO15_cvr_spread.indd 2 8/4/15 9:42 AM Contents

VOLUME 30, NUMBER 5 • SEPTEMBER/OCTOBER 2015

Features 10 Using Technology to Map Out a Population Health Strategy John M. Buell

Special Feature 34 It’s Time to Take a New Look at Inclusion in Healthcare Organizations Leslie A. Athey Contents

Departments

4 ACHE Online 66 Governance Insights Governance Principles for Physician 6 Take Note Organizations Center for Healthcare Governance 8 Perspectives Back to School 70 Improving Patient Care Deborah J. Bowen, FACHE, CAE Assessing Community Health Needs Institute for Healthcare Improvement 44 Professional Pointers 74 On Physician Relations 48 Healthcare Management Ethics Effective Alternatives to Physician The Urgent Need for Fatigue Employment Management Policies Andrew D. McDonald, FACHE Paul B. Hofmann, DrPH, FACHE 52 Satisfying Your Customers Inside ACHE A Model for Change Neil R. Fedders, OTR/L 76 Executive News 56 Community Health Innovations 80 On the Move Improving the Health of Patient-Care Staff 84 Member Accolades Carrie Camin, Stephen L. Mansfield, PhD, FACHE, and Mike Tinney 86 Board Highlights 58 Public Policy Update 88 Chapter News What’s Next for Healthcare Reform? Engaging Early Careerists Daniel B. McLaughlin 90 Professional Development Calendar 62 Careers Coaching Emerging Healthcare 92 Policy Statement Leaders J. Craig Honaman, FACHE, CRC Sue Fairley, Vice President of Nursing and Ancillary Services Dr. Clint Purvance, Chief Medical Oﬃ cer Barton Health

“Partnering with Novia enabled us to identi fy and save $4.1 million in labor expenses, and positi oned us for our future with another $1.2 million in saving opportuniti es…” “Being in a close-knit community with a health system focused on delivering the highest level of care possible to our local residents, we needed a partner who could assist Barton in matching employee resources to community health needs. Partnering with Novia enabled us to identi fy and save $4.1 million in labor expenses, and positi oned us for our future with another $1.2 million in saving opportuniti es, allowing us to bett er deploy our ﬁ nancial resources to conti nue to meet the health needs of the community.” — Dr. Clint Purvance, Chief Medical Oﬃ cer, Barton Health and Barton Memorial Hospital, a 63-bed community hospital

NoviaBaron v1 072015 kt.indd 1 7/22/15 10:43 AM TakeACHE NoteOnline

ACHe-news Highlights Visit ache.org/ache-news for more ACHe-news

Task Force In 2014, ACHE developed a Professional Development Task Force, chaired by Recommendations Address Immediate Past Chairman Christine M. Candio, RN, FACHE, and 10 leaders Challenges Leaders Face in key roles from hospitals and healthcare systems. The committee met to identify how ACHE can successfully address the challenges members and the healthcare community face and the competencies they need to succeed. As a result, members can expect to see new education offerings from ACHE.

The task force also created the ACHE Healthcare Leadership Competency Framework. This is the first time ACHE has created competencies that address all levels of healthcare leaders’ professional development and align with today’s core and ever-changing healthcare environment. The framework can act as a road map for senior leaders as they enhance their professional healthcare knowledge. To match the information outlined in the framework, ACHE created a number of new programs addressing topics such as change management, population health and performance improvement.

The task force also identified opportunities to align ACHE content with delivery channels to maximize the impact of the content based on the audience and setting. One of these opportunities is to offer customized, detailed education onsite at individual healthcare organizations to help them meet the demand for in-house training. Another includes developing offerings for clinicians transi- tioning to executive leadership roles.

For more information or to view the report and the ACHE Healthcare Leadership Competency Framework, visit ache.org/ProfessionalDevelopmentTaskForce.

Take your favorite ACHE publications— ADVERTISING SALES Healthcare Executive (ISSN 0883-5381) is published bimonthly by The Townsend Group the American College of Healthcare Executives, 1 N. Franklin St., Healthcare Executive, Frontiers of Health Phone: (301) 215-6710 Ste. 1700, Chicago, IL 60606-3529. The subscription cost is $110 Services Management and the Journal of Fax: (301) 215-7704 per year (add $10 for postage outside the United States). Healthcare Healthcare Management—with you Email: [email protected] Executive is paid for by members of the American College of anywhere. Digital editions of the latest Healthcare Executives as part of their membership dues. Periodicals TOPIC SUBMISSIONS postage paid at Chicago, IL, and additional mailing offices. Printed in issues are available online at ache.org/ Healthcare Executive does not accept unsolicited manuscripts. the USA. POSTMASTER: Send address changes to Healthcare Publications. The mobile Web app Topic suggestions may be directed to Editor-in-Chief: Executive, 1 N. Franklin St., Ste. 1700, Chicago, IL 60606-3529. functions through any browser, and is Email: [email protected] Fax: (312) 424-9390 To subscribe, make checks payable to the American College of only available to members. You also can Healthcare Executives and send to: Subscription Services, Health download the publications you subscribe Mail: A CHE, Attn: Editor-in-Chief 1 N. Franklin St., Ste. 1700 Administration Press/Foundation of the American College of to on your smartphone or tablet through Chicago, IL 60606-3529 Healthcare Executives, 1 N. Franklin St., Ste. 1700, Chicago, IL ACHE’s Publications App, available at 60606-3529. Single copy is $30.00 plus shipping and handling. For no charge from Apple’s App Store, SUBMISSIONS OF ACHE MEMBER ANNOUNCEMENTS information regarding reprints of articles, contact the Editor-in-Chief at (312) 424-9426. Google Play and the Amazon Please submit announcements for “Member Accolades” or “On the Move” to Editor-in-Chief: Appstore. All material in Healthcare Executive magazine is provided solely for Email: [email protected] the information and education of its readers. The statements and Fax: (312) 424-9390 opinions expressed by authors do not necessarily reflect the policy of Mail: A CHE, Attn: Editor-in-Chief the American College of Healthcare Executives. Authors are 1 N. Franklin St., Ste. 1700 exclusively responsible for the accuracy of their published materials. Chicago, IL 60606-3529 Advertisements appearing in Healthcare Executive do not constitute endorsement, support or approval of ACHE.

Take Note

Defining Your Population Health BOARD OF GOVERNORS Approach CHAIRMAN Richard D. Cordova, FACHE CHAIRMAN-ELECT Jennifer A. Williams Edward H. Lamb, FACHE IMMEDIATE PAST CHAIRMAN Christine M. Candio, RN, FACHE PRESIDENT/CHIEF EXECUTIVE OFFICER Deborah J. Bowen, FACHE, CAE The biggest social determinant of a person’s health is his or her ZIP GOVERNORS code, according to population health expert David B. Nash, MD. Kathleen A. Bizarro-Thunberg, FACHE BG James J. Burks, FACHE James W. Connolly, FACHE Michael A. King, FACHE Marcel C. Loh, FACHE David A. Olson, FACHE “ZIP code is destiny,” Nash told attendees of ACHE’s Congress on Valerie L. Powell-Stafford, FACHE Andrea R. Price, FACHE Heather J. Rohan, FACHE Henry Ruberte, FACHE Healthcare Leadership this past spring, explaining that 85 percent of a Charles D. Stokes, FACHE Christine C. Winn, FACHE population’s well-being is dependent on factors such as the geographical EDITOR-IN-CHIEF CREATIVE DIRECTOR area of residence, socioeconomic status, crime rates, access to fresh Jennifer A. Williams Emma O’Riley SENIOR WRITER WRITER food and more. Jessica D. Squazzo John M. Buell SR. PRODUCTION & MARKETING SR. GRAPHIC DESIGNER There’s a way hospitals can use ZIP codes to identify the geographical Michael R. Baffes Carla M. Nessa ASSISTANT CONTENT EDITOR GRAPHIC DESIGNER areas where the sickest patients and most frequent users of care reside, Brittany D. Trevick Scott R. Miller Nash explained during Congress. With that information, leaders can EDITORIAL BOARD Lucinda K. Carmichael, FACHE, Chair Sandra C. Brown, JD, FACHE home in on the socioeconomic factors that affect the health of people Joanne T. Clavelle, RN, DNSc, FACHE Terry J. Cooper, FACHE in these areas—and can work with community groups to address Frank A. Corvino, FACHE Heriberto Cruz Grant C. Davies, FACHE Kristy K. Estrem, FACHE those factors. You’ll find strategies for using data to inform population Alan O. Freeman, FACHE Barbara A. Hendricks, FACHE Irita B. Matthews, JD, FACHE Sarah K. Maurice health management in our cover story, “Using Technology to Map Alice M. Meyer Ryan N. Schmidt, PhD Out a Population Health Strategy,” pages 10–20. Kimbra C. Wells Metz, FACHE

Authorization to photocopy items for internal or personal use, or the internal or Also in this issue, view case studies of organizations that have found personal use for specific clients, is granted by the American College of Healthcare Executives for libraries and other users registered with the Copyright Clearance new ways to use technology to improve health outcomes in “Leading Center (CCC) Transactional Reporting Services, provided that the appropriate fee is paid directly to CCC, 27 Congress St., Salem, MA 01970. Visit copyright.com IT Innovation in Care,” pages 22–30. for detailed pricing. ISSN 0883-5381. No unsolicited manuscripts are accepted. Please query first. Healthcare Executive is indexed in Hospital Literature Index (AHA) and listed in Current Contents. Our special feature, “It’s Time to Take a New Look at Inclusion in Healthcare Organizations,” pages 34–40, introduces ACHE research © 2015 by the American College of Healthcare Executives. All rights reserved. that offers insight on how healthcare leaders can prepare their organizations for the changing demographics. s

Correction In the Cardinal Health advertorial featured in our May/June issue, “Revolutionizing the Supply Chain for High-Value Inventory,” the email address for Rebecca Hellmann, vice president, services VISION To be the preeminent professional society for healthcare executives dedicated to improving health. for Cardinal Health, was misspelled. She may be reached at MISSION To advance our members and healthcare management excellence. [email protected]. We apologize for the error. VALUES Integrity; Lifelong Learning; Leadership; Diversity

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Back to School said, “Leaders are readers.” Reviewing journals, books and other resources It is no secret that it is not business as usual can be useful ways to gain new in healthcare. insights. Digital formats also have provided ample access to a wide variety of content. Other learning formats Deborah J. Bowen, gaining ground include experiential FACHE, CAE learning such as on-site visits, professional certification and online The job of leadership has always been development needs is a good way to courses, to name a few. More and complex; however, new playbooks start. Many tools are available, includ- more experienced leaders also are now require that leaders embrace ing ACHE’s Healthcare Executive looking to executive coaching to change, navigating the current envi- Competencies Assessment Tool, work on specific challenges. ronment while paving new paths to located via ache.org/careeredge. better serve patients and communities. Give back. As leaders contributing to Participate in learning—both within the field, this is a responsibility we all Last year, ACHE conducted a survey and outside your organization. While share. Presenting a case study on a of select chief learning officers to ask keeping up to date on your knowledge recent project or initiative can help how their organizations are develop- of healthcare and healthcare leadership others doing similar work. The ing healthcare leaders to take on new is important, reaching out to other healthcare community also provides challenges. They agreed that new industries and disciplines for insight ample opportunity to network with leadership styles and competencies on effective leadership approaches peers both nationally and locally at are needed to drive critical initiatives also is key. Including others from trade and professional organizations. around delivering value-based care, your organization in your professional Networking is a powerful tool that ensuring patients’ health is effectively development experiences, such as can help you engage with other managed across the continuum of clinical leaders, also can provide the healthcare professionals while con- care, and managing the shift from opportunity for valuable exchanges. tributing to the development of others. hospital-based care to care provided in community-based settings. In Many leaders are looking globally for There has never been a more impor- short, the need for healthcare execu- new approaches to improving out- tant time to advance our skills and tives to expand their professional comes and reducing costs. Although leadership effectiveness. By develop- competencies and leadership capabili- a number of options exist for these ing new competencies and supporting ties has never been greater. exchanges, one unique educational the development of others in our opportunity co-sponsored by ACHE, field, healthcare leaders can better Taking charge of your professional the American Hospital Association serve their patients and secure a development may be what differenti- and the International Hospital sound future for our profession. s ates you as a leader. Consider the fol- Federation is coming to Chicago this lowing action steps. fall for the first time in more than a Deborah J. Bowen, FACHE, CAE, decade. Look for details on page 72. is president/CEO of the American Conduct a periodic self-assessment. College of Healthcare Executives Using the process of self-assessment Seek solutions in a variety of formats. ([email protected]). to take stock of your professional President Harry S. Truman famously

Moving from volume to value is complex: incentives, processes, technologies and cultures must all align. Philips can help you manage the transition. By applying our clinical expertise, data analytics and telehealth solutions within a unique consulting framework, we can accelerate your transition to population-based care. We partner with you to enhance care delivery, from the waiting room to the living room. Together, we can create a healthier tomorrow.

Learn more at www.philips.com/ache or 866-554-4776. Using Technology to Map Out a Population Health Strategy

By John M. Buell Do you know who your high-risk patients and high utilizers are? More important, do you know precisely where they live?

Population health expert David B. Nash, MD, who presented at ACHE’s 2015 Congress on Healthcare Leadership, believes knowing the answer to those two questions is vital for successful population health management. But without adequate technology to identify these at-risk patients, improving the health of a population will be extremely difficult.

“The most important five-digit number I need to predict your health status and well-being is your ZIP code, bar none,” says Nash, dean of the Jefferson College of Population Health, Thomas Jefferson University, Philadelphia. “It’s not your cholesterol level or your blood pressure number or your age. The No. 1 health pre- dictor in 2015 is your ZIP code.”

In many cities, large disparities in health can be found among pockets of populations that live short distances from each other. For example, babies born to mothers in Maryland’s Montgomery County and Virginia’s Arlington and Fairfax Counties can expect to live six to seven years longer than babies born to mothers in Washington, D.C.—just a few subway stops and one ZIP code away, according to the Robert Wood Johnson Foundation’s Commission to Build a Healthier America, which publishes maps that illustrate disparities in life expectancy within cities (see the exhibit on page 16). In the New Orleans area, the gap is dramatically wider.

Healthcare Executive 11 SEPT/OCT 2015 Reprinted with permission. All rights reserved. Getting There From Here A first step healthcare organizations can take in identifying their most at-risk patients and those who may become at risk is to create a patient registry, similar to “In other words, where you are on the map predicts the work Jeffrey Brenner, MD, in Camden, N.J., con- your life span,” Nash says. “If we use technology to ducted in the late 1990s by sifting through thousands of analyze the small percentage of patients who live in billing records in spreadsheets. Today, sophisticated IT particular ZIP codes and use the data to determine tools are available that make the process of creating a ways to effectively improve care coordination and registry more efficient and effective. delivery, we will make progress in improving the health of these individuals while reducing waste.” “Without a patient registry, you can only manage what you measure,” Nash says. “You have to know Discussions around population health management who the population is.” Basic EHR systems are ter- have taken on greater urgency since this expression rific at handing billing and other “back office” was coined more than 10 years ago. Today, a variety functions, Nash says, but to identify segments of of definitions for population health exist among the population most at-risk, data analytic capabilities healthcare executives and others, but all agree: are needed. Healthcare organizations cannot manage population health effectively without the technological capabili- “The use of data analytics allows me to slice the patient ties and infrastructure to first identify populations information I already have in a number of ways,” Nash most in need of healthcare interventions and then says. “For example, if I’m a primary care physician and track the results of programs put in place to improve want to practice population health management, I need health for these patients. a patient registry. Once I have a regis- “The most important try, I can run an analysis of a particu- All of the big healthcare IT firms are lar set of patients—such as patients furiously creating population health who have diabetes—and examine how software and applications to help hos- five-digit number I need effectively I’m caring for this popula- pitals, health systems and physician tion of patients. I can then run ana- practices identify and manage high- to predict your health lytic functions that compare my risk, high-cost patients—such as the performance against regional and 20 percent of Medicare patients who national benchmarks. Next, I can consume 80 percent of costs. status and well-being is identify gaps in performance and use the data to help determine ways to “IT providers know the ability to improve. At the ground level, the identify healthcare superusers and at- your ZIP code, bar none.” registry function is the linchpin of risk patients is the pot of gold,” Nash —David B. Nash, MD, Jefferson College of making population health manage- says. “If we can find and better man- ment a practical reality.” age these 20 percent of patients, we Population Health, Thomas Jefferson University have a fighting chance of reducing But simply identifying patients who healthcare costs.” are most in need of coordinated care

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EGS_ACHE_150715.indd 1 7/15/15 4:45 PM identifying groups of people who have life needs and creating intervention programs to address those needs—is limited. What healthcare teams need is the ability to marry this information with predictive data and to leverage these data to redesign care for specific management now isn’t enough, according to Brian groups of people.” Silverstein, MD, managing director of HC Wisdom, Chicago, which provides population health manage- First Steps Toward IT-Based Health Management ment advisory services and operational assistance. It remains to be seen whether efforts to use data to redesign care for specific populations will prove widely “The notion that 20 percent of a particular population successful, but there are many signs of progress. For drives 80 percent of cost in healthcare holds true, but just example, early data from the accountable care organi- because you identify these patients as high cost today is zation demonstration projects launched by the Centers not an indicator they will be high cost tomorrow,” says for Medicare & Medicaid Services show such efforts Silverstein, an ACHE member. “The trick to this is to have reduced per capita Medicare spending. Similar determine who will be high cost in future.” success are being shared by hospitals and health systems of all sizes. To attain the level of precision required to predict the future needs “The early outcome measures are of at-risk patients, precise informa- “If you rely solely on good,” Nash says. “So if we can tion in a number of categories— reduce spending and improve out- including socioeconomic historical and utilization comes, we will have found the Holy information, family background and Grail for population health mental health factors—needs to be management.” collected from patients and then ana- data to forecast an lyzed. “What drives future healthcare The following are three examples of utilization for most at-risk patients individual’s health needs, organizations that have leveraged IT on an individual basis is more related and data analytics to improve popula- to behavioral issues, genetics and tion health management. social and cultural factors,” you are not including the Silverstein says. Aurora Health Care, Milwaukee. Aurora Health Care is a network of “If you rely solely on historical and things that are really 15-hospitals in the Milwaukee area. utilization data to forecast an indi- Using IT capabilities beyond what vidual’s health needs, you are not meaningful.” its EHR system offers, the organiza- including the things that are really tion shares data with primary care meaningful,” he says. “The ability of —Brian Silverstein, MD physicians to better manage chroni- an EHR system to help healthcare HC Wisdom cally ill patients. Data analysts teams successfully manage the health review clinical and insurance claims of a population—in terms of separat- data and perform predictive analyt- ing a population into segments and ics to identify patients with

with other organizations, and determine where our greatest opportunities were.”

Aurora Health Care uses a single EHR for all its facilities, but to attain the kind of high-level, hyper-specific congestive heart failure and those with chronic data necessary for effective population health manage- obstructive pulmonary disease and share the informa- ment, the organization invested in an additional IT tion with clinical specialists who can more proactively platform—a population health and clinical and manage their care. claims-based analytical tool.

The system’s population health journey began in 2012. “We can look at clinical and insurance claims to get “We wanted to have the data to drive the direction we a holistic view of where opportunities lie for popula- wanted to take operationally,” says Sylvia Meltzer, MD, tion health management,” says Laura Spurr, director, senior vice president and CMO, Aurora Health Care. medical group operations, Aurora Health Care “The first step was to examine our populations, Medical Group. develop an understanding of where we sit compared WASHINGTON, D.C. METRO AREA The tool provides an addi- Your ZIP Code May Be More Important to tional layer to conduct YourYour ZIP CodeHealth May Than Be YourMore Genetic Important Code to Your Health Than Your Genetic Code national benchmarking and Washington, D.C., Metro Area sophisticated statistical

N analysis, such as predictive 84 analytics the organization YEARS*

PRINCE was unable to previously MONTGOMERY GEORGE’S COUNTY COUNTY achieve. Staff now have the ability to identify patients

DISTRICT OF in different disease cohorts COLUMBIA exhibit varying levels of FAIRFAX risk of being admitted to COUNTY 84 DC 78 the hospital. YEARS* 77 YEARS* YEARS*

ARLINGTON “We run our entire popula- COUNTY tion through that tool,” 83 YEARS* Meltzer says. “And based on information that comes out through statistical modeling WASHINGTON, D.C. and analysis, it predicts METRO AREA what cohorts are highest risk. That’s how we selected congestive health failure and COPD as our two high- 2MI * Life expectancy at birth by county © 2014 Robert Wood Johnson Foundation risk populations to focus

16 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. upon. Once you dive into the data, it’s not about man- “We just started on our journey, and we’ve experienced aging one disease, but the whole patient.” very impressive results so far. Now it’s time to enhance what we have been able to do well,” Spurr says. “How Already, Aurora Health Care’s efforts have resulted in a do we look not just at the impact of our efforts on one 60 percent reduction in hospital admissions for heart patient or interaction at a time, but on an entire popu- failure-related causes compared with the previous year, lation? To do that, we need the technology and tools to and a 20 percent reduction in all cause admissions. analyze the data in multiple ways.”

A CEO To-Do List: 7 Strategies for Better Managing Population Health The following are the top seven things David Nash, MD, dean of the Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, recommends hospital and health system leaders consider to effectively manage population health.

Begin population health manage- need training around how to col- Partner with retail clinics. ment efforts with their employee laborate successfully with other “Because the average diabetic visits population. “Hospitals and health providers and how to coordinate the pharmacy 30 times a year and systems should be the leaders in the work of each member of a sees his or her endocrinologist twice taking care of their own employees patient’s healthcare team—physi- a year, hospitals and health systems and dependents,” Nash says. cians, nurse practitioners, dietitians, need to partner with retail clinics social workers and others—to option patient education and training Keep the well “well.” “This mize care and value,” Nash says. to more effectively manage the sounds obvious, but it isn’t,” Nash health of such patients,” Nash says. says. “The idea—which was first Use patient registries. Patient reg- promoted by health and wellness istries—collections of data for Partner with managed care plans. industry pioneer Dee Edington of patients with a specific diagnosis or “Some insurance companies have the University of Michigan—is to condition or who have undergone a multiple accountable care organiza- keep healthy people healthy by particular procedure—enable phy- tion partnerships with provider providing services such as gym sicians to close the loop on the care groups that have varying risk- memberships and nutritional of their patients and analyze how baring structures. Who knows more advice. If you forget to take care of well their patients’ health is being about managing risks than the man- those who are taking care of them- managed in comparison with simi- aged care industry?” Nash says. selves, you could be in a jam fur- lar populations cared for by other ther down the road.” physicians. “Once the physician Provide funding for physician realizes how he is performing leadership training. “CEOs and Provide appropriate guidance against his peers, this provides board members need to allocate for those who will lead patient- teachable moments and opportuni- resources today to build the medi- centered medical homes. ties to work with the physician to cal staff they are craving for tomor- “Physicians typically will be improve performance,” Nash says. row. This means providing funding charged with this effort, but they for leadership training,” Nash says.

Healthcare Executive 17 SEPT/OCT 2015 Reprinted with permission. All rights reserved. greatest benefit lies. When you take people with risk factors and craft an intervention program for them, it can make a big difference in preventing a heart attack or stroke.”

One initial benefit for the team at St. Joseph’s is the feeling St. Joseph Hospital, Nashua, N.H. The purpose of of empowerment team members gain through the data St. Joseph Hospital’s population health strategy is two- insights now available to them. For example, clinical staff fold: become more agile in stratifying populations by are learning how to encourage responsible use of healthcare risk and create interventions that influence improved resources through population health management. In addi- patient outcomes. tion, care coordinators have the tools necessary to be more proactive in helping to optimize the health of their Because the organization is self-insured, leaders peers. Their efforts are having a financial impact on the believed the best way to gain experience in population health system: The organization projects $1.8 million in health management was to start with its own employ- cost savings in 2015 through this initiative. ees and their dependents. St. Joseph struggled with rising insurance costs for its employee population and Truman Medical Centers, Kansas City, Mo. their families. By using data warehouse software to Population health has been a focus at Truman Medical collect patient data from each of its five third-party Centers for many years. A safety-net hospital for a administrators, the organization identified a small region that provides a great deal of uncompensated number of patients who use a disproportionate amount care, Truman is at risk for 40,000 lives—those who are of healthcare resources. unable to pay for their medical care.

“We get up-to-date information in near-real time on When it comes to using technology to improve popu- utilization by our employees and their dependents,” lation health, Truman’s recently implemented says Richard Boehler, MD, CEO. HealtheRegistry tool, which is “And based on two years of historical “We wanted to have the embedded in its EHR system, has a data, we can identify and risk stratify large potential impact on improving those who are on our health plan. the health of at-risk patients. The For instance, I can identify employ- data to drive the direction tool allows the organization to iden- ees and dependents who are at risk of tify, at the individual provider level, becoming high-risk patients and put how certain at-risk patients are doing in place intervention programs to we wanted to take based on an assessment of a variety positively influence outcomes. of measures for seven chronic operationally.” diseases. “So if I have an employee with two or three risk factors for developing —Sylvia Meltzer, MD “We can slice and dice that informa- kidney failure, why not try to keep Aurora Health Care tion and identify providers and clinics the employee out of that situation? that are doing better or worse than We are in the early stages of this others. We then identify the sources approach, and this is where the of differences in performances so we

18 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. We know exactly what your patients need. Patients often require patience. They need respect and dignity to feel cared for. It’s part of the healing process. Which is why when you partner with us, you can be sure we’ll treat your patients like human beings. Not numbers. capiopartners.com/respect Get your revenue cycle back in gear. To manage population health effectively, Hackman believes the more data an organization can integrate from various sources, the easier it is to do. “In some cases, you’re limited to claims-based data, but it’s a good starting point,” Hackman says. “But when you layer in clinical results and can disseminate best practices,” says Jeffrey Hackman, clinical data, you get a larger view of what really needs to MD, chief medical information officer, Truman be done to move the meter on patients’ health.” Medical Centers. In the past 10 years, the use of IT to more effectively The HealtheRegistry tool pulls data from Truman’s manage population health has reduced the health system’s EHR to analyze specific groups of patients and their ED visits and costs. Data analytics also has enabled health status. “For example, we may have a diabetes reg- Truman to illustrate the value of its efforts in precise istry that has several thousand patients, and we have detail—with reports generated quickly and easily. “Today, 20 measures in that registry, so we know whether these we can demonstrate the impact our efforts are having on patients have had a particular test or scheduled their controlling a patient’s blood pressure or glucose levels in a doctor’s appointment. The goal is to look more at out- matter of hours or even minutes because data analysis comes, rather than just process measures or things like allows us to gather this information quickly instead of how often they come to the ED.” manually reviewing thousands of charts,” Hackman says.

Truman uses patient data from facilities in its health Moving Forward system, along with population health data from local Although many hospitals and health systems have government sources. The health system then exam- touched on population health for years—and some are ines and analyzes the population now using IT to enable them to zero in and the needs of those within that on certain at-risk patients and design- population. This allows the organi- “Based on two years of specific care interventions—the pace of zation to determine high-risk change is quickening. patients and high utilizers, as well as historical data, we can others who should be using “Value-based economic incentives are Truman’s services but haven’t been pushing more organizations to focus getting the care needed. identify and risk stratify on well-being rather than on sick- ness,” Nash says. “And I believe the “What we found in our analysis is evidence will continue to accumulate that we had a very high volume of those who are on our to support the central take-home people with a large number of message of population healthcare.” chronic medical conditions who health plan.” either visited the ED or were That makes the need for tools and data admitted on a regular basis,” —Richard Boehler, MD that provide actionable insight on popu- Hackman says. “As a result of our St. Joseph Hospital lation health more important than ever. findings, we have focused in on our chronic disease management John M. Buell is a writer with solutions.” Healthcare Executive.

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4 Case Studies Leading IT Innovation in Care Healthcare leaders are using From wearable devices that engage patients in their care to mobile apps that help manage population innovative technologies to health, patient-focused technologies are helping transform patient care and providers transform care delivery. For many ready their organizations for healthcare executives, such IT initiatives are not “projects” but rather strategic investments in their the challenges ahead. organizations’ long-term sustainability.

Across the country, leading healthcare organizations by Laura Ramos Hegwer of all types and size are making patient-centered innovation a key component of their business strategy. Following are examples of organizations that are changing the way care is delivered and managed through the use of IT—and the lessons learned that could help your organization drive IT innovation in care.

Finding Solutions to Intermountain Healthcare, Salt Lake City. In a wound care clinic in Achieve the Triple Aim St. George, Utah, a physician dons a hands-free, wearable video camera that Vetting technologies that allows a patient to view a serious wound on the back of his leg for the first have the potential to time. Using a tablet-based app, the physician can share the video with the improve care management patient and demonstrate how to dress the wound step by step. and value can be Leaders at Intermountain Healthcare are closely monitoring whether this tech- particularly challenging for nology can improve patient-provider education and, in turn, boost clinical healthcare executives. But outcomes. Using proven innovations to achieve the Triple Aim is part of prioritizing initiatives Intermountain’s broader business strategy. “We don’t believe we can improve focused on the Triple Aim care quality, sustain costs and improve the care experience without innovating can help leaders make with IT in partnership with our clinical programs,” says Todd Dunn, director tough decisions. of innovation for the large, integrated health system that covers Utah and southern Idaho.

Case in point: Intermountain is testing a telehealth solution in all of its ICUs as an additional safeguard to monitor critical care patients. Based in a hub in Midvale, Utah, a remote team of 22 physicians and 20 nurses assists the bedside teams in monitoring 263 critical care beds across the system. Early results show the program can help reduce length of stay, mortality rates and complications in Intermountain’s community hospitals. By improving these outcomes, the telehealth solution also may help keep costs under control. Photo credit: Intermountain Healthcare. Intermountain Healthcare developed a systemwide telehealth infrastructure that Intermountain, a HIMSS Nicholas E. Davies Award recipient for using IT to fits within clinical workflows. The system is substantially improve patient outcomes, uses a centralized committee that improving quality of care and the care includes clinical leaders, project managers, and operations executives who work experience while reducing costs. together to review new technology. When vetting a new tool, such as remote patient monitoring that can be used in the patient’s home, leaders consider “We don’t believe we can improve three key questions. care quality, sustain costs and improve the care experience • How does this technology improve quality and help sustain costs? without innovating with IT in • How does the technology make a clinician’s work easier? partnership with our clinical • How does the technology help the patient? programs.” “We look for a lot of evidence in those three buckets,” Dunn says. “It sounds Todd Dunn Intermountain Healthcare simple, but those are the guideposts for our investments in IT initiatives.”

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Reducing Harms in Johns Hopkins Hospital, Baltimore. As an ICU nurse, Rhonda Malone the ICU Wyskiel, RN, performs more than 200 tasks a day on any given patient. Technology also is Missing any one of these tasks can put a patient’s health in jeopardy. For exam- helping organizations ple, failing to elevate a bed or delaying oral care for more than two hours can redesign workflow in their put a ventilated patient at risk for infection. Either one of these simple tasks can be missed as the care team juggles patients or changes shifts. Yet by using ICUs to improve patient a tablet-based app, Wyskiel and other clinicians in the ICU have a better way safety and get families to determine what actions they need to take to reduce a patient’s risk of a more engaged in their ventilator-associated event as well as six other preventable harms. loved ones’ care. The app is a key component of Project Emerge, a research project funded by a $10 million grant from the Gordon and Betty Moore Foundation. The app pulls data from multiple information systems and continuously updates a harms monitor—a diagram that looks like a sonar map. Clinicians check the monitor on their tablets and can quickly see what actions they need to take to reduce patient harm based on simple red, yellow and green color coding. “This is at-a-glance information that we absolutely need as clinicians so we have more time to spend with patients,” says Wyskiel, who helped design the app in her role as patient safety innovation coordinator at the teaching hospital and the Armstrong Institute for Patient Safety and Quality.

The other key component of Project Emerge is a portal for patients and families Photo credit: Will Kirk/Johns Hopkins Medicine. they can access on a different set of dedicated tablets in the ICU. The patient Rhonda Wyskiel, RN, patient safety innovation coordinator at Johns Hopkins Hospital and family portal is designed to improve communication between the care and the Armstrong Institute for Patient team and visitors to the ICU. For instance, family members can share their Safety and Quality, checks the “harms loved one’s care goals and upload photos and list favorite music and television monitor” to see which patient care tasks she needs to complete. shows so staff can get to know patients on a more personal level.

More than 230,000 patients have A family involvement menu for the portal allows families to select from enrolled in Johns Hopkins’ online 10 daily care activities, such as shampooing, that help them assist the team caring for their loved one. patient portal, MyChart, which supports improved patient In the six months the patient and family portal has been in operation, Wyskiel engagement and satisfaction. has seen the beginnings of a cultural shift in the ICU. Rather than pushing Through MyChart, patients can families to the sidelines, clinicians recognize that families also can be experts view portions of their medical in care. record, communicate with “This portal is giving new insights to clinicians so they can build better rela- providers, see test results and tionships and trust, which is critical to patient-centered care,” she says. Not request prescription refills. only is this the right thing to do, Wyskiel believes, but it also may help providers protect their reimbursement as more metrics are tied to the patient experience.

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Connecting Rural Patients Grundy County Memorial Hospital, Grundy Center, Iowa. In 2010, the and Providers 25-bed critical access hospital received a $1.8 million grant from the Access to specialty and Broadband Technology Opportunities Program, funded by the American even primary care Recovery and Reinvestment Act. With its grant (plus $528,000 in matching continues to be a major funds), GCMH has equipped 12 healthcare providers with video equipment to give patients better access to neurology, cardiology, oncology and other spe- issue for rural providers. cialty services. Yet, the technology alone is not enough to improve access in Telehealth platforms rural areas, according to Jennifer A. Havens, CEO, and an ACHE Member. can connect patients What providers in these areas need is greater physician buy-in, which is chal- with providers, but lenging when physician schedules are busy and appointments for some special- challenges still remain. ties are filled months in advance.

“The big challenge is encouraging providers to test the waters,” Havens says. “Telehealth patients have generally been very happy with their care, and from a physician standpoint, the visits can often be scheduled for smaller time increments in between regular office visits. We still have a ways to go until we can more effectively convince providers of the benefits.”

Another issue is that physicians usually do not have an IT person in their office to address glitches. “Technology is only wonderful when it works,” Havens says. “It could be working great on our end, but if the physician is having trou- ble on their remote end, that is a lost visit. After the first or second time the Photo credit: Grundy County Memorial Hospital. technology doesn’t work, physicians aren’t going to want to do it again.” Telehealth nurse Theresa Borcherding, RN, uses the telehealth platform with patient Michael Greiner for a visit with cardiologist Despite these challenges, GCMH, which was named a “Most Wired” hospital Kalyana Sundaram, MD, at the Grundy by Hospitals & Health Networks in 2014, can count several wins for its telehealth County Memorial Hospital Specialty Clinics. strategy. For instance, orthopedic surgeons use the platform to round on their joint replacement patients, rather than having to drive 40 minutes to the hospi- “The big challenge is encouraging tal. GCMH also uses the telehealth technology to provide hospitalist coverage providers to test the waters. during off-peak hours. Additionally, the hospital is linked to nine EMS ser- Telehealth patients have generally vices and 10 schools on its telehealth platform, which allows it to provide been very happy with their care, training and education in the community. and from a physician standpoint, As an affiliate of UnityPoint Health, GCMH implemented a sophisticated EHR the visits can often be scheduled that would have been impossible for the hospital to land on its own. Since the for smaller time increments in EHR went live in 2012, it has been a vital tool for improving communication between regular office visits. We and continuity of care. For example, physicians and post-acute providers who still have a ways to go until we can are not part of UnityPoint Health can access patients’ medical records through more effectively convince a secure link. “This is important for us in rural America, where a lot of physicians are still practicing independently,” Havens says. GCMH also plans to providers of the benefits.” work with its health system to test mobile technologies to promote better care Jennifer A. Havens Grundy County Memorial Hospital transitions and expand its telehealth strategies to fill gaps in primary care.

Preparing for CentraState Healthcare System, Freehold, N.J. Leaders at this not-for-profit Value-Based Payment community health system are considering adding a new tool that would allow As providers explore them to send secure text messages to patients to improve compliance with value-based payment treatment plans. “Instead of an app that would require a heart failure patient models that put them in to log in and enter their weight every day, the tool would send a secure text to the patient asking if their weight had gone up,” says John Ulett, vice president charge of managing and CIO. “If we don’t hear back from the patient, the nurse also reaches out.” populations, technology can help engage at-risk Ulett and other leaders at CentraState, which also was named a “Most Wired” patients and streamline hospital by Hospital & Health Networks in 2014, hope such a tool will improve data reporting to monitor clinical outcomes in recently discharged patients with chronic diseases and performance. reduce costly readmissions, which will be critical as the health system takes on more risk in its payer contracts.

“CentraState Healthcare System has invested a tremendous amount of money and resources into utilizing technology for the clinical benefit of our patients,” explains John T. Gribbin, FACHE, president/CEO, a recipient of the CEO IT Achievement Award presented by Modern Healthcare in collaboration with HIMSS. “Clearly we recognize the potential that various software programs have to help clinicians and patients better manage both chronic and acute health concerns at home. We are particularly excited about the potential for mobile technologies to enhance personal accountability for maintaining good health.” Photo credit: CentraState Healthcare System. John Ulett, CentraState’s vice president and CIO, discusses the design of workflows CentraState also has launched an initiative to automate collection of quality and order sets with Gabrielle Pinzon, MD, data across the health system. “There is a seemingly unending supply of qual- a physician informaticist. ity data that we need to provide to various entities,” Ulett says. “In the long run, we can’t afford to hire nurses to do chart abstraction, so we want to auto- Since implementing a workflow in matically harvest the data out of the EHR when appropriate. Our big, auda- its EMR to monitor levels of the cious goal is to automate 100 percent of that collection.” antibiotic vancomycin, CentraState has reduced the incidence of Using informaticists to improve workflows also is an initiative that is enhancing care management at CentraState. Leaders for the health system have lever- missing lab tests between the third aged the workflow engine in their EHR to develop 30 evidence-based care and fourth dose from six to eight plans that standardize treatment for patients. per month to zero, improving patient safety. As they develop these care plans, leaders hope to minimize the time physicians need to feed the EHR with notes and data. CentraState has hired a physician informaticist and several nurse informaticists who reside outside of IT but work with the IT team to design smarter workflows and order sets. “Their goal is to have physicians interact with the EHR using the fewest clicks possible, and they can do that because they understand how physicians interact with patients,” Ulett says.

Healthcare Executive 29 SEPT/OCT 2015 Reprinted with permission. All rights reserved. 4 Case Studies Leading IT Innovation in Care 8 Ways to Drive IT Innovation in Care To effectively use IT to drive innovation, healthcare executives should consider the following lessons learned from other leading organizations.

Harness ideas from outside Automate collection of qual- Consider interoperability firms, as well as clinicians and ity data as much as possible. issues when making purchas- 1employees. Intermountain 3For example, CentraState uses 6ing decisions. “It’s one thing Healthcare has established a partner- a third-party tool to aggregate quality to choose an EHR to meet meaning- ship with a healthcare consultant to data from its physician-hospital orga- ful use, but if it doesn’t interface with investigate potential medical devices, nization into its private health infor- other hospitals you work with, it is digital health apps and other technol- mation exchange so leaders can track not removing any barriers,” Havens ogies proposed by outside companies. performance over the course of the says. “Consider what the major play- Intermountain also has developed a organization’s contracts with payers. ers in your market have and get in process for employees, especially cli- Additionally, CentraState collects alignment with them.” nicians, to submit their ideas for apps data from three post-acute providers and other technologies to improve in its health system to monitor qual- Focus on continuous patient care. Called the Intermountain ity across the continuum and prevent improvement. Clinicians at Foundry, the process allows employees avoidable readmissions. 7Johns Hopkins Hospital con- to submit an application to receive tinually provide feedback on their funding for an innovative idea that Use technology to improve tablet-based apps in development so improves the quality of care and patient engagement. their colleagues from bioengineering helps contain costs. 4Intermountain has developed and applied physics can make a mobile app called Health Hub, improvements to the next prototypes. Leverage partnerships to which allows patients to refill pre- gain access to sophisticated scriptions, find doctors and clinics, Keep good people in IT. 2healthcare technologies. For and access the patient portal, where Experienced data analysts— example, leaders at GCMH leaned on they can view their medical record or 8particularly those with health- their affiliation with UnityPoint Health pay their bills. The app was designed care experience—are hard to replace. to position the organization to become with feedback from Intermountain’s To that end, leaders at CentraState one of the first rural hospitals in the patient engagement steering commit- are designing detailed career ladders nation to implement an EHR. “As a tee, which includes patients and to keep the team engaged in their $35 million organization, we cannot families. work. As Ulett puts it, “The real purchase big-ticket items like a stand- focus of a leader has to be on people alone EHR, but we can make sure we Educate your board on IT as and not on the technology.” are at the table with our senior affiliate a business strategy. Havens of in the health system when those decisions 5GCMH says CEOs and other Laura Ramos Hegwer is a are made,” Havens says. “When we heard senior leaders should make sure their freelance writer and editor based that our senior affiliate was considering board understands how various tech- in Lake Bluff, Ill. an EHR, we told those involved that we nology investments can make their wanted to be the first rural affiliate to organizations more sustainable. go live. As an organization, we run toward change instead of away from it.”

CMY

K Removing Barriers to Building a Nationwide Data Exchange Health IT competitors are collaborating to build infrastructure and services that enable interoperability nationwide, supported by common standards and policies.

“ The vendors who lead CommonWell coalesced link patients across organizations and facilitate secure data CommonWell’s core services—which ensure that patient data Most of its participating members have publically announced because they felt the industry was facing a access and exchange beyond one’s own system or commu- can be securely, efficiently, seamlessly and accurately that they will offer CommonWell services free to their clients, problem worth solving. Patient data should be nity. With those tools, CommonWell hoped to enable its ven- shared—include the following. including ACHE’s Premier Corporate Partners athenahealth accessible to everyone—it should not be dor members to give their customers complete patient health and Cerner. something to compete on. This is the vision to stories, including information from outside organizations and Patient identification and linking. CommonWell services pro- which CommonWell is committed.” from different EHR systems. vide quick and accurate identification of patients as they transi- What Makes This Coalition Groundbreaking? tion through various care facilities anywhere in the nation. “One CommonWell is open to all organizations that are commit- —Jitin Asnaani CommonWell’s 29 members represent more than 70 percent of the key differentiators of our services is that they are entirely ted to making patient data available to providers regardless Executive Director of the acute care EHR market, according to KLAS Enterprises, person-centric,” Asnaani says. “With most current health tech- of where care occurs. It has proven that when competitors CommonWell Health Alliance, Boston and nearly a quarter of the ambulatory care EHR market, nology, users need to know where the data is located and then set aside their differences and focus on competing on func- according to SK&A a Cegedim company. Members support use the technology to pull the data from that point. It’s a very tionality not data access, everyone wins. Most important, Between 2008 and 2013, the number of U.S. hospitals adopt- the belief that provider access to this data must be built into location-centric way of working and assumes that you know patients have the opportunity to receive the best coordi- ing at least a basic EHR system increased fivefold. While such HIT at a reasonable cost. where the data is initially.” nated care possible. rapid adoption is commendable, the ability to share those records among nonaffiliated, geographically diverse facilities What Services Does CommonWell Provide? Patient access, privacy and consent management. “Rather than starting with a forced set of regulations, this ini- continues to challenge the healthcare industry. CommonWell provides interoperability-enabling services that Members can give their users a patient-authorized means to tiative began with organizations that had already internalized are embedded natively within vendors’ own software, not simplify management of data-sharing consents and authori- the belief that highly accessible data should always follow the For the past two years, a group of leading technology vendors tacked on as an afterthought. This helps solve many of the zations. Patients who have given permission to have their patient,” Asnaani says. He describes a recent board meeting has united to address the issue of nationwide interoperability. challenges associated with interoperability and facilitates the health records accessible through the CommonWell Health attended by CommonWell members who are technically Working together as CommonWell Health Alliance, these ven- exchange of healthcare data along the care continuum. Alliance network are associated with a unique “person” iden- competitors. dors recognized a greater cause was at stake and reached tifier that is linked to their existing “patient” records at each across competitor lines to ignite the effort. As a result, “Access to our service is built into the software of our mem- provider location. Ultimately, Asnaani hopes that someday, access to patient CommonWell members have created a real-world service that bers,” Asnaani says. “This is critical because clinicians will be health information can be considered on par with other eliminates the barriers to sharing patient data and leverages less inclined to embrace something that requires switching to Record locator and retrieval. By providing a “virtual table of national utilities—without boundaries or restrictions on loca- the workflow clinicians already use. another program or opening a new window to access a contents” that documents available data from each encounter tions or providers. CommonWell leaders see their efforts as a patient record. Those extra steps create mental and technical location as well as a “virtual librarian” who can find and retrieve solid and significant step in that direction. “The vendors who lead CommonWell coalesced because they barriers that are difficult to overcome.” the data, CommonWell services help providers locate and access felt the industry was facing a problem worth solving,” says their patients’ records, regardless of where care occurs. For this “It comes back to building upon and maintaining the Jitin Asnaani, executive director, CommonWell Health However, CommonWell members have built-in access to the orga- reason, Asnaani says CommonWell thinks of itself as a record momentum of our core mission,” Asnaani says. “If the entire Alliance, Boston. “Patient data should be accessible to every- nization’s services at the end point, so that they can use the soft- locator service, not a health information exchange. industry embraces our belief that the services that enable one—it should not be something to compete on. This is the ware they already have in the workflow they already know. “The interoperability should be as accessible as the ‘File’ menu of vision to which CommonWell is committed.” cool thing about [CommonWell is] it’s presented in the context of Trusted data access. CommonWell offers certification, every software program, the incentive to raise the bar auto- what the provider is used to seeing for that system,” says William authentication and auditing services that facilitate consistent matically moves for everyone.” What Is CommonWell Health Alliance? “Tripp” Jennings, MD, system vice president, Medical Informatics and trusted data sharing among member systems. Data From the outset, CommonWell—which was incorporated as Office–Palmetto Health, a South Carolina-based nonprofit health remains within the health system where it was collected, with For more information, contact CommonWell Health Alliance a nonprofit trade association in 2013—wanted to create ser- system. “We should have overcome these interoperability chal- CommonWell providing authentication and auditing to facili- at [email protected] or visit the organization’s vices that would allow providers to manage patient identity, lenges years ago. It’s the right thing to do for patients. “ tate trusted data sharing among those member systems. website, www.CommonWellAlliance.org.

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SO15_Advert_Cerner.indd All Pages 8/3/15 3:35 PM Removing Barriers to Building a Nationwide Data Exchange Health IT competitors are collaborating to build infrastructure and services that enable interoperability nationwide, supported by common standards and policies.

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SO15_Advert_Cerner.indd All Pages 8/3/15 3:35 PM IT’S TIME TO TAKE A NEW LOOK AT INCLUSION IN HEALTHCARE ORGANIZATIONS

New ACHE research offers insight on how healthcare leaders can prepare their organizations for changing U.S. demographics.

By Leslie A. Athey ealthcare organizations have been addressing the Because those in the study were sampled from member Hissue of diversity in the workplace for decades; why lists, the results are indicative but not necessarily rep- revisit it now? A recent ACHE study shows racial and resentative of all healthcare executives. The survey ethnic disparities and perceived lack of parity still exist in asked black, white, Hispanic and Asian healthcare healthcare workplaces. Although some strides have been executives about a number of topics related to their made, the data indicate that the median salaries of black careers such as education, career progress, career experi- respondents were still lower than that of their white coun- ences and attitudes about their current organizations. terparts, controlling for education and experience. Further, This article focuses on study results in three major minority respondents were, in general, less likely to be in areas: compensation, current position and job satisfaction. CEO positions than white respondents, less likely to report The full results from the research study are posted at that race relations in their organizations were good and ache.org/pubs/research/2014-Race-Ethnicity-Report.pdf. more likely to report their careers had been negatively impacted by discrimination. COMPENSATION When level of education and number of years of Fully developing staff talent, treating staff fairly and experience are controlled, Asian and white men being respectful of cultural issues in interactions with earned similar compensation. One of the positive staff and patients are simply the right things to do. findings from the 2014 study is that when education There are, however, two reasons to take a fresh look at level attained and years of experience are controlled, inclusion and cultural competence. The U.S. Census Asian and white men in the survey earned virtually the Bureau estimates that within the next 30 years, the pop- same median salary in calendar year 2013: about ulation of the United States—and therefore the work- $192,000 and $184,400, respectively (see the exhibit on force and patient population—will be mostly nonwhite. page 36). This is an improvement from the 2008 study As healthcare organizations become increasingly com- when, controlling for educational attainment and years plex, the demand for capable leaders increases. of experience in healthcare management, we estimated Organizations need to make sure they have the right Asian men earned 22 percent less than white men in the policies for attracting and retaining talented staff and previous year. delivering quality patient care to be successful in a country with such rapidly changing demographics. Controlling for education level attained and years of healthcare management experience, Hispanic and black The findings in this article are based on a survey ACHE men earned less than white and Asian men. In 2014, has conducted every five to six years since 1992. It com- taking education and experience into consideration, the pares the career attainments of male and female health- previous year’s earnings for Hispanic men were 8 percent care executives by race and ethnicity. Participants in the less than those of white men. This represents progress since survey were sampled from the memberships of ACHE, the 2008 study, when this figure was 14 percent. In 2014, the National Association of Health Services Executives, however, previous year’s earnings for black male executives, the National Forum for Latino Healthcare Executives accounting for differences in education level attained and and the Asian Health Care Leaders Association. The years of healthcare management experience, was 17 percent survey also was endorsed by the Institute for Diversity less than that of their white counterparts, showing no in Health Management. improvement over the 2008 results.

Predicted Mean Total Compensation 2013, Controlling for Education and Years of Experience and Median Years in Healthcare

25 $200,000 for controlling compensation Median 20.8 $191,961 $184,444 and experience education 20 18.4 19.0 $180,000

$169,829 $159,912 15 13.0 $157,759 $160,000 13.0 13.6 13.5 12.5 11.0 $143,577 $141,563 $155,444 9.0 9.1 10 $153,004 $140,000 $141,899 9.2 $131,933

healthcare management healthcare 5 $120,000

Median number years of in $123,131

Males Females All Black White Hispanic Asian Median compensation controlling for education and experience

Note: The actual (uncontrolled) median income for each race/ethnic and gender group is available in the full report in the Research area of ache.org.

Again, controlling for education level and years of are closing the gap. A higher proportion of white male healthcare management experience, white, Hispanic executives (32 percent) held a CEO position at the time of and Asian women earned similar salaries. Another pos- the 2014 survey than did black, Hispanic or Asian men itive finding from the study was that when differences in (20 percent, 25 percent and 9 percent, respectively). This education level and years of experience were accounted may be due in part to the fact that minority men had for, the median salaries for white, Hispanic and Asian attained fewer years of healthcare management experience women in calendar year 2013 were virtually the same: than white men (see the exhibit). However, the propor- about $141,600, $141,900 and $143,600, respectively. tion of black men in CEO positions was 62 percent of This is also an improvement from the 2008 results, when that of white men, a significant improvement from 2008, Hispanic and Asian women earned roughly 10 percent when this figure was 47 percent. Similarly, the proportion less than white women in the previous year. of Asian men in CEO positions was 28 percent of that of white men, up from 15 percent in 2008. When education level and years of experience are controlled, black women earned less than white, Hispanic A higher proportion of white women than minority or Asian women. The results were not as positive for black women had attained CEO positions, but the gap is female executives in the survey. In 2008, black and white widening for black and Hispanic executives. The pro- women earned about the same salary in the previous year, portion of white women executives (14 percent) in CEO controlling for education level and years of experience. In positions in 2014 was almost the same as it was in 2008. 2014, the adjusted median salary for black female execu- However, in 2014, the proportion of black women hold- tives was 13 percent less than that of white women. ing CEO positions was 57 percent of that of white women; a drop from 2008 when it was 77 percent. CURRENT POSITION Similarly, the proportion of Hispanic women occupying A higher proportion of white men than minority men CEO positions was 78 percent of that of white women in had attained CEO positions, but black and Asian men 2014, a drop from 92 percent in 2008.

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ASHA_CCC_HealthcareExec_8.375x11.125_v1.indd 1 7/13/15 11:08 AM IT’S TIME TO TAKE A NEW LOOK AT INCLUSION IN HEALTHCARE ORGANIZATIONS

Current Position by Race/Ethnicity and Sex (Percentages)

120 Men Women All 100 80 60 40 20 0

Black White Asian Black White Asian Black White Asian Hispanic Hispanic Hispanic

CEO COO/Sr VP VP Dept. Head Manager Dept. Staff Consultant Other

JOB SATISFACTION senior positions in their organizations. Asian and Hispanic Men and women in all racial/ethnic groups are largely respondents fell between these two extremes, with slightly more satisfied with their jobs. A piece of good news from the than half agreeing more effort is needed to increase diversity study is that, within all racial and ethnic groups, most among senior executives. Black respondents also were signifi- healthcare executives are happy with their jobs. About cantly less likely to feel positively about race relations in their three-quarters or more of the study respondents said they organizations when compared to white respondents or mem- were satisfied with their position, almost all identify with bers of the other racial and ethnic minorities in the study. their organization by saying “we” rather than “they” when speaking about their companies and more than half Minority respondents were less likely to report satisfac- intend to stay in their current jobs for the coming year. tion with their career progress than white respondents, and they were more likely to report discrimination had Some minority executives were less satisfied with negatively impacted their careers. More than 80 percent aspects of their jobs. Black respondents reported being of white respondents reported being satisfied with their less satisfied with their compensation, how they are career progress, as were more than 75 percent of Asian treated when they make mistakes and the respect and and Hispanic respondents. However, only 67 percent of treatment their supervisors give them than were members black respondents were satisfied with how they were of any other racial or ethnic group in the study. meeting their career goals. Almost half of black respondents said their careers had been negatively impacted by DIFFERING PERCEPTIONS OF RACIAL/ racial or ethnic discrimination, as compared to about ETHNIC EQUITY one-quarter of Asian and Hispanic respondents and There are clearly differing perceptions between white and 10 percent of white executives. minority respondents about the degree to which healthcare organizations have reached racial and ethnic parity in the work- WHAT ARE ORGANIZATIONS DOING? place. Black respondents were about twice as likely as white The survey results give us an idea of how prevalent differ- respondents (81 percent versus 40 percent) to say more effort is ent types of diversity initiatives are in healthcare organi- needed to increase the proportion of racial/ethnic minorities in zations (see the exhibit on page 40).

38 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. IT’S TIME TO TAKE A NEW LOOK AT INCLUSION IN HEALTHCARE ORGANIZATIONS IT’S TIME TO TAKE A NEW LOOK AT INCLUSION IN HEALTHCARE ORGANIZATIONS

Perceptions of Racial and Ethnic Parity in the Workplace

Black White Hispanic Asian The amount of job security I have 74% 78% 78% 78% The amount of pay and fringe benefits I receive for what I contribute to this organization* 58% 68% 67% 64% The sanctions and treatment I receive when I make a mistake* 64% 74% 71% 70% The degree of respect and fair treatment I receive from those who supervise me* 76% 82% 82% 83% The degree of respect and fair treatment I receive from the employees I supervise 87% 92% 90% 88% The amount of independent thought and action I can exercise in my job 81% 86% 87% 85%

Overall, how satisfied are you in your present position? 78% 84% 86% 82%

(N) 443 400 269 292 * Chi-square significant p<.05

The most common type of diversity program appears to Organizations need mechanisms to periodically review com- be social gatherings for employees, which were reported pensation and ensure each executive’s pay is based on his or by roughly three-quarters of survey respondents as being her qualifications and responsibilities and in no way reflects offered by their organizations. More than half of respondents biases relative to his or her gender or race and ethnicity. reported their organizations had affirmative action plans, and about half said their organizations offered mentoring Sponsor social gatherings for employees. The study programs, diversity training for managers or a policy of seek- showed the existence of social gatherings for employees was ing diversity in candidates considered for hire. Less than half significantly related to minority executives feeling more of respondents said their organizations had a diversity positive about race relations in their organizations. committee, a manager responsible for diversity, a strategic or business objective to increase diversity, affinity groups or Establish mentoring programs. About three-quarters or different types of diversity incentives for managers. more of minority executives in the 2014 survey reported having a mentor at some point in their careers, and mentoring 6 WAYS TO INCREASE DIVERSITY AND programs were mentioned among the best practices to pro- INCLUSION mote diversity in healthcare volunteered by respondents. In We analyzed the relationship between the existence of addition, the existence of mentoring programs was positively diversity programs and the likelihood that minority exec- related to Hispanic and Asian respondents feeling good about utives would describe race relations in their organization race relations in their organizations. Mentors who provide as good (see the exhibit on page 40). That, combined advice, model positive behaviors and introduce protégés into with other results from the survey, leads us to make the networks of other executives are having a powerful impact on following recommendations to healthcare organizations the field, yet only about half of survey respondents reported looking to increase diversity and inclusion. mentoring programs are in place within their organization. Healthcare organizations need to consider instituting or Ensure equity in pay. Salary is by no means the only—or expanding effective mentorship programs. even, sometimes, the most important—reason people choose and remain in their jobs. It is, however, a tangible sign of the Implement a policy of seeking diversity in candidates value the organizations place on individual staff members. considered for hire. Both black and Asian respondents

Agreement With the Statement “Race Relations in My Organization Are Good” By Race/Ethnicity and Presence or Absence of Diversity Initiatives (Percentages)

Black Hispanic Asian Prevalence (all In Not in In Not in In Not in respondents) place place place place place place Affirmative action plan 65% 60%* 45% 78% 71% 78% 77% Diversity committee 46% 61%* 46% 74% 75% 79% 73% A manager responsible for diversity 45% 60%* 47% 72% 77% 75% 78% Diversity training for managers at least every 3 years 51% 60%* 49% 79% 72% 83% 73% Diversity evaluations for managers 21% 62% 51% 91%* 73% 80% 75% Social gatherings for employees 75% 57% 41% 90%* 67% 81% 65% Affinity groups 34% 64%* 49% 79% 75% 83% 72%

Mentoring programs 54% 57% 50% 81%* 69% 83% 70%

Policy of seeking diversity in candidates considered for hire 53% 61%* 47% 74% 74% 82%* 69%

Strategic or business objective to increase diversity and inclusion 43% 66% 47% 78% 72% 78% 75% Plan to increase the number of ethnically, culturally and racially diverse executives on the senior leadership team 31% 64% 49% 73% 72% 86% 73% A portion of executive compensation tied to diversity goals 10% 57% 52% 71% 74% 84% 75%

* Chi-square significant p<.05 were more likely to feel race relations in their organiza- Offer residency and fellowship programs. Based on tions were good if their employers had a policy of seeking the 2014 survey findings, it appears more than half of diversity in candidates considered for open and new posi- those who participated in a healthcare management resi- tions. To help ensure diverse slates of candidates at the dency were eventually hired by that organization. Even senior level, organizations need to factor diversity into higher proportions of those who took fellowships were their recruitment for positions at all levels. hired by the sponsoring organization. Residency and fellowship programs benefit those organizations that offer Increase the diversity of the senior leadership team. The them; leaders get the opportunity to work with a new commitment of top leaders was mentioned by a number of sur- executive before making a permanent hiring decision vey respondents as being critical to the successful creation of about him or her. Healthcare organizations need to con- diverse and inclusive organizations. Further, black and Asian sider offering residency and fellowship opportunities to respondents were significantly more likely to feel positively about qualified graduates to assist their launch into careers in race relations in the workplace in organizations attempting healthcare management. to increase diversity in the senior leadership team. The desire to have healthcare management reflect the populations they Leslie A. Athey is director of Research for the American serve should apply all the way to the top of the organization. College of Healthcare Executives, Chicago ([email protected]).

40 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. Don’t let medication overcharge you. Alaris® EMR Interoperability helps ensure accurate infusions—and accurate infusion documentation. The system automates documentation back to the patient’s EMR for data analysis and maximized reimbursement. With Alaris Viewer Suite for Charge Capture, our system can help prevent lost revenues and help offset unexpected costs. Because medication shouldn’t dictate your finances. Never let good medicine go bad.

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IF5398 ACHE Sept Oct Ad.indd 1 7/23/15 6:33 PM Integrated Technologies Improve Medication Management Safety Bon Secours’ medication management platform allows pharmacists to focus on direct patient care while improving patient safety and quality of care.

“ By reducing steps and being able to access collaborative approach has put health network at the Centralizing Control of Medication Management that enables pharmacists to step out of the central phar- patient and medication data in one place leading edge of innovation in its use of automation. With the desire to expand enterprisewide capabilities, Bon macy and remotely perform patient-care activities from through the ES platform, we have virtually Secours assembled a cross-functional team that included any hospital computer. The ES interface also helps phar- eliminated variation, which often causes Decreasing Medication Turnaround Time staff from pharmacy, corporate IT, clinical IT and nursing. macy staff manage tasks more efficiently. Expanded error, and truly improved patient safety.” Seven years ago, Bon Secours initially committed to “The interconnectedness among departments and hospi- scanning functionality helps ensure the right medications improving itsmedication management processes. “Most tals was crucial to moving us forward,” DeFazio says. “We are loaded into the right system and dispensed for the — Jim DeFazio pharmacists are familiar with the studies showing that a wanted this to be a systems approach, not just 19 different right patient. Corporate Pharmacy Director delay in medication therapy puts patients at unnecessary subunits pushed together.” Using Six Sigma techniques— Bon Secours Health System risks and increases length of stay,” DeFazio says. “With which many team members had already been trained in— “We have created an environment in which pharmacists, Marriottsville, Md. that in mind, we wanted to reduce the time between the group examined workflows from all perspectives to nurses and physicians interact directly. They can discuss when a physician writes an order for a medication to when ensure the process was truly streamlined and would never alternative therapies and work together to come up with Bon Secours Health System counts itself among those that medication is actually administered to the patient.” require a workaround. treatment options that enable patients to heal fast,” providers that have a clinical pharmacist role at the hos- DeFazio says. “It’s about making decisions as a well- pitalized patient bedside. In addition to the nursing The system’s first step toward improvement was to install Next, after researching several options and conducting site rounded team at the point of care.” and physician staff, pharmacists have joined the sys- medication cabinets containing 90 percent of the most visits, Bon Secours chose the Pyxis ES platform from tem’s clinical teams, contributing to improved patient commonly used medications on nursing floors. Since then, CareFusion, a BD company, to help simplify and standard- In addition to facilitating a more hands-on role for phar- care on patient floors in most of Bon Secours’ 19 acute Bon Secours has consistently been reaching its seven- ize medication management across the enterprise. The ES macists, the ES platform helps nursing staff perform care hospitals. minute turnaround benchmark throughout the system. platform is interoperable with Bon Secours’ pharmacy more efficiently and safely. The new system dispenses information system, resulting in a single formulary for the medication in four steps within five seconds. Safety “Our pharmacists aren’t working in isolation in a far-off But during the time since Bon Secours first implemented entire organization that can be adjusted as needed for enhancements, such as clearly highlighting patients with corner of the hospital,” says Jim DeFazio, corporate phar- decentralized medication management, the healthcare each hospital. This interoperability leverages centralized the same last name, help reduce the risk of potentially macy director, Bon Secours. “They’re out on the floors industry has transformed in nearly every arena, from reim- configuration efforts across the health system. harmful errors. discussing medication therapies with physicians and bursement provisions to sophisticated IT requirements to nurses because we have been able to reduce the amount hospital system consolidations. System leaders recognized “The drug database was built just once, and as each hos- With half of the health system fully live on the ES plat- of busywork from our pharmaceutical distribution pro- that to face these growing challenges, they needed flexible pital comes on board, staff are able to simply pull up the form and the rest expected to follow by March 2016, cesses. We know that our pharmacists’ involvement has a medication management solutions to provide enterprise- existing, centralized database. The nomenclature is stan- Bon Secours has achieved a level of integration that sup- direct impact on improved patient outcomes.” wide capabilities. dardized rather than re-created at each site,” DeFazio says. ports centralized control of its medication dispensing sys- “By reducing steps and being able to access patient and tems. At the same time, the platform gives the health At Bon Secours, pharmacists’ enhanced role came as a “We have 19 acute care hospitals in six different states, medication data in one place through the ES platform, we system the data it needs when and where it is needed for result of a partnership among the system’s pharmacy, each with its own unique culture,” DeFazio says. “We have eliminated variation, which often causes error, and immediate decision making and reporting. nursing and IT staff. This cross-functional team rede- wanted to integrate our pharmacy processes with health truly improved patient safety.” signed the health system’s medication management pro- information technology across our system for a cohesive For more information, please contact Jim DeFazio, cesses and workflows that have been impacted by an approach in the current—and future—healthcare Moving Pharmacists Into a Clinical Role corporate director, value analysis, Bon Secours, at industry-leading medication management platform. This environment.” Bon Secours’ new platform hosts a Web-accessible server [email protected] or (410) 362-3000.

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SO15_Advert_CareFusion.indd All Pages 8/3/15 3:38 PM Integrated Technologies Improve Medication Management Safety Bon Secours’ medication management platform allows pharmacists to focus on direct patient care while improving patient safety and quality of care.

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SO15_Advert_CareFusion.indd All Pages 8/3/15 3:38 PM TakeProfessional Note Pointers

LEADERSHIP diversity among their senior ranks, with 68 percent (compared with 53 percent of all other companies) indi- Top Organizations Share cating the diversity of their senior leaders reflects the Similar Characteristics diversity of their employees. According to the Hay Group’s “Best Companies for Leadership” study, organizations that are models for lead- Purpose-Built Leaders ership excellence take a determined and disciplined At the top 20 companies, flexibility to respond to eco- approach to helping leaders develop and rise within their nomic changes was identified as a top challenge for organizations. Eighty percent of the top 20 companies leaders during the next 12 months, along with the abil- had established clear career paths for their employees, ity to capitalize on opportunities within emerging mar- compared with only 48 per- kets. Surprisingly, in an era cent of all other companies. where organizations are Similarly, 80 percent of the top increasingly turning to online 20 were well ahead of their learning, the top 20 are lever- peer groups in providing aging high-touch methods of career development experi- educating their workforce. ences for their organization’s Classroom-based leadership highest-potential talent, ensur- training still remains the pre- ing the company has the right ferred method among the top people with the right skills 20 firms (used by 74 percent when needed to fill their most of the top 20 vs. 51 percent critical roles. of all other companies), with mentoring by senior staff and Not only do the top 20 com- coaching from internal panies provide clearly defined resources also highly priori- and varied routes to leader- tized (69 percent and 61 per- ship, they also intentionally cent, vs. 41 percent and 34 seek to develop diverse lead- percent, respectively). ers. Half offer special leadership development pro- Outstanding companies are recognizing that develop- grams for women, compared with 13 percent of all ing strategic, globally connected leaders for the future other companies, and 40 percent of the top 20 have means they have to make investments to bring leaders programs geared toward diverse groups, compared together to learn as a community while using the best with only 11 percent of all other companies. Top com- technologies to connect people globally and bring panies also tend to make leadership development pro- learning back to their teams and organizations. grams available at all experience levels (83 percent, compared with 57 percent of other companies). Not Source: Adapted from an article by the Hay Group. surprisingly, the top 20 also are more likely to report Visit www.haygroup.com/BCL for more on this topic. “Management is about arranging and telling. Leadership is about nurturing and enhancing.”

—Tom Peters, author, In Search of Excellence: Lessons From America’s Best-Run Companies

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Revenue Cycle Management Patient Communications & Engagement Clinical Integration Population Health Management Financial Risk Management Professional Pointers

PHYSICIAN COLLABORATION MANAGEMENT 4 Ways to Support Emerging From Micromanagement to Physician Leaders Abdication Management We recently touched on the emergence of physician The following is an excerpt from a blog post by leaders in the healthcare industry and how their Patrick Lencioni, CEO of The Table Group, a leadership approach to leadership has the potential to clash with consulting group, and best-selling author of books the more traditional mindsets and backgrounds of the focused on leadership. average senior executive. This phenomenon is called physician whiplash, and it could throw a wrench into In the past, people who have accused their bosses of a health system’s operations if not managed carefully. micromanaging do so as a permanent insult more than a mere suggestion for change. Micromanagers were Thankfully, the overlaps between senior executives and assumed to be insecure and distrustful, so no one wanted physician leaders mean there’s plenty of common to have that label applied to them. To make matters ground to build a respectful co-existence between the worse, being called a micromanager was almost indefen- two. Supporting physicians in mastering the practice of sible; if an employee felt he or she was being microman- leadership requires laying out the challenge and com- aged, those feelings needed to be validated and mitting to physicians who answer the call to lead. If addressed. senior teams and boards can make the following statements and follow up with credible sustained actions, It might be tempting to read this and think, “What’s the they can be confident they are well-positioned to sup- big deal?” Well, there was an unintended conse- port their emerging physician leaders. quence that had a negative effect on leaders that continues today. See, the pendulum swung far away from To best demonstrate support in your physician leaders, it micromanagement and seemed to get stuck on the is important to communicate the following: opposite end of the spectrum, in a place I’ll call “abdication management.” • You understand the challenges they face in practicing both great medicine and great leadership and are committed Today, for every real micromanager I come across, to helping them overcome those challenges to achieve. especially at the top of organizations, there are dozens of abdication managers. These are the people who • You will address and work to resolve any barriers that know little about what their direct reports are working on may be obstructing their transition into leadership, par- and defend their approach by citing their own busy ticularly for integrating physicians into existing leader- schedules—or worse yet, by proudly using words like ship structures. trust, autonomy and empowerment. Unfortunately, the results of abdication management are consistent: a lack • You will lend your support and help reduce their learn- of necessary guidance, delays in recognizing problems, ing curves as they take on leadership duties (such as stunted professional development of key people and heading up projects) so desired outcomes can be anxiety among employees. The consequences of abdica- achieved together. tion management on the bottom line of an organization are not hard to imagine. • That you will offer substantial leadership development catered to the physicians’ specific needs and roles. Addressing this problem requires understanding its root causes. These include the fear of being accused of micro- Source: The O’Brien Group. Visit www.obriengroup.us. management, negligence and ignorance.

46 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. When I’ve confronted CEOs and senior executives about or her and get involved only when a problem arises that their tendency to undermanage their direct reports, I’ve actually impacts my world negatively. I’m usually a little often received an explanation that goes something like grumpy when this happens. Of course, there is nothing this: “Listen, I hire senior people with experience, and I virtuous about that. don’t think they need me to manage them.” This lack of energy for managing people represents one of the big- But when I’m working on a project that is near and dear to gest problems I see in corporate life. Management of my heart, I stay involved in a way that keeps my employ- direct reports is too often ees on task, allows me to seen as a remedial activ- see potential problems ity, reserved for employ- before they get out of ees without experience, hand and provides my rather than an essential staff with a level of confi- requirement for providing dence that they are order and clarity for peo- headed in the right gen- ple at every level of an MANAGE eral direction. Do I occa- organization. The nature sionally wonder if I’m of how people are man- E stepping over the micro- M

aged will certainly vary C management line? Yes.

depending on a person’s O And so I wrestle with the D

role and level of maturity, B tension of being in that A but managing them is place instead of running never optional, and the from it. Consequently, consequences of neglect- those projects usually go ing the need for manage- better than the others. ment are always serious. My challenge, and the None of this is to say challenge of every other true micromanagement is leader who occasionally a good thing. But I’m participates in abdication convinced most companies would be far better served if management, is to be more consistent in the way I man- their leaders walked a little closer toward the microman- age and not let my management style be determined by agement end of the spectrum than the abdication end. my level of interest, energy or curiosity. That would cer- I’ve learned this the hard way. tainly be a more responsible, intentional and effective approach—one that would benefit my company and the I’ve noticed when one of the people I’m supposed to wonderful people who work here. manage is working on something that is not particularly interesting to me, I find it easy to say, “I’ll trust that person Source: Adapted from “Micromanagement Is Underrated,” The to do what’s right.” I proudly leave all the details to him Table Group, April 2015. Visit www.tablegroup.com.

Submit a Pointer to “Professional Pointers” Have you implemented workplace strategies that could help To submit a topic for consideration, please contact the editor- your colleagues succeed as well? Healthcare Executive invites in-chief at [email protected]. you to share the workplace knowledge that has played a role in your career success.

The Urgent Need for engineering and patient safety, University of Michigan, said recently Fatigue Management he is unaware of any institution that has an effective policy for residents Policies and, in his experience, “The situation is worse for other care providers.”

Paul B. Hofmann, Tired staff risk harming patients, themselves There is much more robust litera- DrPH, FACHE and others. ture on fatigue management in other fields, particularly and pre- dictably in ground and air trans- A nurse strikes and kills a cyclist—a Increasing Evidence of portation. For example, in its father of two young children—while Need for Action February 2012 issue, the American driving home from the hospital after In the November 2007 issue of The College of Occupational and working a double shift. Another Joint Commission’s Journal on Environmental Medicine’s Journal of healthcare professional falls asleep Quality and Patient Safety, Steven Occupational & Environmental on the job in a group home; one of Lockley, PhD, and his colleagues Medicine contained detailed guidance her patients dies after receiving with the Harvard Work Hours, on fatigue risk management. insufficient oxygen. Health and Safety Group provided a comprehensive review of the effects The ACOEM report highlighted four These are two extreme, real-life of healthcare provider work hours points regarding the risk of employee examples bolstering growing evi- and sleep deprivation on safety and fatigue in the 24/7 workplace: dence showing that when nurses, performance. In its 2007 analysis, physicians and other members of the the Harvard Group determined that • Fatigue is related to duration of healthcare team are fatigued, they “long work hours increase the risk sleep and timing of sleep. are more likely to jeopardize others that nurses and doctors will suffer • Inadequate sleep is correlated or make a clinical mistake, regard- an occupational injury with poten- with a variety of adverse medical less of their qualifications, compas- tially devastating long-term conse- outcomes. sion and dedication. quences and increase the risk of • Various shift work schedules can motor vehicle crashes.” affect both the duration and tim- A 2013 report, commissioned by ing of sleep. Kronos Inc. and conducted by They concluded the number of • Inadequate duration of sleep is HealthLeaders Media, indicated hours worked by U.S. healthcare correlated with injury rates. more than 25 percent of the nurses providers is unsafe. surveyed said fatigue caused them Last year, the American Organization to make an error at work. The fig- “To reduce the unacceptably high of Nurse Executives reported 56 per- ure may actually be higher because rate of preventable fatigue-related cent of survey respondents said their many nurses, physicians and other medical error and injuries among hospitals disregard required rest peri- staff members are likely unaware health care workers, the United ods, and 65 percent said their hospi- when fatigue affects their States must establish and enforce tals do not have policies regarding judgment. safe work-hour limits,” the authors cumulative days or extended shifts. wrote. One hospital with which I work has a Although the issue of healthcare pro- 48-hour week work limit and another vider work hours and sleep depriva- In 2010, teaching hospitals were has a 60-hour limit. Undoubtedly, tion has been studied for years, required to place an 80-hour weekly other hospitals have different limits, healthcare has been slow to enforce limit on house staff; however, James but how consistently are these restric- policies addressing fatigue. Bagian, MD, director, healthcare tions monitored?

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In addition to fatigue caused by too Preventive Medicine involving almost The policy should begin with a con- many hours of work at the hospital, it 75,000 U.S. registered nurses and cise description of its purpose. By is increasingly common for hospital 22 years of data concluded mortality using this introduction to emphasize employees to have multiple jobs. from all causes appeared to be 23 per- why the policy is needed, the hospital Hospitals with policies stipulating a cent higher for women with 15 years can explain that patients, staff and limit of 48 hours or 60 hours per or more of rotating night shift work. the community will benefit by hav- week rarely, if ever, take this reality ing a clear statement of steps taken to into consideration. Furthermore, in Preparing a Meaningful Fatigue prevent, or at least minimize, fatigue many urban areas where housing is Management Policy and its adverse outcomes. more expensive, longer commutes are It is both organizationally urgent and increasingly common. Research has ethically essential that organizations The American Nurses Association, rep- verified that driving while tired, like take a stand on employee fatigue and resenting the interests of the nation’s driving under the influence of alco- create a fatigue management policy 3.1 million nurses, suggests this policy: hol or drugs, results in slower reac- that promotes both patient and tion times and possible accidents. employee safety. • Limit shift lengths to 12 hours and work weeks to 40 hours. As expected, studies also have con- A logical first step in creating a policy • Abolish mandatory overtime. firmed sleep and the circadian system is to engage a focus group of nurses • Promote regular rest breaks. also play an important role in cardio- and others to begin discussing the • Allow nurses to decline assign- vascular health. A 2015 study pub- issue and solicit ideas and ments they think will cause lished in the American Journal of recommendations. fatigue.

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Exceptional Leadership Superior Productivity in Sept. 9–Oct. 21 Healthcare Organizations A Review of Health Law Oct. 7–Nov. 18 Sept. 16–Oct. 28 Population Health: The Road Physician Alignment and to Transformation Oct. 14–Nov. 25 Engagement: Dos and Taboos Learn more Sept. 23–Nov. 4 Strategic Planning That A Digital Revolution: How Works: Integrating Strategy Health IT Can Improve Access, With Performance and register now at Oct. 21–Dec. 2 Quality, Safety and Efficiency ache.org/e-learning Sept. 30–Nov. 11

50 SO15_OnlineSeminars_half.inddHealthcare Executive 1 7/22/15 1:04 PM SEPT/OCT 2015 Reprinted with permission. All rights reserved. • Restrict consecutive night shifts areas of noncompliance are not Paul B. Hofmann, DrPH, FACHE, is for nurses who work both days addressed, and the policy is not period- president of the Hofmann Healthcare Group and nights. ically reviewed and revised to ensure its and co-editor of Management Mistakes • Provide nurses with places to continued value. in Healthcare: Identification, Correction sleep or transportation when they and Prevention, published by Cambridge feel too tired to drive. Preventing even one tragedy affect- University Press, and Managing ing a patient, employee or member Healthcare Ethically: An Executive’s Expecting hospitals to limit the work of the community is worth the Guide, published by Health Administration GRAY-0013_Healthcare Executive - Doctor Ad_05-06-15.pdf 1 5/6/15 1:34 PM week to 40 hours, given unpredictable investment. s Press ([email protected]). changes in patient census and staffing resources, may be unrealistic, but this doesn’t mean hospitals shouldn’t review their current practices and establish an appropriate policy.

In assessing its safety culture and staff resilience, Duke University Hospital asks WHAT DID THE nurses to indicate how often they got less than five hours of sleep in the past week, a threshold below which social and emo- LAWYER SAY TO tional functioning are significantly com- promised. Analyzing the data by clinical THE DOCTOR? service unit and comparing changes Let us watch out for the health of your practice, so you between survey periods allows leaders can focus your energy on the health of your patients. to develop and focus their organiza- Relax and take a deep breath. tion’s intervention strategies and also helps predict where there are vulnera- bilities (e.g., the potential for disruptive At Gray Reed, our work is no joke . . . because behavior and delays in the delivery of our practice revolves around your business. care resulting from nurse fatigue). With lawyers who understand what drives the market and the experience of overseeing Just as adult children are hesitant to ask hundreds of healthcare providers’ transactransac-- an elderly mother or father to give up tions, lawsuits, arbitrations, and compliance their car keys, there are obvious diffi- issues, we provide creative yet sensible culties in enforcing a policy when it solutions in the rapidly changing healthcare may be evident an employee should not industry. We’re all about your bottom line – be working an extra shift or driving. It we’ll leave the punchlines to someone else. is quite likely the employee will reply, “I’m fine and have no problem working a double shift and driving home.”

As emphasized in “The Myth of Comprehensive Policies” (Healthcare Executive, September/October 2012), even the best policies are meaningless if staff are not educated in their application, compliance is not monitored,

A Model for Change Hospital continued to struggle with its performance. The average ED length of stay was 395 minutes, and Change management techniques help the overall rating of care provided enhance the patient experience. by the ED fell in the 63rd percentile. There were opportunities to improve communication around Neil R. Fedders, medications prescribed to patients OTR/L and discharge instructions.

In 2013, leaders at Anderson At a time when healthcare leaders have strong. For example, in the first quar- Hospital decided to implement access to an unprecedented amount of ter of 2015, Anderson Hospital was a model for change management data, we are only just beginning to recognized by Truven Analytics as one in the ED and throughout the understand how to use it to drive inten- of the country’s 100 Top Hospitals for hospital, using the Institute for tional, measurable change. At Mercy the 10th time, and the hospital has Healthcare Improvement’s small- Health–Anderson Hospital in been rated by Truven as one of the test-of-change guidelines: Cincinnati, our systemwide approach to 50 Top Cardiovascular Hospitals in using data to identify opportunities that the nation. But the data captured • Use Plan-Do-Study-Act to test will transform the patient experience through patient satisfaction surveys ideas for change on a small scale over the past three years has reduced indicated the hospital was not deliver- to determine whether they result ED door-to-provider and treatment-to- ing a fully desirable patient experience. in improvements. release times and left-without-being- seen rates, increased collaboration In 2010, Mercy Health began to focus • If improvements are recorded, between EDs and inpatient units and systemwide on improving operational expand the tests gradually until enhanced patient satisfaction. efficiency, and in 2012, leaders and you are confident the changes staff began concentrating efforts on should be more widely adopted. Linking Data With improving the patient experience. In Process Improvement its EDs, the health system’s goal was In April 2013, team members at In 2009, Mercy Health—the largest to achieve top-quartile performance Anderson Hospital performed a kai- health system in Ohio and one of the on patient satisfaction surveys in the zen event that enabled staff to iden- largest nonprofit health systems in the category of ED overall rating. tify opportunities to improve ED United States, serving communities in throughput, discharge for acute care Ohio and Kentucky—faced challenges Mercy Health’s ED Transformation patients, communication around related to ED crowding and boarding Committee led improvements in medications and room turnaround as well as around efforts to develop a front-end processes, patient flow, times. The team also identified more patient-centered culture. communication and culture that change-management metrics that resulted in demonstrable increases could be monitored to determine the When it came to patient experience, in patient satisfaction, as seen in impact of the hospital’s efforts. data suggested the performance of the exhibit. By 2013, 86 percent of

Anderson Hospital, a 190-bed hospital Mercy Health EDs were performing This column is made possible in part with 1,000 inpatient admissions and as well or better than their national by Philips Healthcare. 3,500 ED visits per month, was medi- peers in the category of ED length ocre, although its quality outcome of stay, and all of the health sys- measures were and continue to be tem’s EDs had decreased the ranked among the best in the country, average door-to-provider time to and its financial performance was 30 minutes or less. But Anderson

52 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. LEADING CARE LEADING EXCELLENCE LEADING STRATEGY LEADING COMMUNITIES LEADING QUALITY LEADING SAFETY LEADING INNOVATION LEADING TECHNOLOGY LEADING PEOPLE LEADING SELF

SAVE THE DATE 2016 CONGRESS ON HEALTHCARE LEADERSHIP MARCH 14–17, 2016, HYATT REGENCY CHICAGO ACHE.ORG/CONGRESS

Congress_SavetheDate.indd 3 8/3/15 1:47 PM Satisfying Your Customers

Using Change Management to We also take a measured and inten- with the patient and family mem- Guide Improvement tional stance in monitoring the success bers, where appropriate, and Anderson Hospital began testing of the initiatives we have implemented answer questions regarding the ideas for improving patient dis- on a weekly basis, knowing patient sat- patient’s care. So far, results for charge. Staff developed a discharge isfaction scores do not become avail- this initiative have varied, primar- checklist to make the process more able until four to six weeks post ily due to inconsistent application patient centered, ensuring patients discharge. Nurse managers complete of this approach. While scores that know who their discharge planner weekly audit forms for our senior lead- rate patients’ communication with is and understand their plans for ership team to review, providing feed- their physician have steadily care after leaving the hospital and back on follow-through for frontline increased since the first quarter of what medications to take; symp- initiatives, the successes and challenges 2014, exceeding top-quartile per- toms and side effects to watch for; related to implementation of such ini- formance in the third quarter of and when to receive follow-up care, tiatives and feedback that could help 2014, scores dipped below top- with follow-up appointments made other units in their efforts. The audits quartile performance in the fourth prior to leaving the hospital. enable senior leaders to view—in near- quarter of 2014. real time—progress made in specific In June 2013, an inpatient unit areas and to spot opportunities to Anderson Hospital’s medication side- piloted the discharge checklist to share best practices in one unit with effect initiative also experienced top- gauge its effect on supporting an the team as a whole so successes could quartile success in 2014. When a enhanced patient-centered dis- be achieved systemwide. patient is placed on a new medica- charge process. Based on the imme- tion, a nurse will place an “M” on the diate improvements recorded, teams Nurses also began to accompany whiteboard in the patient’s room. on several acute care floors soon physicians during rounding. As The “M” reminds nurses to review implemented the checklist, and by part of this initiative, a physician possible side effects of the new medi- August 2013, the checklist was will notify a nurse when he or she cation with the patient during each applied hospitalwide. Since the is ready to see a patient in an inpa- shift and prompts the administrative checklist was implemented, tient unit. Anderson Hospital’s ambassador to provide one-on-one Anderson Hospital has performed EHR features a treatment team col- instruction on why the medication at or above the top quartile in umn that identifies the nurse was prescribed and side effects to patient satisfaction related to the whom the physician should contact watch for. In just three months— discharge process, with monthly and the nurse’s phone number. from the first quarter of 2013 to the top box scores as high as 91.5 per- Together, the physician and nurse second quarter—scores for commu- cent in this domain. discuss the patient’s treatment plan nication about medications rose more than 5 percent, from 61.2 percent to 66.4 percent. Last year, Anderson Patient Satisfaction at Mercy Health–Anderson Hospital Hospital achieved top-quartile performance in this area during all but Top Box Scores for Domain 2010 2011 2012 2013 2014 one quarter.

Overall rating of care 63.4 68 69.7 73 74.1 Administrative discharge rounding— Communication with RN 74.2 78 80.5 81.6 81.8 in which members of Anderson Communication with MD 74.6 76 77.9 78.8 80.8 Hospital’s management team visit Pain control 67 70 72 73.4 73.9 with patients on inpatient units daily—is another initiative in which Explain medications 56 60 62 64.3 64.8 Anderson Hospital experienced top- Discharge instruction 79 81 84.9 86.5 89.5 quartile success last year, improving Source: Mercy Health–Anderson Hospital, based on data collected from Press Ganey surveys. scores in the category of overall rating

54 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. of care. Each day, members of the must believe in the change manage- picture—and when they demonstrate management team are assigned sev- ment process. The message these man- patience with the initiative as well eral rooms to round on. During agers send to their teams during each and share positive, real-time feedback rounds, hospital leaders seek real-time huddle and staff meeting regarding received through efforts such as feedback on the quality of care and the importance of a new initiative administrative rounding—teams will provided services and look for oppor- must be consistent, particularly if the be more likely to believe their efforts tunities to resolve issues, if any, and patient experience scores recorded in have the potential to effect measur- to recognize staff who have delivered the early weeks or months of an initia- able change that makes a difference on our promise and provided an out- tive are less than desirable. for those they serve. s standing experience. Administrative discharge rounding also allows for It’s also important that managers and Neil Fedders, OTR/L, a Member of teach-back moments for staff, com- staff understand gains in perfor- ACHE, is director of operations, munication with family members and mance improvement can be seasonal. Mercy Health–Anderson Hospital, nurses, and establishment of a stron- It is relatively easy to apply, track and Cincinnati ([email protected]). ger connection with patients. measure initiatives when hospital volumes are optimal. It can be difficult The author would like to thank Lessons Learned to apply new processes consistently Denise Irizarry, RN, DNP, CPHQ, Measuring change—especially as it when volumes are very high. When CEN, system director, patient safety impacts the patient experience—can leaders encourage their teams to be and clinical transformation, for her be tedious, as it can take three months patient and focus on the big contributions to this article. to demonstrate measurable improvement and determine how to sustain and build upon successes. When weekly patient experience score updates are posted for staff to see—as 5.2 Million Patients Cared For they are for each site and each inpatient unit throughout Mercy Health— INCREASED DECREASED it can be difficult for staff who are in Patient Satisfaction Time to Provider the midst of a change initiative not to • • Efficiency, Productivity Left Without Being Seen see the results of their efforts reflected • • & Profitability ED Overcrowding in their unit’s scores for some time. • • Hospital-Wide Collaboration • Average Length of Stay • Capacity & Market Share • Readmission Rates That’s why the small-test-of-change process works particularly well with initiatives designed to improve the patient experience: Front-line staff are encouraged to make tweaks to new processes as they are rolled out on a small scale until they feel comfortable Population health starts with the processes. This results in inside your hospital. processes that staff not only use, but also believe in. Visit go.cep.com/hce0815

Overcoming cultural barriers—which can exist from unit to unit and, at times, from department to department—also is critical. Unit managers

Improving the Health of Patient-Care Staff

A Texas hospital network partnered with a wellness company to increase activity. Stephen L. Mansfield, Carrie Camin Mike Tinney PhD, FACHE

Nurses are dedicated to providing that takes less than two minutes. participated in all of the lifestyle patient care, but irregular hours, job These reminders included photo- changes, which included drinking stress and being on their feet all day graphs that demonstrate how to do eight glasses of water a day, getting can cause them to neglect their own each exercise, including chair squats, seven hours of sleep a night and turn- health. According to a University of desk pushups and simply walking up ing off electronic devices an hour Maryland study, 55 percent of a flight of stairs. The exercises were before bedtime. nurses are overweight or obese. In tailored to each participant’s level of December 2014, Dallas-based fitness and became increasingly dif- Employees appreciated how flexible Methodist Health System, a network ficult as the challenge progressed. the challenge was: Although most of hospitals, sought to increase the Participants had an hour to com- participated in it during their shifts, activity levels of its staff in a way plete each exercise so as not to dis- they could start and stop at any time, that was enticing and easy and rupt their patient interaction. giving them the ability to participate didn’t interfere with their ability to after their shifts or during days off. A provide top-notch attention and An Overwhelmingly few employees even encouraged fam- treatment to their patients. Positive Response ily members to participate. After the Following FIX’s advice, Methodist six-week challenge was over, many Methodist Health System found its Health System made the challenge employees continued to replicate it on ideal wellness partner in Fitness completely voluntary for employees. their own. Interactive Experience, an Atlanta- In planning the challenge pilot, based company that creates high- the health system aimed for 100 reg- Overall, the challenge was a huge quality, interactive games to istrations; it experienced such a favor- success, garnering even higher promote health and daily activity in able response that it expanded engagement rates than either FIX or an exciting, socially connected envi- enrollment acceptance to nearly 500 Methodist Health System antici- ronment. A 20-plus year veteran of employees. Eighty-seven percent of pated. It complemented and added a the video-game industry, Mike those who signed up for the challenge layer of fun to the hospital network’s Tinney, CEO, FIX, applies his completed it, and 75 percent partici- existing wellness program, which expertise in incentive and reward pated every day. relies on quantitative measurements mechanisms to encourage users to such as biometric screenings. Later enhance their exercise, nutrition and Employees’ response to the activity overall health. was exceedingly positive, and the This column is made possible in part results were even better than antici- by Trane Healthcare. Methodist signed up for a six-week pated. Of the three activity compo- challenge using FIX’s flagship prod- nents, 100 percent of employees uct, UtiliFIT, which sends an hourly participated in the fitness program, email or text reminder to complete a 63 percent completed everything pre- low-impact but effective exercise scribed for nutrition and 45 percent

56 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. this year, Methodist plans to imple- high potential to drive engage- energy and effort than people ment another one of FIX’s chal- ment. Methodist provided who exercise alone, and people lenges, which focuses on increasing employees with a $20 bonus per who exercise on a team put forth the number of steps participants paycheck. Nonmonetary rewards three times the energy. UtiliFIT take per day. also yield participation. These used a points system for complet- can include a mention in the ing hourly fitness activities, exer- The Four Cornerstones of Wellness company newsletter or a callout cising and making positive At the beginning of its engagement by the CEO during a company- nutrition and lifestyle choices. A with Methodist Health System, FIX wide meeting. leaderboard added a healthy dose outlined what it calls the four corner- of competition to the challenge. stones of wellness, which are the • Leading from the front. The components of a corporate wellness CEO can have a huge influence An upcoming FIX challenge program that can significantly on employees with regard to a Methodist plans to implement increase participation in voluntary wellness program. When an takes the idea of friendly compe- challenges and other initiatives. organization’s leadership is visibly tition even further by creating These cornerstones can be imple- involved in programs the staff is teams that will be pitted against mented by any hospital or healthcare asked to do, engagement rises. each other. This can have a huge organization regardless of its number When CEOs and other execu- psychological impact when it of employees, wellness budget or tives participate in wellness pro- comes to pushing ourselves phys- other factors. grams, this sends a message that ically, as people are more likely to it’s an important part of the com- follow through when others • A track record and established pany, and it should become part depend on them. history of wellness. Wellness of the corporate culture. Even initiatives are a cumulative pro- having the C-suite do a variant of The bottom line is that hospitals and cess. The more positive wellness the program, perhaps with fewer other healthcare organizations must events a company offers, the time commitments, can be a recognize that just because their more participation will grow over powerful way to encourage employees are committed to improv- time. Similarly, healthcare execu- participation. ing the health of their patients doesn’t tives working with a wellness mean they’re paying the same atten- vendor should be wary if the To increase success of the well- tion to their own health and well- organization promises a certain ness program, Stephen being. By adopting wellness engagement rate without asking Mansfield, PhD, FACHE, presi- initiatives that are engaging and easy any questions specific to the dent/CEO, Methodist Health to partake in, healthcare executives organization. System, headed an initiative ask- can overcome many of the obstacles ing all leaders to complete a nurses and other patient-care staff • Rewards and recognition to health coaching session for its encounter when it comes to main- employees who participate in personal benefit and inspire staff taining a healthy lifestyle. s wellness initiatives. Incentives participation. The leadership can encourage staff to complete a team demonstrated its own com- Stephen L. Mansfield, PhD, FACHE, wellness programs—whether it mitment by joining and leading is president/CEO for Methodist be public recognition, meaning- teams and not reducing its own Health System (stephenmansfield@ ful rewards, benefits or all of the participation levels. mhd.com). Carrie Camin is assistant above depends on the company vice president of Methodist Health and its culture. A financial incen- • Teammates and opponents. A System ([email protected]). tive to participate—like a paid University of Michigan study Mike Tinney is founder and CEO of day off, a lunch provided by the found people who exercise with a Fitness Interactive Experience. company or a gift card—has a partner put forth twice the

What’s Next for whose goal is to “close the gaps in evidence needed to improve key Healthcare Reform? health outcomes.” It has four major research priorities, which include assessment of prevention, A close look at reform agenda setting provides diagnosis and treatment options; hints to future policy. communication and dissemination Daniel B. research; addressing disparities; McLaughlin and accelerating improvements in research methods.

From the time ship owners were Medicare demonstration proj- levied a tax in 1798 to pay for sea- ects that had favorable results. To anticipate future men’s healthcare and in almost health policy, it is most every year since, the federal govern- • A wide array of constituencies ment has enacted healthcare can support legislation. Many useful to focus on the reforms. The most recent example of the major healthcare trade agenda setting that is is the 2015 legislation to finally associations supported (and reform physician payment under authored) much of the ACA. occurring today. Medicare. If healthcare reform is a Although the ACA as a whole journey and not a destination, what was strongly opposed in a politi- The institute’s fifth priority is of can we look for in the future? cal manner, most of the policy particular interest to those trying issues within the law continue to to discern future healthcare poli- To anticipate future health policy, have both health professional cies: “improving healthcare sys- it is most useful to focus on the and public support. tems: comparing health public agenda setting that is occur- system-level approaches to improv- ring today. Once an agenda is set, Four major institutions are engines in ing access, supporting patient self- it can be translated into policy, the policy process and regularly care, innovative use of health enacted and then implemented. develop policy initiatives that meet the information technology, coordinat- Agenda setting has three major three criteria to be part of the agenda- ing care for complex conditions components, and they were very setting process. The Patient-Centered and deploying workforce apparent in the Affordable Care Outcomes Research Institute and the effectively.” Act legislative process: Medicare Innovations Center advance improvements in healthcare delivery, PCORI has many interesting proj- • A need to act is widely per- while the Medicare Payment Advisory ects underway in this domain. For ceived by policymakers. Commission and the Medicaid and example, one project involves work- The ACA health exchanges CHIP Payment and Access ing with stroke survivors and their and Medicaid expansion dealt Commission devise actual policy caregivers to develop an effective with the growing number of options for existing problems in the smartphone app, which would con- uninsured. system. The work of each of these tinously monitor health measures, groups could have implications for stay current with a constantly • Policy options are available public policy. changing list of medications and that have been shown to appointments, and encourage the work. Many of the ACA’s fea- Patient-Centered Outcomes patient to keep up his or her exer- tures, such as accountable care Research Institute cise program. Future policy impli- organizations and bundled The PCORI was created as part cations for this project include payments, were based on of the ACA as a separate nonprofit clinical data interoperability,

PCORI has funded 65 projects in this area. Medicare Innovations Center a fresh perspective leads to The Medicare Innovations Center also was created in the ACA and has a mandate to test new innovations in SUSTAINABLE CHANGE care delivery in these areas: Magnifying what’s most important can bring the big picture into focus. Huron Healthcare’s extensive experience working with hundreds of hospitals • Accountable care and health systems gives us a clear perspective to help you develop and execute sustainable strategies. Together, we create immediate change and position you to turn challenges into opportunities. • Bundled payments for care improvement Because when you see things differently, anything is possible. To learn more visit huronhealthcareperspective.com. • Primary care transformation

• Initiatives Focused on the Medicaid and CHIP population

• Initiatives focused on the Medicare-Medicaid enrollees (dual eligible)

• Initiatives to speed the adoption of best practices

An interesting example from a primary care transformation group is the Comprehensive Primary Care Initiative. Its aims are to see whether primary care practices in a predominantly fee-for-service model can be adequately supported by monthly care management fees and net savings in the Medicare program. If successful, this initiative will provide a policy choice that could allow primary care providers to remain independent rather than

be acquired by integrated health- MedPAC Medicare Innovations Center, care systems. The Medicare Payment Advisory which would then embark on the Commission was established in road to becoming part of national The Medicare Innovation Center has 1997 to advise Congress on health policy. Some examples: 61 projects underway. Medicare. Each year it publishes a comprehensive report with multiple • Care delivery changes MACPAC policy recommendations across the prompted by innovations in The Medicaid and CHIP Payment entire Medicare program. Most of primary care, new provider and Access Commission is a federal the recommendations this year are types, telemedicine, home auto- agency that provides policy and to improve further implementation mation wearable technologies data analysis and makes recommen- of ACA policies such as value pur- and the Internet of Things dations to Congress, the U.S. chasing and bundling. Department of Health and Human • Precision medicine—a more Services, and the states on a wide However, the success of the individualized approach to medi- array of issues affecting Medicaid Medicare Advantage program is one cal decision making, treatment and CHIP. Each year, it produces a of the highlights of this year’s and more—is explored even as report to Congress with analysis report. Between 2013 and 2014, the increasing cost of care and recommended policy changes. enrollment in Medicare Advantage remains a national concern Because Medicaid and CHIP are plans grew by about 9 percent (or state-administered programs, 1.3 million enrollees) to 15.8 mil- • HIT effectiveness increases dra- MACPAC’s recommendations tend lion enrollees. About 30 percent of matically—but so do related to be at the broad policy level. all Medicare beneficiaries were security and privacy concerns enrolled in Medicare Advantage This year’s report provides an inter- plans in 2014. Ninety-one percent • Narrow networks expand, but esting analysis on premium support of enrollment was in plans with a access concerns grow that may foreshadow future national positive margin, averaging 4.9 per- policies. The use of Medicaid funds cent in 2012. • Mergers and acquisitions con- to purchase private market plans tinue, presenting growing anti- (premium support) is one way states During the ACA debate, Medicare trust challenges may expand coverage to previously Advantage was targeted for reduc- ineligible, low-income adults. tions in payment. In spite of these Planning for Future Health Policy Arkansas and Iowa have been using reductions, Medicare Advantage Each of the four federal agencies premium assistance to purchase plans have thrived and now provide provides excellent online reporting plans on the exchange through waiv- a possible pathway for ACOs to and resources. Healthcare delivery ers since January 2014, and other move into the Medicare Advantage organizations will benefit from states have expressed interest in this world with more predictable market periodically reviewing their reports approach. Because Medicaid has his- shares and margins. to determine which demonstrations torically provided many wraparound and experiments may become services, access to these services is Trends Not Yet in the Pipeline health policy and how they may unclear. Also, increased cost sharing Because all four agencies have com- affect their organization’s strategic in these plans may restrict enroll- plex governmental processes they plans. s ment and use. However, many state must undertake before initiating legislators want to expand access projects, they are not necessarily Daniel B. McLaughlin (dbmclaughlin@ using the private sector as opposed engaged with emerging trends. stthomas.edu) is director of the Center to the ACA Medicaid expansion Innovative health systems are spon- for Health and Medical Affairs at the option, and therefore premium sup- soring pilots that may become University of St. Thomas, Minneapolis, port may expand to other states. projects within PCORI or the and an ACHE Member.

60 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. To those who go above and beyond in their pursuit of excellence, join us. To learn more about becoming a Fellow of the American College of Healthcare Executives, visit ache.org/FACHE or contact ACHE’s Customer Service Center at (312) 424-9400.

ACHE_FACHEmountain_8-125x10-875.indd 1 6/26/13 10:22 AM Careers

Coaching Emerging Share tips for effective communication skills—written, verbal, visual Healthcare Leaders and listening. With the prevalence of smart devices, emerging leaders from the millennial generation and those Sharing lessons learned is critical to the who are younger often spend a vast future of healthcare leadership. amount of time looking down at their J. Craig Honaman, devices instead of paying attention to FACHE, CRC the world around them. Teaching emerging leaders the importance of looking someone in the eye instead of Developing and molding future three to five years from now. focusing on an electronic device can be senior healthcare leaders is integral to Identifying the lasting skills needed an immensely powerful lesson. Social ensuring the continued success of the for a successful career will go a long media also can contribute to the erosion healthcare field. Making time for way in ensuring job attainment for of communication skills. On many mentoring should be a priority for up-and-coming leaders. sites, users may not be communicating healthcare’s senior leaders, both for in full sentences. Becoming accustomed the good of their organization and Encourage participation in entre- to this shortcut writing style can hurt the industry as a whole. preneurial events. Such events are an early careerist when trying to write a wonderful teaching tools that enable position paper, a business plan or a busi- early careerists to experiment with ness letter. To be taken seriously, early Networking and interacting creativity and risk while finding new careerists must be prepared to deliver with people effectively in a avenues for success. An executive messages more formally, using proper must be able to demonstrate perfor- grammar and conventional business business environment is a mance and personal worth to the style. Coaching emerging leaders on the lifetime essential career skill. company every day to ensure ongo- communication skills needed to suc- ing success—not just when there is ceed in the business setting can set an impending annual performance these young executives leaps and Coaching emerging healthcare leaders is evaluation. Teaching early careerists bounds ahead of their peers. a simple task. It’s even easier for those the value of going for the extraordi- senior executives who received coaching nary in all they do will position Support early careerists in joining themselves and made a record of advice them for success. Thinking outside a professional group. Membership they received: They are primed to share of the box by trying new ventures in a professional organization such as their lessons learned with younger can be a starting point. ACHE advances early careerists’ careerists based on their experience with knowledge of current healthcare senior coaches. Below are 11 successful Be ready to tell your story of han- trends and also provides them with ideas and best practices in leadership to dling difficult situations success- the opportunity to network with col- share with emerging leaders. fully. The sharing of both successful leagues. It gives them a chance to and unsuccessful events that have meet others in the field who can Tips for Success in Mentoring occurred throughout a senior leader’s

Early Careerists career can be learning tools for early This column is made possible in part Think long term. The ways in which careerists, who will gain insight on by CareFusion. senior executives moved up in their what to do when faced with a partic- career may not be transferable to ular issue. By understanding what today’s healthcare environment, and other senior executives have gone jobs early careerists are searching for through, the early careerist’s own today might call for different skills learning curve can be enhanced.

62 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. We’re in different stages of our lives and our careers, but we’re challenged by some of the same hurdles. And so we’ve learned from each other; we supported each other and we continue to support each other. I can’t overvalue the networking and connections made during the program.

Jaquetta Clemons, DrPH, FACHE, Fund Scholarship Recipient Thomas C. Dolan Executive Diversity Program

ACHE’s Fund for Innovation in Healthcare Leadership creates opportunities for the next generation of leaders. Together, we can impact the future of healthcare. Donate today at ache.org/Innovation

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either serve as coaches or assist them information for use in the workplace. employer is delivering twice their sal- in a job search further down the line. Interaction throughout their career is ary toward the company’s bottom important—even when they have line every year. It may sound intimi- Stress the importance of lifelong become senior executives themselves. dating, but it is possible and impor- learning. School is always in session in tant: Demonstrating measurable the healthcare field. Giving emerging Encourage emerging leaders to value to the employer may enhance leaders the chance to attend seminars measure their success in quantifi- career growth potential within the and ACHE programs can help further able terms. One way early careerists organization or show value to a pro- their career by gathering current can quantify their value to an spective employer.

Teach early careerists how to network effectively. Networking and interacting with people effectively in a business environment is an essential lifetime knowing career skill. Help introduce your young executive to peers from outside the organization—connecting with indi- healthcare viduals outside their company who may have fresh ideas can prompt emerging isn’t enough. leaders to bring those concepts back to their organization. Helping establish a process for emerging leaders to keep Today’s healthcare leaders also have to know track of names, addresses, phone num- economics, information management, bers, email addresses and websites so health policy, customer service, the information can be retrieved easily even legal issues. when needed can be an invaluable skill. The connections and ideas that are That’s why we created our new gained can be used in day-to-day work MBA in Healthcare Leadership. or during a job search, when early careerists are looking to stand out from Our program covers these areas with the latest insights and the wide range of applicants during the approaches with: interview process. • expert faculty • online courses* Understand the idiosyncrasies of • option to “test out” emerging leaders. For example, phy- of requirements sicians are more apt to buy into les- You’ll even create a strategic sons that can be backed up with plan for your organization. numbers, so use statistical data when coaching them. On the other hand, those who are on an administrative *Includes three executive weekend retreats, where you’ll network with industry experts and your peers. track may want to learn more of the business rationale behind a suggested approach. Offering tips to the emerging leader on how best to get their learn more message heard and understood by dif- 877-947-4126 | esc.edu/hcl ferent groups can enhance their success. Understanding the way in which

64 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. various types of people prefer to learn of a mentor but might not yet know Planning for the Future can enhance the coaching process. it. Major shifts in the industry can Senior executives who are willing make it difficult to find a healthcare to mentor the emerging leader will Stress the importance of agility in coach today because of short tenure in establish the effort as a priority leadership. As the healthcare field executive positions. In the past, the and make time for coaching undergoes transformative change, some average executive tended to remain in a among the members of their execu- healthcare positions are expanding with position for 10 or 15 years. Once stable tive team. The return on the newly defined responsibilities, while and comfortable in his or her position, human investment can be substan- others are being eliminated, never to the executive typically began to offer tial for an organization, its senior return. New positions also are continu- advice and information to the emerging executives and its emerging lead- ally in the works. Senior executives leaders within the organization. Today, ers. Early careerists who are taught should teach emerging leaders how to senior executives are moving much the skills needed to succeed as successfully adapt to and lead in an era more rapidly into new positions. As a leaders from the beginning of their of change. For example, senior execu- result, they may struggle to find the careers will be better able to help tives can help emerging leaders navigate time to coach early careerists as they guide their organizations and the an era of reform by sharing the changes become established in their own industry when called upon to they witnessed in healthcare while careers. It is important senior executives make a difference. s moving up in their careers. carve out time to provide emerging leaders with the knowledge, experiences J. Craig Honaman, FACHE, CRC, is Look for opportunities to identify and career-growth advice only veteran principal of H & H Consulting Partners early careerists who may be in need executives can provide. ([email protected]), Atlanta.

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Governance Principles for Physician Organizations

Healthcare executive support can influence the value these organizations provide.

“A strong, consistent governance and governance and decision making of their performance are likely to leadership focus on doing what’s best the clinical enterprise. It is among the expand and strengthen as these orga- for patients and communities is first to explore governance and lead- nizations become firmly established positioning physician organizations ership in these organizations from the and continue to broaden their focus as significant drivers of improved perspective of physicians and the outward toward the communities quality and financial performance executives who govern them. they serve. and as architects of the new care delivery system.” Principle No. 2: No single evolu- Best governance practices now tionary path or model of gover- This is one of the key findings of a accepted in hospitals and health nance will work in all organizations recently released report, Governance of and care systems. The study notes Physician Organizations: An Essential systems may not apply in the clinical enterprise boards, enhanced Step to Care Integration. The report same way to physician community boards and smaller, high- shares results of a study conducted by performing boards that typically pro- the American Hospital Association’s organizations. vide system-level oversight of strategy, Center for Healthcare Governance risk and performance can all play roles and Physician Leadership Forum. For the study, AHA interviewed and already are functioning in many board members and executives from markets. The study notes the wide range in six diverse organizations (see the organizational size, structure, owner- sidebar). An expert panel synthesized Principle No. 3: A relentless focus ship and control, geographic location findings to help other physician orga- on mission—providing high-quality, and governance structure and prac- nizations better understand gover- safe care for patients—brings clar- tices among participating organiza- nance and leadership practices in ity and impact to governance tions. It concludes that best these evolving entities. structure and function. Study par- governance practices now accepted in ticipants share examples of defining hospitals and health systems may not According to the study, there are moments in governance—such as apply in the same way to physician 10 principles of strong governance requiring adoption of electronic med- organizations and that there is value that physician organizations can ical records or adding primary care in matching governance practices to apply throughout their development. physicians to the board and leader- organizational needs at various stages ship—that led to higher levels of of their development. Principle No. 1: Governance board and organizational performance becomes more robust and mature with broader impact. Taking a Closer Look as organizations grow and develop. In the study, AHA defines physician For example, the processes physician Principle No. 4: Boards should organizations as entities designed to organizations use to select board adopt a competency-based approach engage physicians in leadership, members, make decisions or evaluate to member selection, board member

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Patient Satisfaction: Meeting the Needs of Our Customers your career John M. Buell

While patient satisfaction has typically been ranked amoung the top con- Building a New cerns of CEOs, financial challenges consistently is the No. 1 issue confront- CEO-Board Dynamic ing hospitals, according to ACHE research. James E. Orlikoff

But if you take a deeper dive into the numbers (see “Top Issues Confronting In the rapidly and radically chang- Hospitals: 2012” on page 2), you will find three specific financial concerns facing healthcare environment, the ing hospitals that all are connected in some way to patient satisfaction: Medicaid CEO’s relationship with the board FRONTIERSreimbursement, government funding cuts and Medicare reimbursement. has never been more important, under more pressure or more chal- Even though CEOs ranked patient satisfaction a 5.6 out of 10, with the of HealtH ServiceS ManageM ent lenging. Yet the quality of gover- lowest numbers indicating the highest concern, 83 percent and 72 percent nance—and of the CEO-board respectively said Medicaid and Medicare reimbursement were among their relationship—that was sufficient specific financial challenges. You may recall that beginning this past Oct. to get your organization where it 1 new payment rates took effect. This specifically included HCAHPS -per is today will be insufficient to get formance in the calculation of the value-based incentive payment in the it where it needs to be tomorrow. Hospital Value-Based Purchasing program. Unprecedented environmental pressures will magnify previously “Value based purchasing has brought increased focus on understanding irrelevant flaws in the relationship the patient’s perception of the care they receive,” says John M. Haupert, and have negative consequences for FACHE, president and CEO of 919-bed Grady Health System, Atlanta. “If Breaking Down Clinical you and the organization. organizations had not previously focused on service excellence, then having their satisfaction scores publicly reported and incorporated into their Value Effective CEOs are rethinking and Based Purchasing equation should get their attention. At Grady, we recog- Silos: Enhancing Care revising the basic dynamics of their nized the need to focus on improving our patients’ perception of the care relationship with their board. Some they receive as part of improving our image in the community. We also see changes will be structural, such as Coordination it as part of meeting the expectations of Value Based Purchasing because who is on the board and how the our scores had historically been low but, most importantly, because our board controls its meetings, and patients deserve to have the best possible experience we can provide when others will be transactional such as they receive patient care services from us.” Feature articles by how the CEO relates to the board. As CEO you will need to establish Haupert says it is imperative that the organization’s operational goals, Michele M. Molden, FACHE; Charles L. Brown III; new and clearer boundaries between including those related to service excellence, be cascaded throughout the governance and management and organization and incorporated into the annual goal documents of every and Bryan E. Griffith allow the board to function more executive, director, manager and supervisor in the organization. Hospitals William B. Leaver, FACHE (continued on page 6) (continued on page 5)

Commentaries by Nicholas Wolter Coming in the Fall Issue of Frontiers M. Jane Mohler Anna Marie Hajek The Moral Compass for Healthcare Leaders Feature articles by Ruth W. Brinkley, FACHE, and John J. Donnellan Jr., FACHE

volume 29 • number 4 • Summer 2013

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and leader development, perfor- with each board’s roles and leadership and governance roles are mance evaluation and board deci- responsibilities. essential for their meaningful par- sion making. For example, in ticipation in the transformation of addition to drawing on leaders of local Principle No. 6: A robust board cul- healthcare. Study participants all medical groups or physician-hospital ture incorporates discussion, debate cited the importance of ongoing gov- organizations to serve on the boards of and dissenting opinions. Advance ernance education, and some have physician organizations that are part preparation, intellectual rigor and con- established a governance and leader- of health systems, several study partic- tinuous learning are expected for par- ship curriculum to support continu- ipants are beginning to look for spe- ticipation in governance. ous learning. cific competencies, such as business, financial or legal skills, as they add Principle No. 7: Boards can lead Principle No. 10: Effective boards new members to their boards. their organizations to higher levels have credibility with the stake- of performance. Making and enforc- holders they serve. Leading the ing tough, data-driven decisions and charge on quality and safety There is value in matching responding productively to defining improvement for the broader health- governance practices to moments are steps boards can take to care organizations of which they are set the tone and direction for ongoing part, or making the decision to par- organizational needs at performance improvement. ticipate in Medicaid managed care various stages of physician because “It was the right thing to Principle No. 8: When clinicians, do” are examples of how physician organization development. outside experts and stakeholders organization boards and leaders are govern collaboratively, the out- focusing on improving care and out- Principle No. 5: Boards should comes are more robust and sustain- comes for the patients and commu- seek and balance diverse member able. One physician organization nities they serve. competencies to ensure necessary executive and panelist noted adding perspectives are present at all lev- an outsider to the board changed the Action Steps for els of governance to meet the tone of the board’s conversations Healthcare Leaders needs of patients the organization from representing constituencies to CEOs and executives can encourage serves. The skills and competencies what was in the best interest of the boards and leaders of physician orga- needed to govern a clinical enter- organization as a whole. nizations that are part of their hospi- prise, for example, may differ in tals or systems to assess how their some ways from those needed to Principle No. 9: Formal, rigorous own governance practices compare govern a health system, and member development, performance evalua- with these principles. Questions to competencies should be matched tion and succession for physicians in guide such an assessment are included throughout the report.

Study Organizations Additional findings from the study also can help hospital and health sys- Board members and senior executives with these organizations participated tem CEOs and senior leaders further in the AHA study: consider how best to support and • Advocate Physician Partners, Downers Grove, Ill. continue to advance the governance • Billings (Mont.) Clinic of physician organizations: • East Bay Physicians Medical Group, Lafayette, Calif. • Hill Physicians Medical Group, San Ramon, Calif. The strong focus physician organiza- • Hospital Sisters Health System Medical Group, Springfield, Ill. tions have on doing what’s best for • Memorial Hermann Physician Network, Houston patients and communities is positioning them as key drivers of improved

68 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. quality and financial performance variation in governance practices the study and its findings, visit and as architects of the new care from those considered most appropri- www.americangovernance.com. s delivery system. By supporting the ate for hospitals and health systems innovative work physician organiza- today. For example, a blend of repre- John R. Combes, MD tions are doing to create new models sentational and competency-based ([email protected]), is of care, hospital and system execu- board-member selection processes president and COO of tives can positively influence the may work best for some physician the American Hospital value these models can deliver for organizations during their formation Association’s Center for patients and communities. and at other key stages in their Combes Healthcare Governance, development. and Mary K. Totten Physician organizations and their (marykaytotten@gmail. governance are still evolving, and If empowered and encouraged, physi- com) is senior consultant the boards of these organizations are cians can play a significant role in for content development growing into their roles. Governance transforming healthcare and will step for the Center for practices will likely evolve to meet up and partner with executives to Totten Healthcare Governance. the needs of these organizations at bring value to the change process. various stages of their development. Editor’s note: This article was Investing in physician organization adapted with permission from “Leaders The evolution of physician organiza- governance is essential to ensure in Transforming Care,” published in tions may indicate the need for success. For more information about the April 2015 Trustee magazine.

Understanding Financial Statements

How Pricing Decisions and Budgeting Can Make A Difference

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Assessing Community Health Needs

Assessments are an opportunity to catalyze population health improvement.

The IRS now requires nonprofit hos- they serve. These have traditionally of members of the Catholic Health pitals in the United States to com- been allocated toward uncompen- Association, VHA Inc., and the plete a community health needs sated or underfunded care provided Association of American Medical assessment—which includes a descrip- by nonprofit hospitals. In a 2013 Colleges found 93 percent of mem- tion of the community served, existing study in The New England Journal ber hospitals prioritized access to healthcare resources and a prioritiza- of Medicine, Gary Young, MD, and clinical care in their community tion of the community’s health colleagues found that in 2009, com- health needs assessments. needs—at least once every three years. munity benefit comprised 7.5 per- These hospitals also are required to cent of nonprofit hospitals’ operating develop and execute an implementation expenses, with 85 percent of spend- A hospital’s community benefit strategy for meeting the needs identi- ing focused on uncompensated office can be a champion for the fied in the assessment. At the same and underfunded care. Only about time, the Public Health Accreditation 5 percent of the total community transition to population health Board—a voluntary, national public benefit provided fell under “commu- management. health department accreditation pro- nity health improvements” under- gram supporting state, local, territorial taken by the hospital itself. and tribal health departments— Logically, hospitals prioritize needs requires health departments to com- A majority of community health that capitalize on their strengths plete a collaborative community health needs assessments completed in the (e.g., providing clinical care). But to assessment every five years and to use first round of required reporting in make a bigger impact on popula- the assessment to develop a community 2012 focused on service capacity tion health, nonprofit hospitals health improvement plan. issues such as access to healthcare must move away from prioritizing services and the provision of clini- service needs in favor of working These requirements provide an unprec- cal care. In a 2014 survey of 51 hos- collaboratively with community edented opportunity for health systems, pitals conducted by the Public organizations to address issues such public health departments and com- Health Institute, 73 percent of as obesity and behavioral health. munity-based organizations to work community health needs assess- These population health challenges together to produce one comprehensive ments in 15 regions identified pri- require new kinds of strategies and community assessment, coordinate orities related to clinical care. A support to help individuals make planning and leverage such plans to 2014 survey of more than 300 non- healthier decisions, targeting those improve population health. profit hospitals conducted by the populations at highest risk for such Health Research & Educational issues and, as a community, recog- Taking a Closer Look Trust found the most commonly nizing the impact and beginning to For years, the IRS has required non- identified driver of community address the socioeconomic dispari- profit hospitals to provide measur- health needs was a lack of access to ties that negatively impact health able benefits to the communities care (67 percent), and a 2014 survey and healthcare.

70 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. Chicago is home to a vibrant health care market with 116 hospitals in the greater metropolitan area, including 15 teaching hospitals. Attendees will get a behind-the-scenes look at several leading Chicago-based health care organizations.

October 6–8, 2015 A CAN’T MISS EVENT Hyatt Regency Chicago International Hospital Federation 39th World Hospital Congress Advancing Global Health & Health Care Join visionary health care leaders and decision makers from around the world to exchange experiences, ideas and best practices. Uncover opportunities to move health care forward as world-renowned speakers discuss: • Equity and access to care • Patient and community engagement and empowerment • Quality and safety • Health care management and leadership opportunities and challenges • Innovation in healthcare delivery • Ethical issues

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As the new business imperative for between the community health needs service area (e.g., the geographic area many hospitals becomes population assessment process, community bene- they serve) rather than their market management, leaders are increasingly fit spending and efforts to improve service area (e.g., where most of their realizing their organizations cannot population health in the communities patients live). tackle this important work alone. they serve. Fortunately, they don’t have to. Hospital leaders also should engage Hospitals, public health departments, Conduct a community health needs community representatives in all and community-based organizations assessment that effectively captures stages of assessment, planning and are partnering and collaborating in the community’s assets and priori- execution. Although 75 percent of communities around the country to tizes health needs. Hospital leaders hospitals in the 2014 Public Health improve community health. and community partners should be Institute survey received direct active participants in conducting the input from community members in Examining the community data avail- community health needs assessment. the community health needs assess- able through the community health There is a plethora of available ment process, community stake- needs assessment process helps hospital resources for hospitals, and engaging holder engagement decreased leaders understand population health leaders and staff in reviewing the significantly during priority setting, management is not just about risk strat- data and even in doing stakeholder program planning and implementa- ification by providing insight into the interviews themselves can be illumi- tion. The community health needs ways that clinical outcomes are inextri- nating for all involved. An effective identified through the assessment cably linked to social determinants of community health needs assessment should regularly be brought back to health. (See the sidebar below.) must clearly define community and community members for validation. identify the varying needs of both Finally, a community health needs Getting There From Here geographic areas and subpopulations assessment should employ a mixed- Here are four practical ways hospital to guide priority setting. Hospitals methods approach, with quantitative leaders can improve the linkage should consider their population data from multiple sources and qualitative data collected through conversations with community leaders and Resources for Community Data members outside of health care, such as elected officials, school representa- • Commonwealth Fund’s Health Systems Data Center, tives and social services. datacenter.commonwealthfund.org • National Center for Health Statistics’ Health Indicators Warehouse, Increase collaboration between www.healthindicators.gov multiple hospitals, public health • Dartmouth Atlas, www.dartmouthatlas.org departments and community orga- • Dignity Health’s Community Need Index, nizations in a geographic area. www.dignityhealth.org/Who_We_Are/Community_Health Duplicative community health • Geographic Information System mapping tools improvement efforts are common; • CDC Community Health Improvement Navigator, www.cdc.gov/CHInav through better alignment of efforts, • CDC Community Health Status Indicators, www.cdc.gov/CommunityHealth duplication could be avoided, and • County Health Rankings, www.countyhealthrankings.org the impact on community health • Community Commons www.chna.org could be heightened. Successful • Healthy Communities Institute, www.healthycommunitiesinstitute.com partnerships require formal docu- • Hospital data: Service utilization and epidemiology of common diseases mentation of commitment (e.g., • Qualitative data: Information from individual interviews, focus groups and memorandum of understanding) town hall meetings with community leaders, community members and through which all partners agree on other stakeholders how they want to proceed on both the assessment and implementation

72 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. plan. A steering committee of repre- population health data can be over- these pervasive problems. Although sentatives from each partner organi- whelming; a shared set of measures working toward improved access and zation should create a common is useful for hospitals to measure clinical care is a good starting place, vision, shared language and a plan impact and facilitates aggregating hospital leaders who wish to move for regular communications. measures to priority areas and entire their organizations toward the Triple communities, states, regions and Aim will need to tackle broader pop- Partnerships must focus on both the even nationally. The sidebar on ulation health issues in collaboration technical (e.g., compliance) and stra- page 72 shows data sources and with community partners. s tegic aspects of the work. A successful resources that can be used as part of partnership also requires staff with a comprehensive community health Mara Laderman is a sufficient time and appropriate needs assessment. senior research associate resources allocated to this work. at the Institute for Many partnerships are funded High healthcare costs and issues Healthcare Improvement through inputs from each participat- around health equity are plaguing ([email protected]). ing hospital and health department communities. The community health Laderman John Whittington, MD, is and should consider collaborating needs assessment requirements pro- a senior fellow and lead with the business community and vide an opportunity for hospital lead- faculty for the Triple Aim area employers with an interest in ers to collaborate with partners in the at the Institute for health promotion. community to coordinate assessment Healthcare Improvement activity, with the aim of helping com- (john.w.whittington@ Create better links between communities across the nation tackle Whittington gmail.com). munity health needs assessments and the allocation of community benefit resources. After the community’s needs are identified, validated and prioritized, the next step is to select effective interventions. Community benefit programs have existing relationships with schools and community groups that can be Save on travel costs while earning leveraged and improved upon. A hos- ACHE Qualified Education credits pital’s community benefit office can be a champion for the transition to with ACHE Webinars population health management. Conveniently obtain timely information on key issues Community benefit is one—but not facing your organization. These 90-minute, interactive the only—funding mechanism for presentations are accessed through the Internet and hospitals engaged in population phone, providing you with a live program and real-time conversations with faculty. health work. Hospital funding is not the only financial resource for com- Sept.16 Population Health: Measuring Success munities. For example, funding from Sept. 29 Redefining Care Through Telehealth-Enabled local foundations and the local Clinical Programs United Way can support community Oct. 29 Engaging Employees From Day One: health improvement initiatives. 10 Orientation Strategies

Measure the impact with a mixed- Learn more and register now at ache.org/e-learning methods approach and a shared- data system. The sheer quantity of

Physician Employment in care and outcomes, such as lower nosocomial rates, improved blood Alternatives conservation measures and enhanced turnover rates. Physicians in specialties such as orthopedics, cardiology, neu- Two lesser-known approaches can improve roscience and oncology are likely can- hospital/physician relations. didates for this approach as they Andrew D. represent high-cost areas, although McDonald, FACHE other specialties also can be a good fit for this approach.

In theory, employing physicians can practice group(s) to enhance a hospi- Physician preference items are one way be a great strategy to align interests in tal service line. to demonstrate how a service line joint a synergistic fashion by enhancing venture can improve efficiency. These referral patterns and building loyalty; items are one of the biggest sources of however, this may not always be the Many physicians excel at supply chain costs in hospitals. Under case. To develop a successful physi- providing care but do not have a traditional affiliation arrangement at cian services business line, the appro- a hospital, orthopedic surgeons, for priate level of resources must be the time or expertise to build an example, commonly use an implant dedicated to the venture that under- effective business. brand they prefer, regardless of price. stands the physician business and cre- But for an orthopedist group in a joint ates the best opportunity for success. venture, it makes financial sense to The second retains the traditional select fewer implant options, poten- Certainly, employment can be the independent ownership and operat- tially maximizing the buying power of right answer by shortening the gap ing structure but helps physicians the group, ultimately reducing costs. between two points that initially may find ways to more effectively manage Cardiovascular service lines have been not have been close. Some hospital their practices. able to decrease costs by establishing a leaders are happy with employment performance measure around whether arrangements and continue to engage Synchronized Rowing the group met appropriate use criteria in them. Others are looking at the The first approach keeps a physician for implantable cardioverter-defibrilla- increased level of financial exposure group and hospital in separate owner- tors. These kinds of progressive strate- such relationships can occasionally ship boats but strongly encourages gies represent an opportunity for create and wondering whether them to row together. By forming a systems struggling to move beyond employment makes sense. joint venture between the physician baseline efforts to impact utilization. group(s) and the hospital to co-man- There are two additional approaches age a hospital service line, each party Decisions, of course, have to be quality that, while not receiving huge amounts gives up a certain amount of control and value driven. This arrangement of attention, can be very effective in but gains a lot of upside potential. holds the promise not only of financial improving alignment between hospi- Possible synergies include enhanced reward but also improved care. When tals and physicians. And, impor- efficiencies as a result of improved aligned physicians partner with a hospi- tantly—if properly structured—neither staffing ratios, lower supply/implant tal, it becomes easier to collaboratively runs afoul of the Stark law. costs, improved service quality and tackle issues like control of hospital- patient satisfaction. based infections, clinical pathways and The first alternative can prove very other clinical enhancement metrics. powerful. Under this approach, a To create a win-win scenario, incentive With bundled payments and other hospital creates a co-management arrangements must focus on quality arrangements on the horizon, it makes arrangement with a specialty metrics that demonstrate improvements sense for hospitals and physicians to

74 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. work together to reduce costs, compensation is determine by FMV refer most independent physician improve outcomes and financially hourly and fixed at-risk compensation. practices to a single management ser- benefit from their efforts. vices organization. This reduced the Results include a far lower incidence of hospital’s exposure and created a more As an example, a 536-bed academic minor complications in post-surgical satisfied physician base. medical center and a joint-venture lim- patients managed by the orthopedics co- ited liability company that represented management teams, compared to Once an alternative to the full-employ- the medical center and three orthope- patients managed under the standard ment model was created, hospitals and dic practices struck a co-management model. In addition, 61 percent of physicians were able to enhance their agreement. They created an orthopedic patients in the collaborative care group overall level of trust and the environ- steering committee that meets on a left the hospital with no complications, ment for recruiting additional physicians quarterly basis and is composed of compared to 49 percent of those treated improved. The hospitals also stemmed medical directors and co-management under the standard arrangement. And the losses on the physician front. medical directors from various ortho- the rate of minor complications was far Initially, the physicians formed an inde- pedic sub-specialties—medical center lower—30.2 percent versus 44.3 per- pendent practice association in many of administration, three surgeons and cent—in the co-managed arrangement. the system’s markets and ultimately anesthesia physicians. The committee formed a single multispecialty group provides expertise in the development The Miracle of Good Management under one tax identification number, and implementation of critical path- Under federal law, it is illegal for a hos- thus enabling them to share in ancillary ways, quality metrics and materiel pital to provide indirect-but-valuable revenues under a Stark-approved com- management standardization. benefits to a physician practice without pensation model. A few of the markets appropriate payment. However, hospi- actually created additional hospital-phy- tals can suggest that physician practices sician integration models and are now be These kinds of progressive partner with a practice management better prepared for the bundled payment strategies represent an firm that can recommend ways to program and expansion of the ACO improve patient satisfaction, build model in the future. opportunity for systems struggling revenue and reduce expense. to move beyond baseline efforts Exploring a Variety of Many physicians excel at providing Models Is Critical to impact utilization. care but do not have the time or exper- With physician alignment at the top tise to build an effective business. A of the priority list for many hospital From a financial perspective, the medi- referral to a practice management firm executives, it makes sense to consider cal center reimburses the LLC for the that can provide billing, management/ a variety of alternatives. Both types benefits and salaries of 36 staff mem- administrative oversight, human of arrangements represent excellent bers’ salaries and benefits. A manage- resources management, accounting precursor-type arrangements that can ment fee is structured in fair market and consulting services can strengthen lead to closer alliances between hospi- value fashion for medical directors. The the quality of services the physician tals and physicians without the stress arrangement equates to 2.5 percent of group provides while bolstering the and exposure of the full-employment net revenues of the overall orthopedic physician group’s relationship with the model. Creativity is still alive in service line. Physicians are compensated hospital providing the referral. One healthcare management via collabor- for meeting time and other administra- well-known hospital system has used ative synergistic models that can tive duties. In addition to the base this approach when acquiring hospi- make sense for your hospital. s management fee, incentives are avail- tals, with strong success for the physi- able for quality of service, operational cian practices involved. Andrew D. McDonald, FACHE, is efficiency and new program develop- partner-in-charge for LBMC ment. These are structured in mea- In one such situation, a large for-profit Healthcare Consulting (amcdonald@ surable quality metric format. All hospital owner/operator decided to lbmc.com) in Brentwood, Tenn.

ACHE Member Update

Interim Regent Appointed ACHE Premier Corporate Partners Center, Normal, Ill.; and Jayne Stephen M. Gather in Chicago for Annual Forum Pope, FACHE, CEO, Hill Country Erixon, FACHE, Several executives representing ACHE’s Memorial Hospital, Fredericksburg, CEO, SageWest 2015 Premier Corporate Partners con- Texas. Susan E. Lawler, PhD, vice Health Care, vened at the annual Corporate Forum president, Division of Professional Lander, Wyo., has held April 29–30 in Chicago. Development, ACHE, moderated been appointed the session. Interim Regent for ACHE Chairman Richard D. Cordova, FACHE Erixon Wyoming. , president/CEO, A CEO panel and Q&A featured Children’s Hospital Los Angeles, Gyasi Chisley, FACHE, CEO, Keith E. Heuser, FACHE, presi- welcomed the attendees, and ACHE Methodist Healthcare North, dent, CHI Mercy Health, Valley President/CEO Deborah J. Bowen, Memphis, Tenn.; Zeff Ross, City, N.D., has been appointed FACHE, CAE, provided an overview FACHE, senior vice president/ Interim Regent for North Dakota. of ACHE. CEO, Memorial Regional Hospital, Hollywood, Fla.; and Mary Michael Nowicki, EdD, FACHE, John Toussaint, MD, CEO, Starmann-Harrison, FACHE, pres- professor, health administra- ThedaCare Center for Healthcare ident/CEO, Hospital Sisters Health tion, Texas State University, San Value, Appleton, Wis., presented System, Springfield, Ill. Marcos, Texas, has been appointed “Creating a Highly Reliable Interim Regent for Texas— Healthcare Organization.” ACHE 2015 Premier Corporate Central & South. Following the presentation, a reac- Partners participating in the forum tor panel and Q&A session was included Aramark, athenahealth, William P. Perno, FACHE, assis- held with the following panelists: Cardinal Health, CareFusion (now tant vice president, Florida Hospital Gary Fybel, FACHE, CEO, Scripps a BD Company), Cerner, Conifer Healthcare System, Orlando, Fla., Memorial Hospital, La Jolla, Calif.; Health Solutions, Philips Healthcare, has been appointed Interim Regent Colleen Kannaday, FACHE, presi- The Risk Authority—Stanford and for Florida—Eastern. dent, Advocate BroMenn Medical Trane Healthcare.

People

Member-Led Organizations • Florida Hospital, Orlando, Fla., Center, Baton Rouge, La., led by Honored for Improving led by president/CEO Lars D. CEO Eric McMillen, FACHE; Our Community Health Houmann, FACHE, for Bithlo Lady of the Lake Regional Medical Six ACHE member-led organiza- Transformation Effort, a proj- Center, Baton Rouge, La., led by tions have been awarded the 2015 ect to transform the city of president/CEO K. Scott Wester, American Hospital Association Bithlo, Fla., due to its lack of FACHE; and Woman’s Hospital, NOVA Award, which recognizes clean water, safe housing and Baton Rouge, La., led by president/ hospital-led collaborative efforts adequate public transportation, that improve community health. and unemployment, illiteracy This column is made possible in part by and homelessness. athenahealth. • PIH Health, Whittier, Calif., led by president/CEO James R. West, for Baton Rouge (La.) General Medical Activate Whittier, a community- Center, led by president/CEO Mark wide program to combat obesity. F. Slyter, FACHE; Ochsner Medical

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To learn more and to purchase these books online, visit ache.org/HAP. To order by phone, call the ACHE/HAP Order Fulfillment Center at (301) 362-6905.

SO15_NewReleases.indd 1 7/21/15 2:05 PM Executive News

CEO Teri G. Fontenot, FACHE, for which identifies and creates efforts more active lifestyles across the the Mayor’s Healthy City Initiative, dedicated to healthier eating and City-Parish.

Leaders in Action

To promote the many benefits of Meeting/Utah Health Executive Meeting Michael A. King ACHE membership, the follow- St. George, Utah Governor, FACHE ing ACHE leaders have recently Virginia Hospital & Healthcare spoken at local, state/provincial, Richard D. Cordova, FACHE Association Annual Meeting regional, national and interna- Chairman Williamsburg, Va. tional meetings: ACHE Corporate Forum Chicago Christine M. Candio, RN, FACHE, Immediate Past Chairman AHA Annual Membership Meeting Utah Hospital Association Annual Washington, D.C.

ACHE Staff Update

ACHE Announces Staff Hires, Sonia S. Hernandez to senior secre- Theresa L. Rothschadlto editor, Promotions tary, Executive Office, from secretary Health Administration Press Following are new ACHE staff members and current employees Kaitlin McKinney to marketing spe- Craig C. Thompson to performance who have recently moved into new cialist, Health Administration Press excellence director, Executive Office, positions at ACHE: from performance excellence manager Carla M. Nessa to senior Tammy G. Dillard-Steels, CAE, graphic designer, Division of Christian M. Volpe to market- to regional director, Division of Communications and Marketing, ing specialist, Division of Member Regional Services from graphic design specialist Services, from marketing coordinator

In Memoriam

ACHE regretfully reports the Katherine J. Corrigan, FACHE Louis A. Rabb, FACHE following deaths of ACHE Scottsdale, Ariz. Tuskegee Institute, Ala. members as reported by the Division of Member Services: Onax F. Garcia James E. Robertson Jr., FACHE Palm Bay, Fla. Trinidad, Colo. Cristine S. Brown Grand Prairie, Texas Robert F. Haas, FACHE Robert M. Schnitzer, FACHE Jacksonville, Fla. Bradenton, Fla. Lourdes D. Carvalho, MD, FACHE Sao Paulo, Brazil Dennis E. Miller, FACHE George R. Strohl Jr., FACHE Franklin, Tenn. East Waterford, Pa. Kenneth H. Cohn, MD Amesbury, Mass. Bonnie L. Peterson Ronald H. Wallace, FACHE Lawrence, Kan. Augusta, Maine

Share your passion Encourage your management team to join ACHE. Together, we can foster a culture of healthcare leaders who care as much as you do. We have the resources to help your team excel in healthcare management. Recommend that they become a part of ACHE.

Check out our Tell-a-Colleague feature on the home page of ache.org today. You may also contact us at (312) 424-9400 or [email protected] for membership information.

cascading_Ad01woman.indd 1 11/27/13 4:05 PM PerspectivesOn the Move

Dewerff Foulkes Hernandez Ransom Spong Trenschel

Stuart B. Almer, FACHE, to admin- Cynthia C. Barginere, RN, David T. Brooks, FACHE, to pres- istrator/COO, Gurwin Jewish FACHE, to senior vice president/ ident, St. Joseph Mercy Ann Arbor Nursing & Rehabilitation Center, COO, Rush University Medical (Mich.) and St. Joseph Mercy Commack, N.Y., from administrator/ Center, Chicago, from vice president Livingston (Mich.) from president, COO, Parker Jewish Institute for clinical nursing/CNO. St. John Hospital & Medical Health Care and Rehabilitation, Center, Detroit. New Hyde Park, N.Y. Kim Barnas to president, ThedaCare Center for Healthcare James T. Callaghan III, MD, John G. Anderson, FACHE, to pres- Value, Appleton, Wisc., from senior FACHE, to CEO, Franciscan St. ident/CEO, Anderson Regional vice president. Francis Health, Carmel, Ind., Medical Center, Meridian, Miss., Indianapolis and Mooresville, Ind., from interim CEO. Jahansha Behzad, FACHE, to from president, Franciscan St. CEO, Rehabilitation Institute of Anthony Health, Michigan City, Ind. Byron G. Atkinson to vice presi- Southern California, Orange from dent/leadership advisor, interim lead- administrator, physical medicine and Jennie H. Chahanovich, FACHE, ership and advisory services, rehabilitation, Johns Hopkins to president/CEO, Wilcox Memorial B.E. Smith, Lenexa, Kan., from Medicine, Baltimore. Hospital and Kauai Medical Clinic, CEO, IBR Healthcare Consulting, Lihue, Hawaii, from CEO, Hawaii Vernon Hills, Ill. James A. Berg, FACHE, to presi- Pacific Health-Pali Momi Medical dent, Texas Health Presbyterian Center, Aiea, Hawaii. Kendra A. Aucker to president/ Hospital Dallas from senior vice CEO, Evangelical Community president/COO. Richard C. Cleland, FACHE, to Hospital, Lewisburg, Pa., from vice CEO, Erie County Medical Center president/COO, Evangelical Jeffrey W. Bloemker to CEO, Corporation, Buffalo, N.Y., from Medical Services Foundation, I-70 Community Hospital, Sweet president/COO and interim CEO. Lewisburg, Pa. Springs, Mo., from vice president, Mosaic Life Care, St. Joseph, Mo. Kenneth J. Cochran, FACHE, to Patrick A. Auman, PhD, to interim president/CEO, Opelousas (La.) CEO, Susan B. Allen Memorial Thomas F. Boggs, CPA, to CEO, General Health System from presi- Hospital, El Dorado, Kan., while main- Healthcare Solutions Network, dent/CEO, River Valley Health taining his role as president/CEO, The Cincinnati, from COO, Aultman Partners, East Liverpool, Ohio. Network Job List Companies, Houston. Health Foundation, Canton, Ohio. This column is made possible in part by Kurt Banas, FACHE, to senior man- Timothy Brady, PhD, FACHE, to The Risk Authority. ager, Deloitte Consulting, McLean, retirement from regional inspector gener- Va., from senior director, value analysis al, HHS OIG, San Francisco. We would and strategic sourcing, Inova Health like to thank Timothy for his many System, Falls Church, Va. years of service to the healthcare field.

80 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. Melissa Cole, FACHE, to direc- Terry J. Fontenot, FACHE, to tor, ophthalmology clinics, CEO, Nix Health, San Antonio, UNM Hospitals, Albuquerque, from president, Executive Healthcare N.M., from quality consultant, Management and Consulting UNM Hospitals. Services, Sachse, Texas.

Thomas A. DeBord, FACHE, to Bill Foulkes II to national vice presi- COO, Overlake Medical Center, dent, healthcare project management, Bellevue, Wash., from president, Cumming, Aliso Viejo, Calif., from Summa Barberton & Wadsworth- vice president, Hammes Company, Rittman Hospital, Akron, Ohio. Irvine, Calif.

Michael Dewerff to president/ Susan Fox to president/CEO, White CEO, UnityPoint Health–Fort Plains (N.Y.) Hospital from president. Dodge from CFO. John A. Gennaro, FACHE, to direc- Steve E. Dobbs, FACHE, to CEO, tor, Cincinnati VA Medical Center Merit Health, Jackson, Miss., from from director, VA Butler (Pa.) CEO, Urologic Specialists of Healthcare. Oklahoma, Tulsa. Greg D. Gerard to vice president, Elizabeth A. Durrence, FACHE, to ambulatory services, Baptist Health COO, Brandon (Fla.) Regional Richmond (Ky.) from president, Hospital from COO, Kendall Saint Joseph London (Ky). Regional Medical Center, Miami. Karen T. Harris, RN, to chief nurs- William G. Englert to CEO, ing and operations executive, Allegheny Valley Hospital, Natrona Henry Ford West Bloomfield (Mich.) Heights, Pa., from vice president, Hospital from vice president, patient operations and business care services and CNO. development. Sandy S. Haryasz, FACHE, to All of the same rich content J. Eric Evans, FACHE, to CEO, retirement from CEO, Page (Ariz.) you’ve come to rely on Tenet Texas Region, Dallas, from Hospital. We would like to thank right from your computer, market CEO, Providence Memorial Sandy for her many years of service smartphone or tablet. Hospital and Sierra Medical Center, to the healthcare field. El Paso, Texas. Beth E. Hawley, FACHE, to senior Delvecchio S. Finley, FACHE, to vice president, strategic initiatives, CEO, Alameda Health System, IPC Healthcare Inc., North Oakland, Calif., from CEO, Hollywood, Calif., from chief cus- Harbor-UCLA Medical Center, tomer experience officer, Cogent Torrance, Calif. HMG, Radnor, Pa. For info at your fingertips, visit Joshua A. Floren, FACHE, to presi- Henry “Hank” Hernandez to ache.org/DigitalPublications dent, Texas Health Presbyterian CEO, Sierra Providence Hospital Plano, from interim president. Transmountain Campus, Sierra

Providence Health Network, Theodore M. Lewis to CEO/ Neb., from manager, marketing and El Paso, Texas, and COO, Sierra administrator, Guam Memorial business development, Nebraska Providence Health Network from Hospital, Tamuning, from presi- Orthopaedic Hospital, Omaha. CEO, Las Palmas Medical Center, dent/CEO, Guam Seventh-Day El Paso, Texas. Adventist Clinic, Tamuning. Richard J. Pollack to president/CEO, American Hospital Association, Mary Anne Healy-Rodriguez, Chris Locke to CEO, Saint Francis Chicago, from executive vice presi- PhD, RN, to senior vice president Hospital-Bartlett (Tenn.), from dent, advocacy and public policy. and chief nursing executive, The COO, Atlanta Medical Center. Brooklyn (N.Y.) Hospital Center London A. Quicci to COO, DMC from vice president, nursing Stephen A. Martin Jr., PhD, to Sinai-Grace Hospital, Detroit, from operations. CEO, Accreditation Association administrator, DMC Surgery for Ambulatory Health Care, Hospital, Madison Heights, Mich. J. Michael Horsley, FACHE, to Skokie, Ill., from executive retirement from president/CEO, director, Association for Natalie Ransom to CNO, North Alabama Hospital Association, Community Health Improvement Florida Regional Medical Center, Montgomery. We would like to at the American Hospital Gainesville, Fla., from CNO, thank J. Michael for his many years Association, Chicago. Mountainview Hospital, Las Vegas. of service to the healthcare field. Federico Martinez Jr. to retirement Virginia Razo, PharmD, DsC, to Sally A. Hurt-Deitch, FACHE, to from CEO, St. Charles Parish interim CEO, Curry Health market president/CEO, Sierra Hospital, Luling, La. We would like Network, Gold Beach, Ore., from Providence Health Network, El Paso, to thank Federico for his many years COO, Tahoe Forest Hospital, Texas, from president/CEO, Sierra of service to the healthcare field. Truckee, Calif. Providence Eastside Hospital, El Paso, Texas. R. Craig McCoy to CEO, Bon Norman G. Roth, FACHE, to pres- Secours Saint Francis Health ident, Greenwich (Conn.) Hospital Edward Jimenez to CEO, University System, Greenville, S.C., from and executive vice president and of Florida Health, Gainesville, from CEO, Emory Saint Joseph’s COO, Bridgeport Hospital, Yale interim CEO. Hospital, Atlanta. New Haven (Conn.) Health System from interim president. Fran Laukaitis, RN, FACHE, Cameron M. McGregor, RN, to president, Methodist Charlton FACHE, to vice president, neurosci- Nikki K. Roux, FACHE, to vice Medical Center, Dallas, from ence and Oncology Institutes, president/CNO, Memorial CNO. Premier Health, Dayton, Ohio, from Hermann Northeast Hospital, director, operational innovation, Humble, Texas, from administrative Karen A. Lautermilch to CEO, Premier Health. director, general medicine, services, Coquille (Ore.) Valley Hospital Memorial Hermann-Texas Medical from CEO, Rehoboth McKinley Rachael L. McKinney, FACHE, Center, Houston. Christian Health Care Services, to COO, VEP Healthcare, Inc., Gallup, N.M. Walnut Creek, Calif., from Candice L. Saunders, FACHE, to regional neuroscience executive, president/CEO, WellStar Health Bruce Lederman to COO, Charles Sutter Health Sacramento Sierra System, Marietta, Ga., from presi- E. Smith Life Communities, Region (Calif.) dent/COO. Rockville, Md., from chief strategy officer, Midwest Administrative Bradley D. Pfeifer, FACHE, to CEO, Brian W. Schroeder, JD, MPH, Services Inc., Chicago. West Holt Medical Services, Atkinson, CMPE, to executive director,

82 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. operations, Vanguard Medical Regional Medical Center from Michael S. Wiggins, FACHE, to Group, Cranford, NJ., from region- administrator/CEO, Ben Taub senior vice president, administra- al director, physician practices, Hospital/Quentin Mease Hospital, tor, Children’s Medical Center Barnabas Health Medical Group, Harris Health System, Houston. Plano, Texas, from vice president, Newark, N.J. operations, Children’s of Gary C. Tucker, FACHE, to pres- (Birmingham) Alabama. Kevin Scoggin to COO, ident/CEO, Mt. St. Mary’s Summerville (S.C.) Medical Center Hospital and Health Center, Lynn R. Wold to president/CEO, from associate COO, Kingwood Lewiston, N.Y., from senior vice UnityPoint Health-St. Luke’s, (Texas) Medical Center. president/COO. Sioux City, Iowa, from interim president. Susan C. Shugart, FACHE, to William Voloch to president/CEO, COO, Carolina Pines Regional Wesley Medical Center, Wichita, Editor’s note: Submissions to Medical Center, Hartsville, S.C., Kan., from interim CEO. On the Move must be submitted from chief administrative officer, by Aug. 1 to be considered for Baptist Easley (S.C.) Hospital. Tiffany Weber to CFO, Sterling the November/December issue (Colo.) Regional MedCenter from due to production lead times. Mark D. Sparta, FACHE, to execu- CFO, Perkins County Health See page 4 for additional submis- tive president and chief population Services, Grant, Neb. sion information. health officer, Hackensack (N.J.) University Health Network from vice president, senior operations officer, Hackensack (N.J.) University Medical Center. Are you interested in an ACHE Bernadette Spong, CPA, to CFO, Fellowship or Internship? Orlando (Fla.) Health from CFO, Rex Healthcare, Raleigh, N.C., and Stuart A. Wesbury Jr. Diversity Internship Postgraduate Fellowship This three-month internship program senior vice president, finance, This one-year fellowship program furthers furthers the education of diverse students University of North Carolina Health postgraduate education in healthcare and in the fields of healthcare and professional Care System, Raleigh, N.C. professional society management. Beginning society management. Beginning in May in May or June, the program allows the or June, the program allows the Intern to Fellow to work in all major ACHE divisions. rotate through all major ACHE divisions. Michael J. Swartz, FACHE, to interim director, Canadaigua (N.Y.) You are eligible to apply if: You are eligible to apply if: You have earned a graduate degree in health- You have successfully completed one VA Medical Center while continu- care or association management from a year of graduate studies in a healthcare ing as medical center director, Bath college or university that is accredited by the or association management program at (N.Y.) VA Medical Center. regional accrediting association in the United a college or university that is accredited States approved by the U.S. Department of by the regional accrediting association in Education or that holds membership in the the United States approved by the U.S. Suanne L. Thurman-Gersdorf, Association of Universities and Colleges of Department of Education or that holds FACHE, to CEO, Tulsa (Okla.) Canada. The degree must have been granted membership in the Association of Univer- no earlier than July 2015. You are authorized sities and Colleges of Canada. You are a Cancer Institute from vice presi- to work for any employer in the United States. minority as classified by EEOC. dent, corporate service lines, ACHE does not sponsor visas. Valley Health Services, Winchester, Va. For application information, visit ache. org/CareersResources, or contact ACHE’s Human Resources at (312) 424-9341 or hr- Robert J. Trenschel, DO, FACHE, [email protected]. Applications must be to president/CEO, Yuma (Ariz.) postmarked no later than December 1, 2015.

The American College of Healthcare Executives extends its Karen S. Lower, RN, director, congratulations to those ACHE members who recently received oncology services, Champlain awards recognizing their contribution to healthcare management. Valley Physicians Hospital, Plattsburgh, N.Y., received the Senior-Level Healthcare Executive Nicholas Bilas, division administra- David J. DeSimone, FACHE, direc- Award from the Regent for New tor, Columbia University Medical tor, planning and business develop- York—Northern and Western. Center, New York, received the ment, McLaren Flint (Mich.), received Early Career Healthcare Executive the Faculty Award from the Regent for Stanley E. McBride, FACHE, Award from the Regent for New Michigan & Northwest Ohio. Cincinnati, received the Leadership York—Metropolitan New York. Award from the Regent for Ohio. John C. Federspiel, president, Karen C. Brown, FACHE, vice Hudson Valley Hospital Center, Christine D. Soufastai, project man- president/COO, OSF Saint Cortlandt Manor, N.Y., received the ager, New York Presbyterian Hospital, Anthony Medical Center, Senior-Level Healthcare Executive received the Early Career Healthcare Rockford, Ill., received the Senior- Award from the Regent for New Executive Award from the Regent for Level Healthcare Executive Award York—Metropolitan New York. New York—Metropolitan New York. from the Regent for Illinois— Central and Southern. Amanda A. Henson, FACHE, vice Henry A. Veenstra, FACHE, presi- president, oncology, Baptist Health dent, Spectrum Health Zeeland William A. Burmeister, FACHE, Lexington (Ky.), received the Early (Mich.) Community Hospital, director, physician practice rela- Career Healthcare Executive Award received the Senior-Level Healthcare tions, Middlesex Hospital, from the Regent for Kentucky. Executive Award from the Regent for Middletown, Conn., received the Michigan & Northwest Ohio. Early Career Healthcare Executive James H. Jackson Jr., executive Award from the Regent for director, Greenwood (Miss.) Leflore Elissa M. Waliszewski, FACHE, Connecticut. Hospital, received the Senior-Level director, performance management, Healthcare Executive Award from the Westchester Medical Center, Dee Dee Chen, FACHE, profes- Regent for Mississippi. Valhalla, N.Y., received the Early sional staff benefits manager, Career Healthcare Executive Award Massachusetts General Hospital, Leslie R. Johnson, senior process from the Regent for New York— Boston, received the Early Career improvement engineer, Silver Cross Metropolitan New York. Healthcare Executive Award from Hospital, New Lenox, Ill., received the Regent for Massachusetts. the Early Career Healthcare Editor’s note: Submissions to Member Executive Award for Illinois— Accolades must be submitted by Aug. 1 John A. Christoforo, FACHE, Central and Southern. to be considered for the November/ president/CEO Beth Israel December issue due to production lead Deaconess Healthcare, Needham, Jay A. Kossman, senior director, JLL, times. See page 4 for additional sub- Mass., received the Senior-Level Norfolk, Va., received the Senior-Level mission information. Healthcare Executive Award from Healthcare Executive Award from the the Regent for Massachusetts. Regent for Connecticut. This column is made possible in part Heather DeCoster, administrative Charles D. Lovell Jr., FACHE, by Aramark. fellow, Spectrum Health System, CEO, Caldwell Medical Center, Grand Rapids, Mich., received the Princeton, Ky., received the Senior- Student Award from the Regent for Level Healthcare Executive Award Michigan & Northwest Ohio. from the Regent for Kentucky.

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HAP_eBooks_fullpg_final.indd 1 7/13/15 12:12 PM PerspectivesBoard Highlights

The American College of Healthcare Executives Board of Governors met June 28–30 in San Diego. Following are Strategic Planning Session highlights of that meeting. The ACHE 2015–2017 Strategic Plan and the March 31, 2015, progress report are available on Financials Approved served on the Board of Governors ache.org. The Board received financial state- and/or the nominating committee, ments for the current period and was charged with conducting a The Board participated in a half- accepted ACHE’s 2014 financial review of ACHE’s day strategic planning retreat to audit, prepared by McGladrey LLP. board-level structures and processes consider opportunities to enhance The auditors issued an unmodified and recommending changes that ACHE’s current strategic plan and opinion regarding the audit. would better align these with the initiatives that have arisen ACHE’s strategic direction and since development of the plan in Governance Review increase ACHE’s ability to respond November 2014. The Board Task Force Report proactively and rapidly to changes in received both quantitative and The Board received and reviewed the environment. qualitative information related to the preliminary report and recom- each opportunity. After careful mendations of the Governance The task force identified and pro- consideration, the Board made a Review Task Force. The task force, posed recommendations related to few modifications to the plan for comprising ACHE leaders who have four key issues: 2016–2018, including a change designed to more effectively com- • Board competencies and municate key components of the LEADERSHIP composition plan with members. The Board • Board nomination and selection expressed its enthusiasm about DEVELOPMENT process ACHE’s strategy and its confi- • How to effectively ensure input dence that the 2016–2018 plan PROGRAM from stakeholders will build on the current direction. • Use of Board meeting time The Board also approved additional resources and funding for 2015 Following discussion of the recom- to ensure continuity and continued mendations, the Board approved progress toward the plan’s the report for field review by implementation. ACHE past Chairmen, Regents and chapter presidents. This review Board Self-Assessment Reported began in late July. ACHE uses a board self-assessment process developed by Board Source Staff Reports and Updates and the American Society of The Board also heard reports from Association Executives. The Board staff regarding corporate and divi- reviewed the results of the sional performance objectives, evaluation. GAIN SELF-AWARENESS member attrition trends, ACHE’s and CONFIDENCE performance excellence journey, Next Meeting Planned progress toward implementation of The ACHE Board of Governors is NOV. 2–4, 2015 ACHE’s 2015–2017 Strategic Plan scheduled to meet Nov. 9–10, 2015, and the initiative to replace in Chicago. Highlights of that meet- CHICAGO MARRIOTT O’HARE ACHE’s current association man- ing will be published in a future ACHE.ORG/LDP agement system. issue of Healthcare Executive.

86 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. Thank You To our members and customers from the American College of Healthcare Executives Board of Governors, Council of Regents and staff for your support and contributions during the past year. We also extend our gratitude to our committee members and nearly 1,500 leaders and volunteers of our partners—the 80 independent chapters of ACHE—for your contributions. See what we have achieved together:

Reached the largest MEMBERSHIP in our history with more than 45,000 members • Chapters provided more than 1,000 events for more than 67,000 attendees • Nearly 600 new Fellows recognized the value of the FACHE® credential • Nearly 2,400 members served as sponsors through the Leader-to-Leader Program, resulting in the recruitment and advancement of more than 2,500 members • Our Physician Executives Forum and Healthcare Consultants Forum continued to grow and expand offerings to these executive segments

Advanced KNOWLEDGE in the field through educational programs and publications • The 2015 Congress on Healthcare Leadership was attended by more than 4,000 healthcare executives from more than 30 countries • Healthcare Executive magazine continues to be one of the most widely read publications in the field • Health Administration Press published 14 new books and 10 journal issues and sold about 55,000 publications

Provided CAREER ADVANCEMENT resources for all members • The online Job Center housed on average 2,500 jobs and 3,000 searchable resumes • The Career Resource Center responded to more than 2,100 member requests for service • The American College of Healthcare Executives Official Group on LinkedIn provided social networking opportunities for nearly 14,000 members

Demonstrated a commitment to LEADERSHIP • ACHE’s Code of Ethics, online ethics toolkit and regular ethics columns in Healthcare Executive promote a commitment to ethics in the field • The Thomas C. Dolan Executive Diversity Program achieves greater diversity among senior healthcare leaders; six scholars were selected for the 2015 program • ACHE continued its support of the Equity of Care initiative to help eliminate disparities in care

Set a high standard of SERVICE EXCELLENCE • Nine Premier Corporate Partners have committed their support, making additional programs and services available • More than 1,900 donors to the Fund for Innovation in Healthcare Leadership contributed more than $2.9 million since its inception

ACHE is your partner and resource dedicated to helping you succeed. To learn more, visit ache.org or call (312) 424-9400.

Affiliate_ThankYou_2015.indd 1 7/13/15 11:09 AM PerspectivesTakeChapter Note News

Engaging Early Careerists satisfaction. In 2012, there were no early careerists on the chapter board; by 2013, two early careerist members Chapters have a number of resources to support early careerist were represented on the board; and in development. 2014, four early careerists were appointed. Overall attendance at chapter programs has grown from an ACHE chapters can seek out creative ways “This was a good way to get senior average of 20 attendees to 40. The to help early careerists become involved executives engaged, and early number of Fellows in the chapter with their chapter. They can provide careerists were eager to have a dia- increased, and many of the senior- career services, such as mentoring logue with them,” Antrum says. level executives who led early careerist and resume review, and they may appoint “Plus, having a diverse board would programs offered to be mentors to an early careerist on the chapter board to help with career progression.” these young healthcare professionals. provide a fresh perspective. One chapter—Healthcare Executive Forum, Building upon 2013’s efforts, HEF “Early careerists bring enthusiasm and Inc., which covers a large geographic established three sustainable career time to dedicate to chapter activities,” area in western New York—developed assistance services for early and mid- Antrum says. “They have the opportunity programs to engage and foster connec- careerists. The first was the to develop different skill sets, bring fresh tions with early careerists. “Conversations with an Executive” ideas and offer new ways of doing things.” series, which featured local senior HEF has 140 members, but before executives who shared their profes- ACHE’s Early Careerist Network 2013 the chapter did not have many sional journeys and offered career If you are a member of ACHE and are programs that targeted early careerists. advice. Next was the resume review under the age of 40, you automatically They also lacked funds to implement workshop, where local healthcare belong to the Early Careerist Network. its ideas for recruiting up-and-coming executives and healthcare system The ECN’s resources, many of which leaders, so in 2013 it applied for and recruiters offered guidance to early are available online, are designed to received the 2013 Grant for Chapter careerists through a panel discussion help you navigate the increasingly Innovation for its Early Careerist on resumes and met with them one- complex professional challenges facing Development Initiative. on-one to review and critique. The early careerists in healthcare. Benefits third was a speed networking event include the Early Careerist Newsletter, HEF President Vi-Anne Antrum, RN, that included three 20-minute ses- ACHE discounts, educational pro- FACHE, lead CNO, for Kaleida sions of roundtable discussions, which grams, and networking and mentoring Health, Buffalo (N.Y.) General allowed early careerists to network opportunities. For more information, Medical Center, who was the chapter’s and receive advice. go to ache.org/ECN. s program committee chair at the time, led the initiative’s implementation. “Chapters can help early careerists To find your ACHE chapter, search the The objectives were to offer more develop in their career,” Antrum says. online Chapter Directory at ache.org ACHE Qualified Education credit “It is invigorating to have that high by entering your ZIP code on the left programs that would attract a diverse level of excitement and energy.” side of the page. Then contact the chap- group of executives to serve as present- ter officials listed for information on ers; provide a Board of Governors HEF has reaped enormous benefits how you can get involved. To discuss Exam study group to encourage from these initiatives. In 2014, the your ideas for chapters, contact the advancement; lead an effort to chapter received the Board of Chapters Committee’s ACHE staff liai- appoint early careerists to the chapter Governors Award for exceeding all son, Desmond J. Ryan, FACHE, CAE, board; and increase the number of four goals outlined in the Chapter associate director in the Division of programs offered in less populated Management and Awards Program, Regional Services, at (312) 424-9325 areas of the chapter’s region. including an increase in member or [email protected].

88 Healthcare Executive SEPT/OCT 2015 Reprinted with permission. All rights reserved. Attend quality educational programs close to home. Volunteer to develop new skills and give back to the profession. Connect with healthcare leaders who share a commitment to your community. Take advantage of the career management tools and local resources to help you advance to the next level.

Opportunities await at your local ACHE chapter. ache.org/Chapters

ACHE Chapters

LEADERSHIP

EDUCATION

ADVANCEMENT

NETWORKING

CAGI_Full_MA13.indd 1 1/24/13 11:00 AM PerspectivesTakeProfessional Note Development Calendar

January 2016 February 2016 18–21 15–18

St. Petersburg, Fla., Cluster Scottsdale, Ariz., Cluster

18–19 The Courage to Lead: Critical Skills for 15–16 Critical Financial Skills for Hospital Healthcare Leaders Success

Journey to Excellence: How High- Reducing the Financial Impact of Performing Healthcare Leaders Achieve Hospital Readmissions and Medical Organizational Success Mistakes

Strategic Planning: From Formulation to Secrets of Great Healthcare Action Organizations in Leading Change

20–21 De veloping and Deploying a Hospital 17–18 Achieving a Strategic Partnership With Business Intelligence Strategy That Works Your Board: Thrive in the Midst of Accountability Effective Leadership for High-Reliability Healthcare Aggressively Improve Cost, Quality and Throughput Using Lean Six Sigma Redesign and Operationalize Your Medical Staff for Health Reform Are Medical Groups in Your Portfolio? Critical Factors to Manager Your Investment

25–28 Hospitals and Integrated Networks of the Future

Beaver Creek, Colo., Cluster Tuition Waiver Assistance

25–26 Behavior Smarts: Increasing Healthcare The American College of Healthcare Executives makes a Leadership Performance limited number of education tuition waivers available to ACHE Members and Fellows. Tuition waivers are awarded Coach, Challenge, Lead: Developing an on the basis of financial need. Applications must be Indispensable Management Team submitted at least eight weeks prior to the program date. For more information on the ACHE Tuition Waiver Possibilities, Probabilities and Creative Assistance Program, visit ache.org/TuitionWaiver or Solutions: Breakthrough Thinking for contact ACHE’s Customer Service Center at (312) 424-9400. Complex Environments Completion of these course(s) earns ACHE Face-to-Face Education credit, 27–28 Leading for Success: Creating a which counts toward Fellow advancement and recertification. Visit the Committed Workforce Credentialing area of ache.org for more information on advancement and recertification requirements. Managing Conflict, Accountability Conversations and Disputes This column is made possible in part by Cerner.

The ACHE Recognition Program celebrates members’ volunteer service and commitment to their chapter and ACHE. You may have served as a mentor, participated on a committee or served as a chapter leader. There are so many ways to serve and earn points. Award levels: Exemplary Service Award = 125 points Distinguished Service Award = 75 points Service Award = 30 points

You will be recognized by your chapter with a prestigious service award and pin when you reach each level. Report and track your volunteer service on My ACHE today! Visit my.ache.org and click ‘My Volunteer Service’

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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)

Statement of the Issue learning, emotional or mental disability or disease; a sen- Despite the passage of the Americans with Disabilities sory impairment; physical handicap; pain; or chronic Act in 1990, disability, whether actual or perceived, pres- fatigue syndrome. ents an ongoing employment challenge in our society. Even in the case of healthcare organizations, which face The prevalence of disability among healthcare workers periodic personnel shortages in administrative, clinical creates a particular responsibility for healthcare executives and support functions, persons with disabilities may not to be vigilant in ensuring ongoing opportunities for persons be sought after as willing, productive resources for with disabilities while fostering an inclusive environment employment. with equitable workplace treatment for all.

Obstacles to including the disabled in the pool of poten- Policy Position tial employees may be related to misperceptions about ACHE believes healthcare executives should take the lead accommodation and healthcare costs, productivity losses, in their organizations to increase employment, advance- reliability of workers, how to access potential candidates ment and leadership opportunities for persons with and, in many communities, the lack of reliable transpor- disabilities. Additionally, healthcare executives should tation. While significant infrastructure investments and advocate on behalf of the employment of persons with systematic process modifications may be needed to disabilities in other organizations in their communities. achieve organizational compliance with regulations such ACHE encourages all healthcare executives to pursue the as those included in the Americans with Disabilities Act, following actions: research suggests that the additional costs to accommodate employees with a disability may be minimal or non- • Develop an organizational culture that encourages existent and that people with disabilities have lower rates persons with disabilities to utilize their potential to of turnover and absenteeism (Job Accommodation contribute rather than discounting them on the basis Network, 2009). of stereotypes or generalizations about their “limitations.”

However, there is evidence that healthcare organizations • Create ongoing programs on disability awareness to may already be more likely to employ those with disabili- educate those within human resources departments/ ties than organizations in other sectors. While in 2009 divisions, supervisors and co-workers. 4 percent of all civilian workers were disabled, a 2005 • Affirm equal access to employment for persons with survey of members of the American College of Healthcare disabilities exists by recruiting governance leaders, Executives (ACHE) showed a somewhat higher rate, with executives, clinicians and support staff with auxiliary an estimated 7.6 percent of respondents being disabled, aids and services (such as Braille or large–print mate- defined as having a condition that limits full participation rials, telecommunication devices for deaf persons and in work and/or having specific conditions such as

92 Healthcare Executive SEPT/OCT 2015

Disabilities.indd 1 7/22/15 2:06 PM Strengthening Healthcare Employment Opportunities for Persons With Disabilities (cont.)

videotext displays); through using networks and recruiting firms committed to accommodating persons with disabilities; and by making auxiliary assistance available throughout the interview process.

• Reallocate or redistribute job responsibilities to accommodate individuals with disabilities and consider reallocating responsibilities to accommodate and retain individuals already on staff who acquire a disability.

• Determine appropriate accommodations using an informal, interactive problem-solving process involving the employer and the individual with a disability. The employer may wish to seek the assistance of a third party who is knowledgeable in disability matters, such as a vocational rehabilitation counselor.

The American College of Healthcare Executives encourages its members to take the lead in their organization and their community in creating working environments that enhance the opportunities of persons with disabilities to gain and maintain employment.

Approved by the Board of Governors of the American College of Healthcare Executives on November 16, 2009.

References Research cited can be found at: Job Accommodation Network (original 2005, updated 2007, updated 2009). “Workplace Accommodations: Low Cost, High Impact.” Retrieved September 23, 2009, from http://www.jan.wvu. edu/media/LowCostHighImpact.doc

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policy statement

Organ/Tissue/Blood/Blood Stem November 1986 Cells Donation Process March 1993 (reaffirmed) February 1997 (revised) November 2000 (revised) November 2003 (revised) November 2006 (revised) November 2009 (revised) November 2014 (revised)

Statement of the Issue • Provide information to enable the organ procurement Medical advances have provided a tremendous opportu- organization or referral center to access donor regis- nity to save and heal lives through organ, tissue, blood tries and support patient authorization for donation and blood stem cells (marrow, peripheral blood and as documented in the registries. umbilical cord blood) transplantation. More than 20,000 lives are saved or healed each year through transplanta- • Adopt best practices for achieving donation goals des- tion but, tragically, thousands more die while waiting for ignated by the U.S. Department of Health and a lifesaving organ. This is because not enough organs are Human Services Health Resources and Services available for the increasing number of people added to the Administration and championed by the Donation transplant waiting list each year. At any given time, more and Transplantation Community of Practice. than 100,000 people in the United States are waiting for • Heighten public and professional awareness of the a lifesaving or life-changing organ. Despite significant problem and distribute information related to poten- improvements in the donation process in hospitals across tial solutions. the country, the transplant waiting list continues to out- pace the number of donors available. Though governments, medical professionals, hospitals, organ procurement organizations and insurance compa- Significant opportunities exist to increase both the pro- nies can provide resources that support donation, only portion of eligible donors who become donors and the individuals and their families have the ultimate power to number of organs and tissues transplanted per donor. To offer the gift of life. increase donation and transplantation: Policy Position • Ensure specific hospital procedures are developed in The American College of Healthcare Executives believes collaboration with affiliated organ and tissue procure- all healthcare executives should work to increase the sup- ment organizations to work with patients and families ply of available organs, tissues, blood and blood stem cells in honoring patient wishes to become a donor. (marrow, peripheral blood and umbilical cord blood) for Successful recovery of organs requires a coordinated transplantation. ACHE recognizes donation as a critical approach to discuss donation with family members component of lifesaving technology and end-of-life deci- and significant others, recognizing that in some cases sion making and supports voluntary efforts to increase the broader definition of family can include signifi- organ, tissue, blood and blood stem cells availability (see cant others. related Ethical Policy Statement: “Decisions Near the End of Life”).

94 Healthcare Executive SEPT/OCT 2015

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As business and community leaders, healthcare executives • Consider serving as a role model by publicizing their have the influence and credibility to motivate individuals own personal decision to register as an organ and and families to consider the donation of organs, tissues, tissue donor, participate in blood drives or join the blood and blood stem cells. As healthcare professionals, it marrow registry. Healthcare executives can provide is part of their responsibility to do everything possible to leadership in the resolution of this important social honor someone’s wishes to be a donor. ACHE encourages problem by encouraging their staff to follow their its members to actively pursue the following: lead and in coordinating community efforts.

Establish Protocols and Information Programs • Participate in national, state and local government • Together with their affiliated organ and tissue pro- and private-sector initiatives to promote organ, tissue, curement organization, establish effective and com- blood and blood stem cells donation, including passionate protocols for working with patients and enrolling in HRSA’s Workplace Partnership for Life their families. Families of dying patients who have at organdonor.gov, and join thousands of other com- not registered as donors should be provided with the panies that are promoting donation in the workplace. information and option to donate. Families of desig- nated donors should be provided with information The issue of organ, tissue, blood and blood stem cells and support. Many appreciate the opportunity to donation and transplantation reaches beyond the limited ease their personal loss with a selfless, giving act and availability of these precious resources in the face of grow- to help their loved ones carry out a lifesaving gift. ing demand, but one issue is clear: By preserving the option of donation for all patients and families, one’s • Develop strong, ongoing public information and edu- choice to become a donor is honored and it provides hope cation programs that help people understand the pro- for the many waiting for a transplant to save or heal their cess of organ and tissue donation, the advantages of life. ACHE encourages its members to develop an envi- registering with their state donor registry and the ronment that fosters this opportunity. importance of sharing with their families the decision they have reached. Approved by the Board of Governors of the American College of Healthcare Executives on November 10, 2014. • Develop strong, ongoing public information and education programs that help people understand the process of blood donation and how to become a potential Related Resources marrow, peripheral blood stem cells or umbilical cord American College of Healthcare Executives Ethical Policy blood donor. Statement, “Decisions Near the End of Life.”

• Support efforts to provide access to state donor regis- Health Resources and Services Administration tries by people in the hospital community. organdonor.gov Encourage Donation http://bloodcell.transplant.hrsa.gov/ • Encourage members of the medical community, par- Organ Donation and Transplantation Alliance ticularly physicians in the critical care setting, to www.organdonationalliance.org develop protocols reflecting the best practices in the field to maximize organ, tissue, blood and blood stem Donate Life America cells donation, availability and transplantation. www.donatelife.net

Healthcare Executive 95 SEPT/OCT 2015

Organ_Donation.indd 2 7/22/15 2:06 PM SEPTEMBER/OCTOBER 2015 Ad Index

American College of Healthcare Executives...... 50, 53, CareFusion...... 41, 42-43 International Hospital Federation...... 71 61, 63, 67, 69, 73, 77, 79, 81, 83, 85, 86, 87, 89, 91 www.carefusion.com The 39th World Hospital Congress www.ache.org (888) 876-4287 www.WorldHospitalCongress.org (312) 424-2800 CEP America...... 25, 55 Novia Strategies...... 3 Actavis...... Insert www.cepamerica.com www.noviastrategies.com www.dalvance.com (510) 350-2777 (866) 747-4200

American Speech Language Hearing Association Cerner...... 31, 32-33 Philips Healthcare...... 9 (ASHA)...... 37 www.cerner.com www.philips.com/ache www.asha.org (816) 221-1024 (978) 659-3000 (800) 638-8255 Conifer Health Solutions...... 45 The Risk Authority–Stanford...... C3 Aramark...... C4 www.coniferhealth.com theriskauthority.com www.aramark.com (650) 723-6824 (800) 909-7373 EMCOR Government Services...... 13 www.emcorgovservices.com Siemens Healthcare...... 27 athenahealth...... 15 (866) 890-7794 usa.siemens.com/healthcare www.athenahealth.com (888) 826-9702 (800) 981-5084 Fidelity Investments...... 49 www.fidelity.com SUNY Empire State College...... 64 BE Smith...... C2 1-800-FIDELITY www.esc.edu www.BESmith.com (800) 847-3000 (855) 254-8261 Gray Reed...... 51 www.GrayReed.com Time Warner Cable Business Class...... 7 Capio Partners...... 19 (214) 954-4135 Business.TWC.Com/Healthcare www.capiopartners.com (855) 217-9349 (678) 781-5164 Halogen Software Inc...... 65 www.halogensoftware.com/healthcare Trane Healthcare...... 5 Cardinal Health...... 21 (866) 566-7778 www.trane.com/healthcare www.cardinalhealth.com (855) 812-1400 (800) 234-8701 Huron Healthcare...... 59 www.huronconsultinggroup.com/healthcare (866) 229-8700

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WE DREAM. WE DO. TECHNOLOGY Using Technology to Map Out a Population Health Strategy VOLUME 30,NUMBER 5 • SEPTEMBER/OCTOBER 2015 SEPTEMBER/OCTOBER

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