What healthcare leaders need to know now

 

Nancy Howell Agee and her team help rejuvenate a region with Carilion’s success

By | July 11th, 2017 | Blog | Add A Comment

 

Nancy Howell Agee: “I want to make sure our caregivers are able to put our patients first and get their work done without any obstacles.”

 

One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

Roanoke, Virginia, used to be a train town. Railroads carved their tracks into the community on the edge of the Blue Ridge Mountains, and Roanoke’s manufacturing of steam locomotives helped make a name for the Norfolk & Western Railway. Even the first hospital came into existence because train workers needed care.

 

Like many such towns dependent on one industry that dot the mountains and the plains and the prairies around America, decay began to seep in when the trains started disappearing. But the Roanoke region, at least, has experienced a rebirth, and one of the people responsible for the city’s turnaround has had a close-up view all her life. That would be Nancy Howell Agee, the CEO of Carilion Clinic, a health system that has soared under her leadership and that has partnered with Virginia Tech for an economic rebound that’s pretty rare these days.

 

“Years ago, when I looked out of my office, I looked out at a brown field and a flood plain,” she says. “Now, I look at a thriving medical complex that includes a medical school and a research institute.”

 

The medical school, developed with Virginia Tech, has quickly become the most competitive in the country, with 4,500 applicants vying for 42 openings each year. The research institute, another joint project with Virginia Tech, didn’t even exist eight years ago, but now has more than $80 million in funded research and is getting ready for an expansion that will double its size.

 

“It wasn’t easy; it wasn’t cheap,” Agee says. “We have a fabulous board who have stood with us through some tough times. I think where we are now is an amazing place. We recruited great talent and offered new services to the community. A lot has changed and, in the next 10 years, I think we’ll see even more evolution of that change.”

 

The Carilion Health System became the Carilion Clinic in 2006 as leaders like Agee (the chief operating officer at the time) and then-CEO Ed Murphy saw the need to change its business model to safeguard its future. Agee says Murphy was a “visionary” in transforming the health system into a clinic. She sees herself as more of a “convener and collaborator,” but her fingerprints are all over the renovated system as well.

 

“It was definitely an audacious goal at the beginning,” she allows. “We adapted the plan for what worked for us. But, nothing worth having comes easy. There’s a saying around here that you can take risks without being reckless. And what we kept at the forefront was, ‘How can we pay attention to our mission of improving the health of those we serve?’ It’s not just words written down some place – it’s really how we believe and how we live.’”

 

Agee’s own life and career has had a similar arc of success. Her mom moved to Roanoke at the age of 16 from a coal mining town in Appalachia. She met another teenager and married him. A year later, Agee was born. They lived with Agee’s grandmother, who became a mentor to the young Agee.

 

Her interest in healthcare began at the Christmas before her 5th birthday, when her gifts included a nurse’s kit – including a cap – and a puppy. “You can imagine how much my little puppy got poked and prodded and bandaged,” she says with a laugh. But her captivation with clinical work solidified at 15 when she was diagnosed with a bone tumor.

 

“I ended up having five surgeries on my knee and was immobilized for the better part of two years, either in a wheelchair or on crutches,” she remembers. “I had extraordinary care from my nurses, and from a wonderful physician, and I wanted to be a part of that. I wanted to be like them.”

 

Along the way to a storied career in healthcare – one that will see her become the chair of the American Hospital Association in 2018 – Agee became the first member of her family to graduate from high school and college.

 

“My family was proud of me,” Agee says. “But, having said that, they weren’t too certain what to do about education. And so, I chose to go to nursing school first because it was cheaper.”

 

She earned her bachelor’s degree from the University of Virginia and her master’s from Emory University, graduating from both with honors.

 

Agee was a nurse and a nursing leader for years at the health system. She says she loved every aspect of clinical care, but eventually wanted to find a way to make a wider impact.

 

“Being a clinician gives you almost instant gratification,” she says. “You assess what’s happening with the patient, you intervene and you see the results. In terms of my own evolution, I loved that part of healthcare. But eventually, I began to ask myself, ‘How do I make a difference to a broader degree?’ ”

 

That led her to administration, but she carries those nursing roots with her in her efforts to be a servant leader.

 

“I haven’t forgotten what it’s like to be at the bedside,” Agee notes. “I’m very visible – that’s important to me personally. I make rounds frequently. I go to all of our hospitals and facilities and talk to the staff. I also spend time with the patients to understand what’s happening with them.

 

“I want to make sure our caregivers are able to put our patients first and get their work done without any obstacles.”

 

It’s not just a business to Agee, who was born at the health system where she has spent her career.

 

“I love this community,” she says. “I love our mountains. I think we’re a strong community, yet we’re humble. We are resilient – and we love what we do. When I leave Carilion, I hope our people will believe I wanted us to have joy and meaning in our work and that we made a difference in the communities we serve. I believe we can do that.

 

“I found my place here.”

 

 

SIDEBAR: Leaving the white coat behind

 

When Nancy Howell Agee made the transition from nurse to executive, she continued to wear a white clinician’s coat – at least until she got some good (and blunt) advice from another executive.

 

“One of my mentors said to me, ‘You need to make a decision here. Are you an administrator or a clinician? The fact of the matter is, you’re confusing people.’ That was good advice.”

 

So, Agee ditched the lab coat. Now, at a time when many health systems have a tremendous need for clinicians to become organizational leaders as the industry continues the evolution to value-based care, she has a few helpful hints from her own journey:

 

  • You can’t do it all. “First of all, you must understand that doing more for more people means you have to give up doing something for a few, and that’s a big jump. You may have to mourn that as well.”
  • Ask great questions. “Be curious. Be disciplined about growing in leadership. Find opportunities to learn more, especially from mentors and advisors.”
  • Make time for your people. “I had a wonderful boss named Charles Crockett, who was the chief medical officer. He would appreciate and recognize people. If a resident or a faculty member was giving a talk or a presentation, he’d go, and ask questions and be thoughtful. He had a hundred other things to do, but he demonstrated such impressive leadership that way.”
  • Don’t forget what your core is. “We make decisions sometimes and they’re hard decisions, but are you doing it because it’s what’s best for the patient? That’s the real test. If that’s your motivation, I don’t think you’re going to go wrong with your decision-making.”

 

 

 

 

From lawyer to leader: Debra Cafaro’s turnaround of Ventas a remarkable, evolving success story

By | July 7th, 2017 | Blog | Add A Comment

 

Debra Cafaro: “Skepticism is crucial to being a successful lawyer, but in a company, you have to be more affirmative and positive. It’s much more like putting together a winning sports team.”

 

One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

If a Fortune 50 company needed a turnaround artist, few CEOs would be in as much demand as Ventas Inc.’s Debra Cafaro.

 

Her early days at Ventas, when she was asked in 1999 to take over what was then a floundering healthcare real estate investment trust, were bleak beyond embellishment.

 

The stock market halted trading of Ventas’ stock. The actions of management prior to Cafaro’s arrival became the subject of a government investigation for Medicare fraud. Ventas’ sole tenant, Vencor, filed for bankruptcy. The banks and the distressed-debt investors were trying to play both sides of the house and get paid back at the expense of the equity investors. To add insult to injury, the airlines lost her luggage and her clothing on Day One.

 

So how did she and Ventas pull off a feat worthy of a Warren Buffett?

 

“At the end of the day, it was the classic skills of maintaining liquidity, understanding how to negotiate to get some time from our banks and enable them to work with us,” Cafaro says. “We also had to think through a complicated solution for all the parties so that each could give up something but get something in return. Then, we had to get everyone on board with that plan.”

 

It was hardly a quick fix.

 

“That,” she says, “took several years.”

 

Similarly, her own transition from lawyer to corporate leader was not a simple one, she says. “It’s very different from law, and the evolution of learning to lead and think organizationally continues for me,” Cafaro says. “When you’re in a law practice, you have a very flat organization and you have a fairly homogenous group of people who are highly educated, highly motivated and highly compensated. In a pyramidical company culture, there is a whole suite of skills that I had never been asked to develop, but which I discovered were necessary for success.”

 

Those all were rooted in the importance of communication – understanding people, motivating people and recognizing people and their accomplishments often.

 

“Skepticism is crucial to being a successful lawyer, but in a company, you have to be more affirmative and positive,” she says. “It’s much more like putting together a winning sports team and making the team perform better as a whole than the sum of its parts.” Cafaro knows a thing or two about sports. She recently purchased a minority stake in her hometown Pittsburgh Penguins, just in time to see them win the 2017 Stanley Cup for the second consecutive year.

 

But her rough beginnings at Ventas have kindled her willingness to talk openly about how women executives don’t face a glass ceiling as much as what she calls a “glass cliff” – being forced to tackle difficult assignments straight out of the box and never getting another chance if they fail. Thankfully, Cafaro has never had to look back. Since 2000, Ventas has delivered 25 percent total shareholder returns; it holds a $35 billion portfolio. Even Vencor, initially its only tenant, emerged from bankruptcy and became the nation’s largest post-acute care company under its new name, Kindred.

 

“Ventas operates at the exciting intersection of healthcare and real estate, each of which represents nearly 20 percent of our GDP,” Cafaro says. “In both, there are limited numbers of women CEOs even though research repeatedly shows that women-led companies produce better returns and that diverse groups of decision-makers create better outcomes. But I continue to be optimistic.”

 

Cafaro and her team have worked hard to bring gender diversity into Ventas’ board of directors, which is now 30 percent female. That’s resulted in Ventas being recognized as a “Winning” company on the 2020 Women on Boards Gender Diversity Index and as a Corporate Champion by the Women’s Forum of New York.

 

“Our organizations and stakeholders are stronger and more effective when we intentionally develop and recruit diverse leaders,” she says. “I have been very fortunate to have been supported throughout my career by many mentors who had different perspectives – and I learned from all of them.”

 

Cafaro says her earliest mentors were her parents. Her father was a mail carrier who bought and sold coins as a side job to help pay for her education at Notre Dame. Her mother was a homemaker. “My parents – who were first-generation children of immigrant parents – were my role models,” she says. “They made so many sacrifices so my sister and I could have a better life. First, they believed in surrounding yourself with high-quality people who shared your values. Our skilled and long-tenured team at Ventas certainly follows that leadership lesson. The other lessons of leadership they taught me include: always doing my best, working really hard, treating everyone with respect and remembering to smile and show kindness.”

 

Her team at Ventas represents another key element that helped the company stave off extinction: people committed to a cause.

 

“When I got to Ventas, the staff was small, and many of them were not really suited for or interested in the challenges that were ahead – that’s not what they had signed up for,” she says. “So, we had to build a world-class team of people who were experts in the areas at issue and were able to work through them and come up with good solutions. It was difficult. It took a huge commitment by a lot of people.”

 

Oh, there was one other factor in Ventas’ success.

 

“You need luck too,” Cafaro notes with a laugh. “It always takes a little bit of that, and we got some.”

 

 

SIDEBAR: The anatomy of risk

 

One of Debra Cafaro’s early mentors, lawyer Howard Kirschbaum, says the Ventas CEO’s success is due in part to an innate sense around what risks are worth taking. Cafaro doesn’t disagree.

 

“Taking risks has been an important part of Ventas’ success,” she notes. “Most people do not understand that, sometimes, the status quo is the riskiest approach. We all get comfortable with the idea that things we’re familiar with have less risk. And that is analytically false.”

 

For example, individuals sometimes put all their savings into their companies’ 401K accounts, Cafaro says, and think it’s not a risky move because they are very familiar with their employer and the account. “But we know that diversification is better,” she adds.

 

In the same way, risk helped Ventas grow. When Vencor, Ventas’ sole tenant, emerged from bankruptcy, it was a victory – but it also meant that all of Ventas’ holdings were limited to post-acute assets. Merger and acquisition is intrinsically a risky proposition but, in Ventas’ case, it allowed the company to diversify into four other sectors: private-pay senior living, hospitals, medical and outpatient office buildings and university-based life science innovation centers.

 

“We’ve done at least 10 successful enterprise acquisitions,” Cafaro notes. “Because of where we started, with one tenant and one asset class, that ability to diversify through merger and acquisition has proven to be a great strength both for growth but also for risk mitigation. And that turns on its head some very conventional thought processes.”

 

 

 

 

Healthcare’s volatility has Marna Borgstrom rethinking how her organization develops leaders

By | June 30th, 2017 | Blog | 1 Comment

 

Marna Borgstrom: “When I get outside of our organization, I will sometimes still look around the room and say, ‘Wait a minute. I’m the only woman here.’ ”

 

One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

The volatility of the healthcare industry has Yale-New Haven Health System CEO Marna Borgstrom reassessing her thinking about leadership, and how to best support the development of her executive team.

 

“The things we’re dealing with today as leaders in healthcare didn’t exist when I was coming up,” says Borgstrom, who has led the system since 2005. “There isn’t a road map to navigate today’s challenges. But what I think we can give people are opportunities and experiences that will stretch their ability to think and be comfortable with ambiguity, to teach them to lead by influence as much as by control.”

 

Borgstrom says her board has been encouraging her to spend more of her time on talent management and development. “What we’re trying to focus on,” Borgstrom says, “is evolving their roles so they can be ‘tested’ in situations where they have to draw on innate strengths, where they need to listen and then to exercise judgment. As part of that effort, we are an inaugural participant in the Carol Emmott Fellowship to advance women health care leaders. One of our Yale New Haven executives is just finishing a year in the Fellowship and another is just starting.”

 

She’s also begun to lead more intentionally beyond Yale-New Haven. She is part of a group called Women of Influence that seeks to promote leadership development and mentorship for women in healthcare. Borgstrom is paired with a young female executive from one of the Advisory Board companies.

 

“I have had the privilege of working with an absolutely spectacular young woman in Washington, D.C.,” Borgstrom says. “She’s smart and focused and committed to healthcare. She’s a lot of fun, and is focused on developing her career.”

 

Female mentors were few and far between when Borgstrom’s own career was on the rise. She was mentored primarily by two male executives, Tom Smith and Joe Zaccagnino.

 

“Neither Tom or Joe ever made me feel like I was being treated differently than other people,” she says. “Both advocated for me as much as they could. Joe, in particular, was the master of immediate and direct feedback. He was always trying to help me grow.”

 

Borgstrom admits it took her a while to find her voice at the health system – literally. She was soft-spoken to a fault. “Joe and Tom used to say to me, ‘Speak up!’ I didn’t volunteer a lot of my thoughts. If I didn’t think I had the perfect thing to say, I generally didn’t say anything – I think women do this to themselves much more than men.”

 

Zaccagnino especially drew Borgstrom out, which led to much upward advancement.

 

“Joe said to me, ‘First of all, not everything you say is going to be brilliant. But secondly, you have as much right to be in that room and at that table as anybody else – say it like you mean it.’ ” Borgstrom is pleased with the progress her own organization is making in terms of leadership diversity, although she is always looking for improvement.

 

“This is the result of 15 years of intentional recruitment – and we’ve made some mistakes – but I’m quite proud that we have probably one of the more diverse leadership teams in the country at Yale-New Haven Health System and particularly at Yale-New Haven Hospital,” she says. “It has been done with intentionality, but the people we have been bringing in are awesome.”

 

The healthcare industry as a whole, though, still has a lot of work to do, she says.

 

“When I get outside of our organization, I will sometimes still look around the room and say, ‘Wait a minute. I’m the only woman here,’ ” Borgstrom says. “That is still a little bit weird and a little bit uncomfortable, because it reinforces that we’re not doing enough to advance women into the senior-most positions in the healthcare field.”

 

Borgstrom’s growth as a leader has led to her becoming a valued member of national and local boards, including Vizient (formerly VHA Inc.), the Association of American Medical Colleges, The Coalition to Protect America’s Healthcare and the Connecticut Hospital Association.

 

But don’t ask her about her legacy.

 

“I hate that word,” she says, laughing. “I’m 63, but I remember when I used to be the youngest person in almost any room and ‘legacy’ wasn’t in my vocabulary. I work with a coach who tries to talk frequently about ‘legacy.’ My response is that organizations have short memories. I’ll be happy if people feel I made the organization stronger by living our values.”

 

But she is intentional about making room for new talent, and working with her board on C-suite succession plans for the future.

 

“I think leadership teams need refreshing periodically,” she says. “Also, I work with some very talented people, and the reality is that, if they don’t see a potential line of sight to grow, they are going to be more likely to be picked off by other organizations and move on.”

 

Borgstrom is in no hurry to head for the exit. But whenever the time comes, she says, “I’d like people to say that our leadership team helped build organizational strength and a corporate culture that was patient-focused, compassionate, respectful and fair.”

 

 

SIDEBAR: Making a difference through value-based care

 

 

Marna Borgstrom says Yale-New Haven Health System opens its meetings these days with patient stories. And as Yale-New Haven continues its transformation to a value-based care system, the tales that are emerging are compassionate and exciting.

 

“Our staff has been treating a gentleman who is now in his late 20s who has chronic sickle cell disease,” Borgstrom says. “As an adult, his disease is chronic with episodes of terrible pain, which are usually treated with opiates.”

 

The pain was so severe that, in fiscal year 2015, the man spent one day short of half a year in the hospital through multiple admissions.

 

“By creating an ambulatory team of caregivers who see him every month, we were able to assist in teaching him how to manage symptoms at home, among other things,” Borgstrom says. “As a result, for the first half of this fiscal year, he has spent less than two weeks in the hospital. It made sense from a financial perspective but, most importantly, he’s had a better life and, for the first time, has been able to hold down a job.”

 

But value-based care will look different in every case, she notes.

 

“What one patient would define as value is not the same as another patient,” she says. “For this patient, it was to minimize disruption in his life and to get him back to an acceptable level of functioning so that he could hold a job and have a real life.

 

“There are some clear, objective measures of quality and safety. But the real measure of what each person is looking for becomes very important to this concept of personalized care.”

 

 

 

 

Once a reluctant leader, Beverly Malone inspires countless nurses with skills that earned her a seat alongside royalty

By | June 27th, 2017 | Blog | 2 Comments

 

Beverly Malone: “People are looking for healing and a relationship and collaboration. That’s a very powerful thing that we as nurses are able to do.”

 

One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

It’s a rhetorical question, but an honest one, as Beverly Malone, now the CEO of the National League for Nursing, looks over the breadth of her career.

 

“How,” she asks, “does a girl from Elizabethtown, Kentucky, end up sitting next to Prince Charles?”

 

Proximity to British royalty was not an accident. The distinguished Malone – who holds a PhD in clinical psychology – spent five years as the general secretary of the Royal College of Nursing in Great Britain, essentially serving as the chief nurse for the nation.

 

“There’s a little cartoon – the ‘Cathy’ comic strip – that shows her with all of these locks on her door,” Malone says. “And Cathy says, ‘Opportunity knocks, but by the time I get the door open, it’s gone.’ That has never been a problem for me. When opportunity knocks, open the door.”

 

Malone didn’t initially receive a warm welcome in the U.K. – some were angry that an American was chosen for the position – but is grateful for the experience, which lasted from 2001 to 2006.

 

“I really believe that healthcare is a right and not a privilege, and their system personifies that,” she says. “Even the most conservative people there – they don’t question it. You are a human being; you deserve healthcare. How different that is from what we have here in the U.S. right now.”

 

Malone says she also learned that all people, from the prince to then-Prime Minister Tony Blair – are all approachable as people, when you get right down to it.

 

“Everybody’s human,” she says, “and when it comes to nurses, we can work with everybody.”

 

Malone was a reluctant leader who was raised by her great-grandmother in a segregated part of Kentucky, someone who encountered a physician only once in the first 17 years of her life.

 

But her great-grandmother was the town healer, who mixed some basic medical knowledge with an uncanny knowledge of the herbs and plants around Elizabethtown that could ease ailments for people with no money and no access to healthcare.

 

“She was a bootlegger too,” Malone remembers. “But everyone who came to the house was told to bring a book as well, and she would ask people to read to me. I learned a lot living with her. Everybody kept saying, ‘You’re going to be a leader,’ but I wasn’t interested. All I really wanted to do was grow up and have children.”

 

Malone did grow up. She did get married, and have children. But with her great-grandmother’s encouragement, she earned her bachelor’s and master’s degrees in nursing and psychiatric nursing, respectively. When it came time to choose a program for a PhD, she says she felt she bungled her interview to study clinical psychology at the University of Cincinnati.

 

“I figured I was not going to be accepted into a program where I spent the interview arguing with the head of the program over Sullivanian theory and Freudian theory. So, I decided to do the next best thing and have another baby – my daughter was 1 year old at the time.”

 

There was just one problem. The program did, in fact, accept her. Her interviewer, Dr. Ed Klein, became one of her mentors. And so, she began a PhD program with a 2-week-old son and a 2-year-old daughter.

 

“That,” she says with a laugh, “was challenging. I don’t recommend it for anyone, but you do what you have to do, and so I did.”

 

Malone says she thinks she knows why nurses often become sought-after administrative leaders.

 

“We go into a stranger’s room, establish a relationship and provide services to them that other people can’t do,” she says. “You establish the intimacy of relationship with your patient that is healing in nature. I think that’s what you do in all levels of leadership. People are looking for healing and a relationship and collaboration. That’s a very powerful thing that we as nurses are able to do. And we give with authenticity.”

 

The nurse who didn’t want to be a leader, who now is a CEO, also served as president of the American Nurses Association. She also was the U.S. government’s deputy assistant secretary for health at the U.S. Department of Health and Human Services. She has even co-written a book on leadership: Diversity and Cultural Competence in Health Care: A Systems Approach.

 

Malone said she believes diversity in leadership is a work in progress, but is at least moving in the right direction.

 

“I always talk about it as a zig-zag growth.” She says. You take two steps up and one step back. When you take the one step back, it actually feels like you went one step below your base, but you didn’t. I believe wholeheartedly that we are continuing to move up.”

 

With her celebrated journey from Elizabethtown to the upper echelons of American healthcare, Malone knows a thing or two about moving up.

 

 

SIDEBAR: Signature sayings

 

Beverly Malone, CEO of the National League for Nursing, is fond of using memorable phrases to illustrate her points on leadership. Here are a few:

 

Excellence is leadership. “That’s exactly what nurses bring to the table.”

 

I can be delayed but not defeated. “I am mission-driven. When you are working on something, especially something that is different and creatively unique, you might be delayed. It might take me a while to get there, but if there are things I am supposed to do, nobody can stop me from doing those things.”

 

Sometimes, you have to feed them with a long-handled spoon. “Not everyone will love you. You can’t get close to everybody. But you still need to serve them. My responsibility is to feed them, but I don’t have to get up close to do it.”

 

You can’t lead unless you follow. “Leadership is a dance. Sometimes, you lead. Sometimes, you follow. I have a healthy self-image, but sometimes I have to get out of the way so others can lead. I move back so others can move forward. And then, when I need to lead, I move forward.”

 

 

 

 

Deborah Bowen’s purposeful leadership sets tone for ACHE members

By | June 21st, 2017 | Blog | Add A Comment

 

Deborah Bowen: “I believe information is power. If I know something, I can do something about it. If I don’t, then I’m vulnerable and I don’t have the ability to know what I need to be working on.”

 

One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

Deborah Bowen, president and CEO of the American College of Healthcare Executives, is leading with purpose.

 

The most recent evidence is the coveted Baldrige Gold Award for the state of Illinois that ACHE recently earned, one of only 12 such organizations to be named out of 270 applicants. ACHE now moves on to consideration for the national award, which recognizes performance excellence.

 

“Having ways to improve our organization in a more systematic way is important to me,” says Bowen. “But let’s be clear – the members own the organization. The board and I have the privilege of serving our members in ways that advance the field.”

 

For more than 40,000 members that ACHE represents, having a clearly delineated plan is important. Bowen and the board recently expanded on that with strategic initiatives that focus on “leading for diversity, leading for safety, and leading for value,” Bowen says.

 

  • On diversity and inclusion: “I’d love to see a more diverse leadership community in the future because we know our leadership ranks in management and in our boardrooms don’t look like the populations we’re serving.”
  • On safety: “If we could eradicate preventable harm, that would be tremendous.” ACHE is, in fact, partnering with the Institute for Healthcare Improvement/National Patient Safety Foundation Lucian Leape Institute (IHI/NPSF LLI) on a practical playbook for executives to enable cultures of safety, which is key to reducing errors within their health organizations.
  • On value: “Regardless of what happens with the ACA/AHCA, we’re going to be in a value-driven climate. It’s going to be about cost and quality and the core of what leaders do.”
  •  

    Having a purposeful approach to one’s career also is part of the ACHE banner, and Bowen exemplified that when she returned to ACHE as the chief operating officer from a different industry and looked at what she would need to do if she wanted to be considered as a successor to renowned industry leader Tom Dolan, ACHE’s CEO at the time.

     

    “I hired a coach about two years before Tom retired,” Bowen recalls. “I did a qualitative 360 assessment where I had former board members, former ACHE chairs and a few staff members do interviews with the coach and then tell me a little about what they saw in my strengths and areas for development.”

     

    That not only showed initiative, but courage and transparency.

     

    “I believe information is power,” she says. “If I know something, I can do something about it. If I don’t, then I’m vulnerable and I don’t have the ability to know what I need to be working on. Self-awareness is very, very important.”

     

    But Bowen didn’t stop there.

     

    “I knew that, as COO, I already had the operational experience,” she says. “But if I wanted to be a candidate for the position of president and CEO, I knew I would need to get more credibility and experience in the external skills. So, I started sitting on a few boards, and I signed myself up for more public speaking where I would be pushed to do more things and provide more insights about the industry.”

     

    In strategic terms, Bowen took more risks in her leadership. That, in turn, encouraged her to take more risks. And achieve more success. “Taking risks,” she says now, “gave me strength and experience and insight.”

     

    But from her vantage point, Bowen sees that ACHE members need to do more to become the leaders that the industry needs.

     

    “We’re in the career planning business,” she says. “We’ve done surveys on this very topic, and only 28 percent of executives have a career plan. People need to devote as much time and seriousness to their own careers as they do to everything else in their worlds.”

     

    Now that she is leading ACHE, Bowen says she is more aware than ever of the power of her words – so she tries to use them sparingly.

     

    “One of our former chairmen, retired Major General David Rubenstein, used to write the initials ‘LWLW’ on the back of his name tent before every Board meeting, and I never understood what it meant. So, I asked him,” she says.

     

    “He said, ‘When you’re the general, people look to you for their cues, so the initials reminded me to, ‘Listen. Wait. Listen. Wait.’ If I wait, someone will break the silence and talk; then, I am in a better position to listen. But if I’m the first to talk, then I’m doing all the talking and directing them to my answer.’ ”

     

    Rubenstein’s story has stuck with Bowen.

     

    “I think that’s very powerful,” she says, “because if you’re talking all the time, you’re not listening; and if you’re not listening, you’re not learning.”

     

    Listening is especially important in healthcare, a profession that’s about compassion and assistance, Bowen adds.

     

    “I really do believe that healthcare leaders are special that way. They have the heart and soul to make a difference in the field.”

     

     

    SIDEBAR: Lessons from the big city

     

     

    Deborah Bowen grew up in Park Ridge, an affluent, middle-class Chicago suburb. However, she became aware of disparities at a young age – through their church, Bowen’s mom gave piano lessons to African-Americans who lived in an economically challenged section of Chicago. When some students would occasionally visit the Bowen home for lessons, some people in the neighborhood didn’t take kindly to it. That disappointed and angered Bowen, and gave her an early determination to make a positive impact in the world.

     

    As the first member of her family to attend graduate school – and one with a lineage that included many entrepreneurs – the future was full of wide-open vistas and possibilities. Like many young people, she was unsure what field to go into. She considered teaching French. She also took acting lessons in Chicago, which set the scene for self-discovery.

     

    “I came downtown for the lessons, during which I found out I was a lousy actress,” she says with a laugh. “But I also saw a lot of homeless people in the city, and I became painfully aware of the need and opportunities to help others.”

     

    So, Bowen decided on psychology as her major. She earned a graduate degree in social work and started to work with heroin addicts one on one. Eventually, through employment at the Wisconsin Medical Society, she saw she could help more people if she was able to influence public policy and the systems that support people. That began a career that has led her to the helm of ACHE.

     

    “It’s that ripple effect that John F. Kennedy talked about,” she says. “If you find the right stone, you can make large ripples.”

     

     

     

     

    IBM Watson Health’s Deborah DiSanzo knew her company could change patients’ lives. She didn’t know hers would be one of them.

    By | June 15th, 2017 | Blog | Add A Comment

     

    Deborah DiSanzo: “The difference between a mediocre leader and a great leader is somebody who can manage through difficult times.”

     

    One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

     

    Deborah DiSanzo knew that IBM Watson Health was a strong company with a superior product, but she didn’t know it would personally transform her life.

     

    DiSanzo, the company’s general manager, had a routine mammogram screening. A follow-up biopsy determined that a tumor was cancerous. Thus began the process of going from oncologist to surgeon and back again. In the course of that time, three different physicians prescribed three very different courses of treatment. IBM Watson Health has a relationship with Best Doctors, a second opinion service that uses Watson for Oncology, which was trained by experts at Memorial Sloan Kettering. Deborah was given three options for treatment and Best Doctors used Watson for a second opinion. Watson recommended one over the others, and today DiSanzo is cancer-free.

     

    “I talk to oncologists every day in my work, but I was blown away that there was this much variability in my own care,” DiSanzo says. “You think if you go to three oncologists at the same academic medical center that you are going to get the same recommendation for treatment – you are not. But the oncologists at Memorial Sloan Kettering took the time to train Watson on what their best practices are. And that gave me peace of mind.”

     

    She is hopeful that Watson Oncology can help many more patients.

     

    “On average, first-time cancer treatments work about 30 percent of the time. We can help. Watson’s Oncology solutions will absolutely reduce the variability in cancer care. It can point doctors to medicine or treatments that they might not have read about, or a clinical trial they might not know about. It makes a difference.”

     

    Making a difference is the reason she is involved in healthcare, DiSanzo says. As someone who has worked at the intersection of healthcare and technology since 1988, she has experienced her share of ups and downs. One down that turned into an up was when she worked for Heartstream, a defibrillator company. “The founder of Heartstream used to tell me, ‘Deborah, just focus on saving lives, and the money will come.’ I confess that I only half-heartedly believed him.”

     

    Heartstream’s defibrillator weighed four pounds, compared to the industry standard of 18 pounds, and other manufacturers derided Heartstream’s device as too small and defective. Their market share was tiny. But then Delta Airlines agreed to a trial run in May 1999. Delta put 30 defibrillators on 30 planes and trained 30 flight attendants on its use. On the flight home from the training, an attendant went into cardiac arrest. A fellow flight attendant and a couple medical professionals who were on the plane used the defibrillator and it saved her life.

     

    “This woman was 39 years old and had a 2-year-old and a 1-year-old daughter,” DiSanzo remembers. “She was a runner and a vegetarian. She wasn’t like a typical cardiac-arrest victim.”

     

    Four months later, DiSanzo was testifying before Congress about the need for defibrillators in airports and on planes. A woman approached her and the flight attendant who was saved introduced herself and said, “I was dead and now I’m alive. Thanks to what you do, I get to hug my daughters and smell the flowers in my garden.”

     

    Recalling those words today, DiSanzo simply says, “I will never forget that.”

     

    And the words of Heartstream’s founder, about “save lives, and the money will come”? After the flight attendant’s life was saved, Delta put the defibrillator on all their planes. The other airlines soon followed suit, and Heartstream earned 70 percent of the business.

     

    Not all of her experiences have turned out that way – and DiSanzo says that has made her a better leader.

     

    “The difference between a mediocre leader and a great leader is somebody who can manage through difficult times. I could list 100 difficult times that have made me the leader that I am,” she says with a laugh. “But that’s where you learn the most.”

     

    She also learned leadership lessons from her parents. Her father was an insurance salesman who belonged to a union, as odd as that sounds. “They went on strike, and we needed money, so my father went out and drove a cab. That stuck with me. It showed me you’re never too good to do anything.” From her mother, she learned reinvention. At 55, DiSanzo’s mom was laid off from her accounting job. Rather than retiring, she followed her passion and went back to school to study interior design before going to work for a prominent designer in Boston. “From her, I learned: Don’t give up. Keep going. Push through the difficult times.”

     

    Pushing through is easier when you remember your work truly makes a difference. That’s the lesson she learned from Bill Hewlett, the co-founder of Hewlett-Packard, where she worked in the ‘90s as Silicon Valley emerged.

     

    “One time, Bill Hewlett came and sat on the edge of my desk,” she says. “He asked me, ‘What are you doing?’ I explained this monitoring system we had installed at the University of Pittsburgh. Then he asked again, ‘What are you doing?’ So, then I explained the network to him. He asked again, ‘What are you doing?’ I explained to him how our imaging was better than anyone’s.

     

    “He kept going. He said, ‘I asked you what you are doing.’ I got really mad and I blurted out, ‘We’re saving lives.’ He said, ‘Very good. Carry on. Carry on.’ And he got up and walked away. I learned that what really matters is how all that technology makes a difference in people’s lives.”

     

     

    SIDEBAR: In leadership, don’t look at the barriers

     

     

    When Deborah DiSanzo’s daughter Emelie was a young child, she asked to take martial arts, inspired by the Disney movie “Mulan.” But when she was about to face a panel of masters to earn her green belt, she started to cry. DiSanzo placated her by agreeing to join her in the lessons. Thus, DiSanzo found herself screaming and ducking from the kick of a black-belt instructor at her first lesson.

     

    But the lessons continued, and DiSanzo and her daughter are now both third-degree black belts. The founder of the school told DiSanzo it would change her thinking. She scoffed, but now finds it to be true.

     

    “It’s obviously metaphorical, but it does help me in business,” she says. “There are times you block defensively, but don’t punch. I also have learned to maneuver. Many times, people look at the barriers that are in front of them. My practice of Tang Soo Do has helped me look at the openings between the barriers. So, if I want to get from here to somewhere down the road, rather than looking at the barriers, I’m looking at the spots in between the barriers. That’s exactly what you do when you’re practicing martial arts. It has helped me tremendously.”

     

    There’s just one drawback. Emelie earned her third-degree belt before DiSanzo—Mom broke her elbow and had to retake the test later. “That means Emelie is senior to me,” DiSanzo explains, “so I have to bow to her. Which she loves.”

     

     

     

     

    Laura Kaiser of SSM Health brings courage, conviction to questions around healthcare’s future

    By | June 8th, 2017 | Blog | 4 Comments

     

    Laura Kaiser: “A lot of people in the U.S. have to make the terrible choice between buying medicines or food. If we changed our approach, we could create incentives for people to stay healthy, and the overall cost of healthcare in this country would decrease.”

     

    One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

     

    U.S. healthcare has more questions than answers right now, but Laura Kaiser doesn’t shy away from them.

     

    As the new president and CEO of SSM Health, Kaiser brings an impeccable resume back to her hometown of St. Louis, along with an inquisitive mind and a willingness to eschew the status quo.

     

    “We need to think about how we make healthcare sustainable, affordable and accessible,” she says. “There’s always going to be a need for emergency care – acute, critical care, for injuries and illnesses that are unforeseen. But we need to invest in programs and services to minimize chronic conditions that are in fact preventable, because that will help us lower the overall cost of care.”

     

    She’s outlined some of her thinking in major periodicals as co-author of articles in the Harvard Business Review and the New England Journal of Medicine. In HBR, she opined on “Turning Value-Based Care Into A Real Business Model.” And, in the medical journal, she and co-author Thomas Lee, MD, were blunt in encouraging big pharma to become full partners in the quest for value-based care: “As payers and providers work together to improve value, will pharmaceutical companies join that effort, or will they acts as vendors that merely maximize short-term profits for shareholders?”

     

    “I think any approach to affordable care must have all stakeholders involved and engaged,” she says today. “I actually heard from one of the pharma companies after that was published, and they are interested in having further dialogue.”

     

    Kaiser has no problem saying that healthcare is a right, not a privilege, for all humans, a stance her faith-based system supports completely.

     

    “I’ve said this to many people without any intended partisan viewpoint,” Kaiser says. “No matter where you sit politically, healthcare isn’t political. For all of its flaws, the Affordable Care Act did three very important things. First, it heightened awareness about the need to provide excellent healthcare to all Americans. Second, it alleviated some financial hardship for people with pre-existing conditions. Last, it extended the availability of healthcare for people up to the age of 26 on their parents’ insurance coverage.”

     

    A year and a half ago, Kaiser saw a different approach to healthcare during a fact-finding mission to Cuba, and she has been ruminating on it ever since.

     

    “I wanted to see how it is that this small country – and one that has relatively limited resources compared to the U.S. – has better health outcomes than we do,” says Kaiser. “How are they doing that?”

     

    Kaiser discovered that physicians, nurses and statisticians are embedded in each community at a rate of about one for every 1,000 to 1,500 residents.

     

    “I visited a few of those clinicians,” Kaiser says. “Their medical records are spiral-bound notebooks with pencils. They provide primary care to patients and, if they need a higher level of care, patients are sent to a specialty practice, similar to a federally qualified health center in the U.S. If they end up needing hospitalization, they are simply referred to one of the hospitals across the country. It is a single system.”

     

    And medicine is free, including insulin for people with diabetes.

     

    “A lot of people in the U.S. have to make the terrible choice between buying medicines or food,” she says. “If we changed our approach, we could create incentives for people to stay healthy, and the overall cost of healthcare in this country would decrease. So, that’s my dream.”

     

    At the time of the trip, Kaiser was chief operating officer of Intermountain Healthcare, a Utah-based health system known far and wide for its quality. Earlier in her career, she spent 15 years with St. Louis-based Ascension, another health system with a stellar reputation. Now, in taking the helm as only the third CEO in SSM Health’s history, she has a similarly pristine heritage to draw from – SSM Health was the first health system to be awarded the prestigious Malcolm Baldrige National Quality Award in 2002.

     

    “The organization is deeply rooted in continuous quality improvement,” she says. “They have been on the cutting edge since the time of the Baldrige award, so there really is a great foundation on which to build the health system of the future.”

     

    The answers that Kaiser and her team come up with should offer some interesting architecture for the future of SSM Health – and American healthcare.

     

     

    SIDEBAR: The end of life brings questions, and courage, too

     

    Much of the country’s healthcare spending occurs during the final weeks and months of patients’ lives. SSM Health President and CEO Laura Kaiser says that needs to be discussed openly and extensively.

     

    “Discussing death and dying is becoming more acceptable thanks to people like Dr. Atul Gawande, who wrote the wonderful book Being Mortal, and Sheryl Sandberg, the author of Option B, a powerfully written book about recovering after suffering the loss of her husband,” says Kaiser, whose parents eventually chose hospice care after battling cancer. “Death and dying can be difficult to discuss, but it is something we need to grapple with as a country and as a society.”

     

    She saw great courage in her parents as they made difficult decisions at the end of their lives.

     

    “What my dad chose and experienced in hospice was beautiful care. It is what everyone should have if that’s where you find yourself,” Kaiser says. “Many years later, my mom made the same choice and had a similarly extraordinary experience.”

     

    Her parents’ bravery flows through Kaiser and gives her confidence while she confronts complex issues as one of the nation’s leading healthcare executives. Kaiser’s dad, a chemical engineer, was her first mentor about leadership. She has fond memories of him from her childhood, listening to classical music in the car while driving to the library together. They shared a love for the “Peanuts” cartoons – especially Lucy, seated in her counseling booth, offering a listening ear for five cents.

     

    “I trusted my dad’s counsel and would knock on his home-office door, saying, ‘I have my nickel.’ He would say, ‘Come on in for the consult,’ ” says Kaiser with a chuckle. “I had many ‘consults’ with him and am the better for it today.”

     

     

     

     

    Florida Hospital’s Marla Silliman hopes to mentor a new generation of women leaders

    By | June 1st, 2017 | Blog | Add A Comment

     

    Marla Silliman: “My hope is that we will be the generation that will truly be there for the generation behind us.”

     

    One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

     

    In the 1980s and 1990s, when Marla Silliman was starting out in her career, there were not a lot of women in healthcare senior leadership outside of nursing. Although there have been improvements, the industry as a whole has a ways to go at the highest levels, she says.

     

    “In terms of women in leadership, we’ve all seen the statistics,” says Silliman, now the Senior Executive Officer overseeing operations for the largest hospital within the Florida Hospital system. “I think it is going to grow – but I don’t think it’s going to happen overnight. I think it’s going to take two full generations.”

     

    Silliman leads the Florida Hospital Orlando Campus, which at times is fondly referred to as the “campus with three hospitals”: Florida Hospital Orlando, Florida Hospital for Women and Florida Hospital for Children.

     

    “It’s a wonderful organization to work in,” she says. “We have an intentional strategy to build more diversity. When I started here 14 years ago, I was typically only one of a few women in a boardroom. Today, you see a growing number of women in leadership.”

     

    For her part, Silliman believes that women leaders need to mentor each other more, and she says she is committed to doing just that.

     

    “I’m a young, healthy 54,” she says. “I bike and participate in half-marathons and, theoretically, I have a dozen years ahead of me in the workforce. But I don’t see a lot of older female mentors that I can turn to – there just aren’t that many. So, my hope is that we will be the generation that will truly be there for the generation behind us.”

     

    Balancing many aspects of work and family is usually part of the package for women leaders, Silliman says, and she thinks aspiring leaders need to be aware of that.

     

    “You can have a balance,” she says. “You just have to define your own sense of balance. Women are relational by nature so you have to do a constant check with those important to you in life to make sure you are not leaving them behind. When you get to an executive level, it’s hard work and many long hours. I personally love it. But it’s not easy, and it comes down to personal choices – what else do you have going on in your life? Only you can answer that. And you have to answer that question daily.”

     

    Silliman rose from a registered nurse to administrative roles overseeing areas like surgical services and ambulatory services. Then she moved into the business side of healthcare consulting and senior leadership in children’s hospitals. She had stops in New York, Boston, California, Chicago and Dallas, including a three-year role as a national healthcare consultant.

     

    Not too long after arriving in Orlando 14 years ago, she was given the task of leading the team to create a children’s hospital. She also led the team strategically that created the only women’s hospital within Florida Hospital’s parent organization, Adventist Health System. Florida Hospital for Women opened in 2016 and, in the last few months, Silliman was tasked with overseeing the Orlando tertiary campus operations. She also leads Women and Children’s clinical networks across Florida Hospital regions in Florida.

     

    The children’s hospital attracted funding and design assistance from Walt Disney Co., the culmination of a longtime working relationship between executives of the two companies. The tertiary campus, in fact, is called the Walt Disney Pavilion at Florida Hospital for Children. Florida Hospital for Children also has affiliated with the Johns Hopkins Pediatric Heart Surgery Program, something that Silliman worked on for many years and hopes is a role model for Children’s hospitals’ partnerships.

     

    “This was my third heart program that I’ve worked on in my career with children’s hospitals,” she says.

     

    She had to shelve an initial attempt to launch a pediatric heart program at Florida Hospital 13 years ago because she didn’t think the hospital was ready. But after building the Children’s hospital and strengthening relationships with the surgeons from Johns Hopkins All Children’s Hospital in Tampa, who would drive up every Friday to do clinic in Orlando, Silliman believes the hospital found a good match for affiliation.

     

    The Orlando women’s hospital, Florida Hospital for Women, opened a year ago and 10 of the 12 floors built out are already at capacity. The day after this conversation, Silliman was poised to cut the ribbon to open a new neonatal intensive care unit (NICU) at the Women’s hospital. It will open at close to full capacity, and Silliman and her team are working hard to open other Neonatal Units within the Florida Hospital network to ease the space crunch.

     

    “It just feels like no matter what kind of strategies we put in place, the growth in neonatal comes,” she says.

     

     

    SIDEBAR: LEARNING FROM DISNEY

     

    The Walt Disney Co. doesn’t run hospitals. But as an outgrowth of their partnership with the leaders of the entertainment conglomerate, Marla Silliman and other executives got to thinking: What would Disney do differently than the healthcare industry?

     

    As a result of partnering with the Disney Institute, Silliman and her team took a different approach to creating a children’s hospital, down to how the hospital is still staffed today.

     

    “We took the best of how they ‘onboard’ and ‘round’ on their staff,” Silliman says. “We learned about how to interview for culture and onboard everyone to expected behaviors that exemplify our mission, including all physicians and leadership. Eight years later, we have onboarded over 6,000 employees and still use their onboarding process every other month and I am there for every one of them. We believe it’s one of the secret sauces to getting people up to date and onboarded to your culture.”

     

    Disney, and other leading companies like Philips, also helped with design of the hospital, creating ambient lighting in each room and allowing the child patient to have choice with the color and mood of their room by flicking a switch and playing with a touch pad. Other hands-on elements await children in the Walt Disney Pavilion lobby area. But the follow-through doesn’t end there.

     

    “One of the phrases that we learned from Disney,” adds Silliman, “is that ‘It’s not magical, it’s methodical.’ ”

     

    That is particularly true when engaging with the public. So, Florida Hospital for Children employees:

     

  • Get on their knee when talking with a child and sit down to speak with parents
  • Are the masters of “relentless intentionality”
  • Have access to front-line leadership every morning as part of a “protected, no morning meetings” organizational commitment
  •  

    Has it worked? The hospital’s patient experience scores have been in the top decile or quartile fairly consistently in their emergency room, outpatient center and in-patient units over the years. Their employee engagement scores and physician satisfaction scores are also in the top quartile. And the Children’s Hospital has experienced consistent growth annually for the past eight years, in the midst of fierce competition.

     

    Says Silliman: “Learning from the best has been exhilarating. Combining those learnings with our own company mission has given this all Purpose.

     

     

     

     

    Hospital Safety Grade is a simple but powerful way that Leah Binder and Leapfrog Group help make patients safer

    By | May 25th, 2017 | Blog | Add A Comment

     

    Leah Binder: “Nothing is as critical as making sure people don’t die from preventable errors. Safety has to come first, every minute of every day. Otherwise, patients will suffer.”

     

    One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

     

    Sometimes, the simple things are the easiest to understand. Perhaps that’s one reason that the Leapfrog Group’s Hospital Safety Grade has caught on in such a big way – even with hospitals, who largely weren’t all that thrilled when it was initially launched five years ago.

     

    “The response of hospitals has been one of the brightest spots for me in my career,” Leapfrog President and CEO Leah Binder says. “Hospitals are approaching their Hospital Safety Grade constructively. They’re talking about what they are going to do to improve and how proud they are of this ‘A.’ They talk about how they’re not going to stop their efforts to ensure that patients are safe, and describing what those efforts will be.”

     

    Every six months, Leapfrog assigns an A, B, C, D or F grade to 2,600 general, acute-care hospitals, rating their performance on safety. It uses standardized measures from the Centers for Medicare & Medicaid Services, its own hospital survey, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention and the American Hospital Association.

     

    “Many people – even if they’re on the board of a hospital – don’t realize the problem of safety,” Binder says. “When they look into it, they realize how many things can go wrong in a hospital, and that makes a big difference. That’s why I think it’s been important for us to highlight this in a way that’s easily accessible to laypeople.”

     

    While everybody wants an “A,” Binder has seen unfavorable grades spur some action.

     

    “We see boards get very upset. We see community members get upset. We see repeated articles in newspapers about poor grades,” Binder observes. “We’ve found that it gets their attention, which is a good thing. In fact, we’ve seen hospitals just completely turn around their safety programs when they get a bad grade.”

     

    What people outside the healthcare industry don’t always recognize is that the Leapfrog Group was founded by large employers and groups who purchase healthcare and wanted to see some changes in the quality of the care they were paying for.

     

    “Employers are not in the business of healthcare,” says Binder. “They’re in the business of doing other things. They make airplanes, and they make automobiles and they run retail department stores. And so, they don’t have a staff of 500 to figure out what’s going on in healthcare, so they rely on organizations like us to try to pull all those resources together for them and help them make the right strategic decisions.”

     

    Leapfrog has some compatriots in this area, including the National Business Group on Health, regional groups, and a newcomer called Health Transformation Alliance, in which 20 major employers are teaming up to lower prescription costs, review claims together, structure benefits and create networks.

     

    “There’s probably at least 50 organizations that represent specialties for physicians alone,” Binder says. “I don’t think there are nearly enough organizations that are advancing purchaser concerns about healthcare delivery. The purchasers pay for about 20 percent of the $3 trillion healthcare industry, which is a lot of money.”

     

    Despite the increased scrutiny, Binder says she thinks the healthcare industry has taken its eye off safety, given the myriad deaths still linked to errors each year.

     

    “I think the industry has not been focused on patient safety enough. They’ve been distracted by the compliance with the Affordable Care Act, value-based purchasing, bill payments, new models for financing and delivering care, and change in state and CMS regulations. While those efforts are important, nothing is as critical as making sure people don’t die from preventable errors. Safety has to come first, every minute of every day. Otherwise, patients will suffer.”

     

    Binder is doing her best to keep the priority on patients. – in fact, the organization is broadening its reach at the request of its members to take a closer look at other sticky matters in safety:

     

  • Maternity. “Employers pay for half of all the births in this country. Childbirth is by far the number-one reason for admission to a hospital. A C-section is the number one surgical procedure performed in this country. So, we now have some incredible data on maternity care, and employers are starting to meet with hospitals and design packages that encourage the use of hospitals with lower C-section rates based on the Leapfrog data.”
  •  

  • Outpatient and ambulatory care. “We’re going to start rating outpatient surgical units and ambulatory surgical centers. That’s a big priority for purchasers because they are sending a lot of employees to ambulatory surgical centers because they tend to be lower-priced. That’s great – some of them are excellent – but we don’t have enough good data nationally to compare them on safety and quality.”
  •  

  • Children’s hospitals. “There’s a lot of people who would never travel outside their community for their own healthcare, but will travel if they have a very sick child. This year, we added two new measures. We ask pediatric hospitals to do a CAP survey for children’s hospitals. The other thing we’re looking at is exposure to radiation. Sometimes, children have repeated imaging and it can really add up.”
  •  

    Although it is Leapfrog’s job to act as a watchdog for employers and patients, Binder says she does see some positive movement.

     

    “There are bright spots,” she says. “There is a Partnership for Patients program that just concluded with CMS that has demonstrated some real impact. We see reductions in certain kinds of infections and real changes in the ways that hospitals are approaching patient care to address safety. CMS has tracked some saved lives as a result of those changes, and we certainly appreciate those numbers. We’re going in the right direction; we just need a lot more push.”

     

     

    SIDEBAR: Making a difference with the mundane

     

    Hospital deaths and injuries from errors are not always obvious.

     

    “When someone dies from an error or an accident, it’s not easy to track,” says Leah Binder, president and CEO of the Leapfrog Group. “It often doesn’t show up in claims. It can be complicated – the death might be attributed to something else even though, say, there was clearly an infection that hastened the death. It’s just kind of the course of business in the hospital.”

     

    Nearly two decades after the ground-breaking report “To Err is Human,” far too many people are still being killed and injured in healthcare settings, Binder says.

     

    “More than 200,000 people are dying every year from preventable accidents in hospitals,” she says. “We believe that’s a low estimate. There’s lots of accidents and problems in hospitals we can’t measure because no one is tracking them. An example of that would be medication errors, which are the most common errors in hospitals. There’s not a standardized way of tracking that, so we don’t even know how many deaths or adverse events result.”

     

    What is especially frustrating for Binder and her team is that many injuries and deaths happen in spite of the fact the healthcare industry knows how to prevent them. “The fact is, patient safety requires a disciplined, persistent commitment to the mundane habits that save lives,” she says.

     

    “How much more mundane can it possibly be than to say, ‘Everybody needs to wash their hands all the time’? ‘We need to wear the right protective clothing.’ ‘Follow the rules – every single rule every single time.’ ‘We need to do the same checklist every time we do a surgery.’

     

    “Let’s face it, these sound boring. But done systematically, they save lives. And everyone in patient care needs to be disciplined about doing them.”

     

     

     

     

    Delaware Valley ACO’s Katherine Schneider uses population health to improve patients’ lives, one at a time

    By | May 16th, 2017 | Blog | Add A Comment

     

    Katherine Schneider: “I’m seeing opportunities to transform the healthcare system to improve population health outcomes. That’s been my career niche since the day I finished my residency training.”

     

    One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

     

    Katherine Schneider, MD, the president and CEO of the Delaware Valley ACO in the Philadelphia region—an accountable care organization owned by Main Line Health and Jefferson Health—has long been ahead of the game in whatever pursuit she has chosen.

     

    She was part of the first group of U.S. physicians to earn subspecialty certification in clinical informatics. She led the implementation of value-based payment models at Middlesex Health System in central Connecticut, long before “value-based” was a common adjective in the healthcare lexicon. She was the senior vice president of health engagement at AtlantiCare, leading its pioneering move to accountable care and co-designing a value-based insurance benefit for 10,000 employees. She also served as executive vice president and chief medical officer for Medecision, which provided population health technology for health systems and health insurers.

     

    That’s a lot of trailblazing but, to Schneider, it’s just a steady progression along the path of transforming care.

     

    “Whether you call it community benefits, clinical integration, population health or accountable care, this concept of a health system being responsible for more than just transactional care is really what this is all about.”

     

    Major achievements started early for Schneider, who skipped from sixth to ninth grade as an adolescent, ending up in college at 15 and in medical school four years later.

     

    “When I was 11, we moved from New York City to Austria due to my father’s work,” she says. “I went from a very good private school in Manhattan to a very small, hands-on international school.

     

    “I had the threat of ending up at an Austrian convent school hanging over me,” she jokes, “so I did really well.”

     

    Though she was much younger than her medical-school classmates, she can’t resist some more self-deprecation.

     

    “Yes, I was 19 when I went to medical school, but I made up for it because I spent nine years in medical and graduate school,” she says of the combination MD-PhD program she enrolled in. “To make a long story short, I became much more interested in public health and policy. So, I actually switched into the epidemiology program at Columbia University.”

     

    She also chose family medicine, not one of the higher-paying specialties.

     

    “Family medicine seemed to me a great fit for someone interested in population health and policy,” Schneider says. “It’s womb to tomb, broad clinical experience.”

     

    That made giving up the practice of medicine difficult when she eventually had the opportunity to potentially impact more lives in a different kind of role. Not that she doesn’t have some regrets about not seeing patients anymore.

     

    “I do miss it,” she admits. “But there are a lot of really good doctors out there. I was a good doctor too, but I have a skill set that not a lot of people have, which is a combination of the population-health aspects and the clinical experience. I’m seeing opportunities to transform the healthcare system to improve population health outcomes. That’s been my career niche since the day I finished my residency training.”

     

    Schneider finds her role leading one of the nation’s leading ACOs to be inspiring, but also challenging at times.

     

    “I was recently at a fireside chat featuring Michael Dowling, the CEO of Northwell Health, and he said that, to be in healthcare, you have to be an optimist but you almost have to be chronically unhappy with the status quo.”

     

    Schneider says she wouldn’t describe herself as an optimist, but says she “is pretty resilient and determined,” traits she learned from her mother who fought—and beat—tuberculosis as a young woman. “What I learned from my mom is the power of perseverance against the odds.”

     

    The perseverance these days comes from battling that persistent status quo—part of the marching orders for an ACO—where so many factions in healthcare have lobbyists to protect their interests, even when change can streamline care or bring about better outcomes.

     

    “What one person calls waste is someone else’s lunch,” she says. “If you’re going to get waste out of the system—even through innovation—that’s still taking money away from someone and they’re going to fight it tooth and nail. We’re not going to solve this problem unless we’re willing to admit that and take it on.”

     

    Schneider, for one, is ready to wade into the fray.

     

    “I truly believe that we can do better and that most of us want to do better to serve our community and our country.”

     

     

    SIDEBAR: In a sea of data, the power of stories

     

    Katherine Schneider is a national leader in clinical informatics, but she’s a big believer in the power of stories. That’s why she and her team at Delaware Valley ACO open their meetings with a value-based story of impacting the life of a patient or a provider.

     

    “You can talk all you want about care management and Triple Aim but, ultimately, if you can tell the story of how you’ve changed a patient’s life or a physician’s practice, people get it,” she says.

     

    One example: A 92-year-old woman has been to the emergency room numerous times because she can’t get out of her bathtub. She calls her friends from the tub, who call 911. Over and over. Delaware Valley steps in and, within 24 hours, has connected her to free services in her community that come in and install grab bars and railings and retrofit her home. She doesn’t need to call for help anymore.

     

    “Not everything we do is that simple,” Schneider cautions. “We also work with some extremely overwhelming, complex patients and make some small wins for them. A win is not like a cell in a spreadsheet. It’s not a graph on a PowerPoint. It’s really in the stories.”

     

     

     

     

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