What healthcare leaders need to know now

 

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.”

     

     

     

     

    Wharton Healthcare Quarterly features article on developing physician leaders by Clarke, Mazzenga

    By | May 5th, 2017 | Blog | Add A Comment

     

     

    The latest issue of the Wharton Healthcare Quarterly is out, and it features a pertinent article from Furst Group’s Bob Clarke and Joe Mazzenga on the challenge and reward of developing physician leaders to lead the entire enterprise, not just a clinical department.

     

    Published by the Wharton Healthcare Management Alumni Association at the University of Pennsylvania, the latest issue of the Quarterly also features articles on the transition to value-based payment, the coming challenges posed by post-acute care, and creating a culture of value.

     

    Clarke is the chief executive officer of Furst Group and NuBrick Partners. Mazzenga is managing partner of NuBrick Partners, our leadership consulting firm, and a Furst Group vice president.

     

    The authors acknowledge that both administrators and physicians have work to do to achieve success in this endeavor and that, ultimately, “True leadership is about building teams who create an empathetic and collaborative culture.”

     

    To read the complete article, click here.

     

     

     

     

    Halee Fischer-Wright recalibrates MGMA to give it a more resonant voice in healthcare

    By | April 27th, 2017 | Blog | Add A Comment

     

    Halee Fischer-Wright: “I view MGMA not as a not-for-profit healthcare association, but as a for-profit, well-funded startup at this point in time.”

     

    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 energy that Halee Fischer-Wright, MD, brings to the Medical Group Management Association is palpable.

     

    She is on a mission to not only transform the venerable medical association she now leads as president and CEO, but to help steer the healthcare industry in a better direction. She came into her role at MGMA in 2015 with a track record as a successful pediatrician and president of a medical group who also served as a chief medical officer within Centura Health, a large health system in Colorado and Kansas. In addition, she spent several years as a management consultant and co-authored the book, Tribal Leadership. “My passion is in culture and leadership,” she says.

     

    Like many storied organizations, the 90-year-old MGMA needed to reassess and reinvent itself. It made its mark developing the cost and compensation surveys for physician practices in the U.S. “If you’re hiring a physician, you need to look at our survey,” Fischer-Wright says. “And if you’re going to buy or sell a practice, you are probably going to buy data from us. That was our claim to fame.”

     

    But the pace of change in healthcare had diminished the brand to some degree, and Fischer-Wright gave it the jolt it needed. She and her team have developed the MGMA Stat text-messaging service that gathers instant feedback from its membership and gives them a unified – and increasingly powerful – voice to the marketplace, among other initiatives.

     

    “I’m very much of a fan of disciplined innovation,” she says. “When I was a consultant, we did work with IDEO in San Francisco. So, that idea of prototype often, fail often and inexpensively, be willing to learn from your mistakes and focus on the end user – that’s what we’ve brought into MGMA. I view MGMA not as a not-for-profit healthcare association, but as a for-profit, well-funded startup at this point in time.”

     

    The results so far have earned Fischer-Wright a 2016 Maverick of the Year trophy from the Stevie Awards, the international business competition. It’s also helped open doors for Fischer-Wright and MGMA that might not have been as pliable not so long ago. When the University of Miami School of Business Administration convened a panel on “National Election Impact on Health Care Sector” a few months after the 2016 election, the luminaries opining on the way forward included American Medical Association CEO James Madara, AHIP leader (and former CMS chief) Marilyn Tavenner, American Hospital Association CEO Rick Pollack, HFMA head Joseph Fifer – and Fischer-Wright.

     

    “What really hit me when I served on that panel is that all of us want the same things, even though the ways we approach them are dramatically different,” she says.

     

    The way to achieve lasting change in healthcare, she adds, is to stop thinking the top-down approach will work – it has to bubble up from the grass-roots level.

     

    “I think most of the change we’re talking about is cultural, and I actually think we can provide analytics that show it’s possible for physicians to have more time with patients, decreased cost, increased quality and increased satisfaction, which are the goals we all aspire to.”

     

    Fischer-Wright points to successes in this vein at Geisinger Health, Cleveland Clinic, Intermountain Healthcare and Virginia Mason as disparate examples of how these outcomes can be achieved. But she cautions that each practice is different, and that what works for one may not work for another.

     

    “Every practice has to figure out what that looks like for themselves. We need to stop looking for the cookie-cutter approach because it’s not valid,” she says. “But there are some guiding principles, and they tend to be cultural, and they center on hiring. It’s like the Jim Collins approach in Good to Great – get the right people on the bus.”

     

    The pressures on physicians are huge. The introduction of electronic health records has many benefits, but it has increased doctors’ paperwork and decreased their time with patients to a 2:1 ratio. The coming MACRA regulations appear to be especially burdensome for independent physicians and those affiliated with smaller practices – and physicians won’t get feedback from the government on how they’re doing for 12 to 18 months. It’s perhaps not too surprising that 83 percent of physicians say they wish they had considered alternative careers, and that the role of physician, which used to be the most respected profession bar none, has dropped to #6 in a recent poll.

     

    “Physicians will report that they spend 13 to 16 minutes with each patient; patients say they actually get eye engagement from a physician for only three of those 13 to 16 minutes,” Fischer-Wright notes. “Providers are increasingly being held accountable for the outcomes of their patients – so if I don’t have much of a relationship with my patient but need them to keep their blood sugar in check, manage their diabetes and do routine care, what’s the likelihood that the patient is going to engage in that?”

     

    Fischer-Wright and MGMA believe there are ways to restructure medical practices to change the status quo. That’s also the premise of her forthcoming book, Back to Balance: The Art, Science, and Business of Medicine.

     

    “One of the things we highlight in the book is asking the right questions,” she says. “We’re not asking the right questions in healthcare to get to the outcomes we want. We’ve tried a lot of top-down change without achieving a lasting impact. Where we really need to work to sustain change, as we’ve said, is at the grass-roots level.” To that end, MGMA also has partnered with the AMA the past two years on the Collaborate in Practice conference.

     

    “Instead of trying to identify one specific constituency within a practice to leverage change, if we can fundamentally get the leadership – which is both the administrator and the provider – engaged and on board, then we’re going to see meaningful change within the practice that helps us get toward our Triple Aim goals,” Fischer-Wright says.

     

    Fischer-Wright says many physicians have felt disempowered over the last decade, but believes the pendulum is swinging back, due to economic constraints and new generations of workers, like millennials, who have little patience for sticking with processes that don’t have the end user in mind. “This entire $3.4 trillion healthcare system really starts with a provider with a patient in a room. And that’s what we need to remember. It’s all predicated on that.”

     

    But she’s quick to note that wishing wistfully for bygone days profits no one.

     

    “A lot of my colleagues will talk about that we need the art of medicine independent of business and science, but that doesn’t work,” she says. “Healthcare is increasingly eating our gross domestic product, and so to say, ‘I just want to see patients,’ is not a sustainable attitude in this day and age. However, to say it’s in our business’ best interests to bring back more of the art of medicine is absolutely a valid argument, and we can demonstrate why that’s important.”

     

     

    SIDEBAR: Shifting our thinking on how to improve healthcare

     

    If the healthcare industry could flip a switch tomorrow and change several things to improve the quality of care, what should it do? Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association, has some ideas about that and covers them in her forthcoming book, Back to Balance: The Art, Science, and Business of Medicine.

     

  • Ask the right questions. “We keep asking how we can make things better incrementally,” Fischer-Wright says. “But I don’t think that’s the right question. I think we have to ask ourselves, ‘What do we want?’ ”
  •  

  • Focus on the outcome instead of the process. “Because business has been driving healthcare, we’re getting very process-driven instead of outcomes-driven,” she says. “Because of that, we keep getting layers and layers of process, as opposed to really looking at the outcomes we want and reverse-engineering the processes to get us to those outcomes.”
  •  

  • Be willing to surrender the things that aren’t working. “A lot of health systems put things into place and then we have an unwillingness to let go of them even though they may not be working for us. We must be willing to let go and move in a different direction than what we know and are comfortable with.”
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