What healthcare leaders need to know now

 

Tejal Gandhi galvanized as merger of IHI, NPSF multiplies efforts around patient safety

By | July 17th, 2017 | Blog | 1 Comment

 

Tejal Gandhi: “We think culture is driven through leadership. The C-suite needs to take ownership and drive this culture of safety.”

 

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 merger of the Institute for Healthcare Improvement and the National Patient Safety Foundation is now official, and Tejal Gandhi, who led the NPSF, couldn’t be happier.

 

“The reason for the merger was really based on mission,” she says. “IHI had been wanting to strengthen its efforts in patient safety, and that was part of its new strategy that it had been thinking about. And we on the NPSF side felt we had been doing some meaningful work in safety, but we’re small and wanted to expand our reach. It was a perfect union.”

 

In the new structure, Gandhi, a frequent honoree as one of the top leaders in healthcare, moves to a new role as chief clinical and safety officer for IHI. “I’ll be overseeing all of the safety efforts and, more broadly, getting engaged on some of the IHI’s other efforts across the spectrum of quality.”

 

In this, Gandhi will lean on her experience as the former executive director of quality and safety at Brigham and Women’s Hospital, and chief quality and safety officer at Partners Healthcare.

 

The patient-safety movement includes dozens of groups, with many different approaches and agendas. As a result, sometimes the approach and effectiveness can be fragmented. Gandhi says she hopes the merger, which combined two respected entities, can help focus future work.

 

“We want to be a single unified voice,” she says.

 

The NPSF released a major report in December 2015 called Free From Harm: Accelerating Patient Safety Improvement Fifteen Years After To Err Is Human, which outlines eight steps that the healthcare industry can take to significantly reduce mistakes and injuries in the healthcare setting. IHI’s muscle will allow for a broader discussion of the themes in that report. In addition, in conjunction with the American College of Healthcare Executives, IHI/NPSF recently released an executive “blueprint” to help healthcare leaders implement real, not theoretical, steps to reduce safety events under their watch.

 

“We think culture is driven through leadership,” Gandhi says. “The C-suite needs to take ownership and drive this culture of safety. We’ve been saying this for 15 years but haven’t necessarily given the C-suite the real tools to do it.”

 

The blueprint is designed to help change that. “If you look at data around the safety culture, we have a lot of room for improvement,” she says.

 

“There’s still about 40 percent of people who answer surveys who say they are worried about punishment if they speak up about an issue.” A wide range of CEOs, safety officers and researchers convened to decide what would go into the blueprint.

 

“We’re very excited about the work,” she says. “It includes practical strategies and tactics for organizations to drive toward a culture of safety. And then, with the partnership of ACHE to help disseminate it, we have a lot of follow-up education planned.”

 

Gandhi also is taking her knowledge to the board room, knowing that directors can set the tone for healthcare organizations. Last October, she was asked to join the board at Aurora Health Care, a major Wisconsin health system.

 

“They wanted a physician, and they wanted someone who very much understood quality and safety,” Gandhi says. “I think Aurora has a great track record already in quality and safety, and they were enthusiastic about taking it to the next level. Given my new role at IHI, the opportunity to bring new ideas will be really exciting.”

 

Some of Gandhi’s ideas, thankfully, are catching on in patient safety, like looking at patient care in all settings, not just the hospital.

 

“When I started out in patient safety, my research area of interest was patient safety in the ambulatory setting,” she says. “We have constantly been pushing the fact that we need to think about safety across the entire care continuum. I think we’re finally seeing a shift now. People understand that it’s not just a hospital issue.”

 

IHI/NPSF currently has a grant from the Moore Foundation to conduct research on patient safety in the home, and Gandhi lists other areas that need scrutiny as well, from primary care to ambulatory surgery to dialysis centers.

 

Behind all these activities stands the need for transparency, which Gandhi has called a paramount attribute in a culture of safety.

 

“We’re making progress, but we have a long way to go – I feel like I say that about everything in safety,” she explains. “Compared to 15 or 20 years ago, there’s much more transparency about errors. There’s transparency about errors when they happen with disclosures and apologies, transparency with the public with data about mortality, infections and readmissions being available, and there’s transparency between clinicians or within and across organizations. But it’s far from perfect.”

 

Yet with all the progress, Gandhi remains wary about errors on another front – electronic health records.

 

“I’m a firm believer that EHRs can provide safety benefits through things like decision support and data accessibility,” she says. “We’ve seen many studies on the benefits of EHRs for quality and safety. But the flip side is that a lot of those studies were done in places that had customized, home-grown EHR systems developed with the end-user in mind. Most EHR systems aren’t like that. And we’ve seen examples of these systems actually creating unintended consequences or new errors.”

 

Gandhi says the IHI-NPSF merger is important because safety remains a bedrock issue that the healthcare industry has not fully come to terms with.

 

“I have spoken to many clinicians who say they would never let a loved one stay in a hospital without them present at all times,” says Gandhi, herself an MD. “But it’s unrealistic to think that’s a solution. Not everyone has a clinician in the family, and even those who do cannot avoid risks entirely. We need to improve safety for all patients in all settings at all times.”

 

 

SIDEBAR: Eight recommendations on safety from ‘Free From Harm’

 

Tejal Gandhi, MD, mentioned the report, “Free From Harm,” contains eight key goals for “achieving total systems safety”:

 

  • Ensure that leaders establish and sustain a safety culture.
  • Create centralized and coordinated oversight of patient safety.
  • Create a common set of safety metrics that reflect meaningful outcomes.
  • Increase funding for research in patient safety and implementation science.
  • Address safety across the entire care continuum.
  • Support the healthcare workforce.
  • Partner with patients and families for the safest care.
  • Ensure that technology is safe and optimized to improve patient safety.
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    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.”
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    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.”

     

     

     

     

    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.”

     

     

     

     

    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.”

     

     

     

     

    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 new 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.”
  •  

     

     

     

    Former ACHE chair Christine Candio charts a nimble, independent course for St. Luke’s Hospital

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

     

    Christine Candio: “To be an effective leader, you need to always keep an ear to the ground and an eye to the future.”

     

    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 St. Louis area, St. Luke’s Hospital is the only independent hospital – and President and CEO Christine Candio is OK with that.

     

    “I have always believed there is a place for independent organizations,” she says. “The differentiator for St. Luke’s is it is a large, advanced community hospital, and we have a strong network of care throughout two counties. That makes a difference. We have the entire continuum of care – including our own skilled nursing facility.”

     

    But that doesn’t mean St. Luke’s isolates itself, Candio notes.

     

    “We are collaborators, which enables us to continue enhancing the services we provide our patients to improve the health of the community. St. Luke’s is the exclusive St. Louis affiliate of Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute, which we’re very proud of,” she says. “We also continue to expand our imaging services through a partnership. And St. Luke’s Rehabilitation Hospital is a joint venture with Kindred Healthcare. We are also starting to belong to different clinically integrated networks.”

     

    Having said that, Candio admits that independent hospitals need to regularly evaluate themselves and their objectives.

     

    “There are some key questions that independent organizations need to continually reflect on, and we do that here,” she says. “Do you have the essentials to remain independent? I believe we do. Do you have collaborations and partnerships? Yes. Are you trying to be all things to all people? No, we’re not.”

     

    Being independent, says Candio, keeps the organization flexible, a point she lightens with a reference to a couple nostalgic Claymation characters from TV.

     

    “We best serve our patients being nimble and responsive to our community’s needs,” she says. “You have to be like Gumby and Pokey – bendable and pliable. We have that here.”

     

    As the former board chair of the American College of Healthcare Executives, Candio has been a national leader among her peers for many years. She lived on the East Coast most of her life but found the opportunity at St. Luke’s too good to pass up.

     

    “First and foremost were the quality outcomes of the organization. That was key,” she says. “The independence of the hospital was an attraction as well. I like to say that we are our own system with one hospital, and our team member engagement is phenomenal. Each individual here is so committed to serving our patients and their families and caring about one another. We have exceptional medical professionals; the teamwork among them is stellar.”

     

    Through her work at ACHE, Candio brought a national perspective to the organization. And national attention has followed.

     

    St. Luke’s has the best safety score of any St. Louis-area hospital in Consumer Reports’ ratings of U.S. hospitals.

     

    “I do believe that, as a healthcare industry, we are always on a constant journey of improvement, and we have to focus on zero harm,” she says. “Human beings make mistakes. As leaders, we have to ensure that we have all the right systems in place and a strong platform for people to work effectively and safely. When mistakes happen, we have to first look at where the process failed and go from there.”

     

    St. Luke’s was already a strong and safe organization when she was appointed president and CEO in January 2015, she says. “But my philosophy is always, how can we get stronger and not rest on our laurels?”

     

    Candio’s leadership is imbued with her early years of experience as a nurse and a nursing leader. “To be an effective leader, you need to always keep an ear to the ground and an eye to the future,” she says. “I keep an ear to the ground through rounding with purpose – talking with our team members and our patients. It’s amazing what you learn when you take the time to do that.”

     

    She also participates in monthly meetings with a rotating group of about 20 staff members in nonmanagerial roles to update them about what is going on at St. Luke’s and to provide an open forum for feedback. She tries to travel to all of St. Luke’s locations in the sprawling St. Louis metropolis as well.

     

    Like many clinicians turned leaders, Candio says she moved into administration because she wanted to have a positive impact on a broader population of people. Her own experience as a hospital patient as a child spurred her desire to serve. She was even what was then called a “candy striper” hospital volunteer as a youth. The influence of those years has not left her.

     

    “We are honored to work in healthcare – it’s a blessing,” she says. “People are letting you into their lives during their most vulnerable times, and that is a sacred honor. That has always touched me.”

     

     

    SIDEBAR: Cheering on the home team

     

    Christine Candio’s biggest adjustment in St. Louis has nothing to do with healthcare.

     

    It has to do with setting aside a place in her heart for a sports team besides the Boston Red Sox.

     

    When she was jokingly asked at the end of her St. Luke’s job interview, “What’s your favorite baseball team,” the words, “Boston Red Sox” passed her lips before she even had time to think.

     

    Some in the room looked surprised. Candio closed her portfolio and joked, “Well, I guess this interview is over.”

     

    So, when she and her husband were picked up for dinner that evening by the physician who had asked the question, two St. Louis Cardinals caps were waiting for them in the back seat.

     

    “It was priceless,” she says. “I do root for the home team now.”

     

     

     

     

    ‘What Does Leadership Look Like?’ Read our new magazine

    By | April 6th, 2017 | Blog | Add A Comment

     

     

    In today’s healthcare climate, leadership is not easy. We’re grateful for the insights and innovations of many of the industry’s top leaders.

     

    As part of our sponsorship of Modern Healthcare’s Top 25 awards programs honoring diverse executives, we explore what leadership means through in-depth interviews with many of these top leaders.

     

    We’ve compiled these profiles, along with pertinent articles on governance, in the new magazine “What Does Leadership Look Like?”

     

    Stories from the 52-page leadership magazine include:

     

  • Philip Ozuah’s journey from medical school at age 14 in Africa to caring for underserved populations in the Bronx
  • Pat Maryland’s axioms of risk-taking as a leader
  • Bruce Siegel’s observation that a diverse board will lead to a diverse organization
  • Debra Canales’ insistence on people-centered leadership
  •  

    Click here to read the magazine.

     

     

     

     

    Top 25 Minority Executives in Healthcare–Ketul Patel: A sense of mission fuels the best leaders in healthcare

    By | December 22nd, 2016 | Blog | Add A Comment

     

    Ketul Patel: “People support what they help to create. If a staff member feels they’re part of a decision-making process that is helping to move the organization in a certain direction, they’re going to unite behind that.”

     

    Classic content: One in a series of interviews with Modern Healthcare’s Top 25 Minority Executives in Healthcare for 2016.

     

    Every month or two, CEO Ketul J. Patel journeys to the convent where the Sisters of St. Francis live and spends some time with the religious women who provide the missional context of the organization Patel leads, CHI Franciscan Health in Tacoma, Wash., part of the Catholic Health Initiatives system.

     

    “I leave energized every single time I go there because of the amount of passion they have for this organization,” he says. “I have always felt that faith-based organizations have an extra touch of focus and mission than others. I couldn’t have asked for a better set of sisters to work with.”

     

    Patel was raised in the Hindu faith but went to Catholic grade schools and high school growing up in Johnstown, Penn., 60 miles east of Pittsburgh. In an earlier role, he also worked for several years at a Catholic hospital in Chicago run by another group called the Sisters of St. Francis, this one based in Indiana.

     

    “The Catholic faith has made a pretty substantial imprint into not only my career, but my life,” he says. “It’s given an extra allure to this type of organization for me.”

     

    It’s also given a sense of urgency to the strides Patel hopes to make in reshaping CHI Franciscan and the other CHI hospitals he oversees as senior vice president of divisional operations for the Pacific Northwest Region. His goal, he says, is to have a top-performing organization with a mission-based focus on quality, safety and patient experience.

     

    “We want to have a system of the most talented providers and innovative services in the Pacific Northwest,” Patel says. “Because of that, we just went through a significant structural reorganization to focus on those areas.”

     

    Chief among the changes is the SafetyFirst Initiative, what Patel calls “a system-wide effort aimed at eliminating all preventable safety events.”

     

    “We’ve branded it throughout the entire CHI system, and we’re seeing declines in serious safety events at all of our hospitals that have implemented SafetyFirst. It’s something our clinical staff is very proud of.”

     

    The sense of service that Patel believes is a necessity for healthcare leaders comes from his parents, he says. Patel was born in Kenya, as were both his parents. His father is a retired physician. His mother, who passed away last year, was a nurse. Read more…

     

     

    A sense of mission drives Ketul Patel at CHI Franciscan Health

    By | August 10th, 2016 | Blog | Add A Comment

     

    Ketul Patel: “People support what they help to create. If a staff member feels they’re part of a decision-making process that is helping to move the organization in a certain direction, they’re going to unite behind that.”

     

    One in a series of interviews with Modern Healthcare’s Top 25 Minority Executives in Healthcare for 2016.

     

    Every month or two, CEO Ketul J. Patel journeys to the convent where the Sisters of St. Francis live and spends some time with the religious women who provide the missional context of the organization Patel leads, CHI Franciscan Health in Tacoma, Wash., part of the Catholic Health Initiatives system.

     

    “I leave energized every single time I go there because of the amount of passion they have for this organization,” he says. “I have always felt that faith-based organizations have an extra touch of focus and mission than others. I couldn’t have asked for a better set of sisters to work with.”

     

    Patel was raised in the Hindu faith but went to Catholic grade schools and high school growing up in Johnstown, Penn., 60 miles east of Pittsburgh. In an earlier role, he also worked for several years at a Catholic hospital in Chicago run by another group called the Sisters of St. Francis, this one based in Indiana.

     

    “The Catholic faith has made a pretty substantial imprint into not only my career, but my life,” he says. “It’s given an extra allure to this type of organization for me.”

     

    It’s also given a sense of urgency to the strides Patel hopes to make in reshaping CHI Franciscan and the other CHI hospitals he oversees as senior vice president of divisional operations for the Pacific Northwest Region. His goal, he says, is to have a top-performing organization with a mission-based focus on quality, safety and patient experience.

     

    “We want to have a system of the most talented providers and innovative services in the Pacific Northwest,” Patel says. “Because of that, we just went through a significant structural reorganization to focus on those areas.”

     

    Chief among the changes is the SafetyFirst Initiative, what Patel calls “a system-wide effort aimed at eliminating all preventable safety events.”

     

    “We’ve branded it throughout the entire CHI system, and we’re seeing declines in serious safety events at all of our hospitals that have implemented SafetyFirst. It’s something our clinical staff is very proud of.”

     

    The sense of service that Patel believes is a necessity for healthcare leaders comes from his parents, he says. Patel was born in Kenya, as were both his parents. His father is a retired physician. His mother, who passed away last year, was a nurse. Read more…

     

     

    Profiles in Leadership: In Detroit, Schlichting’s success story is one to celebrate

    By | July 5th, 2011 | Blog | Add A Comment

     

    Nancy Schlichting became an EVP and COO at 28.

    One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

     

    If you ask Nancy Schlichting about what sparked the most professional growth in her career as she rose to become chief executive officer of Henry Ford Health System in Detroit, she is quick to point to people other than herself.

     

    “Having strong mentors has probably been the most important element of my career,” she says.

     

    The two key ones, she adds, are Al Gilbert and Gail Warden, who led Summa Health System in Ohio and Henry Ford, respectively.

     

    “They are two individuals who had profound impact on my career,” Schlichting says. “Al Gilbert appointed me at the ripe old age of 28 to be executive vice president and chief operating officer of a 650-bed teaching hospital. That was what launched my career in so many ways.” Read more…