Blog from the 2009 ACHE Congress on Healthcare Leadership

March 23-25, 2009  |  Chicago, IL

The 2009 ACHE Congress on Healthcare Leadership offers leaders practical solutions to health care’s tough challenges. Follow blogs from H&HN Staff Writer Haydn Bush and Managing Editor Bill Santamour for daily updates from the meeting.

All comments are welcome and may be posted to the blog. Comments may be edited for clarity or length.

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Wednesday, March 25, 2009

New thinking needed for patient safety
by Bill Santamour @ 2:00PM

Gilbert's talk dovetailed nicely with the next session I attended, "Driving Radical Patient Safety Improvements Within Your Organization," presented by Mary Beth Navarra-Sirio, R.N., and Jacalyn Liebowitz, R.N. Nothing is more foundational to a hospital's value set than preventing errors and providing quality care.

Navarra-Sirio, vice president and patient safety officer at McKesson and a member of the Nursing Leadership Congress steering committee, discussed the evolution in patient safety thinking during the past four years, from a focus on medication safety to one that is trying to nurture a broad culture of patient safety and to drive safety through innovation. She said the need for visible and aggressive advocacy is evident in the disconnect between senior managers’ belief that their organization is obviously committed to patient safety and the feeling among middle managers and directors that senior management has not totally committed either on a conceptual basis or by providing sufficient resources.

Liebowitz, vice president of patient care continuum at Allegiance Health, Jackson, Miss., said organizations shouldn't bite off more than they can chew when starting a patient safety program. She advised setting just two major patient safety goals if hospitals want to be truly effective at defining them, coming up with a strategy to reach them and measuring progress over time. She said hospitals can no longer use the excuse that patient safety standards set by policymakers do not match inpatient care because CMS and other payers are considering bundling payments for the continuum of care. "Guess what," Liebowitz said. "Your standards just changed."

For more information, visit www.nursingleadershipcongress.com/resources.asp.

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'Everyday ethics' keep organizations on track
by Bill Santamour @ 11:00AM

When I got to the ACHE Congress this morning, I was under-caffeinated, running late and unable to find the session I signed up for in the Chicago Hilton’s confounding maze of meeting rooms, ballrooms and exhibit halls. How else would I end up at "Strengthening Ethical Wisdom: The Pathway to Leadership?" Can you say arcane? Can you say abstract? Can you say, "I need coffee, stat"?

As it turns out, Jack Gilbert gave a straightforward presentation that laid out the business case for CEOs and other top executives to continually talk about the organization's stated values and to encourage staff at all levels to exercise what he calls "everyday ethics." Too much of the time, executives and their staffs are ruled by "the tyranny of the urgent," said Gilbert, president of New Page Consulting and author of Strengthening Ethical Wisdom: Tools for Transforming Your Health Care Organization. In other words, if things like workarounds or other seemingly innocuous ethical slips have not created headaches so far, why not just ignore them and concentrate on all the other pressing issues hospital leaders have to deal with every day?

The problem, he said, is that it may be considered "only a workaround right now, but if you don’t do it quite this way this time, it makes it easier to do it a little more not quite this way the next time."

Gilbert noted that values need to be discussed every day—in executive rounding, in staff and board meetings, in chance encounters with employees—to keep them dynamic. Leaders must tap into their own and their staff's "ethical wisdom," the sense of right and wrong possessed by nearly everyone committed to a career in health care. Many people are afraid to express that wisdom even when they sense something does not quite meet the organization's ethical standards because they fear retribution or they don't want to rock the boat. Everyone needs to know the CEO has their back when they voice misgivings, Gilbert stressed.

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Tuesday, March 24, 2009

Engaging physicians on their turf
by Haydn Bush @ 2:30PM

During a Tuesday afternoon session on physician relations, Christopher Boyd, CEO at Sharp Chula Vista Medical Center in Southern California, said that he was surprised to learn in 2005 that his hospital ranked in the 29th percentile of Press-Ganey’s physician satisfaction ratings. By that point, Sharp Chula Vista had achieved regular improvements in patient satisfaction, and Boyd couldn’t figure out why he wasn’t reaching his physicians as well.

"Clearly, there was a huge disconnect," Boyd said. "Where I was thinking I had an open door, they were thinking bureaucracy."

An initial attempt to apply best practices based on available literature only nudged the physician satisfaction score up 3 percentage points in 2006. So the next year, Boyd launched a broad effort to improve hospital-physician relations, which included revamping the physician newsletter to contain physician-written copy about real issues instead of canned calendar items, visits by Boyd to physician meetings, and regular phone calls from Boyd to individual doctors to pick their brains. The efforts paid off, with Sharp Chula Vista earning “unprecedented” gains on Press-Ganey’s physician satisfaction scale in 2007.

Not all of the hospital's tactics worked, however. A hot line for doctors to lodge concerns received only a smattering of calls, and attendance at physician town hall meetings waned considerably after the first session.

Boyd said the take-home message is clear: Engage doctors on their own turf, instead of expecting them to come to you. But some efforts surprised even Boyd in their payoff, including the response to his new e-mail bulletin. When Boyd returned from vacation last year and wrote about a cross-country motorcycle trip he took with his 15-year-old daughter, the positive response from physicians was overwhelming.

"I was stopped in the hallways to talk about it," Boyd recalled. "Now, I put these personal items in from time to time."

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The green advantage
by Haydn Bush @ 12PM

At the outset of his session on green hospitals, George Mikitarian Jr., CEO of Parrish Medical Center in Titusville, Fla., noted that his 210-bed, stand-alone hospital is surrounded in central Florida by large health care systems that include several academic medical centers.

Finding a competitive advantage in that atmosphere can be tough, so when it came time several years ago to build a new outpatient building in a remote, untouched location, the hospital seized on the concept of delivering a "green" facility—one that would be energy efficient, built with recycled materials and respectful of a stunning natural landscape that's home to pristine waterways and endangered animals including gopher tortoises, rare snakes and hawks.

"Instead of looking at the environment as a barrier, why don't we look at it as an advantage?" Mikitarian said.

With gradual buy-in from a surrounding community that was initially skeptical of the hospital's plans, Mikitarian and his team began planning a campaign to gain Leadership in Energy and Environmental Design (LEED) certification for the new building. Given the hospital's limited resources and remote location—which meant it couldn’t get LEED points for mass transit service—Mikitarian decided to shoot for Silver certification, the lowest level, but a goal that made institutional sense. Ultimately, the successful LEED campaign added only 3 percent to the cost of the project, and Mikitarian said the hospital will easily recoup that expense over time in cost savings. What's more important, he said, is Parrish's renewed stature in the community. Describing hospitals as "energy pigs," Mikitarian noted that green building initiatives have the power to transform a hospital's image. "You have to stop thinking about green in terms of 'Will I save a nickel on it?' but in terms of what people know about you," he said.


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'Sewer guy' spreads message of transparency
by Haydn Bush @ 10:30AM

At a breakfast session this morning, Beth Israel Deaconess Medical Center CEO Paul Levy, a self-proclaimed "sewer guy”" who once ran the Massachusetts Water Resources Authority, described an initiative early in his tenure at the Boston hospital to reduce its central-line infection rate. When a lead physician on the project told the clinical staff that the current infection rate was too high, staff members responded that the hospital's infection rate was already below the national average.

"What the doctor said back was, 'I don’t give a blank what the national average is,'" Levy recalled.

Well-known for his blog Running a Hospital, Levy is a strong advocate for transparency reporting and regularly writes about BIDMC's safety and quality statistics. The general response from his staff has been positive, he said, though becoming a transparent culture has had its challenges. When Levy decided to post quality data on the hospital Web site, one board member had some concerns about the chosen language.

"He asked, 'Do we have to call it harm?'" Levy recalled, and to audience laughter added, "I said, 'In my speeches, I call it maiming and killing.'"
Co-presenter James Conway, senior vice president at the Institute for Healthcare Improvement, described a safety effort at Cincinnati Children's Hospital that gives employees logging in to their computers a daily update of the number of days since the last case of patient harm and a narrative of recent harmful incidents. Afterward, a hospital administrator in the audience asked how the hospital's risk management team viewed the practice and whether the effort increased financial settlements with patients.

Levy replied that these types of transparency efforts, when coupled with apologies to patients and their families, often mitigate risk instead of increasing it. "Not only is disclosure the humane thing to do but very often it leads to lower settlements," he said.

Levy also emphasized other forms of transparency. When an audience member praised Levy for frequently blogging about the Service Employee International Union's efforts to organize workers at BIDMC, Levy said he respected SEIU's right to attempt to organize but felt strongly that the union’s corporate campaign was spreading misinformation about the medical center's management and quality track record. By documenting the SEIU’s tactics, which Levy said the union has used at other health care organizations, he said he was protecting his hospital's reputation.

"I'm hearing that they don’t like that I'm doing this," Levy said.

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Monday, March 23, 2009

Taking the guesswork out of capital decisions
by Haydn Bush @ 12:00PM

Making large capital decisions in a large system with a finite amount of resources can be overwhelming, noted Kris Zimmer, senior vice president of finance for SSM Health Care, a 20-hospital system based in St. Louis, in a session on strategic capital planning. And given the current financial climate, careful capital strategy is even more important, said Francine Machisko, senior principal for Noblis Center for Health Innovation.

When it comes time to choose between projects, Zimmer recommended adopting an analytical approach to replace a first-come, first-served mentality and the relative strength of PowerPoint presentations by hospital executives competing for resources.

Any hospital worth its salt is going to continually be looking for ways to improve its physical surroundings, and the member hospitals of SSM are no exception, according to Zimmer. In 2007, the system had to choose among four major projects that included two replacement hospitals, a new facility in a strategically important market and a reconfiguration of hospital services across several sites.

With $2.5 billion budgeted for capital improvements in the next five years, SSM could tackle some, but not all, of its wish list. Zimmer and other leaders didn't want the selection process to be determined by the relative acuity of its hospitals to argue their case to corporate leadership, so the system linked up with Noblis to develop a more strategic, orderly approach to determine which projects would get the green light.

SSM then carefully analyzed and prioritized variables like a project's financial attractiveness, the ability to compete in given service lines, the intensity of competition and the available opportunity within the market. Finally, SSM weighed those characteristics in a framework that assessed overall market attractiveness with the projected ability to achieve success.

In the end, two projects got the green light. One of the hospitals that didn’t get its capital wish list granted was a bit disappointed, as its leadership had already printed up T-shirts celebrating the new building. After a management shake-up, that facility is back on track, and a construction delay at one of the approved projects means that SSM has to reassess which projects will go forward. This time, though, it will have a sound strategy behind it, Zimmer said. “It was a good process with a good result, but that doesn’t mean life is easy now," he said.

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Health care reform in chunks
by Haydn Bush @ 9:00AM

Health care reform may not come in the "big bang" bill everyone has been expecting, predicted keynoter and journalist Charlie Cook of the Cook Political Report. Instead, pointing to the recent passage of the SCHIP bill and support for health care information technology spending in the federal stimulus package, Cook said he expects reform will emerge this year in “medium-sized chunks.”

Noting that Democrats are still energized under President Barack Obama and determined to gain a victory for ailing Sen. Edward Kennedy (D-Mass.), a long-time advocate of reform, Cook pointed to plenty of positive signs for the reform agenda.

However, Cook said those efforts will be hurt by the withdrawal of Tom Daschle’s bid to assume the chairmanship of the Department of Health & Human Services, who Cook noted was to be the "quarterback" of the health care reform initiative. Other challenges will include freeing up the finances to pay for reform within the current “pay as you go” framework established by Congress in 2006. Cook pointed to estimates that project reform costs of $1.5 trillion, noting that finding budget cuts to finance new investments on that scale “gets very difficult.”

But with the president’s popularity still hovering north of 60 percent and Democrats mindful of the lessons learned by President Bill Clinton's failed health care reform effort in 1993, Cook said he expected to see slow but sustainable health care reform legislation this year.

"There will be medium-sized chunks of health care reform," Cook said, adding that "resistance is too great to the big bill."

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A call to action
by Haydn Bush @ 8:00AM

The 75th annual ACHE Congress on Healthcare Leadership kicked off on a cool, overcast Monday in downtown Chicago. Incoming ACHE chair Charles Evans opened the congress by noting the similarly gloomy forecast facing health care executives but emphatically defended the importance of leadership at this critical juncture.

"We can't wait for Washington or the states to take leadership," said Evans, CEO of International Health Services Group.

With an eye toward the global challenges facing the health care industry, including skyrocketing health woes in developing countries and domestic concerns of restructuring the payment system, managing increasing costs and improving quality and safety, Evans declared that health care executives must "recommit" to their role as leaders in delivering results.

"These challenges are indifferent to the model of our ownership, the scale of our systems or the challenges we face as a country," Evans said.

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Comments:

Wouldn't you agree that the statement made by Evans, the CEO of International Health Services Group, is indeed a bit short-sighted as he declared, "We can't wait for Washington or the states to take leadership?" It appears this could be an opportunity missed to partner together on common goals with the states and the federal government, particularly in the areas of health IT (e.g., EHR, PHR and health information exchange). States are making great advances.
-K. Swihart, Monday, March 23