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Rural Health Care Leadership Conference
Jan. 18-21, 2009 | Phoenix, AZ | Sponsored by Siemens
The 2009 Rural Health Care Leadership Conference focuses on accelerating performance excellence and improving the sustainability of rural hospitals. Follow blogs from H&HN Senior Editor Matthew Weinstock and Associate Publisher and Executive Editor Alden Solovy for insights from the meeting. All comments are welcome and may be posted to the blog. Comments may be edited for clarity or length. Click here to return to the H&HN blog homepage. |
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Closing thoughts
by Matthew Weinstock @ 3:00PM
Despite the brilliant sun and nearby hiking trails calling their names, rural hospital officials showed up early every day this week for keynote sessions. I was particularly impressed with the number of trustees in attendance. I spoke with several during lunch and coffee breaks. They come from all walks of life: the retired dentist, the furniture store owner, the family physician, the real estate developer. But they share a common trait: dedication—really, devotion—to their hospital. They recognize the special standing a hospital has in a small, rural community.
Look for additional insight on rural hospital issues in February with the launch of a series of monthly e-newsletters underwritten by Siemens.
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Staying focused
by Matthew Weinstock @ 2:00PM
Todd Linden began his session this morning by quoting from President Barack Obama’s inaugural address:
Our challenges may be new. The instruments with which we meet them may be new. But those values upon which our success depends—hard work and honesty, courage and fair play, tolerance and curiosity, loyalty and patriotism—these things are old. These things are true …. What is required of us now is a new era of responsibility—a recognition, on the part of every American, that we have duties to ourselves, our nation and the world, duties that we do not grudgingly accept but rather seize gladly, firm in the knowledge that there is nothing so satisfying to the spirit, so defining of our character, than giving our all to a difficult task.
"That excerpt defines us as hospitals," said Linden, president and CEO of Grinnell (Iowa) Regional Medical Center. The question is, what do hospital leaders have to do to ensure that their institutions live up to that mission?
Linden argued that leaders have to tap into the "human spirit that is alive in our institutions." There are simple acts, such as leaders—including board members—shadowing an employee for a day. Linden showed a picture of him flipping flapjacks with food service workers. Additionally, the entire staff gets together a few times a year to talk about how they are making a difference in each others’ lives. And everyone—from the maintenance men to the trustees—feels connected to patient care.
Linden asked attendees to jot down ideas on how they are developing leaders and improving culture in their institutions. Health Forum is compiling a list of those ideas and will post it shortly on our Web site.
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Don't be afraid to fail
by Matthew Weinstock @ 12:00PM
Take calculated risks, and don't be afraid to fail. You can learn a lot from those missteps. That's part of the message from Barbara Farrell, R.N., director of quality & innovation, American Organization of Nurse Executives. It's not that you want to fail, but hospital leaders can be too cautious and unwilling to take chances to improve care. Farrell's keynote focused on the Institute for Healthcare Improvement and Robert Wood Johnson Foundation program, Transforming Care at the Bedside. The program seeks to empower frontline nurses and improve patient care at the bedside.
Farrell highlighted the program's successes—better care, improved staff satisfaction, improved staff retention. Focusing on a theme from the past three days, she said that culture is the key. That's especially true for rural hospitals that have a difficult time recruiting nurses to remote locations. Culture can sustain something like TCAB even in the wake of staff changes, Farrell says. Culture stays.
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Please pardon my machine
by Alden Solovy @ 9:30AM
Giving computers on wheels to nurses will change the way patients and nurses interact. Nurses, by and large, are initially uncomfortable with the computer between them and their patients. So they apologize. When these devices are introduced, it’s important to train nurses on how to interact with patients while using the computer. In particular, nurses should be coached to tell patients how it will help them get better care. That was one of the lessons learned by the nation’s Most Wired rural hospitals.
My main job on Tuesday was to moderate two break-out sessions on IT. The audience was most interested in lessons learned, such as the need to provide one-on-one training to physicians. And that a new admissions system can increase the admission time significantly at first, just as a new financial system can increase days in accounts receivable.
But when it comes to IT investments, rural hospitals are a lot like their large urban counterparts. Their concerns are nearly identical. The only difference is scale. Rural executives’ questions ranged from cost and contracting issues to physician engagement and clinical decision support.
These are the same issues confronting all hospitals in adopting clinical information technologies.
Side note: Remember to participate in the 2009 Most Wired Survey. The survey is available now and is open through March 15.
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Are you the ideal boss?
by Matthew Weinstock @ 4:00PM
Would you work for you? Think about it. It’s a pretty provocative question.
Michael Frisina, administrative director at Tuomey Healthcare System in Sumter, S.C., posed that question to 300 people during his keynote this morning. As I looked around the room, I saw very few people nodding. Most had that questioning look on their face, as if to say, "Well, I'm a pretty good boss, but…."
Frisina acknowledged that people probably didn’t want to hear another lecture about leadership and culture change. He noted that very little of what he was talking about was new. It’s been around for generations. But the truth is we need to be reminded of it over and over. There are too many pickle-suckers.
Frisina asked the crowd to shout out the attributes of the ideal boss. The responses were not surprising: fair, honest, standard-bearer, communicator, knowledgeable. Do you have these attributes? Are you this leader?
Importantly, Frisina says we need to pay more attention to people's behavioral competencies. Sure, it’s important to be technically proficient at your job, but he suggests that we often lose sight of how people behave and act.
"The reality is what we do and how we lead is directly proportional to the pain and suffering our patients experience," he says.
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I have to say that I think I'm at least close to being the ideal boss. If you asked the employees who worked for me I think they would agree that I have these attributes. The larger question is, how do we get the pickle-suckers to recognize the impact of their attitude and behavior? It is great to see what is happening at this conference even though I couldn't attend. Thank you!
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History delayed
by Matthew Weinstock @ 3:00PM
Well, it wasn't quiet as impressive as being with the throngs in Washington, D.C., but we did manage to take a break from our sessions today to watch history being made, albeit two hours later.
Laura Woodburn, who heads up Health Forum's education division and puts on these fantastic conferences, managed to show a video clip of President Barack Obama’s swearing in and inaugural address. Several of us—maybe 70 in total—left lunch a little early (desserts in tow, of course) to sit in the main conference hall to watch the clip. The inauguration occurred during today’s keynote, so we relied on the taped clip.
You could hear a pin drop as we watched the address. Some people clapped when it was over. Others didn’t. But even in a remote conference hall on the outskirts of Phoenix, you could feel the history.
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There were 120 people at the 7am Sunrise session this morning to listen to Kristin Welsh, AHA’s vice president of federal relations, outline the AHA’s rural hospital advocacy agenda for 2009. Sunrise proved to be an accurate description since we arrived in the dark of night and left an hour later in broad daylight. It was a perfect metaphor for the terrific presentation by one of AHA’s foremost lobbyists, who among other things emphasized the importance of transparency.
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Culture change for a critical access hospital
by Matthew Weinstock @ 10:00AM
Jerry Worrick has an ambitious goal for his 25-bed critical access hospital: to be the best rural hospital in America. Worrick, president and CEO of Door County Memorial Hospital, Sturgeon Bay, Wis., detailed his hospital’s long journey toward that goal Monday afternoon. The key, he says, is changing the culture. It’s about making sure that employees embrace the hospital’s mission and vision.
There really isn’t anything unique about Worrick’s message. Top leaders need to set the tone. Employees need to buy into it and feel empowered. Good deeds need to be rewarded. You’ve heard it all before. But how often do these things actually happen? If it were easy, every hospital in the country would be doing it.
Five years ago, Door County entered into a partnership with the Baptist Health Care Leadership Institute to help create and maintain great culture. The goal was service excellence. They performed a cultural assessment, created employee teams, developed a recognition program and leaders started rounding.
It hasn’t been easy. There have been bumps in road, Worrick said, like when leaders first started rounding without talking to nurses. Nurses worried that something was wrong. "Why are they in there with my patient?" they wondered. Leaders pulled back, talked to the nurses and developed a plan to work together.
Similarly, when the hospital instituted an electronic medication reconciliation system, nurses complained that it was cumbersome. Worrick wanted to understand what they were talking about, so he sat with a nurse and had her show him how the system worked, screen by screen. He saw what the nurses saw and why they didn’t like it. The system was eventually tweaked. He did the same thing with a bedside medication matching application. It’s part of the culture that Worrick, as CEO, show a commitment to giving staff the best resources.
One of the keys, he noted, is staying committed to the culture change. "If you start, you can’t stop it. If you do that, you have to wait until a new batch of employees comes in," he said. Since embarking on the culture change, Door County has seen satisfaction scores climb. Quality indicators are on the rise, too.
"You have to have good culture before you can have good patient satisfaction," he said.
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- Loss of the critical access designation
- Medicare payment and rules
- Medicaid payment
- Physician recruitment
- Surgeon recruitment
- Nurse recruitment
- Nurse motivation and time for patient care amid increasing reporting burdens
One hospital trustee put it this way: "Congress."
"What is it about Congress that has you worried?" I asked.
"Everything."
What’s keeping you up at night? Drop me a note at hhn@hhnmag.com.
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If it isn’t already on your radar, you should begin thinking about filing Form 990 Schedule H soon. Faculty today presented two sessions on how to manage reporting. Information on requirements and case examples and links to more information are below:
Background information will be required for the 2008 tax year and detailed information will be required for 2009 tax year. Even those who don’t file Form 990 may wish to look at this closely. State and local authorities may be tapping you for this information soon.
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Health reform lies in Senate's—not Obama's—hands
by Matthew Weinstock @ 5:00PM
The endless news coming from D.C. would have you believe that come midday tomorrow, Barack Obama will be in charge.
Well, Kristin Welsh, vice president of executive branch relations at the AHA, debunked that theory, at least as it relates to health care. "President Obama will not drive health reform,” she said during her "Washington Update" session this morning. Rather, health reform will be driven by a handful of senators. And those senators will be doing everything in their power to avoid the failures of Clintoncare in the early 1990s. Democrats, Welsh says, will reach out to conservative—not moderate—Republicans. If Democrats pull a handful of conservatives into the mix, that could equate to 20 or 30 votes down the road.
Welsh knows how things work on the Hill. She spent several years on the staff of the Senate Committee on Health, Education, Labor and Pensions, affectionately known in D.C. circles as HELP. She also suggested that Senate Republicans hold a great deal of power. They control 41 seats, which means the Democrats don’t have the 60 votes necessary to close off debate on legislation. Both sides will have to negotiate.
Finally, Sens. Kent Conrad (D-N.D.) and Judd Gregg (R-N.H.) introduced legislation to form a commission to examine entitlement programs. If this legislation moves forward, Welsh said it would be the most serious consideration entitlement reform has received in several years. Obama already has pledged to make entitlement reform a priority.
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Sorry, Kristin, the train has already left the station. Please read the stimulus package funding proposals. Buried in there are numerous efforts to close the coverage gaps that currently exist in the U.S. Once the gaps are closed, it is fairly simple to get an individual coverage mandate established, enforced and reinforced through the income tax system. What many people are calling reform (value-based purchasing) will have to wait until everyone is covered somehow and until information technology is firmly embedded in all hospitals and physician offices. Coverage and IT are the first-order requirements, and they have been launched with the stimulus package. No need to wait for the formal health reform package, which will have goodies, but not the main thing. Kristin Welsh may be right that health reform lies in the hands of some senators. By contrast, my impression is that real heath care reform cannot proceed in Washington until there is evidence that hospital and health system leaders and related physician and other community leaders have demonstrated a commitment to improved health services at the community level at much lower costs. We must demonstrate that commitment during the next couple of years, before any reform legislation can be seriously debated, enacted and become operational. We can do that with successful community-based, collaborative programs to improve health and health services while spending the much reduced money that will be available to us during the extended recession that lies ahead. Without reduced expenditures for improved health services, real health reform will cost more money than the national budget can possibly handle in the years ahead. This is becoming clear not only to Republican senators but to Democratic senators as well, as they become familiar with international experience. Other countries demonstrate that better health results are almost always associated with lower per capita expenditures than in the United States. That has to be our goal: better outcomes for less money. The senators can’t do that, although they can become important partners in providing effective and practical financial, regulatory and other positive and negative incentives to support our initiatives. Health care reform is really in our hands, not the senators’.
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From pickle-suckers to spark plugs
by Alden Solovy @ 1:00PM
Do you know a negative, bitter, cynical, sarcastic pickle-sucker?
You’ve met ‘em. Colleagues or neighbors or shop keepers who’ve got nothing good to say, the ones who look like they’ve been sucking on dill pickles.
Joe Tye, our opening keynoter, says these pickle-suckers generate toxic emotional negativity. They kill enthusiasm, drain productivity and—worst of all—in time their negativity becomes part of the invisible architecture of your hospital.
There’s an interesting concept, invisible architecture. It’s the cultural foundation of the hospital. Not just the values-on-paper, but the values-in-action that are lived by everyone in the organization. Research suggests that 10 percent to 15 percent of productivity is lost to toxic emotional negativity. Can a nurse who’s a pickle-sucker, Joe asks, one who’s complaining about the hospital or management at the nurses' station, change on a dime and become caring and compassionate 20 seconds later in a patient room?
Here’s a tough one: Are you the pickle-sucker? Are you the one the draining the joy and enthusiasm from your colleagues? Joe is far too polite to ask. Instead, he asks people to take the pickle challenge. It’s simple. Carry a note card and a pen. Every time you say or think something negative, put a check mark on the card. You’ll begin to see how often your own thoughts and actions are negative. Awareness is the first step to becoming what Joe calls "Spark Plugs." Spark Plugs are the people who are enthusiastic, energetic and engaged. Well, there’s more to it than that, but that’s the idea.
So which do you aspire to be? A pickle-sucker? Or a Spark Plug?
Other notes:
The world’s largest shamrock is in O'Neill, Neb., also the home of Avera St. Anthony’s. CEO Ron Cork was named the 2008 Shirley Ann Munroe Leadership Award winner prior to the opening keynote. The 25-bed hospital was opened in 1952. Ron has been CEO for 17 years.
- I spent Sunday hiking the Red Rock in Sedona with Joe and Phil Larson. I’d never met Joe before, although he had the good sense to quote me in his e-newsletter. Phil is a critical care nurse. We had a great time talking about Spark Plugs and pickle-suckers. If you are against traditional dieting but want the benefits of healthy eating, check out his book The Anti-Diet. You’ll see before and after pictures that are convincing.
- Joe gave out a CD to all attendees with lots of resources, including a editor’s proof of his new book, The Florence Prescription. It’s an engaging fable—sort of The Alchemist meets the IOM’s six aims—in which Florence herself helps a hospital to rethink itself.
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Congratulations to Ron Cork on his award. He exemplifies the characteristics necessary for success in a dynamic, rural market. |
Sunny skies ahead for rural hospitals?
by Matthew Weinstock @ 12:00PM
Sixty.
No, I’m not talking about the number of votes needed to shut down debate in the Senate. That’s a good guess though, as Congress prepares to take up some heady legislation to try to fix the economy. Sixty—as in the difference in temperature between my beloved Chicago home and Phoenix, Ariz. To say that we hearty Midwesterners (and even those from the Northeast) who’ve been battered and bruised this winter—my dad use to say, “It builds character”—are looking forward to four days in Phoenix is putting it mildly. As I use to say to my dad, “I have enough character!”
Today, I’m joining nearly 300 people at the Health Forum-American Hospital Association Rural Leadership Conference. It’s an exciting time to gather with health care executives, hospital trustees and others. The 44th president is about to be sworn in. Health reform is near the top of the domestic agenda. Importantly for this crowd, the soon-to-be secretary of Health and Human Services hails from a rural state. Tom Daschle, as many of you know, represented South Dakota in Congress for 25 years—eight of them in the House, the remainder in the Senate.
“We are very excited about the appointment of Sen. Daschle,” Raymond Hino told me the other day. Hino is CEO of the 25-bed Mendocino Coast District Hospital in Fort Bragg, Calif. He also sits on the AHA board. “It sends a hopeful message to rural hospitals that the new secretary comes from a rural state and has been a champion of rural health for decades.”
Tomorrow, Hino and the AHA’s Kristin Welsh will discuss the hospital field’s agenda in D.C. and speculate on how reform will impact rural hospitals. It should be an enlightening general session. Along with reform, Hino fully expects the hallway chatter to center on the economy, the economy, the economy.
If that’s the case—even if it isn’t—I’ll be here through Wednesday, along with my colleague Alden Solovy, to report on all of the interesting news. Stay tuned.
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