Healthcare Setting Management Essay

What problems do leaders encounter when implementing innovation in a healthcare setting? Be specific as to the problems and pose a solution to each problem. Finally, assign a ranking to the problem/solutions being implemented. Which problem/solution is ranked #1 and why?

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PREVIEWHealthcare Management Ethics Leading a Career of Significance Jack A. Gilbert, EdD, FACHE Getting to—and expressing—the heart of the business. Samuel L. Odle, FACHE, senior policy advisor, Bose Public Affairs Group, Indianapolis, and former executive vice president and COO of Indiana University Health, is a Past Chairman of ACHE. In his Chairman’s remarks at the 2005 Congress on Healthcare Leadership in Chicago, he spoke eloquently about the choice of healthcare as a career: “The daily issues that press on us can leave us overwhelmed and fatigued. … We can so easily get wrapped up in personnel issues, in operational problems, in chasing technology, in asset management, and in measuring clinical outcomes. … But we who have chosen leadership roles in healthcare have chosen more. We have chosen what is at its heart a career committed to health, to healing and to compassion. It is the legacy we leave in support of these great purposes that will mark us as having led careers of significance.” Sam lays out an enduring challenge for healthcare leaders.

According to ACHE’s annual survey, Top Issues Confronting Hospitals, for the past 10 years financial challenges have consistently ranked as hospital CEOs’ No. 1 concern. There is no question that healthcare organizations’ financial health is critical to 44 Healthcare Executive SEPT/OCT 2014 success, especially at a time of decreasing reimbursements and increasing demand for access to high-quality, cost-effective care. But it is not the business of the business—health, healing and compassion are the business of the business. Great healthcare leaders not only know what is at the heart of the business, but they also feel it deeply and express it consistently in the everyday life of their organization—in words and actions. Barbara Balik and I had the privilege of interviewing 10 successful transformational leaders in healthcare for a book titled The Heart of Leadership: Inspiration and Practical Guidance for Transforming

Your Health Care Organization (AHA Press, 2010). All of these leaders had a personal passion for care that shaped their strategic and operational leadership. And all were attentive to the issues they faced and to the financial health of their organizations. At the same time, these leaders all believed in the primacy of health, healing and compassion as the drivers at work for themselves and others. Of the 10 leaders interviewed, four were nurses, three were physicians and three came from an administrative background. All of them were strong stewards of the financial health of their organizations, but that wasn’t their North Star. In the words of Sister Mary Jean Ryan, then CEO of SSM Health Care in St. Louis, as quoted in the book, “I worry about finances, capital and so on. But none of it matters if we can’t provide safe care.” Great healthcare leaders not only know what is at the heart of the business, but they also feel it deeply and express it consistently in the everyday life of their organization. So what can we do to strengthen our own careers of significance and encourage others to do the same? Here are three ideas: Start with “why” in your planning and decision making. Leadership expert Simon Sinek, in his highly rated September 2009 TED talk, How Great Leaders Inspire Action, makes the point that people do not buy what you do, but, rather, they buy why you do it. And by why he means your purpose, your cause and your belief. Sinek’s point is that great companies and great leaders start from the why and then make known the how (the goals, the operating model) and finally the what (the everyday product). Not starting with the why, he argues, makes for an unexceptional, uninspired organization, which ultimately is unattractive to customers. It is the reason why it made all the difference that “[Martin Luther King Jr.] gave the I Have a Dream speech, not the ‘I have a plan’ speech,” Sinek said in the talk. Let your passion and the “why” permeate your conversations. Focus on improving the lives of patients and the community as you formulate strategies and goals, and positive results will follow. You will also inspire passion and creativity among your employees. If you are a leader who has a passion for care, then talk about it every day and encourage others to talk about their passion every day. Don’t be shy about it. People around you, including those patients, families and communities you serve, need to hear you talk about your caring again and again. As a society, we spend a good deal of time inside and outside of work categorizing and grouping people by profession, organizational level, background, gender, ethnicity, age and experience. To focus on health, healing and compassion is to remind us all of that which binds us together and unites us, even while respecting our many differences. The why of healthcare—health, healing and compassion—is the tie that binds us together for a common cause. Decide if this is the right place for you and for those you lead. There is too much at stake in healthcare for us to carry leaders who are disconnected from or disregarding of this great calling. If you as a healthcare leader are not called to healthcare, then I encourage you to do the honorable thing and seek a career of significance in another field or industry. If you have people working for you who may be good but who do not seem to share a passion for care, then help them assess their alignment with the values of the profession. If it becomes clear they do not share a passion for care, help them leave the organization with greater self-awareness.

If you are passionate about healthcare but find that passion eroded by your current organization—and you have tried your best to change the environment—then, when possible, seek an organization that honors and is hungry for your passion. I have met and know many caring leaders. By continuing to start with the why in our decision making, sharing our passion for our patients and communities and assessing our professional calling, we will all get to the heart of the business and lead careers of significance. s Jack A. Gilbert, EdD, FACHE, is clinical associate professor and director of executive and professional development, College of Health Solutions and College of Nursing and Health Innovation, and director, Transdisciplinary Consortium for Innovation Leadership in Healthcare, Arizona State University, Phoenix. He can be reached at jack.gilbert@asu.edu. Executive Master of Healthcare Leadership A program of intense study focused on leading transformation in American healthcare. Healthcare in America is undergoing rapid, disruptive, and persistent change. It will take visionary leaders to transform our healthcare organizations in this dynamic environment. 16-Month Intensive Blended Program Online and On-Campus Transforming Leaders. Transforming Healthcare. www.brown.edu/exec Healthcare Executive SEPT/OCT 2014 45 Copyright of Healthcare Executive is the property of American College of Healthcare Executives and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. S A F E T Y Partnership for Patients: Innovation and Leadership for Safer Healthcare Patrick H. Conway, MD, deputy administrator for innovation and quality; Shelly Coyle, RN, nurse consultant; and Nancy Sonnenfeld, PhD, health statistician, Centers for Medicare & Medicaid Services Center for Clinical Standards and Quality, Quality Improvement and Innovation Group, Baltimore, Maryland P atient safety is a chief responsibility of hospital executives. Acute care hospitals are entrusted to provide safe, timely care to a wide array of patient populations, and doing so is no small feat. As the nation’s largest health insurer, the Centers for Medicare & Medicaid Services (CMS) maintains a strong commitment to promoting patient safety in support of the highest quality of care, healthier people, and smarter spending.

In alignment with its payment policies that seek to reward quality, CMS has established a large, action-oriented system of networks to spread innovation and associated safety activities on a national scale. The system includes Quality Improvement Network– Quality Improvement Organizations, Hospital Improvement Innovation Networks (HIINs, formerly known as Hospital Engagement Networks), Practice Transformation Networks, and End-Stage Renal Disease Networks. The United States has recently seen dramatic gains in hospital patient safety. Between 2010 and 2015, the adverse event rate declined dramatically from 145 to 115 harms per 1,000 discharges (Agency for Healthcare Research and Quality [AHRQ], 2016a, 2016b). A harm rate of 115 per 1,000 is still too high—much work remains to be done. This article describes the Partnership for Patients (PfP), a CMS initiative that applies a systems approach to innovation in hospital patient safety, and hospital executives’ contributions to the PfP’s success. LEADERSHIP, SYSTEMS THINKING, AND ALIGNMENT: THE FOUNDATION FOR INNOVATION Senge (2010) defined innovation as the widespread adoption of new technology and ideas. He further described systems thinking as the cornerstone of learning organizations, and organizational learning as the cornerstone of innovation. Explicit effort to think about For more information about the concepts in this column, contact Dr. Conway at patrick.conway@cms.hhs.gov.

The views in this column are the authors’ and do not necessarily represent the views or opinions of the Centers for Medicare & Medicaid Services. The authors declare no conflicts of interest. © 2017 Foundation of the American College of Healthcare Executives DOI: 10.1097/JHM-D-17-00039 166 © 2017 Foundation of the American College of Healthcare Executives SAFETY systems is necessary for organizational learning and innovation because humans tend to concentrate their efforts and understanding on those parts of the system for which they are directly accountable. The interaction of parts within a system affects how the system functions as a whole, so focusing on only one or a few parts of an organization or group of organizations can lead to undesirable consequences (Senge, 2010). In contrast, systems thinking can help to identify unproductive interactions and eliminate these adverse events as well as reinforce innovative and efficient processes. Initiated in 2011, the PfP has taken a systems approach to change through advocacy and education that actively surfaces improvement opportunities, spreads best practices, and supports the achievement of unprecedented decreases in the rates of hospital-acquired conditions and readmissions.

The PfP engages three engines: (a) CMS’s Quality Improvement and Innovation Group and its contractors, consisting of HIINs; (b) federal partners; and (c) state, local, and private partners (see https://partnershipforpatients.cms.gov for details). In addition to engaging these three engines for change, CMS implemented new payment incentives and penalties that were aligned with the campaign goals of the PfP, including programs dedicated to hospital-acquired condition reduction, hospital readmission reduction, and hospital value-based purchasing. By championing culture change, hospital executives play a central role in these efforts to reduce harm in hospitals, save lives, and conserve billions of dollars.

Although an executive-level focus on the financial well-being of the facility is fundamental, a commitment to the community and to patient well-being and outcomes is paramount. Healthcare consumers are seeking more information and engagement as full partners in their care and are demanding personalized attention. In addition to these expectations, the needs of the personnel caring for the patients must be considered and addressed. Given the many priorities and demands that hospital leaders face, a systems approach to improvement offers the best promise for sustainability. Healthcare Setting Management Essay

PATIENT SAFETY MECHANISMS Mechanisms supported under the PfP to improve patient safety revolve around engagement with patients, communities, and staff; strategic partnerships; and further development of existing infrastructure for care. Engagement With Patients and Communities To fully understand what patients need, hospital leaders must commit to hearing their stories. Leaders must be visible in their communities and welcome public input. Enlisting patients for committees and hospital boards provides opportunities for all stakeholders to share their insights, perceptions of the care process, and needs as well as opportunities for improvement. The development of this relationship fosters mutual understanding and trust as well as improved communication, which supports the development of a culture that is patient centered. Healthcare Setting Management Essay

Furthermore, engaging with patients and caregivers after an error occurs can demonstrate accountability and respect of the individual as a partner and provide an opportunity for patients to be involved in the solution. 167 © 2017 Foundation of the American College of Healthcare Executives JOURNAL OF H E A L T H C A R E M A N A G E M E N T 62:3 M A Y /J U N E 2017 The PfP has established goals and measures for patient and family engagement and has suggested approaches to amplify the voices of diverse patient populations. Many facilities are more than willing to share their successes with others (see http://www. healthcarecommunities.org/CommunityNews/PartnershipforPatients.aspx for examples). Leadership Rounds and Engagement With Staff To fully understand the care process, leaders must come out of their offices and see how care is delivered at their facilities. Witnessing the care process firsthand reveals opportunities for improvement from both patient and staff perspectives. Hospital executives who participate in routine daily or weekly rounds will learn that demonstrating interest and concern for the contributions, insights, and assets of frontline staff is invaluable. Healthcare Setting Management Essay

A workforce that feels valued and safe in its environment delivers a higher quality of care with fewer adverse events for both patients and caregivers. Relationship Building: The Power of Partnerships CMS designed the PfP campaign around the principle that aligning multiple programs and policies on the same patient safety goals can reduce the national rate of patient harms more effectively than any individual program or policy could; moreover, this approach would appeal to providers’ intrinsic motivation to provide safe, high-quality care (Berenson & Rice, 2015). The PfP campaign designers seek out existing programs and partner agencies committed to these goals. Some of these partners directly contribute to the PfP by recruiting new member hospitals to the HIINs. Healthcare Setting Management Essay

The PfP stakeholders collaborate to amplify the message of partner agencies throughout the hospital learning community, thereby contributing strength to the network of partners. A similar approach has been taken in the hospital environment itself. For example, by working together to achieve a common vision for patient safety goals—as well as to identify root causes of harm and barriers to patient safety—information technology, nursing, and environmental services teams can achieve much more than any one team might accomplish by itself. Embracing the experiences of others decreases the time necessary to learn processes that produce high quality and reliability. Healthcare Setting Management Essay

Aligning toward a common goal fosters synchronized communications, leverages broader perspectives, and promotes a higher likelihood of success. Declare bold aims; make strong, public commitments; and expect the same from your partners. Leverage Existing Infrastructure to Create Synergy The PfP leverages existing infrastructure to develop data systems necessary for objective monitoring and evaluation. AHRQ and CMS collaborated to create the AHRQ National Scorecard, the first ongoing annual national assessment of all causes of harm in hospitals (AHRQ, 2016a, 2016b). To minimize the burden on hospitals, the AHRQ amalgamated data from several existing systems to establish the PfP’s 2010 baseline. These systems included the Medicare Patient Safety Monitoring System, the Centers for Disease Control and Prevention’s National Healthcare Safety Network, and AHRQ’s claims-based patient safety indicators. The Medicare Patient Safety Monitoring System, a key data 168 © 2017 Foundation of the American College of Healthcare Executives SAFETY source for the scorecard, includes 21 specific measures of patient harm identified through standardized, clinically validated chart abstraction from a large, national all-payer inpatient sample (Hunt et al., 2005; Wang et al., 2014). Healthcare Setting Management Essay

To promote a common vision across hospitals, the PfP seeks to align its program with other CMS programs and policies that have created the hospital infrastructure necessary for success. For example, the CMS Leading Edge Advanced Practice Topics program brought attention to the problem of early recognition and aggressive management of sepsis as early as 2014, with a few PfP hospitals adopting sepsis goals at that time. CMS’s Hospital Inpatient Quality Reporting program finalized a requirement for hospitals to begin reporting on management of sepsis and septic shock to the National Healthcare Safety Network effective October 2015. Alignment with this requirement has enabled widespread adoption of sepsis goals in the PfP’s current HIIN efforts, which began in September 2016. Like CMS, hospital executives and clinical leaders have leveraged data, partnerships, and innovation to develop new and more effective methods of providing care. They have modeled accountability and commitment by reviewing patient safety numbers at board meetings and publicly posting safety results and harm events on websites. They have also encouraged small tests of change grounded in the experience of others to yield sustainable improvements, and modeled key learning behaviors such as being open to small failures in pursuit of larger success. Healthcare Setting Management Essay

Always, the patient and family are at the center of ca re. CONCLUSION CMS has worked to develop, coordinate, and align policies to promote patient safety innovation through • development and leverage of infrastructure for data collection and for learning and action networks, • reputational and financial incentives for strong performance, • formal partnerships and contractual relationships with federal and private stakeholders, and • informal leadership that appeals to hospital professionals’ intrinsic motivation as caregivers and that challenges leaders to commit to bold goals requiring innovation to improve patient safety. Hospital executives can continue to make leadership commitments to develop systemsoriented programs of action at their own facilities—for example, developing a safety culture reinforced by the integration of quality improvement efforts across multiple initiatives while striving to retain the patient at the core. Establishing an environment that expects increased accountability and information sharing will create opportunities for informed decision making as well as enhanced self-management by patients and their families, and it will lead to better health outcomes.

The evidence the PfP has collected to date suggests that this environment can yield cost efficiencies, too (AHRQ, 2016a). It ultimately can make a positive impact on the experience of hospital personnel by reducing staff injury and burnout. Most importantly, these efforts make patients safer. 169 © 2017 Foundation of the American College of Healthcare Executives JOURNAL OF H E A L T H C A R E M A N A G E M E N T 62:3 M A Y /J U N E 2017 REFERENCES Agency for Healthcare Research and Quality. (2016a). Saving lives and saving money: Hospital-acquired conditions update.

Retrieved from www.ahrq.gov/professionals/quality-patient-safety/pfp/2014-final.html Agency for Healthcare Research and Quality. (2016b). National scorecard on rates of hospital-acquired conditions. Retrieved from www.ahrq.gov/professionals/quality-patient-safety/pfp/index.html Berenson, R. A., & Rice, T. (2015).

Beyond measurement and reward: Methods of motivating quality improvement and accountability. Health Services Research, 50(Suppl 2), 2155–2186. Hunt, D. R., Verzier, N., Abend, S. L., Lyder, C., Jaser, L. J., Safer, N., & Davern, P. (2005). Fundamentals of Medicare patient safety surveillance: Intent, relevance and transparency. In Henriksen, K., Battles, J. B., Marks, E. S., & Lewin, D. I. (Eds.), Advances in patient safety: From research to implementation (Vol. 2: Concepts and methodology) (pp. 105–117). Rockville, MD: Agency for Healthcare Research and Quality. Senge, P. M. (2010). The fifth discipline: The art and practice of the learning organization (Rev. ed.). New York, NY: Crown Publishing Group. Wang, Y., Eldridge, N., Metersky, M. L., Verzier, N. R., Meehan, T. P., Pandolfi, M. M., … Battles, J. (2014, January 23). National trends in patient safety for four common conditions, 2005–2011. New England Journal of Medicine, 370(4), 341–351. 170 © 2017 Foundation of the American College of Healthcare Executives Copyright of Journal of Healthcare Management is the property of American College of Healthcare Executives and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use Healthcare Setting Management Essay