Wednesday, September 26, 2007

Big News in Mexico

As I have mentioned before, we know our ministry in Mexico is one of the regions of CHRISTUS Health that will significantly help us restructure our portfolio and drive us closer to our innovative one-third acute, one-third non-acute and one-third international portfolio.

I know I have previously posted about our ministry in Mexico, how we got started there, and our now swiftly growing medical travel program. As I mentioned previously, before we partnered with the Muguerza health system in Mexico, our due diligence clearly demonstrated their high quality as well as a shared mission, vision and values.

However, we were able to provide the Muguerza system with a formal organizational structure through our Journey to Excellence that required them to know their quality and measure it, and stressed the importance that all their Associates must be able to articulate what their quality measurements are and their individual part in assuring that excellence is achieved and sustained. It quickly became clear that a renewed focus on transparency and measuring quality outcomes would serve as the catalyst to propel them to excellence.

So the Associates and leadership at CHRISTUS Muguerza embarked on their own journey to achieve external confirmation of their high clinical quality. They began this journey by pursuing CAP certification in the laboratory of one hospital. Today, CHRISTUS Muguerza Alta Especialidad Hospital’s Clinical Analysis, Pathology and Cytology Laboratory is the only one in Latin America to be certified by the College of American Pathologists (CAP). They are planning to pursue this certification in each of their hospitals’ labs in the near future.

Their next goal, which is part of the CHRISTUS brand, was to achieve accreditation from the Joint Commission International. And last week, we were informed that CHRISTUS Muguerza Alta Especialidad Hospital is the first in Mexico to receive international accreditation from the Joint Commission International, which granted the hospital their Gold Seal of Approval, their highest level of approval awarded. It is rare to receive this high level as a result of an initial survey.

For those of you not familiar with Joint Commission International, it is a prestigious international health care accreditation organization, and is a subsidiary of The Joint Commission, which is the largest accreditor of health care organizations in the United States.

Joint Commission accreditation criteria focus on key functional areas such as patient safety, consistency in the therapeutic processes and infection prevention. During the inspection, hospital Associates, physicians and patients were interviewed and a detailed audit of the hospital’s practices, processes, facilities and systems was conducted.

This accreditation signifies that CHRISTUS Muguerza Alta Especialidad Hospital meets the highest international standards for quality and safety in health care services, and we expect that the remainder of the CHRISTUS Muguerza hospitals will pursue Joint Commission International accreditation as well.

I would like to take this opportunity to again congratulate all of the leadership, Associates and all the physicians at CHRISTUS Muguerza Alta Especialidad. You are living proof of my assertion that we are not in the health care business serving people, but we are in the people business, providing them with compassionate, high-quality health care in the U.S., Mexico and beyond.

Wednesday, September 19, 2007

Sharing Best Practices

In any organization—whether great good, satisfactory or “needs improvement”—there are always some islands of excellence. Some people find innovative ways to overcome the barriers that organizations often create so that they can form excellence in their area of responsibility. And with their persistent focus and attention, they can even maintain these isolated islands of excellence while they are surrounded by chaos or mediocre performance.

I recognized this phenomenon early in my career, and sought ways to identify what was different in these islands of excellence. What were the processes, policies, competencies and skill sets that gave them the ability to excel? Often, the person to whom they reported and certainly a majority of their colleagues either did not posses these qualities or were not motivated to achieve or maintain excellence in their departments or programs.

After studying these islands and determining their unique qualities, it became clear that this was an opportunity to share these learnings with other parts of the organization. Hence, my commitment to the identification of best practices and the development of a process to share these best practices among others in the company was created. I know this is the best way to move an organization from islands of excellence to a continent of excellence as quickly as possible so the brand and brand promise are clear and uniform throughout. It is so essential that an organization’s Journey to Excellence can be accelerated by eliminating the need to “reinvent the wheel.”

It is this learning and understanding that has resulted in CHRISTUS Health developing a formal methodology to foster sharing of and rewarding best practices from around our system. The cornerstone of this process is our Touchstone program and award ceremony. The development of best practices is encouraged throughout our system, and if certain benchmark criteria are met, the practice has sustained itself for a reasonable period of time and has fostered measurable and reportable outcomes, these practices can then be entered into the CHRISTUS intranet for review and sharing across our international system.

Each year, any best practice that has been submitted via the intranet by April 1 can be considered as a finalist in our Touchstone program. To accelerate the Journey to Excellence, each best practice must fit into one of our “four directions to excellence,” which are: clinical quality, service delivery, business literacy and community value. The finalists are reviewed by staff “reviewers” who utilize a uniform set of objective criteria to rank and rate them. These selections are done in a blinded fashion, so as to prevent any prior relationships from influencing this process. Then these best practices are reviewed by the appropriate Senior Leadership Team members (those who are considered the experts in each of the directions). This process results in naming finalists in each of the five categories.

The finalists are then submitted to the appropriate committees of our System Board of Directors, and the board members select the winners. (Specifically, the Quality committee of the board selects the clinical quality and service delivery winner, the Finance and Strategy committee selects the business literacy winner, and the Mission and Ethics committee selects the community value winner.) This process provides high-level recognition and credibility to the participants since their projects have been elevated not only to the CEO and senior leadership, but also to the international CHRISTUS Health System Board.

In addition, this gives the committees of our board a clear understanding of the excellence which the Associates and physicians of CHRISTUS Health are creating on our Journey to Excellence.

In order to stress the importance of this program, an awards ceremony is held annually in association with our September leadership retreat. It is formatted much like the Academy Awards, and is a time of celebration of the highest level within the CHRISTUS family in order to provide enormous energy for all Associates to create and submit best practices throughout the following year.

This year, on Sept. 20, we will be holding our seventh Touchstone awards ceremony, which means we have reviewed over 400 submissions, named over 120 finalists and selected 32 winners. I consider this a clear representation that the “continent of excellence” has evolved during CHRISTUS Health’s eight-and-a-half year history.

In order to stimulate sharing of best practices--which is the ultimate end goal of the Touchstone awards—in the second year of the program we added one more category, the spirit exchange award. We utilize this category to reward facilities that have “stolen” a best practice from another region and implemented it in their own, providing clear evidence of positive results. In addition, we obviously recognize the facility or group that originated the idea and submitted it on the intranet so that it could be viewed and taken to other locations. We are hoping that through this part of the program, we will encourage more and more best practices to be shared. One of the major criteria for winning in any of these five award categories is that the best practice must be easily replicated and transported to another location in almost a turn-key process.

In the end, an excellent organization must move as rapidly as possible to benchmark levels of performance, and it is clear that developing and sharing best practices is the ideal way to accomplish such. It is best if this can be done via a formal, operationalized program such as the one we have described, to not only align the incentives to develop these best practices, but also award the true winners and heroes of an excellent company in a very high level fashion.

Wednesday, September 12, 2007

The Importance of Behavioral Services

As we have been reflecting on the future of health care in many previous posts, it is clear that among our many successes, we have failed miserably in one area of health care delivery: behavioral health.

Although 10 years ago many futurists would have predicted that the rapid development of medications to treat psychiatric illnesses would clear our inpatient mental health facilities, we have found that today there is more confusion and controversy not only on the diagnosis but of the efficacy of many of the drugs that at one time were thought to be miracle cures for mental disabilities. Unfortunately, before the facts were known, inpatient facilities were cleared and closed, driven for the most part by the rapid decline of reimbursement both by governmental and private insurers.

Consequently, our streets became filled with people unable to work or care for themselves, which has added to the growing number of uninsured and underserved in our country.

In addition, because of the aging population, we are seeing mental illnesses such as depression as well as medical diseases now occurring in the elderly that only once occurred in younger people. Consequently, we are seeing the need to open up geriatric psychiatric centers, both in inpatient and outpatient settings. Also, because of the rising ages of our seniors (it was recently reported that there are now 80,000 people in America over the age of 100), we will see more memory loss maladies such as Alzheimer’s or chronic senility. These will require new medications, new settings for care and new surgical treatments.

Hence, in our transformational strategy, we must make sure that we address the issues outlined above and attempt to correct. How might we do that?

1. Require that every region in CHRISTUS Health have a senior strategy that includes care for people with behavioral illnesses.
2. Require that every region have access to both inpatient and outpatient memory stimulation units. One example of this would be an intergenerational program in place in our Utah region or our “animal partner program”, which we are now encouraging not only in our senior centers, but also in our acute facilities.
3. Strengthen our advocacy program to encourage both the government and private insurers to re-establish reimbursement levels which are appropriate to care for this increasing population of senior behavioral problems.
4. Advocate for more research dollars to be spent identifying both causes and treatment for behavioral diseases, including the support of developing more outpatient procedures and safer anti-psychotic medications for this population.

At the present time, CHRISTUS Health has three geriatric psych units which can be studied thoroughly to determine the best treatment plans and can also be utilized as pilot sites for experimenting with new programs and processes which we may represent a breakthrough in care.

In addition, by demanding that these diseases be focused on in our new senior centers, hopefully we can continue to be leaders in advocating for enhanced services for behavioral health in all ages for people both in the U.S. and in our international ministries.

Wednesday, September 5, 2007

Organizational Redesign

As we discussed previously, for reasons that we believe are quite sound, we are transforming the CHRISTUS Health portfolio to one-third acute care, one-third non-acute care and one-third international. In order to accomplish such, it is necessary for our senior leadership team to review the leadership capabilities not only within our own team, but also within the leadership teams of the 11 regions that presently comprise our health system.

As the team reviews these capabilities, it may be necessary to look at both the organizational and governance structure of the system to make sure that our peoples’ capabilities are appropriately aligned. Although I will not discuss specific organizational changes that might evolve over the next several months or year on my blog, I think it would be appropriate for us to converse about several principles which might guide this process.

First and foremost, this transformation will require a clear understanding of not only what is included under the umbrella of non-acute care, but also a clear understanding of the rapidity of the growth in non-acute care as the factors driving it seem to be accelerating its growth at an unprecedented rate. Presently, we are defining non-acute care as “care which does not require a traditional inpatient bed in an acute setting.” However, this definition does include care that requires beds in non-acute settings, such as rehabilitation medicine, and our nine hospitals providing long-term acute care. Of course, all outpatient services would be included in this category, and this division will also include new ambulatory care programs which will evolve due to the technology advancements we discussed in detail in past posts.

At the present time, we are categorizing our non-acute care in four categories:
1. Outpatient care, facility dependent;
2. Outpatient care, non-facility dependent (visiting home nurses, etc.);
3. Inpatient care requiring non-acute beds (rehab) and
4. Housing, including both senior campuses and housing for the underserved.

In addition, our senior care is broken down into independent living, assisted living and nursing home, including memory units. It is clear by reviewing this list that both present and future leaders will need to possess new capabilities and leadership skills if we are to add needed competencies into our leadership portfolio, which has been developed mainly through educational courses and experiences which have been garnered predominately in acute hospital settings.

Then how will we gain this knowledge? Since many of our bachelor’s and master’s health care programs in the country have historically been driven by hospital knowledge, we believe this non-acute care training must occur predominately through our own capabilities. To do this, we have strengthened our organizational development department and are now offering formal courses and experiences in the following four areas:
1. Coaching and mentoring - We are identifying those people who we believe have strong capabilities to be future leaders, but perhaps do not recognize such or feel confident enough to apply for the 3 levels of training outlined below. Consequently, we are assigning each of these people to a coach from our senior teams for a one-year period. Formal training in coaching and mentoring has been provided for the over 60 people who are now serving as coaches, and a formal evaluation by the mentee is done at the conclusion of the year-long program. Now in its fifth year, we have proven that based on this coaching and mentoring—which is usually done by a mentor and a diverse mentee—that these people have gained the confidence and knowledge to apply for and be selected for our more advanced leadership programs.
2. Center for Management Excellence – This four-day workshop has been designed through a Senior Leadership Academy project (see below) to train all managers in a very focused way in the basic skills that they need to manage both the acute and non-acute areas of operations. All present CHRISTUS managers have gone through this course and all new managers go through the course in the quarter they were hired, since it is now repeated every three months during the calendar year.
3. Senior Leadership Academy – Now in its sixth year, a multidisciplinary committee selects 30 candidates from an applicant pool of strong directors and managers in CHRISTUS Health who have demonstrated the skills and motivation to take on additional leadership responsibilities. Through five three-day sessions, and by working on one of four assigned projects, which when completed should help CHRISTUS advance on its Journey to Excellence, these academy members gain a broad exposure to both operational and strategic issues including detailed business literacy and an enhanced focus on governance, which is rarely experienced at this stage in one’s leadership pathway. It is important to note that these graduates are given the first opportunity to apply for leadership openings throughout the organization, and over 30 percent of academy graduates have been promoted.
4. Talent management and succession planning – In order to make sure that there is always a potential internal leadership pool from which to fill the top senior leader and regional leadership team spots, the first class of 16 outstanding leaders have been organized to participate in succession planning and talent management. These participants, who are identified by having outstanding performance in the prior three years as well as outstanding potential based on statistically significant testing, are assigned external coaches for 1 year. During this year, intense developmental plans are implemented to address necessary growth opportunities so that at the end of the year, these 16 people should have the full array of skills necessary to be the transformational leaders of CHRISTUS Health tomorrow.

Yes, at the end of the day, transformational leadership and organizational structural changes must be made to move an organization such as CHRISTUS Health from its traditional hospital inpatient focus to an exciting to one-third acute care, one-third non-acute care and one-third international portfolio. At present, this transformational knowledge must be gained internally, providing future leaders with the knowledge and experience required to be successful.