Wednesday, January 7, 2009

A Message for the New Year: At This Moment in Time

I recently distributed a message about the coming year to all our CHRISTUS Associates. I believe it may be helpful to other health care leaders who are also facing these tough economic times and are reflecting on the most effective methods to achieve excellence in all areas this year.

Below are some excerpts from that message. My video blogs will resume next week.

As each of us enters 2009 as part of the CHRISTUS Family and travels toward the 10th Anniversary of our ministry on February 1, 2009, it seems most appropriate for me to share some important information and reflections as we continue our Journey to Excellence which we, together, began nearly a decade ago. At this significant and historical moment in time it is crucial for us to reflect on and honor our past history and accomplishments, to implement the performance improvement plans necessary for our present success, and to envision and invest in the future of CHRISTUS Health, striving continuously to be one of the best health systems in the world.

Answering the Call for Another Decade

Responding to the call of Bishop Dubuis over 140 years ago which indicated that “a multitude of sick and infirmed of every kind seek relief at your hands,” the two Congregations of the Sisters of Charity of the Incarnate Word in Houston and San Antonio established two health care systems which merged in 1999 to become CHRISTUS Health. We have been driven by our Mission – to extend the healing ministry of Jesus Christ; guided by our Values – dignity, integrity, excellence, compassion, and stewardship; and directed by our Vision – to be a leader and advocate in creating exemplary health care services, processes, and structures that improve the health of individuals and of local and global communities so all may experience God’s healing presence and love.

Together we have experienced 10 years of challenges and changes, while creating significant and measurable progress. During these 10 years, CHRISTUS Health has grown from 23,000 to 30,000 full, part-time, and per diem Associates, from 5,500 to 6,800 physicians and from 1,000 to 1,500 volunteers who serve our ministries in eight states in the United States and nine states in Mexico. Although we have grown and accomplished much, we will still continue to face challenges and will be required to make more changes in the future. As we begin our second decade as the CHRISTUS Family, we also must again reaffirm our commitment to answer the call since there are still a multitude of sick and infirm who seek relief at our hands.

A “Perfect Storm” Sets the Stage for 2009

As we enter 2009, external forces are buffeting the health care industry, forcing all delivery systems, including CHRISTUS Health, to react to and prepare for new financial realities, regulations, and new technologies. Chief among these forces will be the effects, both short- and long-term, of the global economic crisis, a new President, a different Congress, and significant declines in state treasuries. Like the “perfect storm,” we recently experienced in Hurricane Ike, several problematic fronts have been and will continue to brew simultaneously on the U.S. health care horizon, connecting, converging, and challenging hospitals and health care systems to do more with less. The economic crisis, which has affected the entire world, also mandates the same for our international ministries in Mexico.

The realities of rapidly surging health care costs, flattening Medicare and Medicaid reimbursements, the rising tide of an aging population, evaporating of federal and state funding for education and housing – two critical components for creating and maintaining “wellness” – the new wave of the uninsured and underinsured, soaring insurance premiums, and a health care labor shortage are forcibly coming together, leaving providers like us with no easy solutions for surviving the torrential storms. In fact, there is growing evidence that current health care systems of nations around the world will be unsustainable if unchanged in the next 15 years. Five competitor hospitals in our regions have already closed or declared bankruptcy, a number which is rapidly growing in the U.S., which some predict may affect 1,200 of the 5,500 hospitals serving the American people.

At present, hospitals have closed from impoverished Newark, NJ to wealthy Beverly Hills, CA. In addition, other health care systems have implemented layoffs, other cost-cutting action plans, and scrapping or delaying building projects. It is inevitable that more hospitals will close. Most endangered are rural hospitals and urban ones with excess hospital beds and a lot of poor, uninsured patients.

In addition, donations and investment returns are down, patient visits are flat, and profitable diagnostic procedures and elective surgeries have declined as people with inadequate insurance are delaying care. Unfortunately, many of these people are turning up later in our emergency departments seriously ill. And finally, patients and insurers have been paying bills, not only more slowly, but in some cases not at all, thereby increasing our bad debt.

It is in the midst of this storm that we stand at this moment in time. It is in the midst of this storm that we begin our Journey to Excellence for the next decade of the CHRSISTUS Health ministry.

Our Response to the Storm – Enhanced Focus on our 4 Directions to Excellence

The key for us who serve in CHRISTUS Health so as to not only survive but also thrive in the future is to further improve cost management and efficiencies, the major focus of our performance improvement plans throughout 2008. In addition, we must continue, with even more energy, our Journey to Excellence which we have said so often in these last 10 years is a necessity, not a luxury, because each day thousands of people continue to seek CHRISTUS services in our acute, non-acute, and international locations to improve their lives or the lives of their loved ones. These interactions and relationships have been, are, and will always be an awesome and sacred responsibility.

In addition, further quality and service delivery improvements must continue to move toward the goals we have set for these critical Directions to Excellence as part of our Balanced Scorecard which we defined and implemented in 2000. We must also continue our commitment to transparency, reaffirming our belief that the only way we can chart our course to excellence is through open and honest communication of our performance metrics, reported regularly on our web page for all 4 of our Directions –Clinical Quality, Service Delivery, Business Literacy, and Community Value.

Collectively We can Help Create Success in our Second Decade

What can each of us do to collectively make CHRISTUS Health stronger as we begin our second decade?

With our Mission, Vision, and Values always before us, we first and foremost must manage and reduce labor and non-labor costs. This will involve being more accepting of flexible scheduling and monitoring each position to determine its value before immediately filling it. Supply costs, as we all know, are the second largest health system expense. Clearly, being more compliant to our standards, working more closely with physicians after giving them as much cost data as possible, and negotiating reduced costs from pharmaceutical companies and other vendors will continue to be most helpful.

Second, improving patient through-put must receive even more attention. Patient flow is a constant challenge for all hospitals today, and it is one of the most common causes for low patient satisfaction scores, particularly in outpatient areas and emergency departments. Bottlenecks not only compromise access to care when patients are diverted from our emergency departments because of bed shortages, but also prevent us from accepting referrals or direct admissions from physicians. As a team, we must enhance and expand our care management programs, since delays and inefficiencies can cause increased length-of-stays, decreased quality and service, and ultimately lost revenues.

Third, we must more effectively integrate physicians into our operational improvement plans. We know that physicians have progressed well beyond being internal customers to assuming primary roles in health care management. We also know we have increasingly found ourselves in direct competition with our local physicians for patients and residents. Clearly, we must achieve a more successful balance with our physicians and physician extenders, and continue growing our plans to do so with a multitude of affiliation options for partnering that are mutually beneficial, including the physician and physician extender employment model.

Fourth, we must continue to reduce risk and enhance our focus on monitoring compliance, keys to further controlling our costs. It is imperative, with regard to the latter, that we do not lose our “moral and ethical compass” as we face the pressures associated with the challenges we articulated earlier. Fortunately, CHRISTUS Health already has strong internal audit, compliance, and risk management functions which place us, for the most part, in good position as the health care industry is being increasingly scrutinized by a myriad of federal and state regulatory agencies, along with congressional committees and state attorneys general.

And fifth, we must be willing to make additional changes, yet unknown, as we continue on our Journey to Excellence in the next decade of service. A popular bumper sticker says “change is easy – you go first!” Certainly, the pressures to address the challenges outlined earlier can create tension between senior leaders, managers, front line associates, and clinicians. However, if we can each keep a picture of a patient in our minds and hearts as we address the challenge we face at this moment in time, I am positive that, for the most part, we will do the right things which will create more Miracle Moments in our ministries, and help us reach our measurable goals in all 4 Directions to Excellence. It is clear that resistance to change significantly hinders successful execution of improvement plans and it is also clear that if change is to be better, it must be based on an understanding of why things are the way they are.

Future Thinking and Continuous Lifelong Learning: Keys to Our Success

Driven predominately by the rapid development of increasingly non-invasive technology, health care delivery processes are constantly changing. As examples, in the first decade of its existence, CHRISTUS Health has seen some old diseases cured, new diseases identified, healthier aging of seniors, and more understanding and enhanced treatments for memory disorders. Because of this rapidity of change, health systems that strive for excellence must embrace continuous life-long learning, allocate time to future thinking, and support and participate in future, long-term planning. At this moment in time, CHRISTUS Health is known for developing and enhancing these attributes as part of its brand, learning much from Futures Task Force I in 2000-2001, the 10 year Journey to Excellence, the critical Board Retreat in 2005, Dr. Royer’s Task Forces, the articulation of the Umbrella Strategy, and Futures Task Force II work begun in 2008. These important events on our journey have given us the ability to be early adapters of innovative strategies, including focused acute care expansion, growth of non-acute services, and development of an international presence, including the CHRISTUS Muguerza medical travel program. Utilizing the knowledge gained from these intense and beneficial experiences, we will have the opportunity in 2009 to review again many of our learnings and intensify and modify, if appropriate, our focus and strategic directions so we can speed our call to successful actions.

A Perfect and Prayerful Opportunity

A great philosopher once said, “pain is inevitable, but suffering is optional.” Health care’s perfect storm, accentuated by the global economic crisis, is upon us at this moment in time. Many of the external factors causing it can not be controlled. However, we do have the opportunity to control how rapidly we continue to design and implement the action plans to calm the storm. Who better than CHRISTUS Health understands the ravages of floods and hurricanes, and what must be done to bring forth the sunlight!

Calm perseverance, innovative approaches and a clear course of action has in the past, and will in the future, carry CHRISTUS Health through even the worst of conditions. As a family, and as individuals, we can do much to address the challenges in 2009, make the changes required, and thereby, create the progress necessary to not only sustain, but redesign and or grow our various ministries.

A Sincere Thanks

As we begin 2009 and our second decade as part of the CHRISTUS Health Family, it is clear we have traveled far and touched many lives on our Journey to Excellence. It is important at this moment in time that we pause to reflect on the past, present, and future of our sacred ministry. On behalf of the Senior Team, I would like to thank you for your individual and collective team efforts. As you have done so well in the past 10 years, I would ask each of you to again hear and respond to the call of Jesus Christ in the multitude of the sick and infirm of every kind who still seek relief at our hands.

As we continue to answer this call, let us pray that 2009 may be one of the very best for your families and loved ones, that all the lives we touch in CHRISTUS Health in so many different ways will be blessed, and that a more peaceful world will evolve.

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