Thoughts for Holy Week

As Holy Week approaches, leading to the crucifixion on Good Friday and the resurrection on Easter, I am reminded of the inherent message of eternal hope that the season brings. As CHRISTUS continues our Journey to Excellence, we have, and will continue to have, many challenges which may seem insurmountable. However, we all know that with time, effort and focus, potential solutions will be identified and the pathway to success will appear far less daunting.

One recent example that comes to mind is our task force on Haitian Relief, which worked tirelessly over a period of several weeks to coordinate CHRISTUS’ response to the devastating earth quake that struck Haiti on Jan. 12. The task force finalized plans to send a 20-member team, together with ample medical supplies to Port-au-Prince to provide medical care and spiritual assistance from Feb. 20-27 in partnership with the University of Miami Miller School of Medicine. In all, our CHRISTUS team performed 85 surgeries, hundreds of procedures and outpatient visits and delivered nine babies.

Over the course of one week, as challenges and obstacles of all varieties were faced and overcome on a daily (and sometimes hourly) basis, the mission that had seemed overwhelming upon our arrival in Haiti become a miracle in and of itself.

In answering the call for help as the Sisters from France did so many years ago, the CHRISTUS family left the hospital in Port-au-Prince a better place. Our CHRISTUS missionaries will always remain astounded at the incomprehensible resilience of the Haitian people. In the spirit of the Easter season, the Haitian community is slowly and incrementally transforming tragedy into hope.

As we experience Holy Week and the resurrection, I am again reminded of our foundation in Incarnational Spirituality, and the honor and privilege we have each day as members of the CHRISTUS Family, to carry out the healing ministry of Jesus. May we also especially this Easter remember the people in Haiti that touched in Haiti and that we continue to heal in CHRISTUS Santa Rosa Children’s Hospital. So may each of us, in our own way, call upon our spirituality, and reflect on this prayer.

How We Are Seen
An Expression of our Incarnational Spirituality

Wherever our feet walk
We leave footprints
On the ground in Haiti,
on the grass at the Sisters Park
In the floors of our homes
And where we work
Wherever our live travel takes us each day
We leave our identity.

Wherever our hands touch
We leave fingerprints
On our patients and families
Both in Haiti
And those we touch daily in all of our ministries
On the walls, on the furniture
On doorknobs, dishes, books
As we touch them, we leave our identity.

O God, where we go
On our Journey to Excellence today
Help us to also leave heartprints
Heartprints of compassion
Of understanding and love
Heartprints of kindness
And genuine concern.

May our hearts touch
The Haitian children now at Santa Rosa
The concerned family members of our patients
The residents in our senior centers
Those seeking relief in our clinics
And all of those who turn their most precious gift – their lives
Over to us each day.

Lord, send us out today
To leave heartprints on all of these people
And if one of them should say
“I felt your touch”
May that person sense our commitment
To Your healing ministry.
This is our identity.
We are CHRISTUS Health.
Amen.

What Nursing Shortage?

Healthcare Finance News recently published an article about a new study by the Health Resources and Services Administration, which found that the nursing workforce is growing and diversifying.

The study reported that the number of licensed registered nurses in the U.S. grew to a new high of 3.1 million between 2004 and 2008, an increase of more than 5 percent. The study also found a 4.6 percent increase from 2004 to 2008 in the percent of nurses who are Asian, Black/African/American, American Indian/Alaska Native and/or Hispanic.

This further supports my previous assertions that it is possible the nursing shortage has been overstated. When we have “nursing shortages” in a patient care delivery setting, we are able to find a contract nurse to fill the slot. I think that if all the nurses filling more lucrative contracted positions would take permanent employment, the perceived shortage would quickly diminish.

In addition, because of recent layoffs in many other industries due to the global economic crisis, more students are applying to nursing schools. When trained, having put forth the money and time, they will not leave a profession where there is much greater job stability.

In fact, the White House/Congressional Leadership Reconciliation Bill [Health Care and Education Reconciliation Act of 2010 (H.R. 4872)] which was just passed by the House and signed by President Obama yesterday, includes additional investments to improve health care workforce training and development, some of which focus on nursing specifically. For instance, the bill aims to address the projected shortage of nurses and retention of nurses by increasing the capacity for education, supporting training programs, providing loan repayment and retention grants, and creating a career ladder to nursing. (Initial appropriation in fiscal year 2010.) It also provides grants for up to three years to employ and provide training to family nurse practitioners who provide primary care in federally qualified health centers and nurse-managed health clinics. (Funds appropriated for five years beginning in fiscal year 2011.)

Nurses are such a vital part of the care delivery process that what cannot be overstated is the importance of this issue. However, I believe it is possible to meet the nursing shortage we are feeling now, and am hopeful that these investments in encouraging future students to pursue nursing will further enable us to put care within reach of all those who need it.

Disaster Response: What we Learned from Haiti

As I mentioned previously, CHRISTUS’ 20-member team worked in Haiti from Feb. 20-27 and performed 85 surgeries, hundreds of procedures and outpatient visits and delivered nine babies.

We have since debriefed with team members who traveled to Haiti as well as with the task force that worked to identify and vet partner organizations in Haiti and select, organize, orient and commission the Haiti team. I believe our findings are so important that they are worth sharing. We will take these learnings with us if we pursue future trips to Haiti, and know they will also be useful when our facilities situated on the Gulf Coast face future hurricanes.

The principles of CHRISTUS’ successful mission in Haiti include:
• Command - From inception to operation (mobilization and demobilization), command of the task force and team in Haiti were clear.
• Control – Leadership established control via regular conference calls, daily operational updates and by ensuring the team was composed of the right number and type of personnel to meet the mission requirements. Span of control was maintained with appropriate number of workers to supervisors.
• Communication – Planned conference calls and regular communication before, during and after the mission facilitated information exchange and flow (up & down the organization, across functional areas and to/from external partners). This provided opportunities for real-time information to be passed on to appropriate teams so correct responses to changing needs of the mission could be anticipated and planned for and so the CHRISTUS family remained informed.
• Coordination – The coordination amongst partners on the ground in Port-au-Prince, between internal CHRISTUS departments, external government entities, and private resources was notably welcomed.

Members of the team that served in Haiti expressed an overall feeling of pride and accomplishment. They said that the team worked together flawlessly, and they were grateful for the opportunity to care for the people of Haiti. However, many also expressed angst over leaving so much undone, describing their work as a “drop in the bucket” of what would be needed throughout the city.

Almost all team members expressed interest in traveling to Haiti again, and many suggested that the task force consider sending another CHRISTUS team. It was also suggested that we consider a more long-lasting way to respond to disasters by working with CHRISTUS to identify early responders now. We are considering this suggestion and may implement an early response team to provide “intellectual capital” and care to devastated regions.

A few also expressed that one week in Haiti was not long enough, and that they were able to get into the rhythm of the work around the third day, but then had to leave 3-4 days later.

Team members expressed that CHRISTUS’ inclusion of chaplains in the team and their administration of spiritual care were central to our ministry there. “We not only operated on people, but were able to love and care for other needs,” one team member said.

While in Haiti, the wound care team started a Haiti Google group with suggestions and a list of items helpful to pack (sharpies, pens/paper, etc.). New team members emailed and posted questions regarding vaccinations, medications and what personal items to bring, and asked what they could bring to help families and what equipment was needed (connectors for wound vacs, sponges, etc.). This helped old team members keep in touch with local workers and continue the aid process from home.

Many believe that CHRISTUS’ leadership and organizational skills were pivotal to the work there. Team members unanimously expressed that the task force did a wonderful job, especially with organization and supplies.

Additional supplies they would like to have seen include:
• Postoperative needs such as wheel chairs, walkers and crutches
• Mosquito nets
• Additional walkie talkies or a way to facilitate easy communication between all caregivers and not just triage/ER staff
• More bottled water
• Foam hand wash (as there was no running water, we used antibacterial hand gel to sanitize our hands, but some team members felt it was sticky and made getting gloves on and off difficult)
• Extension cords
• Chairs
• Chux pads
• Drapes for tables
• Blue booties to use over dressings on feet
• Small autoclave
• Suction machine and canisters

Team members also mentioned that they discharged many Haitians to the streets, as they were without permanent shelter. They suggested continuing to send tents if possible.

Truly, our time in Haiti was just one more way that members of the CHRISTUS family lived out the CHRISTUS mission to extend the healing ministry of Jesus Christ around the globe. I am proud of each and every one of our CHRISTUS healers, and remain proud to be the team leader for CHRISTUS.

Can an aggregator model really work in health care?

Brandon posted a comment on my previous post about aggregators and health care that I thought deserved a thorough response.

First, let me say that I very much appreciated Brandon’s comment. This is such an interesting topic, and one that deserves much attention and discussion as all parts of the care delivery spectrum—providers, patients and their families and even lawmakers and regulators—determine how we can redesign our current health care system to provide the highest quality care at the lowest cost.

However, I believe that perhaps the metaphor of the travel industry was taken too seriously—there are many aggregators outside the travel sector, like EBay, Craigslist, and Google. We’ve been unable to find a good example of an aggregator within health care, but hope to be the first to establish some future models! Regardless, it’s clear that health care providers must take ownership of the need to connect the dots between the various points of service on an individual’s journey to maintain wellness and health, some of which will require health care services.

This will be a slow process, and probably happen on a region-by-region basis within the CHRISTUS system—we will not jump into an Expedia model overnight! But we may begin by providing service-line-specific or disease-specific or demographic-specific aggregators that link necessary services. All these partners may not be on the exact same computer platforms, but we can develop the necessary interfaces to link critical information to allow us to manage care across the continuum and to reduce cost. Imagine a cancer aggregator or a knee replacement aggregator – we may have to begin in a very informal and inefficient manner and take incremental steps forward, but if we align incentives correctly, we will improve service and reduce cost.

We’re trying to keep in mind that most great ideas—including the great aggregators we’ve run across in our research—were not initially intended to be aggregators. Great ideas like Broadcast.com were born by two guys who wanted to listen to college basketball games and turned their need into a multibillion dollar internet broadcasting business. The founders of Yellow Dog Fly Fishing did not set out to build one of the world’s largest flyfishing Websites (aggregators) in the world—they started by answering questions from people who wanted to flyfish in Montana, and have ended up with a service that brings together busy people who didn’t have the time or energy to research flyfishing trips with flyfishing services around the world that have been vetted and experienced. Aggregators must be able to overcome the barriers to coordinated care that health care providers in the U.S. have been thus far unable to address effectively and efficiently, and we believe that is a possibility.

That’s a very lengthy response to Brandon’s comment, but I look forward to continuing the conversation!

1 of our 5 Strategic Directions: Aggregator Models

Health care in the U.S. is famously fragmented. We’ve heard many times in the health care debate that this problem needs to be fixed so we can ensure that the health care system works to serve patients and not providers. In fact, these breakdowns are well-illustrated by the following video, “If air travel worked like health care,” which we’re showing in one of our breakout sessions.



It’s obvious to all involved that we have silos in health care, and need to find a way to work together to provide a continuum of care that works for everyone. This is what makes aggregators such an important part of the future direction of CHRISTUS.

Being an aggregator does not mean owning all parts of the continuum of care, but partnering and pulling in services from other providers. Websites like Expedia and Travelocity are good examples—they don’t operate airlines, but instead offer a central place where flights from many different airlines can be compared and purchased. In the same way, serving as an aggregator would mean that we would develop partnership models that allow us to generate new revenue, lower cost, improve customer service, etc.

Customer service still remains important in an aggregator model, so Service Quality, one of our directions on our Journey to Excellence, receives continued focus. An aggregator is not a shortcut to the customer—you still have to prove yourself in customer satisfaction every day. If we don’t have the tools in place to measure and track customer satisfaction to ensure high quality service, then providing this model has done nothing more than find a costlier way to provide care.

Findings of CHRISTUS’ Second Futures Task Force

CHRISTUS Health’s Futures Task Force II embarked on a year-long journey to identify the emerging trends that would shape the world, the health care industry and the CHRISTUS Health ministry in 2020 and beyond. This journey included a deep exploration of trends in a vast array of areas including social paradigms, science, technology, energy, consumer empowerment, the environment, geopolitics, innovation and the definition and role of community, to name just a few.

Futures Task Force II identified 5 critical strategic directions that CHRISTUS must follow to meet the changes coming in the next 10 years.

Five Critical Strategic Directions

1. Realign the portfolio to create stronger, more dynamic structures to strengthen and sustain the ministry long term
• Constantly consider optimal processes, structures and services and modify the CHRISTUS portfolio accordingly
• Employ intense and sustained operational discipline to garner optimal performance from all entities
• Invest in innovative new services and markets that increase the relevance and strength of the ministry.
• Divest of ministries that cannot achieve viability or market relevance to meet the needs of our community members

2. Recreate CHRISTUS Health for a Base of the Pyramid (middle/low income) Population - Redesign our health ministry to serve the broadest population in our communities, increasing our reach ten-fold
• Develop a strategic niche as the high quality, low cost care provider by innovating the care delivery process
• Over HALF of the US population cannot be sustainably served with our current health care delivery system. Throughout our CHRISTUS markets, we are called to find innovation solutions to meet the needs of our communities, and serving the base of the pyramid will be critical as this segment expands.
Total US Population - 300 million - 100%
Total US Uninsured - 46 million - 15.3%
Total U.S. Underinsured - 25 million - 8.3%
Total U.S. Medicare population - 45 million - 15%
Total U.S. Medicaid population - 52 million - 17.3%
• Expand existing low cost strategies to new customer bases
• Develop new and sustainable care delivery processes that improve access and maintain quality
• Focus on innovating at the “low end” of the continuum
• Implement internationally and in the US

3. Build “aggregator models,” in which we own, partner for or vet an ever-growing array of products and services designed to meet the needs and expectations of our customers, whatever they may be.
• Develop aggregator models to generate new revenue, lower cost, improve customer service and expand products and services to targeted customers
• Base aggregated products and services on in-depth customer research
• Partner, develop and/or acquire technology to grow and strengthen the aggregator model
• Develop disease/demographic specific aggregator models to support the broader ministry

4. Strengthen and expand our international ministry to diversify and strengthen the system portfolio and expand the ministry in an increasingly global world.
• Build upon our successes of CHRISTUS Muguerza in Mexico to double the size of our Mexican ministry through strategic partnerships and internal growth strategies.
• Expand our international presence throughout the Americas and consider other opportunities as they arise
• Implement “base of the pyramid strategies” internationally
• Incubate innovation in international markets

5. Harness the new power of technology to further our vision and enable our strategy
• Develop a technology strategy to support the broader vision
• Develop partnerships with technology developers to grow and support long-term direction
• Partner to develop branded technologies as new revenue source strategic enabler as well as strategic differentiator
• Embrace GRIN (Genetics, Robotics, Information technologies and nanotechnologies)

How the findings of CHRISTUS’ First Futures Task Force Impacted CHRISTUS

The findings of Futures Task Force I included:
1) The declining reimbursement under the control of both the federal and state governments, and
2) The rapid introduction of technology that would move a significant amount of health care from an inpatient setting to the non-acute arena. At CHRISTUS, we define non-acute care as “care and services that do not require an inpatient acute care hospital stay” (i.e., outpatient sites, clinics, continuing care retirement communities, long-term care, etc.).

In fact, when we began future planning, we believed—and have subsequently proven—that this introduction of non-invasive technology would be so rapid that it would be disruptive. In fact, it is so disruptive we could not respond rapidly enough to its introduction and were burdened with the question, “Should we purchase the first generation of the technology, or wait to purchase the second generation?” Technology is changing so rapidly that with limited financial resources, this question needs constantly to be asked, and then, as objectively as possible, be answered using data as rationale.

You can read more about these findings at a previous blog post here. These findings proved to be such a shift in thinking from traditional health care models that we started on a journey to redesign our portfolio to one-third acute care, one-third non-acute care and one-third international care. I blogged about this redesign in 2007, so feel free to read more there if you’re interested in more in-depth information.

Planning for the future – Futures Task Force II

We will be sharing and building upon the findings of our second Futures Task Force at the CHRISTUS Leadership retreat, which begins today. I know I have mentioned our learnings from these task forces in previous blog posts, but thought it would be useful to start with a description of our task force process. Later today and tomorrow we will share some of the learnings of the task force and how it relates to our future planning.

In 2000, CHRISTUS convened the first Futures Task Force, which was of the utmost importance as our newly-formed health system set out on a new path. The task force undertook an extensive literature review and study of futures thinking to set the context for the challenges that lay ahead in order to anticipate what our world would look like 10 to 20 years into the future.

The four scenarios drafted by Futures Task Force I painted pictures of how the world might look in the future. They predicted that reimbursement would continue to decline, particularly on the inpatient side, which would be exacerbated by a large national crisis (like a war) that would draw further funding away from health care. The events of 9/11 and the ensuing wars in Iraq and Afghanistan have proved that prediction to be true.

The scenarios also predicted an increase in globalization (or the “shrinking of the world”) and the rapid introduction of new technology which would be disruptive but also allow more care to move to the outpatient arena. These scenarios resulted in 19recommendations which altered the strategic trajectory of our health ministry, and fueled CHRISTUS’ partnership in Mexico and restructuring of the portfolio to include one-third acute care, one-third non-acute care and one-third international operations.

In October of 2007, CHRISTUS Health once again engaged in a focused effort to understand the trends shaping the future in order to ensure that our health ministry would be appropriately positioned to continue our mission of extending the healing ministry of Jesus Christ. It was determined that revisiting CHRISTUS’ assumptions regarding the future was critical at that time, given the many changes that the world, the industry and CHRISTUS itself had experienced since the first Futures Task Force completed its work. The world had changed dramatically since June 2001; several global disruptive events had changed the political and economic landscape; the health care industry was challenged with a changing business model, regulatory environment and a rising numbers of the uninsured. Additionally, much of the findings and recommendations of the first Futures Task Force had become industry standard, diluting any strategic value to CHRISTUS. Perhaps most important, we found ourselves at a critical juncture in shaping our strategic direction, and determined that the correct long-term context was critical to long-term success.

Therefore, Futures Task Force II embarked on a year-long journey to identify the emerging trends that would shape the world, the health care industry and the CHRISTUS Health ministry in 2020 and beyond. This journey included a deep exploration of trends in a vast array of areas including social paradigms, science, technology, energy, consumer empowerment, the environment, geopolitics, innovation and the definition and role of community, to name just a few.

Task force members identified three overarching trends that they felt would be most critical in shaping the future and that of the health ministry. These include:

• Customer empowerment is relatively new in health care, but is a phenomenon to which most industries have had to respond. The health care industry is witnessing it now because consumers and patients have greater access to information (including health information and social media and networking online), the fact that they often share a greater responsibility for the cost, and rising dissatisfaction with the health care industry
• Globalization and the interconnectivity of markets, communities and cultures across the globe, which has been a growing reality for decades. It is largely driven by technology, but we know now that there are no geographic boundaries to social networks, so globalization now happens at a personal level. It affords product distribution networks with access to new customers, new products and offers low-cost, highly scalable business models.
• Technology: Trends in information and clinical technology have long been major drivers in the evolution of nearly every industry. Once again, social networking/business distribution networks open up new opportunities for learning, connecting and marketing across the economic pyramid. In health care, the possibilities continue to be astonishing—genetic intervention and DNA therapies may soon eliminate some diseases. Early diagnostics and intervention already eliminate the need for certain care, which continues to migrate out of institutions into new delivery models.

Final Haiti Update and Thoughts on Answering a call

Our flight left Haiti around 5:45 p.m. on Saturday, which was fortunate for the patients, because many caregivers left at noon, with the next team not arriving until around 3 p.m. The CHRISTUS team worked until 2 p.m. in all areas, and then packed and left for the airport around 3:30 p.m. We worked to ensure that there were knowledgeable and hard-working leaders for each of the patient care areas who were adequately trained and transitioned before we left.

Fortunately, there was no rain throughout the duration of our team’s stay, but rain is expected this week. The inpatient areas and the operating room consisted of ply-board flooring, but the remainder of the tents, including the team’s sleeping tent, was packed with straw on the floor.

The team all arrived in Dallas safely, and bedded down in a hotel near DFW International airport at about 1 a.m. Sunday. Team members then made it to their homes safely throughout the day Sunday.

The CHRISTUS team performed 85 surgeries, hundreds of procedures and outpatient visits and delivered nine babies in Port-au-Prince. The Haitian people will be forever grateful and will benefit from the CHRISTUS family long into the future. We were truly blessed to be able to support and send this mission in answer to the call from Haiti, which was very similar to the call that would eventually found CHRISTUS Health.

CHRISTUS traces its roots back to 1866, when Bishop Claude Marie Dubuis issued a call for Religious Sisters to immigrate to Texas to help care for those struggling with illness, disease and poverty of staggering proportion. In a letter to his friend, Mother Angelique, Superior of the Monastery of the Order of the Incarnate Word and Blessed Sacrament in Lyons, France, he wrote, "Our Lord Jesus Christ, suffering in the persons of a multitude of the sick and infirm of every kind, seeks relief at your hands."

Mother Angelique found three young Sisters to travel to Texas from their native France to answer the Bishop’s call, and they founded the two congregations that brought their health care ministries together to form CHRISTUS in 1999.

Almost 150 years later, our hands, supported by the hands of the CHRISTUS family, served our brothers and sisters in Haiti who also face illness, disease and poverty of staggering proportion. We truly fulfilled our mission of extending the healing ministry of Jesus Christ. And to continue our ability to do this far into the future, we understand the importance of future planning and training leaders who can continue the work begun by Bishop Dubuis and three Sisters so long ago.

That is why I have transitioned from our work in Haiti to work in Houston this Thursday and Friday. I will be talking with CHRISTUS leaders about the future of our world, the health care industry and our health care ministry at our regular leadership retreat. The world is changing quickly, so it is imperative that we share what we have learned from our strategic planning initiatives to accelerate our Journey to Excellence through integration, focus and ownership.

We will share some of these learnings online in various ways. Join us by:
• Visiting my blog on Thursday and Friday for posts about what we’re sharing at our leadership retreat,
• Following us at the CHRISTUS Health Twitter account, or
• Tracking the hashtag #CHFuture on Twitter.