Five Ways Hospitals Will Change Over the Next 10 Years

I recently shared an article with our leaders from Becker’s Hospital Review entitled, ”5 Ways Hospitals will Change Over the Next 10 Years”.

I believe the information presented reaffirms what we have been saying, and supports the CHRISTUS vision, as well as our 5 Strategic Directions and 8 Enablers. In fact, I have blogged about all of the changes listed in this publication over the years. If you’d like to read more about how CHRISTUS is addressing these changes, I’ve provided links to these blog posts below.

5 Ways Hospitals will Change Over the Next 10 Years:

1. Hospitals will redesign their current processes rather than build new facilities. Blog post: Organizational Redesign

2. Physicians, RNs and physician extenders will do the work that fits their credentialing. Blog posts: Remembering the Human Touch and Health Care Reform: The Primary Care Crisis

3. Some hospitals will inevitably fail. Blog post: Competition and Collaboration

4. Hospitals will focus more energy on reducing readmissions. Blog posts: Catholic-Owned Health Care Systems Earn High Marks and CHRISTUS’ Changing Portfolio: 1/3 Non-Acute Care

5. Hospitals will have to focus more on disease prevention. Blog post: Health Care Reform: Wellness Programs and Prevention

Mental Health – An Important Part of Wellness

As we have now enhanced our focus on health and wellness as articulated in our current vision statement, it is imperative that our system, regional and business unit governance boards, in partnership with management, embrace, in a more focused way, the “Seven Determinants of Health.” These include:
• Primary outpatient locations that are convenient;
• Schools with quality teachers and educational processes;
• Preschool and after-school programs for working parents;
• Appropriate low cost housing;
• Appropriate nutrition;
• Appropriate psychological and psychiatric services;
• Right-sized hospitals with the appropriate acute care services.

Of all these services, those associated with psychological and psychiatric care have been significantly reduced over the last decade and are minimally available in most communities. This is highlighted in a recent article entitled, “The Forgotten Patients,” which appeared in the Sept. 13, 2010 edition of Forbes magazine. The article’s authors state that the “health industry ignores the 35,000 people a year who commit suicide.” This article also highlights the fluctuation of both mental health issues and suicide with age, gender and ethnicity, factors that we must take into account in our international ministry as the world continues to flatten. And finally, the article concludes by identifying some best practices, including proposed and ongoing research to address these challenges.

As the CHRISTUS Health family continues its Journey to Excellence, it will be necessary for us to develop processes to improve the mental health status of the communities we serve.

Medicine’s Next Frontier: The Brain

In discussions about the future of medicine, I often say that we will understand the brain in the next 25 years as well as we understand the heart today, the majority of knowledge about which we gained just in the last 25 years.

Supporting my assertion was information in a recent article in The Dallas Morning News about a new center for brain research associated with the University of Texas at Dallas that opened this week. I still believe that only one-third of what we do in acute hospitals today will need to be done there in 10- 15 years, and our major surgeries will be in and around the brain. We will discover new ways to treat cancer metastasis and new operative techniques for Parkinsonian and Alzheimer diseases, as well as chronic senile dementia.

CHRISTUS’ new vision statement speaks of being and innovator and partner in health and wellness initiatives, and keeping current on the treatment recommendations coming out of this and other brain study centers will be key as we continue our Journey to Excellence, making sure we are involved in the product lines that will add both quality and quantity of life to the people we serve in our sacred ministry.

A New Way of Thinking About Nonprofit Boards

As we regularly must make decisions about the future of CHRISTUS Health, we are familiar with the tension that some companies feel between “the board’s role” and “leadership’s role.” However, we have clearly defined these roles with a focus on “generative thinking” and have made it a part of our governance processes across the CHRISTUS system.

The greatest example of generative thinking in the CHRISTUS ministry is our future planning processes. Because we do that, it is much easier for leadership to follow through on implementation of plans without the need to return for more robust discussions with the board.

At CHRISTUS, we believe that with the SPA, our operational algorithm, and now our patient satisfaction algorithm, issues and challenges are clearly visible to all of us, including leadership and the board, which helps us to focus on the “generative questions”; for example, whether to stay in or exit a market. Clearly, this is not anything new to how excellent governance and leadership should interact, but it is a new way to express the need for robust, thoughtful and reflective discussions driven by a decision-making process.

Following are excerpts from a Website where one of the authors of the book “Governance as Leadership: Reframing the Work of Nonprofit Boards,” is interviewed:

Q: You introduce a mode of governance called "generative thinking." Can you give a brief overview of what this is, and why it is so essential to governance?

A: The most important work that takes place in an organization is when people first begin to identify and discern what the important challenges, problems, opportunities, and questions are. It's the way in which the intellectual agenda of the organization is constructed.

The generative work that we recommend encourages boards to be present at those times when the organization tries to make sense of circumstances, tries to make meaning of events.

The way in which we first make sense of circumstances is in fact what triggers or spawns strategies, policies, decisions, and actions. (We chose the word "generative" because its roots are in genesis.) Boards need to be there at the creation, when people say, "Okay—that's what we need to work on." Often, it's senior managers as leaders who come to a board and say, "We have looked at all the issues, here is the problem, here's what we plan to do. Does this solution sound right?" The question should be: "Do we have the problem right?"

When you think of a decision-making flow, all we are suggesting is that boards get at the headwaters. They need to get way upstream; they tend to wade in much too far downstream.

Generative thinking is getting to the question before the question. It's actually the fun part of governance. It's not about narrow technical expertise. Generative work is almost always about questions of values, beliefs, assumptions, and organizational cultures. That's what makes it interesting, but also what makes it important is to have people in those conversations who understand the institution, but have some degree of distance.

Catholic-Owned Health Care Systems Earn High Marks

I have repeatedly said since becoming the team leader for CHRISTUS Health that I feel this Catholic, faith-based health care system embodies my personal commitments to treating everyone who needs us with high quality, low cost health care in an accessible manner. Although I have worked in three other systems where I believe people were comfortable treating everyone who presented themselves, the well-documented principles in the Ethical and Religious Directives for Catholic Health Care Services (ERDs) and the resulting policies and procedures guarantee on a consistent basis that everyone will be treated equally and with dignity regardless of their ability to pay, their immigration documentation, the color of their skin, or their religious tradition.

To me, this is an integral part of excellent health care and energizes CHRISTUS’ Journey to Excellence. Embracing the ERDs is a strong, visible demonstration, assuring that the care rendered in connection with the CHRISTUS name will be equal for all and of the highest standard possible as we continue our Journey to Excellence.

To that end, I wanted to share with you a performance study of measures of quality, clinical efficiency and perception of care conducted by Thomson Reuters, one of the nation’s most well-known and highly-regarded providers of information and decision support tools. This study found that Catholic-owned health care systems as a group appear to have a significant head start on other ownership categories such as “other church” systems, secular not-for-profit systems and investor-owned systems.

The results of the study were published in the Aug. 9, 2010 edition of Modern Healthcare, and suggest that leadership at health systems owned by the Catholic Church may be the most active in setting and monitoring achievement of quality goals, as well as aligning the management of hospitals within a system in achieving what they see as a mission.

In addition, a changing role for health system governance and leadership is being seen, with leaders taking responsibility for executing well on clinical performance as well as the purely business and economic reasons that originally drove consolidation into systems. In the clinical and service quality areas, Catholic systems appear to be leading within an industry that is in transition, the Modern Healthcare article reports. And while the Catholic-owned systems tend to lead in this transition, the remainder of the industry is shifting, but not as rapidly.

In addition to using federally reported core quality measures, Thomson Reuters ranks hospital systems in its studies according to inpatient mortality and complications, an inpatient safety index, 30-day mortality and readmissions, average length of stay and patient perception of care. For the study of systems by ownership, a composite score across all the measures was computed for each system, and all 255 of those systems ranked in the report were stratified by ownership as defined by the American Hospital Association (AHA).

The mean performance rank for each category – lower is better – showed the 36 Catholic systems in front with an average rank of 84. Eleven “other church” systems combined for an average rank of 121, and the 176 secular not-for-profit systems combined for a rank of 129. The 26 identified investor-owned systems combined for a rank of 182. Six systems in the study had missing ownership information in the AHA reference guide.

This study seems to support my assertion that our Catholic culture and heritage ensure that the care rendered at CHRISTUS facilities is equal for all and of the highest standard possible.