In previous blog posts, I shared with you the significant findings from CHRISTUS’ Futures Task Force I. As a result of our scenario planning, we determined that the two most significant drivers taking us into the first decade of this century would be declining reimbursement, particularly on the inpatient side, and the rapid introduction of new technology which would give us the ability to move more inpatient treatment to the outpatient arena. We also predicted that the introduction of this technology was accelerating at such a pace that it would be disruptive.
Traveling through this decade, we are comfortable that these are, and will continue to be, the major drivers of health care change in the foreseeable future. In a recent article in the New York Times entitled, “Weighing the Cost of a CT Scan’s Look Inside the Heart,” the authors discuss two major issues associated with the introduction of technology. These two issues, which tend to be on the negative side of the equation, are 1)The overuse of this technology and 2)The cost of the technology when compared to the incremental value it brings in relationship to less costly, more standard procedures. While these treatments undoubtedly improve the health status of some, the overall value of the treatments themselves are called into question.
It is interesting to note also, that in our Futures Task Force II process, which is utilizing “learning journeys,” that in countries we visited (including Canada and India), the availability of technology is highly regulated. Specifically, there are significantly less CAT scans available in Canada than there are in the U.S. And one statistic that is often reported is that there are more CAT scans in Texas than there are in the entire country of Canada in the same time period.
Clearly, the issues identified above have caused hospital-oriented systems to attempt to develop guidelines for the appropriate use of these costly technologies. However, adhering to these guidelines is often challenging because patients and their families will often demand them because of public marketing which is done by vendors to persuade them that they need these treatments. Clinicians may also find it easier and faster to do a study rather than spending the time doing an extensive and complete history and physical. When complete histories and physicals are performed--as physicians were taught to do in medical schools--the correct diagnosis can often be made by supplementing these exams with simple laboratory or X-ray examinations.
There is no question that this requires time and a maintenance of physical examination skills, but it is readily known that there is no better knowledge about what is occurring to a patient than that that is gained from direct observation.
Another reason why these studies are often over-utilized is that they are--at least at this time in the U.S.--significantly reimbursed. Therefore, the financial incentive to deviate from the guidelines is present. Also, these technologies are often purchased by physicians and placed in their offices, where again, the financial incentive to use the expensive technology such as a CAT scan rather than a simple chest X-ray or abdominal film would be adequate. Because of these clear incentives to over-use this technology, we strongly support the utilization of the balanced scorecard, which we have discussed also in prior blogs. The purpose of a balanced scorecard is to balance at all times the value received from a financial, clinical service and community perspective. Only then will the correct guidelines for the use of these expensive technologies be adhered to appropriately.
And finally, with the use of these new technologies, we are now also recognizing that there are side effects. (Honestly, there have always been side effects present with any technology that has been invented in health care since the beginning of time.) Both CAT scans and MRIs temporarily alter the alignment of tissue particles or expose these tissue elements to high doses of radiation. Although these tests are done in a rapid timeframe and therefore necessitate minimal exposure to these side effects in each instance, if they are replicated and overused on any one patient, the accumulative effects will become evident.
In summary, there is no question that the introduction of new technologies has been tremendous and has created life-saving opportunities for many patients who pass through our doors. Cataracts and gall bladders are removed much more safely today, and arteriograms done through catheters in the groin far surpass the dangerous situations that were created by the original needles that had to be inserted in the carotid arteries in the neck. The advantages of these technologies are clearly evident. However, the technologies that have been developed for diagnosis including CAT scans, are initially seen as extremely beneficial, but can quickly decrease in overall value because their ease of deliverance and their high financial reimbursement may cause them to become over-utilized. As this technological equipment becomes more affordable, their availability exceeds need and only accentuates the potential for their overuse.
So what is the answer? For CHRISTUS Health, we will continue to carefully monitor the development and introduction of new technologies. Through our capital allocation process, will make sure we are acquiring and locating appropriate numbers of these technologies in our various regions and business units which will provide adequate opportunities for these studies to be provided to our patients and families, utilizing appropriate guidelines and minimizing overuse.
Wednesday, July 16, 2008
Friday, July 11, 2008
My Thoughts About the Events at CHRISTUS Spohn Hospital Corpus Christi - South
As I’m sure you have heard, a medication error was discovered this past Sunday night at one of our CHRISTUS hospitals. The nursing staff at CHRISTUS Spohn Hospital Corpus Christi – South discovered that some of the babies in the Neonatal Intensive Care Unit (NICU) there may have received a higher than recommended amount of Heparin, an anti-coagulant used to flush intravenous (IV) lines of patients to prevent blood clots from forming in the lines. The Heparin was prepared in the hospital’s pharmacy for use in the neonatal intensive care unit. The hospital implemented corrective measures and immediately notified appropriate persons about the situation.
Babies who need care in a neonatal intensive care unit are there for specialized treatment due to illness or other life-threatening conditions. However, injury to or the passing of any small child is a tragedy that affects us all.
I can relate to the particular grief of losing a child, and my thoughts and prayers are with all persons affected and the staff caring for them. I realize that this is an extremely difficult time for all the families.
Officials at CHRISTUS Spohn Hospital South confirmed that the event occurred during the mixing process in the hospital pharmacy. While our pharmacies have very specific processes to follow in the preparation of medications, something went wrong in this case, and I am deeply sorry.
The staff at CHRISTUS Spohn Hospital South took immediate actions following the discovery of this error, including a review of policies and procedures with pharmacy staff and the implementation of an additional step to the verification process in the production of these medications.
We are committed to a culture of quality and the ongoing review of our policies and procedures will assist us in building better safeguards and strengthening our processes to ensure a safer environment for our patients.
In all my years as a practicing physician and even now as the president and CEO of an international health care system, I understand the great responsibility we are given by our patients and their families when they choose to place their lives and the lives of their loved ones in our hands.
In fact, I can remember the exact moment when the gravity of this awesome responsibility really became clear to me; I remember the day just like it was yesterday.
When I was a third-year medical resident, I was assigned to care for a 10-year-old child who had come into our emergency room. As I came out of room the child’s room after the examination, my attending physician must have noticed the puzzled (and somewhat shocked) look on my face, because he asked me what was wrong.
“Do you not know the diagnosis?” he said.
I told him that I knew the exact diagnosis, and had just finished telling the child’s mother that her child would require surgery. Her response was, “Alright, then. Do whatever you have to do to make him better.”
And then it hit me that this parent trusted me completely with her child’s life, and I was astounded by the awesome responsibility that accompanies the sacred work we do in health care.
Every day, patients come into our programs and facilities and put their health and lives—or the lives of their loved ones—into our hands. This is why I have always said that for CHRISTUS Health, excellence is a necessity, not a luxury.
CHRISTUS has been on a Journey to Excellence—which I have discussed extensively right here on my blog—since 2000, and we have made great strides in many of the metrics of our four directions to excellence (clinical quality, service delivery, business literacy and community value). This Journey requires the absolute commitment of each and every CHRISTUS Associate, physician and volunteer every single second of every single day. I will not be satisfied until we reach absolute excellence in each of our directions.
I realize that the members of our CHRISTUS family do work tirelessly each day to deliver high-quality, compassionate care to our patients and their families, and I recognize that they are the reason we have made such strides on our Journey. Therefore, I am thankful to each of them for their dedication to excellence.
I also cannot stress enough how thankful I am to all the experienced and dedicated neonatal staff and physicians at CHRISTUS Spohn Hospital South who have gone above and beyond the call of duty in response to this incident and always take extraordinary measures to deliver the best care possible to every baby in our NICU. I would also like to extend special thanks to our pharmacy staff, who worked with the nursing staff in response to the situation.
I, along with the CHRISTUS family of almost 30,000 Associates, am dedicated to our mission of extending the healing ministry of Jesus Christ every day. We understand and take very seriously the awesome responsibility of caring for the health and lives of our friends and neighbors. We pray for all who were affected by the event at CHRISTUS Spohn Hospital South as well as for all of our Associates, physicians and volunteers as we work together to continue our ministry in the U.S. and Mexico.
Babies who need care in a neonatal intensive care unit are there for specialized treatment due to illness or other life-threatening conditions. However, injury to or the passing of any small child is a tragedy that affects us all.
I can relate to the particular grief of losing a child, and my thoughts and prayers are with all persons affected and the staff caring for them. I realize that this is an extremely difficult time for all the families.
Officials at CHRISTUS Spohn Hospital South confirmed that the event occurred during the mixing process in the hospital pharmacy. While our pharmacies have very specific processes to follow in the preparation of medications, something went wrong in this case, and I am deeply sorry.
The staff at CHRISTUS Spohn Hospital South took immediate actions following the discovery of this error, including a review of policies and procedures with pharmacy staff and the implementation of an additional step to the verification process in the production of these medications.
We are committed to a culture of quality and the ongoing review of our policies and procedures will assist us in building better safeguards and strengthening our processes to ensure a safer environment for our patients.
In all my years as a practicing physician and even now as the president and CEO of an international health care system, I understand the great responsibility we are given by our patients and their families when they choose to place their lives and the lives of their loved ones in our hands.
In fact, I can remember the exact moment when the gravity of this awesome responsibility really became clear to me; I remember the day just like it was yesterday.
When I was a third-year medical resident, I was assigned to care for a 10-year-old child who had come into our emergency room. As I came out of room the child’s room after the examination, my attending physician must have noticed the puzzled (and somewhat shocked) look on my face, because he asked me what was wrong.
“Do you not know the diagnosis?” he said.
I told him that I knew the exact diagnosis, and had just finished telling the child’s mother that her child would require surgery. Her response was, “Alright, then. Do whatever you have to do to make him better.”
And then it hit me that this parent trusted me completely with her child’s life, and I was astounded by the awesome responsibility that accompanies the sacred work we do in health care.
Every day, patients come into our programs and facilities and put their health and lives—or the lives of their loved ones—into our hands. This is why I have always said that for CHRISTUS Health, excellence is a necessity, not a luxury.
CHRISTUS has been on a Journey to Excellence—which I have discussed extensively right here on my blog—since 2000, and we have made great strides in many of the metrics of our four directions to excellence (clinical quality, service delivery, business literacy and community value). This Journey requires the absolute commitment of each and every CHRISTUS Associate, physician and volunteer every single second of every single day. I will not be satisfied until we reach absolute excellence in each of our directions.
I realize that the members of our CHRISTUS family do work tirelessly each day to deliver high-quality, compassionate care to our patients and their families, and I recognize that they are the reason we have made such strides on our Journey. Therefore, I am thankful to each of them for their dedication to excellence.
I also cannot stress enough how thankful I am to all the experienced and dedicated neonatal staff and physicians at CHRISTUS Spohn Hospital South who have gone above and beyond the call of duty in response to this incident and always take extraordinary measures to deliver the best care possible to every baby in our NICU. I would also like to extend special thanks to our pharmacy staff, who worked with the nursing staff in response to the situation.
I, along with the CHRISTUS family of almost 30,000 Associates, am dedicated to our mission of extending the healing ministry of Jesus Christ every day. We understand and take very seriously the awesome responsibility of caring for the health and lives of our friends and neighbors. We pray for all who were affected by the event at CHRISTUS Spohn Hospital South as well as for all of our Associates, physicians and volunteers as we work together to continue our ministry in the U.S. and Mexico.
Wednesday, July 2, 2008
Redesign of the U.S. Health Care System
I recently gave a presentation to the Healthcare Financial Management Association (HFMA) about health care reform in the U.S. HFMA is the nation's leading membership organization for healthcare financial management executives and leaders, who consider HFMA a respected thought leader on top trends and issues facing the health care industry.
I know that focus on our country’s broken health care system will only continue to grow in the coming months and years, especially as we approach the impending presidential elections, and thought the rest of you might be interested in my latest thoughts on health care reform as well.
Changing the health care system in the U.S. is a high priority for government, business and patients and their families. As I mentioned above, the new president will have a mandate to facilitate a redesign process, so some change (hopefully positive) is inevitable.
In reality, we know that the U.S. health care system is highly fragmented, and many of us recognize that we are all to blame. It is my belief that many constituencies bear the title of “bad guy” because we have all contributed to the current state of affairs. Bad government, greedy insurers and vendors, arrogant administrators, rich doctors and inept boards have gotten us to the broken system we now must heal. In reality, even the desires and values of many American patients and their families have added to this state. Many patients continue to clamor for independence and the ability to choose when, where and how they receive care, and these desires have a direct effect on the system itself, as it struggles to balance the desires of patients with the realities of the day.
Data from various sources confirms that the constituencies I mentioned have focused on health crisis management instead of managing health. The focus on preventative medicine has been historically lacking, so when chronic conditions are identified, they have generally progressed much farther and done more damage than if they had been caught and managed from an earlier stage.
However, the fact remains that health care reform is far too critical for the welfare of Americans for it to be held hostage by the politically motivated or the profit-minded. This means that all of us must accept the need for some form of national health care, along with a collaborative willingness to pay for the appropriate services in the appropriate settings. This redesigned system must avoid excessive administrative costs and significant control by an ultimately rigid and unwieldy governmental, insurance, industry or vendor bureaucracy.
In light of these realities, we have done our best to respond in complete and proactive ways. For CHRISTUS, these responses include our Journey to Excellence, deliberate and structured futures planning (Futures Task Force I and Futures Task Force II) and our reorganization of our portfolio to one-third acute care, one-third non-acute care and one-third international entities.
Because of our belief that excellent health care is a necessity, not a luxury, CHRISTUS’ goal on our Journey to Excellence has been to develop processes and programs which reach global benchmark performance in clinical quality, service delivery, business literacy and community value. On this Journey, we have learned that:
• We must listen to the voices demanding change
• We must be aware of the signs of failure
• We must embrace outstanding health care governance
• Developing, sharing and rewarding best practices are critical success factors
• Effective teamwork is critical
• We can never be satisfied
• Unlimited optimism is paramount
• Use of a balanced scorecard approach is essential
• A high level of accountability must be sought
• Incremental victories must be identified and celebrated
• Great dreams do not occur overnight—where CHRISTUS is today is no accident
• Our theological and ethical foundations do make a difference
• Future thinking and monitoring of innovations are important
• Change management is difficult, but a required CHRISTUS leadership competency
The completion of Futures Task Force I in 2001 reinforced the value of scenario planning and solidified our belief that the major drivers of change in our industry would include declining reimbursement; disruptive, non-invasive technologies and the healthy aging of seniors. The Task Force’s recommendations also helped CHRISTUS to consider the structure of our system that would provide the highest quality of care at the most affordable cost to as many people as possible, regardless of their ability to pay. This, of course, requires a full understanding and integration of the continuum of care, which we continue to study.
In addition, Futures Task Force II includes learning journeys to New Orleans, Canada and India; technology reviews and tours of innovation centers. It is our belief that the work of this Task Force will allow us to articulate and apply Futures Task Force I’s recommendations more fully as well as develop new recommendations for the next 10 years.
As a result of all this work, CHRISTUS is in a transition of our portfolio to include one-third acute care, one-third non-acute care (including post-acute, community health services, clinics, senior services and retail) and one-third international entities (including robust sharing of best practices and a healthy Medical Travel program).
It is clear to me that change in the U.S. health care delivery system must occur, and CHRISTUS Health desires to embrace those changes and to be at the redesign table to share our learnings and best practices. The new model for health care must be evidence-based, must not let the “physician voice” become overwhelming, and must learn to balance individual vs. community focus.
I firmly believe that a successful redesign of the U.S. health care system is possible if we partake in the process with the central idea that health care is a noble humanitarian tradition of helping those who are suffering. Therefore, the welfare of every person must be of the highest priority.
I know that focus on our country’s broken health care system will only continue to grow in the coming months and years, especially as we approach the impending presidential elections, and thought the rest of you might be interested in my latest thoughts on health care reform as well.
Changing the health care system in the U.S. is a high priority for government, business and patients and their families. As I mentioned above, the new president will have a mandate to facilitate a redesign process, so some change (hopefully positive) is inevitable.
In reality, we know that the U.S. health care system is highly fragmented, and many of us recognize that we are all to blame. It is my belief that many constituencies bear the title of “bad guy” because we have all contributed to the current state of affairs. Bad government, greedy insurers and vendors, arrogant administrators, rich doctors and inept boards have gotten us to the broken system we now must heal. In reality, even the desires and values of many American patients and their families have added to this state. Many patients continue to clamor for independence and the ability to choose when, where and how they receive care, and these desires have a direct effect on the system itself, as it struggles to balance the desires of patients with the realities of the day.
Data from various sources confirms that the constituencies I mentioned have focused on health crisis management instead of managing health. The focus on preventative medicine has been historically lacking, so when chronic conditions are identified, they have generally progressed much farther and done more damage than if they had been caught and managed from an earlier stage.
However, the fact remains that health care reform is far too critical for the welfare of Americans for it to be held hostage by the politically motivated or the profit-minded. This means that all of us must accept the need for some form of national health care, along with a collaborative willingness to pay for the appropriate services in the appropriate settings. This redesigned system must avoid excessive administrative costs and significant control by an ultimately rigid and unwieldy governmental, insurance, industry or vendor bureaucracy.
In light of these realities, we have done our best to respond in complete and proactive ways. For CHRISTUS, these responses include our Journey to Excellence, deliberate and structured futures planning (Futures Task Force I and Futures Task Force II) and our reorganization of our portfolio to one-third acute care, one-third non-acute care and one-third international entities.
Because of our belief that excellent health care is a necessity, not a luxury, CHRISTUS’ goal on our Journey to Excellence has been to develop processes and programs which reach global benchmark performance in clinical quality, service delivery, business literacy and community value. On this Journey, we have learned that:
• We must listen to the voices demanding change
• We must be aware of the signs of failure
• We must embrace outstanding health care governance
• Developing, sharing and rewarding best practices are critical success factors
• Effective teamwork is critical
• We can never be satisfied
• Unlimited optimism is paramount
• Use of a balanced scorecard approach is essential
• A high level of accountability must be sought
• Incremental victories must be identified and celebrated
• Great dreams do not occur overnight—where CHRISTUS is today is no accident
• Our theological and ethical foundations do make a difference
• Future thinking and monitoring of innovations are important
• Change management is difficult, but a required CHRISTUS leadership competency
The completion of Futures Task Force I in 2001 reinforced the value of scenario planning and solidified our belief that the major drivers of change in our industry would include declining reimbursement; disruptive, non-invasive technologies and the healthy aging of seniors. The Task Force’s recommendations also helped CHRISTUS to consider the structure of our system that would provide the highest quality of care at the most affordable cost to as many people as possible, regardless of their ability to pay. This, of course, requires a full understanding and integration of the continuum of care, which we continue to study.
In addition, Futures Task Force II includes learning journeys to New Orleans, Canada and India; technology reviews and tours of innovation centers. It is our belief that the work of this Task Force will allow us to articulate and apply Futures Task Force I’s recommendations more fully as well as develop new recommendations for the next 10 years.
As a result of all this work, CHRISTUS is in a transition of our portfolio to include one-third acute care, one-third non-acute care (including post-acute, community health services, clinics, senior services and retail) and one-third international entities (including robust sharing of best practices and a healthy Medical Travel program).
It is clear to me that change in the U.S. health care delivery system must occur, and CHRISTUS Health desires to embrace those changes and to be at the redesign table to share our learnings and best practices. The new model for health care must be evidence-based, must not let the “physician voice” become overwhelming, and must learn to balance individual vs. community focus.
I firmly believe that a successful redesign of the U.S. health care system is possible if we partake in the process with the central idea that health care is a noble humanitarian tradition of helping those who are suffering. Therefore, the welfare of every person must be of the highest priority.
Thursday, June 26, 2008
CHRISTUS Academy Class of 2008 – Projects 3 and 4
Last week we reviewed two of the four projects researched and presented by the latest CHRISTUS Academy graduating class, and I’d like to review the other half of those projects in my post today.
Project 3: Growing Outpatient Services
This CHRISTUS Academy team was asked to identify best practices and business models that will support the development of outpatient services in CHRISTUS Health markets, especially as we have made the commitment to transition our portfolio to one-third acute care, one-third non-acute care (including outpatient services) and one-third international operations.
The team researched numerous hospitals, health systems, imaging centers, ambulatory surgery centers and even car dealerships, an auto parts store and a ski resort. The team also conducted literature searches and customer surveys to gain a perspective on what these best practices do to be financially successful and service-oriented. Key findings that drove the team’s recommendations are as follows:
• CHRISTUS Health’s regions define outpatient services differently
• The current system for analyzing service lines is inconsistent region-to-region
• Each region measures outpatient metrics independently, causing difficulty for comparison to other regions or nationally
• Opportunities are present to grow specific service lines
• Some CHRISTUS regions need to employ or enhance leadership development programs that support outpatient leaders operationally and strategically
• Noticed a of lack of accountability when a new service is introduced into a region that shows little to no success
• Some CHRISTUS regions are behind the curve when introducing customer-focused, volume-driven practices.
As a result, the team concluded that some CHRISTUS regions are employing successful strategies for outpatient growth, but these strategies are not hardwired (practiced at least 90 percent of the time) throughout the system. The team believed that many of their recommendations will not only affect outpatient growth, but also increase patient/physician/Associate satisfaction as well as patient/physician loyalty and reduce turnover. The team’s recommendations are divided into four different categories, which are as follows:
Operational recommendations
• Define outpatient services consistently using ICD-9 and/or DRGs
• Adoption of service lines and service line leaders
• Use of single database and method to gather financial data
• Measure outpatient-specific metrics (management and strategic metrics)
• Use of physician liaisons
• Use of the Management Directive that guides the “new business development process” with more accountability
• Use of “growth teams”
Strategic recommendations
• Joint ventures
• Invest in cardiovascular based on market
• Invest in ortho/neuro based on market
• Invest in imaging based on market
• Invest in oncology based on market
• Employ Planetree practices (a new model for “healthcare/healing/wellness excellence” identified in Putting Patients First by Susan Frampton, Laura Gilpin, Patrick Charmel)
Technology recommendations
• Patient ID cards
• Fingerprint scans/back-of-hand (thermal imaging) scans
• Online registration
• Admitting kisosks
• Electronic email notification of appointments/reminders
• Website posting of service line wait times
• 1-800 numbers with service line information/wait times
• Text messaging for appointment reminders
Educational recommendations
• All regions need to assess Service Line Leaders’ (SLLs) competencies in utilizing standard Meditech reports
• Mandating participation in these programs as part of the development of SLLs
• Improve competency of Microsoft products via Healthstream or the classroom
• Hardwire the “must haves” across the CHRISTUS system
• Training for SLLs on creation and implementation of SMART growth goals
• CHRISTUS Health should create an education plan to enhance project management skills of SLLs
• Assess the SLLs’ financial management skills
• Leadership development, level 1: Human Resource practices, SMART growth goals, “must haves,” programs and systems training
• Leadership development, level 2: Project management, quality improvement, financial management
The team recognized that some CHRISTUS regions have these recommendations in place, but only when all regions are practicing and have them hardwired will CHRISTUS see consistent outpatient growth.
Project 4: Supporting the Umbrella Strategy, Infrastructure Assessment
This CHRISTUS Academy team was asked to examine CHRISTUS’ infrastructure and to answer the question, “Is the current CHRISTUS Health infrastructure ready and able to support the Umbrella Strategy?”
The Umbrella Strategy was developed by CHRISTUS’ leaders in response to industry dynamics (increasing costs, declining reimbursement, governmental mandates, rapidly changing technologies, etc.) and patient needs. The strategy divides the CHRISTUS service portfolio into three equal parts (acute, non-acute and international, as mentioned above). The goal of the strategy is three-fold: 1) to strengthen the organization’s position across the full continuum of services; 2) to develop customer-centric, innovative and integrated approaches to care deliver and 3) to grow and develop CHRISTUS’ international ministry.
The team assessed five major components of the CHRISTUS infrastructure in the course of their research: Human Resources (HR), Information Technology, Financial systems and organizational structure. Research methodology primarily included interviews and surveys of leaders from within and outside of CHRISTUS. Strengths and weaknesses in each area of the infrastructure were identified, as were opportunities and threats. After taking into consideration current initiatives, the team performed a gap analysis and developed recommendations to improve operations and to support the Umbrella Strategy. To this end, they arrived at the following conclusions:
Culture
Since there are inconsistencies in the cultural educational opportunities between the acute, non-acute and international ministries, the team recommends centralizing CHRISTUS’ education and development programs. This will support standardized policies, education contact hours, media and materials for branding the CHRISTUS culture through the orientation and continuing development of Associates.
Human Resources
Recruitment and retention continue to be major challenges for many organizations. Therefore, the team recommends the development of innovative recruiting strategies to transform eligible former Associates back into the workforce. When recruiting current and younger generations, consider offering more scheduling flexibility for greater work/life balance.
Information Technology
The team focused on three areas of Information Technology, including the Enterprise Master Patient Index (EMPI), clinical information systems and information systems technical infrastructure. Survey results indicated that a high level of integration in all three areas is important to CHRISTUS leaders. Therefore, the team recommended the active pursuit of an EMPI system. The team also noted the need for systems to connect patient clinical information between acute, non-acute, international and physician information systems.
Financial
The team assessed four major components of CHRISTUS’ financial infrastructure, including financial accounting systems, decision support tools, revenue cycle and supply chain. The need for expanded standardization and centralization of processes was noted in each of these areas. CHRISTUS should re-evaluate implementation of an Enterprise Resource Planning solution to provide the needed flexibility, reporting and budgeting systems. All entities (acute, non-acute and international)l, should be considered in the scope of the implementation evaluation.
Organizational Structure
A common theme identified among leaders was the need for centralized leadership for non-acute services. The need for increased centralization, standardization and collaboration was also identified in all areas of the CHRISTUS infrastructure. As such, the team proposed a leadership position be added to manage this three-pronged approach to enable the achievement of goals of the Umbrella Strategy of achieving equal distribution between the acute, non-acute and international sectors of the health system.
Overall, CHRISTUS should focus on implementing system-wide standards and actively pursue implementation of best practices. This will require a cultural shift, especially from the traditional regional perspective and a willingness to release control of some historical responsibilities while still maintaining an oversight role.
Project 3: Growing Outpatient Services
This CHRISTUS Academy team was asked to identify best practices and business models that will support the development of outpatient services in CHRISTUS Health markets, especially as we have made the commitment to transition our portfolio to one-third acute care, one-third non-acute care (including outpatient services) and one-third international operations.
The team researched numerous hospitals, health systems, imaging centers, ambulatory surgery centers and even car dealerships, an auto parts store and a ski resort. The team also conducted literature searches and customer surveys to gain a perspective on what these best practices do to be financially successful and service-oriented. Key findings that drove the team’s recommendations are as follows:
• CHRISTUS Health’s regions define outpatient services differently
• The current system for analyzing service lines is inconsistent region-to-region
• Each region measures outpatient metrics independently, causing difficulty for comparison to other regions or nationally
• Opportunities are present to grow specific service lines
• Some CHRISTUS regions need to employ or enhance leadership development programs that support outpatient leaders operationally and strategically
• Noticed a of lack of accountability when a new service is introduced into a region that shows little to no success
• Some CHRISTUS regions are behind the curve when introducing customer-focused, volume-driven practices.
As a result, the team concluded that some CHRISTUS regions are employing successful strategies for outpatient growth, but these strategies are not hardwired (practiced at least 90 percent of the time) throughout the system. The team believed that many of their recommendations will not only affect outpatient growth, but also increase patient/physician/Associate satisfaction as well as patient/physician loyalty and reduce turnover. The team’s recommendations are divided into four different categories, which are as follows:
Operational recommendations
• Define outpatient services consistently using ICD-9 and/or DRGs
• Adoption of service lines and service line leaders
• Use of single database and method to gather financial data
• Measure outpatient-specific metrics (management and strategic metrics)
• Use of physician liaisons
• Use of the Management Directive that guides the “new business development process” with more accountability
• Use of “growth teams”
Strategic recommendations
• Joint ventures
• Invest in cardiovascular based on market
• Invest in ortho/neuro based on market
• Invest in imaging based on market
• Invest in oncology based on market
• Employ Planetree practices (a new model for “healthcare/healing/wellness excellence” identified in Putting Patients First by Susan Frampton, Laura Gilpin, Patrick Charmel)
Technology recommendations
• Patient ID cards
• Fingerprint scans/back-of-hand (thermal imaging) scans
• Online registration
• Admitting kisosks
• Electronic email notification of appointments/reminders
• Website posting of service line wait times
• 1-800 numbers with service line information/wait times
• Text messaging for appointment reminders
Educational recommendations
• All regions need to assess Service Line Leaders’ (SLLs) competencies in utilizing standard Meditech reports
• Mandating participation in these programs as part of the development of SLLs
• Improve competency of Microsoft products via Healthstream or the classroom
• Hardwire the “must haves” across the CHRISTUS system
• Training for SLLs on creation and implementation of SMART growth goals
• CHRISTUS Health should create an education plan to enhance project management skills of SLLs
• Assess the SLLs’ financial management skills
• Leadership development, level 1: Human Resource practices, SMART growth goals, “must haves,” programs and systems training
• Leadership development, level 2: Project management, quality improvement, financial management
The team recognized that some CHRISTUS regions have these recommendations in place, but only when all regions are practicing and have them hardwired will CHRISTUS see consistent outpatient growth.
Project 4: Supporting the Umbrella Strategy, Infrastructure Assessment
This CHRISTUS Academy team was asked to examine CHRISTUS’ infrastructure and to answer the question, “Is the current CHRISTUS Health infrastructure ready and able to support the Umbrella Strategy?”
The Umbrella Strategy was developed by CHRISTUS’ leaders in response to industry dynamics (increasing costs, declining reimbursement, governmental mandates, rapidly changing technologies, etc.) and patient needs. The strategy divides the CHRISTUS service portfolio into three equal parts (acute, non-acute and international, as mentioned above). The goal of the strategy is three-fold: 1) to strengthen the organization’s position across the full continuum of services; 2) to develop customer-centric, innovative and integrated approaches to care deliver and 3) to grow and develop CHRISTUS’ international ministry.
The team assessed five major components of the CHRISTUS infrastructure in the course of their research: Human Resources (HR), Information Technology, Financial systems and organizational structure. Research methodology primarily included interviews and surveys of leaders from within and outside of CHRISTUS. Strengths and weaknesses in each area of the infrastructure were identified, as were opportunities and threats. After taking into consideration current initiatives, the team performed a gap analysis and developed recommendations to improve operations and to support the Umbrella Strategy. To this end, they arrived at the following conclusions:
Culture
Since there are inconsistencies in the cultural educational opportunities between the acute, non-acute and international ministries, the team recommends centralizing CHRISTUS’ education and development programs. This will support standardized policies, education contact hours, media and materials for branding the CHRISTUS culture through the orientation and continuing development of Associates.
Human Resources
Recruitment and retention continue to be major challenges for many organizations. Therefore, the team recommends the development of innovative recruiting strategies to transform eligible former Associates back into the workforce. When recruiting current and younger generations, consider offering more scheduling flexibility for greater work/life balance.
Information Technology
The team focused on three areas of Information Technology, including the Enterprise Master Patient Index (EMPI), clinical information systems and information systems technical infrastructure. Survey results indicated that a high level of integration in all three areas is important to CHRISTUS leaders. Therefore, the team recommended the active pursuit of an EMPI system. The team also noted the need for systems to connect patient clinical information between acute, non-acute, international and physician information systems.
Financial
The team assessed four major components of CHRISTUS’ financial infrastructure, including financial accounting systems, decision support tools, revenue cycle and supply chain. The need for expanded standardization and centralization of processes was noted in each of these areas. CHRISTUS should re-evaluate implementation of an Enterprise Resource Planning solution to provide the needed flexibility, reporting and budgeting systems. All entities (acute, non-acute and international)l, should be considered in the scope of the implementation evaluation.
Organizational Structure
A common theme identified among leaders was the need for centralized leadership for non-acute services. The need for increased centralization, standardization and collaboration was also identified in all areas of the CHRISTUS infrastructure. As such, the team proposed a leadership position be added to manage this three-pronged approach to enable the achievement of goals of the Umbrella Strategy of achieving equal distribution between the acute, non-acute and international sectors of the health system.
Overall, CHRISTUS should focus on implementing system-wide standards and actively pursue implementation of best practices. This will require a cultural shift, especially from the traditional regional perspective and a willingness to release control of some historical responsibilities while still maintaining an oversight role.
Wednesday, June 18, 2008
CHRISTUS Academy Class of 2008 – Projects 1 and 2
As I promised in my last blog post, we will begin a review of the findings and research done by all four CHRISTUS Academy teams that graduated recently. Today, let’s review two of those projects.
Project 1: Weaving Research into the CHRISTUS Tapestry
The CHRISTUS Academy Research team was tasked to determine the extent to which a fully-developed research environment would assist CHRSITUS Health to achieve an environment of excellence and best practice with cutting-edge patient care and patient satisfaction, physician satisfaction, financial health and Associate growth and development, all of which are central to our Journey to Excellence.
Research being conducted in health care systems today consists of far more than the traditional pre-clinical (bench) research and clinical trials for pharmaceuticals and devices. CHRISTUS Health actively engages in Nursing, Community Health, Human Resources, Marketing and Retail research. Life-saving cancer drugs developed by The CHRISTUS Stehlin Foundation for Cancer Research and the titanium rib developed at CHRISTUS Santa Rosa are just two examples of the types of research conducted within the CHRISTUS system.
Today, embracing innovative research is essential for any health care organization to survive, as informed consumers demand a higher quality of care. The CHRISTUS Research Academy team was charged to evaluate CHRISTUS Health’s current state and determine the steps required to create a fully-developed research environment that would assist CHRISTUS Health in achieving excellence and best practices with cutting-edge patient care.
The team contacted numerous facilities involved in research and conducted literature reviews in order to learn what is required to develop a vibrant research environment. Their key findings are as follows:
• A research infrastructure must be in place.
• Culture trumps strategy.
• You must have “the right people on the bus.”
• Partnering with credible organizations and individuals is beneficial.
In order to create a robust research environment, CHRISTUS Health must commit to the following:
• Expand the current research infrastructure to include a system research department.
• Instigate a change in CHRISTUS culture through communications and a recognition program.
• Engage and develop Associates to be innovators with education, mentorship and rewards.
• Identify and support research partnerships.
• Develop the expertise required to locate and secure funding for research.
The CHRISTUS Innovations Institute offers a connection for research to become an integral part of our CHRISTUS mission and to enhance our CHRISTUS brand as a center of innovative excellence.
Project 2: Organizational Excellence: The Baldrige Model
As I have said before, we have done a comparison of our Journey to Excellence goals, the Joint Commission goals, Magnet status and the Malcom Baldrige National Quality Award (MBNQA), and found their goals and requirements to be almost identical. In addition, we are hoping to apply for the Baldrige award for our entire system on or shortly after we reach the June 2009 summit.
This CHRISTUS team was asked to gain an understanding of the measurement, analysis and knowledge management requirements of the MBNQA and evaluate the opportunities for improvement for CHRISTUS Health’s current processes as related to the Baldrige criteria.
According to recent studies, the MBNQA is an excellent indicator of high organizational performance.Health care organizations applying for the award must show a focused and systematic approach to performance management in the following areas:
• Leadership
• Strategic planning
• Customer and market focus
• Measurement, analysis and knowledge management
• Human Resource focus
• Process management
• Business/organizational performance results
Through analysis of winning MBNQA award applications, participation in best practice forums, a site visit to an MBNQA winner, personal interviews and detailed research, a baseline assessment of CHRISTUS’ current processes as related to the MBNQA was achieved.
After an MBNQA award application is reviewed, Baldrige examiners score the application based on the criteria in eight scoring ranges or “bands.” Recent winners have scored in the upper portion of band five. After analysis of the draft MBNQA application for CHRISTUS Health prepared by the team in conjunction with a former Baldrige examiner, they determined that CHRISTUS’ current score is in the range of band two.
According to the band descriptors, CHRISTUS falls into the Early Systemic Approach category, as defined by the Baldrige foundation. This means that CHRISTUS is at the beginning stages of conducting operations by processes with repeatability, evaluation and improvement, and some early coordination among organizational units. Strategy and quantitative goals are being defined.
The team found that CHRISTUS needs to deploy a more robust management of processes throughout the system. To achieve excellence, CHRISTUS must strengthen accountability, deployment of processes and process efficiency in key areas. Our submission of an actual MBNQA application in 2009 will result in valuable feedback from the team of Baldrige Examiners.
CHRISTUS is in the early stages of the Baldrige journey. A careful study of CHRISTUS Health’s draft application and the resulting implementation of the team’s recommendations will align current processes with strategic and operational goals. As a result, CHRISTUS Health will reach organizational maturity and achieve world-class excellence.
For more information on the Baldrige award, see one of my previous posts on optimizing CHRISTUS’ performance.
Project 1: Weaving Research into the CHRISTUS Tapestry
The CHRISTUS Academy Research team was tasked to determine the extent to which a fully-developed research environment would assist CHRSITUS Health to achieve an environment of excellence and best practice with cutting-edge patient care and patient satisfaction, physician satisfaction, financial health and Associate growth and development, all of which are central to our Journey to Excellence.
Research being conducted in health care systems today consists of far more than the traditional pre-clinical (bench) research and clinical trials for pharmaceuticals and devices. CHRISTUS Health actively engages in Nursing, Community Health, Human Resources, Marketing and Retail research. Life-saving cancer drugs developed by The CHRISTUS Stehlin Foundation for Cancer Research and the titanium rib developed at CHRISTUS Santa Rosa are just two examples of the types of research conducted within the CHRISTUS system.
Today, embracing innovative research is essential for any health care organization to survive, as informed consumers demand a higher quality of care. The CHRISTUS Research Academy team was charged to evaluate CHRISTUS Health’s current state and determine the steps required to create a fully-developed research environment that would assist CHRISTUS Health in achieving excellence and best practices with cutting-edge patient care.
The team contacted numerous facilities involved in research and conducted literature reviews in order to learn what is required to develop a vibrant research environment. Their key findings are as follows:
• A research infrastructure must be in place.
• Culture trumps strategy.
• You must have “the right people on the bus.”
• Partnering with credible organizations and individuals is beneficial.
In order to create a robust research environment, CHRISTUS Health must commit to the following:
• Expand the current research infrastructure to include a system research department.
• Instigate a change in CHRISTUS culture through communications and a recognition program.
• Engage and develop Associates to be innovators with education, mentorship and rewards.
• Identify and support research partnerships.
• Develop the expertise required to locate and secure funding for research.
The CHRISTUS Innovations Institute offers a connection for research to become an integral part of our CHRISTUS mission and to enhance our CHRISTUS brand as a center of innovative excellence.
Project 2: Organizational Excellence: The Baldrige Model
As I have said before, we have done a comparison of our Journey to Excellence goals, the Joint Commission goals, Magnet status and the Malcom Baldrige National Quality Award (MBNQA), and found their goals and requirements to be almost identical. In addition, we are hoping to apply for the Baldrige award for our entire system on or shortly after we reach the June 2009 summit.
This CHRISTUS team was asked to gain an understanding of the measurement, analysis and knowledge management requirements of the MBNQA and evaluate the opportunities for improvement for CHRISTUS Health’s current processes as related to the Baldrige criteria.
According to recent studies, the MBNQA is an excellent indicator of high organizational performance.Health care organizations applying for the award must show a focused and systematic approach to performance management in the following areas:
• Leadership
• Strategic planning
• Customer and market focus
• Measurement, analysis and knowledge management
• Human Resource focus
• Process management
• Business/organizational performance results
Through analysis of winning MBNQA award applications, participation in best practice forums, a site visit to an MBNQA winner, personal interviews and detailed research, a baseline assessment of CHRISTUS’ current processes as related to the MBNQA was achieved.
After an MBNQA award application is reviewed, Baldrige examiners score the application based on the criteria in eight scoring ranges or “bands.” Recent winners have scored in the upper portion of band five. After analysis of the draft MBNQA application for CHRISTUS Health prepared by the team in conjunction with a former Baldrige examiner, they determined that CHRISTUS’ current score is in the range of band two.
According to the band descriptors, CHRISTUS falls into the Early Systemic Approach category, as defined by the Baldrige foundation. This means that CHRISTUS is at the beginning stages of conducting operations by processes with repeatability, evaluation and improvement, and some early coordination among organizational units. Strategy and quantitative goals are being defined.
The team found that CHRISTUS needs to deploy a more robust management of processes throughout the system. To achieve excellence, CHRISTUS must strengthen accountability, deployment of processes and process efficiency in key areas. Our submission of an actual MBNQA application in 2009 will result in valuable feedback from the team of Baldrige Examiners.
CHRISTUS is in the early stages of the Baldrige journey. A careful study of CHRISTUS Health’s draft application and the resulting implementation of the team’s recommendations will align current processes with strategic and operational goals. As a result, CHRISTUS Health will reach organizational maturity and achieve world-class excellence.
For more information on the Baldrige award, see one of my previous posts on optimizing CHRISTUS’ performance.
Wednesday, June 11, 2008
Introduction to the CHRISTUS Academy
Although the availability of the latest technologies and efficient and effective designs of both inpatient and outpatient facilities are significant factors for health care success today, the most critical factor continues to be the quality of leadership. Recognizing this as a critical success factor, when CHRISTUS was formed in 1999, the Senior Leadership Team worked with our Organizational Development department (a division of our Human Resources function) to put together programs which would identify and develop future leaders for CHRISTUS Health that were comprised of ethnic, gender and age diversity. A key program as a result of this effort was the introduction of the CHRISTUS Leadership Academy in the U.S. in 2001 and the introduction of the same activity in Mexico in 2005.
Although during the first year of this program the Academy candidates could be self-nominated, they now need to be nominated by the Senior Team of the region or business unit in which they work or by the leader of the global corporate services division where they are employed. Over 50 potential candidates are identified each year, and 30 are chosen to participate by a selection committee which includes representatives from a cross-section of CHRISTUS leadership.
The successful candidates must have a bachelor’s degree or sufficient experience in health care to serve as a proxy for the college experience. Candidates are also encouraged to be pursuing post-graduate degrees at the time of their selection and are usually at the director level when they enter the class. Once selected, the class begins a 12-month journey which consists of five two-day sessions in various locations throughout the CHRISTUS global system, with one shared session always held in Mexico. In addition, since the Mexico class was formed, two bilingual Mexican Associates are accepted into the U.S. program and two bilingual American Associates participate in the CHRISTUS Muguerza Academy.
This process has added a multicultural dimension to our leadership training and provides an opportunity for the significantly younger population of leaders in CHRISTUS Muguerza to not only be exposed to the U.S. CHRISTUS programs, but also open the doors for the possibility of bilingual leaders working in countries that differ from their birthplace.
During these five sessions, the leaders are addressed by predominately internal faculty, covering all areas of leadership including strategy, business development, finance, advocacy and philanthropy. In addition, the leadership competencies identified by the CHRISTUS Health leadership team (which hopefully will guarantee successful leaders into the future) are all explored and taught through various learning sessions including workshops and panel discussions.
Two significant learning journeys, however, in this year’s program include a significant exposure to the governance process in addition to team participation in one of four projects selected by system and regional leadership, which always takes place before the start of each class. The projects center around current challenges within CHRISTUS with the expectation that the teams from the classes working on each project will come forth in May with significant recommendations to address these challenges with solutions that can be implemented throughout the CHRISTUS system.
Three such projects that have been utilized fully from past classes include
1. How to develop programs and seek that support Magnet status for nurses. This has been fully implemented and has been successful in one of our regions and is now being explored in multiple regions throughout CHRISTUS.
2. The Center for Management Excellence. This project was based on the fact that often the weakest link in leadership is at the management level, and this project team designed a four-day course which is now given to every manager during the quarter that they enter their management role within CHRISTUS.
3. Associate innovative ideas for improvement. This project set forth a process for Associates to submit to their regional leadership or business unit leadership ideas to improve efficiency and effectiveness of the workplace. (If an Associate’s idea is selected and implemented, the Associate will then reap a percentage of the cost savings.) This program has been implemented in several regions and also is being explored throughout the CHRISTUS system for possible future implementation.
The class is divided each year into four teams, each assigned a critical topic similar to those outlined above. They are provided an opportunity to do research, both within and outside CHRISTUS to learn as much as possible about the issue and are expected to prepare a professional paper which is publishable not only this research, but more importantly, their recommendations for solutions to the problem or challenge which was assigned to them. With a graduation of the sixth class in May of this year, 24 projects have been completed, all of which have contributed partially or totally to improvement initiatives within our health system. In addition, the students have learned how to work in teams and to utilize both virtual and real learning tools to advance their knowledge. And finally, they have developed analytical skills which have given them the ability to take the data from their learning and derive recommendations that can be implemented system-wide. Each year, the presentations of their projects are heard by the Senior Leadership Team and regional leaders, who give real-time feedback as to both the benefits of their recommendations as well as constructive input as to how their projects could even be further strengthened.
The learning opportunities from these processes are immeasurable and have increased in value each and every year. The governance exposure the experience affords participants is critical, because the one weakness that many candidates who present themselves for leadership positions within CHRISTUS have is a lack of knowledge about what is involved or the importance of the governance process at both the local and system level. Therefore, incorporated into this Academy experience is a requirement that each of the students participate in a board meeting in the region or business unit in which they work. Their participation is preceeded by a three-hour didactic session on governance presented by the Senior Vice President for Legal Services and the CEO of CHRISTUS Health. In addition, those students who are from corporate global services areas attend a system board meeting in January prior to their graduation. It is interesting to note that the graduates often indicate that this governance exposure is a highlight of their learning journeys.
In closing, I believe we would all agree that developing leaders with the competencies required to transform the present into the future must be a key area of focus for all present leaders in health care and therefore must be a high priority for CHRISTUS Health leadership. The Academy process supplemented by system-wide coaching and mentoring as well as the CHRISTUS Center for Management Excellence and now the Center for Nursing Management Excellence provides a unique opportunity for the up-and-coming leaders in CHRISTUS Health to perhaps even provide better leadership in the future than those of us are providing today who learned much of our leadership skills by on-the-job work experience dotted with many failures as well as successes.
In several future blog posts we will review specifically the four projects completed by the CHRISTUS Academy in the U.S. from this most recent class and we will specifically discuss how these support the strategies for CHRISTUS Health which we have in place for the next several years.
Although during the first year of this program the Academy candidates could be self-nominated, they now need to be nominated by the Senior Team of the region or business unit in which they work or by the leader of the global corporate services division where they are employed. Over 50 potential candidates are identified each year, and 30 are chosen to participate by a selection committee which includes representatives from a cross-section of CHRISTUS leadership.
The successful candidates must have a bachelor’s degree or sufficient experience in health care to serve as a proxy for the college experience. Candidates are also encouraged to be pursuing post-graduate degrees at the time of their selection and are usually at the director level when they enter the class. Once selected, the class begins a 12-month journey which consists of five two-day sessions in various locations throughout the CHRISTUS global system, with one shared session always held in Mexico. In addition, since the Mexico class was formed, two bilingual Mexican Associates are accepted into the U.S. program and two bilingual American Associates participate in the CHRISTUS Muguerza Academy.
This process has added a multicultural dimension to our leadership training and provides an opportunity for the significantly younger population of leaders in CHRISTUS Muguerza to not only be exposed to the U.S. CHRISTUS programs, but also open the doors for the possibility of bilingual leaders working in countries that differ from their birthplace.
During these five sessions, the leaders are addressed by predominately internal faculty, covering all areas of leadership including strategy, business development, finance, advocacy and philanthropy. In addition, the leadership competencies identified by the CHRISTUS Health leadership team (which hopefully will guarantee successful leaders into the future) are all explored and taught through various learning sessions including workshops and panel discussions.
Two significant learning journeys, however, in this year’s program include a significant exposure to the governance process in addition to team participation in one of four projects selected by system and regional leadership, which always takes place before the start of each class. The projects center around current challenges within CHRISTUS with the expectation that the teams from the classes working on each project will come forth in May with significant recommendations to address these challenges with solutions that can be implemented throughout the CHRISTUS system.
Three such projects that have been utilized fully from past classes include
1. How to develop programs and seek that support Magnet status for nurses. This has been fully implemented and has been successful in one of our regions and is now being explored in multiple regions throughout CHRISTUS.
2. The Center for Management Excellence. This project was based on the fact that often the weakest link in leadership is at the management level, and this project team designed a four-day course which is now given to every manager during the quarter that they enter their management role within CHRISTUS.
3. Associate innovative ideas for improvement. This project set forth a process for Associates to submit to their regional leadership or business unit leadership ideas to improve efficiency and effectiveness of the workplace. (If an Associate’s idea is selected and implemented, the Associate will then reap a percentage of the cost savings.) This program has been implemented in several regions and also is being explored throughout the CHRISTUS system for possible future implementation.
The class is divided each year into four teams, each assigned a critical topic similar to those outlined above. They are provided an opportunity to do research, both within and outside CHRISTUS to learn as much as possible about the issue and are expected to prepare a professional paper which is publishable not only this research, but more importantly, their recommendations for solutions to the problem or challenge which was assigned to them. With a graduation of the sixth class in May of this year, 24 projects have been completed, all of which have contributed partially or totally to improvement initiatives within our health system. In addition, the students have learned how to work in teams and to utilize both virtual and real learning tools to advance their knowledge. And finally, they have developed analytical skills which have given them the ability to take the data from their learning and derive recommendations that can be implemented system-wide. Each year, the presentations of their projects are heard by the Senior Leadership Team and regional leaders, who give real-time feedback as to both the benefits of their recommendations as well as constructive input as to how their projects could even be further strengthened.
The learning opportunities from these processes are immeasurable and have increased in value each and every year. The governance exposure the experience affords participants is critical, because the one weakness that many candidates who present themselves for leadership positions within CHRISTUS have is a lack of knowledge about what is involved or the importance of the governance process at both the local and system level. Therefore, incorporated into this Academy experience is a requirement that each of the students participate in a board meeting in the region or business unit in which they work. Their participation is preceeded by a three-hour didactic session on governance presented by the Senior Vice President for Legal Services and the CEO of CHRISTUS Health. In addition, those students who are from corporate global services areas attend a system board meeting in January prior to their graduation. It is interesting to note that the graduates often indicate that this governance exposure is a highlight of their learning journeys.
In closing, I believe we would all agree that developing leaders with the competencies required to transform the present into the future must be a key area of focus for all present leaders in health care and therefore must be a high priority for CHRISTUS Health leadership. The Academy process supplemented by system-wide coaching and mentoring as well as the CHRISTUS Center for Management Excellence and now the Center for Nursing Management Excellence provides a unique opportunity for the up-and-coming leaders in CHRISTUS Health to perhaps even provide better leadership in the future than those of us are providing today who learned much of our leadership skills by on-the-job work experience dotted with many failures as well as successes.
In several future blog posts we will review specifically the four projects completed by the CHRISTUS Academy in the U.S. from this most recent class and we will specifically discuss how these support the strategies for CHRISTUS Health which we have in place for the next several years.
Wednesday, June 4, 2008
New Work Habits for a Radically Changing World
As CHRISTUS Health moves toward our 10th anniversary on Feb. 1, 2009 and anticipates the recommendations emulating from the Futures Task Force II learning journeys, it is most appropriate to pause and reflect on how our health system might need to change from a governance and operational perspective to be successful as our future unfolds.
In a recent leadership booklet published by Price Prichett, which I shared with the Senior Leadership Team, we are reminded that CHRISTUS Health’s work, like that of many organizations, is going global. As the world flattens, jobs are going virtual.
The author states that: “Business is being conducted in ways that were simply impossible a few short years ago. The economy is shifting more and more towards services and towards knowledge work. Before long, top management absolutely won’t be able to run things the old way, even if it desperately wants to.”
In addition, the author reminds us it does no good whatsoever to complain about how new technologies are changing the health care industry. “The world will reward only those of us who will catch on to what’s happening. We must invest our energy in finding and seizing the opportunities brought about by change.”
“And change always comes bearing gifts. Considering the scope and speed of change these days, there will be precious gifts – many priceless opportunities – for those of us who can play by the new rules, positioning ourselves right and take personal responsibility for our future.”
Based on these introductory remarks, the author then articulates 13 guidelines for managing our performance during these times of radical change. These include:
1. Become a quick change artist. Change can be painful. But being a quick change artist can build our reputation, while resisting change can ruin it.
2. Commit fully to your work. We must fully commit to our Journey to Excellence, bringing forth our very best potential.
3. Speed up. We must continue create efficiencies in our processes, enhancing our reputation as an organization that pushes change processes along.
4. Accept ambiguity and uncertainty.
5. Behave like you’re in business for yourself.
6. Commit to life-long learning. We must continue to identify and share best practices. Our ability to debrief on each of our successes and failures and capture lessons learned will continue to be a vital success factor.
7. Increase accountability for outcomes.
8. Evaluate and quantify the added value of all we do.
9. Continue to see ourselves as a service center.
10. Make our own morale and optimism, while being realistic about the “moment in which we are living.”
11. Accept continuous improvement as a critical success factor
12. Be a fixer, not a finger painter.
13. Continuously raise your expectations. We must continuously review our metrics on our Journey to Excellence.
Yes, the future we have envisioned and continue to study will bring forth new challenges while also promising us new possibilities. In our first nine years, CHRISTUS Health has had astounding opportunities. By listening to the learnings from our Futures Task Force II, incorporating them into our future strategies and embracing new work habits we can continue our journey to be one of the best health care and wellness care delivery systems in this radically changing world.
In a recent leadership booklet published by Price Prichett, which I shared with the Senior Leadership Team, we are reminded that CHRISTUS Health’s work, like that of many organizations, is going global. As the world flattens, jobs are going virtual.
The author states that: “Business is being conducted in ways that were simply impossible a few short years ago. The economy is shifting more and more towards services and towards knowledge work. Before long, top management absolutely won’t be able to run things the old way, even if it desperately wants to.”
In addition, the author reminds us it does no good whatsoever to complain about how new technologies are changing the health care industry. “The world will reward only those of us who will catch on to what’s happening. We must invest our energy in finding and seizing the opportunities brought about by change.”
“And change always comes bearing gifts. Considering the scope and speed of change these days, there will be precious gifts – many priceless opportunities – for those of us who can play by the new rules, positioning ourselves right and take personal responsibility for our future.”
Based on these introductory remarks, the author then articulates 13 guidelines for managing our performance during these times of radical change. These include:
1. Become a quick change artist. Change can be painful. But being a quick change artist can build our reputation, while resisting change can ruin it.
2. Commit fully to your work. We must fully commit to our Journey to Excellence, bringing forth our very best potential.
3. Speed up. We must continue create efficiencies in our processes, enhancing our reputation as an organization that pushes change processes along.
4. Accept ambiguity and uncertainty.
5. Behave like you’re in business for yourself.
6. Commit to life-long learning. We must continue to identify and share best practices. Our ability to debrief on each of our successes and failures and capture lessons learned will continue to be a vital success factor.
7. Increase accountability for outcomes.
8. Evaluate and quantify the added value of all we do.
9. Continue to see ourselves as a service center.
10. Make our own morale and optimism, while being realistic about the “moment in which we are living.”
11. Accept continuous improvement as a critical success factor
12. Be a fixer, not a finger painter.
13. Continuously raise your expectations. We must continuously review our metrics on our Journey to Excellence.
Yes, the future we have envisioned and continue to study will bring forth new challenges while also promising us new possibilities. In our first nine years, CHRISTUS Health has had astounding opportunities. By listening to the learnings from our Futures Task Force II, incorporating them into our future strategies and embracing new work habits we can continue our journey to be one of the best health care and wellness care delivery systems in this radically changing world.
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