It has come to my attention that President-elect Barack Obama and Vice President-elect Joe Biden have been soliciting Americans’ thoughts on all sorts of issues on their transition website, change.gov. One of the issues receiving much attention is health care, and members of the transition team have posted video discussions on this very important topic.
We at CHRISTUS want to join in the discussion, so I thought it would be appropriate to post some video blogs for the next few weeks on my ideas regarding health care reform. I will tie these videos back to previous posts where you can gather more information on topics that interest you, and hope that my experience as a physician and health care leader will aid us in framing this very important discussion in a helpful way.
So let’s get started.
Wednesday, December 10, 2008
Wednesday, December 3, 2008
The Hidden Barrier to U.S. Health Care Reform
We know that because of the priorities of the incoming Obama/Biden administration, there is a great possibility that health care reform in the U.S. may be designed and (hopefully) implemented in the next several years. We also know that the major barrier that any potential reform will face is the cost and who will pay.
There is no doubt that this is a key question which must be answered. But because of the overuse of medical services, the duplication of many health care product lines and expense associated with the reworking of procedures that were not done correctly the first time, there are dollars that could be significantly saved and redirected to care for the large number of under- or uninsured. These issues must be addressed if we are to provide basic health care for all.
This undoubtedly will take a strong collaborative effort between all constituencies--including health care providers, the government and insurance companies--in order to develop an equitable source of funds for this expanded coverage.
We do know that both president-elect Obama is aware of the Massachusetts plan which, although unique, has successfully put together a multi-tiered and multi-participant funding program which is creating the dollars necessary to deliver care for all in that state. However, closer inspection of the Massachusetts plan and its results over the last 6 months uncovers a significant issue which I call “the hidden barrier” in making health care reform possible.
Although Massachusetts has enough money to provide the care, their issue now is the lack of primary care providers to see the patients who now have insurance coverage. This issue is present throughout the U.S. and will clearly come into focus to everyone who has the ability to pay for care that they either think they want or clearly need, regardless of their method of payment.
At the present time, less than 2 percent of all medical school graduates are entering family practice or internal medicine, which serve as the primary caregivers for adults in this country. For years these residency programs have been challenged to fill their open slots with American-trained medical students; therefore, the majority of those training slots in these specialties have been filled with foreign medical graduates.
We find ourselves in this situation primarily because primary care is not seen by the reimbursement bodies as significantly important in the health care continuum, and therefore these physicians have been the lowest on the reimbursement scale for many years. Their low payment rates for services provided are not only causing fewer people to enter the field, but most recently are causing family practitioners and internists who have been practicing for many years to decide that they can no longer continue as independent practitioners. This exodus from primary care is prevalent everywhere, but is mostly exaggerated in rural communities, where--in fact, if reform occurs--the needs will be greatest.
In addition, American health care has not rapidly embraced non-physician health care providers such as nurse practitioners, midwives and physicians’ assistants. This lack of support for these important professions has also been exaggerated recently because of declining reimbursement. Therefore these professionals have become very threatening to primary care physicians, who see any decline in volume as the result of treatment by others as a significant blow to their ability to survive.
I believe that our ability to increase the quantity of primary care providers to care for all of the uninsured in America might be more critical than finding ways to financially support this important undertaking.
So what are some of the possible answers to this dilemma?
1. Both federal and state governments must restructure their payment scales through the Medicare and Medicaid programs so that primary care reimbursements move closer to the payments that some specialists are receiving.
2. Medical school faculties must encourage their students to consider primary care residencies as valuable and exciting as those for surgery.
3. Incentive programs must be developed to entice medical students to enter primary care residencies. This could be done through loan forgiveness programs or providing perks and benefits which might be different than those offered to residents who will eventually go into high-paying specialties.
4. The American Medical Association must do a strong marketing/public awareness campaign to educate the public on what an important role primary care specialist play in maintaining the health of communities throughout the U.S.
5. Health systems should undertake similar awareness programs to make sure primary care physicians know that there are opportunities to enter medical groups. This would provide guaranteed salaries and opportunities to serve in multiple positions (including acting as hospitalists), which would give them the ability to not only make an adequate living, but have a better balance of their personal and professional lives.
6. Health systems, hospital associations and physician societies should understand the appropriate use for well-trained ancillary providers and create opportunities where they can be utilized appropriately to fill in the voids that are created by this low number of primary care providers. There is adequate proof, based on sound research, that midwives, physicians’ assistants and nurse practitioners can work in independent duty stations with clear guidelines that are formulated and overseen with physicians’’ input. These groups of people must be seen as adding value to rather than competing with physicians.
If health care reform is to be successful, not only will the question of affordability have to be answered, but perhaps even more importantly, the question that will need much more deliberation will be, “Who will be providing this care once we make it affordable?” The sooner we address the latter question, the greater chance we will have of being successful in creating some meaningful health care reform that will have permanent sustainability.
There is no doubt that this is a key question which must be answered. But because of the overuse of medical services, the duplication of many health care product lines and expense associated with the reworking of procedures that were not done correctly the first time, there are dollars that could be significantly saved and redirected to care for the large number of under- or uninsured. These issues must be addressed if we are to provide basic health care for all.
This undoubtedly will take a strong collaborative effort between all constituencies--including health care providers, the government and insurance companies--in order to develop an equitable source of funds for this expanded coverage.
We do know that both president-elect Obama is aware of the Massachusetts plan which, although unique, has successfully put together a multi-tiered and multi-participant funding program which is creating the dollars necessary to deliver care for all in that state. However, closer inspection of the Massachusetts plan and its results over the last 6 months uncovers a significant issue which I call “the hidden barrier” in making health care reform possible.
Although Massachusetts has enough money to provide the care, their issue now is the lack of primary care providers to see the patients who now have insurance coverage. This issue is present throughout the U.S. and will clearly come into focus to everyone who has the ability to pay for care that they either think they want or clearly need, regardless of their method of payment.
At the present time, less than 2 percent of all medical school graduates are entering family practice or internal medicine, which serve as the primary caregivers for adults in this country. For years these residency programs have been challenged to fill their open slots with American-trained medical students; therefore, the majority of those training slots in these specialties have been filled with foreign medical graduates.
We find ourselves in this situation primarily because primary care is not seen by the reimbursement bodies as significantly important in the health care continuum, and therefore these physicians have been the lowest on the reimbursement scale for many years. Their low payment rates for services provided are not only causing fewer people to enter the field, but most recently are causing family practitioners and internists who have been practicing for many years to decide that they can no longer continue as independent practitioners. This exodus from primary care is prevalent everywhere, but is mostly exaggerated in rural communities, where--in fact, if reform occurs--the needs will be greatest.
In addition, American health care has not rapidly embraced non-physician health care providers such as nurse practitioners, midwives and physicians’ assistants. This lack of support for these important professions has also been exaggerated recently because of declining reimbursement. Therefore these professionals have become very threatening to primary care physicians, who see any decline in volume as the result of treatment by others as a significant blow to their ability to survive.
I believe that our ability to increase the quantity of primary care providers to care for all of the uninsured in America might be more critical than finding ways to financially support this important undertaking.
So what are some of the possible answers to this dilemma?
1. Both federal and state governments must restructure their payment scales through the Medicare and Medicaid programs so that primary care reimbursements move closer to the payments that some specialists are receiving.
2. Medical school faculties must encourage their students to consider primary care residencies as valuable and exciting as those for surgery.
3. Incentive programs must be developed to entice medical students to enter primary care residencies. This could be done through loan forgiveness programs or providing perks and benefits which might be different than those offered to residents who will eventually go into high-paying specialties.
4. The American Medical Association must do a strong marketing/public awareness campaign to educate the public on what an important role primary care specialist play in maintaining the health of communities throughout the U.S.
5. Health systems should undertake similar awareness programs to make sure primary care physicians know that there are opportunities to enter medical groups. This would provide guaranteed salaries and opportunities to serve in multiple positions (including acting as hospitalists), which would give them the ability to not only make an adequate living, but have a better balance of their personal and professional lives.
6. Health systems, hospital associations and physician societies should understand the appropriate use for well-trained ancillary providers and create opportunities where they can be utilized appropriately to fill in the voids that are created by this low number of primary care providers. There is adequate proof, based on sound research, that midwives, physicians’ assistants and nurse practitioners can work in independent duty stations with clear guidelines that are formulated and overseen with physicians’’ input. These groups of people must be seen as adding value to rather than competing with physicians.
If health care reform is to be successful, not only will the question of affordability have to be answered, but perhaps even more importantly, the question that will need much more deliberation will be, “Who will be providing this care once we make it affordable?” The sooner we address the latter question, the greater chance we will have of being successful in creating some meaningful health care reform that will have permanent sustainability.
Discussing Health Care Reform
As President-elect Obama and his transition team prepare to take control, continue to fill important leadership positions and discuss issues of top priority to their administration, U.S. health care reform remains a significant issue to those of us who are blessed to work in health care. Therefore, I thought this would be a great opportunity to gather my blog posts about the U.S. health care system and health care reform together in one place so they are easily accessible. It is my hope that this will help us continue to dialogue about this important issue.
Health Care Reform (7.11.07)
Health Care Reform – Who Should Come to the Table? (7.18.07)
No Common Voice in Health Care (12.5.07)
Tort Reform in Texas (12.11.07)
Futures Task Force II Journeys to Canada (4.16.08)
Canada's Health System and the Determinants of Health (4.30.08)
The Importance of Advocacy (5.28.08)
Redesign of the U.S. Health Care System (7.2.08)
Could segmented health care be part of the solution? (8.6.08)
Competition and Collaboration (8.11.08)
The Hidden Barrier to U.S. Health Care Reform (12.3.08)
Health Care Reform (7.11.07)
Health Care Reform – Who Should Come to the Table? (7.18.07)
No Common Voice in Health Care (12.5.07)
Tort Reform in Texas (12.11.07)
Futures Task Force II Journeys to Canada (4.16.08)
Canada's Health System and the Determinants of Health (4.30.08)
The Importance of Advocacy (5.28.08)
Redesign of the U.S. Health Care System (7.2.08)
Could segmented health care be part of the solution? (8.6.08)
Competition and Collaboration (8.11.08)
The Hidden Barrier to U.S. Health Care Reform (12.3.08)
Wednesday, November 26, 2008
Giving Thanks for the CHRISTUS Family
We at CHRISTUS Health have much to be thankful for this year, especially the opportunity to care for people who turn their most precious gift—their lives—over to us.
However, it may be more difficult for many of us to stop and give thanks this holiday season. It is true that over the past year the CHRISTUS family has endured hurricanes, tough economic times, turmoil in the world at large and other valleys on our Journey to Excellence.
But I believe that tough times make clearer the importance of celebrating our incremental victories and giving thanks for the blessings we do have in our lives, both personally and professionally. As we journey toward our 10th anniversary in February of next year and as many of us prepare to spend the holiday season with our families, we pause to appreciate the blessing of being a part of the CHRISTUS family.
I continue to be incredibly proud to be a part of this wonderful family, which works together during good times and bad to support and care for each other as well as extend the healing ministry of Jesus Christ to our patients and residents each day. I was once again humbled this year that as we faced multiple hurricanes targeting our regions, every CHRISTUS Associate continued to go above and beyond the call of duty in their responses to the hurricanes and their willingness to serve our patients and their fellow Associates.
Every day, in each of our facilities, services and programs, members of the CHRISTUS family are creating Miracle Moments by bringing hope and health to people who are scared, sick, vulnerable or just need a helping hand. May God bless each of us as we continue this sacred work.
However, it may be more difficult for many of us to stop and give thanks this holiday season. It is true that over the past year the CHRISTUS family has endured hurricanes, tough economic times, turmoil in the world at large and other valleys on our Journey to Excellence.
But I believe that tough times make clearer the importance of celebrating our incremental victories and giving thanks for the blessings we do have in our lives, both personally and professionally. As we journey toward our 10th anniversary in February of next year and as many of us prepare to spend the holiday season with our families, we pause to appreciate the blessing of being a part of the CHRISTUS family.
I continue to be incredibly proud to be a part of this wonderful family, which works together during good times and bad to support and care for each other as well as extend the healing ministry of Jesus Christ to our patients and residents each day. I was once again humbled this year that as we faced multiple hurricanes targeting our regions, every CHRISTUS Associate continued to go above and beyond the call of duty in their responses to the hurricanes and their willingness to serve our patients and their fellow Associates.
Every day, in each of our facilities, services and programs, members of the CHRISTUS family are creating Miracle Moments by bringing hope and health to people who are scared, sick, vulnerable or just need a helping hand. May God bless each of us as we continue this sacred work.
Wednesday, November 19, 2008
An Innovative Solution for Those with Mental Illness (Part I)
As we discussed in my last blog post, Catholic Health World, a publication of the Catholic Health Association of the United States, recently published an article on CHRISTUS’ practice of using Community Health Workers (CHWs) to help patients access behavioral health services in Texas.
We originally used CHWs to help patients get through the health care system as expeditiously possible and provide them with resources that permit them to monitor their health care status at home, hoping that they will require less costly health care services in the future.
In the city of Corpus Christi, Texas and other rural communities in the area where CHRISTUS facilities are located, CHWs are participating in a pilot program to help patients with mental illness. It is clear that limited resources are allocated to mental health, especially in remote rural communities.
These CHWs are tasked with making sure that seriously mentally ill patients get their medical and dental needs met and that medical patients get screened and treated for situational depression, debilitating anxiety and substance abuse. To be considered for care by a CHW specializing in helping clients with mental illness, a patient must have had two psychiatric hospitalizations in as many months or had three psychiatric admissions within 12 months. Patients are also usually uninsured and can’t be currently enrolled as clients of the state’s Community Mental Health and Mental Retardation system, which provides medical services exclusively to people with bipolar disorder, schizophrenia and major depression. Patients generally stay in the program for three months.
They are offered the Aggressive Community Treatment program (ACT), which is reserved for patients who have no resources, poor life skills and nowhere else to turn. ACT is free to patients. In this way, it addresses not only poor mental health, but many of the contributing factors that exacerbate it.
Some of these CHWs meet candidates for the program while they are patiens in the behavioral health unit at CHRISTUS Spohn Hospital Corpus Christi – Memorial. They then offer to help the patient with some of the factors that fueled the chain of events that led them to a hospitalization. Eventually, the CHW will hand these patients totally to the care of the state’s mental health system, but in the first 90 days after psychiatric hospitalization—a critical time—the CHW works to stabilize a patient on medication as directed and aid in securing everything from sobriety programs, housing aid and job hunting assistance. Many times, the CHW will check in on new patients daily.
We have seen this pilot program bring impressive results in South Texas. One of the best measures of success in the treatment of serious mental illness is the measure of time that patients can successfully function in the community. Only six of approximately 40 individuals in the program in the first year were readmitted to the hospital.
It is important as CHRISTUS continues to care for our patients in these increasingly tough financial times that we remain committed to our mission and ensuring that we have the resources to sustain this care for years to come. One of the ways we do this is by creating new programs that care for our communities in cost-effective ways.
It is my belief that in a system the size of CHRISTUS Health, someone, somewhere has devised a best practice for almost every action we undertake in our facilities. That is why we are so committed to our Touchstone Awards—which annually recognize best practices throughout our system. This Community Health Worker program is just one of the examples of innovation at work in CHRISTUS Health, and I am hopeful that we will continue to collect data and share this as a proven best practice in the future.
We originally used CHWs to help patients get through the health care system as expeditiously possible and provide them with resources that permit them to monitor their health care status at home, hoping that they will require less costly health care services in the future.
In the city of Corpus Christi, Texas and other rural communities in the area where CHRISTUS facilities are located, CHWs are participating in a pilot program to help patients with mental illness. It is clear that limited resources are allocated to mental health, especially in remote rural communities.
These CHWs are tasked with making sure that seriously mentally ill patients get their medical and dental needs met and that medical patients get screened and treated for situational depression, debilitating anxiety and substance abuse. To be considered for care by a CHW specializing in helping clients with mental illness, a patient must have had two psychiatric hospitalizations in as many months or had three psychiatric admissions within 12 months. Patients are also usually uninsured and can’t be currently enrolled as clients of the state’s Community Mental Health and Mental Retardation system, which provides medical services exclusively to people with bipolar disorder, schizophrenia and major depression. Patients generally stay in the program for three months.
They are offered the Aggressive Community Treatment program (ACT), which is reserved for patients who have no resources, poor life skills and nowhere else to turn. ACT is free to patients. In this way, it addresses not only poor mental health, but many of the contributing factors that exacerbate it.
Some of these CHWs meet candidates for the program while they are patiens in the behavioral health unit at CHRISTUS Spohn Hospital Corpus Christi – Memorial. They then offer to help the patient with some of the factors that fueled the chain of events that led them to a hospitalization. Eventually, the CHW will hand these patients totally to the care of the state’s mental health system, but in the first 90 days after psychiatric hospitalization—a critical time—the CHW works to stabilize a patient on medication as directed and aid in securing everything from sobriety programs, housing aid and job hunting assistance. Many times, the CHW will check in on new patients daily.
We have seen this pilot program bring impressive results in South Texas. One of the best measures of success in the treatment of serious mental illness is the measure of time that patients can successfully function in the community. Only six of approximately 40 individuals in the program in the first year were readmitted to the hospital.
It is important as CHRISTUS continues to care for our patients in these increasingly tough financial times that we remain committed to our mission and ensuring that we have the resources to sustain this care for years to come. One of the ways we do this is by creating new programs that care for our communities in cost-effective ways.
It is my belief that in a system the size of CHRISTUS Health, someone, somewhere has devised a best practice for almost every action we undertake in our facilities. That is why we are so committed to our Touchstone Awards—which annually recognize best practices throughout our system. This Community Health Worker program is just one of the examples of innovation at work in CHRISTUS Health, and I am hopeful that we will continue to collect data and share this as a proven best practice in the future.
Wednesday, November 12, 2008
An Innovative Solution for Those with Mental Illness (Part I)
Catholic Health World, a publication of the Catholic Health Association of the United States, recently published an article on CHRISTUS’ practice of using Community Health Workers to help patients access behavioral health services in Texas.
I have said before that I believe the health care industry has failed miserably in the delivery of behavioral health.
As recently as ten years ago, many inpatient behavioral health facilities were cleared and closed, driven especially by the rapid decline of reimbursement by both governmental and private insurers. (In addition, it was believed that the rapid development of medications to treat psychiatric illnesses would clear our inpatient mental health facilities, which has not been the case.) Consequently, our streets became filled with people unable to work or care for themselves, which has added to the growing number of uninsured and underserved in our country.
Therefore, CHRISTUS is working on innovative and cost-effective solutions to aid patients in difficult situations when the resources available to them are few.
The Catholic Health World article summarizes Texas’ problem well, as it is the state “with the highest number of uninsured residents and one of the smallest per-capita public investments in mental health services in the nation.”
Therefore, CHRISTUS is working to strengthen the safety net for these seriously ill patients—many of whom are homeless--by helping them access a number of needed services in addition to mental health assistance, such as housing and job search help.
We do this in South Texas by utilizing Community Health Workers (CHWs), who we have historically used to help clients with high-ED utilization to access health resources at the appropriate level of care, find medical homes and help to prevent and manage chronic illnesses.
These original CHWs were part of an innovative pilot program started in the CHRISTUS Spohn region, and generally do not have a background in health care. However, we provide them with training and then assign them to 9 or 10 chronically ill, uninsured people.
The CHWs really become navigators for these people, to get them as expeditiously through the health care system as possible, but also provide them with resources that permit them to monitor their health care status at home, hoping that they will require less costly health care services as they continue life’s journey.
Our initial data from studying the patients cared for by these general CHWs show that their ED visits have been reduced drastically, the medications they have taken could be eliminated or reduced also, and their activities of daily living are enhanced.
Now, CHWs are being used to assist those with mental illness as well, which I will examine in more depth in my next blog post.
I have said before that I believe the health care industry has failed miserably in the delivery of behavioral health.
As recently as ten years ago, many inpatient behavioral health facilities were cleared and closed, driven especially by the rapid decline of reimbursement by both governmental and private insurers. (In addition, it was believed that the rapid development of medications to treat psychiatric illnesses would clear our inpatient mental health facilities, which has not been the case.) Consequently, our streets became filled with people unable to work or care for themselves, which has added to the growing number of uninsured and underserved in our country.
Therefore, CHRISTUS is working on innovative and cost-effective solutions to aid patients in difficult situations when the resources available to them are few.
The Catholic Health World article summarizes Texas’ problem well, as it is the state “with the highest number of uninsured residents and one of the smallest per-capita public investments in mental health services in the nation.”
Therefore, CHRISTUS is working to strengthen the safety net for these seriously ill patients—many of whom are homeless--by helping them access a number of needed services in addition to mental health assistance, such as housing and job search help.
We do this in South Texas by utilizing Community Health Workers (CHWs), who we have historically used to help clients with high-ED utilization to access health resources at the appropriate level of care, find medical homes and help to prevent and manage chronic illnesses.
These original CHWs were part of an innovative pilot program started in the CHRISTUS Spohn region, and generally do not have a background in health care. However, we provide them with training and then assign them to 9 or 10 chronically ill, uninsured people.
The CHWs really become navigators for these people, to get them as expeditiously through the health care system as possible, but also provide them with resources that permit them to monitor their health care status at home, hoping that they will require less costly health care services as they continue life’s journey.
Our initial data from studying the patients cared for by these general CHWs show that their ED visits have been reduced drastically, the medications they have taken could be eliminated or reduced also, and their activities of daily living are enhanced.
Now, CHWs are being used to assist those with mental illness as well, which I will examine in more depth in my next blog post.
Wednesday, November 5, 2008
Being aware of the signs of failure
Recognizing the reality and concerns expressed in last week’s blog post related to the volatility of the market and the global economic crisis that has ensued, it is undoubtedly important for all health care institutions, including CHRISTUS Health, to be more cognizant of the signs of failure than ever before. I would suggest that there are six clear signs of failure which, if seen early, can hopefully be minimized and also serve as energizers to make sure that incremental successes are cancelling out the failures as quickly as possible.
1. How is your performance measurement, and therefore, your performance credibility? As I believe I have shared before, one of my greatest mistakes in my early leadership years was not having metrics for everything that I was doing or leading in the organization where I worked. You have undoubtedly heard me discuss many times our Journey to Excellence and the metrics associated with our Four Directions, hallmarks of all of our regions and programs both in the U.S. and internationally. Hence, by monitoring these metrics on a daily, weekly or monthly basis, it is very easy to determine if the measurements are being met. If not, then we can reaffirm that there are clear action plans in place to ensure that these metrics are going to be reached in as timely a fashion as possible.
2. Are you focused on the basics of execution? Leadership teams must always demonstrate the ability to do good strategic planning and to articulate the tactics to bring these plans to reality. However, where teams most often fail is the ability to execute these tactics and, more importantly, to hold people in the organization accountable to bringing these plans to fruition. Again, by monitoring metrics as outlined above, one can determine if the execution is successful or not. If the latter is the case, one can quickly reaffirm the need to improve them to the responsible party, or remove the responsible party and replace them with someone who understands the urgency of the day and is willing to take not only the responsibility, but the accountability to fully implement the tactical plans for improvement.
3. Is bad news coming to you regularly? Is each day filled with an array of emails, written communications, telephone calls or personal interactions which indicate that something unexpected--and more importantly, negative--has been occurring more frequently than would normally be the case? In addition, are people presenting these reports without quickly articulating the action plan which they have already put in place to assure you that the problem will quickly be ameliorated? Bad news is expected in the complex health care environment in which we function today. But good leaders in good times never present the bad news without the action plan to turn it around.
4. Is your own team disconnected? In bad times, weak teams become weaker. Finger-pointing is accentuated and excuses run rampant. The resolution of problems in challenging times can rarely be carried out by a single individual in a single department, program, or region, and therefore the cohesiveness of the team and the ability to act in a collaborative and connected way is essential. If this is not happening, then it is most appropriate to pause and do some basic team building exercises, for the solutions that are reached will parallel the effectiveness of the team.
5. Are you unable to confidently predict your outcomes daily, monthly or quarterly? It is imperative that during challenging times, an increase effort be placed on processes to predict at mid-month what the month-end operational margins will be. Likewise, it is important to monitor labor and supply costs on a daily basis and create as much variable budgeting in these two areas as possible to parallel the predicted revenue that they are generating. The degree to which these predictions can be made accurately will be the degree to which the proposed solutions will be successful in addressing the reality of the market volatility.
6. Are the things that you were doing well becoming now the things at which you are failing? Perhaps more important than a snapshot of today’s metrics is the trend of these metrics over the last several months or year. Recognizing, as we have stated before in prior posts, that health care change is never linear, we expect some ups and downs as normal variability as we climb from the valley to the top of the mountain. However, if the trends are showing that the peaks we’ve reached on our climb are no longer in view and we are standing at a much lower level on the mountain for a prolonged period of time, we should be honest with ourselves and understanding that what we thought was hard-wired into our improvement plans was in fact extremely transient, therefore new performance plans must be devised and implemented to replace those that are not working.
Yes, it is imperative that we accept the volatility of the market as what will probably be a longer-term reality for us. But we also must accept that our mission, vision and values cannot be altered during this period of time, and that in fact we must continue to energize ourselves to maintain our Journey to Excellence as our highest priority. These times may require different approaches, different tactics and innovative methodologies to create change, and if we are successful by clearly monitoring the signs of failure and correcting them as quickly as possible, it seems reasonable to expect that reaching the top of the mountain is still extremely important and very possible.
1. How is your performance measurement, and therefore, your performance credibility? As I believe I have shared before, one of my greatest mistakes in my early leadership years was not having metrics for everything that I was doing or leading in the organization where I worked. You have undoubtedly heard me discuss many times our Journey to Excellence and the metrics associated with our Four Directions, hallmarks of all of our regions and programs both in the U.S. and internationally. Hence, by monitoring these metrics on a daily, weekly or monthly basis, it is very easy to determine if the measurements are being met. If not, then we can reaffirm that there are clear action plans in place to ensure that these metrics are going to be reached in as timely a fashion as possible.
2. Are you focused on the basics of execution? Leadership teams must always demonstrate the ability to do good strategic planning and to articulate the tactics to bring these plans to reality. However, where teams most often fail is the ability to execute these tactics and, more importantly, to hold people in the organization accountable to bringing these plans to fruition. Again, by monitoring metrics as outlined above, one can determine if the execution is successful or not. If the latter is the case, one can quickly reaffirm the need to improve them to the responsible party, or remove the responsible party and replace them with someone who understands the urgency of the day and is willing to take not only the responsibility, but the accountability to fully implement the tactical plans for improvement.
3. Is bad news coming to you regularly? Is each day filled with an array of emails, written communications, telephone calls or personal interactions which indicate that something unexpected--and more importantly, negative--has been occurring more frequently than would normally be the case? In addition, are people presenting these reports without quickly articulating the action plan which they have already put in place to assure you that the problem will quickly be ameliorated? Bad news is expected in the complex health care environment in which we function today. But good leaders in good times never present the bad news without the action plan to turn it around.
4. Is your own team disconnected? In bad times, weak teams become weaker. Finger-pointing is accentuated and excuses run rampant. The resolution of problems in challenging times can rarely be carried out by a single individual in a single department, program, or region, and therefore the cohesiveness of the team and the ability to act in a collaborative and connected way is essential. If this is not happening, then it is most appropriate to pause and do some basic team building exercises, for the solutions that are reached will parallel the effectiveness of the team.
5. Are you unable to confidently predict your outcomes daily, monthly or quarterly? It is imperative that during challenging times, an increase effort be placed on processes to predict at mid-month what the month-end operational margins will be. Likewise, it is important to monitor labor and supply costs on a daily basis and create as much variable budgeting in these two areas as possible to parallel the predicted revenue that they are generating. The degree to which these predictions can be made accurately will be the degree to which the proposed solutions will be successful in addressing the reality of the market volatility.
6. Are the things that you were doing well becoming now the things at which you are failing? Perhaps more important than a snapshot of today’s metrics is the trend of these metrics over the last several months or year. Recognizing, as we have stated before in prior posts, that health care change is never linear, we expect some ups and downs as normal variability as we climb from the valley to the top of the mountain. However, if the trends are showing that the peaks we’ve reached on our climb are no longer in view and we are standing at a much lower level on the mountain for a prolonged period of time, we should be honest with ourselves and understanding that what we thought was hard-wired into our improvement plans was in fact extremely transient, therefore new performance plans must be devised and implemented to replace those that are not working.
Yes, it is imperative that we accept the volatility of the market as what will probably be a longer-term reality for us. But we also must accept that our mission, vision and values cannot be altered during this period of time, and that in fact we must continue to energize ourselves to maintain our Journey to Excellence as our highest priority. These times may require different approaches, different tactics and innovative methodologies to create change, and if we are successful by clearly monitoring the signs of failure and correcting them as quickly as possible, it seems reasonable to expect that reaching the top of the mountain is still extremely important and very possible.
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