As U.S. hospitals receive guidance on Ebola from infectious disease specialists at the Centers for Disease Control and Prevention, some hospitals say they are prepared.
As the second of two American patients infected with the Ebola virus in Western Africa was admitted to a U.S. hospital Tuesday, infectious disease specialist from the Centers for Disease Control and Prevention updated healthcare workers on the status of the outbreak and provided guidance on preparing U.S. hospitals for Ebola cases.
Aside from the two medical evacuations, there has yet to be a confirmed case of the Ebola virus in the United States. But hospitals are preparing for that possibility. A woman in an Ohio hospital tested negative for Ebola and a man at Mt. Sinai Hospital in New York is in isolation awaiting test results, but it "is unlikely to have Ebola," the city's health department said in a statement Monday.
In a one-hour webinar for clinicians, Barbara Knust, epidemiologist at the CDC's division of high consequence pathogens and pathology and David Kuhar, MD, from the CDC's division of healthcare quality promotion, shared information about the cause of the disease, how it is transmitted, and offered guidance on preventative measures.
Knust and Kuhar emphasized that Ebola is only transmittable through body fluids and quickly dies outside a host body. Victims are not contagious until symptoms develop. The CDC supplied guidelines for evaluating patientsand for managing infection prevention and control for hospitalized patients.
For healthcare workers in hospitals, the preventative steps shouldn't feel that different from normal, day-to-day precautions that are already in place, says Shira Doron, MD, a physician specializing in infectious diseases and an associate hospital epidemiologist at Tufts Medical Center in Boston.
"[The precautions we're taking] are not so different from what we do on a day-to-day basis. We're using equipment we're comfortable with… what's different is that we're using all of these at the same time."
Doron says her team is prepared to wear protective gowns, head coverings, disposable booties, goggles and N-95 respiration filter masks when seeing suspected Ebola patients. She and her team of four are responsible for educating Tufts' staff about Ebola and creating plans to deal with cases of exposure.
She's been working to get the word out to both patients and staff—from lab workers, who have been instructed to use a high degree of caution with samples— to front line staff, who have been educated about the symptoms of Ebola and instructed to ask about recent travel history. "Everyone is getting ready," she says.
While they hope it never becomes necessary, the Boston Medical Center is well prepared to see Ebola patients should the need arise, said Nahid Bhadelia, MD, director of infections control at the national emerging infectious diseases laboratory at Boston University.
"When a suspected Ebola patient comes to the emergency room, we identify them… [based on travel history and symptoms]. They are then placed in isolation away from the public, in a negative-pressure room… where the air is circulated back into the room rather than circulating out."
"I think that the important thing is the comfort level of the healthcare workers who work with the patients," Bhadelia continued. "That comfort level requires comfort, training, and drilling," she said.
But Bhadelia is convinced that American hospitals and healthcare centers are up to the challenge. "All tertiary care hospitals are equipped to deal with Ebola," she said. "We've been getting… guidance from CDC. We're all keeping our ears to the ground, but I think we're equipped for this."
Remote teams can cut hospital costs and help fill staffing gaps, but HIT and regulatory requirements can be daunting, especially for small, remote hospitals.
Bryan Coffey
CEO of Hamilton County Hospital
A human-size robot roams the halls of Hamilton County Hospital. Through cameras and a tablet mounted at eye level, doctors working as far away as California, New York, or Massachusetts view and treat patients in this rural Kansas hospital remotely.
Hamilton County Hospital is a 25-bed critical access care hospital in Syracuse, a small town of just over 1,800 people on the southwestern Kansas frontier. "The nearest Walmart is 55 miles away," says Bryan Coffey, the hospital's CEO. While it's typically difficult to recruit staff to work in such remote care settings, Coffey has found a technology-based strategy for both keeping the hospital fully staffed and cutting costs.
"We're the perfect model for telehealth and remote teams," says Coffey.
"I have a passion for two things: rural healthcare and telemedicine," he continues. Delivery of care in Coffey's part of Kansas is not always easy. "This is a region where people have to drive eight hours one way to see a pediatric specialist." Recognizing that his patients would be better served by access to more specialists than Hamilton County could realistically attract or support, Coffey found a that telemedicine is the right answer to his hospital's staffing challenges.
The robot, identical to robots used for healthcare by the Department of Defense cost $2,300 a month to rent. "But, if we keep even one patient [at this hospital], it pays for several months of the robot," Coffey says. Not only can rural hospitals take advantage of talent from outside the immediate area, hospitals in areas where labor is expensive can take advantage of less expensive labor pools in other areas, says Bruce Carothers, vice president of Telehealth Solutions at AMN Healthcare, a healthcare recruiting firm. "You can definitely cut costs by employing specialists part time and remotely," he says.
Besides dealing with regional labor issues, there are many other benefits to implementing a telehealth program.
Convenience
Cost-saving is just one benefit of telehealth. "It's much more efficient," says Carothers. Telemedicine allows doctors to quickly log out of an appointment with one patient and into another in seconds. "If they're prescribing an antibiotic, they can finish the video consult in 15 minutes, then move on to the next," added Carothers. "Many physicians toward the end of their careers chose this as a way to start winding down."
Aside from clinicians, other roles that lend themselves to remote teams include customer service, radiology, triage, billing, coding, and "Anything that doesn't involve having to touch or manipulate the patient," says Carothers.
The flexibility afforded by telehealth technologies allows workers who cannot commute due to health issues, child or eldercare responsibilities or lack of access to transportation a chance to work.
Radiologists Available at Any Hour
"There's a whole sector of teleradiology called 'nighthawking,'" explains Carothers. "They find US- licensed physicians who live oversees who can look at images on weekends and at night." It's one way to ensure all radiology results are in by Monday morning.
Some organizations, especially in remote areas, also employ a team of remote telepharmacists who can review prescriptions after hours. Because the pharmacists are employed by an outside service and shared by multiple hospitals, they are a less expensive option, and provide just the right amount of coverage for weekends and evenings.
But there are some challenges to be mindful of when considering remote staffing.
Remote Possibilities As attractive as telehealth can be, the barriers to adoption are many. For starters, a hospital must have robust and reliable high-speed broadband connectivity to support clinical functions.
Another vital requirement: Physicians must be properly licensed to practice in remote locations. Since licensure is regulated by the states, this can be very complicated.
As for reimbursement, traditionally, Medicare and insurance companies have only covered telemedicine appointments when the patient was in a very remote area like Hamilton County. "This is improving every year," says Carothers. "Currently, 20 states mandate that commercial payers pay for telehealth services. But this has… been a downside."
Coffey concedes there are certain jobs around the hospital that still require in-house staffing. "Housekeeping and maintenance… Phlebotomists, bedside RNs, that need to touch the patient or change bedding and wound care all have to be done on-site," he says.
And that brings to mind an additional obstacle: bridging the gap between both doctor and patient. While the goal is seamless delivery of care, sometimes, the distance becomes noticeable. "It's critical to establish a relationship prior to telemedicine," says Carothers.
He cautions that it's important to properly collaborate with and manage a remote team as well. "There's always a little bit of a gap when doing things remotely relative to a face-to-face conversation. It isn't always easy." He suggests putting in extra effort to fill the void with phone calls, instant messages, and video call services such as Skype and Facetime.
Coffey insists, however, that Hamilton County's patients hardly notice the distance once they spend a few minutes with a remote doctor evaluating them via the robot. "You would be shocked how many people extend a hand and say 'thank you, doc,' only to remember there's no hand to shake on the robot."
One advantage of adopting a private health exchange is that it takes the responsibility of administering health insurance benefits off of HR's plate completely. But there's more to know before making the leap.
One of the many questions surrounding healthcare reform is how the introduction of private health insurance exchanges and state health insurance exchanges—could affect how—and eventually whether—employers offer health insurance coverage to employees.
HR departments face the age-old challenge of keeping health insurance premiums low and benefits offerings competitive. That hasn't changed.
But research indicates that as much as one quarter of American employers is considering moving benefits to a private health exchange within the next three to five years.
Meantime, the number of consumers covered under a private health exchange has grown from zero a year ago to three million today, and it's estimated that 18% of the US population will hold such coverage by 2017.
One of the greatest advantages of adopting a private health exchange is that it takes the responsibility of administering the health insurance benefits off of HR's plate completely. Many consumers also like being able to choose their own coverage and the opportunity to compare different plans in a retail-like environment.
This shifts the responsibility of understanding those benefits to the employee, however, which has potential to end badly, should the employee not thoroughly understand all the options, costs, and risks.
While ending up overinsured—paying too high a premium for a plan that is too comprehensive—isn't great, the larger danger is choosing a plan that looks inexpensive—but that has a high and hard-to-meet deductible.
Joe Donlan
President and Co-Founder of ConnectedHealth
Joe Donlan, president and co-founder of ConnectedHealth, a private health exchange vendor headquartered in Chicago, walked me though some of the considerations HR executives should be weighing before switching to a private health exchange.
HLM: What are the top benefits of employing a private exchange rather than traditional health insurance plans?
Donlan: First, a private exchange will help reduce HR's benefit administration burden. Employers also have more predictability in terms of cost, as they determine a set amount to offer their employees to use toward their benefits through defined contributions.
Also, many employees say that they like the personalized benefit solutions based on their own individual needs, behaviors and attitudes.
HLM: Tell us a bit more about some benefits of private exchanges as opposed to traditional health insurance Plans.
Donlan: Perhaps the most important aspect is the broader array of benefit options being provided to employees. Health insurance used to be a one-size-fits-all kind of thing. At most companies, an employee could expect between one and three options—none of which [might have been] the best fit for the consumer.
Many people ended up overinsured, some underinsured. Private health exchanges offer a broader mix of benefit designs, from least to most coverage, and offer your employees more options. They get to pick the plan that is best for their circumstances.
HLM: Some HR pros worry about confusion among employees or negative customer experience when dealing with a new system such as private health exchanges. What are your organization and others doing to ensure a positive customer experience on the exchange?
Donlan: Well, we're doing a couple things. First, we acknowledge that we're dealing with a diverse workforce of employees who are eligible for group-oriented benefits. We know that we need to offer benefit solutions that will work for everybody within that workforce.
The communications and information about plans and individual offerings that we provide to employees really help them once they embark on enrolling in different products and services.
We also like to make sure employers have decision support tools provided to end users. Employees are starting to buy higher deducible health plans, which means consumers may be more financially exposed.
Our system helps individuals figure out which plan is best for them based on their personal risk tolerance and how they use health insurance. We make it a point to show them what their total financial exposure might be. Not just via premiums, but total out of pocket health costs. With that information available, people can start making trade-offs to decide what risks they want to take for dollars they might save.
I think [human resources leaders] need to know that if you don't have those tools available, you run the risk of an employee realizing they bought a plan with a $10,000 deductible without realizing it. That's not a place you want to be.
HLM: On that topic, how can the industry overcome potentially uninformed consumers? What are you doing to ensure they are not surprised by a high deductible, high copayment, procedures and services not being covered at all?
Donlan: Decision support tools. Healthcare is overwhelming, confusing, and can get emotional. It's important for organizations… to help users navigate the system. We need to provide context and framework to help create an informed consumer, so that consumer will make very good choices and be able to properly make tradeoffs at certain decision points as they utilize healthcare services.
We don't want to see customers on the front page of the paper because they chose a plan where they didn't know what their total exposure was and are now deep in debt. We want to set customers up with the right product and services.
New laws aim to make it easier for retired doctors, nurses, and dentists to find meaningful work seeing patients and mentoring younger clinicians.
Know any elderly clinicians bored of tea parties with the grandkids and golf at the country club? A future of helping disadvantaged patients or mentoring young physicians just might await them, especially if they are residents of Illinois, where lawmakers think they've got the doctor shortage all figured out.
While different states have been attempting to find solutions to the doctor shortage ranging from expanding the current cap of Medicare-supported training slots for doctors in NY to allowing nurse practitioners to practice without physician oversight in Illinois, legislation aims to expand access to care by making it easier for clinicians, including doctors, nurses, dentists, and optometrists to find meaningful work after leaving full-time practice.
"I'm not surprised that all that this is happening," says Ralph Henderson, president of healthcare staffing at AMN Healthcare. "There are lots of incentives to work in certain states or rural areas. This is a logical next step given the shortage of physicians in the marketplace, and personally, I love the idea."
But this isn't an isolated anomaly—it's part of a greater trend toward clinicians working longer after retired from the full-time demand of their medical careers.
The Lure of Working Life Nothing lures a clinician out of retirement like a feel-good assignment, says Henderson. "Retired [clinicians] love situations where their work can make a difference in other people's lives in a positive way. They're often looking for a way they can give back."
It's not a hard sell to give someone a chance to feel they're using their skills to make the world a better place. In addition to working with underprivileged populations, other capacities appealing to retirees that can be done on a volunteer or part-time basis include covering for peers during vacations or family leave.
Sometimes, these placements are considered locum tenens assignments. Physicians can travel to another area to take advantage of these opportunities or do them close to home. Some professionals pick up one shift a week, others take 30-day placements, all depending on what they feel up to or have time for.
"It's a nice supplemental income for [retired physicians]," says Henderson.
Hospitals located in an area where there's a seasonal change in population, can consider hiring retired clinicians for the busy season, suggests Henderson.
Such arrangements can be especially alluring to clinicians who crave an opportunity to explore other parts of the country or spend time near family. "We'll frequently have a retired nurse talk to a recruiter and say, 'I just had a grandbaby—and I want [a placement near family] for 13 weeks,'" says Henderson. These employment situations allow clinicians to keep their medical licenses current.
Other roles clinicians have found a second life in telehealth environments or working from home doing telephone triage, or in following up with patients after appointments to make sure they understood their conditions and physicians' instructions.
Strategies for Recruitment "The recruitment strategies are very different than with younger clinicians," says Henderson. While younger clinicians are excited to make a name for themselves and work for organizations where there's a lot of room for advancement, older clinicians want flexibility and the chance to share their wealth of wisdom and experience with others.
"Their marketing or advertising [strategy] is the opposite [than for] new grads," says Henderson. "The opportunities that you present to them aren’t about long hours and money…. We often pitch travel as a different way to see the world while you still earn income."
Some organizations have had success by advertising these positions as opportunities to help guide new clinicians. Many clinicians relish the opportunity to mentor or train young healthcare workers.
An added perk is the flexibility of a mentor position—they don't require the grueling 12-hour shifts many healthcare workers are accustomed to, and leadership can add or subtract other roles and responsibilities as needed.
"I guess some people might worry about a job going to a volunteer physician rather than a new doctor right out of med school," says Henderson, "but really, it's hard to see a downside to this."
Given the looming shortages of clinicians and the tightening of hospital budgets, retired clinicians working on a volunteer or part-time basis can be a huge help to hospitals. "We need every physician we can get out there," says Henderson.
The Washington, DC health plan provider says it has improved healthcare access for at-risk populations while lowering costs.
CareFirst BlueCross BlueShield, the dominant health plan provider for the Washington, DC area, says it has a secret sauce for reducing costs for insuring high-risk populations while improving their health.
Last week, flanked by Johnathan Blum, former principal deputy administrator and director of the Centers for Medicare & Medicaid Services, and others, Chet Burrell, CEO and President of CareFirst announced that, for a third consecutive year, the organization's Patient Centered Medical Home Program has achieved lower than expected costs.
Launched in January 2011, the PCMH program was designed to incentivize primary care providers to offer a care coordination program to CareFirst customers. It also offers access to tools and support to offer care that is theoretically higher in quality and lower cost.
The program specifically aims to work with patient populations that would benefit from personalized medical attention, such as those with multiple chronic conditions. Another goal of the program is to help these patients better manage their diseases and improve their overall health through collaboration with panels of five to 15 physicians and nurse coordinators.
Providers who participate in the program receive a 12% increase in their fee schedule. They may also receive payment for keeping care plans for select patients current or showing better treatment outcomes. The program rewards practices for ordering fewer unnecessary tests and for treating patients in an outpatient setting rather than requiring a visit to the hospital.
CareFirst also incentivizes patients for seeking quality care, reducing or eliminating copays when top performing in-network physicians are chosen.
Slowing Spending Growth "I had hoped there would be results in three years that would be exciting to talk about," said Burrell.
Burrell said that CareFirst has seen the overall rate of increase in medical care spending for its members slow from an average of 7.5 percent per year to 3.5 percent. Additionally, he said that CareFirst has seen encouraging trends regarding patient health, including:
6.4% fewer hospital admissions
11.1% fewer days in the hospital
8.1% fewer hospital readmissions for all causes
11.3% fewer outpatient health facility visits among its members
Credit Where Credit is Due CareFirst acknowledges that readmissions rates and emergency room visits have declined since 2010 when the PPACA was signed into law, and that access to care has generally improved over the last few years.
"It would be unfair to attribute these shifts solely to our program, but we believe the PCMH program has had a significant contributory effect," Burrell said in a press release sent about the announcement.
Other organizations have been trying similar programs. In 2013, HHS initiated improvement projects like the Partnership for Patients and the Hospital Engagement Networks (HENs), both of which are heavy on the care collaboration and use similar strategies to get patients to utilize preventative services.
As of February, about 1,500 hospitals were participating in the largest of the federally funded HENs.
Hospitals are among the most dangerous places to work and there are high costs associated with injured workers, but hospitals and health systems can strategically reduce the risk of injury to staff.
Despite the public image of hospitals being places of healing and health, those who work in them know they can be very dangerous places. Spills, slips, falls, exposure to dangerous chemicals and infectious diseases, musculoskeletal injury and the never-distant threat of workplace violence hover over hospitals.
But there are everyday dangers related to nursing as well. One study found that 64% of nurses report having been stuck by a needle at some point in their career.
And back injuries are common among nurses. Many "don't have access to lifting equipment," says Dawson. "Frequently, they must transfer patients manually, which can lead to musculoskeletal injuries." A 2012 study of nurses leaving the profession found that 12% cite chronic back pain as the main reason for quitting.
"Hospital administrators tend to focus on the financial repercussions of workplace injuries and forget the human cost. These are highly skilled healthcare workers, and they're losing their [jobs]," says Jaime Dawson, senior policy analyst at the American Nurses Association.
What she doesn't mention is the cost to hospitals who must recruit, hire, and train, new nurses to replace those lost to injury.
Making Hospitals Safer Places to Work Nurses aren't the only ones at risk—janitorial staff and physical facilities workers are also among the most at-risk employees for a workplace injury. One of the greatest mistakes hospital administrators can make is not involving staff at every level of the organization in finding potential hazards—and solutions to make the campus a safer place.
For example, a security guard will notice a poorly lit, unsafe area, while a maintenance worker probably knows where the roof leaks.
Human resources leaders are in a unique position to help create safer environments in hospitals. "Collaboration is absolutely key," said Dawson. "It needs to involve every level in an organization. People at the top need to keep the doors open and welcome input from all employees."
Frequently, staff will go to HR with concerns about safety and security, and in turn, HR staffers can help encourage knowledge sharing between teams. And, when setting the organization's values, culture and policies, HR should strive to be the voice of safety.
Below are Hollier and Dawson's top tips for reducing risk to hospital employees:
1. Acknowledge that there's risk.
Because we associate hospitals with health and healing, it's easy to forget that the hospital setting can be very dangerous. "Really take a look at the work you do, the dangers that exist, and examine the data that exists. See what's really happening," suggests Dawson.
She also recommends looking at the number of accidents that have occurred in your facility and in hospitals in general. Be aware of the greatest risks facing hospitals and ready to for them.
2. Create a blame-free environment. If employees feel like they can't report hazards without getting co-workers or themselves in trouble, they won't. Therefore, it is vital to foster an environment where the focus is on removing safety threats rather than pointing fingers.
When a potential danger comes to light, simply address the problem rather than punishing the offender, especially if they were unaware that they were creating a hazard.
3. Make safety and anti-violence training a priority. Every employee, from the janitor to the CEO, should have a working knowledge of hospital safety steps. This is even more relevant to employees who are at risk. For example, nurses should be aware of how to prevent musculoskeletal injury, while front-line employees need to be trained to deescalate potentially violent situations.
"Invest in training programs so your employees can be more proactive, and give your leadership the tools and training to be successful [at preventing accidents]," Hollier recommends.
4. Check your facilities. Talk to your employees—especially members of your janitorial, physical facilities and security teams—and ask them what needs better maintenance or general improvement. Is the lighting adequate in all areas? Are all of the staircases in good repair? Does your security team have all the resources they need?
"Involve your workers in selecting equipment. They're the ones who will be using it," says Dawson.
5. Have policies on the books that promote safety. Address the process for safe staffing, and make sure employees are aware they have a right to refuse to perform tasks that might put their health or safety at risk. Keep a written statement of commitment to a culture of safety posted where all employees will see it. Dawson suggests making safety training a part of the onboarding process.
6. Debrief all injuries. Sooner or later, despite everyone's hard work and caution, an on-the-job injury is inevitably going to take place. When that happens, Hollier urges a formal debriefing to examine the situation and look at how it can be prevented in the future. "Take that pregnant pause every time there's an injury. There's always an opportunity to learn from them and do better in the future."
Simply being aware that there is a very real risk of an accident or violence and formulating policies to try to prevent these things from happening is the most important step.
"It's safer to work in a hospital… where they know stuff can happen every day and are prepared for it—as opposed to a hospital… where people just don't realize that incidents happen and don't prepare for them," Hollier says.
Job growth in the healthcare sector continues, but at a tempered pace.
In a month that has seen remarkable job growth in multiple sectors, healthcare can no longer be called one of only a few bright spots in the economy preliminary, federal data suggests.
The overall economy added 288,000 jobs in June, dropping the unemployment rate from 6.3% to 6.1%, according to the Bureau of Labor Statistics.
The healthcare sector added 21,000 jobs in June 2014, a figure in line with the average gain of 18,000 new healthcare jobs per month over the last year.
Predictably, the greatest growth was in ambulatory health care services, which added more than 13,000 new jobs. But the rate of growth, a 2.8% increase over June 2013, was modest. Nursing and residential care facilities also experienced relatively strong growth, with more than 6,000 jobs added.
Within hospitals, 2,200 jobs were added. And outpatient care centers notched fewer than one thousand new jobs.
While the latest jobs figures may be considered generally positive, it should be noted that the pace of job growth in the healthcare sector is not as rapid as several other areas of the economy. For example, manufacturing added 16,000 new jobs in June—fewer than healthcare in absolute terms, but respectable for a sector that has been struggling for at least a last decade.
In the general economy, professional and business services employment increased by 67,000 workers. Other standout growth sectors included retail, which added 40,000 jobs, and has been growing, on average, by 26,000 employees per month this year. Food and beverage services added 33,000 employees.
BLS data from May and June is preliminary, and may be revised in the coming months.
Healthcare hiring trends favor physician leaders with clinical knowledge and an aptitude for strategy, rather than only business school smarts.
Healthcare leadership roles are changing swiftly in response to shifts in payment models and the relentless pace of business consolidation. Executive teams and human resource executives are now carefully designing these roles for maximum strategic and clinical effect.
"For years, leadership said, 'throw another MBA [at the problem]. But that way of thinking doesn't work anymore," says Travis Singleton, senior vice president at Merritt Hawkins & Associates, a healthcare recruitment firm. "Hospitals and healthcare systems are going to need physicians who are active, strategic, and want to take an active role in shaping healthcare delivery systems."
Unlike the healthcare systems of a generation ago, most of these leadership positions aren't just jobs any MBA could hold down; these jobs require a physician with strategic ability and business sense.
"If you don't have 'em, grow 'em," says Singleton. "Take these physicians and make them leaders."
He suggests that HR look into leadership courses or physician MBA programs. "There are programs made for working physicians. You don't have to wait for that shining star to come along. Just take a strategically thinking, strong physician and put them through these courses," he said.
The four toughest healthcare executive jobs recruiters are trying to fill today are expected to be tougher to staff over the next five years. And, perhaps surprisingly, one executive position is seeing its numbers dwindle.
1. Chief Population Health Manager
Chief population health managers are responsible for conducting managed care operations. They direct the strategic direction of population health initiatives, care management, and outcome components.
This job is about to become the hottest position in healthcare, Singleton told me— although health systems are still trying to figure out how to staff this position. "No one knows how to do that yet. We're all struggling to find the right skill set for this role." He says many hospitals have had better luck giving this role to physicians who have spent substantial time working in both hospital and non-hospital settings.
"You need someone who understands how a team health environment is supposed to work—that's the only way you'll get these metrics. How do you get highly efficient as fast as possible? You can't manage that population unless you have a team equipped to do so."
Singleton says this role is most in demand at health systems with large patient panels and a diverse patient population.
2. Chief Clinical Transformation Officer
This role acts as an administrative leader across many change initiatives. CCTOs are responsible for system-wide improvements and innovations, and oftentimes oversee and help with the implementation and design of population health initiatives.
"Getting into the broad scope [of the care continuum] takes a massive amount of clinical transformation and case management," says Singleton, who says it's also complicated to fill. While the person who holds this role should be a physician, healthcare systems should also be looking outside of traditional healthcare settings to find the right candidates.
"This is a broader role in an area where many hospital doctors haven't had experience," he says, adding that this role demands someone with the ability to plan and think strategically. Singleton has seen some success with candidates who come from the medical device industry.
3. Chief Strategy Officer
The buck still stops at the CEO's desk, but increasingly, a healthcare organization's strategic path is being mapped by the chief strategy officer. The accelerated pace of change within the healthcare industry has given rise to the need for strategic thinkers who are not bound or distracted by some of the CEO's other traditional responsibilities.
Candidates for CSO often come from within an organization, because they must fully understand how that particular system functions.
4. Chief Medical Officer While this title isn't new, the responsibilities that come with it are. "The chief medical officer of today is different from the CMO of five years ago—and definitely different than the CMO of 10 years ago," Singleton says.
CMOs have traditionally been responsible for the defining the overall clinical strategy and direction of a hospital or healthcare system. While the responsibilities of a CMO have become much larger in scope in years past, they are now transforming into something altogether different.
"We're seeing a shift where responsibilities have gone from taking place inside the hospital walls to going outside of them," he says. "A CMO is now much more involved with the health of an entire community than ever before. They now need a total understanding of US healthcare delivery system," he said.
Additionally, while the CMO role used to focus on the staff at one hospital, consolidation has made a CMO's reach wider. One CMO may oversee staff at multiple hospitals in a single healthcare system. In this way, CMOs can help ensure a single standard for quality of care and direction of staff across multiple hospitals within a system.
5. Chief Executive Officer The forces that are expanding the roles of the CMO and the CSO are also working against CEOs. As the industry continues to consolidate, the CEO ranks are shrinking. Who needs more than one CEO? As health systems grow, responsibilities that used to fall under the CEO are being reapportioned.
Not all of the work is staying in the C-suite, either. Some health systems with multiple hospitals, for example, put presidents in charge of individual hospitals rather than CEOs. The truth is, the average healthcare CEO tenure is shorter than the average NFL head coach's.
"There will always need to be a mix, but we've got non-physician leadership roles covered," said Singleton, who believes there will be plenty of opportunity for physicians who want to move into leadership roles in the value-based healthcare system. "It looks like healthcare has finally figured it out," said Singleton.
Visitation rules based on "outdated beliefs that frequent contact with loved ones interferes with care" neglect the negative consequences of restrictive policies, says a group that advocates for family-centered care.
Hospitals are considering allowing families 24 hour access to their loved ones—but some hospital employees worry that relaxing security policies will come to mean the end of boundaries in care settings.
The Institute for Patient- and Family-Centered Care (IPFCC) is challenging hospitals to reevaluate their visitation policies. Through its Better Together Campaign, IPFCC hopes to raise awareness of the benefits of unrestrictive visitation policies and make hospital leaders aware of negative consequences associated with restrictive visitation policies.
"It's really tragic that the majority of hospitals in the US have restricted visiting policies, and there's no evidence that it's the right thing to do," says Beverly Johnson, president and CEO at IPFCC said in a phone call. Nevertheless, restrictions are the norm.
"All too often, families and loved ones are prevented from being with patients, leaving them alone and isolated, often when they need support the most," says IPFCC's Johnson. "These policies are based on outdated beliefs that frequent contact with loved ones interferes with care, exhausts the patient, or spreads infection; research and hospitals' experience show that these just aren't true."
The benefits of allowing relaxing visitation rules include less anxiety for patients and their families, who may be able to speak for the patient and answer questions about medical history that might help clinicians.
After a child who had been raised by his grandparents was not allowed to visit his grandfather in the ICU and was separated from him when he died, leaders at Contra Costa Regional Medical Center in Martinez, CA, realized that changes had to be made, recalls Anna Roth, Contra Costa's CEO.
The boy had been raised by his grandparents, but was not allowed to visit his grandfather in the ICU where he died.
So Contra Costa began looking at how to integrate patients' families into their care. First Roth had to make sure everyone in the hospital understood what that meant. "The most common concern from nursing and security were that we would be taking away boundaries—but that's not correct," she says.
"Our policy welcomes families 24/7, but that doesn't mean there aren't boundaries," says Roth, adding that there are many misconceptions about what open visitation means.
"We always consider safety and our patients' preferences in every situation. But now, having a family member or loved one by the bedside is the norm, in every unit of our hospital."
The new approach is to treat families as a part of the patients' care team. That includes the patient's family, front line staff, the security team, nurses, physicians, other clinicians, and any volunteers who work with the patient.
"We're offering better care, safer care, and empowering our staff to do the right thing," says Roth. The biggest change, though, has been with interactions with families and the community. "Previously, we only had relationships with angry families."
A medical staffing firm survey shows what's really behind job dissatisfaction among physicians: stress, declining reimbursements, and loss of autonomy.
Six out of ten physicians said they would quit if they could, a survey commissioned by the Physicians Foundation in 2012 revealed. Recently, healthcare staffing firm Jackson Healthcare, released the results of its third national survey of career satisfaction among physicians.
It sheds some light on the reasons why doctors are so dissatisfied:
1.High Stress
While no one in healthcare has an easy job, some roles are more stressful than others. For example, dissatisfied physicians are more likely than satisfied physicians to work in high-stress emergency medicine or critical care positions. Thirty-one percent of dissatisfied respondents in the JH survey said they regularly see patients in the emergency department.
Another source of stress is understaffing. More than a quarter of dissatisfied doctors surveyed said they don't work with nurse practitioners or physician assistants, an indication they are overworked.
2. Dissatisfaction with the PPACA While satisfied physicians are more likely to say they've acquired new patients as a result of the PPACA or to have had no shifts in their patient panels, almost a third of dissatisfied physicians say their business has suffered due to patients losing insurance coverage.
Sixty eight percent of those that are unhappy in their jobs say their income has fallen in the last year, which is almost twice the number of content physicians who say the same.
Additionally, 59% of dissatisfied physicians say they've had more issues with billing and collections from insurance companies in 2014 than they did in 2013, while only 44% of satisfied physicians said the same.
3.Shrinking Medicare Reimbursements
More than half of the physicians surveyed say Medicare billing was harder in 2014 than last year, and just under half said Medicaid billing was also harder. Half of the dissatisfied physicians said they would accept no new Medicaid patients. Almost half (44%) said they would discontinue seeing Medicare patients.
4. Career Path According to the JH survey results, more than a quarter of dissatisfied physicians said they began working at a hospital because they could not afford to invest in their own medical practices. This group's career path veered from its plan, and not all were happy about it.
On the other hand, more than a quarter say they have chosen to be employed physicians because of the lifestyle benefits employment offers.
Fostering A Two-Way Street For those who once aspired to own their own practices, but instead found employment at a hospital or health system, integration can be tough, says Kenneth Hertz, FACMPE, a consultant at MGMA. He says this is especially true for doctors accustomed to working with smaller groups of people who share their values, vision for the practice, and thoughts on how to run a business.
"Those who became employed physicians immediately after training may not have the experience of self-determination from having been in private practice. If I… don't have that experience or set of expectations, it's easier to integrate into the hospital culture."
But, whether or not a physician's roots are in private practice, anyone can feel alienated by a faceless bureaucracy.
The best solution is to bring physicians into the fold, says Hertz. "Bring physicians into the process of making decisions. Let them know what's going to happen before it happens."
He urges human resources and management to be transparent with physicians about finances, management shift and other strategic issues.
In particular, Hertz says, it's critical to ensure physicians feel valued. "Communication is critical, not just from the HR department, but from more senior levels." Hertz advocates C-level execs dropping by physicians' offices occasionally to make sure they feel included and recognized.
Finally, Hertz suggests facilitating real, honest communication with physicians. Ask what's important to them, what barriers they are facing and create ongoing dialogues, he suggests. "If physicians are communicating with leadership… and leadership is not just communicating at physicians, but with physicians, which is a two-way street—physicians will respond to it," says Hertz.
In turn, they are more likely to feel appreciated—which might lead to increased job satisfaction and physician retention.