A $3 million campaign by doctors, scanner operators, manufacturers, and groups devoted to women's health helped persuade lawmakers to overrule Medicare administrators this year and restore much of the reimbursement for osteoporosis tests. In a provision buried deep in the new healthcare bill, Congress decreed that Medicare shall pay $97 for each test, instead of $50. It was an instance of a narrowly tailored, special-interest political victory in a law trumpeted by President Obama and Democrats as putting America on a path to a more rational healthcare system, where decisions are made on medical evidence and patient outcomes, the Boston Globe reports.
Medical-device maker Medtronic Inc. disclosed that it made payments of more than $15.7 million in royalties and consulting fees to U.S. doctors in the first quarter, the first time the company has provided such details. In making the voluntary disclosure, Medtronic is stepping ahead of requirements of a new federal law mandating such publication by 2013. The vast majority of the payments, or $14.2 million, went to orthopedic specialists and orthopedic surgeons, the Wall Street Journal reports.
In a robust healthcare system, strategy is executed from the ranks. Employees must understand what the corporate strategy is, why it is important, what their role is within it and how to make decisions in everyday activities that breathe life into the strategy. In other words: they need to know how to execute the strategy. But explaining a strategy is not easy. Here's how to translate effective strategic imperatives to the rank-and-file.
Support
Promoting a culture of communication, support and empowerment has to come from the top down. Employees need to see that everyone who works for the organization is part of its strategic success. All managers, from the CEO down, need to be accountable for achieving their critical success factors, as well as working closely with their direct reports to develop their CSFs, determine timing for achievement and establish responsibilities for each item. Every employee should be given the tools necessary for their success, from IT support to managerial coaching. Scheduled evaluations on CSF standing and support should occur on a weekly to monthly basis and become part of the culture of the organization.
Along with the strategic planning communications program, incorporating integrated lean communications—such as a strategic planning quarterly newsletter, monthly e-mail blasts on achievements, posters and brochures on the five top strategic planning initiatives, and a CEO video on where the health system has been and where it is going—can be supported by personal training and development. Rich communication channels, such as seminars or webinars, on the organizational strategic plan, steps to success, or being a strategic manager may be helpful. Employee role-playing may demonstrate how they can achieve their CSFs in everyday interactions with patients and other employees.
Executive leadership should be able to walk through the halls of the hospital or out to the ambulatory sites and ask a physician, janitor or office clerk, "What are the strategic planning initiatives for our health system?" and "What are your critical success factors for achieving organizational success?" Every employee and volunteer should be able to answer these questions. They should also be able to name the tools for success provided to them by their management as well as the personal reward allocated to them if they achieve their CSFs on time.
At AtlantiCare, each employee carries a strategic planning "roadmap" that outlines the overall strategic planning initiatives and exactly how their individual CSFs work toward achieving organizational success.
"There is a deep employee pride in AtlantiCare's strategic initiatives, because each employee knows specifically how their day-to-day actions matter," says Rene Bunting, Vice President of Marketing at AtlantiCare. It is said that David Tilton, CEO of AtlantiCare, can walk up to any employee at any time and ask the questions noted above, and all employees are able to show him their roadmap and discuss how their contributions are making a difference to their organization and the community in which it serves.
Empowerment
The single greatest cause of corporate underperformance is the failure to execute. In the Harvard Business Review article "Conquering a Culture of Indecision," author Ram Charan writes, "The inability to take decisive action is rooted in a company's culture. Leaders create this culture of indecisiveness—and they can break it by doing three things:
First, they must engender intellectual honesty in the connections between people. Second, they must see to it that the organization's social operating mechanisms—the meetings, reviews, and other situations through which people in the corporation transact business—have honest dialogue at their cores. And third, leaders must ensure that feedback and follow-through are used to reward high achievers, coach those who are struggling, and discourage those whose behaviors are blocking the organization's progress."
Empowering employees to take action and succeed above and beyond their CSFs, as well as recognizing and rewarding employees for doing so, is a necessity for achievement. Proving a culture of honesty and support for underachievers is equally important. You do not want your employees covering up failures and not sharing information that could lead to process improvements. Health system managers must also hold employees accountable for not achieving their CSFs, all the while creating a culture of honesty for employees to admit the reality of where they stand. Then management needs to discuss if there is an opportunity for more support through training, IT, marketing or other support services.
Sharing the organization's CSFs in a data dashboard is also helpful. Information may include goals for numbers of procedures preformed, average length of stay, market share, operating margin and so on. Clear information readily available to health system leadership is vital to ensuring honest communications and smart decisions to build organizational success. You can't have a culture of decisive action when management is working in a vacuum, without accurate, up-to-date information.
Lastly, throughout the execution process, it is beneficial to conduct periodic checks of CSFs against the overall vision and goals. If the CSFs which you thought were correct are tracking well, but the plan is not actually being realized, you may not be really measuring what you thought you were.
Out-executing competitors
As Lou Gerstner, former CEO of IBM, stated in his book Who Says Elephants Can't Dance? Inside IBM's Historic Turnaround, "If you want to out-execute your competitors, you must communicate clear strategies and values, reinforce those values in everything the company does, and allow people to act, trusting they will execute consistent with the values."
It is sometimes difficult to see the forest for the trees. Just as a hospital hires outside consultants to write their master-brand and service-line marketing plans, having external support in creating a plan to execute a health system's strategic plan may be necessary for success. They can support healthcare leadership by clearly communicating organizational strategy to all employees, setting up feedback loops to listen to employee feedback, and include all stakeholders in the execution process. A hospital's physicians and employees are the lifeblood of the organization. Having pride in them and challenging them to make a difference with their day-to-day actions may mean the difference between strategic success and failure.
Gabrielle DeTora is a strategic healthcare consultant in Philadelphia. She may be reached at 908-447-9231 orinfo@GabrielleDeTora.com.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Rolling out new policies and procedures is a challenge for hospital leaders. Effective communication is critical to ensuring healthcare staff comply with new patient care protocols. House staff are an important audience to reach because they're typically providing the bulk of patient care in many hospitals. Without their buy in and support, many initiatives fall short.
New York-Presbyterian Hospital's Housestaff Quality Council (HQC) provides hospitals with a model for engaging residents in patient safety and quality initiatives and policymaking.
The HQC is a win-win
The HQC facilitates two-way communication between residents and the rest of the hospital—administrators, hospital and patient safety, nursing, etc.—regarding quality and patient safety issues and initiatives, says Peter Fleischut, MD, anesthesiology resident at New York-Presbyterian and cocreator of the HQC.
"The mission of the HQC is to engage house staff in policy and decision-making processes to further improve quality and patient safety within the institution," Fleischut says.
The council is run by residents, but other members include:
Resident representatives from each department
Faculty advisor
Liaison from the office of quality and patient safety
Office of the vice president representative
Representatives from infection control, nursing, epidemiology, and pharmacy
With an HQC, institutions can more easily:
Identify opportunities to improve frontline patient care. Although hospital administrators can identify quality initiatives derived from data, such as hand hygiene compliance, they often do not have insight into what's happening on the front lines of patient care.
Residents have this knowledge and can identify system issues that can be improved to prevent errors, says Adam S. Evans, MD, MBA, anesthesiology resident at New York-Presbyterian and cocreator of the HQC.
However, residents often do not have a venue for making their observations known and they are not invited to help develop solutions. During HQC meetings, residents have the administration's ear, and they can partner with them and other hospital departments to develop solutions.
Increase compliance with new policies. All too often, decision-makers develop patient care policies or processes without resident input or an effective way to spread the word. Ultimately, they end up with low compliance rates.
"House staff need to be at the table and they need to be involved in the decision-making process," says Gregory E. Kerr, MD, MBA, associate professor in the Department of Anesthesiology and faculty advisor for the HQC at New York-Presbyterian.
By engaging residents and asking them for solutions, the hospital gets their perspective on important patient safety issues, and creates buy-in with trainees, Kerr says.
If trainees participate in the policymaking process and support it, they're also more likely to enforce it with their peers, Evans says.
Get the word out. "The hospital was having a hard time communicating patient safety and quality information to residents. They didn't have an outlet, and they weren't sure about the best way residents learn, so the HQC is also charged with communication," Evans explains.
Resident representatives to the HQC take information back to their programs.
"Every department communicates differently," Evans says. "I know how residents in my program like to have information delivered and what they will respond to, so we encourage residents to take the information back in the manner that will be best received."
For major, broad-sweeping patient safety programs, the HQC raises awareness for all healthcare providers with banners, e-mails, posters, dissemination of data, and an HQC newsletter, Fleischut says.
HQC structure and function
The HQC addresses patient safety and quality on two levels. First, the HQC adopts one or two large-scale initiatives each year that affects patient care throughout much of the hospital. Second, it is a forum where people working on specific quality improvement projects can come for resident input.
HQC leadership works with hospital administration, quality officers, and residents to identify an area for improvement for larger projects. At New York-Presbyterian, the HQC's large-scale projects have included developing an electronic solution that increased medication reconciliation compliance rates from 46% to 95% in one month. Another campaign to reduce Clostridium difficile rates led to a 50% reduction in most of the major units, Evans says.
Smaller quality projects are presented and discussed during the HQC's monthly meetings. For example, a vascular surgeon developing a new order set for pulmonary embolisms came to the HQC, presented the tool, and requested the residents' opinion on whether the tool was too complex, how he should advertise it, and whether it could be improved.
The HQC's input has been so valuable that there is a six-month wait to present at the meeting. "It's such a hot commodity within the institution," Kerr says.
The HQC concept is a model that can be easily replicated in other institutions. Kerr, Evans, and Fleischut are already working with other teaching hospitals around the country to implement HQCs in their institutions.
Julie McCoy is an associate editor with HCPro, Inc.'s Residency Department. For more residency news, please visitwww.residencymanager.com.
Kathleen Sebelius, the secretary of health and human services, said that employers should immediately offer or continue health insurance coverage for workers' children up to the age of 26, at little or no additional cost. Employers will have to offer such coverage under the new healthcare law, and Sebelius said they should act sooner, without waiting for the requirement to take effect. At the request of the Obama administration, more than 65 insurers have already agreed to allow young adults to stay on their parents' policies before the insurers are required to do so, under the new law, later this year or early next year, the New York Times reports.
Washington, DC-based Sibley Memorial Hospital and Johns Hopkins Health are in talks to have Sibley become a subsidiary of the Baltimore-based health system, officials announced. The development will give the $4.5 billion Hopkins system a greater presence in the Washington, DC, region, with a foothold in a part of affluent Washington where patients have insurance. Officials of both systems say it is anticipated that Sibley will join Johns Hopkins Health in early fall. Sibley spokeswoman Sheliah Roy said the nonprofit, 328-bed hospital is not being sold and will stay open.