HealthLeaders Media Council members discuss what's driving the increasing patient volume in their ED, and how they plan to handle it.
This article first appeared in the November 2016 issue of HealthLeaders magazine.
Paul Hensler CEO Garfield Medical Center Monterey Park, California
Our organization is expecting increased volume. A lot of it is driven by Medi-Cal—California's Medicare program—expansion, and we treat a lot of capitated lives as well.
We've always had a significant share of Medi-Cal patients, but with Medi-Cal expansion, the patient population has changed. Medi-Cal was once largely a program for moms and kids; the expansion brings in a lot of middle-aged men, and within that group there are a lot of mental health issues, drug issues, and probably more issues with homelessness. So that's part of the new volume.
Disposition is a challenge when dealing with homeless patients. We can't send them home if they don't have one. We've contracted with shelters that have programs that not only give homeless patients a place to live—at least for a couple of weeks while healing—but also have some nursing care available.
When the weather gets really hot or when it's raining, some people who are homeless decide the ER is a good place to hang out, which can be a challenge for us. We've instituted fast tracking in the ER; we can quickly evaluate them, a medical decision is made, and if they don't need medical attention, they can be quickly discharged.
William Cors, MD Vice President and Chief Medical Officer Pocono Medical Center East Stroudsburg, Pennsylvania
We don't expect an increase in volume, we are living the increase right now. We are doing about 78,000 emergency room visits a year now. That's up about 8%–9% from the previous year.
We have a three-part strategy. The first part is the emergency room itself. We just finished a nearly $4 million renovation and have added 13 additional treatment spaces. They're mostly for what we call vertical patients: patients requiring minor care. We have found that much of the increase in volume has been patients with minor care needs.
Second, we've opened up immediate care centers that are staffed by nurse practitioners. We currently have four of them in the region that we serve, and we're looking at opening an additional one or two. We thought that would help decompress the emergency room, and it might have in its first year—visits went down in the emergency room a bit.
But, over the past two to three years, we've not only seen the volume in the emergency room increase but we've seen volume in each of our intermediate care centers go up, too. If you add the two of them in aggregate, we are probably seeing close to 100,000 patients in more of the acute care medium-sized settings, whether it's an emergency room or an immediate care center.
That said, in our final strategic change, we placed primary care positions at key points throughout our service area. We have recruited 12–16 new physicians and nurse practitioners. But, despite increasing access, volume still continues to increase across the board, in all care settings.
John Sigsbury, MHA President SSM Health St. Mary's Hospital Centralia, Illinois
Our hospital is in rural southern Illinois. As in many southern Illinois communities, we have not seen any population growth. In fact, in the last decade, we have seen our population decline as many jobs have moved out of the region.
Many of our local physicians are in independent practice and in their late 60s or early 70s, and are starting to reduce the scope of their practice and hours worked. In addition to these two factors, we have not had any expansion or construction in our hospitals emergency department in quite some time.
Instead, our strategy has been to open freestanding urgent care centers in the community. They are fully aligned with the hospital, our parent company SSM Health, and our medical staff, but they are freestanding. We have been able to bleed off some of the lower-acuity patients from our ER, seeing them now in urgent care instead of in the ER.
This works for us because, as the independent physicians start to age out of their practices and make themselves less available for their patients, we're still providing access points. It's not a strategy that anticipates an increase in ER visits, but we are seeing an overall increase in ambulatory visits, mostly through our urgent care centers. We still want these patients being seen in urgent care centers to be part of the healthcare system, so we are now focusing on recruiting additional primary care physicians into our medical group.
Jane Curran-Meuli Chief Operating Officer and Executive Vice President Holy Family Memorial Manitowoc, Wisconsin
On accommodating mental health patients: There are not a lot of resources for treating mental health patients in our community. In Manitowoc county, there is no inpatient behavioral health unit at all. We do have outpatient behavioral health, but demand exceeds what we can provide. Some people come in with severe problems that are simply beyond our scope of practice.
One thing the state of Wisconsin has done recently is that hospitals have worked collaboratively to create a website that lists all available behavioral health beds throughout the state. This saves us from having to call from institution to institution to see if they can take a patient. Now, we can just go down the list and see if there's a space, and then call hospitals with available beds. It saves a lot of time and takes a lot of work off our providers.
On paying for emergency care: One of the chronic conditions in healthcare these days is people needing care and not having the funds to get it. The exchanges helped quite a bit, but this community also has a process where a local credit union helps patients take out loans to pay for the care they need. The credit union pays us in full, giving the patient the means to pay.
We are the guarantor of the loan and pay the credit union if the patient defaults, but that rarely happens. Most patients truly want to do the right thing and pay their bills, but these expenses can have a huge impact on a family.
While volunteering at the Los Angeles Zoo, cardiologist Barbara Natterson-Horowitz, MD, discovered that some ailments aren't just part of the human condition—they are zoobiquitous.
This article first appeared in the November 2016 issue of HealthLeaders magazine.
When the Los Angeles Zoo asked Barbara Natterson-Horowitz, MD, professor of medicine and cardiologist at UCLA's David Geffen School of Medicine, to consider volunteering her cardiovascular expertise, she didn't expect that it would change her life; she was just excited to try something different and lend her knowledge to the zoo's veterinarians. But that changed quickly when she began to observe the number of medical similarities between humans and animals.
Consulting on animal patients as diverse as chimpanzees, lions, and California condors, Natterson-Horowitz observed a number of conditions—including heart disease, breast cancer, melanoma, arthritis, and diabetes—that many healthcare professionals attribute to poor lifestyle choices in humans. She coined a term—zoobiquity—to describe these interspecies health similarities and the fact that animals and humans suffer from the same diseases. In June 2012, Natterson-Horowitz, along with science writer Kathryn Bowers, published a book on animal-human health parallels, Zoobiquity.
On what physicians can learn from veterinarians: As I delved into this work, I became aware of the tremendous overlap in animal and human pathology and found that veterinarian medicine has much to offer physicians and other human health practitioners. There is a great deal for physicians to learn from animal patients about reaching human patients. This is important, because it turns out that many of these so-called diseases occur in animals and are not disorders that are unique to humans.
On reducing the stigma of mental health issues: Autism, PTSD, self-injury, eating disorders, and compulsive disorders are not unique to humans. Beyond physical illness, awareness of psychopathology in animals can help advance our understanding of mental illness in humans and potentially reduce the stigma associated with many psychiatric conditions. The increased awareness of the natural occurrence of anxiety, self-injury, and eating problems, for example, can help shift the shaming and self-recrimination that so many human patients experience when trying to understand their issues. I'm very interested in writing and speaking about comparative psychopathology as a way of penetrating the stigma problem; these disorders are part of the natural world and have natural causes.
Avoiding divisive topics can help maintain workplace morale during a contentious election season—and afterward.
There are some things we would rather not know about the people we work with. Generally, it's a good idea to avoid complex health problems discussed in detail, intimate lives, and the intricacies of religious beliefs.
Then there are political views, especially during a bitter, divisive Presidential election season.
You shouldn't—and legally can't—officially try to stop employees from talking politics, says David Sanders, chief talent officer at Faegre Baker Daniels, an international law firm.
That doesn't mean such conversations should be encouraged, says Diane Gottsman, a national etiquette expert and owner of San Antonio-based Protocol School of Texas who has consulted on corporate etiquette and branding.
Gottsman urges extreme caution when conversations could turn political, both on ethical grounds and to ensure the comfort of all workers.
"Much like religion and other confidential, sensitive topics that are highly emotional or emotion-provoking, you should try to avoid the conversation," she says.
Gottsman and Sanders offered the following tips for avoiding charged conversations.
1. Change the Subject
There are plenty of things to talk about that don't reference the current political climate and are unlikely to offend coworkers or patients, says Gottsman.
You can advise managers to try suggesting a different topic when they hear an employee bring up a candidate's recent antics or another controversial theme; a couple of non-offensive suggestions might include plans for Halloween or Bob Dylan's intriguing reaction to winning a Nobel Prize.
2. Make a Neutral Comment
You can also remain neutral without stating an opinion, says Gottsman, who suggests saying something like, "what interesting times!" and then moving on.
"The bottom line is that you're at work. You have a job to do, and a relationship with clients and coworkers. You're not there to be divisive," she says.
This can be especially important in a hospital, as you never know which patients and families could be offended—and lives could literally be on the line if a coworker relationship suffers.
3. It's OK to Bow Out
Sanders says no organization he's ever worked for has felt the need state a policy proactively, but employers should intervene when they hear an employee say something that sounds dismissive.
"You tell [the employee] that something that happened hurt somebody. It hurt how they felt about themselves, or how they felt others thought about them, and you ask them to stop doing that."
It's important to allow people to bow out of conversations if they seem to be getting uncomfortable, he adds.
4. Silence Isn't Always Agreement
It's also important that workers never assume that they know colleagues' or patients' political orientation or views, says Gottsman—and, above all, never assume that people agree if they aren't actively disagreeing with views a coworker is presenting, or are quiet.
"In fact, they may be forming a very strong opinion about that person, and it's not good."
Our work lives don't occur in a vacuum. From time to time, controversial topics will make their way into the breakroom. When they do, it's natural that differences will come up, especially in a diverse work environment.
"I think the first rule is respect, and the second is consideration—and I think they're related," says Sanders. "That sometimes means asking people to keep that in mind."
So, if you hear a conversation that seems to be getting just a bit too heavy on the politics, it makes sense to remind employees that the election will be history on November 9—but relationships with coworkers and patients are here to stay.
"We have to remember that after the election, we all are going to be in the same spot, enjoying the same relationships as before," says Gottsman.
The large health system recently overhauled its onboarding procedures to save time and money and to get new hires to work as soon as possible.
For the protection of workers, patients, and organizations, hiring healthcare workers involves a number of necessary steps including vaccinations, drug screenings, background and reference checks, and health tests.
But these actions can cause hiccups in the onboarding process if the results come in after the worker has already started working, and the consequences can be costly. So anything that expedites the process or cuts costs is welcome to most HR departments.
Christopher Bos is director of human resources at Mercy in Springfield, MO. Mercy operates 45 acute care and specialty hospitals and more than 700 physician practices and outpatient facilities. He discussed the highlights of the organization's recently streamlined onboarding process. The transcript below has been lightly edited.
HLM: Tell me a bit about how streamlining your onboarding processes has helped with recruitment and retention.
Bos: We are in a competitive market for healthcare coworkers. The faster we can get workers in here and get them to work, the faster they can see our culture and experience it, and the greater the chance they're going to stay.
HLM: How has HR been able to involve the recruitment team to increase the efficiency of the onboarding process?
Bos: One thing we started back in January through employee health was giving vaccines to our healthcare workers, such as MMR and T-Dap. But we quickly went over our budget. New coworkers would come in, they couldn't remember which shots they had already received, so we had to give them a vaccine.
But we realized there might be a more efficient way to handle this. We partnered with the recruitment team and made asking applicants to check in with their healthcare providers about which vaccines they have already received ahead of time a part of our onboarding process.
This change put the candidates at ease. Now, they know what to expect. They aren't going to employee health and being put on the spot about something they haven't thought about in years.
Now, new workers are coming in with all of their vaccination records, and we're not spending the dollars to do vaccinations unnecessarily. We're actually below budget in this area presently.
HLM: What are some other examples of how you have made onboarding less time-consuming?
Bos: We're required to do TB testing, and we previously used skin tests. You inject serum into the skin, wait two to three days, check it, wait another two to three days, and check it again. So, best case scenario, if everything went right with that skin test, it was 13 days until we had final clearance for a new applicant to start.
In September 2013, we adopted a new blood-draw based TB test. When our coworkers get their blood drawn at our lab, prior to even doing their new-hire paperwork, it takes about three to four days to get the results back, and they're ready to go.
With our new blood tests for TB, there's no coming back for a second screen. It's easier for the HR team, the employee health team, the applicant, and our patients, too, because these professionals are starting work faster.
Workers can still request the skin test, but I've not had anyone request the skin test since we introduced the blood test.
HLM: What is the price difference between the two tests like?
Bos: The new blood test is $50 per applicant. The old test was $13.17 per applicant time last I looked, but there were more soft costs involved, such as loss of hours worked. That amount gets pretty high when you look at the hourly wage of a physician or other highly paid clinician.
HLM: Were there any other pre-employment tests you've been able to streamline?
Bos: We also went to rapid drug screenings. It's a ten panel screen, and they have their drug results within five minutes. It's faster, and it saves recruiters from the awkward position of pulling the new worker out of orientation should the results come back positive.
HLM: And what's the cost differential for this test versus the old one?
Bos: It's less expensive than the traditional drug screen we previously used, unless we have to send them to the lab to do further analysis due to prescriptions or other issues. There's more cost there, but overall, we're running ahead of budget. I'm very pleased with the way that's working.
A chief diversity officer shares his top tips for making inclusion a vital, living value in every healthcare organization.
Culturally competent care and patient satisfaction are more important than ever, but how can healthcare leaders ensure staff actually live those values, rather than paying them lip service?
This is a challenge Joseph Hill, senior vice president and chief diversity officer at Thomas Jefferson University Hospitals in Philadelphia, faces daily.
"We don't want them to just be buzzwords," says Hill of diversity and inclusion.
In the 18 months Hill has held his job, he's created initiatives, speaker series, employee engagement surveys, and education focused on treating colleagues and patients with dignity and respect.
But what's most important, says Hill, is to truly live the values of diversity and inclusion in the hospital, and to make sure that everyone from the patients to hospital leadership feels valued, respected, and included.
Hill recently spoke with me his organization's efforts toward diversity and inclusion. The following transcript has been edited for brevity and clarity.
HealthLeaders Media: Why is it important to have a diverse workforce?
Joseph Hill: Your workforce needs to mirror your patient population. If you're going to be providing culturally competent care and treating people with dignity and respect, you need to have folks from your community working within your health system.
HealthLeaders: What is the business case for diversity and inclusion?
Hill: People often ask, are diversity and inclusion really needed? What's the strategic focus?
The focus should be around workforce, workplace, marketplace, and community. Diversity and inclusion need to be thought of holistically—it's not just an HR function where you're counting heads; you're making heads count.
Many organizations see diversity and inclusion as an HR function, but it's important to realize that diversity and inclusion are part of the operation of the system—meaning that this theme impacts everything you do as an organization. It impacts the workforce and the workplace, but it also impacts the market perspective and the community.
HealthLeaders: How do you get executives onboard for diversity education?
Hill: What I do is called an "executive briefing" on diversity and inclusion. I call it that because oftentimes, it's difficult to get executives to want to do training. But when you call it an executive briefing, it's easier to engage your execs and get them involved.
HealthLeaders: What's the toughest issue you've had to tackle as a diversity officer?
Hill: We've seen different responses from our employees and members of our communities around the recent killings of young African American males. Unfortunately, one of our employees posted something on Facebook that was extremely negative and derogatory against African Americans.
Had we not handled the situation well, it could have blown up in our faces. But collectively, the diversity office, along with HR and the legal department, recognized that this was something we had to address.
We recognized that we would have to act swiftly, and that we would have to let that person go, because otherwise, it would have had a major impact on morale within our organization.
HealthLeaders: Can you give me an example of a time when having a diverse workforce was helpful?
Hill: The last organization I worked for was in a community with a large Hmong population. At one time, a Hmong patient died, and there was an issue where the family and friends of that patient wanted to gather in the room just after the patient had passed away.
Some of our nurses didn't understand that, but we had staff who were part of the Hmong community who could explain to them why the whole family was going to be in the room at one time. That was a cultural dynamic that some of our nurses weren't aware of.
That's why it's important to have a diverse workforce. If you're going to be providing culturally competent care, you need an understanding of the dynamics within various cultures.
This article first appeared in the October 2016 issue of HealthLeaders magazine.
Todd Chang, MD, MAcM, director for research and scholarship in the division of emergency medicine and transport at Children's Hospital of Los Angeles and associate professor of clinical pediatrics at University of Southern California's Keck School of Medicine, had always enjoyed playing video games, but he never thought he could apply this interest to his healthcare profession.
But that changed when Chang began using mannequin simulations as a part of training, which led him to think of ways physician education could be improved through technology. Soon after, he met representatives of the Hunt Valley, Maryland–based game design company BreakAway LTD at a conference. BreakAway's developers allowed Chang to use their infrastructure to develop VitalSigns, a video game–based training tool that allows emergency room staff and leaders to practice their resource and personnel management skills through a video game–based simulation.
On getting fellow professionals to take video game training seriously: I'm passionate about video games, and I feel that much of my career has been spent trying to prove the legitimacy of what I do. When I tell people what I do, they do one of three things: First, just kind of stare at me, then walk away; second, they are utterly fascinated by the novelty, but don't understand the actual impact it might have; and then, there's that rare population of people who think about the implications of a generation of clinicians and healthcare staff who grew up with this technology and interaction, and they understand that this is how we learned and socialized.
On what you can't teach via games: The hardest things to teach in a video game setting are professionalism and communication. I think that requires a lot more human contact, where I can tell by the tone of your voice or body language how to talk with you. There is technology being developed to measure these things, but it is still in its infancy.
On the value of gamification: Gamification has different psychology, education, engineering, and human resource management applications. There are horrible ways to do gamification and video game training; I think most of us can remember playing video games in school or at work that were clearly designed with no budget, and not to be fun, but to get a point across or fulfill a checklist. I think many CEOs and other leaders have experienced that side of gamification, and often come to people like me with skepticism. But I would challenge everyone in those echelons to rethink that paradigm; there is a place for games in learning.
HealthLeaders Media Council members discuss their organizations' experience with risked-based payer contracts.
This article first appeared in the October 2016 issue of HealthLeaders magazine.
Brian S. Bizub Chief Executive Officer Palm Beach Orthopaedic Institute Palm Beach Gardens, Florida
We don't have a risk contract at the current time. Our contracts are based upon negotiated contracts with each insurance payer, but we are in a comanagement agreement with our hospital that involves a gainsharing model for total joints and fractures.
There are benefits and downsides of the comanagement agreement; the downside is that the hospital takes more of a control position in the negotiations, and controls the payment. The pros to it would be that the physicians and hospitals work together collaboratively in ensuring that quality of care is not jeopardized, nor are the outcomes based upon reducing cost.
I think both insurance payers and providers are interested in sharing risk. They believe that's a fair model, versus being at the mercy of a payer, who may decide that an arbitrary amount is what they are going to pay based on the Medicare fee schedule. Risk-based contracts give providers an opportunity to show that they are responsible for taking care of patients, making sure their costs are low, and not overutilizing the system. In the past, it felt like reimbursement was based solely on DRG or ICD-10 codes, and that was the extent of it. From a monetary standpoint, gainsharing would be advantageous for both sides.
Dennis Empey
Chief Financial Officer
Trinity Health
Minot, North Dakota
We're just starting to dabble in risk-based contracts. We started implementing some aspects of pay-for-performance last year with our major commercial contracts, and we're going through the second phase and getting more involved this year. North Dakota is more of a rural area with a lower population, and the payers require a higher number of patients to get into a risk-based reimbursement scheme.
We're still on a fee-for-service payment model. Every time we see a patient, we get paid for it. And we know that if a number of patients are taken out of the system, we're not going to get reimbursement. In order to maintain profitability, cost will need to be reduced.
In some of the areas, you can't reduce cost—for example, in the emergency room. If you had 30 patients who used to come in five times monthly, and now don't, you're not recouping that cost. And if you set up a program where someone monitors those patients, well, there's a cost for that.
And you don't get reimbursed for that, but you can't cut back staff, either. For the ER, staff numbers are fixed. The balance from the financial perspective is: How do you balance that with fee-for-service, but also maintain emergency room staffing? When these issues are spread across the entire hospital or health system on a greater scale, that's where the challenges are for healthcare.
Herbert Sohn, MD, JD
Chief Executive Officer
Strauss Surgical Group
Chicago, Illinois
Our organization is mainly fee-for-service. I have no real experience with risk-based contracts. It may be a little different here in Chicago than in other places. In my organization, we feel that payers haven't done enough work on risk practice to really have a good risk-based contract yet. It's not easy to figure out.
Being an attorney in addition to a physician, I run the healthcare section for the Illinois State Bar, and we have seminars on this all the time. It's not an even field. I feel that contracts must be fair for both parties, but these contracts aren't. They're all in the favor of the insurance companies.
I have nothing against payers, but it isn't fair. And you, as a provider, have no input into the contract—you either take it or you leave it. With large national physician groups now in existence, there may be some hope for leverage, but a great many of these groups haven't become involved in contract negotiation yet.
Some of the local and national organizations I've worked with are trying to change things so that physicians, smaller providers, and hospitals can have more say in what they're doing, and so that physicians can have more say in what the hospital does, but none of that has gone through yet.
Charles Vignos
Vice President of Managed Care Initiatives
Wake Forest Baptist Medical Center
Winston-Salem, North Carolina
On partnerships and contracts: Wake Forest Baptist participates in the Medicare Shared Savings Program, and we also have a contract with United for their Medicare Advantage Plan. We started that in the beginning of this year. On July 1, we began a contract with Humana's Medicare Advantage Plan. We anticipate participating with Aetna for their Medicare Advantage Plan as well.
Our focus has really been around the Medicare population at this point. It has been moving pretty slow on the commercial business side here in North Carolina. Some of the larger payers in our marketplace don't really have an effective program around value-based contract relationships.
On the shift to fee-for-value: I think we, as a healthcare organization, have learned that we need to be proactive toward the population we're managing as opposed to reactive. We used to wait for the patients to come to our office, we provided them with the service, and we hoped that they followed our advice; and out the door they went, and the next patient came in. That's a very reactive healthcare delivery system.
Now that we need to be proactive, we also know we need to be flexible. We've known we have to meet the patients at the time they need the care, and new technology, like telemedicine, for example, can make that possible.
As health systems take on more long-term care services, healthcare executives must choose between paying living wages to CNAs and health aides, or dealing with the consequences.
Anna Ortigara, RN, an organizational change consultant at the Paraprofessional Healthcare Institute, routinely gives talks about how healthcare organizations can improve person-centered care, boost morale, and retain more workers. During a recent speaking engagement, an executive from a healthcare organization approached her with a problem this leader believed to be unique.
"This person told me that they have some employees that cannot work more than 28 hours a week, because if they work more than that, they will stop qualifying for their Medicaid benefits," Ortigara says.
It's not that these workers don't want to work over 28 hours, the leader explained to Ortigara; it's that, even when working in these roles full-time, these workers cannot afford to pay for health insurance, much less to pay for healthcare out-of-pocket.
And so, these workers stay in a permanent state of underemployment and without opportunity for advancement, because providing adequate care for their family is unreachable should they cease to qualify for Medicaid.
The healthcare leader Ortigara was speaking to was certain this problem was rare, but Ortigara was familiar with it.
As health systems consolidate and become responsible for more services, including long-term care and care transitions, more healthcare leaders will find themselves making decisions regarding providing livable pay and benefits.
Run the Numbers
The first step to addressing this problem is admitting that there is one.
According to research conducted by PHI, 39% of direct care workers and their families in 2013 were found to receive benefits from Medicaid; 33% receive public assistance for food and nutrition support, and the total number of direct care workers receiving any sort of public assistance is 49%.
"Many of these people are working full-time jobs, but it's not a living wage," says Ortigara.
Looking at median wages doesn't tell a much rosier story. According to the Bureau of Labor Statistics, in 2014, the average hourly earnings for three common direct care provider roles were:
CNA: $12.07
Home health aide: $10.28
Personal care aide: $9.83
Most people cannot live comfortably on those wages, says Ortigara. "Anything can happen to upset the apple cart with these workers."
The example Ortigara likes to point to is the common annoyance of a car breaking down. For most workers in the professional class, several hundred dollars in car repairs is an annoyance, but survivable.
For someone earning less than $13.00 hourly, "their world is torn apart," she says. "They now can't get to work, and they may need to quit their job. Or they may just stop showing up to work because they don't have the money to fix their car."
The High Cost of Turnover
Consider what high turnover might mean for the bottom line.
Ortigara's colleague Abby Marquand, director of policy research at PHI, points to reduction in turnover as a vital part of improving patient outcomes. The "cycling in and out of the workforce" can undermine care relationships between staff and their patients, she explains. And what leads to reduced turnover?
"Increases in wage are linked with reduction in turnover," says Marquand, while lower wages are associated with higher turnover in workers. Research places the cost of this turnover at about $6 billion across the US health system, or $3,500 per lost worker, she says.
"That's just the cost of people leaving jobs and needing to replace them... I'm sure organizations could better spend that money in a way benefits people."
Increased starting wages also makes recruitment easier, says Ortigara.
"People act like it's not about the money, but guess what? It is…. If we start offering a reasonable wage, I believe we will attract wonderful workers who want to do this work. It's about respecting and being valued."
Workforce diversity means differences, which can bring conflict. A chief diversity officer can help.
Workplace harassment complaints. Recruiting a diverse workforce. Cultural competency training. These are matters that traditionally fall under HR, but healthcare organizations are increasingly relying on professionals with specialized skills to work on these sensitive and important issues.
Enter the chief diversity officer, or CDO.
As the country grows not only more ethnically diverse but more diverse in personal beliefs, regional origin and identification, and disability status, the demand for leaders who specialize in creating dialogues between people with differences will increase, says Oliver B. Tomlin, III, senior partner at search firm Witt/Kieffer and founding member of National Association of Diversity Officers in Higher Education. He has assisted with several CDO searches.
Below are several functions a CDO might play to make a hospital a more welcoming place both to workers and the community they serve:
1. Make Sure Everyone is Heard
Many of us can remember attending a party or other event where we didn't fit in, possibly because of differences between ourselves and others.
A CDO specializes in being the person who makes sure workers don't have to feel uncomfortable about what makes them unique, and that they can bring their "whole selves" to work, says Deborah L. Plummer, PhD, vice chancellor and chief diversity officer at University of Massachusetts Medical School and UMass Memorial Healthcare.
"If everyone feels they can bring their whole self to work and they feel like differences are respected, it can make the workplace richer and stronger," Plummer says.
"Then, we are able to come together and work in diverse teams, and are able to solve challenges with our collective wisdom."
2. Teach Awareness
What's the next step that will lead toward improved patient satisfaction and both clinician and worker retention? Teaching the workforce to be sensitive to and accepting of the differences that are inherent to a diverse organization or in a diverse community.
Sometimes it's not always easy to gain the trust of people when there are differences involved, especially in light of healthcare disparities members of minority groups often experience, says Tomlin, but educating a workforce can help.
Plummer suggests offering regular inclusion events, hosting employee and community research groups, and familiarizing hospital leadership with hot topics in the workforce and within the community.
She also suggests that CDOs organize training sessions around current topics, such as:
LGBT-related issues
Sexual harassment
Building an inclusive workforce
Cultural competency education
3. Devise and Implement Inclusion Strategies
Diversity and inclusion aren't easy topics to tackle, says Plummer. "There has to be someone who gets up every morning thinking about the complexity of these differences."
A CDO can fit that bill.
Plummer makes it clear that she believes HR is "necessary and great function. [It keeps] the trains running." But appointing a leader to specialize in diversity makes sense.
"I can say that the space of diversity is more about people strategy and management, while HR is about the employee, and their employment relationship to the organization," she says.
A CDO will be able to prioritize diversity matters above all else; these hot topics will have their full attention. Far from being just another C-suiter, the CDO has potential to be a mediator, a teacher, an outreach coordinator, and someone who helps make your hospital a more comfortable place for everyone.
HealthLeaders Media Council Members discuss how they implement clinical analytics in their population health initiatives.
This article first appeared in the September 2016 issue of HealthLeaders magazine.
Kathy Fair
Director of Medical Economics
Blue Cross Blue Shield of Kansas
Topeka, Kansas
As a payer, it's still a challenge to get clinical analytics data right now, with there being so many different EMRs in use; a common extraction system still doesn't seem to exist. We are going to do a pilot with a company that says it can provide an extraction service, but it remains to be seen if this is really possible.
I think that clinical data is the missing piece of the puzzle—we already have the claims, the member information, and the provider information, and this data piece would complete the picture we have of our members. With that said, there are probably many things we need to learn about that data that we don't know yet. It's probably going to be another three to five years before we get that kind of information.
At this point, we've got analytics all over the place, in just about every department of the company. We run analytics for membership information, provider data, everything. We look for anomalies in different data just to see if something is "sticking out" where it shouldn't be.
We used population health data most recently with our PCMH and our HMO activities. We're still new to that arena, but we've been analyzing this data for over a year now, and I think it helped us to identify potential process improvements for physician offices and factors that were outside the norm that they could work on to improve their quality and cost of care.
Matt Ebaugh Vice President, Chief Strategy and Information Officer King's Daughters Health System Ashland, Kentucky
Analytics are a cornerstone, and foundational to whatever we will be doing, whether it's within analysis of clinical process, of integration and transitions of care, of risk-bearing contracts, or of patient population.
Within that, the first step is to understand the population that you serve. Population health basically puts people into logical groups based on their health status. The next step is to isolate the most high-risk patients who need to be managed, focusing on the patients who may be incurring more costs than the average across the nation, and to figure out how to treat those individuals, engage them, or work on behavioral modification.
When you blow population health up to the highest level, it really is working with a certain individual on specific needs; it just happens that you're grouping the patient into like populations. That might change with precision medicine, but people go into groups based on past family history, age, gender, and other factors. We put them in groups from a clinical standpoint. So, it's difficult for me to divorce population health from anything else that we do, because that is essentially how we provide care today.
Until the past one or two years within our market, I hadn't found payers to be cooperative or helpful, but we're slowly seeing better discussions around clinical bundles and taking on risk.
Simon Lin, MD, MBA Chief Research Information Officer Nationwide Children's Hospital The Research Institute Columbus, Ohio
The way I see it, clinical analytics act as an enabler of the data-driven healthcare enterprise. What I mean by that is three things: first, that clinical analytics make the data accessible; second, that they make it possible to analyze the data and create valuable insights; and third, that clinicians can use those insights to make informed decisions.
I see the clinical metrics as a major connector for the data by which clinicians and patients can make informed decisions.
My organization's situation is somewhat unique, as we are a research institute in addition to being a hospital. Because of this, we've put the effort into developing many analytics capabilities, and analytics are strongly intertwined with our research process—for example, the analysis of a genome, the analysis of clinical utilization, and the analysis of clinical trials results. Some of this might be specific to our research projects, but it also complements population health research and data. Research is an area where analytics really have an opportunity to shine.
I think it's still a little early to call out the benefits of analytics for population health, but we are definitely hoping to see improved outcomes, reduced costs, and stronger patient satisfaction.
Tom Lowry Vice President of Finance, Physician Integration Dignity Health Rancho Cordova, California
The answer to your question depends upon how you define population health. If you want to talk about programs such as CMS' bundled payments, or the Comprehensive Care for Joint Replacement Model, those programs will cause you to manage on the continuum of care, and you are going to need clinical data to do that. Today we are using clinical data for those purposes.
There are other population health programs that you might consider, and in California we've been utilizing some for quite a while. In some of these, you have metrics for things like pay-for-performance measures under capitation. Under these and similar programs, you need to be able to tap the clinical data. To go back to bundled payments, you have to identify patients who are going to fit into a bundle, and you want to do that at the front end as soon as possible, as you are responsible for each of these patients.
For example, under the bundled payments model that we've chosen at Dignity Health, we've elected to carry risk for 90 days postdischarge from the anchor admission, so we're going to want to look at that patient and understand his or her health needs—not just from the anchor admission itself, but also at what his or her health needs are that might affect care in postdischarge. That information is found in the health record—it's found in the patient's clinical data.
