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Building a Culture of Sustainability
October 15, 2014 12:00 PM by Lynn

[Editor's note: This blog is posted on behalf of Paul Spiegelman, chief culture officer, Stericycle, Inc., award-winning speaker and best-selling author of "Patients Come Second."]

Gallup, a global research and consulting firm, annually conducts a survey called "The State of the American Workplace." This year the results should alarm American business leaders, particularly our healthcare colleagues.

Of the approximately 100 million people in America who hold full-time jobs, 50% of American workers are not engaged. Another 20% of those surveyed - 20 million people - are actively disengaged from work. Chances are these employees - statistically 70% of our workforce-will not improve our patient experience or fulfill our institutions' mission unless the culture changes. 

Their discontent affects your bottom line, too. Disengaged workers cost the U.S. between $450 billion to $550 billion each year in lost productivity. They can also cause increased physical injury. Gallup compared the top 25% of engaged teams with the bottom 25% and found that the poorly managed teams experienced 50% more accidents than their counterparts. Employee injuries mean risk-particularly related to costs, compliance and reputation.  With millions of dollars now at risk based on patient satisfaction and the increase in pay for performance initiatives, how do we prioritize our efforts for the best return on investment?

The answer is we need to start inside. We need to show our commitment to our own employees first, because engaged employees will provide better patient care, which in turn will drive patient loyalty, and positively impact the bottom line. We need to focus on our core purpose as healthcare organizations to heal and promote health. And we need to rally around initiatives that make our employees feel good about the impact they are making. One such initiative that touches all of these issues, makes the world a better place, and impacts the bottom line is sustainability. Greening operations is an opportune platform to align employees to your institution's values, provide them with more training for a safer work environment and bolster pride in their employer-all of which results in better engagement. 

Here's how:

Define and Align Your Values

The healthcare landscape is in a state of constant change:  90% of newly hired physicians are employed by brick and mortar hospitals and our networks are getting more spread out with multiple sites with the growing development IDNs and ACOs.  This is why we need to align our teams with a common strategy and purpose.

Getting Started

The first steps in making sustainability an element of your cultural framework is  to make sure that it is stated as part of your organizational vision .  For example:

  • Define sustainability as a core value
  • Quantify what it means to have a sustainable "impact" for your organization - measure and monitor over time
  • Recruit executive buy-in; the message has to be delivered repeatedly and consistently from the top

Help the Initiative Trickle Down

Establishing "green teams" empowers employees to help manage sustainability initiatives with pride.

  • Find internal champions and develop an oversight committee
  • Recruit department representatives to be the conduit to their teams. Engage in friendly competitions and publish results and best practices
  • Become a thought leader in your own community by publicizing your impact on patient safety and the environment via your organization's public channels and trade media

Learn From Others

When it comes to building great cultures around sustainability, there are some influential examples in our industry.  Consider the following:

  • John Hopkins Hospital found employee education a critical component to green operations. Through recycling, its overall trash production decreased by 17 percent.

Beaumont Hospital, Royal Oak, a 1,070-bed hospital in metro Detroit, has 500 "green officers" - employees who are ambassadors of green practices to their departments. 

Measure the Initiative: Going Green, Seeing Green

Can greening operations also drive financial results? With a culture of properly engaged employees, of course it can!  Arkansas Children's Hospital saw a significant cost savings with a "Know Where to Throw" campaign that educated employees about red-bag disposal, resulting in a 32% waste reduction and a six-figure savings. 

Sustainable Change

By making purposeful culture changes, supported by consistent and ongoing training and communication, your management team leverages the power of engaged employees. As this base grows, your patients, community and environment can feel the power of a well-managed and motivated staff.  And if we have a motivated staff, we'll see better patient care, better safety scores and better financial results.

The Paradox of Innovation: Overcoming Resistance to Change
December 5, 2013 11:37 AM by Robby Chakler

Editor's note: the following blog post was written by Tom Hills, executive vice president of sales, PerfectServe

I regularly cross paths with hospital executives looking to integrate the latest and greatest health IT tool or processes. By far their primary challenge in adopting new technology is dealing with resistance to change. Last month, I attended a bi-annual Health Management Academy meeting that addressed this common obstacle. The forum - which brought together CEOs, CMOs, COOs and CFOs from the largest health systems in the US - sparked me to think about a few things causing this barrier to adoption, and how we can overcome them:

  • The value of time - In healthcare, time is money. But when the next big thing is at our fingertips, how do we capture the attention of administrative leaders when there are so many initiatives competing for their time? I think the solution lies in physician leadership. I can attest to the fact that hospitals and health systems with early adopter physician visionaries are more successful in rallying their organization to consider innovative, easy-to-use technologies that support more efficient and higher quality care. It's important to involve these doctors in the decision-making process from the get-go, as this often spurs adoption of the technology once it's been implemented.
  • Real-time revenue vs. long-term investment - Current change in health care is requiring CFOs to attack every budget line item. Thus, providers are wary of implementing something new and innovative if it can't demonstrate clear and immediate ROI. But oftentimes, the real value of a solution comes from using it over a long period of time. Key to the successful implementation of technology is considering the long-term value - in helping to drive more efficient communication processes, a more mobile clinical workforce, faster time-to-treatment, etc. - versus focusing only on the short-term return on the investment.
  • The "risk" of implementation - Health systems all across the country are consolidating resources through M&A, reorganization and downsizing, often causing leaders to be more averse to taking risk.  New technology isn't often apt to make it into the mix, as it adds another unknown variable that clinicians need to get used to. But it can be a valuable tool in standardizing care across multiple facilities and departments. Provider leadership must show a commitment to innovation by devoting time and budget to it, perhaps by even creating a separate "innovation fund" to fuel these critical projects.

What's clear to me is that while the industry as a whole recognizes that innovation is critical to improving care delivery, it can be challenging during tough times to inspire the adoption of new technologies across provider organizations. Providers need to be sure to continue to commit to funding innovation despite uncertain return. Fostering collaboration between physicians and executives to choose the best new technologies can help ensure the innovations that do make the cut are ones with the highest odds of success.

Optimizing Labor Management in Accountable Care Organizations Part 3: Key Technologies
November 13, 2013 1:53 PM by Robby Chakler

Editor's note: this is the final installment of the 3-part series on ‘Integrating Labor Across ACOs.' It was written by Chris Fox, CEO of Avantas

In the first two posts of this three-part blog post series, I outlined the current state of ACOs, the need to focus on labor across the organization, including medical groups, and offered a few key labor management strategies to take advantage of the opportunities of belonging to an ACO (and not let the potential inefficiencies of a larger organization take hold).

In this final post I'll discuss technology, specifically what you should look for in labor management software to effectively manage your workforce at the enterprise level - the key to capturing economies of scale in an ACO. Before I get into that however, I want to stress the importance of what we see as one of the most integral, but too often neglected steps in a technology implementation: policy and process alignment.

Labor management is complex. You can't just plug in a solution and expect all the pain points to disappear. It takes some due diligence to make sure the foundation is set; then comes technology. Part of that due diligence is policy and process alignment. Every organization has specific business rules it operates under. These rules can be things like last float/last cancel policies and protocols for how staff sign up for open shifts. Within the outpatient/clinic world, this can include things like consistent shift start times, the ability to share like skills across locations, and standardized labor targets within like cost centers. It is crucial that any policies your organization is utilizing are standardized across the enterprise and that they are carried out in practice, every time.

The alignment between policies and practices is crucial because your workforce management software should serve to automate them. By embedding your rules into your labor management tool you all but ensure consistency - and consistency leads to predictable and sustainable results. Within an ACO, as multiple hospitals and clinics may be involved, standardization can yield substantial savings and process improvements. This brings us to the list of what to look for in labor management software:

  1. Customizable. As I just mentioned, your software should have your business rules embedded. Ideally, the vendor you partner with for your software solution will have expertise in best practice labor management strategies. If they do, they will understand how crucial this step of the process is. If your solution is going to help you achieve your specific business goals and work within your unique culture, it must be tailored to help you do just that.
  2. Accurate Forecasting. This is virtually becoming a standard feature in labor management software. Many vendors tout the accuracy of their predictions, but the key question to ask here is how far out are the predictions accurate. Many are claiming a high degree of accuracy, but it's only a day or two before the shift. This does little to help an organization build better initial schedules. Once schedules are built around an accurate prediction, that forecast must be continually refined in the weeks leading up to the shift, with anticipated holes in the schedule being automatically posted as open shifts for qualified staff to pick up. This increased accuracy of initial schedules along with a continually refined prediction of needs will help your organization be proactive in its approach to delivering patient care.
  3. Analytics Powered. Famed management consultant Peter Drucker said "What gets measured gets managed." This has never been more true, but one of the problems today is that there is so much to measure. A health system can generate hundreds of metrics. The key is deciphering what metrics are the most meaningful - which ones, if tracked and improved on, will help the organization realize the greatest benefits. For analytics to be powerful they must be transparent. Meaning, everyone who should have access does have access. Next, the data must be easy to understand and prescriptive, so those who view it know what to do to improve. Finally, it must be timely. If it is not timely it is not actionable. Lessons can be learned from older data, but true power comes from the ability to leverage data to make course corrections so targets are hit now, not the following pay period or next quarter.
  4. Cloud-based. With virtually all organizations we partner with, we are replacing a competitor's software. Typically, the tools we replace are not cloud-based. This usually means we are supplanting a software that is several versions outdated. This happens for several reasons, one of which is "version fatigue." It often seems like no sooner has a tool been installed, the vendor is back pushing the organization to purchase an upgrade. This can be an especially hard sell if the software does not have widespread user adoption and is, consequently, not producing the results the vendor promised. With a web-based tool there is no versioning. You always have the latest enhancements and functionality. And most vendors provide, or should provide, these updates at no additional cost. Within an ACO, web-based software solutions, where applicable, can provide substantial cost savings and provide greater flexibility to staff, who can access the tool any time anywhere.

It's important to mention here that cultural change must be a key component of any new technology implementation. Technology serves to automate best practices. It will not fix anything unless the people using it are focused on doing so. An organization's leaders and employees must be committed to learning what they must do to reach their objectives and then make the necessary changes to actually do it. Within an ACO, whose members may be dozens of hospitals and/or clinics, the need to address cultural change elements is absolutely crucial.

Care Transitions and Clinical Communication – Key to the Readmissions Equation
October 23, 2013 11:03 AM by Robby Chakler

Editor's note: this blog post was written by Leigh Ann Myers, vice president and Chief Clinical Officer at PerfectServe

I spend a lot of time discussing the need to fix broken clinical communication processes in hospitals. That's partially because I've experienced these issues personally, but also because I've spent much of my career trying to address them. The clinical communications problem that challenges the industry now extends beyond the four walls of the hospital, and this has serious implications when it comes to reducing readmissions to avoid costly CMS penalties.

Today, when patients leave the hospital, their care is transitioned to a range of different folks - from care coordinators to home heath managers to primary care physicians to nursing homes. Each of those entities likely prefers to be contacted in a range of different ways, at different times and with different types of information. If that system or process is flawed or cumbersome, the result is that the necessary information doesn't reach the right outpatient coordinator - whoever it is - and the patient is at risk of missing follow-ups, skipping a medication or experiencing delays in the care they're provided.

For example, say an outpatient care coordinator is following a chronically ill patient.

Step 1: The patient arrives in the ED and is admitted to the hospital. Is that outpatient care coordinator notified? Is the PCP? And how? Is there a way to confirm that message was received? Is there a way to escalate the communication should either of these folks be out of the office or unavailable?

Step 2: The patient is admitted to the hospital. Is the outpatient care coordinator notified at this point? The PCP? How do they know or find out what happened to their patient while they were in the hospital? For that matter, how much information is communicated from the care coordinator or PCP to hospital staff about that patient's history of chronic illness and current treatment regimen?

Step 3: The patient is discharged, and told to follow-up with primary care within 48 hours. Does the care coordinator or PCP know this? If the patient forgets to schedule an appointment, who is responsible for follow-up with them? If they do schedule an appointment, does the PCP or care coordinator know what medication they were sent home on, or what the results of lab work done in the hospital were?  Is it easy for them to obtain this information, or will it cause a delay in patient care?

These questions get to the root of the problem - it isn't about technology, it is about process. Effective communication processes are complex to determine and implement, but they are key to balancing the readmissions equation. I know I want my family members' care team (inpatient and outpatient) talking to each other, helping them remain healthy and out of the hospital.

Optimizing Labor Management in Accountable Care Organizations Part 2: Key Strategies
October 11, 2013 1:29 PM by Robby Chakler

Editor's note: this blog post was writen by Chris Fox, CEO, Avantas

In the first post in this three-part series focusing on the potential of enterprise workforce management strategies and technology in ACOs, I outlined the current state of ACOs, the year-one results of the Pioneer group, and the need to focus on labor, especially within medical groups – the growing driver of care in this model. In this post I’ll dive into key strategies to include upfront in your labor optimization plan and highlight how they set the framework for predictable and sustainable positive clinical, operational, and financial results.

The rise of ACOs alongside the increase in healthcare consolidation has created a lot of opportunities for providers to grow their patient base and expand services, develop more reliable referral systems and better coordinate care, as well as decrease expenses by creating efficiencies. It’s this last element that can be the trickiest from the perspective of labor management. When organizations consolidate or partner they can sometimes open a Pandora’s Box of issues including:

  • Staff size and layering that does not reflect patient demand
  • The amalgamation of policies and practices that can be inefficient and disparate

One of the main reasons this can happen is that “staffing and scheduling”  is typically considered a tactical process rather than a strategic opportunity. Labor optimization is not about the activities that occur within the few hours leading up to a shift, but rather the planning done over months and weeks to ensure a repeatable structure of efficiency.

Following are two of the main elements that must be part of that planning.

Right Sizing and Layering Staffing
An enormous amount of savings can be realized by answering two seemingly simple questions:

  • What number of core staff do you need on each unit/medical group practice site to meet workload benchmarks and patient demand while limiting overtime, cancelation, and floating?
  • How many and what types of staff do you need to fill in when core staff can’t take a patient, such as increases in census?

Simple questions maybe, but the answers to each require some digging, analysis, and best practice application. By looking at key optimization statistics (e.g., workload, “FTE leakage,” incidental worked time, etc.), core staff behaviors and trends, historical census levels and predicted future census, staffing levels, payroll data, and various HR information an organization can determine the number of core staff it needs on a unit-to-unit level. This is a number that will need evaluation every six months to a year to account for changes in volume due to increased competition, new physician hiring, etc., but that initial baseline is imperative.

Determining and then hiring the right number of core staff is the first priority. Next, organizations must have the right number and layering of internal contingency – PRN / per diem and float resources – to provide a flexible supply of resources that can cover off on PTO, leave, education / meeting time, and sudden spikes in volumes/census across the organization.

Policy Standardization and Practice Alignment
An organization’s staffing polices, and how they are applied, can vary greatly across the entities forming an ACO. For some context on this, we have seen stand alone, 200-bed facilities as well as specialty practices with policy and practice variances unit to unit, shift to shift, and minute to minute depending on the individuals involved. These variances can include things like not following an approved cancelation order to using unapproved agency personnel. At larger, more complex organizations these issues are often compounded to the extent that standardization (and faithful application) can amount to millions of dollars in savings opportunities, not to mention improvements to morale that come with employees knowing that the rules are applied fairly and consistently.

The heavy lifting comes with the cultural issues inherent with any change in process. Effective change management and communication protocols must be employed and followed if any change will be successful. This can be especially complicated when it comes to ACOs and system consolidations when you are dealing with different organizational cultures. That said, clear, consistent communication that explains to individuals across the enterprise the reasons why a change is being implemented along with the “what’s in it for them” goes a long way to helping create buy-in.

The final post in this series will focus on strategies to leverage technology, and more importantly, meaningful data to automate the gains of establishing the right size and layering of resources and standardizing and enforcing policies and processes.

Naught or Nice – Happiness as the New Currency
October 9, 2013 9:30 AM by Robby Chakler
This blog was written by Anthony Cirillo, FACHE, a healthcare consultant and aging expert who helps CEOs connect the dots that start healthcare movements. Contact him at cirillo@4wardfast.com and learn more at www.4wardfast.com.

I was preparing a slide deck for my webinar, The Patient Experience Trifecta when I kept butting my head against some troubling research.

  • Half of new nurses are verbally abused in their first three months of work
  • Empathy and moral reasoning erode during the third year of medical school
  • One in five nurses report being depressed
And on it goes. In August, the RN Work Project reported that half of 1,300 nurses surveyed reported “moderate” verbal abuse from doctors and other nurses, defined as up to five incidences in the last three months.

Of course these findings have consequences. According to Pearson and Porath, in the book, “The Cost of Bad Behavior: How Incivility Is Damaging Your Business and What to Do About It’, work place incivility has these consequences:

  • Loss of work time worrying about the incident and future interactions with the offender
  • A weakened sense of commitment to the organization
  • Weakened effort on the job
  • Decrease in the amount of time spent at work
  • Spend time thinking about another job
  • Actually change jobs
And they pin a cost to this. To be exact, a 10,000 employee organization where half the workforce has one incident of incivility annually costs the organization $71,000,000. Yes that is six zeroes.
In a March Harvard Business Review blog, How Happy Is Your Organization?, the author poses some pertinent questions that might help gauge the happiness of your organization such as:

  • Do your employees enjoy their relationships and their environment at work?
  • Do your employees feel they are part of something that matters?
Shawn Achor of Good Think, Inc. and the most noted expert on happiness says that “Happy brains improve business, education and health outcomes.”  I am working with colleagues to bring Happiness work into healthcare. You see we used to think that if we were healthy we would be happy. It turns out it is just the opposite. In order to be healthy, holistically, you need to be happy.
The good news is that happiness can be taught and practiced. In a recent Hospital Impact blog, I shared the first principle we teach organizations  - Be Conscious. I call it being in the moment. Here is an excerpt from that blog.
“Life is more joyous when lived consciously. This lack of awareness causes some to live in a "walking sleep" in which actions are done but feelings are absent. You may call it going through the motions. When you live consciously you are aware of your feelings as you experience life.” 
There are exercises that go along with this and the other four principles. These principles are:
  • Honor Your Feelings – locate the deeper nature of how you feel, communicate those feelings constructively and use them to guide conscious decision
  • Co-Create What Works – in other words give up the notion that you are right and the other person is wrong. We are here to work together
  • Release Your Desire to Control Others – you can’t do it anyway so why get all frustrated
  • Learn Your Life Lessons – realize discomfort is a part of life and that it serves you only if you pay attention to it and honor what it is trying to teach you
This last one resonates with me particularly. Entering this year, I was coming off the breakup of what it hindsight was a terrible business relationship. It caused me to pause and re-evaluate how I do business. There were hard lessons. But I followed the last principle, got uncomfortable, and then changed things.
In a Health Leaders survey, 22 percent of leaders reported that lack of cultural fit and employee buy-in was their biggest obstacle to their patient experience initiatives. No wonder. Can’t have “fit” if employees are not happy.
Some may roll their eyes at the warm and fuzzy of this happiness stuff. Before you do, take the Happiness Survey and see how you rate. It just might be that we have to get back to whistling while we work.
How to Not Build a Clinical Trial System
September 17, 2013 2:28 PM by Lynn

This blog is posted on behalf of Abraham Gutman, CEO of AG Mednet. We welcome comments. 

About a month ago a friend sent me a link to an article entitled "Building a Better Clinical Trial System." After reading it, I had to make sure it actually appeared on The Daily Beast, and it was not from a satirical magazine like Mad or The Onion

The article argues that governments, not companies, should be in charge of drug  discovery and testing. The author bases her argument on two points. First, that pharmaceutical companies choose to withhold comparative results obtained when testing their drug against that of industry competitors. Second, that the elimination of disease is "a true public good."

Of the thousands of arguments I have against this idea, I'm unsure of which I should present in this short post. I would encourage the author to take a look at the  drug development activities of the old Soviet Union, as well as present day North Korea, and analyze the real life success of her vision. It is a well-known fact that government controlled bureaucracies have hardly ever produced innovation, unless one considers the self-preservation of the bureaucracy to be an achievement.

The article tries to imply, sub rosa, that companies by their very nature, do not work for the common good, perhaps because of their need to earn a profit from their work. That of course is precisely why companies can work for the greater good. The biggest motivator for innovation is profitability, and we know that even if you work for a charity, you are the beneficiary of someone else's ability to help your  organization. This help is only available if they have a surplus of capital, small as it may be, which is ultimately: profit. Implying that competing for and profiting from finding cures for disease is evil, ignores the lessons of history.

Marxism is dead for good reason. Pharmaceutical  companies risk billions of dollars of their shareholders' capital searching for elusive cures, just as agricultural and manufacturing companies do in their fields. Would  the author say that John Deere's research in combines does not promote the greater good? As such, should the government be in charge of building tractors?

What if a  computer chip manufacturer, trying a new technology finds that it's less compelling than that of their competitor, and chooses not to publish their results? Aren't computers part of the greater good too? After all, they can be found in pacemakers, MRI scanners and other life saving devices.

Perhaps we should just nationalize Pfizer, Monsanto, and Intel. We know how well that strategy has worked for the Venezuelan people and their oil industry. There is a place for government in drug research, and it's not to compete, but rather to regulate. These regulations promote safety, and they have been found to be valuable. Not perfect, but effective. They can certainly be refined, so long as they don't remove competition.

Without competition it's only a matter of time before we begin having to import all our food from ... wait, nobody else in the world has the needed production scale of the US, which is fueled by ... markets and competition.

Optimizing Labor Management in Accountable Care Organizations
August 15, 2013 11:41 AM by Jill Hoffman

Editor's note: This blog was written by Chris Fox, CEO, Avantas.


Simply stated, accountable care organizations (ACOs) are intended to increase quality and reduce overall costs by improving the coordination of care for a population of patients. As you can imagine, implementing ACOs is proving difficult and producing the intended outcomes is not immediate.


It’s hard to argue with the merit of the intent; however, the amount of complexity inherent in building something so large and important without the benefit of an established blueprint all but ensured a bumpy start. What’s interesting is that the early returns show that achieving the cost savings objective is proving more difficult than accomplishing the other main goal of quality improvements.


In addition to the models in place at the more than 400 private payer ACOs across 49 states, CMS.gov has information on 20 ACO models, seven of which are run at the state level with another 13 dubbed as innovation models. Perhaps the most widely known innovation model is the Pioneer ACO model, which is in the middle of its second year.


In the news a lot lately for the recent exodus of nine of the original 32 participants, all in all, the first year of the program had decent results. CMS’ report revealed that all 32 Pioneers successfully reported quality measures, resulting in incentive payments. Twenty-five had success in reducing readmission rates and more than half realized modest savings. However, only thirteen Pioneers saved enough money to share their savings with Medicare.


The Pioneer group consists of large, sophisticated systems that were already lauded for their ability to deliver high quality, coordinated care. The fact that almost half did not meet their savings targets tells me that not enough attention is being paid to cost efficiencies and that labor optimization is not often even discussed as part of an ACO’s plan.


While emphasis on things like better revenue cycle management and more sophisticated approaches to coordinating care are good steps, attention must be paid to better coordinating care staff to meet demand if improvements are going to be at the levels necessary to make a dent in the $536 billion in Medicare spending last year. Care staff account for around 60% of a healthcare organization’s operating budget and closer to 30% for the average Medical Group, minus physician compensation. Increased efficiencies in this area have proven to provide cost savings in addition to increased staff morale and quality scores.


An interesting development in the formation of ACOs is that physician groups have overtaken hospital systems in their adoption of the various programs. This is an encouraging sign, as medical groups are fast becoming the driver of healthcare in its push for integrated care models. This necessitates that physician groups pay particular attention to areas typically not at the forefront of their thoughts, like optimizing labor.


The Penn State Hershey Medical Group is one such organization “pioneering” the switch to more sophisticated approaches of managing labor, namely implementing a variable staffing model and leveraging data, technologies, and best practice strategies to align the right resources with patient demand and other workload indicators. This involves the development and implementation of enterprise resource policies in addition to utilizing a flexible technology to provide accurate forecasts of demand in line with the evolving continuum of care.


The implementation of the labor strategies needed to bring about and sustain improvements is not something that happens overnight – for hospitals or medical groups. It relies as much, if not more on an organization’s culture and its willingness to change as it does on the technologies they install.


The point here is that this is not easy. ACOs will not be successful right away. The number and complexity of the pieces at play are immense (and I’m only referring to the provider side). Labor is a huge piece of the puzzle and one that has been largely untapped. Large organizations and those that have gone through consolidation are particularly at risk of amplifying the inefficiencies that commonly happen across the care delivery system that includes hospitals, physicians, post-acute facilities, and other providers. While that is certainly a possibility if the proper solutions and strategies are not utilized, larger organizations are in the best position to take advantage of economies of scale and can reap huge returns by implementing and faithfully adopting technologies and strategies that promote transparency.


The success of ACOs will require a methodical, multi-pronged approach that focuses as much on the business of healthcare as it does on coordinating the care of patients.

Avoiding HIT Delays
August 14, 2013 10:18 AM by Jill Hoffman

Editor's note: This blog was written by Dan O’Connor, VP of client relations, Stoltenberg Consulting.

A number of challenges faced by the HIT industry lead back to an important question: How can organizations avoid implementation shortfalls and delays? Considering the pressures for reform amidst a constantly-evolving tech landscape, organizations must establish ways to adapt and thrive in this environment. To do so successfully, there are a few key areas of focus.


Both short and long-term strategic IT planning can be essential for organizations. Short-term plans must undergo regular review and updating to ensure the alignment of IT plans and goals with organizations’ strategic plans and goals. They must then be utilized in the evaluation of the internal staff’s skillset and coordination of their training and development plans, which can contribute to staff retention and prevent hindering the momentum of implementations.  

Staff Programs

Organizations can additionally counteract staffing shortages by enacting, or maintaining, programs such as paid tuition, payment for professional organization memberships, professional development programs and salary and benefit plans are atop most current and potential employees’ lists.


Outsourcing must be viewed in different ways than in the past, as it isn’t necessarily easier or less expensive to keep all IT internal anymore. Each situation must be assessed with a set of principles to evaluate staffing and outsourcing, such as:

  • Type of skills required
  • Length of project/initiative
  • Future projects
  • Ability of staff to adapt or learn new skills

Another factor is the make-up of an organization. Are the organizations’ departments acting as many or as a more centralized system that uses many of the same skills and communication throughout? 

Outsourcing can prove efficient when used to support legacy systems being replaced by integrated solutions.

Making the Right Hire

In a job market suffering from a shortage of qualified candidates, making the right hire requires identifying key skills and traits that fit an organization. Organizations must use innovative ways to find ideal employees, such as:

  • Looking to colleges/universities offering educations in technical roles
  • Using internships to evaluate potential staff before they enter the job market 
  • Ensuring compatible dynamics for potential employees and current teams

Many organizations are slow to change in the wake of pressing issues. With the current challenges facing the healthcare IT industry and workforce, only organizations intent on adapting quickly can overcome the challenges in implementing IT initiatives and staffing shortages, while reaping the benefits of an ever-changing marketplace.

Health Datapalooza IV: Opening Systems = Liberating Data
July 11, 2013 10:14 AM by Jill Hoffman

Editor's note: This blog was written by Larry Schor, senior vice president, Corporate Development and Analytics, Medecision. 


In this emerging era of consumer-driven healthcare delivery, the most successful providers will be those who recognize the importance of leveraging open technology to liberate data — not only to connect healthcare stakeholders, but also to “activate” consumers in their own health maintenance. This was the resounding point I heard loud and clear while attending Health Datapalooza IV (HDP IV) last month in Washington, D.C.


In its fourth year, Health Datapalooza was born from efforts to join together thought leaders committed to liberating health data to enhance consumer engagement and value, improve quality, and even reduce total cost of care. Think of it as a 48-hour pep rally — the kind that inspires and fills you with excitement—bringing together the healthcare industry’s best and brightest to discuss how to build open source- and open standards-based solutions in an effort to liberate data.


The event features the newest, most innovative and effective uses of health data by established companies, startups, academics, government agencies and individuals. At the core, the Datapalooza envisions a new generation of real-time clinical analytics powered by free, consumer-approved access to personal healthcare data.


This year, HDP IV zeroed in on several trends — all of which hinge on liberated health data — that promise to impact healthcare significantly over the next five years, including: Open Health Data + Mobile Technology + Predictive Analytics + Connectivity = Personalized Health Management. This is the formula for a new model of consumer engagement that leverages access to open data with existing, mature technologies and telecommunications infrastructure to enable consumers and their healthcare providers to prevent — not just treat — adverse health events before irreversible injury occurs.


For instance, one start-up technology company featured at HDP IV demonstrated how Bluetooth-enabled wireless devices can passively capture patients’ real-time personal data — activity, weight, insulin dosing, glucose levels — to remotely monitor current, up-to-the minute health status. This personal health data can be analyzed against expected and personal benchmarks of past experience to identify and flag subtle patterns correlated with clinical risks that too often go overlooked before it’s too late.


Easy to Look at + Easy to Use = Market Share and Adoption. Personal health management and clinical informatics technologies that deliver the most concise and intuitive user experience — one that is easy to navigate, makes great use of graphics and doesn’t require a manual — will win. The user experience that filters out extraneous data in favor of actionable data will win. The user experience that is just a single click away from turning key findings into workflow-enabled action…you guessed it, will win. In the next few years, technologies designed for the engaged consumer, working in partnership with their health professionals, will unleash the potential of liberated open data to power personal health and revolutionize the way care is delivered.


Liberated Data = Liberating the Patient. Health data’s future is to be liberated — it will be free, on-demand and controlled by the consumer who will have the opportunity to engage and opt into increasingly more personalized health management programs.


Further, as health insurance transition from third-party coverage to a retail service model, consumer expectations and buying patterns will drive use of precision DTC marketing technologies and sophisticated real-time predictive models — long leveraged in other verticals, like retail market giants Amazon.com, Google, and Apple — to segment the market, personalize communication and outreach, and achieve meaningful consumer engagement.


Finally, it is important to understand that open health data is more than a technical innovation. Liberating personal health information to activate the consumer is a powerful concept promoted by a handful of thought leaders. In fact, it just took a major step into the mainstream: The federal government announced at HDP IV the CMS BlueButton+ program that will allow Medicare beneficiaries to authorize physicians and other care providers to have on-demand secure web access to personal health data. Provider access to recent and more complete medical data is important and meaningful progress toward realizing the triple aim — quality and cost-effective care that consumers value. CMS policy is routinely endorsed by commercial payers and employers; in the coming months we should see an acceleration of the open data movement.


At its core, Health Datapalooza IV was all about what you can do once healthcare data is liberated and all key stakeholders connected. While there are many ways to accomplish these objectives, open data access offers some of the most forward-looking and exciting prospects for the healthcare industry. I’m looking forward to seeing how the conversations held at this year’s event will translate into real change within the healthcare industry.

Tweets of the Week (6.20.13)
June 20, 2013 1:50 PM by Adrianne OBrien

New Twitter list! A how-to for "guaranteeing" innovation failure. ACA could lead to more hospital consolidation. Bravo to Dr. David Barbe, who was named a board chair of the American Medical Association. The future of medical school is on the horizon, with five schools lighting the way. Get daily tweets by following us @ExecInsight.

David Chase How to guarantee innovation failure: pass ideas through existing operations http://t.co/UFfvBOznY1

KentBottles ACA likely to produce more hospital consolidation http://t.co/qtkWP491Z7

Ben Nwomeh, MD What does the future of medical education look like? These 5 medical schools offer some clues http://t.co/WYYEgMA8e1

Dr. Sanjay Guptua 15 million Americans take statins to lower cholesterol. But they can have painful side effects: http://t.co/6Lhty1ZW8j

Lenox Hill Hospital Over 1/3 of Americans are obese and American Medical Association has now officially recognized obesity as a disease: http://t.co/u4UrZMUVKy

FierceHealthIT NeimanInstitute: Innovative payment models boost access to cost-effective imaging http://t.co/flaMy7yB3V

Perficient Health IT Distribution of Medicare ACOs Varies Widely http://t.co/K03y5t3sVV

Nature Medicine RT@naturenews: Silver makes antibiotics thousands of times more effective http://t.co/PMhi4fFGMe

HFNewsTweet Risk sinks U.S. hospital credit ratings http://t.co/SpsXZ3Gk2B

Mercy Springfield As of this morning, Mercy family physician Dr. David Barbe is board chair of @AmerMedicalAssn Board of Trustees.

HFMA National Institute Offers Inspiration and Guidance
June 18, 2013 12:24 PM by Jill Hoffman

With the sun shining in Orlando, the 2013 Healthcare Financial Management Association (HFMA) National Institute (June 16-19) kicked off with inspirational messages from the association's last and current chair.

Ralph E. Lawson, FHFMA, CPA, 2012-2013 chair, HFMA, executive VP and CFO, Baptist Health South Florida, said now is a great time to work in healthcare despite the fact that there are greater challenges, changes and uncertainty than at any time in the recent past.

"I believe the people in this room will reform healthcare," Lawson said. "I don't think it's going to be done in Washington."

Taking the stage next, Steven P. Rose, FHFMA, CPA, 2013-2014 chair HFMA, CFO, Conway Regional Health System, urged healthcare finance professionals to employ a "whatever it takes" mindset: "I learned early on you can't just be worried about credits and debits."

He said a "whatever it takes" mindset means leading by example and inspiring others to follow. Something as simple as stopping to pick up a piece of paper on the floor of the hospital can show other colleagues and staff members of an executive's or manager's dedication to their organization. "This is not just a slogan for me," Rose said.

Hall of Fame Football Coach Joe Gibbs gave Monday's Keynote Address. The former head coach of the NFL Washington Redskins took the once-failing Redskins to four Super Bowls and three world championships. Later as leader of the Joe Gibbs Racing team, Gibbs won the Daytona 500 in his second year of racing and went on to win two Winston Cup Championships.

Wearing one of his Super Bowl rings during the talk, Gibbs drew parallels between coaching and managing employees, and said he looked at healthcare management professionals as coaches. "You pick people, put them on a team, ask them to sacrifice their individual goals for the goals of a team…We're team-building."

Gibbs offered several specific pieces of advice, including:

  • Define and measure your goals in the shortest timespan possible for your team.
  • Make sure you're handing out rewards. People will compete.
  • What is the most important asset in an organization? Your people.

    "If I pick the right 50 players, they're gonna make me look good," Gibbs said. "What's the hardest thing that you and I have to do? Pick people. How are you picking people? The resumee?"

    He challenged attendees to make sure they were considering the right factors when hiring employees. "What you and I need to do in picking people is to find people that care about what they're doing. They come early. They stay late."

    In a breakout session called "Improving Quality Data to Drive Financial Performance," Kari Conicelli, FHFMA, CPA, vice president and CFO, Sharp Grossmont Hospital, and Garri L. Garrison, RN, director, Consulting Services, 3M Health Information Systems, discussed the importance of getting clinicians and staff members on board with a Clinical Documentation Improvement (CDI) program through education on issues such as the way information is abstracted by coders and potential RAC problems, as well as better training on coding and new technology.  

    Grossmont, part of a Pioneer ACO and two other ACOs, utilized information from the Medicare Severity Index Comparisons from MEDPAR data to learn that $10.1 to $13.4 million of annual revenue could be recaptured, and that their mortality rate was much lower than the state average due to the way physicians were reporting information. The problem, not a quality of care issue, related to understating risk.

    "If you don't report the risk then your data's going to be inaccurate," Garrison said.

    A dedicated effort to improve documentation led to $3.6 million in new revenue for the hospital over three months.

    Later in the day, Paul Keckley, executive director, Deloitte Center for Health Solutions, spoke to a packed room of attendees on the effects of healthcare reform in the coming decade. "This system is a confederacy of self-interest, and what it has now faced is its own mortality," he said. After a number of sobering statistics relating to growing healthcare costs, he concluded that there will be a national referendum by 2020 about a single-payor system.

    Tuesday's Keynote Speaker Don Berwick, MD, former administrator, CMS, and founding CEO, Institute for Healthcare Improvement, discussed the ACA and its triple aim of better care, better health outcomes and lower costs, and gave evidence for why the law is needed. One statistic revealed that 2011 total U.S. healthcare waste cost $558 billion to $1,263 billion. Berwick discussed a variety of quality improvement systems, and listed several examples of health entities in the U.S. and internationally showing early success at improving care and outcomes, and reducing costs.

    "You can't say, ‘It can't be done,'" he told the audience. "It can…It is not a problem of possibility. It is a problem of will."

    Tweets of the Week (6.13.13)
    June 13, 2013 12:50 PM by Adrianne OBrien

    New Twitter list! Healthcare transparency on the rise, hospitals cutting jobs, fixing the chaotic pricing system of employment-based health insurance, and why healthcare's take on non-compliance is all wrong. Get daily tweets by following us @ExecInsight.

    David Chase ONC holds key to dismantling provider & patient lock-in at core of institutional pricing leverage http://t.co/0989mOaNpl

    ASC Communications Healthcare price transparency market to grow 55% by 2016. http://t.co/W2z9idiuTZ

    Harry Greenspun, MD How mobile phones can improve healthcare -- see the Tanzanian case study: http://t.co/CqnrcM2ECZ via @BloombergView

    KentBottles Mayo doc: Stop blaming patients. Healthcare industry's take on non-compliance is all wrong http://t.co/1kMyOTHMFa 

    Deloitte Health Care How might California healthcare companies thrive in an ever-changing and dynamic environment? http://ow.ly/lWjWF 

    Ben Miller "How long must chaotic healthcare pricing system of employment-based health insurance in United States persist?" economix.blogs.nytimes.com/2013/06/07/the... 

    Stephen Wilkins 10 Reasons ACOs Should Invest in the Patient Communication Skills of Their Provider Networks http://t.co/5l7RKvZMN7

    Hospital Review Hospitals slash 5,900 jobs in May http://goo.gl/cGcPj  

    Farzad Mostashari HT @Jonathan_Bush "when I am honest with myself, I know that [gov't] supposed to step in when a market is broken." bit.ly/16Q9HY7 

    JohnHopkinsMedicine Smart investment: US gov't support for Human Genome Project yields 53k jobs and $293 billion in personal income. http://t.co/r7ItO25PFQ



    Safeguarding the Electronic Communication of PHI
    June 12, 2013 8:29 AM by Jill Hoffman

    Editor's note: This blog was written by Don Dally, CTO, and Terry Edwards, CEO, both of PerfectServe.

    HIPAA provisions emphasize the risk management process, rather than the technologies used to manage risk – so for hospitals and health systems, the pathway to safeguarding electronic communication of PHI lies in the creation of an overall risk management strategy. Ideally, leaders of the covered entity (CE) will form an information security committee to develop and execute the strategy, which includes representatives from IT, operations, the medical staff and nursing, as well as legal counsel.

    Leaders should also consider including an external security firm in the group. Once the committee is formed, the organization should take four essential steps for protecting the security of ePHI.

    Step 1: Conduct a formal risk analysis – Whether conducted internally or outsourced to an external consultant, this step is critical, and must include inquiry about the types of technology used for electronic communication, as well as the transmission routes for all ePHI.

    To ensure HIPAA compliance, ePHI transmitted across all channels must be "minimally necessary" – which means it includes only the PHI needed for that clinical communication. This layer of complexity, which is common in clinical communication processes, underscores the need for a comprehensive security assessment and strategy appropriate for the organization, coupled with the resources necessary to implement that strategy. The assessment should also evaluate the strength of the administrative, physical and technical safeguards currently in place.

    Step 2: Develop an appropriate risk management strategy – Once the analysis is complete, the committee should develop a risk management strategy that’s specific to the needs and vulnerabilities of the organization and is designed to manage the risk of an information breach to a reasonable level. HIPAA does not specifically define "reasonable" – but in general, the risk management strategy should include policies and procedures that ensure the security of message data during transmission, routing and storage. The strategy should also include specific administrative, physical and technical safeguards for ePHI.

    Decisions about safeguards will require the committee to consider the limits the organization will impose on electronic communication of PHI. The committee should develop detailed written policies regarding permitted staff behavior when communicating ePHI, including required actions in the case of a suspected breach (e.g., contacting oversight agencies, patients, and media; consequences for employment status). It’s also critical for the group to determine processes for creating an audit trail of messages that includes the sender, receiver, date and time to provide the information necessary for accounting and reporting in case of a breach. 

    Step 3: Implement policies and procedures and train staff – Implementing new policies and procedures is the biggest challenge for organizational leaders – especially as a substantial proportion of reported security breaches are due in part to insufficient training of staff. As a result, appropriate individuals should be assigned specific implementation tasks for which they are held accountable, while leaders and committee members must carefully monitor the success of implementation. All staff with access to PHI must be educated about the specific policies and procedures, and training should be included during new hire orientation and on a regular basis (e.g., annually) for other employees.

    Step 4: Monitor risk on an ongoing basis – To ensure continued compliance with security standards, organizations must conduct ongoing monitoring of their information security risk. Leaders should receive regular trend reports from the information security committee based on their ongoing assessment of ePHI security at the organization. Leaders should ensure the ongoing assessment of security needs as technology and health care delivery change – for example, in response to the greater care coordination required with accountable care.

    HIPAA provisions do not include detailed regulations around specific electronic communications like text messaging – making a "HIPAA-compliant texting application" a misnomer. Instead, HIPAA requires that CEs complete a risk assessment and implement policies and procedures to manage the risk of an information breach to a reasonable level. In today’s increasingly complex healthcare environment, analyzing and implementing a broader policy around security across all forms of electronic communications – rather than focusing on any one mode of communication in isolation – and following the steps above will be critical to any health system’s ability to avoid and mitigate the adverse consequences of a breach.

    Five Best Practices for EHR Training
    June 6, 2013 4:55 PM by Adrianne OBrien

    Editor's note: This blog was written by Amanda Guerrero, who originally contributed this piece to Software Advice. Amanda is a writer and blogger specializing in EHR, patient portal technology and Meaningful Use. From her years working as a file clerk at a doctor's office to her time as an implementation manager at an EHR company, Amanda has witnessed the evolution of the healthcare industry's charting system firsthand.

    Let's face it: electronic health record (EHR) implementation is a challenge. But it doesn't have to be something your practice dreads. With effective training, your staff can avoid the setbacks many practices encounter. Here are five best practices for training your staff to ensure a smooth EHR implementation.

    1.  Identify Computer Proficiency Levels and Provide Training.

    Determine whether any of your employees need basic computer training in order to be comfortable operating in an electronic environment. You can do this by using assessment online resources - some are free, others are paid, and others even let you create your own test.

    If you identify employees in need of training, you'll need to get them up to speed. You could pay for classes at a community college or pay an instructor to visit your office. Alternatively, if budget is an issue, you could take advantage of a free online resource.

    2.  Select "Super Users" to Help Train Staff.

    Identify one or two tech-savvy individuals in your practice who will learn the EHR backwards and forwards to serve as go-to people for EHR questions. These individuals should be highly computer literate, excited about learning new concepts, and willing to help teach others.

    Look for someone who's been with your practice at least a year, and who isn't already over-burdened at work - this person will likely be answering a lot of questions for the first few months. Consider offering an incentive (such as extra vacation time or a small bonus) to encourage skilled employees to step forward for this added responsibility.

    3.  Tailor Training to Each Employee's Role.

    Don't make the mistake of thinking every employee needs to learn every function of the EHR. For example, billing employees will need to learn how to submit electronic claims, but not how to view test results or enter a diagnosis.

    Avoid confusion among your employees - and save their time - by training them only on areas they'll need to use regularly. This will help get your staff up to speed more quickly.

    4.  Regularly Gather Feedback After Implementation.

    The process isn't over as soon as your EHR is live. Once you begin using the system, you'll likely encounter some snags - some function that isn't clear to you, or a workflow process that isn't efficient. Identifying these issues quickly is important to avoid mistakes.

    Conduct regular feedback sessions, and include individuals from across your practice so that every type of user is represented (nurses, physicians, billing, administrative, etc.). When issues are raised, prioritize them by determining how they impact patient care. For example, knowing how to properly enter vitals will be a more immediate priority than redesigning an inefficient workflow process.

    Don't try to fix everything at once. Attack issues one at a time, starting with the most urgent.

    5.  Make Use of Your Vendor's Online Resources.

    EHR vendors usually provide learning and training materials online. Take advantage of those resources if questions arise that your "super users" can't answer. You'll also likely find discussion forums, which are often tied to vendors' websites, where you can engage with other EHR users about how they're using the software.

    EHR implementation takes time, but employing the best practices provided here will help your practice get operational more quickly while avoiding common headaches. That way you can focus on what matters most: providing quality care to your patients.



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