First and Third: One World Serious Health View

“Don’t go walking around like you just hit a triple – when you were born on third base.”

- unknown

“He wants to know why your skin is white and his is black,” clarified my translator. The Tanzanian boy, about 10 years old, was pointing to the skin on his hand and then to mine. His question in this remote kijiji (Swahili for village) was as arresting and profound as the inequities in global health.

My global interdisciplinary health team was in Africa as part of a feasibility assessment in partnership with a Tanzanian team to determine how to improve health in the region near Lake Tanganyika, which borders western Tanzania. While Tanzania is considered a low-resource, less developed country, the western region is considered the least developed area within this ‘third world’ country.

The local team was dedicated and committed to make a difference in the health of the people in the region. They believed that they needed a hospital and many clinics to do this since they knew that my colleagues and I had led hospitals and clinics in the U.S. and in eastern Tanzania. But my team was convinced that exporting the U.S. acute care model was not going to help them improve health, at least not nearly as much as investing the few available resources in other more impactful social determinants of their health. In addition, the local team did not have the resources, expertise or mission to expand the existing healthcare system.

First world population health is not an effective solution for Third world health challenges. First world population health efforts are often supported on the back of an acute care funding chassis: a hospital or healthcare system with access to a reimbursement system to sustain it. By design and nature, first world population health is typically incremental: icing on the core fee-for-service reimbursement cake.

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Everything I learned in Girl Scouts

I was honored as a Girl Scouts of Western Ohio Woman of Distinction a few years ago, and I was asked to share some of the lessons or “words of wisdom” that I’ve learned through my own experiences and through others. As I reflect, the Five Key Ways that Girl Scouts help young adults thrive, are applicable and transferrable to every rising leader in general.

Girl Scouts is proven to help girls thrive in five key ways as they:

  1. Develop a strong sense of self.
  2. Seek challenges and learn from setbacks.
  3. Display positive values.
  4. Form and maintain healthy relationships.
  5. Identify and solve problems in the community.

Read the Girl Scout Difference here .

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The Benefits of Building a Diverse Team

“Strength lies in differences, not in similarities.” - Steven Covey

Diversity and inclusion are top priorities in many organizations today, and there are plenty of benefits that come with implementation. First of all, there’s an increase in profitability. A McKinsey & Company report found that companies with leadership in the top quartile for gender diversity were 15% more likely to have financial returns above their industry median, and those with leadership in the top quartile for racial and ethnic diversity were 35% more likely to do the same. On the other hand, McKinsey also found in a follow up that companies with executive teams in the bottom quartile for both gender diversity and racial and ethnic diversity were 29% less likely to achieve above-average profitability.

There’s more at stake than immediate profitability. Through my own experience, I’ve also seen improvements in:

Retention - Diverse leadership communicates that leaders cannot all look and sound the same, and a diverse leadership team helps create an environment where people of all races, genders, sexuality, religions, socio-economic backgrounds can thrive. It creates an environment where employees can see their path to advancement and leadership positions within the industry.

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It’s a Matter of Scale for Healthcare System CEOs

For healthcare CEOs, as the size of the healthcare system grows, so grows their need to balance priorities. By organizational structure, larger system CEOs, including those individuals who are Physician CEOs, often coordinate with multiple individuals reporting to a board of directors. The CEO perhaps has a specific specialty from past experience––finance, legal, medical––with next-level leaders who broaden the operational bandwidth through their specialties.

In contrast to the stand-alone hospital CEO who are more intimately involved in the daily operations of the rural or individual hospital, large system CEOs find themselves in larger cities with more public points of interactions and more team members among the healthcare staff to whom they must stay connected.

Time is always a factor

Hospitals are 24/7 operations, and large systems have hundreds or thousands of people relying on services at any given time. The large system CEO cannot reasonably be involved in these daily functions and resource needs. This CEO is consistently informed by the people they’ve entrusted with overseeing specific functional areas. The CEO must hire the correct people to provide operational knowledge and support who report back on the needs of the system.

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Leading from the front: The importance of community building for non-profit hospitals

Non-profit hospitals are beholden to stakeholders (i.e. the communities they serve), not shareholders, and are thus pivotal community assets. While for-profit hospitals report to shareholders and investors, non-profit hospitals have an obligation to use assets for the betterment of the communities they serve. Community benefits can include charity care, expansion of existing services such as trauma care and maternity services, clinical education, increasing access to care for Medicare and Medicaid patients, and promoting community health.

One of the best ways to promote community health and serve the community at large is to create community partnerships and develop relationships with those involved in existing healthcare services in the area. This way, non-profits are not duplicating existing resources and are working toward a common mission of improving the health of the people and communities they serve.

The move to value-based care is slowly migrating to capitated payments. This is an important progression, as the capitated payments model is more person- and outcomes-centered; the focus shifts to prevention and wellness; and hospitals are incentivized to improve health status. The notion suggests that the health of the population will continue to gain importance.

True population health requires addressing underlying social determinants of health, including socioeconomic status, level of education, neighborhood environment, nutrition, activity levels and access to healthcare. It is well documented in the literature that social determinants drive healthcare outcomes. As an example, those with wealth generally enjoy better health status than the poor.

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Hurricane Florence is no match for Florence Nightingale: Nursing process and human resiliency wins out every time

Since the 1990s, I used the nursing process (assessing, diagnosing, planning, implementing, and evaluating) plus a healthy dose of human resiliency in healthcare leadership and my personal life. Little did I know that this training would benefit me when I least expected it. In September 2018, Hurricane Florence made landfall on the coast of North Carolina and with it permanently changed the residents’ lives. Homes were swept away and people feared how they would provide something as simple as the next meal for their families. My family was fortunate because our home only sustained minor structural damage; the only major damage was losing our dock. With hard work, determination and a disciplined process, the dock was transformed into something even better than it was in its previous state.

The nursing process started in the form of preparation. Before the storm hit, we boarded all windows and doors, turned off all utilities and prayed that no one would be injured as we drove away to ride out the storm in Virginia. The process continued as my wife, Angie, and I left to return to North Carolina and assess the damage. We loaded our utility trailer with fuel, building materials, food, water and shelter. By determining safe, accessible travel routes within 24 hours of the storm and leaving the area kept us safe. Constant reassessment of changing travel conditions kept us alert and ready. No planning in the world could have prepared us for the devastation that we would see. When we arrived at our home, we found the lower level destroyed, the main level exposed to the elements, debris as far as you could see, and only broken poles where our boat dock and pier had stood.

Hurricane Florence met the nursing process in North Carolina. Constant implementation of the process (assessing, diagnosing, planning, implementing and evaluating) ensured that the right steps were taken in a structured and manageable fashion. Florence Nightingale is widely known as the founder of modern nursing. Nightingale said “Rather, ten times die in the surf, heralding the way to a new world, than stand idly on the shore.” Over 110 years after her death, and throughout the Hurricane Florence recovery process, Florence Nightingale was a beacon of hope in my life.

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Navigating the Outsourcing vs. Hiring Dilemma

Among the dilemmas facing healthcare executives, the decision to hire more in-house staff or outsource non-core functions of an organization is becoming increasingly common and complex. In the healthcare industry, business process outsourcing (BPO) can allow hospitals to increase their focus on what they do best: caring for patients and serving them well.

BPO includes benefits like lowering costs, increasing efficiencies, increasing focus on core business functions, and partnership with trusted experts in a wide variety of front- and back-office functions. But outsourcing has a cost that is more than just financial. Working with a BPO company requires releasing control, and if the relationship doesn’t work out, it can be hard to recover, both for your organization and your people.

Is business process outsourcing (BPO) right for my organization?

How do you know if it makes sense to outsource a function of your hospital or healthcare company? Start by weighing the costs and benefits to determine if outsourcing makes more sense financially than hiring or training an in-house employee. Ask yourself questions like:

  • What specific process or function does my organization need performed? Where is this function lacking in efficiency or cost effectiveness?
  • Does my organization currently have the skill set needed to perform this function internally? Locally?
  • What is our budget for this function, process, or service? What can we afford?
  • How often and for how long do we need this function performed?

If it has been determined that it is financially viable and necessary to your company running efficiently to outsource a service or process, here are some things to consider as your company explores outsourcing options.

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The Wedding Toast: Lessons in Leadership from Love

Recently, I had the opportunity to share the joy and intense emotions of giving away my daughter in marriage. At this extraordinary event, I had the fatherly privilege of making the welcome toast. Reflecting on these thoughts in the days that have passed, I realize that these principles and practices that guide us toward happy and healthier relationships are key traits that great leaders exhibit. Please indulge me in the following excerpt from that toast I gave at the wedding of my daughter Francesca to her husband Matthew.

One of the privileges of being the Dad of a little girl is that she sits on your lap and you have little talks from time to time. One I remember in particular is when her mother was out shopping, because that’s what she did when Daddy and daughter spent time together, Francesca looks me in the eyes and says: “Daddy when I grow up I want to marry you” ….. I had to politely explain to her that Mommy wouldn’t like that too much! She then went on to say: “How will I ever find the right person to marry?” I said: “Honey, when you fall in love and if that person treats you as well as I do, then he’s the one.” Matthew you’ve passed that test.

So I can’t leave without a little advice for Francesca and Matthew…..You are starting your life together, what’s the most important thing? The most important thing is LOVE….that’s a great word but there are a lot of things that go into it. For my colleagues in medicine, you know we have to make acronyms out of everything to help us remember….

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Can our Board be better? A few considerations

The best healthcare boards are dedicated to the success of the organizations and communities they serve, have a sincere hunger to stay up-to-date and informed about industry standards and stay curious about emerging trends. Board members have to be well educated on the issues, well prepared for generative discussions, and be mindful of the interests and concerns of stakeholders. Being a contemporary healthcare board member demands a great deal and, in turn, can provide a rewarding experience.

Boards play a critical role in the long-term success of organizations. In addition to the expected fiduciary responsibilities, healthcare boards are tasked with promoting and embodying the mission and vision of the institution and advocating for its well being while setting aside self-interest. Advocacy includes ongoing education of politicians and civic leaders, fundraising and networking with potential donors, and telling the organization’s “story.” It is imperative that the board builds relationships in the community in order to expand services to meet community needs and partner with other aligned organizations.

The highest functioning boards share similar traits: absolute fiduciary responsibility inclusive of finances, safety, quality and the employee and patient experiences; development, implementation and monitoring of a long-term strategic plan; and establishing leadership goals and monitoring performance compared to the goals. Additionally, most not-for-profit boards are self-perpetuating so a key responsibility for today’s board is selection of new board members. Now more than ever, an important criterion for board member selection should be diversity. In this case, diversity should be considered in the broadest sense.

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Lessons from Global Health Development: Insights from Four Change Models

This is Part 3B of this three-part series.

Part 3A briefly reviewed four change methods. This Part 3B compares them to elicit insights.

Motivational Interviewing, Kotter’s 8-Step Model, Baldrige Communities of Excellence, and SEED-SCALE, reviewed in Part 3A, were selected to reflect and reveal the wisdom of a range of disciplines, applications at different levels (individual, organizational, community and population) and purposes to aid change practitioners in the thinking and doing of their craft. How can comparing these models elicit deeper insights to affect sustainable change sooner and better?

Some Questions for Cross-Benefit

Organizational leaders are inclined to plan and motivated to implement. How can leaders apply the individual-based MI change process, especially its relentless focus on the “why,” to better empower others to engage in large-scale challenges?

Organizational leaders and MI counselors are tempted to pursue short-term results over long-term empowerment and are challenged to sustain progress. How can they employ the iterative, escalating scaling process and longer-term, biologic view of SEED-SCALE to advance in a manner that harnesses the human energy of self-direction and local ownership? Read Full Article.

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Good Operations is Good Strategy

Good operations is good strategy. Operational excellence. Blocking and tackling. Within health systems, the ongoing importance of good operations should be highlighted as a foundational element of every strategic plan. Good operations is a “no lose” strategy that positions a health system for success regardless of the many external forces providing new challenges. Value-based contracting, risk-sharing and Medicare break even strategies are all dependent on the fundamentals of sound operations. Operational Excellence requires strong and improving performance across a broad spectrum of metrics related to safety and quality, customer service and cost efficiency.

Safety and quality. Our consumers have historically assumed that a healthcare system – especially one with brand recognition – provides a safe environment and good clinical quality. They have had little information to guide decisions related to safety and quality. Health systems must compare performance against top quartile performers and make the changes necessary to achieve this level of achievement consistently. And make the information available to the public in a discernible manner that is meaningful to consumers and motivating to caregivers. Safety and quality must be embedded within any strategic plan.

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Developing leaders must navigate the hallway of hell

Enhancing our own leadership development along with the novice and advanced leaders on our teams is mission critical in healthcare today. The environment that we are challenged to be successful in is very harsh — increasing the cost of technology and pharmaceuticals, the ever-increasing cost of labor, on top of declining reimbursement.

The formula for success appears simple enough, but the challenge (as always) is the execution. Clearly, educating leaders and enhancing their skills will yield great outcomes; yet the material that must be mastered is not intuitive, and the skills must be practiced over and over to be mastered.

One of the first lessons to be mastered is abandoning time-tested strategy, focusing on maintaining current productivity and volume levels, and being content with the fundamental processes currently in place. In other words, leaders must be comfortable being uncomfortable, embracing the feeling of being unsettled. Read Full Article.

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Lessons from Global Health Development: Sustainable Change Contrarian

Part 1 of a three-part series

“We cannot solve our problems with the same level of thinking that created them.” ― Albert Einstein

In the U.S., some refer to healthcare system change as an oxymoron. It is complicated. It is hard. And while progress has been made, we have a long way to go.

But if such change in healthcare is challenging in the richest nation, then imagine it in low resource countries. In many sub-Saharan African countries, healthcare must compete with investment in other more impactful determinants of health such as education, food security, and sanitation that, if present, are weakly established. Layer in different governments, languages/dialects, and cultures; include frontier rural locations, tribal influences and religious differences and the challenge to improve health and healthcare in countries such as Tanzania, Madagascar, and Nigeria can feel truly overwhelming.

Historically, the traditional approach to both change in U.S. healthcare and global development has been to identify needs and direct resources, typically money, at the perceived needs. This pattern has resulted in little success and in many cases, regression, harm and/or increased costs. In global development, despite over a trillion dollars channeled to low resource countries in the past two decades, little progress – and often regress – has resulted (Taylor, Empowerment On An Unstable Planet). In U.S. healthcare, it has created and perpetuated a medical industrial system that is three times as expensive as other countries for almost median outcomes. The lesson? Funds are zero sum limited; human energy is not. And the only real empowerment is self-empowerment.

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It takes a team - the story of a turnaround that could have and should have happened

As discussed in the blog, Success or Failure: Healthcare Can Not NOT Change, healthcare is a business. And, considering the economic contribution they make throughout their region, it is big business. With each hospital closure that hits the media, it is not simply the services provided that is at issue, but the financial impact to the community as well.

Serving as a consultant at a very impressive $40M health system, I dove deep into the Community Health Needs Assessment and each component of the strategic plan. My initial task was to meet one-on-one with each member of the executive team and department heads – of course my daily rounds (LBWA) meant I was meeting front line staff throughout the day each day – before reporting back to the Board of the Directors at the end of the month.

Meeting with the CFO, she was gravely concerned with the system’s operating margins, which were the narrowest they had been in her entire 12-years. She provided me with benchmark data showing the continuous decline over the last several years.

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Leading Your Team Through Complexity

Leading and working in healthcare has always been complex, never more so than in today’s healthcare environment. Increased regulations, government reforms, alternative based payment models, rising consumerism and expectations have come together in a perfect storm swirling around the industry. On top of this, the world economy has become a destabilizing factor as we realize now more than ever how interconnected we are to our world partners, almost a giant game of Jenga, where one false move by a world leader could topple the whole tower.

So how do we lead in an era of increasing complexity and more ambiguity than ever before? In previous articles I’ve discussed the importance of mission and a common set of values to ground the organization and guide our decision making, and this is foundational. However, in this article I would like to discuss the skills and the leadership maturity it takes to lead successfully in a complex environment.

I’m going to use the term “maturity” here, not necessarily the chronical definition of age, but the maturity that comes with leaders who have had numerous and diverse leadership experiences. Leaders who have seen enough, had their share of successes and failures to understand the important role they play in guiding the decision-making process.

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Good Leaders Drive Results!

Leaders are expected to be creative problem solvers, challenge the status quo and visualize problems before they occur. Your success as a leader is largely dependent upon how quickly you seek improvement in broken processes, develop new procedures and maximize efficiency and effectiveness.

Below are three tips to help you stay in front of the curve when managing your people and organization through change and drive results: Read Full Article.

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Success or Failure: Healthcare Can Not NOT Change

One can not, not change – especially in business. And, though not always a popular perspective, healthcare is not only a business, it is big business. With many rural communities, the local healthcare system is the primary economic driver. It may sound harsh, but in business, it has been said that we are either growing, adjusting or dying.

As an avid fitness enthusiast, I can personally attest that I must either work to improve, or I will lose the progress I have made - requiring almost constant re-assessment and modifications to my programs. Especially as I age. What I was able to do 10, much less 20 or 30 years ago will no longer render the same results today. Very much like rural health.

Change and growth can be intimidating. It requires making choices on probability weighted outcomes. There must be a willingness to make additional investments, or cutting budget of one area to expand another. And, perhaps the scariest issue is leaving the known (what has been done), to embrace the unknown.

With any business, we must continuously evaluate our market to make effective strategic adjustments. Our communities’ needs, demographics, reimbursement, regulations and staffing – the only constant within healthcare is change. Read Full Article.

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Sustainable Population Health -- Who's on First?

Part A of this article clarifies the blurring terminology that can inadvertently stunt health improvement understanding and action.

Post-truth, Fake news, Misinformation (Dictionary.com words of the year for 2016, 2017 and 2018, respectively). Let’s be clear: How is population health different from community and public health? How does it relate to health disparities? A senior leader discussion on these topics can begin to sound like a rendition of Abbott and Costello’s “Who’s On First?”

The terms Community Health, Public Health and Population Health are often used with the same broad brush. But advancement in our thinking and action start with clarity of our language and terminology. Clearly there is much common ground with these terms. To start 2019 off with clarity, below is a summary delineation of these terms. Read Full Article

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In Praise of Corporate Tension

“Corporate will be here next week to help…”

“Corporate is sending out a team in person to review the project.”

“Corporate is coming out for a visit.”

These words can immobilize the most courageous of hearts. Many at the clinical sites believe corporate exists to disrupt and provide self-enhancement for the corporate individual making the demand. The incoming request often appears as a consistent disruptor to the local individual who is focused on the hospital, clinic or community issues. As a non-corporate individual, you are at the site addressing immediate and multiple priorities. The demands can range from concerns for improving patient care, addressing colleague concerns or responding to the corporate enhanced financial issues to name just a few of the more common daily agenda items. In fact, you may even be reacting to a situation affecting the greater importance (?) of your immediate supervisory interacting environment (i.e. keeping your local boss happy). Whatever the corporate demand at the time, it can seem to distract from the work necessary to be successful at the site. Furthermore, from the limited view in field, the request can sometimes make no sense as to its timing or priority except “Home Office needs it now.”

The tension between the entities in the field and the corporate power is real. The euphemism of “Corporate,” with all of its priority setting, sweeping powers, and down-flowing time demands can cause untold tension and disruption at the sites. However, corporate has its own demands and in the final measure is often made up of people just attempting to survive and succeed. Good leaders are conscientious individuals balancing competing demands, shifting priorities, and seemingly continuously adjusting metrics driven by someone else’s “higher-up” tinkering. Both sections of the organization contain people searching for a positive impact. Same organization. Different pressures. Competing language. How does that language sound as a result of differing views? Let’s take a look and listen in: Read Full Article.

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The Obstacle is the Path

“The obstacle is the path” is a Zen proverb that tells us that obstacles are the key to success.

Sometimes the only way out is through. The key to overcoming adversity is at times simple perseverance. Winston Churchill said, “If you’re going through hell, keep going.” Churchill was surrounded by people who, early in World War II, wanted him to give in to Hitler. He would not surrender. If he had, the world would be a very different place today.

Adversity gives us strength. Great athletes must challenge their bodies to develop the strength, skill and agility needed to excel. My mother is fond of quoting Ralph Waldo Emerson who said, “That which we persist in doing becomes easier, not that the nature of the task has changed, but our ability to do has increased.” The Russians are the masters of extended times in space. These cosmonauts were able to spend many months in the apparent weightlessness of space free of the constraints of gravity, but when they landed on the steppes of Kazakhstan, they had to be carried away on stretchers. They had lost so much bone and muscle mass that they could no longer stand.

In entrepreneurship, we are taught that the key to innovation is the “pain”. The pain is the problem that your innovation solves. If there is no pain, no problem, then there is no need for your innovation. Many entrepreneurs developed innovations that made them very successful when they found that the marketplace did not offer a solution to their own problem. They knew that others would value their solution if available so they offered a product or service to solve the same problem for others. Read Full Article.

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