Achieve Value-based Results in Healthcare: Knowledge Management/Transfer Through Data Analytics

Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.

Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.

The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:

  • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
  • Service Excellence (service delivery exceeding patient and family expectations), and
  • Clinical Excellence (best clinical outcomes for every patient and patient population).

The next essential element of a performance excellence culture is to define the “HOW” organization will be led through:

  • Stakeholder Engagement
  • Knowledge Management/Knowledge Transfer
  • Process Management

Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery.

As highlighted in previous articles:

  • Value Based Care is here to stay and healthcare organizations must overcome multiple organizational gaps that may contribute to not fully realizing a vision of success in a high performing integrated delivery system. Here
  • Key Stakeholder Engagement is essential to execution of a common Vision:
    • Physician Stakeholders (as well as others) should be engaged in organizational Governance, especially among healthcare providers, is essential to success in a value based environment. Here.
    • Physician Stakeholders should also be engaged in Leadership and Management to achieve sustainable results. Here.

This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Knowledge Management/Knowledge Transfer. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of:

  • Operational/Financial Performance,
  • Service Performance, and
  • Clinical Performance.

Knowledge Management/Knowledge Transfer Through Data Analytics

The days of making claims of high-quality, service oriented and low cost care delivery are gone. Regulatory requirements and consumers of healthcare demand demonstrated proof. On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program is intended to improve Medicare by helping you focus on care quality and focusing on making patients healthier (population health management). The Quality Payment Program’s purpose is to provide new tools and resources to help organizations to provide patients with the best possible, highest-value care. The Quality Payment Program has two tracks to choose from:

  • The Merit-based Incentive Payment System (MIPS), and
  • Advanced Alternative Payment Models (APMs).

Healthcare providers are required and must report key measures of performance in order to maintain a competitive edge and to maximize reimbursement for services rendered. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. The best place to start is to define your measures, based on industry standards. Engaging your Governance, Leadership and Management representatives, as well as other key stakeholders, in defining performance metrics is essential to gain a common understanding. Begin by gathering potential sources of industry standards (see table).

Knowledge Management/Knowledge Transfer Process:

The quest for appropriate data analytics to measure, monitor, report, analyze, improve and control can be challenging. Once sources of industry standards have been identified, engage stakeholders in organization-wide effort to define your measures of Operational, Service and Clinical metrics:

  • Review and select meaningful measures:
  • Verify the organizational capacity to measure, monitor and report measures:
    • Be sure all metrics of performance are measurable.
    • Operational and Financial Metrics are typically readily available, but may not be reported in an intuitive format with full-transparency across the organization and among key stakeholders.
    • Service Metrics (patient engagement) should be standardized using a formal survey tool, administered by a vendor approved for use by The Centers for Medicare & Medicaid Services (CMS).
    • Measures of Clinical Performance may present the greatest challenge:
      • While sources of key measures are readily available, the ability to measure performance across all providers may be limited.
      • Desperate systems in multiple healthcare settings increase complexity of data collection.
      • Clinical information may be captured as free form text and may require manual/human intervention for interpretation.
      • Manual data abstraction may present a high cost alternative to automated reporting.
      • Lack of interoperability of information systems creates complexity.
      • Clinical and claims data are not typically consolidated.
      • The good news is: multiple vendors are available with advanced tools to aggregate data to support your efforts to measure, monitor, report, analyze, improve and control clinical performance.

  • If necessary, select reliable vendors to provide external support for the purposes of understanding measurable performance.
  • Create detailed analytics reports across the organization at the Enterprise, Specialty, Practice Location and Individual Provider levels,
  • Determine baseline performance at all levels,
  • Set routine reporting intervals (daily, weekly, monthly, quarterly and annually), as appropriate,
  • Set levels of performance:
    • minimum level of performance,
    • expected/goal level of performance, and
    • Level of performance exceeding goal.
  • Utilize high level dashboard reporting tools for ease of review and understanding across the organization:
    • A simple “stop light analysis” provides ease of review (see below):

    Click here for Reference Sources.
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    A Strategic Nursing Career

    What would it take to build your career strategically?

    Nursing Leaders think strategically about the work they do, often considering the needs of their organizations, their staffs, and the patients they care for as their primary focus of their careers. Rarely, however, do they spend much time thinking about a personal strategy for their own careers.

    Have you considered what you want for the next chapter of your career?

    If you are in the middle of your leadership career or heading to the end of traditional employment, making the next phase of your career the most intentional and thoughtful of your life is within your reach. At Wiederhold and Associates, we have witnessed the tremendous outreach nursing leaders can have when they take their careers to the next level. Be it within the same position, or a new direction, the strategic career does not wait for opportunities to come along.

    Strategic careers are often designed and created by individuals who have developed shifts in thinking that utilize an increased awareness of themselves to confidently self-determine their offerings and value. Learning to communicate that value to others is a key part of the strategy.

    A personal career strategy is not a selfish endeavor. When a nursing leader combines passions, talents (or potential talents) with intention, many lives and careers can be changed for the better. It could be the most important work of your life.

    Taking stock of new or unrealized potential is the work of our organization as we expertly coach leaders to understand their career trajectory and make self-determination strategic goals for the most optimal work experiences. We have been honored to work with great leaders and assisting them to achieve their potential is some of the most important work we do.

    As an experienced consultant in strategic and transformational change, Diane has an extensive background in helping leaders develop and succeed. Her healthcare experience spans three decades as a healthcare administrator, clinician, and graduate school educator. To learn more, click here.

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    Strengthening Our Nation’s Healthcare Leadership

    Wiederhold and Associates is partnering with Yaffe & Company to host a series of discussions with select healthcare leaders across the country to examine the issue of executive recruitment, retention and leadership development. The gatherings will take place in cities such as Dallas and Houston, Denver, Chicago, San Francisco, Philadelphia, and New York, offering an opportunity for top-level executives and state hospital associations to network and share their opinions.

    Do We Need a Treatment Plan?

    The CEOs and other high-level executives who run our nation’s healthcare institutions form an important framework of our entire system. In recent years, a maze of migration has formed: in major urban markets, as well as outlying areas, these executives are coming and going from one position to the other, more often than ever. Sometimes, this happens for legitimate reasons. But all too often, it occurs because of a hiring mismatch, or misunderstandings between the board and the executive team, or some other reason that may have been avoided. The effect on our nation’s healthcare organizations, combined with the lack of viable succession plans in many institutions, is costly.

    How much better off would we be if we could strengthen our country’s healthcare leadership overall? Imagine a system where many more of our healthcare executives are finding their best personal fit, and functioning in the places and positions where they are most likely to be successful. This series addresses these issues and opens the floor for candid discussion among our nation's top executives in the healthcare industry.

    While we are only able to invite a select group of individuals as space is limited, we do want to hear your thoughts on the above issues. Please complete this survey or contact This email address is being protected from spambots. You need JavaScript enabled to view it..


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    Career development- Top 5 ways to stand out

    Developing one’s career is multifaceted and takes time, energy and intentionality. In a competitive market one must differentiate. Here are five ways to stand out and help your career develop over the long-term:

    • Grow your network- it’s about who you know and who knows you. Spend time each month connecting with new people to expand your network. 70%-80% of jobs are found through networking.
    • Know your value proposition- what is your calling card? Communicate this through words and actions. Include tangible results when communicating your value- not just phrases like “hard-worker” or “loyal”.
    • Help others- don’t always make it about you. Help other people find solutions to their problems. Give referrals to recruiters.
    • Perform in your job- help your boss win. Create value for the company and your boss.
    • Have a learner’s mindset - never stagnate. Learn new skills and never stop growing. Become indispensable.

    Respond on this blog what you would add to this list!



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    Strategies for Active Career Advancement

    Are you looking to be promoted?

    If getting a promotion is important to you, then it is time to sit down and look at the external and internal factors that will influence your strategy of advancement.

    Define Your Target

    The very first and most important step in your career advancement strategy is to define what success is to you. From my observations, too many individuals choose a path that is somebody else's dream rather than their own. It's how you define moving up that really counts. It's also hard to be passionate about a direction that isn't your dream.

    Do Your Part

    The internal factors are all about you. This is where you exert the highest level of control. Are you being intentional about putting yourself in a position to be promoted? [Click to read more]

    Survey Your Surroundings

    If you are seeking to move to the next level within your organization, there are a few items that need to be explored:

    • How has this organization historically handled promotions?
    • Do they generally promote from within or seek externally?
    • What is the general timeframe for people to get promoted within the organization?
    • Is the person you report to going anywhere?
    • Does the person you report to have a history of mentoring his/her direct reports?

    I call these external factors because you can only influence them not control them. Your answers to these questions may suggest that the only way you're going to move up is to move out. If these external factors align with an internal promotion, then you have additional steps.

    • Have I asked my immediate superior what it takes to get to the next position?
    • Did their answer have enough specificity to suggest that they had thought about this possibility?
    • Can I continue to gain clarity around the possibility of promotion? (If you cannot gain clarity, then more than likely that's not a real possibility.)

    By defining your goals, developing a strategy, and become intentional about executing your plan, you can increase your chances of advancement immeasurably.

    Here’s to Your Success-


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    The Discipline of Project Management

    In this time of rapid transformation of care delivery, financing and business models, successful project management is more critical than ever. Whether a major facility or IT project or operational projects such as new staffing models, population health initiatives or business process enhancements, projects of all types benefit from project and change management expertise. Well run projects have a far greater chance of coming in on time and on budget. Organizations with high-performing projects realize project success more than twice as often as do their counterparts with low-performing project management.

    Successful projects share several key elements, including: committed, supportive leadership, a clear definition of success, trained project management professionals to drive change through each phase of the project and engaged and informed stakeholders who will support and adopt the changes associated with the project.

    What do these critical factors mean for a typical healthcare organization?


    The role of leadership cannot be under-estimated. Studies have shown a direct correlation between senior leadership engagement and project success. Senior leadership commissions the project and approves the project charter. In addition, senior leadership engagement is critical throughout the lifecycle of the project: as champion for the project, in active monitoring of its progress, taking decisive action when issues are escalated and removing roadblocks that are beyond the influence of the project team.

    Project Charter

    A well-crafted project charter provides the framework for the project: its scope, the strategic and business objectives to be achieved and timelines. It identifies the stakeholders to be considered and involved. A well-crafted charter provides the basis for the project plan. Equally important, the project charter establishes what is out of scope which provides focus for the project team, creates clear expectations of the project and prevents scope creep.

    Professional Project Management

    All managers are responsible for managing projects. But, not all projects are alike. Nor are all project managers. Some managers naturally bring the change, time and project management skills needed to lead a project. However, even the most naturally gifted can benefit from project management training. The more complex the project, the greater the need for trained, experienced project managers. The number of disciplines and departments involved, the degree of transformation required, the criticality of timing, the need for IT changes and the cost of the project are all considerations in determining the type of project manager best suited for the project.

    Stakeholder Engagement and Change Management

    Too often, projects are de-railed due to lack of key stakeholder engagement, understanding and adoption. The discipline of project management includes a thorough assessment of stakeholders impacted by the project, their needs and the best means of engagement. This assessment combined with time tested change management processes improves the level of stakeholder understanding, participation and adoption to ensure that project goals and outcomes are achieved. Stakeholder engagement is a critical investment in long term project success that cannot be over-looked.

    Where to turn for assistance

    There is an array of resources available to establish the discipline of project management throughout an organization, both internal and external. For organizations with an Enterprise Project Management Office (EPMO), internal project management experts can be tapped to provide training and resources for their non-EPMO project management colleagues. Training programs that offer project management certifications are a rich source of education. Local chapters of these organizations, colleges or other community organizations are also a good for source of training and networking. Independent project management consultants can offer an array of project management resources to support an organization’s needs, both educational and contract project management. Any combination of these resources can fill gaps while an organization builds the internal project management competency and infrastructure to ensure the success of projects throughout the organization.

    These fundamental steps lead to a greater discipline in managing projects, minimize risk and create a culture that can effectively manage the innovation and change required for future success.

    Theresa Lewis
    Practice Management Consulting and
    Interim Management

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    In transition? Cast a wide net

    If you find yourself in transition one of the worst things you can do is limit your job search. Do not say things like, “I don’t want to live in . . . . that part of the country,” or “That job is too small”. There are several reasons to cast a wide net:

    1. Practice. Getting a job is totally different from doing your job. If you’ve not interviewed in the recent past (6-12 months) you will be rusty. Casting a wide net gives you interview practice.
    2. Confidence. Getting in multiple job searches builds your confidence and confidence sells.
    3. Leverage. Which sounds better- “I have nothing going on,” or “I’ve had 3 interviews in the past two weeks.” The latter makes you look marketable to others.
    4. Networking. Every time you enter a job search you get an opportunity to start meaningful relationships with recruiters, executives and hiring managers. 80% of jobs are won through networking. These relationships pay off in the long run.

    You have nothing until you have a job offer. Work to get the cards in your hand and do not ever turn down a job that you don’t have. Cast a wide net in your job search- you will be surprised to see what you catch. For professional help with your transition, please contact us at

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    Develop and Maintain Effective Nurse Leaders

    According to the Bureau of Labor Statistics, 1.2 million vacancies will emerge for registered nurses between 2014 and 2022. In fact, the shortage is anticipated to be twice as big as when Medicare and Medicaid were introduced in 1965.

    Nursing plays a huge role in the success of our hospitals and healthcare systems today. Developing and retaining great nurses has never been more important.

    Untapped Talent

    Many organizations have "diamonds in the rough" just waiting to be discovered. The very skills that make effective nurses such as creative problem-solving skills, exceptional communication skills, and emotional intelligence are the foundational building blocks required to make exceptional leaders.

    However, being a good nurse doesn't always naturally translate into becoming good a nurse manager. Like many others who are promoted into management roles, nurses are generally not offered a great deal of assistance as they move into these new and challenging positions. Their raw talent must be inspired and carefully cultivated to become a thriving leader. With proper guidance, the transition into a senior leadership role can be very successful.

    W&A Nurse Leadership Program

    To maximize the success of our nursing clients, we have partnered with Nursing Leadership Coach Diane Scott, RN, MSN, ACC. With her strong clinical background, Diane has a deep understanding of the nurse executive role. Coaching is customized to every situation and organization, with outcomes driven models implemented to ensure success.

    Diane explains, "Senior nursing leaders usually are in charge of the majority of the workforce of any healthcare organization. They are often promoted through the ranks and experience challenges with increasing their ability to critically think at their new leadership level. However, once they reach that level, the new challenge is the overwhelming desire to meet the mission of patient care and balance a seemingly polar opposite of managing the numbers, especially financials. They also struggle with developing a self-strategy for their career, finding it too self-serving and not patient driven.
    The most successful senior nursing leaders learn that by increasing their own abilities, they can achieve their own potential, develop their managers as well as provide excellent patient care. In this way, everyone benefits under leadership that understands needs from the ground up."

    At Wiederhold & Associates, we know an organization can optimally increase a nursing leaders’ capacity for successful outcomes through professional Nursing Leadership Coaching. It is the single most powerful way for a leader to achieve their potential for superior leadership, strategic thinking, and measurable results.

    If you would like to learn more about our Nursing Leadership Program, download a tri-fold brochure here

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    Can I Trust You?

    In its 2016 global CEO survey, Price Waterhouse Coopers reported that fifty-five percent of CEOs think that a lack of trust is a threat to their organization’s growth.

    Stephen M. R. Covey, in his book: “The Speed of Trust,” asserts, "The ability to establish, extend, and restore trust with all stakeholders – customers, business partners, investors and coworkers – is the key leadership competency of the new, global economy."

    Paul Zak, in the January/February 2017 issue of Harvard Business Review and the feature article: “The Neuroscience of Trust,” states that employees in high trust organizations are more productive, have more energy at work, collaborate with colleagues and stay with their employers longer than in low trust cultures. Regardless of industry, your job as a leader is to create a culture of trust.

    In our work with clients, we coach them around the following five behaviors which are scientifically proven to promote trust:

    1. Model transparency and vulnerability: While it may seem ironic, there is great power in admitting when we’ve made mistakes. In healthcare, we strive to create just accountability cultures. The most powerful and impactful leaders are those who stand up in front of their organizations and tell stories about their mistakes and the critical learning from those mistakes.
    2. Leverage inquiry AND advocacy: Judith Glaser, in her book: “Conversational Intelligence,” describes three levels of conversation. All are necessary in certain circumstances, yet we tend to overuse the first two: telling, and trying to convert others to our perspective (levels I and II), and we underuse the last: transformational discussions (level III) with a mutual sharing of perspectives and an attitude of curiosity. This sharing stimulates our pre-frontal cortex which allows for our most creative thinking. “Imposing our perspective: telling behavior” can trigger another’s primitive brain (amygdala) and can result in fight, flight, or freeze reactions. Through coaching, one of my clients re-defined the 80/20 rule where it now means that she talks only twenty percent of the time and listens eighty percent of the time. The impact on her engaging with others, her talent selection success, and her ability to make strategic decisions has been powerful.
    3. Identify and honor your values: What do you stand for? As I coached a physician client, she discovered that her words and actions were not honoring what she said she held as most important. She was torn between caregiving needs for her aging mother and her work demands. Through coaching, she transformed her thinking from reactionary: worrying what others might think, to purpose-driven: honoring private time AND work responsibilities.
    4. Make it easy for others to provide you constructive feedback: the higher you go in organizations, the fewer people there are who feel comfortable providing you constructive feedback. My clients expect that I will offer observations of their behaviors and/or thinking that is interfering with their leadership effectiveness. One simple question you can ask on a routine basis is: “What can I do differently that would support my being a more impactful leader?” And then do it.
    5. Deliver on promises and do NOT promise anything you cannot deliver: Sometimes as leaders we believe we must respond immediately to a request. In doing so, we risk promising something that we later determine is less of a priority or can’t be done. Trust means following through with commitments.

    While not always easy, leaders who are committed to creating a culture of trust will continue to be disciplined around these 5 behaviors- especially in hard situations. As employees become more emotionally engaged with leadership, productivity and retention will naturally increase.

    Joy W. Goldman RN, MS, PCC, PDC
    Executive Director, Leadership Coaching
    Wiederhold & Associates

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    Achieve Results through Physician Alignment, Integration and Engagement: Governance

    Culture of Performance Excellence: A simplified Approach

    Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Thomas Edison is quoted as saying “Vision without execution is hallucination.” My expertise in leading physician alignment and integration strategies leads me to believe: “Vision without execution is worse than having no vision at all.”

    A vision of developing highly integrated, well-coordinated and person-centric care is essential to success in today’s healthcare market. Best practice in integration and alignment will begin with key stakeholder engagement in executing organizational vision. Physicians, as key stakeholders in care delivery, respond well to a establishing a common vision. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.

    As previously highlighted, multiple organizational gaps may contribute to not fully realizing a vision of success in a high performing integrated delivery system. This article expands on development of a philosophy of performance excellence to achieve a vision of success. The schematic shown above provides a roadmap for navigating the performance excellence journey toward becoming a fully integrated and well-coordinated care delivery system, focused on the value-based equation of healthcare.

    Vision and Execution

    Today’s ever-evolving healthcare industry requires a comprehensive vision of performance excellence:

    • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
    • Service Excellence (service delivery exceeding patient and family expectations), and
    • Clinical Excellence (best clinical outcomes for every patient and patient population).

    More importantly execution of that vision is imperative. Most healthcare organizations have developed a vision of service delivery that meets the value-based equation of operating/financial, service and quality excellence. Direct employment of physicians and other providers is one model of integration. Other models, including developing a Clinically Integrated Network, create other opportunities for integration and alignment. Either way, it is essential to build a culture of inclusion.

    Execution of an organization’s vision for the future is best achieved through fostering and developing a culture of comprehensive performance excellence. Measurable results are achieved when time and energy are devoted to:

    • Key Stakeholder Engagement,
    • Knowledge Management/Knowledge Transfer through data analytics, and
    • Formal Process Management.

    Physicians, as irreplaceable key stakeholders in care delivery, should be engaged in decision making and in charting the course for success. Physicians and other key stakeholders can quickly become disenfranchised when the vision of integration is not well executed. Having physicians actively engaged at the table to participate in decision making is essential. Whether healthcare organizations are focused on growing and developing an employed physician network, or seeking to align and integrate through other means, physicians should be formally and informally engaged in:

    • Governance,
    • Leadership, and
    • Management

    This article focused on physician engagement in Governance of a Physician Enterprise Organization. The article in this series will focus on establishing Leadership and Management Structure to execute the organizational vision.


    Hospital organizations have been inviting physicians to be members of governance structures for many years. In addition to representing medical staff activities, physicians can help foster a physician friendly culture at the board level. Gaining the physician perspective of hospital operations and embracing input will contribute to an environment of high performance. Physicians are typically viewed as customers of hospital based services.

    Governance within a physician enterprise organization (employed model or clinically integrated network) requires a very high level of engagement among physicians. Physician enterprise organizations have a profound impact on a physician’s practice and physician’s entire livelihood. A high level of governance to oversee and provide direction is needed. A physician led governing board is recommended. Physicians should be viewed as key stakeholders and leaders in care delivery.

    While physician governance is recommended, organizations may adopt a formal governing body with corporate bylaws which define scope of responsibility and accountability, or less formal governance oversight in an advisory capacity. Scope of responsibility and accountability of the physician led governance and reserved powers of higher governing authority at a system-wide level must be clearly defined. The majority of governing body membership should be comprised of physician members with predetermined representation from medical and surgical specialties from within the group. Administrative leadership is tasked with facilitating and directing physician governance through a high level of trust and credibility.

    The Governing Body of a physician enterprise organization may be structured to include the physician led board, as well as several sub-committees with defined functional oversight as defined by committee charters:

    • Policy and Procedure
    • Regulatory Compliance
    • Physician/Provider expectations:
      • Productivity
      • Access
      • Guiding principles related to citizenship and behavioural standards
      • Quality performance
      • Service performance
      • Operational/Financial performance.

    Sub-committees of the governing board are recommended to foster a broader level of engagement and participation among physician members of the group. The board may consider delegation of oversight to subcommittees to create focus and subject matter expertise through measuring, monitoring, reporting and improving performance. Sub-committees to consider include:

    • Finance Committee
      • Oversight of provider productivity
      • Oversight of financial measures
      • Capital allocation and approval
      • Oversight of Revenue Cycle

    • Clinical Quality Committee:
      • Regulatory required quality reporting
      • Non-regulatory quality improvement activities
      • Growth Committee:

    • Growth Committee
      • Provider manpower planning
      • Provider recruitment and selection
      • Provider retention
      • Provider engagement and satisfaction
      • New service development

    • Service Excellence/Patient Experience Committee:
      • Patient experience survey process
      • Patient experience expectations
      • Patient experience improvement initiatives

    • Informatics and Automation Committee:
      • System selection
      • System implementation
      • System performance and optimization

    • Physician Compensation Committee
      • Create a common understanding of fair market value for physician compensation models
      • Create incentive based compensation and align with value
      • Communicate broadly among all physician members of the group

    • Payer Relations and Contracting Committee:
      • Contract negotiation
      • Engagement in value-based initiatives

    Key Take-Aways:
    • Active engagement of key stakeholders is essential to fostering a culture of performance excellence
    • Physicians can quickly become disenfranchised when not engaged in developing organizational vision
    • Physician engagement and satisfaction in improved when organizational vision is well executed
    • Execution is best achieved when the organization is focused on performance excellence in operations, service and clinical activities
    • Developing and fostering a culture of performance excellence requires physician engagement Governance of the Physician Enterprise

    Next Steps:

    • Assess and design the Leadership and Management structure of the physician enterprise to enhance the performance excellence culture
    • Knowledge management and transfer through data analytics:
      • Determine the most important operational, service and clinical data analytics needed
    • Process Management through formal methodologies:
      • Determine the process management for the organization
      • Develop leadership, management and staff to focus on processes to:
        • achieve results,
        • standardize operating norms,
        • reduce variation, and
        • hardwire best practices.

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    Prepare Leaders for Long-Term Success

    Wiederhold & Associates currently partners with healthcare systems to support their succession planning process. One organization we are working with is unique in their foresight in planning for critical impending retirements. They recognize the need to invest on a longer-term basis to prepare their leaders for future success. Joy W. Goldman RN, MS, PCC, PDC, Executive Director of Leadership Coaching is leading the charge.

    "We not only want our clients to achieve their next career goals; we want them to excel and grow into the best leaders they can be. Now, more than ever, our world needs effective and values-driven leaders." - Joy W. Goldman

    As we work with our client systems, we know that we need to leverage confidence AND humility; individual interests AND team interests; a centralized AND decentralized focus; safety AND risk. We challenge ourselves with these polarities as we challenge our clients and client systems.

    "In working with one client, I took the risk of saying, 'It seems that you’ve been waiting for permission and approval to make a move. When are you going to take matters into your own hands and just act?' While difficult to hear, this challenge caused an empowering shift in the client. His words, after having time to process this, were: “I feel like a phoenix rising!” -Joy W. Goldman

    Our mission is to groom and develop agile leadership that is able to intelligently navigate the challenges and changes that our industry is facing. We look forward to partnering with you as you strategize your succession strategy for long-term success.


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    Executives- Read this if you made $100k or more last year

    Last year your employer gave you a bunch of money- what did you do for it? If you cannot clearly answer this question, you are vulnerable. In today's competitive market it is imperative to create value for your employer. Employers have problems- executives are hired to solve these problems. You must be able to clearly demonstrate a ROI on your salary- otherwise you are simply unnecessary overhead. If you cannot measure improvement in profit, sales, quality, customer satisfaction, efficiency, or cost reduction from a year ago I guarantee your employer is wondering if they are getting commensurate value with the money they are giving you.

    How do you create value for your employer? First, make certain you completely understand your boss's goals- they are your goals. Second, make sure these goals are quantifiable. Third, achieve those goals. If you rinse and repeat this process year after year you will continue to create value for your employer. In turn your employer will keep giving you fistfuls of cash.

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    Value-based Care is Here to Stay

    Simplified Approach through Physician Alignment and Integration

    Value Based Care is defined as provision of services that are low cost, highly efficient, service-oriented and provide the highest quality outcomes. Consumer expectations of values in the healthcare industry will continue to increase. Serving healthcare needs of a community that meet and exceed consumer expectations is complex and multi-faceted. The healthcare industry needs a simplified approach to address complexity and move toward a coordinated care delivery system. Healthcare organizations must first define a compelling vision for coordinated care delivery. Execution of that vision is best achieved through a leadership philosophy of performance excellence.

    The schematic shown below provides a roadmap for navigating the performance excellence journey toward value-based care (see schematic). This introductory article, the first in a series, outlines a vision for maximizing organizational success in the evolving healthcare industry through physician alignment and integration. A consistent and simplified leadership philosophy is provided to assist in execution of a strategic vision. Organizational gaps that may interfere with achieving organizational vision are also identified.

    Vision and Execution:

    The journey begins with:

    • Strategic vision for the future, and
    • Execution of the strategic vision through a leadership philosophy and organization culture of performance excellence.

    The culture of performance excellence focuses on measurable results and outcomes in three main areas:

    • Operating/Financial Excellence,
    • Service Excellence, and
    • Clinical Excellence.

    Performance excellence is best achieved when time and energy are devoted to:

    • Key Stakeholder Engagement,
    • Knowledge Management/Knowledge Transfer through data analytics, and
    • Formal Process Management.

    Organizational Gaps:

    Physicians and other providers are often not fully aligned with hospital organizations. Competing interests among physicians, other providers and hospital organizations may exacerbate misalignment. Hospital organizations know they need physician alignment and integration strategies. Many hospital organizations are unclear regarding scope of physician alignment and integration strategies. Some hospital organizations tend to view integration as a model of employment only, when there is a vast array of physician integration models.

    Each hospital organization possesses a unique climate and organizational culture for effective physician integration. Execution of physician integration strategies may lack depth of understanding. Structure and infrastructure needs for effective strategy execution are often underestimated. Governance, Leadership and Management representation among physicians and other providers is necessary, but often ignored. Significant variation in level of engagement exists among key stakeholders in healthcare delivery. High levels of engagement in organizational change are needed among leadership, management, physicians, other providers and staff, as key stakeholders in the delivery of care. Common understanding among key stakeholders is often lacking.

    Traditional healthcare leaders may have a tendency to exert “control” rather than engage physicians and other providers when focusing on organizational initiatives to improve care delivery. In addition, development of multi-disciplinary teams to focus on organizational initiatives may be difficult. Multi-disciplinary teams are especially prone to experiencing team dynamics of forming, storming, norming and performing. Many organizations have a low tolerance for the highly productive storming phase of team development, especially when physicians are involved. Embracing physician input is imperative.

    Many healthcare organizations have not adopted a meaningful and comprehensive process management methodology. There may be tendency to focus process management efforts within the confines of the hospital organization. Process management initiatives must become much broader in scope, must address care delivery across the entire continuum of care, and must focus on enterprise-wide initiatives, including care delivery in physician offices. Application of a formal and reliable process management methodology is often underestimated. Establishing an enterprise-wide process management approach requires vision, and investment of time and money. Physician stakeholders, being scientifically trained, tend to naturally adopt process management principles. The investment in education and training may be substantial. A multitude of models exist and it may be difficult to select and sustain a consistent approach that is embraced by all key stakeholders.

    There exists an ever-increasing emphasis on service, cost and quality outcomes. Government payers are increasing regulatory requirements, but those requirements may not be universally understood. Variation in understanding among key stakeholders may exist. Non-governmental payers may institute additional requirements and variation adds complexity and lack of common understanding. Employer demand for reduced healthcare costs, while providing service oriented and quality services, creates another set of demands on healthcare providers. Suppliers and vendors to the healthcare industry lack a comprehensive view of what is needed to improve service delivery.

    Traditional hospital based healthcare organizations are deeply grounded in meeting the needs of the communities in which they serve. Traditionally, hospital based organizations have long and established histories of serving patients at times when they are most in need of life saving intervention. Consumers and payers of the healthcare industry expect an effort to create healthier communities and to reduce high cost, episodic and acute interventions. Healthcare systems are not always well positioned to meet comprehensive consumer expectations beyond episodes of care. Healthcare systems have traditionally survived and measured success, based on payment models that encourage utilization of high cost, revenue producing services. The path to managing the health status of communities at lower cost requires engagement and alignment of services outside of the acute care setting.

    Key Take-Aways:

    The future of the healthcare industry is uncertain. Care delivery is complex and multi-faceted with organizational gaps impeding the journey to designing and developing healthcare systems to meet ever increasing consumer expectations of value. The healthcare industry will continue to experience constant pressure to modify and change current care delivery systems to meet rising consumer expectations. Navigating the journey to coordinated care delivery across the full continuum of care requires strong vision for the future and a refined leadership philosophy.

    This article provides a simplified approach to defining a compelling organizational vision. The need for a leadership style and organizational culture of performance excellence are outlined. Gaps in traditional organizational approach are also highlighted. The schematic below provides a roadmap for comprehensive improvement.

    Future articles will provide additional detail related to how to lead the performance excellence journey to achieve an organizational vision of the future.

    Next Step: Evaluate the company’s governance, leadership and management structure to identify opportunities for meaningful formal and informal engagement.

    Performance Excellence Roadmap toward Value Based Care

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    Leadership Success in Times of Uncertainty

    These are extremely challenging times in healthcare.

    We know changes are coming, but no one has a clear understanding of what those changes will be. When change happens, people look to their leaders to navigate them through. Are you prepared to be a successful leader in a time of such uncertainty?

    Leadership Keys to Thriving Through Change:

    Keep Consistent

    Organizations should develop five key objectives and stick with them. Resist following the latest fads and avoid adding multiple new objectives. Overwhelming your people with too many objectives creates the “deer in the lights syndrome” and can hinder forward progress. Giving consistency will give your employees a feeling of security and will build both confidence and trust.

    Solidify Trusted Relationships

    Everything you read about America today suggests that the trust level of employees for their leaders and organizations are at an all-time low. It is imperative that you solidify relationships within all your key groups: Superiors, peers, and direct reports.

    While you work to solidify interior relationships, also work to build relationships with experts outside your organization and possibly outside your industry. Connect with others who faced similar uncertainties and learn how they maneuvered through challenging situations

    Be Agile and Adaptable

    Remember, doing the same old things will get the same old results. Changes are coming quickly, and leaders must actively prepare. Some may consider hiring an executive coach to equip them with better leadership tools and enable them to produce better results.

    Supersize the Soft Skills

    According to the Carnegie Institute of Technology, 85% of your financial success is due to your personality and ability to communicate, negotiate and lead. Shockingly only 15% is due to technical knowledge. Communication, integrity, and empathy will pay dividends in the form of loyalty and engagement of your team. Encourage diversity of thought and embrace collaboration. Balance confidence and humility. By utilizing your soft skills, you will create an environment that each member can invest their best into and will cause the whole organization to succeed.

    Change brings opportunity so don’t be afraid to take some risks. Great leaders became great because they could successfully navigate through the challenge of change. Utilizing these keys will allow companies not only to survive but also to seize the extraordinary opportunities that arise during periods of immense uncertainty.


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    2016 Is Closing... Did You Accomplish Last Year’s New Year’s Resolution?

    Whether it’s personal goals or career goals, we’ve all been there – setting aggressive and ambitious resolutions, chasing after it, hitting setbacks, and eventually become unmotivated to continue.

    It is important to set goals, but if you measure success only by achieving your next goal, you probably have not accomplished as much as you would like. Willpower alone is usually not strong enough to overcome setbacks which ultimately result in failure.

    Change of Focus, Change of Heart

    Scott Adams, the creator of the immensely successful Dilbert Cartoons, reiterates a Wiederhold & Associates approach to finding success. He states, “When you approach life as a sequence of milestones to be achieved, you exist in a state of near-continuous failure. A system, by contrast, is something you do on a regular basis that increases your odds of success in the long run, regardless of the immediate outcome. People succeed every time they apply their systems, in the sense that they did what they intended to do.”

    A simple shift in focus from goals to systems will ultimately help you find the success you have been longing to realize. The sense of accomplishment that comes from working the system each day creates a momentum that will carry you to the next goal. You may find yourself achieving goals faster than ever before with a new found personal invigoration.

    As you plan your New Year’s Resolution, set your sights on implementing new systems for success instead of a milestone to be achieved. If you would like to discuss what systems could propel you the furthest fastest, give me a call. Together, we can map out a plan to that will put you in prime position to achieve your 2017 personal and career goals.

    Here's to your success,


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    Where's me money?!?

    What your boss, Mr. Krabs from SpongeBob Squarepants, and Rod Tidwell from Jerry Maguire have in common and why you should care.

    “Where’s me money?!” as Mr. Krabs would say. That is exactly what your boss is thinking but won’t ask given today’s decorum. As we learned in graduate school at the University of Minnesota, “it’s not about the money… it’s about the money”. Yet no one wants to talk about money- it’s uncomfortable. Try and ask people about their bank account, salary, or taxes and you will get some awkward reactions. Likewise your boss and the company you work for don’t want to look bad by overemphasizing finances. Don’t let this fool you as your company lives or dies by its profitable growth. That means your boss is counting on you to drive profits and make more money.

    A system CEO once told me, “You know it’s very hard to get fired when you’re making budget.” I got it - message delivered. How can you deliver? First, cover your own costs. You better produce enough revenue to cover your salary or else you are vulnerable. Next, if you manage a budget you want to grow revenue at a rate faster than expense growth (positive spread ratio).

    Finally, make sure you communicate to your boss the actions you will take to drive profitability. This builds trust as your actions turn into results. Remember- the bottom line is the bottom line. Pay attention to it and it will pay dividends for your career.

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    7 Steps to Effective Crisis Management

    If you have worked in healthcare for more than a few years, you have probably seen at least one crisis develop in your facility. Although every incident can become a crisis, there are some that happen that can have lasting effects for the facility and everyone it touches. Crises can be from a natural disaster, human error, regulatory non-compliance, to equipment failure. All have the consequences of affecting human lives to negatively impacting the institution both financially and its reputation. What is common to all of these situations are how you and your team react to them. I have found common steps to ensure that you can react quickly, efficiently, and minimize the negative effects.

    • Policies and Procedures – All too often, leadership recognizes that a crisis can happen, but few believe it can happen to them. Because of this denial, many leaders may read the administrative policies and procedures when they first come on board, and never review or update them at least annually. It is extremely important to know your crisis plans and review them annually. The time to become familiar with you plan is not in the middle of a crisis.
    • Drill, drill, drill – The old saying, practice makes perfect is critical in the middle of a crisis. Practicing not only a disaster drill such as a fire or bomb threat, but also when JCAHO or the State comes in for an unannounced visit will go a long way to putting calm in the chaos. When everyone knows their role in the plan, everything goes much smoother. In addition, outsiders, such as inspectors or even the public, will gain a sense of calm and confidence in your team if everyone reacts according to the plan.
    • Be the leader – If you are the one responsible for leading the institution, everyone will be looking to you for clues on how to react. If you seem rattled or unsure, your staff will also be rattled and unsure. If you present confidence and surety, the actions of your team will also demonstrate the same. If you are familiar with the plan and follow it, the crisis will play out more favorably than if you are unsure of your and your team’s role.
    • Trust your team – They are there for a reason and should be experts in their roles. If you have practiced drills and ensured competence during a time of crisis, your team needs the space to do their job. Let them. It will go a long way to resolving the issue and building trust for the future.
    • Communicate openly and honestly – There is a time and place to communicate what is going on in the facility, but when you do, and I recommend the leader of the facility being the spokesperson, being as open and transparent as possible can help stop rumors and defuse a potential media frenzy. The same message must be transmitted through all channels whether that is media, memos, or social media. Different messages will create confusion and distrust.
    • Update often – If the crisis is one day, one week, or ongoing, keep everyone updated. A lack of communication will be filled with rumor and innuendo.
    • Finally, debrief – When the crisis has passed, perform a thorough analysis of what happened and institute corrective measures.

    You will experience a crisis in your institution. How you prepare and act during the crisis will define you as much as your success or failures as a leader.

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    The Secret Source of Great Leadership

    When I picture a great leader, I picture someone who never lets their temper get out of control, no matter what problems they are facing. I think of someone who has the complete trust of their staff, listens to their team, is easy to talk to, and always makes carefully informed decisions.

    What I have described is an emotionally intelligent leader.

    Emotional intelligence is the ability to be keenly aware of your own emotions, and the emotions of those around you. These individuals are aware of the root cause of their emotions and how their emotions affect those around them.

    According to Daniel Goleman, an American psychologist who helped to popularize Emotional Intelligence (EI),
    there are five main elements of emotional intelligence:

    Self-awareness --- Self-regulation --- Motivation
    Empathy --- Social skills

    The more that you, as a leader, manage each of these areas, the higher your emotional intelligence.

    To be effective, leaders must have a solid understanding of how their emotions and actions affect the people around them. The better a leader relates to and works with others, the more successful he or she will be. The good news is, Emotional intelligence can intentionally be developed.

    We are facing a critical era of transformation in healthcare and success is entirely dependent upon strong leadership. As you rise through the leadership ranks you must master Emotional Intelligence as a key component if you hope to become a great leader.

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    Physician Alignment and the Triple Aim

    I was recently attending a hospital association breakout session listening to two reputable healthcare systems present how they aligned their respective medical staffs to achieve quality outcomes. They demonstrated how they achieved reduced unnecessary admissions, reduced lengths of stay and the reduction of clinical testing and procedures. They specifically portrayed how they worked with their medical staffs to strive for best practice outcomes. Clearly the outcomes were impressive, but they neglected a key component of the Triple Aim: Reducing the per capita cost of healthcare.

    Never once did they present actual cost reductions that their efforts rendered. When I posed the question about cost savings, the response I received from the two presenters was like it was the proverbial elephant in the room. They told me that they didn’t discuss cost to align their physicians “unless it was absolutely necessary”. They implied that they avoid it at all costs.

    I disagree. My experience is that the cost of healthcare, or namely the waste in healthcare, needs to be shared with this key group of decision makers – our medical staff. Estimates of the money wasted on overuse each year range from around $200 billion to over $800 billion – between 10 percent and 30 percent of US health care spending. In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year. The report found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. Bigger than any of those, however, was the amount spent on tests that are overused, unnecessary or potentially harmful to patients.

    Although it’s the “right thing to do”, I guess I can understand the presenters’ obvious trepidation to relate the cost savings to their physician partners. Sometimes it can be potentially career ending. For instance, I had a pulmonologist on staff that was a nightmare for our Case Management department. By himself, he accounted for 29% of all Medicare admissions and had a variance of the geometric mean length of stay for his patients of 2.5 days. His estimated uncompensated cost to the hospital was $1,818,300. Furthermore, we haven’t even touched on the cost of bad outcomes and malpractice cases, but I also had another surgeon on staff that was on the “watch list” for our Medical Malpractice carrier.

    Sadly, both of these physicians were on the hospital’s Board of Directors and I paid the ultimate price for “doing the right thing”. They continue their ways unaddressed and I moved on.

    Working with physician partners isn’t always negative, though. In the same institution the price being paid for physician preference items by my stand-alone hospital I had just become the CEO at was shockingly high. When I insisted that this egregious price difference for such things as cardiac stents and orthopedic implants be shared with the respective interventional cardiologists and orthopedic surgeons, the alignment towards the hospital point of view was overwhelming. Despite the fact that these physicians had close ties and relationships to the individual companies and/or the representatives, since they were astounded at the price difference they worked with the hospital to leverage an $8M annual savings for the same implants! It was the “right thing to do”.

    My message is that reducing the cost of healthcare goes hand-in-glove with the other two prongs of the Triple Aim: improving the patient experience and improving the health of populations. You can be selective in how you share the cost information, but it must be shared with all decision makers in order to achieve the ultimate value.

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    A Tribute to the American Worker

    Labor Day means more than great BBQ and spending time with friends and family. For me, it is a celebration of American leadership, strength, and ingenuity.

    In the days following World War II, when the economic strength and power of America was all that stood between the world and the return to the dark ages, Pope Pius XII said, "The American people have a great genius for splendid and unselfish actions. Into the hands of America God has placed the destinies of an afflicted mankind."

    Wiederhold & Associates joins in the national tribute to the American workers who have made contributions and achievements to the strength, prosperity, and well-being of our country and the world. Happy Labor Day!

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