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2016 Top 25 Minority Executives in Healthcare--Bruce Siegel: Diverse leadership is a must on the road to equity of care

By | December 14 th,  2016 | America's Essential Hospitals, Center for Health Care Quality, Equity, population health, Top 25 Minority Executives in Healthcare, C-suite, healthcare disparities, Modern Healthcare, president, risk adjustment, safety net, Blog, boards, CEO, diversity, Johns Hopkins, academic medical centers | Add A Comment

 

Classic content: One in a series of interviews with Modern Healthcare's Top 25 Minority Executives in Healthcare for 2016.

 

Thirty years ago, Bruce Siegel had what he calls “a rude awakening,” running headlong into the perplexing spider web of health disparities as a young MD. It’s been something that he’s spent his entire career trying to solve, albeit not with a stethoscope.

 

“I went off to medical school and started my internship, and I was stunned by what I encountered,” says Siegel, now president and CEO of America’s Essential Hospitals. “I worked in the clinic at our hospital, and it was just a tidal wave of diabetes, heart disease and lung cancer. Most of it was preventable. And the other thing I noticed was that it was mostly affecting communities of color.”

 

It was a frustrating experience, one that led Siegel to pursue a master’s in public health at Johns Hopkins University and try to find public-policy solutions to the nagging issues he saw as a physician. “I felt like I was running an assembly line that never ended. I’d see 200 people with these problems. I’d send them back out and they’d be back a month later.”

 

The New Jersey Department of Health helped pay for Siegel’s education at Hopkins, so he owed them some time when he graduated. He did so well that he eventually became a very young state commissioner of health, then parlayed that experience into running New York City’s health system and a Tampa, Fla., hospital. His early years in leadership after being a clinician were rocky, he admits.

 

“It was a crucible in many ways,” he says. “Sometimes, it was very uncomfortable and I was probably in over my head at points. But it’s where I began to learn that leadership is about giving people space. I really think a leader’s job is to create a safe space for talented people and tools to help them move forward. If I’m giving orders, then I’m failing.”

 

Siegel joined America’s Essential Hospitals in 2010 after eight years as a professor and the director of the Center for Health Care Quality at George Washington University. But at each step of the way, his thoughts went back to those diverse patients in the clinic who found little hope in healthcare. “I had so many patients of color for whom the system simply wasn’t working, but I didn’t understand why.”

 

In recent years, Siegel has begun to see a change as he leads the nation’s essential hospitals, his association’s term for public and other non-profit hospitals with a safety-net role. The association’s members often are a driving force, he says.

 

“It’s great to be in the company of change agents,” he says. “Our members have leaders who care about these problems and are working to fix them. Equity is now front and center in the American agenda. We’re not there yet, but at least today we have the tools.”

 

At times, it’s still a tough slog, he notes. One of the must-haves on the road to equity is diverse leadership, and the effort to improve that is stalled. Medical schools are failing to enroll minority communities, and boards have been far too quiet on the lack of diversity, Siegel says.

 

“I don’t think our boards of directors are demanding this,” he says. “They need to be unequivocal that this is an expectation, not just a nice thing to do. But I don’t think our hospitals are going to look diverse in the C-suite if our boards don’t.”

 

Lack of diversity, Siegel says, is short-sighted because it is harmful to patients and harmful to an organization’s bottom line.

 

“The slow walk on diversity is just bad business,” he says. “We’re not going to succeed if our leaders don’t fully understand the lives of our community and their priorities.”

 

America’s Essential Hospitals is working with the Robert Wood Johnson Foundation on a population health project, and Siegel sees a disconnect between some healthcare executives and the communities they try to serve. “I’ve been in communities where, if you ask the CEO, he or she will talk about chronic disease management as their main concern on population health. But if you ask the people, they’ll say their most pressing need is a safe street for them to walk on, and safe playgrounds for their children. We’re not going to get to population health without addressing what people think of as health.”

 

In the same way, he adds, population health can’t be attained if you weaken the academic medical centers which comprise much of the association’s membership. The AMCs, with their three-legged stool of clinical care, education and research, sometimes feel the ACA is applied like a wildly swung ax, Siegel says.

 

“These are places in America that do what no one else does,” he says. “They attract the sickest people who have the greatest social and economic challenges. Home may be a homeless shelter. English may not be their first language. These patients may have a harder time navigating the healthcare system, and they may be readmitted through no fault of the hospital.”

 

Siegel’s association is pushing Congress for a risk adjustment for these hospitals, which, he notes, had an aggregate operating margin slightly in the red for 2014. Compare that to, say, the pharma industry, which banks about 20 percent profits each year.

 

“To me, the future of healthcare is that hospitals will be at risk for dollars they get. I accept that,” Siegel says. “We’ll do everything we can to make that better, but we also need the regulators and the payers to do their part.”

 

The challenges of America’s Essential Hospitals’ members are personal to Siegel. He and his sister were both born in a public hospital. Their mom emigrated to the U.S. from Haiti. “My family very much depended on a safety net when they came to America. So these issues are near and dear to me and my loved ones.”

 

 

Bruce Siegel: Hospitals need to listen to their communities to tackle health disparities

By | July 18 th,  2016 | America's Essential Hospitals, Center for Health Care Quality, Equity, population health, Top 25 Minority Executives in Healthcare, C-suite, healthcare disparities, Modern Healthcare, president, risk adjustment, safety net, Blog, boards, CEO, diversity, Johns Hopkins, academic medical centers | Add A Comment

 

One in a series of interviews with Modern Healthcare's Top 25 Minority Executives in Healthcare for 2016.

 

Thirty years ago, Bruce Siegel had what he calls “a rude awakening,” running headlong into the perplexing spider web of health disparities as a young MD. It’s been something that he’s spent his entire career trying to solve, albeit not with a stethoscope.

 

“I went off to medical school and started my internship, and I was stunned by what I encountered,” says Siegel, now president and CEO of America’s Essential Hospitals. “I worked in the clinic at our hospital, and it was just a tidal wave of diabetes, heart disease and lung cancer. Most of it was preventable. And the other thing I noticed was that it was mostly affecting communities of color.”

 

It was a frustrating experience, one that led Siegel to pursue a master’s in public health at Johns Hopkins University and try to find public-policy solutions to the nagging issues he saw as a physician. “I felt like I was running an assembly line that never ended. I’d see 200 people with these problems. I’d send them back out and they’d be back a month later.”

 

The New Jersey Department of Health helped pay for Siegel’s education at Hopkins, so he owed them some time when he graduated. He did so well that he eventually became a very young state commissioner of health, then parlayed that experience into running New York City’s health system and a Tampa, Fla., hospital. His early years in leadership after being a clinician were rocky, he admits.

 

“It was a crucible in many ways,” he says. “Sometimes, it was very uncomfortable and I was probably in over my head at points. But it’s where I began to learn that leadership is about giving people space. I really think a leader’s job is to create a safe space for talented people and tools to help them move forward. If I’m giving orders, then I’m failing.”

 

Siegel joined America’s Essential Hospitals in 2010 after eight years as a professor and the director of the Center for Health Care Quality at George Washington University. But at each step of the way, his thoughts went back to those diverse patients in the clinic who found little hope in healthcare. “I had so many patients of color for whom the system simply wasn’t working, but I didn’t understand why.”

 

In recent years, Siegel has begun to see a change as he leads the nation’s essential hospitals, his association’s term for public and other non-profit hospitals with a safety-net role. The association’s members often are a driving force, he says.

 

“It’s great to be in the company of change agents,” he says. “Our members have leaders who care about these problems and are working to fix them. Equity is now front and center in the American agenda. We’re not there yet, but at least today we have the tools.”

 

At times, it’s still a tough slog, he notes. One of the must-haves on the road to equity is diverse leadership, and the effort to improve that is stalled. Medical schools are failing to enroll minority communities, and boards have been far too quiet on the lack of diversity, Siegel says.

 

“I don’t think our boards of directors are demanding this,” he says. “They need to be unequivocal that this is an expectation, not just a nice thing to do. But I don’t think our hospitals are going to look diverse in the C-suite if our boards don’t.”

 

Lack of diversity, Siegel says, is short-sighted because it is harmful to patients and harmful to an organization’s bottom line.

 

“The slow walk on diversity is just bad business,” he says. “We’re not going to succeed if our leaders don’t fully understand the lives of our community and their priorities.”

 

America’s Essential Hospitals is working with the Robert Wood Johnson Foundation on a population health project, and Siegel sees a disconnect between some healthcare executives and the communities they try to serve. “I’ve been in communities where, if you ask the CEO, he or she will talk about chronic disease management as their main concern on population health. But if you ask the people, they’ll say their most pressing need is a safe street for them to walk on, and safe playgrounds for their children. We’re not going to get to population health without addressing what people think of as health.”

 

In the same way, he adds, population health can’t be attained if you weaken the academic medical centers which comprise much of the association’s membership. The AMCs, with their three-legged stool of clinical care, education and research, sometimes feel the ACA is applied like a wildly swung ax, Siegel says.

 

“These are places in America that do what no one else does,” he says. “They attract the sickest people who have the greatest social and economic challenges. Home may be a homeless shelter. English may not be their first language. These patients may have a harder time navigating the healthcare system, and they may be readmitted through no fault of the hospital.”

 

Siegel’s association is pushing Congress for a risk adjustment for these hospitals, which, he notes, had an aggregate operating margin slightly in the red for 2014. Compare that to, say, the pharma industry, which banks about 20 percent profits each year.

 

“To me, the future of healthcare is that hospitals will be at risk for dollars they get. I accept that,” Siegel says. “We’ll do everything we can to make that better, but we also need the regulators and the payers to do their part.”

 

The challenges of America’s Essential Hospitals’ members are personal to Siegel. He and his sister were both born in a public hospital. Their mom emigrated to the U.S. from Haiti. “My family very much depended on a safety net when they came to America. So these issues are near and dear to me and my loved ones.”

 

 

From Brigham and Women’s to the NFL, Elizabeth Nabel looks to make an impact

By | August 26 th,  2015 | risk, cardiologist, heart disease, Modern Healthcare, NFL, NHLBI, president, Red Dress Heart Truth, Blog, intellectual humility, value-based care, women, academic medical centers, Brigham and Women's Health Care, Elizabeth Nabel, Top 25 Women in Healthcare | Add A Comment

 

Elizabeth-Nabel-Headshot

 

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

 

Elizabeth Nabel already was one of the nation’s premier cardiologists and researchers before she began leading the respected Brigham and Women’s Health Care system in Boston as president in 2010.

 

Yet even with such an impeccable pedigree, she has never been shy about taking risks. She took on a very visible role earlier this year as the first-ever chief health and medical advisor to the NFL. And when she was director of the government’s National Heart, Lung and Blood Institute, she worked with commercial industries – even Diet Coke – to spread the message that women were just as susceptible to heart issues as men.

 

“For me, these positions aren’t about visibility, but about the impact I can make,” Nabel says. “I feel it’s important to be a positive deviant, to have the courage to take risks and stand up for what you believe in, and not be afraid to be different or unpopular to get something done.”

 

While the NFL recently has had its share of controversy, she sees her role as an opportunity to make sports safer for people far beyond the professional level.

 

“The NFL has the opportunity to innovate in a way that will impact the health and safety of all athletes of all kinds, at all levels. I see this partnership as a great way to apply the knowledge acquired through the efforts of the NFL to the greater population of professional, amateur and recreational athletes.”

 

Before taking on her current position at Brigham and Women’s, Nabel served as director of the NHLBI from 2005 to 2009. It was there that she sought to drive change by launching the Red Dress Heart Truth campaign that still is going strong today.

 

The Red Dress, she says, “is a symbol of women and heart disease. Our goal was to raise awareness about heart disease in women to encourage them to take action and improve their heart health.”

 

Nabel lined up 150 partners, including 50 companies, to spread awareness. That included Diet Coke, which stamped the campaign on its cans and delivered a visibility that the government agency couldn’t have touched on its own.

 

“The strategy wasn’t without risk, and it earned me some harsh public criticism from detractors who felt it wasn’t the place of government to ally so closely with industry,” she says. “But I firmly believed it was the right thing to do, and looking back I consider these partnerships instrumental to The Heart Truth’s tremendous success.”

 

Due in part to the campaign, Nabel says heart disease awareness among women has risen to nearly 70 percent, compared to 34 percent just a decade ago.

 

As a cardiologist, Nabel’s concern for women’s heart health is natural, yet there is a deep-seated connection to an incident early in her career.

 

“One night, a 32-year-old woman arrived in the emergency room where I worked,” she says. “She described vague symptoms: aches, fatigue, a low-grade fever – nothing terribly specific. I ran some tests, didn’t find anything telling, and sent her home with Tylenol. Two days later she came back with a full-blown heart attack.”

 

Nabel was stunned – it contradicted her medical education that males were typically the only gender with heart issues.

 

“I had been trained by the best,” she continues, “and the best had taught me what the best had taught them: Heart disease was a man’s disease, and the primary symptom of heart attacks was chest pain, which my patient did not have. Thank goodness, that woman survived. The experience stayed with me, and I recognized the need to raise awareness about women’s heart health.”

 

If you called that incident a humbling experience, Nabel might agree – she sees no need for egos where patient care is concerned. In fact, she delivered a fascinating TED talk on the need for intellectual humility. From her vantage point at Brigham and Women’s, she stresses the need for those who work in healthcare to admit what they don’t yet know.

 

“An essential part of our mission at BWHC is to educate the next generation of healthcare providers,” she says. “Based on my experiences as a physician and researcher, I believe it’s vital for future healthcare providers to understand the importance of challenging the known and putting our ‘knowledge’ to the test.”

 

Admitting what you don’t know, she says, can actually be the starting point for breakthroughs.

 

“An oft-shunned word—ignorance—carries great importance when we consider it as the driver of scientific inquiry, and thus, the molder of new knowledge. Yet when myths—such as heart disease as a man’s disease—are widely believed to be facts, ignorance can kill. If we can help the next generation of care providers embrace the idea of humility, it will open the door for a wider range of new discoveries that will ultimately save lives.”

 

With value-based care becoming the holy grail in healthcare, discovery and innovation are sorely needed, Nabel says. Yet the pressures on academic medical centers are multiplying, from readmission penalties to cuts in NIH funding.

 

“In the context of healthcare’s new economic reality, innovation is more important than ever,” she says. “The answers to so many of the challenges we face in healthcare are so close – it is incumbent upon us to provide an environment where solutions can be cultivated and future innovations can flourish.”

 

Nabel hopes the game-changers that are within reach don’t get derailed by outside forces.
“We must help the policymakers and the public understand that investments in biomedical research drive improvements in patient care, which could ultimately reduce cost.”

 

 

Quality, safety at crux of healthcare delivery for UHC's Irene Thompson

By | July 1 st,  2013 | Healthcare, Modern Healthcare, patient safety, AHRQ, Blog, CEO, Hospital Engagement Network, Irene Thompson, leadership, UHC, academic medical centers, quality, Top 25 Women in Healthcare, University HealthSystem Consortium | Add A Comment

 

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

 

The University HealthSystem Consortium has a lot of ground to cover as a leading representative of academic medical centers, but it’s chosen to delve deep into matters of quality and safety under the direction of President and CEO Irene Thompson, who has been chosen as one of the Top 25 Women in Healthcare by Modern Healthcare.

 

“If you’re looking to improve a hospital,” she says, “needless to say, you need to get into the way healthcare is delivered.”

 

UHC’s Patient Safety Net, for example, is a real-time, Web-based reporting system that has long been a part of its offerings to its members. In 2012, however, UHC entered into a collaboration with Datix, a U.K.-based developer of patient safety technology solutions, to create “a broader suite of patient safety tools,” Thompson says.

 

West Virginia University Healthcare was the first member to begin using the new software, and Johns Hopkins followed suit. UHC is ready to roll out the product on a wider level to members of its alliance, and demand is great, Thompson says.

 

“The members who have been on our older platform have been very eager to transition onto this new one,” she adds. “They’re very excited.”

 

In fact, UHC’s Performance Improvement patient safety organization was among the first PSOs recognized by the Agency for Healthcare Research and Quality (AHRQ).

 

“This is a natural outgrowth of what UHC is all about, which is performance improvement for the academic medical center,” Thompson says.

 

UHC also was named as a Hospital Engagement Network in an initiative by the Department of Health and Human Services Center for Medicare and Medicaid Innovation. As part of HHS’ Partnership for Patients program, UHC has been working since late 2011 to increase safety and quality by taking aim at two benchmarks:

 

**To reduce hospital acquired infections by 40 percent by the end of 2013, and

 

**To reduce preventable hospital readmissions by 20 percent by the end of 2013.

 

“It’s going extremely well,” Thompson says of the work. “We’re seeing great results in terms of


change among our members so we’re very pleased to be part of it, and very excited. I think CMS is pleased, too about the results that we’re achieving. We have about 80 hospitals participating and many of our institutions have exceeded the end goal already.”

 

Thompson had been president and CEO of the University of Kansas Hospital Authority for 10 years before joining UHC in 2007. It was those experiences in the hospital setting, she says, that made her an advocate for safety.

 

“I saw firsthand how patients and families suffered loss—loss of independence, loss of function, loss of life,” she remembers. “As frightened and vulnerable patients entered our level I trauma center, I saw the trust they placed in our hospital to treat injuries from an automobile accident, a fire, or a violent act. Witnessing the profound impact that our focus on quality and safety had on patients and their loved ones made me determined to spearhead initiatives to provide the highest quality of care possible.”

 

When she moved from serving on UHC’s board to leading the organization, Thompson saw the potential that the alliance of non-profit academic medical centers could have.

 

“UHC has a proud tradition of providing outstanding membership value and leadership for academic medical centers. Yet unprecedented change in the health care industry required us to think more boldly about how to position the organization to best serve members’ needs in the future,” she says.

 

Yet, personally, the shift in culture between the two jobs was enormous. At Kansas, her schedule was packed, and doled out in 15-minute increments. “It was a very dynamic and complex job, and I loved doing it,” she says. “You never know what you’re going to be addressing in a day – it could be anything from a broken elevator to a fire in the operating room.”

 

As UHC’s very visible leader, Thompson spends a lot of time on the road, interacting with and visiting the CEOs of UHC’s member institutions. “It’s certainly an experience that’s unique in this field,” she says. “There aren’t that many national posts where you get the opportunity to work with so many outstanding people. And the fact that I had been one of their peers makes it much easier for them and for me because I understand what they’re dealing with.”

 

In Chicago, Thompson has worked hard to get others who are in a position to make a difference involved in the American Heart Association. She has met with healthcare leaders in the Chicago area to encourage their support of the Chicago Heart Ball, a major source of funding for research and programs. She also hosts benefit events in her home and is one of the charter members of the Go Red for Women program, which focuses on raising women’s awareness of the unique warning signs of heart disease in women.

 

Thompson also has paid attention to the well-being of her own team as well. For the 10th year in a row, UHC was named to the Honor Roll for the Center for Companies That Care. No other company has been so honored.

 

The center cited the community involvement of UHC employees as one reason for the honor – more than 90 percent engage in monthly service programs. Flexible and work-from-home scheduling also were mentioned as traits that UHC excelled in.

 

“UHC is very engaged in what the new workforce wants,” Thompson explained. “We have many opportunities for them to participate in community involvement, and our new offices are designed to encourage openness and create energy.”

 

But the hard work remains as Thompson says UHC has evolved from a quiet little association to a powerful industry alliance. She says healthcare reform remains a moving target.

 

“There is action in terms of people recognizing they need to deliver care in a more efficient way,” she says. “But when you look, for instance, at the insurers, there are very few contracts that would reflect accountable care or population health – their systems don’t allow them to account for it. So there is a lot of talk but, truthfully, not much action.”

 

And, under reform, Thompson says academic medical centers may have higher hurdles to clear than other providers.

 

“Among AMCs, the research and the academic side have relied upon the hospitals over the years to support some of their activities that are either not funded or insufficiently funded by other sources. As the revenue is reduced at academic medical centers, they seem to be taking a bigger hit in certain areas than other hospitals. It puts at risk the whole tripartite mission of the academic medical center.”

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