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Insights from the Top 25 Women in Healthcare

By | August 28 th,  2015 | executive, Modern Healthcare, Blog, CEO, diversity, healthcare reform, leadership, gender, Top 25 Women in Healthcare | Add A Comment

 

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

 

Over the past few months, we've brought you reflections on leadership and their careers from Modern Healthcaree's Top 25 Women in Healthcare, a program we have been proud to sponsor for the past seven years. We still have a few to offer you in the months to come. In the meantime, it seemed like an appropriate time to give you an overview of what these successful executives have had to say. Please click on any of the snippets or photos below to read the full interview.

 

 



 

Elizabeth Nabel: 2015 Top 25 Women in Healthcare

Elizabeth Nabel strives to make an impact in healthcare

 

 

 

 

 

 

 



 

Deborah Bowen: 2015 Top 25 Women in Healthcare

Deborah Bowen: Leadership still about people trying to make a difference

 

 

 

 

 

 

 



 

Marna Borgstrom: 2015 Top 25 Women in Healthcare

Marna Borgstrom: A new era calls for a new kind of leadership

 

 

 

 

 

 

 



 

Leah Binder: 2015 Top 25 Women in Healthcare

Leah Binder and Leapfrog Group put pressure on healthcare providers to deliver on quality

 

 

 

 

 

 

 



 

Penny Wheeler: 2015 Top 25 Women in Healthcare

Penny Wheeler: Even in value-based care, leaders of varying backgrounds can thrive

 

 

 

 

 

 

 



 

Mary Brainerd: 2015 Top 25 Women in

Healthcare

At HealthPartners, Mary Brainerd's leadership approaches solutions from a nuanced angle

 

 

 

 

 

 

 



 

Donna Lynne: 2015 Top 25 Women in Healthcare

Donna Lynne: Healthcare leaders need to be able to manage crisis, volatility

 

 

 

 

 

 

 



 

Tejal Gandhi: 2015 Top 25 Women in Healthcare

Tejal Gandhi: Push for quality, safety needs to come from boards

 

 

 

 

 

 

 



 

Sister Carol Keehan: 2015 Top 25 Women in

Healthcare

Sister Carol Keehan: Gender diversity is a must-have for healthcare leadership -- and so is

solidarity with the poor

 

 

 

 

 

 

 



 

Pam Cipriano: 2015 Top 25 Women in Healthcare

Pam Cipriano: In value-based care, nurses are ready to lead

 

 

 

 

 

 

 



 

Nancy Schlichting: 2015 Top 25 Women in

Healthcare

Nancy Schlichting's willingness to take risks is still paying off for Henry Ford Health

System

 

 

 

 

 

Marna Borgstrom: A new era calls for a new kind of leadership

By | August 14 th,  2015 | Healthcare, Marna Borgstrom, Modern Healthcare, president, Blog, CEO, health disparities, healthcare reform, leadership, Yale-New Haven Health System, Top 25 Women in Healthcare | Add A Comment

 

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

 

For healthcare leaders today, it is clear that the big challenge, and the big opportunity, is to invest in the evolution of what has been a cottage industry into a true system of care. One in which efficient, integrated healthcare services are aligned with the ways in which care is paid for; where both provider and patient accountability matter.

 

While Marna Borgstrom, CEO of Yale New Haven Health System, believes we are moving in this direction, she notes that few systems, if any, are “there” yet. Many providers are not organized to take risk for populations of patients. Many payers can’t accurately and effectively take and manage capitated payment or significant risk arrangements. And the state and federal governments aren’t aligned on what or how they pay for care.

 

As Yale New Haven Health System is on its journey to provide unparalleled value to those it serves, Borgstrom stresses that at the same time health systems must continue to provide life-saving care and invest in the research and technical advances that have turned many terminal diseases into manageable chronic conditions. Borgstrom says, “We don’t want to lose that which has made us great in our quest for a more sustainable, comprehensive system of care.”

 

This need to thrive in both worlds – improving the health of the population while also healing the sick – demands effective, committed and innovative leadership in healthcare that can navigate these changing dynamics. This is a topic Borgstrom has been returning to often lately as she works with her own leadership team and her board and begins to build a template for the type of leadership that Yale New Haven will need in the years to come.

 

To that end, she has begun collecting her thoughts to share with the organization on developing executives who can guide a large, complex enterprise like Yale-New Haven. Some qualities, she says, are must-have standards that make sense in any business climate:

 

General leadership abilities. “You have to be able to get people to follow your vision and prepare for the future before change is upon us, while weighing the risks. You also have to be able to hold people accountable – sometimes we tolerate cultures of optionality that haven’t delivered well.”

 

A mastery of complexity. “Be able to juggle a lot of things as you evaluate decisions. Have an understanding that it’s not going to be linear and ambiguity rules.”

 

Able to balance “what” vs. “how”. “You can’t just say, ‘We’re getting this done at all costs.’ You can’t leave bodies in your wake; you can’t sacrifice the culture of an organization to achieve a single goal. You have to play for the long term but perform well and consistently in the interim. It’s not easy.”

 

A knack for partnership. “It’s all about partnership today . . . partnerships within your organization and with other businesses. To be a good partner, a leader needs individual qualities like integrity; like being a thoughtful listener. And you’ve got to enjoy working with others.”

 

Solid professional skills. “You need good strategic positioning skills and, in our case, a passion for academically based healthcare. You also need a depth of knowledge of healthcare as a mission and a business, and the public policy that goes with it.”

 

But then there are other intrinsic, less-obvious traits that she says are becoming just as essential given the landscape of the healthcare industry.

 

Among them, Borgstrom says, are:

 

Building cohesion. “You have to be able to bring out the best in other people because this is increasingly a team sport. It’s not just bringing people together; it is making them feel good about contributing toward specific goals together.”

 

Being open to dialogue. “I think you have you have to be receptive and responsive to feedback. You have to be able to put yourself in the other person’s shoes.”

 

Getting comfortable with ambiguity and imperfect processes. “I’m pretty good at taking the hill, but the issue of ambiguity is you’re not really sure whether that’s the hill on your left or your right. You may have to start out on the journey and have a few less than optimal experiences to inform your thinking about what is the best hill to take.”

 

Making diversity a map for improving care. “We’ve got to be committed to the principles of diversity and inclusion, not just in developing leadership teams but in eliminating healthcare disparities, being mindful that it isn’t just about running a financially successful business model if we can’t improve our communities too.”

 

With all of these qualities, Borgstrom says, the days of “command and control” leadership have disappeared. That even applies to how health systems operate, she adds.

 

“The future is going to require that we pursue partnerships rather than try to control everything in healthcare. We don’t have the competencies, the experience or the balance sheet to put together the ideal integrated delivery system. I think well-conceived and well-structured partnerships are going to end up being integral to an integrated healthcare system where the focus has to be on providing the best value to patients.”

 

 

Innovation keeps George Brown, Legacy ahead of the curve

By | October 20 th,  2014 | Furst Group, Top 25 Minority Executives in Healthcare, executive, Modern Healthcare, Blog, CEO, diversity, George Brown, healthcare reform, leadership, Legacy Health, physician executive, safety, Walter Reed, physician leadership, quality | 1 Comments

 

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

 

George Brown, the CEO of Legacy Health System in Portland, Ore., has had a long and distinguished career as a physician and leader, but his talents in innovation help him keep his organization on the industry’s leading edge.

 

From collaboration and affordable care to medical homes and information technology, Brown and his team have been unafraid to adapt and take risks, providing an example to the northwest region and the country at large.
Legacy joined with a number of organizations to form an integrated delivery system, Health Share of Oregon. It’s partnering on the OHSU Knight-Legacy HealthCancer Collaborative. In an era bursting with mergers and acquisitions, the path Brown has charted is intriguing.

 

“I have accepted the need to change from a completely competitive mindset to a collaborative mindset,” he says. “Competition doesn’t help the economics of healthcare – it divides communities.”

 

The Affordable Care Act has prompted soul-searching on the part of many executives, and Brown applauds the arrival of reform.

 

“I believe healthcare is too large of an issue for this country not to have a thoughtful and near-universal solution,” he says. “The Affordable Care Act is a step in the right direction.”

 

Although Brown has a sterling history in healthcare, it’s clear he doesn’t waste time looking back. He is especially proud to be on the board of Cover Oregon, despite some of the hits that the exchange took in the media for its early problems.

 

“We’ve enrolled 400,000 people,” he says. “We are moving in the direction to have affordable healthcare for all Oregonians.”

 

The ACA, he says, mirrors some of the measures Legacy has already been working on for some time, foremost of which is quality.

 

“The number one project we have been working on is how to make our organization more efficient,” he says, “and what we’re driving efficiency to mean is quality. We believe if you do things right, you don’t have to do them all over again, and that means it’s also less expensive.”

 


Brown also has led Legacy as an early adopter of the patient-centered medical home, an area in which some other health systems are just getting started.

 

“It’s important for me to say that all of our primary care clinics are Tier 3 certified patient-centered medical homes, and they’re doing very well,” he says. “Patient satisfaction scores are going up and we think we’re making an impact. In fact, we were recently recognized by the Oregon Health Leadership Council as being one of the top performers, so we’re quite proud of that.”

 

It’s also been a learning experience, Brown says candidly. He says Legacy has three main takeaways from the experience thus far:

 

--Specialization is needed. “If you have a population that’s heavy with patients who have congestive heart failure, diabetes, hypertension and obesity, a lot of contact is required with patients.”

 

--The influx of Medicaid patients changes preconceived notions for providers and patients alike. “There are a significant number of people who have not had access to healthcare services. We are evaluating those people and their needs. Some of these people have never seen us before, so that’s going to be an area of revelation for us.”

 

--Mental health is a gaping need in the community. “We’re realizing that behavioral health, mental health and addiction issues are a lot more prevalent in the population than I think we realized, so we’re looking at how best to provide access to those services for our patients who are in medical homes.”

 

Legacy also earned kudos via a Stage 7 award from HIMSS last year. Brown has long been a proponent of how technology can improve care.

 

“I think the lesson we’ve learned – and we have to remind ourselves so we don’t get to learn it again – is that a lot of IT projects really are not IT projects. They are clinical projects that require IT expertise,” he says.
“If you get the clinicians involved early they can become champions of the initiative, where before there may have been some naysayers. It’s important to listen to the clinicians, particularly in their early experience and exposure with products, so that you can modify and incorporate those things that they think are essential.”

 

Listening to the clinicians, Brown adds, “has been the key element of our success.”

 

It surely helps that cause that Brown is a physician himself, a gastroenterologist and internist who rose to the rank of brigadier general in the U.S. Army and led several military healthcare installations, including Walter Reed Health Care System in Washington, D.C.

 

At one time, he found little interest among his colleagues for administrative work. Now, under reform, that has changed as clinicians see their input as essential to changing the industry.

 

“I think the old attitude of some of my colleagues was, ‘I just want to be a physician. I don’t want to be bothered with running an organization.’ Now, clinicians are more involved. They realize they need to help shape the future of healthcare if they want to see things change in a way that’s commensurate with their beliefs. You shouldn’t be passive about change.”

 

Working hard to achieve change, he says, is an attitude he inherited from his parents, who saw him become the first family member to graduate high school and were unwavering in their support of Brown and his two siblings, seeing education as the door to opportunity.

 

“They would tell me, ‘You have the ability. If you apply yourself, you’ll be able to achieve whatever you want.’ “

 

It’s a lesson he’s applying at Legacy, facing the future with resolve.

 

Nursing roots important to Judith Persichilli as she leads one of the largest U.S. health systems

By | August 14 th,  2013 | Catholic, C-suite, Catholic Health East, clinical process, faith-based, health system, hospital, Lean In, Modern Healthcare, nurses, president, Sisters of Mercy, Blog, CEO, healthcare reform, leadership, nursing, safety, work-life balance, quality, Top 25 Women in Healthcare, Trinity | Add A Comment

 

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

 

“When I wake up in the morning and look in the mirror, I see a nurse. I don’t necessarily see a healthcare executive.”

 

Those words don’t belong, say, to the CNO of a small Midwest hospital. They’re coming from Judith Persichilli, who serves as interim president and CEO of Trinity/Catholic Health East, one of the largest health systems in the country. (Prior to the merger of Trinity and Catholic Health East, Persichilli was president and CEO of CHE.)

 

Nursing, Persichilli says, “has always been in my heart. It still is.” In fact, there is no shortage of executives on Modern Healthcare’s list of the Top 25 Women in Healthcare who have a background in nursing, including Persichilli.

 

Why do many nurses become successful healthcare executives? Persichilli says she thinks she knows.

 

“The education of nurses prepares them to be leaders,” she says. “You’re educated across the continuum; you understand the clinical process. You need strong relationship and communication skills as you’re dealing with physicians and other allied health professionals to promote a plan of care. At the same time, you are responsible in many instances for the communication with the family and significant others of the patient.”

 

While Persichilli leads an organization with $12.8 billion in operating revenue, she says healthcare workers at any level can make a significant difference in safety and quality in an era in which cost has become a driving concern.

 

“With healthcare reform, I truly believe that people with clinical knowledge – including, of course, physicians – have the skills to make the right decisions about the clinical process of care and actually lower the cost of care overall. They will make the right decisions about where patients can safely be taken care of with the highest quality.”

 

The merger of CHE and Trinity created a huge, national Catholic health system. Previously, some other Catholic systems merged with secular counterparts, but Persichilli said that doesn’t mean they’ve abandoned their faith-based roots.

 

“The other systems that have merged may organize themselves differently, but they still have a faith orientation within their organization,” she says. “We have decided, based on the heritage and the tradition of the women religious who sponsored the healthcare entities that formed into a system, that our system would be Catholic. That doesn’t mean we won’t be welcoming to secular relationships that share our vision and values.”

 

In fact, prior to the merger, Persichilli was part of a team at CHE that made the difficult decision to sell Sisters of Mercy Hospital in Pittsburgh to the University of Pittsburgh Medical Center system. The move enabled CHE to create a foundation that enabled the sisters to continue their work with the homeless, a population that depended on the faith-based care in the community.

 

“One of the Trinity CHE values is courage, taking risks,” she explains. “Our founding congregations came to this country with 50 cents in their pockets to take care of people. Mercy was an excellent hospital, but UPMC was so large. The situation gave us an opportunity to say, what are the unmet needs? How can we continue this ministry that was started more than 100 years ago by the Sisters of Mercy?”

 

Persichilli says she believes similar crossroads are in the future of many communities.

 

“I think we’re going to be making more of these decisions in healthcare as you look at the community needs assessments that are required under healthcare reform.”

 

Reform, she adds, resonates with the work that faith-based systems have been doing for years.

 

“That’s who we are in Catholic healthcare. It’s not just CHE and Trinity – that’s who we are. Sometimes it means saying, there’s enough acute care. How can we creatively develop the structures and the financial foundation to meet the unmet need? It definitely pulls us into environments that perhaps other people don’t want to go into – the homeless, the vulnerable.”

 

While it’s a well-known fact that the U.S. spends more than any other country on healthcare with less than stellar results, Persichilli says the belt-tightening prevalent in the industry doesn’t have to make quality decline at all.
“I spent three weeks with Catholic Relief Services in Uganda visiting AIDS clinics and looking at their ‘hospitals,’ ” she says. “And I came back to the United States with the understanding that, even in a time of constraint, we live in an era of abundance. We have to figure out how to tap that strength, to do things better at a higher quality and a lower cost.”

 

One idea on how to do that? Better communication.

 

“We can do it. It’s there. It will take people in the provider sector and the payer sector to talk to one another, not past one another.”

 

Persichilli says industry executives need to know their numbers, but also understand that healthcare goes beyond costs.
“No matter what, you need to know that you’re doing really important work. You have the privilege of taking part in and changing people’s lives. When I was a nurse, I used to say, ‘Let’s all stand together and ask the question: ‘What difference did you make in the lives of your patients today?’ ”

 

That kind of attitude is especially important to people at the beginning of their healthcare careers, she adds.

 

“Once you bring meaning to your work,” she explains, “you go about it with such commitment and passion that it’s hard not to be recognized. And once you’re recognized, you’re appreciated. Once you’re appreciated, you’re promoted. And once you’re promoted – if you bring that same passion and commitment forward – you will reach an executive level.”

 

Persichilli mentors a number of young female executives, but says she doesn’t get sucked into the “Lean In” debate.

 

“Work-life balance transcends gender when it comes to these executive positions,” she says. “I don’t ever step into somebody’s life and say, ‘You should do this or that.’ I always tell younger women, ‘It has to feel comfortable for you.’ And if it doesn’t feel comfortable for you and your career is going to be stalled as a result, understand the choices you make and be happy that at least you can make them.”

 

Today, she notes, stress about family isn’t confined to children – it could just as easily be about caring for one’s parents as part of the “sandwich generation.”

 

“If it’s too stressful and the children or your parents are not being taken care of the way you want, it’s not going to do anyone any good at work or at home. So understand who you are and what’s important to you. I don’t have any children, but I can tell you there’s nothing more important than raising good kids.

 

“I don’t have the answers here. I just know that, if you’re uncomfortable, own it and figure it out.”

 

Marna Borgstrom: In healthcare and life, relationships matter

By | July 29 th,  2013 | Connecticut legislature, Healthcare, Marna Borgstrom, Modern Healthcare, nurses, patient-centered, president, reimbursement, Smilow Cancer Hospital, Blog, CEO, children's hospital, health disparities, healthcare reform, leadership, Yale-New Haven Health System, Top 25 Women in Healthcare | Add A Comment

 

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

 

Marna Borgstrom was shopping for vegetables at a farmers’ market recently when an acquaintance approached her to say, “I just can’t thank you enough for the Smilow Cancer Hospital.”

 

It was a moment for the president and CEO of the Yale-New Haven Health System to reflect on why, ultimately, she was involved in healthcare. It didn’t matter that Yale-New Haven could boast that it was one of the largest systems in the country or that she’d enjoyed a productive career and interesting work that spanned more than three decades. It came down to one family finding the help it needed at a critical time. Just as all good healthcare does.

 

“Her kids went to school with my kids,” Borgstrom recalls. “And she was standing over the asparagus telling me about her husband’s diagnosis and the treatment. But she was really talking about all the talented people at Smilow who have been making a difference in their lives.”

 

Making a difference. That was the example she got from her parents, both of whom were first-generation Americans from families who did not have the benefit of much formal education. Borgstrom’s father became an ophthalmologist simply because the Army was doing manpower planning during World War II and they told him to go to medical school.

 

“When my dad was in private practice, house calls were de rigeur, and we’d all pile into the station wagon after church on Sundays and go to house calls to his patients, most of whom were older,” she says. “My mother would be home making a big Sunday lunch for us and extended family, and my dad’s older ethnically diverse patients would all feed us too, so we were rarely hungry when we got home.”

 

But what she and her siblings took away from those trips was much more than a full stomach.

 

“I think what we learned was that some of the real joys of healthcare are people and relationships. I have people who come up to me even now and say, ‘Your dad did my surgery.’ (He’s 90 years old and hasn’t performed an operation in 25 years.) And I don’t think that’s all that different from a lot of the people who work here now.”

 

Those warm memories help keep her going when faced with issues like the 2013 Connecticut legislature taking $550 million out of hospital-based reimbursement over a biannual budget, as it did the night before she paused to discuss her selection as one of the Top 25 Women in Healthcare as chosen by Modern Healthcare.

 

“They’re taking as much out of hospital reimbursement in 24 months as the entire industry in the state is taking under the sequester in 10 years,” she noted. “When you make dramatic cuts and you make them too fast, what you cause is more reactionary behavior than thoughtful behavior. Our system happens to be the largest provider system in the state, and we also are the largest providers of care to the medically indigent, so we got whacked disproportionately in this.”

 

No one in the industry, she adds, is arguing the contention that healthcare costs too much and that it is not always delivered in the appropriate way. Borgstrom says Yale-New Haven will weather the storm, but Connecticut healthcare as a whole may be damaged irreparably.

 

“I’ve said to members of the legislature here that there are some hospitals that will not make it with these cuts. And the irony is that some legislators think we will go in and buy them. We aren’t everybody’s savior. It’s a bad business strategy. So what the legislature may have to do in the next two years is go back and put money back in the budget to help the organizations that are really struggling. It just doesn’t make sense.”

 

Compounding the issue are an aging population and health disparities in the state.

 

“We have an older-than-average population, and we also have more people below the federal poverty level, ironically, in a very wealthy state, than most states in this country,” Borgstrom says. “A lot of what we see are diseases in the elderly that come from years and years of excess, and what we see in the younger populations are diseases and problems that come from socioeconomic disparities.

 

“Those aren’t going to change this year or next year just because somebody decided they were going to pay us less.”
The solutions that the healthcare industry is searching for under reform are pretty comparable from hospital to hospital, state to state, she adds.

 

“In this industry, I would contend that everybody has similar strategies,” Borgstrom says. “We’re all trying to get better on the value equation, we’re trying to build scale because it will help us with our business model, and we’re trying to integrate and align with other providers, most notably our physicians.”

 

The difference, she says, is in execution.

 

“The holy grail is in execution, and how people execute, I think, is based mostly on organizational values. And those have to be values that people lead by.”

 

In Yale-New Haven’s case, Borgstrom can rattle off those values pretty quickly: patient-centered, integrity, respect, being accountable, being compassionate. She learned them from her mentor, former CEO Joe Zaccagnino, who saw leadership qualities in her early on.

 

“He was somebody who gave me real and real-time feedback about what I was doing and how I was doing it. Sometimes, it really stung,” she allows. “But I knew he was not giving me the feedback for any other reason than to make me better at what I did and how I was perceived at doing it.”

 

Ultimately, she succeeded Zaccagnino as president and CEO when he retired in 2005. She’s been the architect of numerous major projects at Yale New Haven, including a children’s hospital, the cancer hospital and the recent acquisition of St. Raphael Hospital, a 520-bed facility that was teetering on the brink of bankruptcy. The Sisters of Charity of St. Elizabeth in charge of the hospital ultimately decided that Yale-New Haven was the best fit among St. Raphael’s suitors even though they gave up their Catholic affiliation in the process, a move that Borgstrom calls “one of the most courageous I’ve ever seen.”

 

Yet she is quick to deflect credit and to use self-deprecating humor to minimize it. “I’m the orchestra conductor,” she says. “I don’t do a whole lot. I just stand up in front and try to keep everybody playing and singing in harmony.”
One key, she says, is hiring good talent and then getting out of their way. Another is ensuring that the staff has a work-life balance that they are comfortable with, a prominent discussion especially among women leaders since the publication of “Lean In” by Sheryl Sandberg.

 

Borgstrom said she recently interviewed a candidate for an executive role and spent most of the time on that topic. The woman had become the breadwinner for her young family. She wondered if Yale-New Haven would be a good fit since she would have to move away from the support of extended family.

 

“What I said to her is, there’s no one answer to this, but I fundamentally believe that you cannot be a good executive if you aren’t happy and also able to manage your personal life. Because long after these jobs are gone, the people who will hopefully be in our lives will be that partner we’ve spent significant time with, our children and our extended family.

 

“If it’s the right person, the right job and the right organization – and both parties live up to their end of the bargain – I think you can have a successful and happy career and personal life. And happy is really important.”

 

Helen Darling: A strong voice for employers in the healthcare debate

By | June 10 th,  2013 | Furst Group, glass ceiling, Healthcare, mentoring, National Business Group on Health, payers, executive, health insurance, Lean In, Modern Healthcare, patient safety, president, providers, Sheryl Sandberg, 100 Most Powerful People in Healthcare, Blog, board of directors, CEO, employees, employers, Fortune 500, healthcare costs, healthcare reform, Helen Darling, leadership, marketplaces, national debt, quality, Top 25 Women in Healthcare | Add A Comment

 

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

 

The healthcare industry is undergoing major changes, but Helen Darling says the providers and payers who comprise much of the industry aren’t doing enough to control costs and improve quality. Her words carry a lot of weight – she’s the president and CEO of the National Business Group on Health, which represents many of the large employers in the U.S.
Darling says her membership would like to see big improvements in safety, quality and costs, but have doubts about whether that could actually happen in an industry with limited competition.

 

“With our healthcare system, there are no countervailing forces that will essentially force organizations to reduce costs and improve quality and safety,” she says. “We saw very little attention paid to patient safety until the federal government took this tiny amount of money and said, ‘We’re going to hold this back if you don’t meet certain Partnership for Patients goals.’ And that did get people’s attention, but that’s what it took.”

 

Darling’s non-profit organization represents many Fortune 500 and other large companies, serving as a united voice on healthcare policy and offering solutions to healthcare issues in the marketplace. She says her membership is concerned about where healthcare is headed.

 


“All you have to do is look at every report written concerning the national debt or the annual deficit and see that healthcare is the driver,” she says. “It’s not Social Security. It’s not education. It’s not feeding children. It’s all about healthcare.”

 

Darling herself has led a storied career, directing studies at the Institute of Medicine before becoming the health legislative aide for U.S. Sen. Dave Durenberger (R-Minn.). She later worked as a senior executive for Mercer, Xerox and Watson Wyatt (now Towers Watson) before agreeing to lead NBGH. She is a member, and co-chair for ten years, of the Committee on Performance Measurement of the National Committee for Quality Assurance and is Vice Chair of the Board of the National Quality Forum.

 

Patient safety, she said, is a key concern for her and NBGH.

 

“There’s nothing like statistics having to do with patient safety to galvanize attention to the problem,” she says. “Just think about the amount of harm or death because somebody, for example, gets an infection. Even if they don’t die, they suffer. I’m sure everybody knows families of someone who got C-Diff or MRSA in the hospital. All you have to do is look at the data and see how much human suffering and wasted cost are behind healthcare associated harm.”
The lack of progress on that front, she says, is perplexing.

 

“What I don’t understand, to be honest, is why there isn’t more of an outcry,” she adds. “If somebody eats a hamburger that has some contamination, it’s all over the television. If a plane goes down, people are on it for days in the 24/7 news cycle. And yet every day, in hospitals across the United States, people are being harmed and in some instances are dying from conditions that are preventable and avoidable.”

 

Darling encourages the executives she represents to serve on the boards of hospitals (something she herself has done), and her group offers them a patient safety toolkit. She encourages trustees to press for frequent safety reports to be given to the CEO and the Board of Directors.

 

“Historically, hospitals have a risk-management report, and they might have a quality report if, say, the Joint Commission did its audit and found something. The risk-management report will say things like, ‘There was a patient fall this month and we have booked $3 million as part of the liability reserved to take care of it.’ That’s it. Historically, there has been no root cause analysis, no report on what changes they’re making to stop that from ever happening again. That is changing but it isn’t fast enough or universal.”

 

To be fair, a few of the major employers who make up NBGH’s membership have similarly been criticized for their reaction to healthcare reform, including some who have changed terms of employment that make fewer employees eligible for health insurance. But Darling says health insurance has never been an automatic benefit for the workforce.

 

“At any given time during the year, we have 60 million people without coverage, and most of them are working people. Health insurance has always been a perk,” she says. “It’s never been something that everybody has, and it is very much related to wages. The irony is, the people with the lowest wages get the least benefits. But I don’t think it’s going to get worse. If the insurance marketplaces work the way they’re supposed to work, we will be better off in terms of coverage (although not in terms of the costs of health benefits coverage on a net basis).”

 

But the penalties for lack of coverage will need to change before that happens, Darling adds.

 

“The penalty is not as much as it will cost people to get the coverage. They can’t tell people they have to have a package that will cost, on average, $7,000, and then tell them the penalty for not buying coverage is $1,000. They’re going to have to change the package because it makes the subsidies much richer. They will bankrupt the country on that one.”

 

Still, she says she’s confident that the gap will be bridged.

 

“All that needs to be sorted out, but I actually think we will have more people covered. Nobody will be happy about a lot of the details. In the end, I think more states will look a little more like Massachusetts.”

 

Darling has been selected numerous times by Modern Healthcare as one of the Top 100 Most Powerful People in Healthcare in addition to her new award as one of the Top 25 Women in Healthcare. The Modern Healthcare article announcing the Top 25 Women was headlined, “Beyond the Glass Ceiling,” and Darling said she thinks some of that ceiling is self-imposed among women.

 

“I belong more to the Sheryl Sandberg ‘Lean In’ school,” she says. “I’ve been hiring men and women and mentoring them for a long time. I still see significant differences in the way men and women assess themselves, in the way they think about their careers and their families.”

 

She laughs as she relates a humorous story she heard on the radio recently. “It said that if women miss a child’s school event, they are just wracked with guilt. But if a man merely drops the child off at the event, he feels like he made a major contribution. That’s pretty funny, and pretty accurate.

 

“And as long as that’s true, women won’t always be able to have the same kind of executive career that men do. They can have the combined benefits of living in both worlds but as long as executive careers require the kind of 24/7 commitment to work that most do, women and men will have to choose what balance or lack of balance they really want.”

Profiles in Leadership: Top 25 Minority Executives Ben Chu helps Kaiser Permanente make quality count

By | July 6 th,  2012 | American Hospital Association, change management, Furst Group, Healthcare, population health, health system, hospital, Modern Healthcare, physician, Blog, CEO, diversity, healthcare reform, Kaiser Permanente, leadership, chairman-elect | Add A Comment

Chu

 

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

 

Benjamin Chu, MD, MPH, MACP, oversees Kaiser Permanente Southern California and Hawaii as group president. In the seven years since he arrived, Kaiser Permanente has amassed many awards for quality. He also is chairman-elect of the American Hospital Association and will begin serving in that capacity in 2013.
Prior to joining Kaiser, he was president of New York City’s Health and Hospitals Corp., the largest public health system in the country. He also served as associate dean at both Columbia University and New York University.

 

Following is an edited transcript of the conversation:

 

You have a Bachelor’s degree in Psychology. What spurred you to go for an M.D.?

 

I think I always was going to be a doctor. Unlike a lot of people who have a core basic science orientation, I was always more interested in the human side of medicine. Psychology, child development, and anthropology are more in line with things I was thinking about. As you know, in medicine, there are a lot of behavioral and developmental aspects. In order to be effective, you have to understand the cultural determinants of health. All of these factors led me to pursue work in a field where I could actually help people. There is a whole sociology and culture of medicine that one cannot fully understand unless viewed from the psychological perspective.

 

You spent most of your life out East before moving to California. What spurred that move, and has it worked out as you expected?

 

I was running the NYC public hospital system under Mayor Bloomberg. It was an incredible experience and an incredible job. We were doing very innovative things in that system. It is a huge system that cares for 1.3 million NYC residents. When the opportunity arose to move to California and run a large chunk of Kaiser Permanente, the prospect piqued my interest. How far can you take a systems approach to delivering on improving the health of the population under the care of a large system? In Southern California, Kaiser Permanente has 3.6 million members, three times the size of the population we were caring for in NYC. The nice part about it is that the components and pieces are linked in a large multi-physician group that only works with the health plan and the hospitals. The health plan allows for pre-payment for care of the population. There is an entire delivery system under us that allows us to decide how to parcel resources in order to achieve the goal of maximizing the health of the population we serve.

 

How do you get a big system like KP to deliver on its promise and to take healthcare to a whole different level?

 

That was both the challenge and the fun part of coming to KP & California.
I didn’t know many people when I was coming to Kaiser – primarily George Halvorson [chairman and CEO] and Ray Baxter [senior vice president for Community Benefit, Research and Health Policy]. It’s been an incredibly rewarding experience. We had to put systems in place – our electronic health record and other systems – to allow us to look at our performance in a very open, honest, and critical way. We had to reconfigure the system. KP had been better than average on quality and outcome for our members. Now, because of what we’ve been able to do with tools, reconfiguring our system, and getting complete alignment of our systems, components and people (including the 60,000 employees in Southern California), we are pretty close to leading the country on many metrics.

 


From Leapfrog to NCQA, KP across the board has achieved some remarkable ratings for quality.

 

There has been a steady progression over the last half dozen years. We’ve taken a systematic approach. We engaged every member of our staff, from doctors to non-doctors and from professionals to frontline workers, to get to that point. It has been very rewarding and a lot of fun to do.

 

The last six years coincide with your arrival. What role did you play in these changes? What role did you leadership team play? What did you look for when bringing a new leader on board?

 

To tell you the truth, I don’t think I have brought anyone new in, believe it or not. I spent time getting to know the people here. We have a wonderful leadership group, and there have been very few changes. The changes were largely to replace people who left. What would be the key to our success? It hovers around getting complete alignment over what we wanted to do.

 

Much of the alignment was around trying to make sure we did everything possible to benefit our members. It was not a financial decision. While financials are important, they aren’t driving our goals at this point. The larger point was to make sure everyone understood that at the end of the day, it is our members and patients, and how we perform for them, both in the individual aspect and aggregate aspect.

 

People rallied to this message of reaching for the higher mission. It’s hokey to think about in that way, but you’d be surprised. Everyone comes into healthcare to make a difference in another person’s life. One of the things we did as a leadership team was to galvanize everyone’s desire to make a difference and reminded people of this. I think this is the key to leadership overall. I am blessed to have a lot of incredible people working with me on much of this.

 

Obviously we had to put in the systems to give us the information to know if we were making a difference in people’s lives. Once we got that in place and held that mirror up, the ideas came flowing out, and we could tap into this wellspring of creativity and desire to do the right thing. I am a doctor by training in a non-clinician role right now, but it is a pleasure to see that marriage of clinical outcomes and my public health background on population health outcomes come together in a delivery system.

 

As you look at your role at the American Hospital Association as chairman-elect beginning in 2013, do you get the sense that part of what they are looking to you for is to help other hospitals across country pick up on what Kaiser has done and get the quality scores up and make a difference nationally?

 

If you actually talk to the hospital leaders and members of the boards across the country, there is an enormous amount of energy working to find ways of taking care of their communities. Part of this is the quality agenda. Thousands of hospitals have joined the hospital engagement networks that are forming right now and are trying to learn from each other and optimize the quality of care given in the hospitals themselves. Hospitals are beginning to see that they play a pivotal role in their communities.

 

Rather than be passive and wait for people to get sick and come in, there is a role to be played more upstream – to make a difference in the community’s fabric and in its health. Some of it has a lot to do with impacting the developing ACOs. It is an often misunderstood, yet often used, term. The idea is to get an organization and care delivery system to care for a population and try to go as upstream as possible to find strategies that lead to good health and mitigate things that lead to bad health, not just treat emergency situations. It means partnership with providers who work in the upstream levels. Doctors who see patients in an outpatient setting tied to the hospital or in their practices – we need to link the two together.

 

There is a lot of energy in the hospital world. One of the reasons I was asked to chair in 2013 is that there are tremendous, yet uncertain, changes that are happening. There are also these powerful positive forces that can help hospitals and health systems come together in a better way to take better care of their communities. I think I was asked to chair so we can engage in a system-wide and country-wide dialogue to help each other overall.

 

Given the uncertainty around reform – does that make leadership harder for you and the people running hospitals round the country?

 

It depends on what you mean by harder. It certainly makes it much more interesting. The pathways to choose are much more ambiguous. In uncertain times, leadership needs to focus energy on the right things. I think that is why the AHA is working with our member hospitals to determine the higher-order outcome. If we dive into the weeds and get into the arcana of legislation and stay there, we will get lost. That is not to say reimbursement and policy changes aren’t important, but if that is all we think about, there is no ability to guide organizations through a field of uncertainty.

 

If you can’t pick up your head to see where you are going, you cannot mobilize physicians and institutions to move in the same direction, and we will be mired in the field and will not get anywhere. That is the difference between someone who is good operationally and a leader who can engage people in dialogue to get everyone to a place where we want to be.

 

There seems to be a growing consensus among healthcare leaders that we are on a course of change that will continue whether mandated or not.

 

I think that is absolutely correct. Healthcare is changing in a good way, I think. I know people worry about losing the good things in uncertain times. When you think about what we are capable of doing and how many people we are capable of doing things for, I am convinced that with a little change in perspective and focus, we can utilize the dollars we spend in healthcare and create a lot more healthy communities. It is a journey in a lot of ways – a very uncertain journey. I think the focus is changing. Payment reform is happening. A lot more transparency is coming. There will be changes to tell us how we are really doing. Once you are confronted with that information, it is a compelling force driving changes that could get us to a better place.

 

I think that in the best framing of what is happening now, that is the direction the country’s healthcare systems is headed. Probably the direction the world’s healthcare system is headed. Even though we are making a difference, how do we know we couldn’t be making a bigger difference? When you think of disparities in healthcare and how uneven results are, I think in this day and age, there is little the systems cannot tackle. We won’t all get there at the same time, but if we focus right, there’s a lot more good that we can do.

 

There seems to be an increasing interest in physician executive leadership. As a doctor and physician yourself, what is your take on that?

 

The lesson we’ve all learned is that in order to take on the larger tasks, the triple aim, all of the key pieces must be aligned. Physicians and other healthcare professionals have to be integrated into the whole system. We are trained to be separate. Even though hospitals are a part of the action where people are treated and where doctors do what they do, they are still only a piece of the puzzle. To integrate the perspectives, many places are looking towards physician leadership, whether as an administrator or at a Medical Director/CMO level.
We need voices there and to be open and honest about the larger goal. We cannot just see hospitals as a doctor’s workshop. That will only get us so far. Obviously, we want someone to care for patients and bring their expertise. However, it is not just a single doctor, but multiple healthcare professionals. We want to see the larger role for the community.

 

We need to make decisions on the deployment of resources and make a bigger difference than just delivering the best care in the ER. I’m not saying the best care shouldn’t be delivered in the ER, but when you think about it, it may not be the optimum expenditure of resources if you only concentrate on the ER.

 

In my opinion, there should be more doctors at senior levels of health systems. Having everyone’s perspective is important and makes a difference.

 

You spent time working in the office of Sen. Bill Bradley. What insights from that time guide your perspective in today’s healthcare climate?

 

I’m not sure there is a tremendous amount of insight but, when I worked for Senator Bill Bradley, it was one of the last times for major Medicaid expansion. The American with Disabilities Act was passed the year I was there; we passed the Medicaid Best Price legislation for pharmaceuticals, and expanded Medicaid to children up to 133% of the poverty line and pregnant women up to 185% of poverty. That was really the last big expansion before the children’s health program came in.

 

When I think of that era, it was a time of greater bipartisan collaboration. I worked for a Democratic senator when the first George Bush was president. There was a lot more collegiality. That’s not to say that cannot happen again, but I’m hoping after the upcoming, probably raucous, presidential campaign, that people will be more realistic in looking at the problems of our country and figure out how to solve them.

 

Even if we concentrate on legislation, that’s not always where the action is. Many core changes are already starting to happen. Core systems changes are being worked on. I don’t think there is a way back. From the hospital perspective, one of the opportunities was finally being able to count on some sort of payment for care of the significant portion of uninsured patients that would come in to the ER and hospitals. This includes upstream care and hospitalization. From the community and hospital point of view, that was one of the best parts of healthcare reform. I hope that will continue. I know it presents problems for many aspects of the healthcare world, the Medicaid expansion, as well as the exchanges, but I hope that some sort of increase in uninsured care will continue. We will always muddle our way through. We always have muddled our way through, based on my experience with Senator Bradley. It was not always clear then (1989-1990).

 

Healthcare organizations, particular in the inner cities, are creating senior housing, opening banking centers, farmers’ markets, and developing other innovative systems and ideas such as free surgery day. Some might think it’s a bit far afield of healthcare, but it seems to be a growing part of preventive care. Is this part of the equation at Kaiser Permanente as well?

 

Every one of KP’s medical centers runs a farmers market. In fact, we run the only farmers market in Los Angeles. This is illustrative of what I was talking about earlier – the tremendous amount of energy spent in the hospital world trying to figure out how we go upstream. The medical model is individual – one person at a time. When someone is sick, you care for them and send them back out. This is an important function for every community. The underlying premise is that the sum of all the good one-on-one work will translate into a healthier community. Clearly, this model leaves huge gaps. The medical model really is not directly focused on the population’s and the community’s total health.

 

There is a broader understanding that what makes a person healthy or not is as much about the health of the community and total health of the environment as it is to prescribing the right medicine. Eighty percent of the determinants of health are not linked to care. Smoking, exercise, drug use – these are things people need to think about if we are going to make a greater impact on the community and population health.

 

At Kaiser, we have a theater troupe that goes into grade schools to do thousands of performances on healthy eating to influence kids on eating habits. Collectively, if 5,000 hospitals and health systems can get it together and start moving upstream together, it could be a very powerful force. To become a vibrant part of the community is key. We helped invest in parks. We have beautiful weather in Southern California, but unless you have good outdoor spaces, people will stay in their homes or in their cars to go from place to place. The built environment in the community makes a difference. Do people have the choice to make better decisions? We need to provide spaces to make better decisions.

Profiles in Leadership: Healthcare reform a worldwide need, Bisognano says

By | September 12 th,  2011 | Healthcare, Top 25 Women, IHI, Maureen Bisognano, Modern Healthcare, patient-centered care, patient safety, president, Blog, CEO, healthcare reform, Institute for Healthcare Improvement, leadership, quality | 2 Comments

 

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

 

In her travels around the world as the president and CEO of the Institute for Healthcare Improvement, Maureen Bisognano has discovered something: healthcare reform isn’t an exclusively American issue. Many countries, she says, are realizing they need to make some fundamental changes in their healthcare systems.

 

“There are so many similarities that it’s uncanny,” she says. “You need to use different languages in different countries, but the fundamental problems are very, very similar.”

 

Bisognano sees several universal issues, including finances, labor and patient-centered care.

 

“In every country that we work in, there are insufficient numbers of skilled people to do the kind of work we need,” she notes. “Even here in the United States, we’ve got a graying population and fewer people coming into the healthcare systems as caregivers.”

 

And, while American expenditures on healthcare outpace the rest of the world, Bisognano says the rest of the world is still wrestling with a lack of funds in that area.

 

“Even in the developing countries, and the low and middle-income countries, finances are an issue. We need new designs in order to provide the care with limited resources. All over Europe and the U.K., we’re seeing budgets needing to be constrained.”

 

Patients’ voices are being heard now more than ever in most sections of the globe, but Bisognano says they sometimes have a different idea of patient focus than in the U.S.

 

“When I’m in Malawi or Ghana, in talking about patient-centered care, they actually kind of chuckle because they think that we don’t understand what patient-centered care is – and, in a sense, they’re right,” she says. “Because there, it’s not just the patient. It’s the family, it’s the village, it’s the tribe. And if you don’t get all these supports lined up, then a woman will not get to the hospital for a delivery. So they have a much more sophisticated understanding about what patient-centered care means.”

 

IHI has long been known for its championing of patient-centered care. Bisognano and former CEO Don Berwick worked side by side for 16 years. She said she is encouraged by the strides she is seeing in this area, citing four examples:

 

**In Sweden, a young aerospace technician wanted to do his own dialysis. A nurse taught him. He taught another patient. And now, in this Swedish hospital, 60 percent of the patients run their own dialysis, and their outcomes are better than those that don’t.

 

**At Cincinnati Children’s Hospital, the staff conducts “Huddles” every few hours to coordinate patient care where the focus is always on the future – what might happen. “In many hospitals, you’ll see nurses meet periodically to discuss what happened, but it’s always in the past tense,” Bisognano says.

 

**In Cedar Rapids, Iowa, Mercy Medical Center, without the benefit of being part of a large health system, has drastically reduced mortality rates and made patient-centeredness part of its DNA.

 

**In Pittsburgh, orthopedic surgeon Anthony Digioia has redesigned the way hips and knees get replaced. Patients who go through the new process spend an average of 2-1/2 days in the hospital and 95 percent go home without a walker or a cane.

 

Bisognano says these examples illustrate how innovation can revitalize healthcare.

 

“I think the old methods of management that were much more top-down control don’t work when you’re undergoing transformations as radical as we need to undertake in these times,” she says. “And so, people are turning to innovation, and they’re turning to quality improvement and design.”

 

As a former nurse herself, she sees nurses as an undertapped resource for driving improvement and innovation, because nurses have long had to troubleshoot at every turn.

 

“If the medication wasn’t there, if supplies weren’t available, if the IV pole wasn’t there or a patient was late in arriving at the operating room, the nurse would scurry around to make up for that deficit in the process,” she says. “Nurses were rewarded for being able to adapt and overcome process-level problems.

 

“We need to be trained a bit to be able to stop in the midst of fixing something and say, ‘Am I the only person this has happened to today? Is this a problem that happens frequently? Do I predict this will happen again tomorrow? If so, how do I use quality improvement methods to prevent this from happening tomorrow and to any other patient?’ ”

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