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Hard work a key to Sally Hurt-Deitch's quick ascent

By | July 31 st,  2017 | El Paso, Market CEO, Modern Healthcare, Sally Hurt-Deitch, Tenet, Blog, leadership, nursing, the Hospitals of Providence, Top 25 Women in Healthcare | Add A Comment

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

The career trajectory for Sally Hurt-Deitch was set early – so it’s no surprise to see her as the Market CEO for The Hospitals of Providence, the Tenet Health system that dominates the El Paso market.

 

At her first job, fresh from earning her bachelor’s degree in nursing, Hurt-Deitch’s boss was close to retirement. So, on top of learning endoscopy and the operating room, and in addition to learning instrumentation and learning how to circulate, her supervisor put her to work on a host of other duties.

 

“She would come to me and say, ‘Sally, you’re young. You know this stuff. You just graduated from college. Go and do this for me,’ ” Hurt-Deitch remembers.

 

Her nursing preceptors told the bewildered rookie, “Just go do it.”

 

Thus, by the end of her first year, in addition to doing cases and being a clinical nurse, Hurt-Deitch got a crash course in how to run every aspect of a department.

 

“I was doing her payroll and her scheduling,” Hurt-Deitch says. “I’d done her operating budget and her capital budget. I had rewritten all of her policies and procedures. I’d gone through a Joint Commission survey and I was doing all of her Performance Improvement and Quality Improvement.”

 

An amazing story, yes? It gets better.

 

When Hurt-Deitch’s boss retired, a group of physicians went to the CEO of the hospital with a request: “We want Sally to be the new director.”

 

The CEO called her into his office.

 

“How old are you?”

 

“23.”

 

“I don’t know about this. I’ll tell you what. I’ll give you 6 months. Let’s see what you can do.”

 

Hurt-Deitch sailed through the tryout. She became the assistant chief nursing office two years later and, by the age of 27, she was the CNO.

 

“When my nursing boss retired, I never even thought, ‘I want this position.’ ” Hurt-Deitch notes. “It grew very fast.”

 

Hurt-Deitch was born and raised in the El Paso area and, except for a short period when she left to work in Oklahoma, has watched the region grow from a close-up vantage point. Healthcare is personal to her, an attitude that developed unconsciously when she was a child.

 

At the age of 10, her mother nearly died from idiopathic thrombocytopenic purpura, an autoimmune disease in which the person’s body destroys its own platelets and thus, the ability for the blood to clot.

 

“My father was amazing,” Hurt-Deitch says. “He would sneak us up a back staircase at the hospital so we could go see her. He was a football coach and I can remember my mom doing her exercises with my dad coaching her: ‘You’re going to do this. You’re going to come back.’ Watching how he acted around her was very inspiring to me. I had a deep desire to care for people. I think my mother and her experience provided a lot of fuel for that fire, but I think nursing inherently was my calling.”

 

Hurt-Deitch got to see her mother completely come back from the disease, and her mom has had a front-row view to see her daughter become one of the powerful Latino executives in the country.

 

The El Paso region is unique in that it is still a border community, one whose economy is still very much based on homeownership as opposed to another economic driver. But Tenet itself has invested more than $1 billion into El Paso in the last 10 years, and Hurt-Deitch says the county has a consumer mindset to healthcare that is no different than the rest of the U.S.

 

“We are the community choice for healthcare, which is a hugely positive thing – we have about 50 percent of the total market share,” she says. “But people want healthcare in their community. They don’t want to drive 20 or 30 minutes to receive care. They want it right around the corner. The days of having a family physician and going every year for your checkup are disappearing. So, you’re seeing the free-standing ERs and the urgent-care centers proliferating because people are wanting to be treated per health episode, not for their long-term health needs.”

 

As the Market CEO, Hurt-Deitch oversees the CEOs who lead the three Providence hospitals and one micro-hospital. And, like her early years in healthcare, she utilizes some unorthodox ideas to develop her team.

 

“We trade positions. One month a year, I will leave and become the CEO of one of our other hospitals. The other CEOs will do the same,” she says. “We can identify a lot of best practices this way. It also helps us to establish stronger relationships with our medical staff and the other directors. At the same time, we may have instances where we need each other to step in and run a meeting for us in our absence.”

 

In doing so, Hurt-Deitch is infusing her leadership team with the same type of liberty she experienced as a rising star in her 20s.

 

“I have to be open to listening to them and accepting what they’re saying and allowing them enough freedom to do what they need to do in their hospitals,” she says. “You can look at The Hospitals of Providence and look at the results. What it would show you is a team that is connecting with the community from every standpoint.”

 

 

SIDEBAR: Embracing cultural diversity: A personal story

 

 

At the recent 2017 Congress presented by the American College of Healthcare Executives, Sally Hurt-Deitch was part of a panel on “Building An Inclusive Culture: Whose Job Is It?”
Her years in El Paso, a predominantly Hispanic region, and her experiences as a healthcare executive gave her plenty of points to ponder.

 

“El Paso creates this very interesting dynamic because it is a minority-majority community,” she says. “When you’re raised in a minority community, you’re not raised to see color. Your friends were your friends. It was a very inclusive environment, and I was not exposed to anything different until I left El Paso.”

 

Being looked at differently because of her ethnicity happened when Hurt-Deitch took a job in another state with a large Native American population. At her first meeting with her governing board, one of the directors asked her, “So, what tribe are you from?”

 

Everyone in the room was a bit stunned and Hurt-Deitch managed to say, “Excuse me?”

 

“Yeah,” the trustee went on. “Are you Cherokee? Choctaw? Chippewa?”

 

“There was no malice in it,” Hurt-Deitch says. “He wasn’t trying to malign me in any way. And I laughed and said, ‘I’m from the tribe of Mexicans. We’re from way south of here.’ But there was also a part of me that thought, ‘Who says something like that?’

 

“I don’t think I ever fully embraced the true meaning of cultural diversity until that point in time.”

 

 

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

By | July 14 th,  2015 | care coordination, finance, Pam Cipriano, chief nursing officer, nurses, Blog, nursing, value-based care, American Nurses Association, executive leadership, quality, Top 25 Women in Healthcare | 3 Comments

 

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

 

As the healthcare industry begins to shift to value-based care, Pam Cipriano is utterly convinced that nurses are prepared to lead that transformation in many ways.

 

“I believe nurses are continuing to be the key providers in this transition of care,” says Cipriano, president of the American Nurses Association, which represents the interests of 3.4 million registered nurses. “Nurses have been the owners of care coordination for decades – they have this skill as a core competency. They tend to be the most holistic members of the team regardless of settings.”

 

Care coordination, says Cipriano, is a linchpin for quality, and the industry is taking notice of the pivotal role nurses can bring to the entire equation.
“That may come under many different names: care coordinator, case manager, outcomes manager,” she notes. “The major insurance companies have already seen the enormous value of having nurses in these roles.”

 

In every quality-improvement initiative, it is nurses who play a crucial role in determining if that patient experience will succeed or fail, adds Cipriano, who has served on boards and committees for a variety of respected industry organizations, including the Joint Commission and the National Quality Forum.

 

“When providers say, ‘We’re going to prevent readmissions, we’re going to prevent hospital-acquired conditions, or we’re going to make sure that people with chronic conditions don’t come back to the emergency room for their care and that they’re taking their medications’ – it’s nurses who are driving all of these activities.”

 

Cipriano herself has been driving the agenda for the ANA since her election in 2014. Yet she took a non-traditional path to nursing, beginning in a med tech program at a state college in rural Pennsylvania. Dissatisfied, she began looking for a parallel course of study to which she could apply her chemistry and biology courses and ended up at the Hospital of the University of Pennsylvania School of Nursing. She became heavily involved in the National Student Nurses Association and her career took off. She eventually earned a Ph.D. and has served in a variety of leadership and teaching roles for the University of Virginia, including chief clinical officer and chief nursing officer.

 

Her first year leading the ANA was a whirlwind, including a very visible role as the nation dealt with a number of cases of Ebola.

 

“What was most important was not only protecting the nurses, but also making sure we played a role in reducing the fear and anxiety of the public,” she says. “There was so much bad information that was being propagated and people were unable to focus on the science in the height of emotion.”

 

The ANA worked with the AMA, AHA, CDC, HRSA and many nursing associations to provide information and a reasoned response to the situation. Cipriano even did a media tour with Rich Umbdenstock, retiring CEO of the AHA, guesting on numerous morning radio shows across the country to assuage the public’s concerns.

 

That’s the kind of leadership that many nurses demonstrate, Cipriano shrugs. But she is not sure they receive adequate credit for their executive acumen.

 

“First and foremost, I believe there is a myth that nurses don’t understand finance, and so I believe there is a bias against placing nurses in positions that would oversee an organization’s financial position and budgets,” she says. “Yet if you think about a typical hospital, over half of the personnel and usually more than half of the budget is under the leadership of the chief nursing officer.”

 

That’s a lot of responsibility. And so Cipriano admits one of her pet peeves is when chief nursing officers or executives don’t report to the chief executive officer of the organization.

 

“It is absolutely critical that the chief nursing officer not only report to the highest level executive but also has access to and regular interactions with the governing body of the organization,” she says. “We now have pretty solid data linking outcomes of care and patient satisfaction and engagement scores with direct relationships to not only the nurses but also other employees directly involved in care. So why would you relegate that CNO to a role that is viewed as less important?”

 

Cipriano says many nurses don’t seek out a CNO role not only because they prefer to manage at the point of care but also because of the politics that can derail a career at that level.

 

“If you talk to nurse executives across the country, there are many who have left their jobs or been removed from their jobs because they didn’t get along with the CEO or they didn’t go along with the CEO,” she says. “And so, being in a CNO job is really tough work advocating for person-centered care and those who provide that care.”

 

If you get the impression that Cipriano is a fierce advocate for nurses, you’re right. As she continues her term as ANA president through 2016, she’s also helping nurses adjust to possible shifts in the setting of patient care as it moves from primarily hospitals to all sorts of venues, including the home, along the continuum of care. She’s also testified at briefings on Capitol Hill championing the installation of lifting equipment because nurses and so many others are injured trying to lift patients.

 

“Nurses are fifth in line among occupations for the most musculoskeletal injuries, ahead of many manufacturing jobs. It’s scary,” she says. “The turnover cost for a nurse can be huge --- it can be over $100,000 for an organization.”

 

Ultimately, she says, she wants to see nurses recognized by consumers and policy makers as intelligent, highly skilled and resourceful healthcare leaders.
“I want nurses at every level to be recognized as individuals who bring a lot of underrepresented knowledge to the conversation.”

 

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.”

 

A devastating injury failed to derail Karen Daley’s remarkable career

By | August 2 nd,  2013 | prevention, women executives, C-suite, Karen Daley, medical devices, Medicare, Modern Healthcare, nurses, nursing shortage, president, sharps, Baby Boomers, Blog, injury, leadership, nursing, patient care, safety, safety needles, American Nurses Association, 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)

 

Karen Daley loved being a nurse, and she was a good one. But all that changed one day in 1998 when she was stuck by a needle while treating a patient. From that one needle stick, she contracted HIV and hepatitis C.

 

Her clinical nursing days were over. Over the next couple of years, she would undergo exhausting treatment regimens. But she was determined that the incident would not end her healthcare career.

 

“I learned how resilient I was physically and emotionally,” says Daley today, now president of the American Nurses Association and one of the 2013 Top 25 Women in Healthcare as chosen by Modern Healthcare. “It was a grueling time. I was constantly worried about fatigue, falling and exposing others to my blood, and I had little appetite because of the drugs. I looked sick.”

 

Yet while she underwent treatment, she plunged into advocacy, petitioning the U.S. Congress to change laws to reduce the odds that other nurses would have to face what she was going through. The laws were eventually changed to mandate use of safety-engineered sharps devices that could prevent similar injuries. Now, more than a decade later, compliance isn’t where it could or should be.

 

“We had to educate the healthcare system that these injuries and associated bloodborne pathogen exposures were preventable,” Daley explains. “Not only were they losing workers to these injuries, they were risking the goodwill of workers who learned over time that these were injuries that should not have occurred.”

 

In hospitals, she says, “prevention often is not seen as a viable strategy because it often costs money on the front end versus money you may or may not have to pay on the back end.”

 

While more safety needles are on the market and in greater use, Daley says the price drop that was promised by the medical device industry for the costlier devices as market penetration increased has not occurred. She also says federal enforcement of OSHA requirements is now a priority issue because “we know there are employers who are still not compliant with the requirements under the law.”

 

Beyond the institutional level and despite evidence that the overall number of these injuries has declined since the law was enacted, Daley says operating rooms remain a very high-risk area because surgeons control the kits and sharps that are used in each procedure, and are often resistant to changing their instruments or sharps devices. That has to change, she says. “Everyone’s health and safety is at risk with these injuries. It really is about what’s right across the board for a safer work environment.”

 

And medical device companies haven’t stopped making conventional or less effective early-generation safety needles and devices , nor have hospitals stopped buying them, she laments. “Today, despite the fact that the technology has improved significantly, we have some of the same devices on the market as when the law was passed.”

 

In the process of advocating around this issue, she says she’s learned that change is never simple, and that it’s important to get all stakeholders to the table, even congressional leaders who are feeling pressure from constituents and lobbying groups.

 

“For any movement, persistence is necessary,” she says. “It’s seeing the change through. We are still not where we need to be on needlestick injury prevention, so the need for persistence is another lesson learned.”

 

That’s a lesson she’s taken to heart in her own life, where she has gone back to the classroom numerous times to earn advanced degrees. Beyond her bachelor’s degree in nursing, she has earned a master’s in public health from Boston University School of Public Health, and a master’s in science and a PhD in nursing from Boston College.

 

To keep up with technological advances, the growing complexity of the healthcare system and patient healthcare needs, and to help combat the shortage of providers in healthcare, nurses need more education, she says.

 

“We need to make sure we’re helping nurses go back to school to advance their education. It’s an expensive proposition and that investment doesn’t always get recouped when they go back into the workforce,” Daley adds. “We also need to continue to grow the number of advanced practice registered nurses to provide care that is not going to be met by primary-care physician workforce, just based on numbers and geography.”

 

But shortages of all kinds are facing the practice of nursing, Daley says. There is an impending shortage of nurses, of nursing faculty, of chief nursing officers, and nursing-school deans – due to age, experienced nurses are retiring in large numbers. But the lack of adequate numbers of qualified nursing faculty is particularly vexing, she says.

 

“The faculty shortage represents a huge barrier for educating enough nurses. In fact, over the past several years, we’ve turned away more than 70,000 qualified applicants from nursing programs each year in this country because we don’t have enough faculty or clinical sites to accommodate them.”

 

Taken together, those numbers mean Daley will often be headed back to Capitol Hill to ask for more government funding to help to ease the crunch, exacerbated by the prospect of 2 to 3 million Baby Boomers aging into Medicare every year for the foreseeable future.

 

“We have to make sure the supply of care providers meets the demand,” she adds. “That care is largely going to be nursing care. So we have to feed the pipeline, and I’m concerned when I see so much reticence in Congress around the budget regardless of the issue, that we might not be able to keep up with what is going to be a very unusual shortage and critical demand over the next decade.”

 

Part of the issue, she suggests, is a lack of understanding of the value the nursing profession brings to patient care.
“What has to happen,” she adds, “is nurses need to be better understood as not simply compassionate caregivers, but as knowledgeable and skilled providers who impact patient outcomes and are licensed and accountable as part of their societal contract to assure patients of safe, quality care.”

 

She notes the case of two nurses in Texas’ Winkler County who anonymously reported a physician for unsafe practices (their allegations were proven to be true). But a law-enforcement official who was friends with the doctor uncovered the nurses’ identities and they were fired, prosecuted and indicted. Though they were later vindicated and won a settlement, the entire episode gives other nurses pause about speaking up, Daley says.

 

She is no less candid in describing the state of women in the C-suite, noting the paucity of female leaders in healthcare. “If I were to characterize it in one sentence, I would say we’re not doing very well at all in shattering the glass ceiling. We need to make a lot of progress to raze that ceiling.”

 

Daley hopes she can play a small role in changing that view of the ceiling.

 

“As I go out and speak with nurses and other leaders around the country, my job is to inspire and empower them to find their own voice, and to encourage them to take the risks that are necessary for making change. I want to help them continue in their own journey to be effective change agents within a larger system.”

 

Undaunted by the setback that ended her nursing career, Daley is taking her own advice to heart.

Personal experiences add passion to Maureen Bisognano's drive for patient-centered care

By | July 18 th,  2013 | Triple Aim, IHI, Maureen Bisognano, Modern Healthcare, nurses, patient-centered, patient safety, president, Blog, board of directors, CEO, Institute for Healthcare Improvement, leadership, nursing, safety, 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)

 

Questions.

 

Maureen Bisognano asks a lot of them. She asked many questions when she was a nurse, and when she ran a hospital. Now, she asks plenty as the President and CEO of the Institute for Healthcare Improvement, the renowned organization that helps the healthcare industry improve the quality and safety of care.

 

Leadership in these areas, Bisognano says, has to start at the top.

 

“Many boards and leadership teams still don’t understand the meaning of these quality measures, in cost terms, and in terms of the impact they have on patients,” she says. “Leaders get a quality report that is red, yellow or green -- self-defined colors that don’t tell them nearly what they need to know When I go to visit a board or a senior team, I ask them four questions to provoke them to think at a deeper level.”

 

Here are Bisognano’s four questions, with some of her comments for annotation:

 

**Do you know how good you are as an organization? “It’s knowing this qualitatively and quantitatively, not just in terms of red, yellow or green. Do you hear what patients are saying? Do you have patients at the board meetings? Not just patients who have been harmed, but ones who have had a great experience, because boards need to know where to reinforce quality as well as where to push for better quality.”

 

**Do you know where your variation is? “Boards and leaders mostly look at averages. So they don’t know if they’ve got some performers in their organization who are superstars and some who are really poor performers. By looking only at averages, they’re tolerating a level of bad performance that they wouldn’t if they better understood variation.”

 

**Do you know where you stand relative to the best? “Most leaders don’t know the answer to this. They look at their own data and they may not realize that there are other organizations in their state, in the country, or in the world that are doing dramatically different, dramatically better. And that provokes thinking.”

 

**Do you know your rate of improvement over time? “If you’re looking at static numbers, and thinking that they’re getting better, you may never know what the rate of improvement is. So I suggest to leaders that they always look at the rate of improvement over time.”

 


As the developers of the Triple Aim, IHI’s knowledge and unique culture encourage and nurture respect.
“At IHI, we are very much a team-based culture and our layout in Cambridge, Mass., reflects this,” Bisognano says. ”Everybody’s working throughout the course of a day on teams, so there’s constant challenge and learning and a great sense of camaraderie.”

 

Even Bisognano, the CEO, doesn’t have an office of her own.

 

“In my office, there are multiple workstations and a big table in the middle. So all day long, you’ll hear different conversations taking place. It’s very much a culture where, if you’re in the middle of something, you may need to stay focused on that. But if you’re interested in what your colleagues are talking about, you can turn around and contribute.”

 

Currently, Bisognano’s office has ten names listed outside its doors, representing a diverse mix of IHI senior executives, Fellows, and Senior Fellows, including the former chief executive of the National Health Service in England as well as the president of the National Academy of Medicine in Mexico.

 

Bisognano says IHI’s influence is felt in four concentric circles. Every 90 days, the members of the IHI R&D team select five to seven unsolved problems in healthcare to research in an attempt to generate solutions. That’s the inner innovation ring. The second circle is one focused on partnerships with organizations like Premier, Catholic Health Partners, Kaiser Permanente and the nation of Scotland to test out those solutions and demonstrate results.

 

The third circle is where IHI concentrates on equipping thousands of professionals with improvement skills and capabilities, using the educational vehicles of forums, seminars and webinars. The last, outer ring is all about dissemination, “getting the word out” on IHI’s website, via IHI’s online ”talk show,” WIHI, through blogs and social media, and by actively working with reporters on timely stories for a wide range of media outlets. Thus, the work begun by 130 people in IHI’s offices can reach millions.

 

“A lot of people know us by the Forum and by the Open School, but it’s a much more strategic and all-encompassing view when you look at us from the inside out,” she notes.

 

The focus on partnerships is critical, Bisognano says, because IHI wants to help equip healthcare providers with the tools they need to achieve optimal care. And to do that, the care needs to be patient-centered. That’s a mission and a journey that is very personal to Bisognano.

 

When she was in nursing school, Bisognano’s younger brother (she’s the oldest of nine children) was diagnosed with Hodgkin’s disease at a young age, a disease that ended his life.

 

“I watched healthcare provide what it could for him. But I also watched what it didn’t do for him, and that was to support him and our family facing this inevitable death,” she says.

 

She also grew in her own understanding, moving from a focus on what medicine could do, to what the patient wanted. She remembers vividly a day in a Boston academic medical center. The doctors had made their rounds as her brother Johnny grew weaker. One radiation oncologist, though, came back into the room.

 

“Johnny, what do you really want?” he asked.

 

“I want to go home,” he said.

 

The physician didn’t say a word. He came over to Maureen, took her jacket from her, and wrapped it around Johnny. Then he carried Johnny to Maureen’s car.

 

“I know that doctor broke every rule but he taught me an incredible lesson,” Bisognano says. “I thought my role was to give him encouragement and say, ‘Let’s try another round of chemotherapy.’ But my role was to ask him what he wanted. So when I got him home, I asked him what he wanted. He said, ‘I want to be 21.’ He died about five days after his 21st birthday. Those last few weeks were very meaningful, but very different. He was home, and we had all the family coming around to visit.”

 

She learned another lesson from Robbie, her sister’s son. Robbie was a perfectly healthy baby, but had a severe allergic reaction to a DPT shot at 2 months old that put him in the intensive care unit for a week. He recovered. At his 4-month exam, the doctor was about to give his 4-month DPT vaccine, when Bisognano’s sister stopped him.

 

“Don’t you remember what happened the last time?” she asked.

 

“No, what?” asked the physician.

 

She explained the reaction, the fear, the long hospitalization. The doctor paused for a moment, then said, “I don’t think the shot had anything to do with it, but I’ll only give him half a dose.”

 

The vaccine was administered. Robbie was dead within 24 hours.

 

Like Bisognano herself, her sister had questions.

 

“My sister asked me three questions,” she remembers. “Why were his records in the hospital separate from the records in the doctor’s office? How did the doctor not know that you don’t give even half a dose if there has been an allergic reaction? And, most importantly, why didn’t he listen to me?”

 

Those questions have driven Bisognano’s passion and guided her to this day.

 

“What happened to Robbie changed me. But my sister never sued. Most families who have experienced medical errors don’t sue. They’re looking for recognition and acknowledgment and apology more than anything else.”

 

One of the themes that Bisognano returns to is that healthcare is so complicated that a team approach is needed, and that one person can’t do it all.

 

She was with a group of residents recently who had come through a Lean training week.

 

“The first resident,” she says, “stood up to give his report and said, ‘I was blind to the mayhem. I would come in each morning, do my procedures, and I never saw all the other pieces of what was happening to these patients over the course of 24 hours, or over the course of a treatment diagnosis.’ ”

 

That light bulb moment is similar to what nurses experience continually, she says. The Top 25 Women in Healthcare include a lot of women who, like Bisognano, got their start in nursing; she believes this view of the sum of the parts is one reason so many nurses have made the transition to the corner office.

 

“Nurses are taught to see the whole health system, the whole journey of care, and we’re taught to see the family as part of the team,” she says. “I think that broad view of systems helps when you get to an executive level because you’re looking at how to put all the pieces together in a different and more effective way.”

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