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At Ascension, Patricia Maryland’s patient-centered focus aligns with a passion for analytics

By | September 25 th,  2015 | Healthcare, Patricia Maryland, executive, Modern Healthcare, patient-centered care, president, analytics, Ascension, Blog, leadership, Top 25 Women in Healthcare | 1 Comments

 

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

 

As the oldest daughter in a large family, Patricia Maryland, Dr.PH, was often left in charge when her mother was hospitalized during a years-long struggle with Type 2 diabetes. Her mother eventually died of complications from the condition, and Maryland recalls her frustration with the fragmented healthcare system in which they found themselves.

 

“We didn’t understand at that time she needed more than general primary care,” she says. “Someone should have been helping us navigate her care to the appropriate subspecialist and other support systems as her condition continued to worsen.”

 

Unfortunately, similar stories have played out within hospitals and health systems across the United States.

 

As president of healthcare operations and chief operating officer of Ascension Health, a subsidiary of Ascension, Maryland is committed to leading change – knowing from experience the great need for personalized, coordinated care in this ever-changing healthcare environment.

 

“I think we can do a better job in healthcare,” says Maryland. “The time has come for us to turn the process upside down – or should I say right-side up – organizing the providers around the needs of the patients, not expecting the patients to figure where to go in our complicated health systems to get the care they need at the convenience of the providers.”

 

As the world’s largest Catholic health system, Ascension’s mission is steeped in delivering spiritually-centered, holistic care to all with special attention to those who are poor and vulnerable. Maryland makes a point of saying that all healthcare leadership should approach the business of healthcare from a similar perspective.

 

“Without passion for why we are here and what we are trying to do, we will not be able to be the transformational leaders that healthcare needs today.”

 

That passion has not dampened her business objectivity, however. Quite the contrary. Maryland’s passion is paralleled only by her dedication to analytics, cultivated through her master’s degree in biostatistics and doctorate in public health.

 

 

Maryland explained that biostatisticians tend to work in pharmaceutical industries or medical research areas, with a focus is on efficacy, research, precision and statistical analysis. However, she believes that in today’s health industry, metrics are essential for all healthcare leaders.

 

“Data analysis is the lifeline of any business, particularly a healthcare organization,” she says. “It is vital that we maintain clear and measurable data so that we can address opportunities for improvement that would not be realized otherwise. By tracking trends, Ascension analyzes where we need to go and what decisions we need to make on any given initiative.”

 

Maryland says statistics are especially crucial as the roles of payers and providers overlap and converge.

 

“As we think about population health management and the direction that the health industry is moving, analytics and the ability to predict outcomes using data is so important,” she says. “Predictive analytics have helped us manage risk.”

 

Her background has come in handy as Ascension has moved boldly into this new era of providers taking on risk. She was one of the architects of Together Health Network (THN), formed by partnering with Trinity Health, another Catholic system, to create a physician-led, clinically integrated network in the state of Michigan. THN worked with Blue Cross Blue Shield of Michigan to create Connected Care, a Medicare Advantage product that rolled out in January 2015 and already has surpassed enrollment projections.

 

“We are especially attractive to payers because our organizations – both Trinity and Ascension – have some of the best metrics in the state,” Maryland says. “We are able to offer the value combination of high quality and low cost to major payers, and to take on and manage their members with a level of consistency.”

 

With Ascension operating in 23 states as well as the District of Columbia, the THN experience has been a strong test run to for the organization in developing comprehensive, integrated systems of care. It’s also working to round out other parts of the care continuum – including senior care and home care – so it can better serve its communities.

 

Ascension also has taken the plunge into insurance. The system acquired U.S. Health and Life Insurance Co. last December and is using that platform as well as MissionPoint Health Partners, its population-health management company, to develop benefits and gain experience by managing the quality and cost of care for Ascension’s own associates and their dependents. In essence, it has become its own incubator for development of an insurance product for self-insured employers.

 

“We are going to pilot it first with our own employees,” Maryland says. “Once we have a proven track record with our associates, we’ll take it to market. How do we go anywhere else and offer the product unless we ourselves can say, ‘Look at our results.’ This is also why data is so important. We believe we have the best practices, and with this data we will be able to demonstrate it.”

 

From new partners to new products, healthcare’s future looks a lot different than it did just a few short years ago. Yet despite the changes in how her system and the industry operate, she says the fundamentals are the same. After all, as Maryland knows, healthcare is deeply personal.

 

“Considering Ascension’s scale and scope, we asked ourselves, ‘If not us, then who?’ We are committed to leading change in the healthcare arena,” she says. “Through standardizing and connecting once disparate systems, we remain true to our Mission of delivering compassionate, personalized care to those who need it the most.”

 

 

Quality, safety fuel Pujols McKee's drive at The Joint Commission

By | October 6 th,  2014 | chief medical officer, Furst Group, Healthcare, Penn Presbyterian Medical Center, physician engagement, Top 25 Minority Executives in Healthcare, executive, Modern Healthcare, patient-centered care, patient safety, physician, Ana Pujols McKee, Blog, diversity, leadership, The Joint Commission, quality | Add A Comment

 

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

 

Ana Pujols McKee’s passion for quality and safety existed long before she joined The Joint Commission as executive vice president and chief medical officer. She previously served as the CMO and associate executive director of Penn Presbyterian Medical Center, in Philadelphia, and as a clinical associate professor of medicine at a teaching hospital in Philadelphia. Pujols McKee has championed for years the need for transparency and patient-centered care.

 

“I’ve had my own personal experience with injury as a patient, and I think what began to propel me in this area were some of the unfortunate patient injuries I had to deal with as a chief medical officer. Seeing up close how deep the injury extends to the patient and family is truly overwhelming,” she says.

 

The physicians and nurses who are involved in an incident when a patient is harmed suffer too, she is quick to add.

 

“What we don’t always talk about is what we now refer to as ‘the second victim,’ and that’s the clinician and staff that are injured as well. It’s a tough situation.”

 

Being able to make strides in that area, Pujols McKee says, has been one of the highlights of her career.
“When you work at an organization and you start to see those injuries decrease, and you start to see your infection rate come down and you start to see (patient) fall rates come down, there is nothing more rewarding than that – to know that you’re making a difference.”

 

From the time she was a child, she says, she knew she wanted to not only become a doctor but to run a large clinic – “all those altruistic dreams of taking care of people and making people well,” she says with a chuckle.

 

Pujols McKee’s prospects on the surface looked daunting – the world in which she grew up had some prejudicial obstacles blocking her way. She remembers constantly visiting a high school counselor to obtain information on college admission, only to have the woman continually tell her that she was busy or had no guidance for her.

 


“One day, I walked in on her as she was sitting in a circle with students who all were white, along with a gentleman in a suit,” she relates. “She jumped up from the chair and started to dismiss me when the gentleman said, ‘No, let her come in. Remember? I told you I was looking to recruit minority students.’ ”

 

It was, she says, a devastating experience, but not uncommon. “I have been told similar stories from many people of color. I’m not unique in any way. This is the way things were back then – and I believe they are, in some situations, not very changed.”

 

Besides being a driven student, Pujols McKee says, her parents were a strong cheering section. In her Puerto Rican family, her father was an electrician and her mother was a teacher. Together, they taught her the importance of perseverance as she grew up in the South Bronx.

 

“If I came home and said, ‘They closed the door on me, Dad!’, my dad would say, ‘Go right back out and open it.’ ”

 

She is hopeful that the changing face of The Joint Commission, which she joined in 2011, opens many doors for hospitals to achieve their full potential.

 

“When I got to The Joint Commission and I started to see how Dr. (Mark) Chassin, our president, was transforming our organization, I found it extremely exciting,” Pujols McKee says. “He has boldly said that accreditation is really the floor for transformation. We want to help organizations go above and beyond that.”

 

To that end, The Joint Commission enterprise has expanded its offerings by adding a new affiliate to its portfolio, the Center for Transforming Healthcare, to help health care organizations improve patient safety through the use of Robust Process Improvement™ tools including Lean Six Sigma and change management. The commission also partnered with the American College of Physician Executives to begin an academy for chief medical officers.

 

“One of the things I’m doing at The Joint Commission is leading a strategic initiative to support our physician leaders and provide them with the skills and resources that they need,” she says. “We recognize the need to support physician leaders as critical since, when we see a high-performing organization, we almost consistently see a high level of physician engagement.”

 

Pujols McKee’s own journey from clinician to C-suite executive has been typical of physician leaders, she says – one that included some growing pains.

 

“In today’s world, there’s so much transition that has to occur in an organization from the administrative to the clinical side,” she says. “I think we’re coming close to a time when it’s almost impossible to make that transition without being mentored or being part of a succession plan that includes spending time with finance, quality, and the operations team.”

 

Such transitions, she says, need to thoughtfully include more diverse leaders to improve healthcare and to more accurately represent the diverse communities they serve.

 

“The pipeline for future physician leaders has a fair number of women, but in terms of African-Americans and Latinos, the outlook is not very promising. There are some who believe that until we improve diversity in health care leadership, disparities in health care are not going to be fully addressed.”

 

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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