C-Suite Conversations

What healthcare leaders need to know now

Tejal Gandhi galvanized as merger of IHI, NPSF multiplies efforts around patient safety

By | July 17 th,  2017 | chief executive officer, patient safety, Blog, Institute for Healthcare Improvement, National Patient Safety Foundation, Tejal Gandhi | 1 Comments

 

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 merger of the Institute for Healthcare Improvement and the National Patient Safety Foundation is now official, and Tejal Gandhi, who led the NPSF, couldn’t be happier.

 

“The reason for the merger was really based on mission,” she says. “IHI had been wanting to strengthen its efforts in patient safety, and that was part of its new strategy that it had been thinking about. And we on the NPSF side felt we had been doing some meaningful work in safety, but we’re small and wanted to expand our reach. It was a perfect union.”

 

In the new structure, Gandhi, a frequent honoree as one of the top leaders in healthcare, moves to a new role as chief clinical and safety officer for IHI. “I’ll be overseeing all of the safety efforts and, more broadly, getting engaged on some of the IHI’s other efforts across the spectrum of quality.”

 

In this, Gandhi will lean on her experience as the former executive director of quality and safety at Brigham and Women’s Hospital, and chief quality and safety officer at Partners Healthcare.

 

The patient-safety movement includes dozens of groups, with many different approaches and agendas. As a result, sometimes the approach and effectiveness can be fragmented. Gandhi says she hopes the merger, which combined two respected entities, can help focus future work.

 

“We want to be a single unified voice,” she says.

 

The NPSF released a major report in December 2015 called Free From Harm: Accelerating Patient Safety Improvement Fifteen Years After To Err Is Human, which outlines eight steps that the healthcare industry can take to significantly reduce mistakes and injuries in the healthcare setting. IHI’s muscle will allow for a broader discussion of the themes in that report. In addition, in conjunction with the American College of Healthcare Executives, IHI/NPSF recently released an executive “blueprint” to help healthcare leaders implement real, not theoretical, steps to reduce safety events under their watch.

 

“We think culture is driven through leadership,” Gandhi says. “The C-suite needs to take ownership and drive this culture of safety. We’ve been saying this for 15 years but haven’t necessarily given the C-suite the real tools to do it.”

 

The blueprint is designed to help change that. “If you look at data around the safety culture, we have a lot of room for improvement,” she says.

 

“There’s still about 40 percent of people who answer surveys who say they are worried about punishment if they speak up about an issue.”
A wide range of CEOs, safety officers and researchers convened to decide what would go into the blueprint.

 

“We’re very excited about the work,” she says. “It includes practical strategies and tactics for organizations to drive toward a culture of safety. And then, with the partnership of ACHE to help disseminate it, we have a lot of follow-up education planned.”

 

Gandhi also is taking her knowledge to the board room, knowing that directors can set the tone for healthcare organizations. Last October, she was asked to join the board at Aurora Health Care, a major Wisconsin health system.

 

“They wanted a physician, and they wanted someone who very much understood quality and safety,” Gandhi says. “I think Aurora has a great track record already in quality and safety, and they were enthusiastic about taking it to the next level. Given my new role at IHI, the opportunity to bring new ideas will be really exciting.”

 

Some of Gandhi’s ideas, thankfully, are catching on in patient safety, like looking at patient care in all settings, not just the hospital.

 

“When I started out in patient safety, my research area of interest was patient safety in the ambulatory setting,” she says. “We have constantly been pushing the fact that we need to think about safety across the entire care continuum. I think we’re finally seeing a shift now. People understand that it’s not just a hospital issue.”

 

IHI/NPSF currently has a grant from the Moore Foundation to conduct research on patient safety in the home, and Gandhi lists other areas that need scrutiny as well, from primary care to ambulatory surgery to dialysis centers.

 

Behind all these activities stands the need for transparency, which Gandhi has called a paramount attribute in a culture of safety.

 

“We’re making progress, but we have a long way to go – I feel like I say that about everything in safety,” she explains. “Compared to 15 or 20 years ago, there’s much more transparency about errors. There’s transparency about errors when they happen with disclosures and apologies, transparency with the public with data about mortality, infections and readmissions being available, and there’s transparency between clinicians or within and across organizations. But it’s far from perfect.”

 

Yet with all the progress, Gandhi remains wary about errors on another front – electronic health records.

 

“I’m a firm believer that EHRs can provide safety benefits through things like decision support and data accessibility,” she says. “We’ve seen many studies on the benefits of EHRs for quality and safety. But the flip side is that a lot of those studies were done in places that had customized, home-grown EHR systems developed with the end-user in mind. Most EHR systems aren’t like that. And we’ve seen examples of these systems actually creating unintended consequences or new errors.”

 

Gandhi says the IHI-NPSF merger is important because safety remains a bedrock issue that the healthcare industry has not fully come to terms with.

 

“I have spoken to many clinicians who say they would never let a loved one stay in a hospital without them present at all times,” says Gandhi, herself an MD. “But it’s unrealistic to think that’s a solution. Not everyone has a clinician in the family, and even those who do cannot avoid risks entirely. We need to improve safety for all patients in all settings at all times.”

 

 

SIDEBAR: Eight recommendations on safety from ‘Free From Harm’

 

Tejal Gandhi, MD, mentioned the report, “Free From Harm,” contains eight key goals for “achieving total systems safety”:

 

  • Ensure that leaders establish and sustain a safety culture.
  • Create centralized and coordinated oversight of patient safety.
  • Create a common set of safety metrics that reflect meaningful outcomes.
  • Increase funding for research in patient safety and implementation science.
  • Address safety across the entire care continuum.
  • Support the healthcare workforce.
  • Partner with patients and families for the safest care.
  • Ensure that technology is safe and optimized to improve patient safety.
  •  

     

    Hospital Safety Grade is a simple but powerful way that Leah Binder and Leapfrog Group help make patients safer

    By | May 25 th,  2017 | Healthcare, ambulatory care, Leah Binder, maternity, Modern Healthcare, patient safety, president, Blog, CEO, children's hospitals, employers, Hospital Safety Score, Leapfrog Group, outpatient, 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.

     

    Sometimes, the simple things are the easiest to understand. Perhaps that’s one reason that the Leapfrog Group’s Hospital Safety Grade has caught on in such a big way – even with hospitals, who largely weren’t all that thrilled when it was initially launched five years ago.

     

    “The response of hospitals has been one of the brightest spots for me in my career,” Leapfrog President and CEO Leah Binder says. “Hospitals are approaching their Hospital Safety Grade constructively. They’re talking about what they are going to do to improve and how proud they are of this ‘A.’ They talk about how they’re not going to stop their efforts to ensure that patients are safe, and describing what those efforts will be.”

     

    Every six months, Leapfrog assigns an A, B, C, D or F grade to 2,600 general, acute-care hospitals, rating their performance on safety. It uses standardized measures from the Centers for Medicare & Medicaid Services, its own hospital survey, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention and the American Hospital Association.

     

    “Many people – even if they’re on the board of a hospital – don’t realize the problem of safety,” Binder says. “When they look into it, they realize how many things can go wrong in a hospital, and that makes a big difference. That’s why I think it’s been important for us to highlight this in a way that’s easily accessible to laypeople.”

     

    While everybody wants an “A,” Binder has seen unfavorable grades spur some action.

     

    “We see boards get very upset. We see community members get upset. We see repeated articles in newspapers about poor grades,” Binder observes. “We’ve found that it gets their attention, which is a good thing. In fact, we’ve seen hospitals just completely turn around their safety programs when they get a bad grade.”

     

    What people outside the healthcare industry don’t always recognize is that the Leapfrog Group was founded by large employers and groups who purchase healthcare and wanted to see some changes in the quality of the care they were paying for.

     

    “Employers are not in the business of healthcare,” says Binder. “They’re in the business of doing other things. They make airplanes, and they make automobiles and they run retail department stores. And so, they don’t have a staff of 500 to figure out what’s going on in healthcare, so they rely on organizations like us to try to pull all those resources together for them and help them make the right strategic decisions.”

     

    Leapfrog has some compatriots in this area, including the National Business Group on Health, regional groups, and a newcomer called Health Transformation Alliance, in which 20 major employers are teaming up to lower prescription costs, review claims together, structure benefits and create networks.

     

    “There’s probably at least 50 organizations that represent specialties for physicians alone,” Binder says. “I don’t think there are nearly enough organizations that are advancing purchaser concerns about healthcare delivery. The purchasers pay for about 20 percent of the $3 trillion healthcare industry, which is a lot of money.”

     

    Despite the increased scrutiny, Binder says she thinks the healthcare industry has taken its eye off safety, given the myriad deaths still linked to errors each year.

     

    “I think the industry has not been focused on patient safety enough. They’ve been distracted by the compliance with the Affordable Care Act, value-based purchasing, bill payments, new models for financing and delivering care, and change in state and CMS regulations. While those efforts are important, nothing is as critical as making sure people don’t die from preventable errors. Safety has to come first, every minute of every day. Otherwise, patients will suffer.”

     

    Binder is doing her best to keep the priority on patients. – in fact, the organization is broadening its reach at the request of its members to take a closer look at other sticky matters in safety:

     

  • Maternity. “Employers pay for half of all the births in this country. Childbirth is by far the number-one reason for admission to a hospital. A C-section is the number one surgical procedure performed in this country. So, we now have some incredible data on maternity care, and employers are starting to meet with hospitals and design packages that encourage the use of hospitals with lower C-section rates based on the Leapfrog data.”
  •  

  • Outpatient and ambulatory care. “We’re going to start rating outpatient surgical units and ambulatory surgical centers. That’s a big priority for purchasers because they are sending a lot of employees to ambulatory surgical centers because they tend to be lower-priced. That’s great – some of them are excellent – but we don’t have enough good data nationally to compare them on safety and quality.”
  •  

  • Children’s hospitals. “There’s a lot of people who would never travel outside their community for their own healthcare, but will travel if they have a very sick child. This year, we added two new measures. We ask pediatric hospitals to do a CAP survey for children’s hospitals. The other thing we’re looking at is exposure to radiation. Sometimes, children have repeated imaging and it can really add up.”
  •  

    Although it is Leapfrog’s job to act as a watchdog for employers and patients, Binder says she does see some positive movement.

     

    “There are bright spots,” she says. “There is a Partnership for Patients program that just concluded with CMS that has demonstrated some real impact. We see reductions in certain kinds of infections and real changes in the ways that hospitals are approaching patient care to address safety. CMS has tracked some saved lives as a result of those changes, and we certainly appreciate those numbers. We’re going in the right direction; we just need a lot more push.”

     

     

    SIDEBAR: Making a difference with the mundane

     

    Hospital deaths and injuries from errors are not always obvious.

     

    “When someone dies from an error or an accident, it’s not easy to track,” says Leah Binder, president and CEO of the Leapfrog Group. “It often doesn’t show up in claims. It can be complicated – the death might be attributed to something else even though, say, there was clearly an infection that hastened the death. It’s just kind of the course of business in the hospital.”

     

    Nearly two decades after the ground-breaking report “To Err is Human,” far too many people are still being killed and injured in healthcare settings, Binder says.

     

    “More than 200,000 people are dying every year from preventable accidents in hospitals,” she says. “We believe that’s a low estimate. There’s lots of accidents and problems in hospitals we can’t measure because no one is tracking them. An example of that would be medication errors, which are the most common errors in hospitals. There’s not a standardized way of tracking that, so we don’t even know how many deaths or adverse events result.”

     

    What is especially frustrating for Binder and her team is that many injuries and deaths happen in spite of the fact the healthcare industry knows how to prevent them. “The fact is, patient safety requires a disciplined, persistent commitment to the mundane habits that save lives,” she says.

     

    “How much more mundane can it possibly be than to say, ‘Everybody needs to wash their hands all the time’? ‘We need to wear the right protective clothing.’ ‘Follow the rules – every single rule every single time.’ ‘We need to do the same checklist every time we do a surgery.’

     

    “Let’s face it, these sound boring. But done systematically, they save lives. And everyone in patient care needs to be disciplined about doing them.”

     

     

    ICYMI: Top 25 Women in Healthcare: Tejal Gandhi

    By | October 23 rd,  2015 | Lucien Leape Institute, Modern Healthcare, patient safety, Blog, boards, Brigham and Women's Hospital, CEO, chief quality and safety officer, National Patient Safety Foundation, Partners Healthcare, safety, Tejal Gandhi MD MPH CPPS, quality, Top 25 Women in Healthcare | Add A Comment

     

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

     

    The patient-safety movement has made slow and steady progress in the U.S. healthcare industry. But to achieve a faster pace of change, Tejal Gandhi, MD, MPH, CPPS, says change needs to come from the top of each organization – and that means above the CEO.

     

    “We talk about CEOs and leadership in terms of patient safety, but I think the involvement of governance and boards is a major gap we’re overlooking,” says Gandhi, president and CEO of the National Patient Safety Foundation. “Most boards don’t know much about quality and safety. They tend to leave that to the clinicians and aren’t necessarily demanding better performance in this area.”

     

    The move away from fee-for-service payment in healthcare makes this even more critical, she adds.

     

    “If you start to pay for value, part of the value is quality and safety,” Gandhi says. “Boards are going to have to become more knowledgeable, and they will; they are smart people and will ask the right questions. Workplace safety is a big issue in every industry. The directors will need to demand more and even think about CEO incentives being tied to safety and quality.”

     

    Gandhi, who served as chief quality and safety officer at Partners Healthcare and executive director of safety and quality at Brigham and Women’s Hospital before joining NPSF, believes most healthcare CEOs want to improve safety but get overwhelmed about where and how to begin.

     

    “I think CEOs want to create the right culture – they know a culture of safety is important – but how to actually do it is where the challenge is.”

     

    One key element of NPSF is its respected think tank, the Lucian Leape Institute, named after the Harvard physician and researcher regarded as one of the pioneers of the patient-safety movement. At the institute’s retreat last February, Gandhi said the leaders came to the conclusion that they needed to sharpen their focus on helping healthcare CEOs.

     

    “For the last five years, we’ve been focusing on what we call the transforming concepts, the big issues that we need to see change to really make advancements in safety – issues like patient engagement, transparency and reforming medical education,” she says.

     

    “At the retreat, we asked, ‘Where are we struggling, and what theme ran across all five of the reports we released on the major issues?’ The theme was culture.”

     

    Back when the seminal “To Err Is Human” report on medical harm was published in 1999, little was written about culture in the healthcare environment. Today, notes Gandhi, culture can be measured and stakeholders sometimes insist that organizations do just that. Going forward, the Leape Institute plans to get down to brass tacks to help CEOs create safer systems.

     

    “We can’t just say, ‘Go change your culture,’ ” Gandhi says. “We need to give people things that are much more tactical. And I come from an operational, tactical background so I like the fact that we’re going to create a playbook that says, ‘Here are the concrete steps you can take as a CEO to start down this path.’ ”

     

    As a relatively young CEO who has been on the job for two years, Gandhi has great empathy for leaders. She says her own learning curve was steep and that getting up to speed on issues ranging from finance to human resources to even real estate “was like drinking through a fire hose for the first six months. There’s a different level of stress when you’re the leader, so that’s taken some time to get used to. But what makes this job fun is the learning.”

     

    Key to any discussion of quality and safety in a healthcare setting are the doctors, and Gandhi, a board-certified internist, worked in clinical care for many years.

     

    She is hopeful that the transition to value-based care will allow mid-level providers to participate more in patient care and allow physicians to get back to having significant conversations with their patients. Primary care physicians, she said, sometimes have a tough time even visiting their patients in the hospital because they’re seeing an overwhelming number of patients in clinic on any given day.

     

    “The primary care physician is the person who can advocate for the goals and values of the patient when interfacing with the rest of the healthcare system,” she says. “I’ve seen payment models where the primary care doctor gets reimbursed for going to the hospital and seeing a patient. It’s very important.”

     

    While patients can and should partner with physicians on decision-making and with organizations by being welcomed onto quality improvement committees, Gandhi says the predominant responsibility for patient safety should be with the caregivers.

     

    “The whole ‘ask-me-if-I-washed-my-hands’ thing drives me a little crazy because the patient shouldn’t have to ask – that’s on us,” she says. “But we do need their advocacy, making sure patients feel comfortable asking questions, that they agree with and understand their plan of care and that their voice is part of creating that plan.”

     

     

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

    By | August 12 th,  2015 | Healthcare, Leah Binder, Leapfrog Hospital Survey, patient safety, president, Blog, CEO, executive compensation, Hospital Safety Score, Leapfrog Group, quality, Top 25 Women in Healthcare | 1 Comments

     

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

     

     

    Patient-safety organizations have proliferated in the last decade, from the respected National Patient Safety Foundation to numerous groups founded by patients or their relatives who have experienced pain and loss from medical errors. Yet few have the muscle that the Leapfrog Group does, using its research and clout on behalf of businesses that pay for their employees’ healthcare coverage.

     

    That marriage of safety and statistics, with a streak of blunt boldness, is personified by Leapfrog President and CEO Leah Binder, who has led the organization since 2008. She is a friend to many in the industry, but notes that Leapfrog fiercely guards its watchdog status.

     

    “I think a lot of people who are involved in the healthcare industry also have tentacles into a lot of different interest groups that they need to maintain strong ties to,” she says. “And while we also like to maintain strong ties to and collaborate with our colleagues in healthcare, we maintain a strong independence from the industry. And that has enabled us to talk about reality in a way that is different from what others who are within the system feel able to do.”

     

    While she is a champion of the quality care that many systems and physicians provide, she’s not afraid to take them to task when she feels U.S. consumers and their employers aren’t getting stellar treatment. Leapfrog’s voice has been getting louder and more urgent lately, Binder notes, because it hasn’t always seemed that the healthcare industry has been paying attention.

     

    “When I am speaking from the perspective of a purchaser who is spending more money on healthcare than they earned in profits last year, they expect tough talk,” she says. “They want to make sure their employees are safe and healthy and they get the right value for their money. It’s just been very difficult to get that message out to the healthcare community that employers want change and expect it.
    “I’ve certainly had to begin to communicate in ways that make clear that the business community considers this to be serious business.”

     

    Binder got to know the Leapfrog Group when she was vice president of Franklin Community Health Network, a healthcare system in Maine that participated in Leapfrog’s surveys on quality and safety. Prior to that, she was a senior policy advisor to then-New York City Mayor Rudolph Giuliani. She began her career as public policy director for the National League of Nursing.

     

    Her life-changing encounter with the importance of safety came when her infant son was sick, and she and her husband couldn’t get their pediatrician to listen to them.

     

    “When he was 3 weeks old, he was misdiagnosed with acid reflux. The actual diagnosis was that he had pyloric stenosis which, if it goes untreated for too long of a period, can be dangerous if not deadly,” Binder remembers. “And it was only because of my husband’s aggressiveness in insisting on a re-evaluation of him that we were able to get him in for emergency surgery. And that probably saved his life.”

     

    The episode made a deep impression on Binder and her family.

     

    “It just showed me that when ordinary people like me make mistakes – perhaps we miss an appointment or forget to get milk from the grocery store – they don’t have a huge impact. But when you’re in healthcare, even minor mistakes can have catastrophic effects for people. That’s a lot of pressure on people who work in the healthcare system and it is a lot of responsibility. It made me realize just how important it is for us to respect that and to make sure that vigilance continues.”

     

    The Leapfrog Group conducts its vigilance through the Leapfrog Hospital Survey, an annual report that tracks hospitals’ performance on safety, quality and efficiency. Its Hospital Safety Score also assigns letter grades – from A to F – to more than 2,500 U.S. hospitals.

     

    While numerous groups create “top hospital” rankings each year – so much so that a provider can pick and choose which report shows it in the most favorable light – Binder says she believes one factor elevates Leapfrog’s reach beyond the others: transparency.

     

    “Our transparency is absolute,” Binder asserts. “We make everything public by hospital and there are a number of groups working with hospitals that specifically do not make that data public. They collect it in order to work with it internally to improve the safety profiles of their members, and that’s certainly one model. We believe that transparency actually galvanizes improvement faster, but we support the fact that these other groups are working on it and we know they have had success.”

     

    The other pressure that the Leapfrog Group brings to bear on safety and quality is financial in nature.
    “We are working from the perspective of the purchaser, so we want to bring value-based purchasing into the equation,” Binder says. “We really want to start to tie payment to performance on key safety and quality metrics. Employers want to see results.”

     

    Binder said she believes the industry has made significant progress on quality and safety, although she admits that the pace of change is uncomfortably slow. She is concerned about consolidation among providers and payers because she says the trend “traditionally has meant lower quality, higher costs.” But lasting change, she adds, has to come from the top, and she is not convinced healthcare CEOs have made safety the priority it should be.

     

    “For me, when we start seeing CEOs believe their jobs are on the line if they can’t get the safety record better, that’s when we’re going to see rapid change,” she says. “I have heard directly from some CEOs who say that it was a very significant moment in their career when they saw the Leapfrog letter grade that reflected poorly on their hospital, and that spurred them into action. I’ve also seen some hospitals or systems that are putting CEO and senior-level compensation at risk based on their letter grade or their safety record, and that’s also a very positive sign. But we’re not there yet.”

     

     

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

    By | July 24 th,  2015 | Lucien Leape Institute, patient safety, physicians, Blog, boards, Brigham and Women's Hospital, CEO, chief quality and safety officer, directors, National Patient Safety Foundation, Partners Healthcare, Tejal Gandhi MD MPH CPPS, culture, quality | Add A Comment

     

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

     

    The patient-safety movement has made slow and steady progress in the U.S. healthcare industry. But to achieve a faster pace of change, Tejal Gandhi, MD, MPH, CPPS, says change needs to come from the top of each organization – and that means above the CEO.

     

    “We talk about CEOs and leadership in terms of patient safety, but I think the involvement of governance and boards is a major gap we’re overlooking,” says Gandhi, president and CEO of the National Patient Safety Foundation. “Most boards don’t know much about quality and safety. They tend to leave that to the clinicians and aren’t necessarily demanding better performance in this area.”

     

    The move away from fee-for-service payment in healthcare makes this even more critical, she adds.

     

    “If you start to pay for value, part of the value is quality and safety,” Gandhi says. “Boards are going to have to become more knowledgeable, and they will; they are smart people and will ask the right questions. Workplace safety is a big issue in every industry. The directors will need to demand more and even think about CEO incentives being tied to safety and quality.”

     

    Gandhi, who served as chief quality and safety officer at Partners Healthcare and executive director of safety and quality at Brigham and Women’s Hospital before joining NPSF, believes most healthcare CEOs want to improve safety but get overwhelmed about where and how to begin.

     

    “I think CEOs want to create the right culture – they know a culture of safety is important – but how to actually do it is where the challenge is.”

     

    One key element of NPSF is its respected think tank, the Lucian Leape Institute, named after the Harvard physician and researcher regarded as one of the pioneers of the patient-safety movement. At the institute’s retreat last February, Gandhi said the leaders came to the conclusion that they needed to sharpen their focus on helping healthcare CEOs.

     

    “For the last five years, we’ve been focusing on what we call the transforming concepts, the big issues that we need to see change to really make advancements in safety – issues like patient engagement, transparency and reforming medical education,” she says.

     

    “At the retreat, we asked, ‘Where are we struggling, and what theme ran across all five of the reports we released on the major issues?’ The theme was culture.”

     

    Back when the seminal “To Err Is Human” report on medical harm was published in 1999, little was written about culture in the healthcare environment. Today, notes Gandhi, culture can be measured and stakeholders sometimes insist that organizations do just that. Going forward, the Leape Institute plans to get down to brass tacks to help CEOs create safer systems.

     

    “We can’t just say, ‘Go change your culture,’ ” Gandhi says. “We need to give people things that are much more tactical. And I come from an operational, tactical background so I like the fact that we’re going to create a playbook that says, ‘Here are the concrete steps you can take as a CEO to start down this path.’ ”

     

    As a relatively young CEO who has been on the job for two years, Gandhi has great empathy for leaders. She says her own learning curve was steep and that getting up to speed on issues ranging from finance to human resources to even real estate “was like drinking through a fire hose for the first six months. There’s a different level of stress when you’re the leader, so that’s taken some time to get used to. But what makes this job fun is the learning.”

     

    Key to any discussion of quality and safety in a healthcare setting are the doctors, and Gandhi, a board-certified internist, worked in clinical care for many years.

     

    She is hopeful that the transition to value-based care will allow mid-level providers to participate more in patient care and allow physicians to get back to having significant conversations with their patients. Primary care physicians, she said, sometimes have a tough time even visiting their patients in the hospital because they’re seeing an overwhelming number of patients in clinic on any given day.

     

    “The primary care physician is the person who can advocate for the goals and values of the patient when interfacing with the rest of the healthcare system,” she says. “I’ve seen payment models where the primary care doctor gets reimbursed for going to the hospital and seeing a patient. It’s very important.”

     

    While patients can and should partner with physicians on decision-making and with organizations by being welcomed onto quality improvement committees, Gandhi says the predominant responsibility for patient safety should be with the caregivers.

     

    “The whole ‘ask-me-if-I-washed-my-hands’ thing drives me a little crazy because the patient shouldn’t have to ask – that’s on us,” she says. “But we do need their advocacy, making sure patients feel comfortable asking questions, that they agree with and understand their plan of care and that their voice is part of creating that plan.”

     

     

    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.”

     

    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.”

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

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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


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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

     

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

    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 The undercover exec: Wright Lassiter III scoped out his hospital before he took the job, then forged a bond with his board to stage a remarkable turn

    By | September 11 th,  2012 | board, Furst Group, Healthcare, executive, Minority Executives, Modern Healthcare, patient safety, Alameda County Medical Center, Blog, CEO, directors, leadership, Top 25, Wright Lassiter III, quality, trustee | Add A Comment

    Lassiter

     

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

     

    Back in 2005, before Wright Lassiter III interviewed for the position of CEO at the then-beleaguered Alameda County Medical Center in Oakland, Calif., he decided to see for himself if there were some signals of hope in an institution that had seen 10 CEOs crash and burn in the previous 11 years.

     

    “I flew in the afternoon before and grabbed a taxi over to the hospital,” he says. “I was in street clothes; I wasn’t in a suit. No one knew who I was. I walked into the ER waiting room and then walked the hallways. I wanted to get a sense of how the staff functioned; to see if people might help you find your way.”

     

    What he found surprised him, especially for an organization with such a troubled recent past. Everyone he encountered was consistently courteous and helpful to him as a visitor, and to patients.

     

    “There wasn’t one interaction that was negative,” Lassiter remembers. “The people doing the work in the trenches serving the community were doing the best they could.”

     

    That, Lassiter says, gave him some hope that the health system could be turned around with the right moves. It also helped persuade him to give up a solid, comfortable position at JPS Health Network in the Dallas-Fort Worth area where he was senior vice president of operations.

     

    Fast-forward a few years and the work that Lassiter has accomplished earned him a glowing write-up in Fast Company magazine, a spotlight that brought him national attention as well as some good-natured ribbing from his peers, he adds.

     

    But to Lassiter, none of it would have happened without the backing of his board of trustees, a source of strength that is sometimes overlooked in the business world, he says.

     

    “Two board members who served on the search committee that selected me are a large part of the reason why I considered the job in the first place,” Lassiter says. “They were instrumental in the turnaround. I think it’s important for CEOs to partner with their boards to drive change.”

     


    It was the board’s backing that enabled him, he says, to press forward with an aggressive plan to reduce errors and champion quality and patient safety.

     

    “I generally take my board members to health care conferences to help them understand the nuances of what’s being presented,” he says. “But I purposely did not go with my vice chair when he attended an IHI conference on quality because I didn’t want to influence him. He went with our chief medical officer instead. When he came back, he told me, ‘OK, Wright, I get it. I am scared out of my mind, but we have to do this.’ ”

     

    The leaders at Alameda County Medical Center presented a plan for “harm reduction” and, in 18 months, reduced incidents of harm by 48.5 percent across the system.

     

    “People get uncomfortable with the word ‘harm,’ but the board agreed that it was the correct word to use. The groundbreaking report “To err is human” found that harm was happening in hospitals and we were willing to acknowledge that a problem existed,” Lassiter says bluntly. “Our work drew glowing comments from the Joint Commission and Donald Berwick, a member of the original committee that published the report on errors. That’s what happens when you educate a board well and then engage them.”

     

    Healthcare and leadership are part of Lassiter’s heritage. His mother is a nurse, and his father is chancellor of the Dallas County Community College District. What he’s learned from them, and from his career, is that a critical factor in leadership is simply courage, like the move he made in accepting the Alameda position. “That doesn’t mean blind courage,” he notes, “or taking risks that are inappropriate. But when the lights are off and you don’t know what’s around the corner, you have to lead with courage.”

     

    Closely aligned with courage, he says, are transparent communication and flexibility. “Communication is especially important with the medical staff,” Lassiter notes. “You tell them, ‘Here is our plan, and we will keep communicating with you all the way through this process.’ ” It’s a reason why he still takes part in new employee orientations, he says.

     

    Flexibility is based in honesty, Lassiter says. “You have to do your planning with flexibility. You can plan so that you have a baseline for your actions as an organization, but you have to be willing to be flexible if conditions change.”

     

    And as conditions change within the healthcare industry itself, he says, building a leadership team requires flexible people. “Healthcare is a relationship business, and I’m always looking for folks who can foster, build and maintain strong relationships. It takes perseverance too. You can’t be dissuaded easily by problems or challenges.”

     

    At Alameda, the challenges have been formidable, but Lassiter and his team have stepped up to the task, stopping seven-figure financial losses and building a new facility while dealing with all the issues that come with being a safety-net hospital.

     

    “When I talk to our people, I say, ‘Think of your loved ones and put their faces on the patients and families you’re caring for.’ When you approach your work with this in mind, you will do all you can to provide excellent service.”

    Page 1/2