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

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

 

Elizabeth-Nabel-Headshot

 

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

ACHE’s Deborah Bowen: Healthcare leadership is still about people trying to make a difference

By | August 18 th,  2015 | disparities, Healthcare, ACHE, ACHE Congress, American College of Healthcare Executives, Deborah Bowen, Modern Healthcare, president, Blog, CEO, diversity, FACHE, healthcare policy, Top 25 Women in Healthcare | Add A Comment

 

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

 

 

Deborah Bowen guides one of the most influential associations in healthcare, but her complex work with C-suite leaders is rooted in a simple desire: to change people’s lives for the better.

 

As the president and CEO of the American College of Healthcare Executives, Bowen heads an enterprise that assists administrators in developing their abilities to lead their organizations. Its Fellow certification (FACHE) is one of the most respected designations in the halls of a health system and its annual Congress is one of the industry’s biggest draws. But Bowen says she herself is drawn to the servant leaders she sees all around her.

 

“I think one of the great things about this profession and this field,” she says, “is that I’ve always found the people in it are very dedicated to giving back. I think we all come to it from a place of trying to make a difference in whatever way we can.”

 

Bowen began her career as a social worker dealing with some of the toughest issues out there – drug addiction and alcoholism.

 

“I started out working with heroin addicts,” she says. “That is a difficult line of business because people often don’t get better because they don’t have the right support networks. Some of them get detoxified, but then they’re going right back into the same environment that probably drove them to addiction in the beginning. That was the catalyst for me to say, ‘Maybe there is another way to do this work that might have more impact.’ ”

 

She moved on to Wisconsin’s Department of Health and Social Services, where she gave grant money to programs battling drug abuse and alcoholism.

 

“That’s where I started to learn a little but more about what it means to influence decision-makers,” Bowen says, “and if you influence decision-makers, you can potentially have a bigger imprint in changing policy.”

 

 

Her interest in policy work led her to the state medical society, where she held a variety of roles.
“I have a great deal of respect for physicians and the work that they do,” she says. “Wisconsin was very progressive in their thinking. We opened free clinics. We did a lot of good work there, which I’m sure continues today. So my first foray into association management was through the physician community.”

 

She eventually spent a number of years at ACHE, but found the path to advancement blocked, so she joined the Society of Actuaries in the No. 2 role before ACHE recruited her back to become the chief operating officer under longtime CEO Tom Dolan.

 

When Dolan announced his retirement, Bowen says she never thought she was a shoo-in to succeed him.

 

“Being an internal candidate is a blessing and a curse,” she says. “Everybody knows you well, and sometimes the allure of an outside candidate can be greater than the person you really know. Obviously, I’m honored to be in this role.”

 

As the first female CEO at ACHE, her promotion mirrors an industry trend – about half of ACHE’s members are now female.

 

“I grew up at a time when it was a male-dominated field,” Bowen says. “I remember the early days when they always turned to the woman to take minutes in a meeting – it didn’t matter what your title was. But I’ve been fortunate because I’ve had good people in my court and, frankly, almost all of them have been men.”

 

Bowen says attitude can be a bigger determinant of success than gender. “The way I have thought about it over the years is that we all have choices to make. You can choose to focus on those things that are going to detract from you, or you can choose to focus on the things that represent who you truly are: What is your purpose and how are you going to move the needle?”

 

Finding purpose has been a key attribute for Bowen since her formative years. Even before her work as a social worker, it was instilled in her by her mother, a piano teacher who would take Bowen with her as she gave lessons in an African-American church on the South Side of Chicago.

 

“It was an eye-opening opportunity for me as a child to understand that not everybody lived the way I did,” she says. “Understanding the challenges of other communities was very revealing for me. There were women who had to stay up all night because they were worried about rats getting to their babies. When you hear that, you realize there are disparities in life.

 

“I took that to heart and thought, ‘That’s not fair and that’s not right. And if I can do anything to even the scales, I’m going to try to do that.’ ”

 

Sometimes the piano students would come to Bowen’s home in middle-class suburbia for a lesson, and it was not unheard of for Bowen’s family to find newspaper burning on their lawn.

 

“In some respects, those were different times. But in some respects, they’re not different at all when you think about some of the things that have gone on lately with race relations. We have much work to do.”

 

It’s also why Bowen remains determined to chart a different path for her own leadership and for ACHE.

 

“My legacy, I hope, is going to be all about building the culture of ‘and.’ We need to make sure we are understanding each other’s point of view and leveraging each other’s skill sets, because we all have something to bring to the table to improve healthcare.”

 

 

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Among them, Borgstrom says, are:

 

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

 

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

 

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

 

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

 

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

 

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

 

 

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.”

 

 

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

By | July 30 th,  2015 | health plan, Healthcare, reform, women in leadership, Donna Lynne, president, Blog, Colorado, Kaiser Permanente, matrix, Top 25 Women in Healthcare | Add A Comment

 

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

 

Kaiser Permanente’s success in Colorado when the federal insurance exchange launched in January 2014 was a perfect example for Donna Lynne and her team of the new type of leadership needed under reform.

 

Lynne, president of Kaiser’s Colorado health plan and the EVP who leads its Pacific Northwest and Hawaii regions, said Kaiser was anticipating perhaps 3 percent growth when the new era began. Instead, Kaiser’s membership in the state grew a whopping 14 percent overnight.

 

“We recognized that we were beginning to have a situation that required extraordinary measures,” she says. “As a leader, you need to be nimble and you need to be confident that the people who are working for you can execute.”

 

Lynne’s leaders put together rapid-response teams to tackle needs like customer service, ID cards, appointment-setting and billing. “These were people who had not had healthcare before,” reasons Lynne, “and if their first experience with a health plan was not a great one, then we ran the risk of them making a different decision a year later.”

 

The approach was successful, says Lynne, and helped her team develop new skills.

 

“The primary characteristic of what people need to be able to manage in healthcare reform is volatility,” she says. “You need to be able to deal with ambiguity but you also need to have the skill set to be able to manage in a crisis environment.”

 

Crisis is nothing new to Lynne. She began her career more than 30 years ago working for the New York City government at a time when the city was bordering on bankruptcy. But she witnessed a remarkable thing. Leaders from government, business and labor unions set aside their own agendas and worked together to bring the city back from the brink.

 

“Everybody had to give a little to rescue the city from a crisis situation, and that taught me a lot,” she says. “You realize very quickly how interdependent you are on other people.”

 

Ultimately, Lynne spent 20 years working for New York City. She’s fiercely proud of that time in public service. “Sometimes people poke fingers at people who work in government, but I felt very committed to excellence in government. I wanted to make a difference on behalf of the millions of people served by New York City,” she says.

 

She was renowned as a labor negotiator, and that led to the next step in her career as she began to see from her dealings with unions that healthcare was as important as wages and pensions to the middle class.

 

“I felt very committed that, if I could do anything to make healthcare affordable, it would be a great pursuit,” Lynne says. She worked in operations for a health system before moving to managed care and rising to CEO of Group Health. Then she joined Kaiser Permanente.

 

The move to Colorado enabled Lynne to turbo-charge her already active lifestyle. She began climbing mountains and has tackled major peaks in Colorado and overseas. She’s also a skier who has done marathon ski events for charity.

 

“I think I like on-off switches, if you understand what I mean. I completely turn the work button off; I have to, because most of my pursuits involve risks so I need to concentrate,” she says.

 

Lynne grew up playing every sport under the sun – softball, field hockey, volleyball and tennis – and says sports were a natural training ground for leadership development.

 

“I felt very strongly that there were a lot of things that women either were told they couldn’t do or weren’t supported in doing. And I liked being a pioneer or even a little bit of a rebel,” she says. “By participating in sports, I understood the interdependence of all the positions on the field. In the business world or in government, you can work in your own silo and become an expert, or you can drive for change and try to get things done together.”

 

Lynne has chosen the latter, and says what some would call a matrix structure at Kaiser has served her well, helping her to focus more on the human side of leadership.

 

“I think some of it came with maturity,” she says. “Taking the time to engage and influence people is a critical part of leadership that I had to learn over a period of time, and Kaiser is in many ways the crown jewel in terms of a place where that really works.”

 

She’s also learned, she says, “to appreciate the importance of developing the leaders underneath you.” Kaiser has annual individual development plans for its executives, and that’s helped Lynne to “develop my leaders, who are now stronger and allow me to step back and do different kinds of things than I might have thought about when I came here 10 years ago.”

 

Leadership innovation is sorely needed, she says, as reimbursement models have caused upheaval in the industry.

 

“We’re all seeing less revenue because so many more of our members are coming from Medicare or Medicaid,” Lynne notes. “That’s creating tremendous pressure on us to reinvent the way that we do things.”

 

The turmoil has been felt among both providers and payers. Lynne says no one is sure how it all will play out, but both finance and delivery need to get along.

 

“I think the best way that payers and providers can work together is to acknowledge that, while we may have started out with different interests, we are ultimately trying to provide care to as many people as we can so that they’re healthy.”

 

 

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.

Marna Borgstrom: In healthcare and life, relationships matter

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

The difference, she says, is in execution.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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.”