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Physician leadership profile: Dr. LaMar Hasbrouck brings rare perspective to healthcare’s most vexing issues

By | December 5 th,  2018 | population health, healthcare disparities, healthcare executives, value-based care, physician leadership, leadership traits, mission-based leadership | Add A Comment

Hasbrouck-LamarAt a time when the healthcare industry is putting a premium on physician leadership, while seeking to address the disparities threatening value-based care, few executives are better positioned at the convergence of those streams than LaMar Hasbrouck.


Hasbrouck, who holds an MD and an MPH, is Senior Advisor for Strategy and Growth with the American Medical Association. He helps design and build the association’s equity portfolio, as well as cultivate corporate and private foundation relationships. He also guides the association’s chronic disease initiatives and heads efforts to improve internal team cohesion.


“I describe my job as a strategy whisperer,” he says. “I’m a fresh set of eyes to look at problems in healthcare and advise the Group VP where we should be putting our resources and what types of talent we should hire.”


But don’t be fooled; that fresh set of eyes has experienced a lot. Hasbrouck has worked at the local, state, federal and international level in healthcare. He worked at the Centers for Disease Control and Prevention for 11 years, first as a senior medical officer and later as the director of its work in Guyana, South America.  He was health commissioner of New York’s Ulster County, leader of the Illinois Department of Public Health and CEO of the National Association of County & City Health Officials.


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That’s a rare perspective on some of healthcare’s most vexing issues. As such, he finds that the various entities don’t often work well together. That’s a challenge, because all hands are needed to try to solve the tenacious problems in healthcare.


“The local level works best with the state level, and the state works well with the federal, but the local and federal levels don’t work well together,” he says. “Then, at the global level, there tends to be a real disconnect in that the U.S. government tends to be one small layer in a very large pool with a lack of fluidity.”


Despite his distinguished track record, Hasbrouck is bold in championing solutions outside traditional thinking and is eager to bring his experience to bear on a wide range of issues. His international experience, from South America to Africa, also has molded his views.


“What I have learned in my travels is that innovation is essential for solving problems, yet it’s the simple things that you take for granted,” he says. “For instance, when I was in Uganda, we had problems getting medications into hard-to-reach areas. We considered flying the medicine in, but then we came up with the idea of a motorcycle tag team using dry ice to keep the medicine cool.


“We didn’t stop there. We trained some laypeople as health workers to address the most common side effects with the patients.”


Hasbrouck grew up in a world where preventive health didn’t exist. His family, led by a single mom, was, for a period, reliant on welfare to survive.


“It might be surprising to some people, but it was a very happy time,” he says. “We were materially poor, but spiritually and culturally rich. We were inventive in our play because we didn’t have material things. I didn’t know I was deprived, although there were clearly not a lot of male role models who were white-collar professionals.”


Yet it’s precisely that upbringing that gives Hasbrouck his mission in stamping out inequity in care.


“I have lived that experience and it gives me credibility,” he says. “I’m very driven by my personal narrative. I have chosen roles carefully by the impact I can have through my skills and competencies.


“That’s who I am.”


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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





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.”



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

By | August 6 th,  2015 | Allina Health, health systems, Modern Healthcare, physician, providers, Blog, CEO, clinical care, collaboration, leadership, Penny Wheeler, value-based care, 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.


In the era of value-based care, many health systems are looking for ways in which they can develop their physicians into administrative leaders who can guide the organization, not just a physicians’ group.


While Allina Health CEO Penny Wheeler, MD, can certainly relate to such endeavors, she’s not ready to brand the clinician-to-chief-executive transformation as the sole formula for all organizations.


“Some doctors are scrambling to get their MBAs, but I wonder if there is going to be a time when people who have been in the administrative ranks will get certifications in clinical care process and care model design,” says Wheeler, an obstetrician/gynecologist who has led Allina Health to a Truven Analytics ranking as one of the top large health systems in the country.


Both types of knowledge are needed in the C-suite, Wheeler says, and can come from an administrator who has an empathetic mindset and has spent time learning how to reduce clinical-care variations, or from a physician who has accumulated experience in finance and operations.


“There is a convergence these days,” she notes, “of needing to understand clinical-care models and clinical-care processes, and having the operational and financial acumen to know what kind of team you have to assemble to lead.”


The learning curve can be steep regardless of which side you begin on. Wheeler was named chief clinical officer of Allina in 2006 and freely admits it took her time to adjust.


“You can go from feeling pretty adept at doing a complex hysterectomy with a lymph-node dissection in the operating room to feeling like you don’t know how to run your email account,” she says with a laugh. “When you’re relatively good at something you trained your whole life for, and then all of a sudden you feel like you’re on a separate orbital plane, that’s hard.”


What kept her going, she says – and what led to her growth as an executive that ultimately put her in charge at Allina – was the purpose and mission she had, which did not change in the move from the exam room to the administrative offices.


“It’s just a sheer privilege that we get to be in a role where, by our actions, we can improve the lives of thousands,” Wheeler says. “That’s an incredibly fortunate position to be in.”


The opportunity to make a larger impact on communities in breadth and scope is an important consideration for physicians who are considering a move into an administrative role, she adds. Just as critical is the understanding that a clinical background provides a necessary balance in an organization’s decision-making.


“This is what turned the equation for me,” she says. “Instead of emphasizing what you don’t know yet about business or operations, emphasize what you do know. There was one time when a light bulb went on for me in a meeting of the executive leadership team. I was the only physician in the room and realized, ‘I am the only one that has been next to a patient for 20 years and knows what it feels like to provide their care when you have 23 other things going on that you need to attend to.’ ”


Wheeler’s advice for new physician leaders is just as applicable for all administrators:


Realize that you can’t do it all. “As physicians, we’re used to being the one that our patients put their trust in. But in a business environment, you really have to rely on those around you, so you need to assemble a team that thinks differently than you do and complements your skill set.”


Time is your most precious resource. “Your time is your currency. A lot of people make demands on your time and you have to think about what’s important – advancing the performance in terms of our mission – so you should spend your time on what is most impactful.”


Invite your team to be truthful. “When you get in these positions, people want you to be happy and want to highlight the good performance we’ve had. They might be more reticent to talk about where things aren’t going well or failing, so you actually have to ask for difficult messages. Invite people to be open and honest because, if they’re not, somebody’s life could be affected adversely.”


Wheeler has been instrumental in championing Allina’s collaborations with other providers, from an accountable-care alliance with HealthPartners to transitional care facilities built with Presbyterian Home & Services and Benedictine Health System.


“I really hope collaboration between systems beats out competition, so we can avoid unneeded duplication of services,” Wheeler says. “When we say we compete in healthcare, I think sometimes other countries look at us like we have an arm growing out of our head. I think that, to the extent we can do it effectively, collaboration is important. Even when you see acquisition and merger activities occurring in healthcare, I think it’s going to be more about adding complementary services across the continuum.”


Yet the transition from a fee-for-service to a value-based model brings its share of growing pains. Wheeler points to a recent program Allina developed to provide care coordination for cancer patients. In terms of care, it was a huge success – it kept 95 people from needing to be readmitted to the hospital and saved the community $1.2 million. There was just one problem: Allina lost $600,000.


“Right now, we’re in an environment where you actually lose money by doing the right things sometimes,” she says. “It is a conundrum for all of us in healthcare. I think we’re going to experience some whitewater rapids getting to where we need to be, but it will be good for the people we serve when we do.”


Still, Wheeler says, these and other winds of change stirred up by reform “make it an exciting time to be a leader. There’s no better time to be in healthcare because the sails are up in the air and you can turn this big Queen Mary of healthcare in a better direction for the people we serve.”



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

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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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