News and Updates

Staff Motivation Key to Change

Posted on July 1, 2014

To manage change, healthcare organizations should re-wire the thinking framework, or structure, of their employees, according to two healthcare management experts.

Penny Crow, CEO of Operational Strategies, a healthcare consultancy, and Paul Selivanoff, a vice president of finance for Adventist Health System, Saint Helena Region, urged attendees at ANI: The HFMA National Institute to instill a “thinking framework” in their organizations’ workers. Such a system, they said in a June 25 innovation lab session, would spur faster decisions, increased productivity, and permanent behavior change.

Employees generally respond to change through a series of steps:

  • Denial
  • Resistance
  • Exploration
  • Commitment

Leaders need to create an environment that will move people through these stages to the commitment stage, Crow and Selivanoff said.

Strategies usually fail because culture trumps strategy. In turn, structure trumps culture. If the structure is not in place to support a strategy, execution and implementation of the strategy will fail, Crow and Selivanoff said.

To stop the chaos of change management, healthcare leaders need to think about the thought structure used to drive solutions in their organizations.

For instance, measurement shapes the path of change. Organizations usually get the results that they reward; they reward based on what they measure, and they measure based on what they want to achieve.

Motivating Employees to Invest in the Organization

Crow and Selivanoff said that for healthcare organizations to change their employees’ thinking, leaders need to make the change personal. They offered the example of riding a horse that is motivated by a carrot on a stick held in front of its face. The horse is only motivated to obtain the carrot. He’s not invested.

In contrast, Crow and Selivanoff said employees need to have an interest in getting the organization to its destination.

They discouraged financial incentives because it has only a 90-day window of memory in individuals’ psyche. After that point, the reward “wears off,” and it no longer motivates us. After that point, people only want more money and are not emotionally invested in desiring the change and the result of the change.

Tapping an Organization’s Hidden Talent

Posted on June 25, 2014

How can finance leaders come up with solutions for the many and varied challenges that are roiling the healthcare industry? Try leading differently, according to a keynote speaker Wednesday at ANI: The HFMA National Institute.

Liz Wiseman, president of the Wiseman Group, said greater productivity is possible when leaders inspire their staff to find solutions to challenges.

11768A-3009“Are you leading like the genius who has the answer to solve the problem, who knows it all, who offers a solution? Or are you leading like the genius maker, who issues the challenge, asks the question, and builds a whole organization, who can lead intelligently, adapting to change around them?” Wiseman said. “One of these is a more scalable model and is going to allow us to build a model for health care.”

Wiseman’s management philosophy is based on a leader who acts as a “multiplier” instead of as a “diminisher.”

Diminshers act as if they are the source of all ideas and end up putting down or lessening the creativity and potential contributions of their staff, Wiseman said. Meanwhile, multipliers encourage their staff to tap their range of abilities and identify solutions to drive organizational improvement.

Multipliers have both a “soft side,” which encourages and empowers, and also a “hard side,” which demands that workers give their best—even if they don’t succeed. These leaders create pressure, but not stress, a distinction Wiseman illustrated by having audience members model a scene involving William Tell, who was required to shoot an apple off his son’s head. Tell felt pressure but not stress because he had the ability to direct the outcome, Wiseman noted

The Tell reenactment was one of a range of interactive techniques Wiseman used to engage the audience in the leadership theme. Others included urging audience members to call out answers and send tweets that shared their own experiences with the two types of leaders.

Leaders Fall on a Spectrum
Most leaders fall in between the two types of leadership, Wiseman said. That is, they have good intentions, but their style fails to draw out the best from their workers. For example, “the pacesetter” leader tries to inspire by example but gets so far out ahead of subordinates that they become spectators.

“They are watching us doing our thing, thinking we’re having a great time,” Wiseman said.

Wiseman asked the audience of finance leaders to begin moving toward the “multiplier” role over the next 24 hours by taking small steps. For instance, instead of setting meetings to issue a decision, a leader could schedule a debate. When employees are able to offer input before an important decision, they buy in and help implement the course that is ultimately selected.

Drawing more ideas and approaches from more employees will prove critical to finding solutions to the numerous finance challenges that are sweeping across the healthcare industry, Wiseman said.

New Disruptor Model Impacts Hospitals

Posted on June 25, 2014

Kenneth Kaufman, managing director and chair of Kaufman, Hall & Associates, discussed the new disruptor model, its impacts on healthcare and ways that hospitals are responding to it during an interview at 2014 ANI: The HFMA National Institute.

How to Overcome Physicians’ EHR Concerns

Posted on June 24, 2014

Given the physician’s central role in the shift toward value-based payment, hospital CFOs should not allow dissatisfaction with electronic health records (EHRs) to limit physicians’ participation in such initiatives, according to experts on payment reform.

11768A-2298Although physicians favor the concept of the EHR, they report that the digital record-keeping systems have impeded their ability to care for their patients, speakers noted during a presentation Tuesday at ANI: The HFMA National Institute.

Despite those reservations, physician engagement is needed to prevent the failure of a range of CFO initiatives. Such engagement allows for improved patient care, more accurate reimbursement, and enhanced organizational stability, and provides the necessary infrastructure for ongoing success.

Money Atwal, CFO and CIO of Hawaii Health Systems Corporation’s East Hawaii Region, described the process of implementing a new information system at Hilo Medical Center, Hilo, Hawaii, to highlight how his hospital fostered physician engagement. CFOs need to have a close working relationship with their CIOs, and physicians need to be an integral part of the discussion when implementing an EHR, he said.

Atwal said hospitals need to provide opportunities for physicians to vent about issues and offer input regarding workflow. Additionally, physicians should be part of the IT selection process and involved in decisions such as when to implement computerized provider order entry, clinical documentation, and ICD-10.

Physicians are asking for data analytics, he said. Physician alignment is achieved by providing more immediate data feedback to help physicians make the changes to their practice that are necessary to increase value.

For example, Atwal said his organization decreased costs of knee replacement surgeries after finding that two orthopedic surgeons had a 25 percent difference in costs. They found that the higher costs for one were driven by the surgeon’s use of a vendor to set up his equipment for surgery. Providing this data made the physician willing to take the necessary steps to lower these costs.

Follow Steps to Engage Physicians
For CFOs, key takeaways from the session include:

  • Identify physician leaders and collaborate with them on a regular basis. CFOs should go to medical-executive committee (MEC) meetings, providing financial updates and tailoring presentations to physicians.
  • Involve physicians in the selection and implementation of technology and operational solutions. Do not introduce programs to the MEC without involving physicians in the decision-making process. Involve practicing physicians in every step of a process. 
  • Educate the broader medical staff regarding the clinical benefits of technology and of process improvements. 
  • Translate Six Sigma strategies and lean processes to health care. 
  • Focus on physician workflow when considering innovation. Have the CIO and staff shadow a physician to understand workflow in the system.

How a ‘Medical Neighborhood’ Was Created

Posted on June 24, 2014

A new clinically integrated network (CIN) found that achieving superior results required moving beyond the medical home concept and embracing the concept of a “medical neighborhood.”

11768A-2329UniNet Healthcare Network, a CIN consisting of 2,200 providers (800 employed, the rest independent), was formed as a partnership between a hospital and physicians.

With UniNet focusing its strategy on population-health management, its leaders realized they needed better care coordination. The network implemented a certification program in health coaching to help engage patients in managing their own health.

“You need a medical neighborhood, not just a medical home,” Hank Sakowski, MD, medical director of UniNet, said during a presentation Tuesday at ANI: The HFMA National Institute.

To create the medical neighborhood, nurses focused on discharge transitions, social workers connected patients with community resources, the CIN worked closely with pharmacists to provide medication therapy management, and the services of dieticians and diabetes educators were enlisted.

The medical neighborhood was among the features that were credited with helping the CIN save about $3 million in care costs for its enrollees over each of the last three years as part of its shared-advantage risk program.

Evolving the Medical Home
The medical neighborhood was a modification of UniNet’s use of patient-centered-medical-home care coordination. Goals included developing patient registries, improving clinical quality scores, and reducing waste by avoiding low-acuity emergency department (ED) visits. The program also sought to prevent readmissions and avoidable admissions, particularly for patients with chronic obstructive pulmonary disease and heart failure.

The CIN also used more traditional population-management approaches, such as data systems based on claims data to identify sectors of their population on which they needed to focus their care-coordination services.

The registry was used to identify high-risk patients, manage patients with multiple or major chronic conditions, and focus on health maintenance. UniNet hired ambulatory care coordinators to work with physicians and advanced practice nurses (APNs) to manage chronic conditions.

The care coordinators were registered nurses and employed by Uninet, not by the clinics. This approach allowed the coordinators to avoid being pulled into doing clinical work, and instead focus on care coordination, Sakowski said.

Another area of focus was post-acute care. UniNet developed relationships with continuing-care networks and brought in skilled nursing facilities (SNFs), placing APNs in the SNFs to focus on keeping patients in the SNF rather than sending them to the ED.

UniNet also established a community-based care transitions program, for which they received funding from the Centers for Medicare & Medicaid Services. Care coordinators focused on high-risk patients with the help of a clinical dashboard that gives an overview of patients, enabling coordinators to quickly ascertain their health issues and better coordinate their care.

Lessons Learned
For CINs, key takeaways from the session include the following:

  • Understand the role of the hospital in putting pressure on payers regarding terms of value-based contracts
  • Know when to jump to risk; UniNet concluded that the time to change payment models had arrived
  • Assess the amount of risk that your organization can assume
  • Understand how to measure quality and how to fund needed infrastructure
  • Gain independent physician participation and integrate physician-owned ancillaries
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