"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Friday, May 20, 2016

Does a Shift in Care Delivery Change One’s Mission, Vision & Values?

As you may know, I contribute to a blog called Hospital Impact.  My latest submission was about the effect of value-based care on our mission, vision and core values at WMHS.  Here is what I submitted and was published on May 19.   

It is interesting to see how our mission, vision and core values at Western Maryland Health System have been applied over the last few years as we transitioned to our value-based care delivery model.  As we transitioned from volume to value, we felt that it was essential to re-examine our mission statement, our vision statement and our values. 
As we embraced the triple aim of health care reform, our Board decided to bring our mission statement more in line with our new commitment to value-based care delivery.  It was changed from “superior care for all we serve” to “we are dedicated to providing patient-centered care and improving the health and well-being of people in the communities we serve.”  The board felt that our previous mission statement focused more on care delivery within the hospital while the new mission statement introduced a much needed community health perspective. 
Our vision statement was also adjusted to reflect the change in care delivery that depends on establishing partnerships in advancing the health and well-being of those we serve now and into the future.  Many of our previous competitors are now our partners in this care delivery shift and we are continually seeking new partners to best deliver care in the most appropriate setting.  
After considerable input from a variety of stakeholders, the board felt that it wasn’t necessary to change our core values.  It was determined that they could be applied quite easily to our new care delivery model.  Our core values at WMHS are Innovation, Integrity, Compassion, Accountability, Respect and Excellence.  Innovation has been the mainstay of our core values as it relates to value-based care.  We have introduced many new and innovative initiatives into our care delivery model that are designed to keep patients out of the hospital and cared for in the most appropriate location.  Most importantly, they work!  There has been change in how our core values of integrity, compassion and accountability have been applied at WMHS over the last few years.   We have become much more transparent with the sharing of our quality and performance data; we always show compassion to all whom we serve and our accountability has been extended to ensuring that we provide the most appropriate care in the most appropriate location.  We will always respect the dignity and worth of each person whom we serve by delivering care in such a way that they can live their lives to the fullest going forward.  Lastly, excellence through superior performance has resulted and is supported by our recognition in improved systemwide metrics specifically in quality and patient safety. 
Our values haven’t changed, but the manner in which they have been applied has been expanded to encompass the new dimensions of care delivery.
On a personal note, I have been significantly impacted by the transition to valued-based care delivery.  To see firsthand the very positive impact that we continue to have on those patients who are considered to be the sickest of the sick is just short of amazing.  We are seeing significant reductions in admissions, readmissions, ED visits and ancillary utilization because these patients are benefiting from the many initiatives that have been put in place and they are being case managed like never before.  In many instances, we are also reaching their adult children who could be pre-disposed to similar co-morbidities in the future.  We are truly making a difference in the lives of these patients and our staff is also seeing the impact firsthand.

Monday, May 9, 2016

Nursing - It's Hard to Think of a More Wonderfully Deserving Profession

Last Friday began another Nurses Week, and I can't think of a more deserving group of people for such recognition.  For 14 consecutive years, nurses are our nation's most trusted profession with the highest ethical standards.  Wow!  Rounding out the top five according to Gallup were medical doctors behind nurses, pharmacists in third place followed by police officers and then members of the clergy.  That is quite a group of honorable professions.  

As soon as Gallup added nurses to the list in 1999, they have held the top spot except for 2001 when they were knocked off the top spot by firefighters, another very honorable profession.  According to clinical psychologists, people tend to trust those who are directly caring for them.  In the care of the patient, the nurse is the captain of the ship, if you will; they provide the continuity of care at the bedside.  Being in this business for over 40 years, I have had the pleasure of meeting, working with and being cared for by thousands of nurses.  They are truly amazing people in the care that they deliver, the compassion that they express and the advocacy that they demonstrate.   

At WMHS, we are now highlighting our nurses in a promotional campaign.  The spots are reflective of our amazing nurses.  The idea came from Texas Health Resources after their Ebola situation a few years ago.  There was a great deal of misinformation about their hospital and their care of our nation's first Ebola patient.  Their nurses said let us be interviewed by 60 Minutes and we'll set everyone straight--and they did.  These nurses were masterful and certainly made their profession proud.  Just as our nurses have done in their reflections on being a nurse.  

Nurses at WMHS and across the nation have truly earned their recognition as the most trusted, highly respected and ethical in their profession and in the care of their patients.  Happy Nurses Week! 

Monday, April 25, 2016

We Are Unique

Last week after the Dr. Perman lecture, I stopped to thank him.  He was engaged in a conversation with Hans Killius, the WMHS Director of Pastoral Care.  Hans had a cell phone and a pager on the table in front of him.  I commented that I didn't realize that we still use pagers at WMHS.  We all laughed.  

The next morning, I received an email from Hans commenting on the preceding evening's event and asked that if I ever wanted to take chaplaincy call that I could and it would be assuredly eyeopening.  I responded that my days of "on call" were over, excluding urgent or emergent situations involving the CEO.  I explained that my start in health care was processing bedpans in Central Sterile Service as an equipment orderly.  I continued that throughout my career from that entry-level health care position to CEO and every position in between (Equipment Technician; Equipment Supervisor; Manager CSS; Assistant Director, Materials Management; Director, Materials Management; Assistant VP; VP; Chief Operating Officer; and CEO), that I had not only spent decades on call but also worked years of weekends and holidays.  During such time, I had to deal with some very interesting and enlightening situations over my 41 years in health care.  I told Hans that I would leave the eyeopeners of today to both him and his associates.  

Hans responded that he was glad that I knew health care from the front lines.  He said that knowing my career path will empower his advocacy of health care leadership and our health system going forward in the presence of occasional negative and ill willed messages.  (Very well stated.)  

Hans' response got me to thinking as to how fortunate and unique we are to have an administrative team that pretty much began their careers in health care at levels well below administration.  Many in health care leadership upon completion of their graduate degrees (MBAs, MHA, MPH, etc.) go directly into administration and never experience the "front lines," using Hans' terminology.  Personally, I have found working at every level of health care has been exceedingly beneficial and rewarding, as have my colleagues at WMHS.  The following is a list of our Senior VPs and VPs at WMHS and where they started in the front lines of health care:

  • Nancy Adams, Chief Operating Officer and Chief Nurse Executive - EEG Technician at Sacred Heart
  • Dr. Jerry Goldstein, Chief Medical Officer - Dishwasher at Baltimore County General Hospital
  • Kim Repac - Chief Financial Officer - Staff Accountant at Sacred Heart
  • Bill Byers - Chief Technology Officer - Computer Systems Manager at Memorial
  • Jamie Karstetter, Vice President Patient Care Services - EVS Assistant
  • Michele Martz, Vice President, Clinics and Practices - Staff Accountant at Memorial
  • Kevin Turley, Vice President, Operations - Manager, Sacred Heart Home Medical Equipment
  • Jo Wilson, Vice President, Operations - Radiologic Technologist
Impressive to say the least!

Thursday, April 21, 2016

Team-Based Care

Last evening, I had the pleasure of introducing Dr. Jay Perman, President of the University of Maryland at Baltimore, who spoke at the health system about interprofessionalism, which succinctly put is team-based care.  He talked about how team-based care is optimal  for our patients, its importance in our transition to value-based care delivery, and how it results in better quality and allows us to better address the socioeconomic factors that our patients experience.  
Team-based care involves a care team that may include physicians, nurse practitioners, RNs, respiratory therapists, pharmacists, dietitians,  dentists, attorneys, social workers, care managers, physical and occupational therapists, physician assistants and the list goes on.  In addition to teaching the concept, Dr. Perman uses the team-based approach in his clinic when he sees patients.  After his presentation, I offered an example here at WMHS  that supports his concept of interprofessionalism. 
Our Center for Clinical Resources was built around team-based care delivery.  I explained that when WMHS began our demonstration project on value-based care delivery, we learned that there were 1,972 patients who accounted for $140 million of our cost.  Obviously, these were patients with multiple co-morbidities such as diabetes, congestive heart failure (CHF), COPD and hypertension. To help these patients manage their conditions, we opened a Diabetes Clinic and a CHF Clinic and then added an Anti-Coagulation Clinic.  Unfortunately, all were in separate locations, both on and off campus and it was difficult for patients who had appointments in more than one clinic.  It was then that we decided to combine all of the clinics into one location, the Center for Clinical Resources.  We moved the separate clinics to one office suite in our medical office building and decided not to charge any co-pays or deductibles .  We consolidated the pharmacists in our Anti-Coagulation Clinic, the Diabetes Clinic and its team of a nurse practitioner, a dietician and others, along with the CHF team that was led by a nurse practitioner.  We then added a navigator, respiratory therapists, nurses and other key staff all with access to physicians who specialize in each area.  Through the team approach, we provide a more comprehensive level of care to these patients with multiple illnesses.  They can get their care in one location by a team that is focused on them specifically.  We have reduced admissions, readmissions, ED visits and ancillary utilization for these patients, resulting in a saving of over $8 million in less two years.  Through this approach and a host of other initiatives those 1,972 patients incurring $140 million in cost is now 1300 patients incurring $80 million.

None of our successes in value-based care delivery or the Center for Clinical Resources could have been achieved without using the team-based care approach.  It was also nice to be able to provide Dr. Perman with a real live success story related to his passion for interprofessionalism.

Wednesday, April 20, 2016

Telling Our Story

As you may know, I contribute to a blog called Hospital Impact.  The editor asked if I would comment on an article that recently appeared in the Journal of the American Medical Association.  Below is my post from April 14, 2016.  I thought you would find it interesting.

When I was asked if I would blog about pushing the healthcare industry into a new era, I agreed based on my own personal experience. At the time, I wasn’t aware of Don Berwick’s recent commentary in the Journal of the American Medical Association on the subject. Fortunately, I can certainly relate to his commentary since I have been living his “Era 3” for the last several years.

Berwick states that healthcare needs to be pushed into a new era. He writes about Era 1 when medicine was good and depended on self-regulation. Then Era 2 evolved once the flaws and contradictions of Era 1 became apparent. Era 2 saw the need for accountability and measurement. Era 3, though, will require a combination of Eras 1 and 2, but emphasizing less measurement related to cost and volume and more measurement related to quality and value; moving away from maximizing revenue; focusing on care improvement as a core competency for healthcare leaders; and complete transparency with the communities that we serve.

At Western Maryland Health System, Era 3 has been evolving over the last several years. In 2011, we transitioned to a value-based care delivery model, and care improvement has been at the core of our care delivery model ever since. We have to maintain market share, but otherwise we are expected to bend the cost curve, which we have achieved each year since 2011.

We deliver care in the most appropriate location and partner with many who previously were our competitors. We have reduced use rates, emergency department visits, readmissions, unnecessary admissions and use of observation beds. We have added primary care practices throughout the region, embedded care coordinators in our physician practices and established a pay-for-performance initiative for our physicians to better align incentives. We provide medications for 30 days to any patient upon discharge, follow up immediately with discharged patients and have dramatically expanded our Home Care program. We also work in partnership with our area skilled nursing facilities, and we address chronic conditions such as diabetes, COPD and hypertension at no cost to the patient through our Center for Clinical Resources

Our quality measures focus on a host of hospital-acquired conditions and potentially preventable conditions, but our performance measures such as readmissions, length of stay and mortality rates are equally important.

Over the last six years, we have become a very different organization by moving away from volume and focusing on a value-based care delivery system that embraces the components of the triple aim of health care reform. It wasn’t easy, but we are now very well positioned in an Era 3 healthcare landscape as well as for an ever-challenging healthcare landscape in the future.

Tuesday, April 5, 2016

What a Great Start to our 20th Anniversary Celebration

In Sunday’s Cumberland Times News, there was a wonderful letter to the editor from Steve Friend, a local attorney.  The letter is attached below.  I have received many complimentary letters regarding the health system, but this has to be up there in the top three.  To have a prominent attorney tout our health system and our staff as excellent, superb, professional, courteous, attentive, pleasant, a culture of kindness and very importantly, great senses of humor, is quite an honor.  All of these attributes are true, but then again I am biased.  But as Steve writes, look at the external objective sources like US News and World Report (hospital rankings), Healthgrades (top 50 heart programs in the US), the Maryland Patient Safety Center (Distinguished Achievements in Patient Safety Innovation),  the American Hospital Association (Living the Vision Award), Premier (Cares Award finalist) and being recognized as one of the nation’s Most Wired Hospitals by AHA.

We have so much to be proud of at WMHS as we celebrate our 20th anniversary.  In addition to our awards and what we do every day in the care of our patients, we successfully consolidated three hospitals in Allegany County, we built a new state of the art medical center and now provide care under a model that focuses on value not volume and is recognized nationally.  Our 20 years as a health system have been remarkably successful and our success is attributable to an amazing team of people doing some amazing things day after day.

Friday, April 1, 2016

Family Feud at WMHS

The other evening to celebrate Doctor’s Day, we entertained the staff and each other with a game of Family Feud.  Our Medical Staff Services team asked 100 nurses at WMHS a series of questions, captured their answers and then used them for a game show match between the Scopes (our Medical Docs) and the Scalpels (our Surgeons).  The winner then got to play the Suits (Executive Staff).

What a great evening!  The Scalpels beat the Scopes and then Doctors Allaway and Hasslinger did the bonus round with Dr. Allaway getting 198 of the needed 200 points.  The Scalpels then went up against the Suits.  My wife said that the Suits had an advantage by having two women on the team, one of which is a nurse.  Both Nancy Adams and Michele Martz answered the questions as nurses (the great majority of those surveyed being women) would. Thinking back on the questions, she was right.  For the most part, the men who participated answered as men would answer.  The advantage of having two women on team Suits paid off since we beat the Scalpels handedly.  Although after the game was over Dr. Allaway, the Scalpels team captain, asked if it was that obvious that they let us win.

It was a lot of fun and it was obvious that a lot of work went into the event.  My thanks to the doctors who participated, our Food Service staff, EVS staff, Cindy Bridges, our MC for the evening and the master planner of the event, her staff, Tim Abrell, Pam Kline, Karen Ashby and of course, our 100 nurses.

Some photos of the night have been included.