By Dr. Michael J. Zappa

Too much of a good thing can sometimes be a problem; there is a risk that caring too much can result in burnout. Even a profession that is literally and figuratively built on it, as is healthcare, there is not immunity to an overdose of caring.

You might be thinking: “What healthcare leader would ever tell a member of their team to care less?”  Self-reflect and visualize your peers and the people you are leading.  Do any of these characteristics seem familiar? 

• Constantly worries about what people think

• Always feels obligated to fix things

• Has a hard time letting things go

• Starts the day with a list of worries

• Ends the day with a list of worries

• Stresses about staff turnover

• Stresses about staff happiness

I’m sure you can identify with some of these tendencies personally or amongst your team.  The answer is not to stop caring about patients, staffing, getting through your “to do” list, or about being liked; the answer is to care just the right amount! Think of care as sugar; in the words of Mary Poppins it takes “Just a spoonful of sugar…!”

Care enough to progress toward your goals, being visible and open, maintaining control while knowing when to let go, and earning respect.  Care about being liked, but do not rest your self-worth on it. Sound advice you might say, but easier said than done.  Try this CARE PLAN:

By Mike McBride

Non-profit hospitals are beholden to stakeholders (i.e. the communities they serve), not shareholders, and are thus pivotal community assets. While for-profit hospitals report to shareholders and investors, non-profit hospitals have an obligation to use assets for the betterment of the communities they serve. Community benefits can include charity care, expansion of existing services such as trauma care and maternity services, clinical education, increasing access to care for Medicare and Medicaid patients, and promoting community health.

One of the best ways to promote community health and serve the community at large is to create community partnerships and develop relationships with those involved in existing healthcare services in the area. This way, non-profits are not duplicating existing resources and are working toward a common mission of improving the health of the people and communities they serve.

The move to value-based care is slowly migrating to capitated payments. This is an important progression, as the capitated payments model is more person- and outcomes-centered; the focus shifts to prevention and wellness; and hospitals are incentivized to improve health status. The notion suggests that the health of the population will continue to gain importance.

By Rodney Reider

Recently I had the privilege to be a guest on the podcast, “Getting Your Hospital to Act Like a Startup.” My part begins in minute 28, but please enjoy the entire episode.

Summary:

The innovative path is the key to the future of successful healthcare. Innovation and technology are the indispensable components for tomorrow's care; unfortunately, health systems and hospitals often allow the here and now focus to take precedence over the future. The internal daily demands can force a loss of perspective and a diminished capacity for a cultural attitude of innovation. The future positioning of the healthcare organization is always where the CEO and leadership team must be viewing today's decisions for organizational viability and long-term success.

Designing and living a successful innovative culture is possible. The adoption of the "start-up" culture should be the drive of every CEO and leadership team. In this podcast I share my experience in working within health systems and discuss adopting the necessary characteristics to successfully acquire the adventure, joy, focus and discipline of a startup culture. In addition, the obstacles start-ups face when working with health systems is also explored.

By Michael “Mike” J. Jones

PRIORITIES MAY BE SHIFTING FROM THE STATUS QUO FOR HEALTH CARE EXECUTIVES

According to a recent article written by Rachel Popa for Becker’s ASC Review, healthcare executives are increasingly focusing on revenue growth in outpatient services, according to Advisory Board's 2019 Health Care CEO survey.

Advisory Board, a research and consulting company, surveyed 90 C-suite leaders between January and March. Fifty-seven percent of respondents said their No. 1 priority was increasing ambulatory access.  Increasing ambulatory access includes changing hours of operation, the number of staff available and the movement of patients through a facility.

The other four top priorities for healthcare executives include:

1. Minimizing unwarranted clinical variation

2. Strengthening primary care alignment

3. Redesigning health system services for population health

4. Innovative approaches to expense reduction

Status quo: The current state of being

For healthcare professionals, particularly physicians, what is the status quo? It’s already high and ever-increasing costs of healthcare, with inconsistent clinical outcomes and low patient satisfaction. Burnout among physicians is very high because they find multiple stumbling blocks in their medical practice.  Professionals frequently refer to the current state of healthcare organizations as a “sick care system” with hospital services as a primary focus and designed to take care of patients when illnesses and injuries occur. 

By Rand O’Leary

Gallup’s State of the American Workplace reports that while the U.S. has more than 100 million full-time employees, only about one-third of them could be considered engaged at work. These are the staffers leaders dream about - they love their jobs and just make their organizations better. At the other end of the spectrum, 16% of employees are actively disengaged and generally miserable at work, and the remaining 51% of employees are not engaged at all – they’re just there.

For a leader, those are some sobering statistics, and should serve as a wakeup call. While engagement is important, chances are, you don’t just want your employees to engage, you want them to be inspired. Suze Orman once said you cannot inspire unless you’re inspired yourself. That means as a leader you should have passion – for the work, for the mission, and for what that means to people and the communities you serve.  

Inspired employees impact an organization’s bottom line too, and studies have shown that inspired employees are more than twice as productive as satisfied employees. Inspiring behavior unleashes the energy within people to do their best work. It also helps them connect with an organization’s purpose and meaning.

By Lee Ann Liska

This article published recently in the The Atlantic points out that unexpected, large hospital bills can happen to anyone.  This caregiver was hounded by collectors, one even inviting them to connect on LinkedIn!  As healthcare administrators, we have a good understanding of our average reimbursement and collection rates, as a percentage of the gross, billed charges.  But do we really know what happens when the uncollected charges are turned over to collection agencies?  Are we aware when and if they are then turned over or “sold” to other debt buyers?  To me, poor treatment by collection agencies and debt buyers is still a reflection on the health system where the patient received their care.  Can health systems and doctors afford this type of reputational risk?

I turned to a colleague, a revenue cycle professional and expert - the best I’ve ever worked with in the business.  They provided a more balanced perspective:

There are two sides to this dilemma depending whether you are a patient or provider.  From the patient perspective, medical debt is increasing and in too many cases crippling, often leading to financial ruin, depression and shattered lives.  Statistics show the percent of total bankruptcy, because of medical debt, at over 50% and employers shifting costs through deductibles, now on average over $1,300 and growing, according to the Kaiser Foundation.  On top of that, healthcare spending as a percent of GDP is approaching 20%; an unsustainable trajectory.  Bottom line, patients and families are harmed by unaffordable medical debt and there is no solution in sight.

By EW Tibbs

Since the 1990s, I used the nursing process (assessing, diagnosing, planning, implementing, and evaluating) plus a healthy dose of human resiliency in healthcare leadership and my personal life.  Little did I know that this training would benefit me when I least expected it.  In September 2018, Hurricane Florence made landfall on the coast of North Carolina and with it permanently changed the residents’ lives. Homes were swept away and people feared how they would provide something as simple as the next meal for their families. My family was fortunate because our home only sustained minor structural damage; the only major damage was losing our dock. With hard work, determination and a disciplined process, the dock was transformed into something even better than it was in its previous state.

By Pamela J. Gallagher

Among the dilemmas facing healthcare executives, the decision to hire more in-house staff or outsource non-core functions of an organization is becoming increasingly common and complex. In the healthcare industry, business process outsourcing (BPO) can allow hospitals to increase their focus on what they do best: caring for patients and serving them well.

BPO includes benefits like lowering costs, increasing efficiencies, increasing focus on core business functions, and partnership with trusted experts in a wide variety of front- and back-office functions. But outsourcing has a cost that is more than just financial. Working with a BPO company requires releasing control, and if the relationship doesn’t work out, it can be hard to recover, both for your organization and your people.

Is business process outsourcing (BPO) right for my organization?

How do you know if it makes sense to outsource a function of your hospital or healthcare company?  Start by weighing the costs and benefits to determine if outsourcing makes more sense financially than hiring or training an in-house employee. Ask yourself questions like:

• What specific process or function does my organization need performed? Where is this function lacking in efficiency or cost effectiveness?

• Does my organization currently have the skill set needed to perform this function internally? Locally?

• What is our budget for this function, process, or service? What can we afford?

• How often and for how long do we need this function performed?

If it has been determined that it is financially viable and necessary to your company running efficiently to outsource a service or process, here are some things to consider as your company explores outsourcing options.

By Dr. Michael J. Zappa

Recently, I had the opportunity to share the joy and intense emotions of giving away my daughter in marriage. At this extraordinary event, I had the fatherly privilege of making the welcome toast. Reflecting on these thoughts in the days that have passed, I realize that these principles and practices that guide us toward happy and healthier relationships are key traits that great leaders exhibit. Please indulge me in the following excerpt from that toast I gave at the wedding of my daughter Francesca to her husband Matthew.

How to think critically when solving healthcare operations issues

By Pamela J. Gallagher 

Within the next five years, technology could be performing as much as 30% of tasks commonly performed by people in today’s workplace, according to Supply Chain 24/7.

People tend to react to statistics like this in one of two ways. Some throw their full confidence behind the inevitability of technology, believing it to be the solution to nearly every financial or operational issue.  Others view these numbers through the lens of a “doomsday-er,” prophesying that technology will upend business-as-usual—for the worse.

Whether 30% of people-powered tasks will be fueled by technology a few years from now, I can’t say. But here’s what I do know: The future of the workplace and of the healthcare industry will look different than it does today. We just have to make sure it’s going to be better.  With the costs of technological solutions playing a role in the skyrocketing cost of healthcare, hospital executives must think critically when considering tech solutions to operational issues.

How can you tell if a tech solution is 1. necessary, and 2. worth the time and money to implement?

By Mike McBride

Mentoring has been one of the most rewarding benefits in my career. I have also been the beneficiary of great relationships with mentors and am forever grateful that extremely busy professionals made time for me - and made me feel like a priority - when I was learning my role as a young administrator and a new leader.

There is so much more to the mentor and mentee relationship than just learning the ropes – it’s about being a guide, a coach and a friend. The relationship is mutually beneficial, and I continue to fill both of the roles – mentor and mentee. I have been in the position of the young careerist seeking guidance, as the mentor providing the guidance, and as the mentee who needed the support to progress in my knowledge and experience. My mentors helped shape who I am today, and from their insight and lessons, I am able to mentor others to help them develop their talent, avoid common pitfalls, and guide career paths. 

Perhaps the most unique aspect of being a mentee is having the full confidence to ask the mentor about industry or workplace-related questions they might not be comfortable asking others. The relationship is built on mutual trust and cannot exist without a clear understanding that questions asked in confidence stay in confidence.

By Pamela J. Gallagher

For some hospitals, the close of the fiscal year comes with a sense of dread—it’s time to run the gauntlet of another audit.

Though audit requirements vary based on whether a hospital is public or private, for-profit or nonprofit, audits are an inescapable reality for every hospital. The audit process can feel like an irritation, yet another project to add to an already full plate, but audits also bring an opportunity to develop stronger accountability and transparency within the organization.

Preparing for an audit can be daunting, but it doesn’t have to spell disaster for your organization.  There are steps healthcare executives can take today to allow a smooth audit process down the road.

Always be prepared.

The best way for your hospital to prepare for an audit is to always be audit-ready.  Of course, this is easier said than done, especially if financial credibility and accountability haven’t been made a priority across all levels of the organization. It’s only when you haven’t been keeping up with your finances that an audit is a potential issue for your organization. 

By Michael “Mike” J. Jones

Physician dissatisfaction, staff dissatisfaction, and low patient satisfaction are interconnected, common themes in healthcare leadership discussions. While the cycle seems to spiral uncontrollably, it isn’t impossible to manage the processes of healthcare to positively influence outcomes.

Certainly, not all outcomes are positive. Some diseases may only be managed, not cured.   Any number of factors impact patient, physician and staff attitudes. It is possible, though, to systematically modify healthcare organizational cultures to reach goals of a performance excellence philosophy.

Begin with understanding the VISION you seek: To maximize success in the ever-evolving healthcare environment through physician alignment and integration.

By Dr. Michael J. Zappa

A mentor of mine is often quoted: "Hope is not a strategy!"

Indeed, there is a world of difference between hoping things will improve and implementing a well thought out plan. However, nothing can ever change or improve unless we can imagine it as such. Once it is imagined, there must be some belief or "hope" that this vision can be realized. Now that's where strategy comes in, making the vision a reality.

As leaders, we must start by inspiring hope, not by asking for the action plan. When your team believes they can make a difference, they will. It is very obvious in healthcare: patients would never come to us without the hope that we can make them better. Hope is not just for our patients, it is for every member of our team.

By Michael J. Zappa 

The human body is the most brilliant machine ever created and the quintessential work of art.  The headline above is not referring to your creativity and accomplishments in your clothing optional private abode; it is taking literary license from 19th century Danish author, Hans Christian Andersen.

Reflect on the fairy tale, The Emperor’s New Clothes.  The Emperor (leader) was a vain man, concerned more with appearances, accolades, and maintaining his current position than the harsh realities that others faced.  His subjects were afraid to express their honest opinions to him, fearing they might be deemed unfit for their position or even stupid.  The climax of this tale occurs when he is fooled by some weavers into wearing a “spectacular new suit” that, in fact, doesn’t exist at all.  The Emperor is allowed to parade through the town naked.  Finally, a mere child blurts out in honesty that the Emperor is wearing nothing at all.

Leaders at all levels of an organization run the risk of being caught naked at work, but this risk increases as one ascends the ranks.  People see pleasing their boss as important, essential to keeping their jobs.  Most leaders would proclaim they are wise enough to detect blatant deception, but it is often more subtle than that.  Very often what happens is filtering; direct reports present the info that makes them look good and their boss is expecting.  This filtering of information is equivalent to a slight degree of course variation which becomes obvious 100 miles or more into the journey.

By Mike McBride

The best healthcare boards are dedicated to the success of the organizations and communities they serve, have a sincere hunger to stay up-to-date and informed about industry standards and stay curious about emerging trends. Board members have to be well educated on the issues, well prepared for generative discussions, and be mindful of the interests and concerns of stakeholders.  Being a contemporary healthcare board member demands a great deal and, in turn, can provide a rewarding experience.

Boards play a critical role in the long-term success of organizations. In addition to the expected fiduciary responsibilities, healthcare boards are tasked with promoting and embodying the mission and vision of the institution and advocating for its well being while setting aside self-interest.  Advocacy includes ongoing education of politicians and civic leaders, fundraising and networking with potential donors, and telling the organization’s “story.”  It is imperative that the board builds relationships in the community in order to expand services to meet community needs and partner with other aligned organizations.

By Rodney D. Reider

Politicians, businessmen, and even housewives ask the questions: “Why is healthcare so complicated?” “Why can’t it be simpler?” 

They even demand: “I need care, tell me the price, and don’t make me wait so long.” 

Amazon knows me as a member of Prime and maintains my information securely in the cloud.  Amazon knows where I live with my saved data/information and then delivers to my house in three days or even less.  They know me.  “Why do I have to keep filling out the same paperwork at my hospital every time I arrive?  It is my regular appointment with my same doctor and the same office and hospital.  Why don’t they know me by now?” 

Apple has all those apps I can just download from the app store for service, education, entertainment or every day conveniences. 

“If physicians and hospitals are so sophisticated with all their expensive equipment, why can’t I just get an app to simply make an appointment, review my bill and pay utilizing PayPal?” 

“I’ll tell you what causes a real headache, trying to pay a bill after a stay at my hospital.” 

Finally, “Why can’t I just download my healthcare information and take it with me wherever I go?”

Industry-wide, we providers are internally focused on creating results; too often myopic in our approach.  Ongoing comparisons within the healthcare industry are continuous and judicial yet we restrict our world toward outmaneuvering only the local competitors; however, our patients are judging us by the expectations created outside of healthcare through their engagement in the broader world of technology and business.  As leaders of the Provider sector, we often carryout numerous discussions resulting in mediocre attempts, limited investment and a haphazard focus to lightly adjust our way into the next necessary realm of healthcare’s future.  Yes, some such as Banner, UPMC, Kaiser, and Providence are having an impressive innovative approach and positive impact, yet most, even if they have established Innovation Centers, provide limited capital and secondary support.

Customer expectations originate from numerous smaller entrepreneurs to the headline grabbing Amazon, Apple, Walmart, CVS-Aetna advancements.  Payers such as United continue multiple acquisitions generating a ground-breaking family of companies striving to buy, disrupt, create, and combine beyond the healthcare landscape’s meager approaches.  Forward thinking innovators and disruptors from biotech, pharma and technology are continuing to enhance their progressions.  Their actions will have renewing and lasting effects on every portion of our future healthcare business.

By Dr. Michael J. Zappa

Long term success in life is rarely achieved by perpetual crisis management and the ability to work around the clock to meet a deadline…not that great leaders and successful individuals don’t have that ability and need to deploy it from time to time! One of the keys to sustained success is balance. Balance should not be viewed as a goal that is attained; rather a dynamic state in need of frequent adjustment…like a see-saw.

By David Berger, MD

In this episode on helping digital startups sell their solutions, I want to focus on the issue of implementation. It is certainly important to have a wiz bang digital solution. Equally important is how to implement the solution and manage the changes it causes. All startups should understand the concerns the hospital C-suite has around the implementation process. Specifically, the startup must be prepared to answer the following:

By David Berger, MD

In my last blog post I discussed the challenges digital health startups face when trying to sell to hospitals and health systems.  In this post I suggest some ways to overcome the hurdles and succeed in building a client base. 

Startups need to be realistic about where they are in their product life cycle.  As I mentioned previously, hospitals are risk adverse with tight budgets.  …