Monday, October 02, 2017

Emergency Preparedness


Steve Chies, Program Manager of the Long-Term Care Administration Program at Saint Joseph's College, has written an excellent blog about being prepared in the face of hurricanes and other emergencies!  Check it out at http://seniorcareleadership.blogspot.com/



Wednesday, September 13, 2017

Defending Patient Rights

Consent is a tricky issue in healthcare.  Every procedure performed by a healthcare professional requires consent.  It can be obtained in three ways:

Informed Consent – the procedure is explained to the patient (in language they can comprehend), including any options and possible outcomes.  The patient agrees or refuses.  A signed form is sometimes obtained.

Implied Consent – the procedure is explained to the patient and they indicate with their body language that they consent (e.g., rolling up a sleeve for a blood draw or sticking out a tongue for a strep culture).

Assumed/Presumed Consent – the patient is unconscious, but it is assumed that they would want life-saving measures taken as needed.  Once the patient becomes conscience, informed consent is obtained.

The distinction between these consent lines is sometimes blurred, but for liability purposes, healthcare professionals should obtain informed consent on any invasive procedure.  Using language the patient understand is crucial – we don’t want patient’s agreeing to something simply because we suggest it – that is considered paternalism and prevents the ability of a patient to make an informed choice.  A culture of patient autonomy depends on providing as much information to the patient as possible and allowing them to make an educated choice.

Enter the situation in Salt Lake City.  A nurse was recently arrested for refusing to draw blood from an unconscious patient.  The patient could not give informed consent, was not under arrest (which causes an individual to lose certain rights), and the blood draw was not for medical purposes.  The police officer forcibly removed the nurse from the hospital in handcuffs.  She was later released and not charged.  The police officer was put on administrative leave and the incident gained national attention.  As a result, the hospital created a new policy – all police officers must stay out of clinical areas and must go through a liaison versed in health law and ethics.  There is also an ongoing federal investigation.

What can we learn from this incident?

1.  Healthcare administrators need to make sure that healthcare professionals understand patient rights, including consent.  

2.  Hospitals and HCO’s need to have clear policy for outside authority – including police, firefighters, federal agents, etc.

3.  A clear chain of command needs to be in place to avoid situations from escalating to violence in a healthcare setting.
Obviously, it is easy to look at this situation and list all the problems.  It would be better to use this issue as a teachable moment.  Here we have a healthcare professional ready to defend patient rights to the end.  That is an amazing culture for a HCO to have developed.  Follow up is needed to ensure the support for that healthcare professional exists beyond just her own integrity.




Valerie Connor, MA CCC-SLP; MS CHES

Thursday, August 31, 2017

MHA Competency Model



The Master of Health Administration Program at Saint Joseph’s College has adopted a modified version of the Healthcare Leadership Alliance Competency Model as the basis for the program. Students completing the program are expected to have achieved at least intermediate mastery of each competence noted below.

Domain
Competence
Communication & Relationship Management
Utilize effective Interpersonal Communication


Exhibit Effective Writing Skills

Demonstrate Effective Presentation Skills
Leadership
Effectively Lead and Manage Others


Manage Change Effectively


Able to Honestly Assess Self


Demonstrate Systems Thinking


Effectively Solve Problems and Make Decisions

Professionalism
Exhibit Personal and Professional Ethics


Contribute Profession and in Community


Work Effectively in Teams

Knowledge of the Healthcare Environment

Explain Health Care Issues and Trends


Analyze Population Health and Status Assessments


Explain Health Policy


Apply Health Care Legal Principles

Business and Analytical Skills

Manage Healthcare Finance


Effectively Manage Human Resources


Explain Organizational Dynamics and Governance


Apply Strategic Planning


Utilize Effective Marketing Principles


Understand and Effectively Manage Information and Use Technical Skills


Employ Quality Improvement/Performance Improvement Strategies


Demonstrate Quantitative Skills


Planning and Manage Projects


Analyze and Apply Economic Principles



Adopted July 2017

Tuesday, August 15, 2017

The Reason for Our Hope - Knowing Our Calling

Throughout all our lives, there comes a defining moment where we must decide what our calling in life is. Those in the healthcare industry generally aim to serve those in need. Why is this? I like to think every one of us desires to serve some greater good. From an anthropological standpoint, humans have had somewhat of a natural inclination to help those in need. Regardless of our ethical and moral views, we as humans take care of someone in our lives. This can be our parents, children, friends, or from a healthcare setting, patients.

While taking the Leadership in Healthcare Administration course, we were required to listen to a podcast for one of our assignments. The title of the podcast was, "Erie Chapman - Bettering Healthcare with a Servants Heart." As I began to listen to the podcast, I was struck with somewhat of an epiphany. All of us in healthcare are servants. No matter what job title you obtain, you are a leader and servant to someone in need.

Knowing we are leaders and servants is a humbling, but exciting thing. As a future leader in healthcare administration, I always want to have the reason for my hope held tight to me. Our calling in life is ultimately serve daily for the betterment of others in need. THIS is why we work in a healthcare industry. If it is not, then maybe we should have some self reflection.

How is servant leadership effective? This question strikes and provokes my mind very often. Servant leadership reminds us daily of why we are involved in healthcare. It reminds the nurse every day of why she cares for the sick and dying. It reminds the surgeon of why he saves a dying child's life. It reminds the hospital manager of why he makes sure patients and caregivers are taken care of, and lastly, it reminds me of why I chose Saint Joseph's for graduate school.

Chapman proposes a leadership concept called the Radical Loving Care Program. In this program, he asks himself who are his clients. His immediate answer was the employees - Those who take care of people. With compassion, empathy, and vision, leaders must guide and show their team members the reason for their hope. Not just the reason for their hope, but for the hope of every patient in need. The front-line caregivers are the reason for every patients hope. This is the passion and vision leaders should have! Leaders must have confidence in their employees. In doing this, it is imperative that leaders re-spark that passion into employees every single day. This is effective servant leadership. May we all follow the reason for our hope, and through this, know our calling.
Written by Cameron Davis, Graduate student at Saint Joseph's College 

Monday, July 24, 2017

A Leader's Role in the Patient Experience

Healthcare is a highly regulated and in some cases, a highly competitive environment.  Healthcare delivery is changing at a rapid pace. Healthcare leaders are learning how to adapt and lead their hospitals into the future.  The center for Medicare services over the last few years adapted the Hospital Consumer Assessment of Healthcare Providers and Systems; better known as HCAPHS patient satisfaction scores to tie patient satisfaction in the calculation of reimbursement for patient stays (CMS, 2015).

Hospitals in competitive environments focus on how to deliver care and stand out from the competition. Additionally, social media has changed how patients share their healthcare experiences.  Patients can praise or complain about their hospital experiences on Facebook, Twitter, Instagram and the like.

Leaders are in a great position to help staff understand the importance of patient experience to an organization, whether it be to improve overall scores or patient perception. Quality care is increasingly linked to efficiency, cost reduction and optimal utilization of resources. Healthcare quality care programs and metrics are increasingly influenced by financial incentives and measured by state of the art scientific tools and sophisticated methodologies. (Belasen, Eisenberg & Huppertz, 2016 p 144)
Patients and families view their experience of care in its entirety: The clinical treatment, the interactions with staff, and the physical and ambient environment all tie together as one, overall impression and journey. Leaders and caregivers who commit to observing and learning in detail about this journey quickly identify what needs to improve to create a better experience. (IHI, 2011)

How can you as a leader showcase the importance of patient experience in your workplace? Interpersonal relationships can go a long way to helping organizations improve scores. Effective leaders practice with conviction, and demonstrate the importance of the caregiver/patient relationship.

 An important leadership quality is social intelligence. “Socially intelligent leaders have strong conversation and listening skills, a keen understanding of social roles and rules, confidence in interacting with different types of people and a fine-tuned ability to understand other’s thoughts and feelings.” (Sowick et al, 2015) One of my favorite quotes is from Maya Angelou “I have learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”  This statement holds true not only to the patient’s we serve but also how we as leaders serve our teams.

 Leaders of today must use both transactional leadership skills and transformational leadership skills to be an effective leader in today’s workplace.  Being the vison setter to bring new ideas forward, to have the courage to lead by example and advocate for employees and patients will go a long way toward improving not only the patient but staff experience.

References

Balik, B. (2011, July). Institute for Healthcare improvement, Patient Safety Reprinted from ACHE.org
Belasen, A. T., Eisenberg, B, Huppertz, J. W., (2016). Mastering Leadership: A Vital Resource for Health Care Organizations, pgs.
https://www.medicare.gov/hospitalcompare/search.html
Sowick, M, Andenoro, A, McNutt, M, Murphy, S.E (2015) Leadership 2050: Critical Challenges, Key Contexts, and Emerging Trends; Emerald Group


Provided by Robyn McDevitt, Graduate Student, Saint Joseph's College

Tuesday, July 18, 2017

There is Hope!!

Lately, I pondered the question of “….how would the retiring Boomer Long-Term Post-Acute Care (LTPAC) leaders be replaced….?"  With the average age of administrator’s being in their 50’s, this is a real challenge for licensure boards, employers and educators.  Public policy makers will need to find some solutions to this complex problem.

I had the opportunity to work with a number of students who are majoring in healthcare administration and are going out on a one-year practicum.  I found them to be a delight to teach, but also to learn from.  They are bright, focused,  passionate about the LTPAC sector and were excited to learn about the profession.

It was enlightening and heartening to interact with this group, as they progressed in their studies.  They asked great questions, researched many of the challenges facing our sector, and suggested innovative methods to approach some of the difficult issues facing the LTPAC sector. 

What has been encouraging to me was that the students were from the millennial generation and very interested in an aging services career!   There have been some articles and suggestions about the characteristics of this coming generation that were considered to be negative, when compared to Boomers.   I did not find the “generalities” about millennials that have been suggested to be true nor accurate.  They were serious with their studies, willing to learn, and excited about working in the sector. 


It gave me considerable comfort that these students will make great leaders in the LTPAC sector.  Now the question is how do we find more of the millennials that will be willing to prepare to learn and enter this profession?

Submitted by Steven Chies, Faculty at Saint Joseph's College

Friday, July 07, 2017

The New Moon in Healthcare

The Medicare Outpatient Observation Notice (MOON) came out earlier this year and this is something that always comes up as a question and not many know where to find the answers.

Medicare put out a MLN article in February for Critical Access Hospitals (CAHs) that provide observation services to Medicare Beneficiaries. The main point of this article was to identify and drive home a clear and concise message covering how providers in CAH facilities should utilize the MOON to educate Medicare beneficiaries. CAH providers should use the MOON to inform any Medicare beneficiary who is an outpatient in their facility that happens to be receiving observation services and are not an inpatient in the CAH or hospital.

Hospitals and CAHs must provide the MOON to beneficiaries who receive observation services in a CAH or hospital for more than 24 hours. This form must be provided to the Medicare beneficiary no later than 36 hours after observation services begin in the outpatient setting. Now, this is not only for the traditional Medicare Part A and Part B patient, but those beneficiaries that do not have Part B coverage, as this is optional, and when a patient is admitted prior to the required delivery of the MOON.

Now, one may think, let’s give these to all of our Medicare patients receiving outpatient services. This will not work as the MOON should not go to all beneficiaries receiving outpatient services. It is intended only for patients that exceed 24 hours of observation services. But here is a good twist, the CAH or hospital can deliver the MOON to Medicare beneficiaries that are receiving observation services in a CAH or hospital, but have not exceeded the 24 hour rule. As long as they are receiving observation services the CAH or hospital can deliver the MOON to the patient, but no later than 36 hours after observation services have started.

Some other points:
  • The MOON must remain two pages
  • Additional information may be attached, per individual state regulations
  • Hospitals and CAHs can put their logo on the top of the MOON
  • In completing the MOON, hospitals or CAHs must type or write (clearly) the patient name, patient number, and reason for outpatient in the blanks of the MOON.
  • CAHs and hospitals must provide, not only the written MOON, but an oral notification as well. This must consist of an explanation of the standard written MOON.
  • To show proof of delivery, the patient or representative must sign and date the MOON to show delivery and understanding of the information contained in the form.
  • An electronic form of the MOON is permitted with an electronic signature capture pad.
  • With an electronic form of the MOON, the patient must receive a paper copy as well.
If a patient or their representative refuses to sign the MOON, the facility representative can sign the document, state their title, date and time presented to the patient, and the staff member will note in the “Additional Information” portion of the MOON that the form was delivered and the patient refused to sign, then date and time of refusal will be noted as well.

This is very similar to other forms for CMS, such as an Advance Beneficiary Notice (ABN), and the same care must be taken to remain in compliance with CMS and to make sure you are keeping your patients educated.
Submitted by Kevin Harrington, MS, RHIA, CHP, Faculty, Saint Joseph's College

Wednesday, June 07, 2017

Alternative Payment Models (APMs)

Alternative Payment Models (APMs) is an approach that was developed in partnership with the clinician community and it provides added incentives for clinicians to provide high-quality and cost-effective care. The APM can apply to a specific condition or a specific episode of care, or a population. APMs can offer significant opportunities to eligible clinicians who are not ready to take on the additional risk and requirements of Advanced APMs.

Advanced Alternative Payment Models (Advanced APMs) enable clinicians and practices to earn greater rewards for taking on some risk related to the patients that they serve and their associated outcomes. It is important to mention that the Quality Payment Program does not change the design of any particular APM, however, it can create extra incentives for an ample degree of participation in Advanced APMs. There are six models for APMs and they are Comprehensive End Stage Renal Disease Care Model, Comprehensive Primary Care Plus (CPC+), Shared Savings Program Track 2, Shared Savings Program Track 3, Next Generation ACO Model, and the Oncology Care Model. The listing of Advanced APMs are posted on the CMS website at QPP.CMS.GOV and will be updated as needed.


To help identify future opportunities, MACRA established the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to review and assess Physician-Focused Payment Models based on proposals submitted by stakeholders to the committee. In future performance years, we anticipate that the following models will be Advanced APMs such as Comprehensive Care Joint Replacement Payment Model, Advancing Care Coordination through Episode Payment Models Track 1, ACO Track 1+, New Voluntary Bundled Payment Model, and the Vermont Medicare ACO Initiative. 

Submitted by Kevin Harrington, MHSA, RHIA, CHIPFull-Time Faculty Member at Saint Joseph's College

Thursday, May 18, 2017

What do We Deserve?

When the Affordable Care Act was passed in 2010, it was met with two completely different reactions.  Some viewed it as a mandate, while others viewed it as a right.  In a sense, the law mandated that all United States citizens carry health insurance while also propagating that all United States citizens have a right to affordable access to health care.  Not everyone agrees with either of these proponents, which has made for interesting conversations over the past year.  One of those conversations focuses on patient rights – specifically how much we deserve.

If you have not read the Immortal Life of Henrietta Lacks, I highly suggest that you do so.  Or, if you prefer to watch TV, you can watch the TV version that was just released.  Either way, it is a very interesting story.  Henrietta passed away from cancer, but before she died, a sample of her cancer cells were used to create the HeLa chain – a chain of cells that proved to be very helpful to scientists.  These scientists eventually benefitted financially from their research (involving Henrietta’s cells), but neither Henrietta nor her living relatives received any compensation for the cells or research finds.

Is this unusual?  Not really.  Henrietta’s cells were unusual, yes, and very helpful to scientists, but we do not usually benefit from body parts that are donated in our country.  The law states that once a blood or tissue sample taken from a patient leaves the room that the patient occupies, it becomes property of the healthcare facility.  The healthcare facility is then free to use it for purposes beyond the tests that have been ordered.  In Henrietta’s case, the cells were found to be very helpful to scientists.  But, without the scientist’s expertise, the cells would have simply sat in a petri dish or been discarded.

Some may argue that Henrietta did not consent for her cells to be used for research.  The law is also clear on that issue – patients have the right to consent to or refuse research.  However, the research was conducted after Henrietta’s cells were removed from her presence.  It’s actually quite remarkable that her family members learned about the research – most of us never know what happens to that blood or tissue sample after we rececive our test results.

It really boils down to “what do we deserve”?  Should Henrietta’s family be compensated for the use of her cells?  Or should the compensation stay with the scientists who used their knowledge to further research surrounding cancer and cancer treatments?  A lawsuit will be looking at that issue later this year.  If the courts rule in favor of Henrietta’s family, we might be looking at another dynamic change in our country.

For more information:


Submitted by Valerie Connor, M.A., CCC-SLP, Adjunct Faculty at Saint Joseph's College.

Friday, April 28, 2017

Developing Leadership Effectiveness Using a Polarity Lens Part 2

When June became aware her growing impatience with her staff was a result from trying to solve a problem that was not a problem to solve but a polarity to leverage, her capacity to be an effective leader increased.

Healthcare leaders are master problem solvers.  There are many situations and issues that daily require problem solving skills and decision making.  For example, do we need a policy for xyz? Who should we have complete the survey? And, Should Mary be promoted to nurse manager? Problems to solve have end points.  They are not ongoing. They have mutually exclusive opposites. Problems to solve require Or thinking.

Polarities require Both/And thinking.  Both sides of the polarity are important. There is a natural tension in polarities and the oscillation between both sides is ongoing.  Other realities about polarities include:

·         Polarities are inherently unsolvable in that you cannot choose one pole of the pair as a “solution” to the neglect of the other pole and be successful over time.
·         If you treat a polarity as if it were a problem to solve, the natural tension between the poles becomes a negative, self-re-enforcing loop or “vicious cycle” leading to unnecessary dysfunction, pain and suffering.

·         If you can see a polarity within an issue, you can leverage the natural tension between the poles so it becomes a positive, self-re-enforcing loop or “virtuous cycle” lifting you and your organization to goals unattainable with OR thinking alone.

·         The natural tension within all polarities is often experienced as resistance.  Polarity thinking helps us leverage the wisdom within this resistance.  It helps us convert resistance to change into a resource for stability AND change.

·         Polarity thinking helps us see ourselves and our world more completely thus increasing our capacity to love.     
        Dr. Barry Johnson www.polaritypartnerships.com 

In addition to Task AND Relationship, other common leadership polarities include: Stability AND Change, Candor AND Diplomacy, Directive AND Participative, Collaborate AND Compete, and Conditional Respect AND Unconditional Respect.

What can we do when we experience the tensions and dilemmas of polarities?  Dr. Barry Johnson created the Polarity Map and his team at Polarity Partnerships created the 5 Step S.M.A.L.L process to help leaders leverage polarities.

Seeing – Identify the tension and the two interdependent poles that when leveraged well will create a virtuous cycle toward a greater purpose.

Mapping – Determine the upsides (values) and downsides (fears) of both poles.

Assessing – Gather data to determine how well or how poorly we are leveraging the polarity.

Learning – Understand what we learn from the assessment.

Leveraging – Create action steps and early warning signs that provide us a path to navigate the energy of the polarity.

June’s map helped her organize the energy she was experiencing while feeling impatient with her staff and acknowledge the oscillation of energy needed in the polarity of Task AND Relationship to help her reach her greater purpose of being an effective and inspiring leader.  



Polarity Thinking – Dr. Barry Johnson  www.polaritypartnerships.com

Blog post submitted by: Danine Casper, MHA,  St. Joseph’s Adjunct Faculty Member  HA 511 Leadership in Health Administration.  Danine is also a Leadership Coach and Consultant. www.aponicoaching.com  and is completing the Polarity Mastery Program to be a licensed polarity consultant.