Tuesday, May 22, 2018

Family Financial Responsibility for Senior Care

Several recent items got me thinking about how American society is planning for senior care needs as Boomers age and start accessing LTPAC services. 

 ·        A New York Times article titled “The New Retirement: Near the Kids”  (hhtps:nyti.ms/2HNJ1j5) details a discussion of retirees moving away from the “sunbelts” and in to senior communities near their children. The article discusses the importance of family contacts, isolation, and nutritional needs as we age. While news articles and anecdotal stories do provide some interesting examples, they are limited in their scope and might not reflect the trends in society as a whole. 
 ·        Another article reported from the life insurance company (Northwestern Mutual) reported that 21% of Americans have no retirement savings and 33% of Boomers have less than $25,000 in savings. Those savings amounts are considerable less than the cost of a year in any senior care settings.
 ·        Another article in the Wall Street Journal was a question in their “Market Watch” section from someone asking about children’s responsibility to support aging parents. The author reports that about two dozen states have laws that have “filial” responsibility or “piety” laws, which require that families have a duty to support parents of adult children. While these have rarely been used and date back to colonial times, they are enforced on an occasional basis.
 ·        The final article (The Investment News Adviser Center) reported that two-thirds of financial fraud against the elderly was perpetrated by those closest to the victim. (ie. family, friends or trusted individual).

 All of the articles are concerning individually, as they have broad public policy issues on how to provide, support, and finance senior care needs into the future. Taken together, the potential for seniors and their families to be able to find and afford quality senior care is very concerning. The demographics of American society are very well known and should be used by public policy makers to prepare society for the coming challenges of aging Americans. Doing nothing to change the service delivery and financing for seniors has grave potential for taxpayers and families of seniors.
Written by Steve Chies, Program Manager, Long-Term Care Administration, Saint Joseph’s College

Tuesday, May 01, 2018

Great Article!

One of our graduates has written a terrific article!  I have linked it here!

Why I Chose to Join the Nursing Home Profession

Monday, April 16, 2018

Annual Wellness Visits

With Health Administrators changing place of service/employment and organizations expanding their presence in Primary Care Practices (PCP), there are many areas of focus for the PCP, of which one of them is Annual Wellness Visits.

An Annual Wellness Visit (AWV) has the following characteristics:
  • It is an enhanced visit that lasts 45-60 minutes, at no-cost to the patient, including preventive labs
  • The goal is to see every Medicare patient every year and for this service to be billed once per calendar year
  • The benefit refreshes January 1 of every year. There is no need for the PCP to wait 365 calendar days between visits
  • In addition to the traditional AWV CPT codes G0438 and G0439, some insurance plans offer the ability for the PCP to submit additional codes for reimbursement.  Check your local plans for details.
  • AWVs need to be performed by a primary care physician, contracted nurse practitioner, or PA

 During an Enhanced Annual Wellness Visit the practitioner must
  • Document patient’s current chronic conditions and ongoing treatment plans
  • Conduct preventive screenings for conditions such as high blood pressure, diabetes, depression, and heart disease
  • Review medications
  • Schedule preventative treatments: colonoscopy, blood work, mammogram, etc.
  • Complete lab work as necessary
  • Use a pre-populated template based on the requirements of the specific payer

Benefits of an Enhanced Annual Wellness Visit
  • Allows for accurate reporting/submission of patient’s chronic conditions to Medicare in the current year
  • Maintains best practice of seeing your patients at least once a year
  • Allows opportunity to identify care gaps and create a plan of care for the year
  • Ensures acceptable medical record documentation in the case of a Risk Adjustment Data Validation (RADV) audit.
  • Compliance with Star Measures is also required by CMS.
  • Other considerations:  
CMS measures outcomes in multiple domains, including measures focused on your efforts to manage chronic conditions/issues in the Medicare population:
                                          i.    Osteoporosis
                                        ii.    Diabetes (retinopathy, nephropathy, HgbA1c, and cholesterol control)
                                       iii.    Hypertension
                                       iv.    Rheumatoid arthritis
v.  Bladder control

This is just a quick overview of the Annual Wellness Visit. If you find yourself or your organization getting more involved in Primary Care Practice Management, this is one of several areas that you as a Healthcare Administrator can find areas of efficiency for both the practice, and most importantly, the patient.
Submitted by Kevin Harrington, MATS, MSHA, RHIA, CHP, Full-Time Faculty, SJC

Thursday, April 05, 2018

Cultural Agility & Long-Term Care Settings

In my opinion, in the service industry, whether it is elder care or kinder care, cultural competence is the nexus that can determine success and satisfaction in any service business. I learned this fact early in my education as a recreation therapist. I had to understand the specific cultural interests of each population so that I could engage clients in meaningful activities in which they felt connected. For example, my Hispanic students wanted to learn the salsa and liked the upbeat tempo of that genre. My African American students wanted to listen to hip-hop and dance like Michael Jackson. We all compromised and had fun and a lot of laughs learning the various styles of dance and music.
Likewise, as a recreation therapist in a nursing home, I had to provide a variety of activities which would connect to a multitude of cultural interests. The religious activities were where I saw the most distinguishable segregation in cultures. The African American religious groups were more robust, loud, and lasted hours. Whereas, the non-Hispanic white religious activities were conservative and quick. The Catholics preferred to take Mass in their room. We had both an English-speaking priest and a Spanish-speaking priest who would visit the Catholic residents in their room.
I have always worked in very culturally rich locations and have been mindful of cultural differences both in the client population and the workforce. In fact, in the Northern Virginia market, a common complaint among patients is that they don’t understand the staff. In our demographic area, many African workers from Sierra Leona have a strong dialect and speak broken English. We also have many Hispanic workers and Filipino workers. There exist language barriers between staff and residents who are of not a minority background. Equally, many of our workforces are Muslim, and employers have had to adjust workflow to accommodate Muslim traditions and religious observances. So, as a health administrator, I have had many experiences with implementing cultural competencies to serve minority elders effectively.  I equally have had to apply cultural appreciation and diversity training to my non-minority elders and workforce to get along with and accept the cultural differences of our minority workforce.
Competencies Needed in Skilled Nursing Facilities
            There are three competencies that I believe skilled nursing facilities in culturally rich areas could do more to integrate into their healthcare settings. These include coordinating with traditional healers, incorporating culture-specific attitudes and values into health promotion tools, and locating clinics in geographic areas that are easily accessible for specific populations.
            Many years ago, I contracted with a massage therapy school to provide therapeutic massage to our bedridden and chronic pain residents. For me, massage is healing to the body and mind and works much better for my aches and pains than pain medication. Traditional healing methods offer a holistic approach to healing. Common traditional healing methods include acupuncture, sauna and steam baths, herbal teas, and herbal or mineral body scrubs. When I think of traditional healing and the elderly, I think of the power of touch and the power of spirituality. Sometimes, a hug or sharing a prayer is all that is needed to ease some pain and suffering of our fragile elders. Bearing in mind the variances in cultures where touch or eye contact may be offensive or an untoward expression.
            In the context of meeting a specific cultural need, there are practicing traditional healers for the African populations, the Chinese populations, and Native American populations. In my opinion, skilled nursing facilities should consult with residents and families to see if they have these specific preferences and make the accommodations, as feasible, to provide traditional healing to these residents.
            Preventive medicine, healthy lifestyle choices, and chronic disease management are how we will help the influx of the older population age well. The use of health promotion tools such as educational seminars and workshops, published literature, e-health, m-health, telemedicine, and health screenings are all useful tools to manage our aging population. However, if we don’t implement cultural sensitivity into the tools, the message will be lost on the minority elder population.
            Something as simple as the standard rehab ladder could reflect cultural sensitivity. How difficult would it be to ask the patient what their rehab goals are and establish a personal ladder of achievement? Maybe there is a grandchild’s graduation in the future? Perhaps there is a 50th wedding anniversary party? Maybe it is to golf or possibly swim? I use this as a simple example of a complicated issue. However, awareness is half the battle.
            As a skilled nursing facility provider, I would like to see more referrals being made to outpatient therapies, home-health agencies, physicians and specialists, and social workers who share not only the demographics of the discharged patient but also the culture. Most insurance companies include in their directory of providers the languages that the provider speaks. I think the same should be included in a list of home health agencies, outpatient therapy clinics, and enrichment programs for the elderly.
Cultural Sensitivity & Patient-Centered Care
            To conclude the discussion of cultural competencies, I would be remiss not to parallel cultural sensitivity to patient-centered care. Both models aim to improve healthcare.  Whereas, 
“the primary aim of the cultural competence movement has been to balance quality, to improve equity and reduce disparities by specifically improving care for people of color and other disadvantaged populations. [And] the primary aim of patient-centeredness has been to individualize quality, to complement the healthcare quality movement’s focus on process measures and performance benchmarks with a return to an emphasis on personal relationships and customer service. As such, patient-centeredness aims to elevate quality for all patients” (Saha, Beach, & Cooper, 2010, p. 9).
About the Author

Saha, S., Beach, M.C. & Cooper, L.A. (2010, February 18). Patient centeredness, cultural            competence and healthcare quality. Retrieved from          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824588/

Contributed by Donna Rein, Graduate Student, MHA Program, Saint Joseph's College

Monday, March 05, 2018

Aging and Dehydration

What is dehydration? Simply put “Dehydration occurs when more water and fluids leave the body than enter it” (Crosta, 2017).  Studies show that even mild dehydration (1-3% of body weight) can impair many aspects of brain function (Leech, 2017).

Research has also shown that between 6-30% of people over age 65 are hospitalized for some form of dehydration.  The major cause is the lack of fluid intake.  This is often attributed to patients not having the sensation of “thirst”, and not recognizing the signs/symptoms of dehydration such as a sense of dizziness, dry mouth, headache, or a feeling of tiredness.  Another reason noted by patients is their desire to avoid frequent, inconvenient trips to the bathroom, and lastly a fear associated with spontaneous incontinence or loss of bladder control.  (Konings, F., Mathijssen, J., Schellingerhout, J., Kroesbergen, I., Goede de, J., & Goor de, I. (2015).

The benefits of proper hydration aid the body in getting rid of waste - through urination, perspiration and bowel movements.  Proper hydration also keeps body temperature normal, lubricates and cushions joints, and assists in protecting sensitive tissues.

How much fluid should adults drink per day? About 15.5 cups (3.7 liters) of fluids for men and about 11.5 cups (2.7 liters) of fluids a day for women (Mayo Clinic Staff,1998-2018).   Tips to encourage/increase hydration are as follows:  make it a game/encourage the use of colored drinking glasses, incorporate more fluids into other foods such as soups and less sugary beverages like vegetable juices and non-caffeinated beverages such as herbal teas and fruit juices, and making fluids easily accessible.

Crosta, P (2017, December 20). What you should know about dehydration. Retrieved from https://www.medicalnewstoday.com/articles/153363.php
Konings, F., Mathijssen, J., Schellingerhout, J., Kroesbergen, I., Goede de, J., & Goorde, I. (2015).  Prevention of dehydration in independently living elderly people    at risk: A study protocol of a randomized controlled trial. International Journal    of Preventive Medicine6103. doi:10.4103/2008-7802.167617
Leech, J. (2017, June 4). 7 Science-based health benefits of drinking enough water.  Retrieved from https://www.healthline.com/nutrition/7-health-benefits-of-water  
Mayo Clinic Staff. (2018). Water: How much should you drink per day? Retrieved from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256

The author, Patricia M. Cuddy, is a student currently enrolled in the Master of Health Administration program at St. Joseph’s College.  Ms. Cuddy has worked in healthcare for 24 years as a registered, licensed Radiology Technologist, Clinical Manager of Radiology, and is currently working in Human Resources.

Monday, February 26, 2018

Morbidities Experienced by Geriatric Combat Veterans

One disease of the circulatory system that is associated with geriatric combat veterans is ischemic heart disease. Ischemic heart disease (also known as coronary artery disease) has been linked to exposure to Agent Orange during the Vietnam War (Veterans' Diseases Associated with Agent Orange, 2015). Coronary artery disease is common even among non-combat veterans. It is the number one cause of death in the United States (Coronary artery disease, 2017). While this morbidity is comparable to civilian counterparts, for geriatric combat veterans of the Vietnam War exposure to Agent Orange has become an uncontrollable risk factor.
            When compared to non-veteran populations, some respiratory morbidities are higher among veterans. One study revealed adjusted ratios of mesothelioma to be higher among veteran populations than among New York state or Los Angeles County totals (Spirtas, et al., 1994). While asbestos was once common in the United States in carpentry related taskings, it was also common in Naval shipyards. This translates to an increased risk of mesothelioma for Navy Veterans especially during and before the 1980s.
            Because of one of the more recent conflicts, veterans of the Gulf War have experienced chronic digestive symptoms (Weng, Guo, & Yang, 2015). These morbidities range from heartburn to irritable bowel syndrome. Many gastrointestinal symptoms experienced by these Gulf War veterans began while they were in country. Many veterans did not report this especially if there was minimal interference with day-to-day life.
            Another by-product of Agent Orange is early onset peripheral neuropathy. Some combat veterans of the Vietnam War began suffering from peripheral neuropathy within only one year after their time in country ended (Veterans' Diseases Associated with Agent Orange, 2015). Thus, many veterans have been suffering weakness, numbness, and pain in their extremities for a very long time (Peripheral neuropathy, n.d.). Most people do not develop peripheral neuropathy until they are over the age of 55 (Understanding peripheral neuropathy, n.d.).
            A morbidity of the endocrine system that is experienced by geriatric combat veterans is Hodgkin’s lymphoma. Hodgkin’s lymphoma is another morbidity that is secondary to Agent Orange exposure during the Vietnam War (Veterans' Diseases Associated with Agent Orange, 2015). Also known as Hodgkin’s disease, this is a cancer of the lymphatic system (Hodgkin's lymphoma (Hodgkin's disease), n.d.). Research has shown a positive association between Agent Orange and the development of Hodgkin’s lymphoma (Hodgkin's disease and Agent Orange, 2016).
            Immune system disorders are dangerous because they reduce a person’s natural ability to fight diseases. While some studies have suggested a statistical difference in the immune systems of Vietnam veterans exposed to Agent Orange, follow-up studies do not support these findings (Veterans and Agent Orange, 2010). While Immune disorders in combat veterans may not be related to combat exposure, there is a link between autoimmune disease and prevalence in their descendants. Adult children of Vietnam veterans who were exposed to Agent Orange seem to have a higher prevalence of autoimmune disorders (Ornstein, Fresques, & Hixenbaugh, 2016).
            One disease of the skin that occurs more often in Vietnam War veterans is chloracne. Chloracne, for many Veterans, began soon after exposure to Agent Orange during their time in country (Veterans' Diseases Associated with Agent Orange, 2015). Chloracne is a rare skin condition that includes blackheads, cysts, and nodules (Chloracne or Acneform Disease and Agent Orange, 2017). Studies have shown a direct link with this skin condition and chemicals used in Agent Orange (Institute of Medicine, 1994).
            Amputation has been a historically unavoidable byproduct of combat. While amputations accounted for 5% of combat wounded during World War II, they rose to 19% during the Vietnam War (Burkhalter, 1994, p. 131).  Most of these service members had more than one limb amputated due to use of field-expedient tourniquets. Advancement in prosthetics has improved the day-to-day lives of many of these veterans.
            One of the greatest problems experienced by geriatric combat veterans is mental health ailments such as post-traumatic stress disorder (PTSD). There is a demonstrated long-term pattern of healthcare utilization by geriatric veterans with serious and chronic mental illnesses (Sajatovic, Popli, & Semple, 1996). Chronic mental health issues have led to an increase in suicides in Veterans. The rate of suicide among veterans reached 22 per day in 2010 (Lazar, 2014, p. 459).
Conclusions and Final Thoughts
While there are several morbidities that seem to be consistent among civilian populations, there are several that are exacerbated by conditions experienced during combat. There seems to be a lack of foresight with use of chemicals such as Agent Orange. The military is learning from the mistakes of the past. All soldiers heading to combat are now assigned gas masks and chemical suites called JSLIST (Joint service lightweight integrated suit technology) and MOPP gear (mission oriented protective posture) for short.
Tricare and the VA have both made grand strides in delivery of mental healthcare as of late. Last year, the new Secretary of the VA, Dr. David Shulkin, opened access for mental healthcare to those with other than honorable discharges. This was important because many of these discharges came about because in the past, services didn’t recognize the need for mental healthcare and it was seen as a weakness by not only seniors but peers and subordinates. This is a stigma that we are still getting past, but we are heading in the right direction.
About the Author
Josh Johnson is a former combat medic in the U.S. Army with three combat tours, Joshua Johnson currently works as an Administrative Officer at the Robert J. Dole VA Medical Center in Wichita, Kansas. In addition, he is completing his M.H.A. degree at Saint Joseph’s College of Maine.

Burkhalter, W. F. (Ed.). (1994). Orthopedic surgery in Vietnam. Washington, D.C.: Medical Department, United States Army.
Chloracne or Acneform Disease and Agent Orange. (2017). Retrieved from U.S. Department of Veterans Affairs: https://www.publichealth.va.gov/exposures/agentorange/conditions/chloracne.asp
Coronary artery disease. (2017). Retrieved from Medline Plus: https://medlineplus.gov/coronaryarterydisease.html
Hodgkin's disease and Agent Orange. (2016). Retrieved from U.S. Department of Veterans Affairs: https://www.publichealth.va.gov/exposures/agentorange/conditions/hodgkins.asp
Hodgkin's lymphoma (Hodgkin's disease). (n.d.). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/hodgkins-lymphoma/symptoms-causes/syc-20352646
Institute of Medicine. (1994). Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. Washington, D.C.: The National Academies Press.
Lazar, S. (2014). The mental health needs of military service members and veterans. Psychodyn Pschiatry, 459-478.
Ornstein, C., Fresques, H., & Hixenbaugh, M. (2016). The children of Agent Orange. Retrieved from Pro Publica: https://www.propublica.org/article/the-children-of-agent-orange
Peripheral neuropathy. (n.d.). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
Sajatovic, M., Popli, A., & Semple, W. (1996). Ten-year use of hospital-based services by geriatric veterans with schizophrenia and bipolar disorder. Pschiatric Services, 961-965.
Spirtas, R., Heineman, E. F., Bernstein, L., Beebe, G. W., Keehn, R. J., Stark, A., . . . Benichou, J. (1994). Malignant mesothelioma: attributable risk of asbestos exposure. Occupational and Environmental Medicine, 804-811.
Understanding peripheral neuropathy. (n.d.). Retrieved from American Academy of Neurology: http://patients.aan.com/globals/axon/assets/9585.pdf
Veterans and Agent Orange. (2010). Washington D.C.: National Academies Press. Retrieved from https://www.nap.edu/read/13166/chapter/1
Veterans' Diseases Associated with Agent Orange. (2015). Retrieved from U.S. Department of Veterans Affairs: https://www.publichealth.va.gov/exposures/agentorange/conditions/
Weng, W., Guo, X., & Yang, Y. (2015). Gastrointestinal problems in modern wars: clinical features and possible mechanisms. Military Medical Research, 1-8.

Thursday, February 15, 2018

What an Emergency Room Nurse Thought Management Was

               Management is about trading in your scrubs, sneakers, and nursing station for a corner office on the 5th floor. It’s about buying a new wardrobe filled with skirt and pant suits and walking down the hallway with a new pair of Christian Louboutins. Management gives me the opportunity to work Monday through Friday with holidays off, and a guarantee extended vacation. I am in charge of budgets, timelines, meetings, hiring new employees, and addressing issues on the unit to the best of my ability. Executives say they respect what I do and honor all my hard work. However, my ideas are often pushed to the side and ignored. Some of my staff look up to me as their leader, and some talk about how I don’t do anything right. Management does not allow me to be creative and implement new strategies or ideas. It does not allow me to fight for my staff and get them and the patients that they need. I am unable to push my employees to reach their full potential. When my employees make mistakes, I must discipline them according to policy without empathy or compassion to what is going on. I am a manager.
            Over the last 11 weeks, Leadership in Healthcare Administration has taught me about being a leader. Prior to taking this class I was a firm believer that managers managed and were not considered leaders. From previous employments, mangers did their rounds and I never felt supported or heard. However, with the start of my new job I started to see a difference in management and what I learned in this course supported those observations. To manage effectively one must be a leader. A manager needs to lead along with handling budgets, staffing, schedules and meetings. Throughout this class, I have learned the roles and skills of a true leader and the influence they have to inspire the team.
            Leadership effectiveness in healthcare is an important role.  It merges the work of clinical staff and administrators in the success of the organization. Leaders have a large effect on inspiring the team, managing, reaching goals and changing the atmosphere of the facility. They are able to do this by tapping into many of the topics discussed throughout this semester. Leaders must shift between roles daily for each encounter they face. These roles include being an innovator/broker which focuses on creativity and communication, a monitor/coordinator focusing on project management and supervising. Leaders need to be a director/producer in order to achieve goals and facilitate and mentor which supports their managerial role. Along with switching between roles, groundbreakers need to be skilled in motivating, vision-setting, analyzing, and task managing. It is important to utilize these roles and apply their skills while dealing with the constant tensions within the organization. Tensions are required to balance each other out. Polarity maps help visualize the need for these tensions. Freedom and hold responsible is a good example a tension that complements each other. As a leader, we must give others the chance to grow and perfect their skills. By doing someone else’s work we are not holding them responsible and not allowing them to flourish. What surprised me most in leadership was the need for creativity and empathy. As I stated before, management at my current employment has confirmed the benefits of empathy and creativity in effective leadership. Leaders working among the staff have the power to voice their needs and implement new strategies. Open minded managers can take imperfections in the system and innovate creative alternatives to those problems. With flaws in the system, leaders must empathize with staff, patients and family. Staff who feel disconnected and not cared about tend to be distant and their work is less effective. Patients and family who feel uncared for, unheard and not a priority will not come back to the facility. Empathy is needed in leaders to connect with staff and patients and make them feel like they are important. Empathy will keep staff happy and patients and family coming back to the organization.
            Mangers are not the only leaders in a team. Staff who apply leadership qualities and values are leaders themselves. Anyone can be a leader. Throughout this course I have learned that management is more than pant suits and red bottom heals. Leaders who manage effectively are still wearing their scrubs and sneaks, working among staff and listening to patient needs. They may have a corner office on the 5th level, but their real office is on the clinical floor. Healthcare is in need of leadership, and with the understanding and implementation of what I have been taught in this class, I know I will be a pronounced leader in healthcare.
Belasen, A.T., Eisenberg B., Huppertz, J. (2016) Mastering   Leadership A vital Resource for Health Care Organizations.   Burlington MA: Jones and Bartlett Learning 978-1-284-04323-5

Patel, N. (2014, May 19). 8 must-have ingredients of a successful blog post. Entrepreneur. Retrieved from https://www.entrepreneur.com/article/233891
Contributed by Brianna Colleran, MHA Student, Saint Joseph's College

Thursday, February 01, 2018

Making a Positive Disruption in Healthcare before it is too late

We are fast approaching a healthcare bubble that will eventually pop if healthcare leaders do not start to “think outside the box” in making a positive disruption in the healthcare industry. What will the future state of healthcare look like and how will it impact you and your family? We have all seen healthcare expenses continue to rise at an alarming rate, premiums continue to increase, quality of care is not consistent, and the future state of healthcare is truly unknown. Who will be responsible for helping resolve these issues before it is too late? Now is the time for healthcare leaders to step up to the plate and find creative ways to change healthcare instead of waiting around for someone else to make these changes, which are not occurring fast enough. Now is the time for Healthcare leaders to make a positive disruption in the Healthcare sector before it is too late!

How can this be done? Well, it cannot be done by following the same processes repeatedly yet expecting different results. Leaders cannot afford to wait for someone else to make innovative changes. Instead, each leader must personally create an environment which fosters creativity so that innovation can occur within their departments/facilities. Today more than ever, maximizing overall efficiency while still providing a high level of service is a focus for most hospitals, yet creativity in improving and/or creating new and improved processes are not occurring fast enough. Why? As our class HA511 noted and in speaking to my colleagues throughout the country, most leaders have become unbalanced in their leadership approach focusing more time as transactional leaders and are not focusing enough time on being a transformational leader due to today’s fast-paced environment. However, we do see some hospitals/leaders looking at best practices across their industry in utilizing proven methods that have been shown to work. While this is a great starting point to improve processes/outcomes in healthcare, more innovative solutions must be created from front line healthcare leaders and their staff for our healthcare system to take steps towards creating a much-needed positive disruption in the industry before it’s too late.

Now is the time for leaders to take time and make time in helping their staff meet as a team in discussing creative solutions focused around improving processes/workflow/patient outcomes. I truly believe that future leaders and healthcare organizations need to devote time in forming highly engaged and functional teams within their organization in setting up “think tanks” to help create a new positive disruption in how they will deliver more efficient care in the future. While leaders can and should utilize technology and technological advances to improve healthcare, they must never forget the importance of personal connection and creativity amongst their team as that is the true key to unlock creativity and is how we will save the future state of healthcare.

How can future leaders create innovative solutions focused around making a positive disruption in changing healthcare as we know it? This is a very tough question to answer, especially since the fasted paced environment that we are living in has programmed most leaders to become transactional, more than transformational. Understanding yourself is the first step needed to be innovative and impact change which I feel a lot of leaders unintentionally lack in today’s fast paced environment. A leader taking EQ tests can help them recognize their current mindset and manage those identified tendencies. By understanding your strengths and weaknesses as a leader, you will have a better chance of navigating through your emotional tendencies and work on creating a more balanced leadership approach. I feel for this to happen, leaders must humble themselves and keep an open mind. The next step is to understand the Competing Value Framework (CVF) model to help leaders view, then balance their leadership tendencies. This theory consists of four quadrants which are further broken down into eight competing roles to include; mentor, facilitator, innovator, broker, monitor, coordinator, director and producer. These eight competing roles are then broken down to transformational leadership and transactional leadership.

As I have discussed, leaders need to focus more time on the transformational leadership approach in helping their team “think outside the box” in solving problems and in improving healthcare as we know it before it’s too late. Once employees are engaged, appropriately trained and tap into their creative processes, they will be able to help come up with creative solutions to problems within their department/facility that were previously never thought of. If done correctly, this will in turn create a more efficient and effective system for the employee’s as well as their patients in creating a positive disruption.

Regulations and legislation are also stressing the current healthcare system, because hospitals now get reimbursed according to Key Performance Indicators (KPI) results that are set by organizations such as Medicare, Medicaid, Affordable Care Act and HCAPS. I have personally seen hospitals trying to prepare for these KPI’s in a silo, at the executive level only, which to me is not a smart approach. Instead, why wouldn’t they take a more collaborative approach across hospital divisions to see what suggestions each area has? Is it a lack of time? Well, one thing is for certain, if you do not make time to think of creative solutions to problems as a team, eventually you will be left behind as other organizations may already be focusing on fostering creativity throughout their entire organization.

 As one of my favorite quotes by Kenneth Blanchard goes, “None of us are as smart as all of us.” Therefore, it is so important for you as a leader to not constantly work in silos as that will greatly limit the possible creative solutions that your staff are able to come up with in addressing a specific barrier/topic at hand. We cannot tap into our staff’s creative process without making time to meet and discuss creative solutions to the problems at hand. I challenge each of you as leaders and/or future leaders to keep this in mind as you manage you teams/organizations into the future. Don’t wait around for change to occur on its own, instead create an environment for your team which fosters creative solutions in making a positive disruption within the healthcare sector before it’s too late. 
Contributed by Aaron Kawa, MHA Student

Monday, January 22, 2018

Providing Safe, Quality Care. How Are We Doing?

Providing quality patient care continues to be the underpinning of all patient experiences from hospital and long term care, to physician offices and community clinics. Quality, safe patient care impacts patient satisfaction, employee retention, and reimbursement. Have we made any progress since the 2002 publication Across the Quality Chasm? This Institute of Medicine’s (IOM) publication, written in response to the seminal treaty on patient harm titled To Err Is Human: Building a Better Healthcare System, still informs and guides quality initiatives today. The Institute of Medicine continued to bring focus to the patient safety movement with seven more publications highlighting rural health care, healthcare provider competency, communication and interdisciplinary teamwork.

Since 1970, the IOM’s goal, under the US National Academy of Sciences, has been to focus on utilizing evidence based research to make recommendations and provide guidance for the health of the general public as well as advising science policy. Beginning in 1996, the IOM began a healthcare quality initiative that involved three phases. To Err Is Human was published within the end of phase one (1999), bringing to light the challenges for providing quality care, and the devastating impact medical error has on individuals, communities and health care organizations. Across the Quality Chasm, published in 2002, laid the foundation and vision to promote safe quality care through the work of health care policy, and health system involvement. The IOM’s Six Aims of Quality continues to be the template in the ongoing phase three. Quality care should be Safe, Effective, Patient-Centered, Timely, Efficient and Equitable.

So how do we measure up, 17 years after the publication of To Err Is Human? Do we see less medical error and stronger, safer health care models for patient care? A recent report by researchers at Johns Hopkins University states that after an eight year review of data, more than 250,000 deaths in the US per year are due to medical error, and is the third leading cause of death. This increase in deaths is possibly due to the underreporting of medical error.

Great strides continue to be made in areas such as standardization of care and procedures, advancements in technology, and stronger leadership commitment to high reliability organizations.

Hospitals maintain  focus on several crucial areas to reduce error. First, involve the patient in their care by empowering and encouraging them to question, engage and partner with all health care providers in health care decisions. Next, monitor vulnerable populations and strive to eliminate disparities in healthcare. Third, make communication between all members of the health care team essential in all patient interactions. Finally, health care leaders must encourage a culture of safety, allowing all members of the health care team to not only safely report error, but be involved in ongoing safety plans and initiatives. All of these areas assist in becoming high reliability organizations. A highly reliable organization views safety as an ongoing, ever changing strategy to monitoring, reviewing and adjusting safety plans at every level of the organization.

Agency for Healthcare Research and Quality. High Reliability. (2017). Retrieved from: https://psnet.ahrq.gov/primers/primer/31/high-reliability

Harvard Business Review. (2016). The Next Wave of Hospital Innovation to Make Patients Safer. Retrieved from: https://hbr.org/2016/08/the-next-wave-of-hospital-innovation-to-make-patients-safer

Institute of Medicine. (2001). Crossing the Quality Chasm: A new Health System for the 21st Century. Retrieved from: http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

Johns Hopkins Medicine. (2016). Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. Retrieved from: https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us

Managed Healthcare Executive. (2017). Four ways to reduce dangerous medical errors at your hospital. Retrieved from: http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/four-ways-reduce-dangerous-medical-errors-your-hospital?page=0,1


Written by Katie Cross, MSN, RNC-OB, Part-Time Faculty, Saint Joseph's College

Friday, January 05, 2018

Leading Trustees

Working with trustees or boards of directors is a critical skill essential for healthcare administrators. 

Our own Steve Chies, Program Manager of Long-Term Care Administration, has considerable experience in this area and has recently taught a webinar about this important topic.  Check it out here!