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WorkforceNEXT Healthcare: Talking with Jim

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Jim Smalley, Ed.D, SPHR 
HR Executive, Talent Management Expert
Texas Children’s Hospital

Jim is a Talent Management expert with experience in the healthcare, high-tech, higher education, non-profit, energy and financial services sectors. His experience ranges from succession planning and executive development, to high-performance coaching,  organization design, metrics for human performance programs, and diversity & inclusion initiatives.

What are you doing to address the planning-for-growth problem that exists within many health systems?
One of the ways we address this issue is to challenge it directly.  Clayton Christensen, author of the book The Innovator’s Dilemma and principal of the Christensen Institute, observes that while 20th-Century Health Care moved from doctors making house calls to physician offices to “the grand general hospital”, the 21st-Century model will reserve this by utilizing emerging technologies and adapting to consumer/patient expectations and demands.  The linear assumptions of growth will be totally disrupted by exponential technologies and health care moving from a producer-oriented model to a consumer-oriented one.

What is the generational employment breakdown within your company? How does this affect HR Management?
45% Millennial, 35% Gen X, 20 % Boomer.  This generational constellation invites/compels HR and Senior Leadership to focus more on technological presence and process, structure in career development, and a focus on “work is *not* my life” approaches to performance management.  Millennials are impatient with processes and procedures developed in the 1940’s and 50’s, over reliance on paper, and a lagging technology infrastructure (other than clinical) from what they’ve experienced in school and in other segments of the economy.  Boomers continue to insist on “leaning in,” which doesn’t play well with the younger generations. In recruiting, leading, rewarding and promoting, there is intense pressure to be transparent, logical and accountable. Business disciplines adopted in other industries decades ago are now vital for Health Care talent management to succeed.

Get to know the HR Pro:

What’s the one thing you want to accomplish before you die?
I wish to be present at my great-grandchildrens’ weddings!

If you weren’t doing what you do today, what other job would you have?
Computer animator!

If you could spend a week anywhere in the world, where would it be?  
Oxford, England.  The history of the university and its many notables would keep me busy for a week and more!

This Q&A is merely a preview of the topic, Developing Healthcare Leaders: Leadership Development in Volatile Times, which Jim will be speaking on at the upcoming WorkforceNEXT Healthcare Summit,;taking place January 9, 2018. Hear more from Jim and register today!


*Ever wonder what perspectives colleagues in your segment of Healthcare might offer? Would you like to participate in a Q&A to share your point of view? We want to encourage you to engage with your Healthcare community all year ‘round, not just at our Summits — connect with me with questions you want answered or to volunteer for a Q&A Insight Article.

10 Steps to Becoming More Analytical

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Business leaders value analytics because they want to better understand how the business works, gain insights and assess the value of talent investments. They want to get help solving problems and to make better decisions. As an HR business partner, recruiter or specialist, you may find that exciting, intimidating or a bit of both. The good news is that you don’t need deep quantitative training to help leaders make more informed evidence-based decisions.

The list below contains 10 simple, but powerful, actions for approaching your work more analytically. They’re based on my 15 years of experience helping leaders at a top professional services firm find ways to attract, engage, develop and retain highly talented people, and on my time at other organizations as a manager and consultant.

  1. Get to know your organization’s strategy.

Do you know how your company makes money? The organization’s strategic imperatives? Your source of competitive advantage? It’s important to explore your company intranet, look at external media and find a mentor who can share insights with you on what leaders care about most. Chances are, most people in your organization only have a general knowledge of your strategy at best. A little time invested in understanding your organization’s strategy will help you focus your conversations, priorities and day-to-day work on the things most important to the business.

  1. Understand your organization’s talent imperatives.

There’s a difference between an organization’s talent imperatives and its HR team priorities. Talent imperatives are the critical human capital decisions, investments or actions required to achieve your organization’s strategic goals. HR team imperatives may be operationally important, but not critical to achieving strategic goals.

What has to happen talent-wise in your organization to meet your organization’s strategic goals?

  1. Ask good business questions.

Do you want to be taken seriously? To be a trusted advisor? You can, by asking powerful questions that get to the heart of the problem the leaders you are supporting are trying to solve. The following seven questions will serve you well:

?          What are you trying to accomplish?

?          What prompted this request?

?          What problem(s) are you trying to solve?

?          What do you hope to learn?

?          How will you use this information?

?          What audience will you share this with?

?          Is there a story you hope to tell?

  1. Get to know your organization’s structure and data.

You should know the types of data you have available to you and get to know the data itself. Understanding the basic calculations (turnover, retention, etc.) your organization uses and making connections with people in other parts of the business who may have access to data that could be useful to you are great ways to learn more.

Other suggestions include the following: learn how the business is organized, how it is managed day to day and how money is allocated among business units, and learn how leaders prefer to look at the organization and data.

  1. Learn some very basic Excel functions.

You don’t need to be an Excel wizard to be analytical, but you do need a basic familiarity with Excel. It is easy to learn, though; anything you need to know is an Internet search away. You should be able to do basic calculations and to use a pivot table to summarize data.

  1. Make and test hypotheses.

Everyone has hypotheses (explanations) about how the world works at work. Sometimes hypotheses come out as stories, rumors or myths: “All the level 5 engineers are quitting!” You’re fully capable of testing this hypothesis with the data in your reports and coming back with a response.

You can make and test a wide range of hypotheses. Maybe the engineers are being poached by a competitor; maybe they’re only leaving in a particular location; or maybe it’s a combination of things. Using the data you have to test hypotheses like these can help narrow the range of possible responses and increase the likelihood that any action taken will make a difference.

  1. Develop and share a point of view.

Many requests are for a specific piece of data rather than a point of view: “Please send me the headcount report.” It’s important to give your perspective anyway: “Here’s the headcount report you asked for. We currently have 5,417 employees; that’s up 10 percent year to year.”

Why give a point of view? Remember, a leader’s goal is to gain insights that help him or her solve problems. Do you want to be the go-to person for reports, or the go-to person when a leader has a problem he or she is trying to solve? People will become accustomed to your offering a point of view and will soon come seeking it out.

  1. Know when to call in the experts.

You don’t need to know how to do a regression analysis. Decisions to pull in an expert should be based on the cost of the problem or size of the investment being made. If you’re proposing a $2 million training program, it’s probably worth spending $10,000 to test the impact of a pilot. When contemplating a survey, get help from someone who has done surveys many times before. If you don’t have a person with these quantitative skills on your HR team, you may find someone in finance, strategy or marketing who is able to help.

  1. Explain things simply and clearly.

Sometimes analysts are tempted to try to impress with big technical words, artistic charts or lots of data. One of most valuable things you can do is to share your conclusions in plain but precise, everyday language. Charts should be simple and clean, and they should only include elements needed to make your point.

  1. Persuade others to act on what you’ve learned.

My team has a saying: “Now we know this. So what?” It turns out that 20 percent of analytic work is done in spreadsheets. Eighty percent is done by communicating what we’ve learned and encouraging people to act on it. Data by itself typically isn’t enough to persuade people to act. It needs to be put into context, linked to the issues leaders care most about, presented simply and clearly demonstrate what action should be taken.

Jeff Merrifield is a leader in the Americas Organizational Development and HR Enablement function at EY, Ernst & Young LLP, a member of the EY global professional services organization. The views expressed are his own and not necessarily those of EY. Send questions or comments about this story to

>> Link to original article.


How to Make a Complex Quality Challenge Simple

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Hospital CEO incentives are often driven by how well the system meets financial, and increasingly, clinical goals. At Mercy Health, the occupants of the C-suite are not the only ones who benefit when the Ohio-based system meets or exceeds expectations.

The system’s 33,000 employees working within the 23 hospitals in southern Ohio and Kentucky also stand to gain. Once the hospitals’ operations meet a simple set of financial and clinical goals, everyone who works at Mercy gets an incentive payment.

Like other systems, Mercy is coping with long list of quality measures required by or requested by government agencies, insurers, and rating sites such as U.S. News & World Report.

The key is to keep things as simple as possible, offer clear, easy-to-digest feedback and “get everyone rowing in the same direction” said Anton Decker, MBBCh, who serves as chief clinical officer of Mercy Health and president of Mercy Health Select.

“It is very hard to keep it all straight, in terms of what is important, what truly changes patient outcomes and, frankly, what has the largest return on investment,” Decker said.

He has a three-pronged approach to quality and financial measures linked to staff incentives.

Keep it Simple
The first step is to limit the number of measure that will drive the bonuses. This year, the hospital launched a program that identified six key measures (the work to identify them began last year). It set goals and incentivized the entire staff to meet them. If the six goals are met, the hospital board reviews and approves bonuses. Each region gets a percentage and the board uses a formula that allows the incentive money to “trickle down” to all employees, Decker said.

The measures, many serving double duty for other quality monitoring programs, are:

  1. Net revenue growth
  2. Skilled nursing facility utilization for joint replacement patients in bundled payment programs
  3. Readmission rates
  4. Access to primary care
  5. Implementation of programs to address the opioid epidemic
  6. A package of primary care benchmarks such as blood pressure and colon cancer screenings.

On the 15th of each month, the hospital publishes what it calls the “clinical operation performance report” on the six measures. It first goes out first to 2,500 managers and then to the rest of the staff, both electronically and in booklet format.

In the quest for simplicity, information is provided in data visualizations, rather than numbers-heavy Excel spreadsheets. The visualizations are not fancy; often they are simple line charts. The goal was to create “crystal clear” messages, something Decker and his team worked hard at. They want to ensure that staff could understand at a glance what the graphs are telling them.

“The culture started changing when people started almost looking forward to it—’I wonder how we’re doing this month?'” he said. “Previously, this was the purview of select leaders…. Suddenly, 33,000 people had something to rally about.”

He called it “the joy of exploration,” not a term generally associated with quality measures.

The monthly report features data, plus an executive summary and stories from a clinician and a patient. In addition to the measures in the incentive program, the document and website also include charts on performance in other areas, such as length of stay and patient experience.

The online version is interactive. Clicking on part of a graph opens an in-house intranet page with a monitored discussion group, he said.

The dynamic Decker wants to get away from is “us-versus-them.” Staff are incentivized for both clinical and financial performance, and so is the CEO.

Greater Physician Awareness
The system is also using data and staff engagement to drive individual projects, such as trying to break even on Medicare.

Some of the doctors didn’t even know the health system lost money on Medicare, Decker said. But, they got on it and reduced Medicare losses on vascular and general surgery.

“We are never going to be successful financially if our clinicians are not a part of operations and finance,” he said. “The notion that physicians can just mind their own business and see patients and, miraculously, we’ll take care of finances… we just don’t think that works. ”

Decker said he gets the impression that a lot of hospitals could do more to address their concerns about how to deal with the abundance of quality measures.

“Most health systems just throw their hands up,” he said. “They basically do the victim thing––it is being done to them––instead of driving the message and being in control of it.

Not that it’s easy.

There are challenges, Decker acknowledges, and the wins are coming slowly. Some problems are stubborn, such as the high use of the emergency department by the hospitals’ own employees.

‘Good Leaders Simplify’
Health systems that want to try the Mercy Health approach should start by identifying ten items that are important to the organization, and which can be measured. It won’t be easy, Decker warned, and it won’t be fast.

The alternative? “If everything is important, nothing is important,”

The next step is to hire a data visualization expert to come up with simple, easy-to-understand graphics that will best communicate performance measure to staff.

Finally, keep simplicity in sight. Always.

“Healthcare is complicated everywhere,” Decker said. “Good leaders simplify.”

Medical Marketing in a Digital World: Content, Social Media, and Mobile

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For healthcare professionals, the days of hanging your shingle and waiting for the ravages of flu season to bring in a steady supply of patients is over. Like every other business model out there, the healthcare field, from community clinics to famous national brands, finds itself in flux as it adjusts its marketing to reflect the expectations of an increasingly technologically adept and mobile patient pool.

Healthcare consumers today are as likely to google your practice from your parking lot as they are to google your reputation before they even pick up the phone to schedule an appointment. Your content marketing must therefore not only demonstrate relevance to the end user but also deliver it in digestible morsels and on-the-go.

With that in mind, what are the best strategies for healthcare organizations, doctors, and physician practices for marketing their services?

The following list may sound like industry buzzwords, but they are content and social media best-practices:

  • Quality content
  • Authentic engagement
  • Brevity, brevity, brevity
  • Mobile access

Relevance and the Art of Quality Content

Organic content. An increasingly jaded shopping public is at the heart of the move toward organic and relevant advertising and content. With a constant barrage of images, messages, and sound bites from billboards, radio commercials, and even from elevators, we tend to tune out the noise of incessant advertising.

Quality over quantity. Engaging customers and potential customers in a meaningful dialogue means placing quality over quantity, which translates into providing genuine service and eschewing the delivery of canned commercial messages that people purposefully ignore.

Relevant resource. Today, most consumers turn first to the Web when seeking out answers to health-related questions. Accordingly, under the right circumstances, the Internet is the ideal platform on which to build a public relationship based on the most private of matters. Perhaps it is the anonymity afforded patients as they explore what ails them before committing to potentially expensive treatment options; regardless, by featuring salient and actionable advice on a variety of helpful topics, your site becomes the go-to resource for trusted medical information.

But, be clear that online content is not medical advice. Offering expert advice on healthcare can be challenging. Of course, the best course of action is for a patient to make an appointment. However, people’s need for instant gratification is even stronger when they are thinking about their health or the health of a loved one. Be clear that you, as a medical marketer, doctor, or healthcare organization, are not offering advice on your website—that research and facts on your site are merely medical best-practices. Encourage readers to contact their physician to discuss their individual needs. Your attorney is a great resource for protecting your ability to engage with prospective patients online safely and conscientiously. By providing expert content, you resonate with your readership and can transform your practice from a random Google search result to a trusted resource in healthcare.

Social Media and the Art of Conversation

For those clinicians and office managers looking to define their “voice” when reaching out to prospective clientele, experience on social media platforms such as Facebook can be highly instructive. The personal and sharing nature of social media makes the platform an ideal avenue for healthcare professionals who want to establish themselves with an increasingly engaged consumer-base.

Genuine engagement. Industry experts note that one of the rising trends in healthcare is the growth and reliance on these social media forums in the engagement of prospective patients. Successfully generating positive buzz regarding your practice’s performance and services is a powerful influencer. One of the major advantages of this format is that it allows for the display of third-party endorsements. When casting about for a medical service provider, consumers react favorably when presented with positive feedback from patients who are just like themselves.

Draw from trusted help. As a healthcare provider, caring for patients is your first job. One of the most empowering things you can do for your medical practice is to learn when to delegate. Enlisting the services of a professional public relations firm or integrated marketing agency can help ease the time-consuming nature of social media. These skilled cadres of experts know the ins-and-outs of engaging a distracted public so you can get on with the important work of helping patients feel better. These marketing professionals should also know how to use analytical tools designed to measure the efficacy of your online efforts.

Plan your content. Develop social media and content posts in advance and use a posting tool such as Buffer or Hootsuite. By creating a content calendar, you can be one step ahead of cold and flu season, allergy season, or potential snow-shoveling-induced injuries or heart attacks. Provide useful information and plan ahead. That way, you can spend more time monitoring conversations and responding to inquiries you may receive through social media.

Absorbable Amounts of Information in Exciting Formats

Attention is fleeting. The axiom that “less is more” has never been truer than in the delivery of actionable bits of information designed to hook the reader’s attention and carry them through to the end of an article or other piece of content. According to scientists, humans’ attention span is now even less than that of a goldfish! In the last 15 years, our attention span has fallen from 12 to 8 seconds. So grab their interest, and be brief! People want the information they want without resorting to reading entire medical journals for an idea of their treatment options.

Micro-content. Brevity, therefore, should be your watchword. For example, marketers have perfected the art of the infographic, and your medical practice should be using infographics to create engagement. Easily processed bits of information, aimed at delivering the greatest amount of information in the shortest amount of time, is the goal of medical marketers trying to engage new patients using infographics.

YouTube it. YouTube is the second-largest search engine after Google. It’s not just something kids use to watch funny videos. In fact, short videos are one of the strongest growing marketing trends within the healthcare industry. Information, offered in short video bursts that are easy to share, is the cutting-edge of medical marketing.

If Mobil Content Is King, Then Local Focus Is Queen

Mobile-friendly. According to the Pew Research Center, nearly 80% of the top 50 digital news outlets in the United States report that the bulk of their online visitors originate from mobile devices, and, significantly, those consumers of information spent considerably less time reading the average article than their desktop-computer-based peers.

It’s cellular. With more than 2.25 billion people accessing the Internet via their cell phones, and one billion of those admitting that they only use their cell phones to access the Web, customizing your site so it looks great across every platform is a critical consideration in developing a responsive design that caters to user experiences. Having to squint, pinch, scroll, and zoom will quickly dampen the enthusiasm of even the most ardent of fans, so offering a clean layout that is tailored to the mobile platform eliminates the threat of dropped traffic owing to an increased frustration level.

Location, location, location. Consumers are likely to shop at local establishments. A whopping 62% say they share locally based advertisements to friends and family, so you can expect that the real estate axiom “location, location, location” will have increasing importance within the medical marketing as well.

Medical Marketing in the Digital Age

A sophisticated potential patient market is conducting its own research and engaging in online conversations prior to making any choices about which doctor to visit. Wouldn’t it be better to be in on the conversation?

For medical professionals, the new frontier of patient outreach is on the pages of social media, search engine results pages, and website content. And they will be rewarded by optimizing content to operate on mobile platforms, and delivering that content in easily absorbable packets of information and videos.

Finally, you might want to consider help from a professional marketer, whether in-house or as an outside resource, to help manage this brave new world of digital marketing.

>> Link to original article.

Hospitals get creative to attract doctors

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Facing a growing physician shortage, area hospitals have developed a variety of recruitment strategies to bring new doctors to the region.

In the next decade, the United States will face a shortage of at least 62,000 doctors, according to last year’s physician workforce report by the Association of American Medical Colleges.

The shortage hits harder in rural areas and smaller communities, where longtime independent physicians are retiring and new graduates are more interested in major population centers, Conemaugh Health System Chief Medical Officer Dr. Susan Williams said.

“Primary care is where we are feeling this particularly acutely,” Williams said. “We have a number of excellent independent primary care docs, but none of them are adding. Unless we want to wait until suddenly one day they retire and we’re short, we need to backfill that.”

While Conemaugh continues to include independent doctors and physician groups, such as Western Pennsylvania Orthopedic and Sports Medicine, the health system hires others to fill important roles.

“The philosophy is to employ all the physicians we need in the community,” Conemaugh President and CEO Steve Tucker said.

“We have a mixed model,” Williams said. “This positions us well for what is coming in health care. Our best model is a mixed model.”

As a Level 1 trauma center, Conemaugh Memorial Medical Center is required to have certain specialties available around the clock.

“If you don’t happen to have those in the community, you need to recruit and employ,” Williams said.

As the health care world continues to move toward preventive medicine, also called population health, communities are developing clinically integrated networks to combine all areas of patient care, Tucker said.

“What we are pursuing in a clinically integrated network is truly a combination of independent and employed physicians.”

Employing physicians is not always Conemaugh’s first choice in recruiting, Williams added.

“We look to augment and complement an existing group of independent with employed physicians,” she said.

Chan Soon-Shiong Medical Center at Windber has had success in partnering with independent physicians and groups.

Cardiologist Dr. Samir Hadeed is spearheading Windber’s new cardiac catheterization lab and orthopedic surgeon Dr. Brian Gunnlaugson has led a resurgence, helping double inpatient surgery at Windber.

“A lot of it is orthopedics,” Windber President and CEO Tom Kurtz said. “We focus on our surgical volumes. We just recruited another general surgeon, and we are actively recruiting another orthopedic surgeon.”

Although Windber continues to employ some physicians directly, specialists such as Gunnlaugson and Hadeed are contracted through a physicians group, Alleghenies Independent Physicians.

“It’s a good model for us,” Kurtz said.

“They do the records and they do the billing. The benefits are through them. We can pick and choose what specialties we want and what coverage they want.”

Since the physicians are owners in the group, there are advantages to participate.

“They can build some equity,” Kurtz said.

“They can pay themselves better benefits than we can offer.”

Since many of Windber’s patients come from the Richland area, Kurtz said it made sense to work with Hadeed to create an outpatient care center in the East Hills.

Windber will rent the 14,000-square-foot second floor suite of Hadeed’s new Johnstown Heart and Vascular Center at Schoolhouse Road and Eisenhower Boulevard in Richland.

The location worked for Hadeed as well, who noted many patients travel from Ebensburg, Somerset, Windber and other areas.

“It makes it closer, having my home office right in the middle,” Hadeed said. “Plus, it gives me an opportunity to grow and expand. Most of the growth in the area is in Richland.”

At Somerset Hospital, difficulty in attracting new doctors to the rural area has led to expanded partnerships with larger networks, including Conemaugh and Allegheny Health Network of Pittsburgh, Somerset President and CEO Craig Saylor said.

While the partnerships allow Somerset to continue such important services as cardiac catheterization, cancer care and urology, it wasn’t enough to preserve the obstetrics program.

Although Dr. Charles Camacho’s office in Somerset still offers prenatal, postnatal and gynecology services, all babies are delivered at Memorial in Johnstown.

Obstetrics is just one of the areas challenging the medical community, Saylor said.

“It is not just a challenge for us,” Saylor said. “It’s a challenge for urban areas. The supply does not meet the demand.”

Sometimes, recruiting takes a little creativity.

When Conemaugh was unable to bring in a new vascular surgeon, leaders found two experienced surgeons who were willing to split the job.

Dr. John Gray of Lewisburg and Dr. Stephen Lalka of Charlotte, North Carolina, are alternating two-week stretches in Johnstown.

Both were working as substitute doctors, known in the industry as locum tenens, and had both been assigned to Johnstown.

“The first (temporary) job they had me sent to was Conemaugh,” Lalka said. “I really liked the hospital. I was used to a teaching hospital with residents.”

Lalka is semi-retired after 29 years of practice and teaching, most recently at Sanger Heart and Vascular Institute at Carolinas HealthCare System in Charlotte.

Gray had a similar path to Johnstown, stepping back from is practice at Geisinger Health System to work part time filling in as needed.

Both said they were looking for something more stable, but not full time.

“In the fall I had the opportunity to do the job share,” Lalka said. “It was like the perfect opportunity to work at a place I like.”

The arrangement will help Conemaugh build its vascular surgery program and attract full-time surgeons to continue the service.

They would love to have two full-time people living in Johnstown,” Gray said.

“But they got two very experienced physicians. The plan is to build the practice back up to what it was, and then recruit a younger individual who is interested in a full-time position here.”

New physicians are reluctant to step into programs in need of rebuilding, he added.

“Younger people are looking to come to a place where they feel supported and there is infrastructure in place,” Gray said, adding that the new doctors feel comfortable with experienced backup during transitions.

>> Link to original article.

3 Ways Hospitals Can Support Nightshift Workers

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Hospitals are a 24/7 business, but errors and on-the-job injuries both spike after hours, says Ann E. Rogers, PhD, RN, Edith F. Honeycutt chair of nursing and professor and director of graduate studies at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta.

“We know that during night shifts, no matter how well rested you and your colleagues are, everybody will experience some fatigue and may have to fight sleep. You simply are not as alert as you should be,” says Rogers, who researches the effects of sleep deprivation and shift work on nurses.

Even seasoned night shift workers can experience sleepiness while on the clock.

Acknowledging that working at night presents special challenges is an important first step toward supporting nightshift workers, says Rogers. She offers three steps management can take to help them.

1. Look for Signs of Fatigue

“All of us can hide the symptoms [of sleep deprivation] with coffee,” says Rogers. But being under the influence of caffeine only masks the symptoms of fatigue.

Caffeine doesn’t restore attention to detail, grant patience in the face of frustration, or improve coordination, which are all consequences of sleep deprivation.

Other signs of fatigue include slowed reaction time or responses, irritability, poor memory, lack of attention to detail, and excessive consumption of caffeinated beverages.

If a usually calm and collected worker shows signs of fatigue, it wouldn’t be out of line to ask him how he’s adjusting to working the night shift.

2. Tamp Down External Cues

Imagine a clinician wrapping up a 12-hour shift at the hospital to go home and get some rest, only to feel themselves suddenly perking up as they walk outside and are greeted by sunshine and bustling streets.

That wakefulness will likely persist once the worker is at home, lying in bed, desperately trying—and failing—to fall asleep.

Along with circadian rhythms, people rely on external cues to tell them when it’s time to get up, go to sleep, or eat meals. Even if a worker has been awake for a long time, it can be difficult to fall asleep after exposure to bright sunlight and street noise.

Rogers suggests encouraging shift workers to wear dark sunglasses on their way home from the hospital and discouraging caffeine use during the latter part of their shifts. She also advises that workers use earplugs to block out daytime noises and to hang dark curtains in their bedrooms if they need to sleep during daylight hours.

3. Set Rules for Shift Work

Even with environmental checks in place, it’s up to hospital managers and administrators to set rules that can protect workers and patients.

The first is to ensure proper scheduling so workers can get the proper amount of sleep, says Rogers. She has written that the likelihood of a clinician making an error can increase by as much as 36% after working 12-hour shifts on consecutive days.

“We know that workers only use half of their time off to sleep,” says Rogers. “If a nurse has 10 hours off, they will sleep for about five hours, which is not enough rest for anybody,” she says.

It’s also important to ensure shift workers take breaks. Because fewer restaurants and shops are open at night, many shift workers neglect taking lunches and scheduled breaks. Have clinician supervisors and managers encourage their reports to take their scheduled time off, and keep an eye out for workers who skip lunches or work through their breaks.

Additionally, most hospitals don’t allow workers to nap during breaks, says Rogers. She believes this policy is a missed opportunity. “Allowing a nurse to do that will encourage alertness for the rest of the night,” she says.

The night shift may not be the first choice for most healthcare workers, but by acknowledging its unique challenges, hospital administration can help keep workers awake, alert, and present in their jobs.

>> Link to original article.

Job Switchers Want Challenge

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The latest chapter in the ongoing book on employees and what they really want from their employer finds them pursuing a slightly different Holy Grail than previously reported: challenge.

In a recent global Korn Ferry survey of nearly 2,000 professionals, nearly three-quarters (73 percent) say that if they were to plan on being in the job market this year, it would be because they’re looking for a more challenging position while the quest for greater compensation comes in almost dead last as a reason to leave.

Trailing far behind that 73 percent, 9 percent say they would be looking elsewhere because they either don’t like their company or their efforts aren’t being recognized, 5 percent would blame the fact that their compensation is too low and 4 percent say it would be because they don’t like their boss.

“What that answer tells HR is if people are thinking of moving for challenge, how do we challenge them?” says Kevin Cashman, senior partner at Los Angeles-based Korn Ferry. “It presents a call to invest in more engagement, challenge, stretching, coaching and developing. That’s what you’re competing with, [employees who are] looking for challenge, and growth and development, especially the high-potentials. HR and managers need to be aware of this and [either set up or] have engagement programs in place.

“These results mirror study after study Korn Ferry has done [including one HREOnline? reported on in January] that show money is not the key motivator for employees,” Cashman says. “Professionals who have progressed in their careers have done so for a reason. They’re passionate about what they do and need to feel that they are being pushed professionally and continually learning new skills.

Sandra McLellan, the Toronto-based North America practice leader for rewards at Willis Towers Watson, however, sees the latest Holy Grail of challenge as more integrated into everything an employee is seeking.

“That notion that people will trade off, [preferring] a promotion over a pay increase [which the earlier Korn Ferry study mentioned above found], I just think it’s more complicated than that,” McLellan says. “A lot of times, the promotion comes with a pay increase,” and the worker is certainly seeking both.

Even challenging assignments are craved for, especially by high-potentials, because of the full package, she says; i.e., what they bring in terms of new skills, advancement, career development and, yes, pay.

“Many of our future leaders may be craving [challenge],” McLellan says, “however, in designing career paths, it may be more important for the success of the organization to have those challenging assignments, but . . . know many of these people actually want more traditional, incremental development, not necessarily huge challenges.

“Remember,” she adds, “career development means different things to different people” and, many times, what employees are really craving, especially the top-talented ones, is an ever-growing bank of marketable skills they can take with them into the outside world.

“So here’s my challenge that I put to organizations: How do you create an environment that will replicate the outside world of skills-building? How can you create these challenging assignments within your cultures that better replicate that outside world they’ll find when they leave?”

And there’s nothing wrong with building people’s skills for success outside your doors, McLellan adds. Facilitating growth in such a way, she says, “helps build up the organization and keeps pace with how work is changing, but every employer needs to decide what kind of organization it wants to be and how it will create this culture.”

And given the right environment, “it’s also up to employees to talk about where their aspirations lie and where they can get the right experiences within the organization.”

Her company’s recent survey, the Willis Towers Watson 2016 Global Workforce Study, based on responses from 3,105 U.S. employees, finds they would like their employers to do better jobs at providing substantive career management. Highlights from that study include:


* Only 41 percent of employees think their employer does a good job of providing advancement opportunities or promotions;


* Barely half (52 percent) say their organization does a good job of providing opportunities for personal development, such as challenging project assignments;


*Only 41 percent say their employer offers career-planning tools and resources such as coaching, self-assessment and career paths;


* Less than one in three employees (32 percent) say their immediate supervisor or manager helps them with career planning and decisions; and


* Almost half (47 percent) think they would have to leave their employer and join another company to advance to a higher job level. Additionally, a comparable number of high-potential employees say they would need to leave their employer to advance their career.


Which ties right into what Korn Ferry has found, says Cashman.

” ‘Challenge’ is a word for accelerating,” he says. “In general, people are looking for ways to grow and be challenged, but they’re also human and thinking of their individual gains in career development and marketability in the global marketplace, not just their corporation.”

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Micro-Hospitals Fuel Growth Strategy at a Texas Health System

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Part of CHI St. Luke’s growth strategy involves combining inpatient and outpatient services into a smaller, more scalable and less capital-intensive facility model: the micro-hospital.

Health systems used to depend on high-dollar inpatient care for growth. Not anymore.

With health plans and Medicare seeking to move care to lower-acuity, and thus lower-cost, sites, and with advances in technology adding to the practicality of moving procedures out of the hospital, the outpatient environment is poised for growth, while inpatient may stagnate.

CHI St. Luke’s Health, a six-hospital health system in Houston, is like many health systems that responded to HealthLeaders’ recently released annual Industry survey. It is looking outside the traditional hospital environment by adding physician practices and other outpatient sites of care.

But part of its growth strategy involves combining inpatient and outpatient services into a smaller, more scalable and less capital-intensive facility model, the micro-hospital.

CHI St. Luke’s opened its first four-bed micro-hospital, Springwoods Village Hospital, in January 2016. David Argueta, its president, calls the facility an “innovative solution to get clinically appropriate high-quality care in a low-cost environment.”

Speed to Market
Argueta, who is president of CHI’s Woodlands-area facilities, which includes the micro-hospital as well as the 242-bed The Woodlands Hospital and 30-bed Lakeside Hospital, says he views micro-hospitals in general as one of the ways the health system is able to grow access points in a thoughtful manner.

“It really brings value-added services together in a more cost-effective manner than a big hospital or individual clinics,” he says.

What also made this micro-hospital a particularly attractive opportunity is that it allowed CHI St. Luke’s to negotiate an exclusive deal within the master planned community of Springwoods, in suburban Houston, 10 miles away from The Woodlands Hospital.

“We had an opportunity that a lot of people don’t, which is to grow with the community,” says Argueta, who adds that the hospital is scalable. The micro-hospital features four inpatient beds, 10 ED bays, four operating suites, two endoscopy suites, imaging, labs, and pharmacy and dietary departments.

‘Scaled Appropriately’
It has everything a hospital has, it’s just scaled appropriately, says Kevin Harney, a principal and architect with Earl Swensson Associates, the Nashville-based architecture firm that designed Springwoods Village Hospital.

“Some owners see this concept as a way to establish their brand and identity within a community and have even planned these micro-hospitals for growth to become a larger tertiary hospital,” he says.

Earl Swensson Associates sees the niche as a growth opportunity as well. Springwoods Village is its first such facility, but Harney says the niche will grow, and the firm has several other such facilities in various stages of design.

According to The Advisory Board, most micro-hospitals are between 15,000 and 50,000 square feet average eight to 10 inpatient beds and are usually within 18-20 miles of a major hospital. In that sense, Springwoods Village is smaller than most and closer to a main hospital than many.

“We chose four beds,” says Argueta. “I’ve seen some with more, but unless you have a real need to hold patients over for observation, you really don’t need more than that.”

“Micro hospitals, sometimes called an ’emergency hospital,’ become, in essence, a matter of creating accessible, convenient care,” says Harney.

Establishing a Presence and Raising All Boats
In theory, a micro hospital establishes a presence in a growing market, capturing market share for a larger hospital system. Patient stays in these facilities are short, usually 24 to 48 hours, and patients who need longer lengths of stay or more specialized care can be transferred to a larger hospital within the system.

“A lot of the patients we see are outpatient surgical-type patients who may come through the ER and we may need to hold them overnight for surgery in the morning,” says Argueta. “If they need higher level care, we’re 10 miles away from the Woodlands Hospital.”

CHI St. Luke’s is bringing another micro-hospital online over the course of this year. That facility was received as part of an acquisition, and two others are in various states of planning.

Executive leaders serve across the local campuses as does Argueta.

“Springwoods Village complements the services we offer at our larger hospitals,” he says, adding that the service area is experiencing annual growth of around 14% in surgeries and imaging, and the Springwoods Village option has helped eliminate wait times in imaging, and has allowed more time for surgeries.

“It’s raised all boats for our North Houston campus,” says Argueta. “Twenty-five years ago we were three access points in north Houston. Now we’re at over 40 access points: 37 clinics and three hospitals.”

Through clinical research, strategic partnerships, early adoption of innovations and highly-specialized clinical programs, one Silicon Valley hospital is changing its role. Check out this live HealthLeaders Media webcast,
Redefining What it Means to be a Community Hospital: Innovation at El Camino Hospital on March 17.

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Medical providers oppose Trump-backed health plan, Democrats take aim

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The top U.S. doctors’ organization and several hospital groups came out strongly on Wednesday against a Republican plan backed by President Donald Trump to overhaul America’s healthcare system, as Democrats mounted a fierce battle to thwart the bill.

Two House of Representatives committees debated the plan late into the night, two days after the proposals were unveiled by Republican leaders. The legislation aims to repeal and replace the Obamacare law, which Republicans call a government overreach that has ruined healthcare in the United States.

Trump and fellow Republicans in Congress campaigned last year on a promise to dismantle the signature domestic policy achievement of Democratic former President Barack Obama.

However, they face resistance from conservatives in their own party who have condemned the bill as too similar to the law it is meant to supplant. Democrats, meanwhile, have denounced it as a gift to the wealthy that will take insurance away from millions of people.

“What they’re doing is very destructive. … It represents the biggest shift of money to the wealthiest people in our country, the top 1 percent, at the cost of working families,” House Democratic leader Nancy Pelosi told reporters.

Doctors and other providers said the bill would probably cause many patients to lose insurance and raise healthcare costs. The American Medical Association urged senior lawmakers in a letter to reconsider drastic changes to Medicaid, the government health insurance program for the poor.

The AMA, which supported Obamacare, said the replacement of income-based subsidies with age-based tax credits to help people buy insurance would make coverage more expensive, if not out of reach, for poor and sick Americans.

Obamacare, formally called the Affordable Care Act, enabled 20 million previously uninsured people to obtain coverage, about half through a Medicaid expansion the new bill would end.

Insurers are worried about the affordability of the tax structure and proposed major changes in Medicaid financing.

In a letter to Congress, America’s Health Insurance Plans, which represents Anthem Inc and others, indicated that was still a concern, despite many aspects of the draft that would help stabilize the individual insurance market.

Seven hospital groups, including the American Hospital Association, America’s Essential Hospitals and the Catholic Health Association of the United States, also voiced opposition. They wrote in a letter to lawmakers that the proposal could lead to “tremendous instability” for people seeking affordable medical coverage, including children, the elderly and disabled.

Republicans control both chambers of Congress and the White House for the first time in a decade. But the bill’s fate is far from certain, with a number of Republican conservatives saying it is not a full repeal and sets up new entitlement programs.

Trump and Vice President Mike Pence met leaders of conservative groups who have concerns about the bill.

“I’m encouraged that the president indicated they are pushing to make changes,” David McIntosh from one of those groups, Club for Growth, told reporters after the meeting.

A White House official said Trump and Pence were “open to constructive improvements that maintain the core principles and get the bill over the goal.”


The House Ways and Means Committee, with jurisdiction over taxes, and the House Energy and Commerce Committee, which oversees health issues, kicked off what could become marathon sessions working on the legislation.

The plan would scrap the Obamacare requirement that most Americans obtain medical insurance and would replace its income-based subsidies with a system of fixed tax credits to coax people to buy private insurance on the open market.

Trying to mollify skeptics in his party, House Speaker Paul Ryan, an architect of the plan, touted it as “a conservative wish list” and “monumental, exciting conservative reform.”

Representative Mark Walker, head of the Republican Study Committee (RSC), the largest group of conservatives in Congress, said RSC leaders might support the bill if two changes are made.

The first, proposed by Representative Joe Barton in the Energy and Commerce Committee, would bring forward the end of enrollment in Medicaid expansion by two years to January 2018. The second would make age-based tax credits for purchasing health insurance partially rather than fully refundable.

With those changes, “we’d be a hard ‘yes’,” Walker told reporters.

Democrats were using every procedural maneuver possible to delay the committee work, including demanding votes to adjourn on the House floor. The top Energy and Commerce Committee Democrat, Representative Frank Pallone, called the Republican plan “a prescription for disaster” and said not a single hearing had been held to develop the bill.

Republicans insisted on committee action even though the nonpartisan Congressional Budget Office (CBO) had not yet done its customary assessment of the cost of the measure and how many people it would cover.

White House spokesman Sean Spicer said: “If you’re looking at the CBO for accuracy, you’re looking in the wrong place.”

Ways and Means Democrats raised questions over the bill’s proposed tax break for insurance company executives, with Representative Lloyd Doggett calling it a “$400 million windfall” for insurance company executives.

Hospital stocks clawed back some of Tuesday’s losses after the bill’s unveiling. Community Health Systems Inc rose 4.5 percent and Tenet Healthcare Corp gained 1.5 percent. Health insurer shares, including WellCare Health Plans Inc and Aetna Inc, closed moderately higher.

(Additional reporting by David Morgan, Caroline Humer, Eric Walsh, Susan Heavey, Doina Chiacu, Toni Clarke and Steve Holland in Washington, and Lewis Krauskopf in New York; Writing by Will Dunham and Nick Tattersall; Editing by Leslie Adler, Jonathan Oatis and Paul Tait)

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Rethinking Your Physician Staffing Strategy

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The two major trends that have defined physician staffing over the past five years – hospital employment of physicians and consolidation of outsourced physician groups – show no signs of slowing. The uncertainty that characterizes the next phase of health care reform all but ensures that these trends will continue for the foreseeable future. A closer look, however, reveals that both hospitals and physician groups are engaging in creative ways to address the rapidly changing health care landscape.

Achieving the flexibility to address these new uncertainties is prompting hospital leaders to re-evaluate their staffing strategy and rethink what the physician-hospital relationship should look like. A look beneath the surface shows that strategies available to hospitals look quite different from the way they looked just a few years ago. There are three primary staffing models, each with its pros and cons.

Hospital employment

Estimates vary, but roughly half of all physicians in the United States now work for a hospital or health system. Four of five residents will begin their careers working for a hospital, supporting the prediction that this trend is expected to continue. While there is some variability among the medical specialties (for example, about two-thirds of emergency physicians are still independently employed), the trend lines are the same.

As hospitals take over more independent groups and increase their in-house hires, hospitals are becoming much more adept at managing physicians as employees of a special class, embracing a transition from a vendor-client relationship to a more practical partnership with physicians. Managed effectively by attuned and enlightened administrators, employed physicians will come to identify with the goals of their employer and will be more willing to relinquish some of their prized autonomy for the benefit of the facility.

If this relationship is managed poorly, on the other hand, physician satisfaction will nosedive, turnover will increase, and animosity will ensue. It takes a highly self-aware hospital management team to honestly ascertain what kind of leadership it can provide to employed physicians. Its staffing strategy should accord with that assessment.

Pros: There is closer physician-hospital alignment, the physician group has less administrative burden, the hospital is better able to build bridges to post-acute care, and physicians may develop more solid community ties.

Cons: Productivity may suffer slightly without an offset in improved quality; a “corporate” culture may negatively affect physician morale; the cost of physician support may be hidden or difficult to identify but still present; and it can be difficult to maintain successful recruiting efforts in key medical specialties.

National multispecialty groups

In recent years, several physician companies have experienced rapid growth and attained a national footprint in fields such as hospital medicine, emergency medicine and anesthesia; the list of their medical specialties keeps growing. Some of these “mega-groups” count their staff in the thousands. One company has a roster approaching 20,000 physicians, and other companies are not far behind.

For hospital leaders who decide against employing a substantial portion of their physicians, the big multispecialty groups offer a way to centralize physician operations in the hands of focused, professional physician operators. The groups also enable hospitals to focus accountability and streamline physician vendor relations in a single interface.

All the mega-groups are public companies (or divisions of public companies) with strong financial resources. Consequently, they have multiple stakeholders to satisfy. This leaves them open to concerns that their physicians have potential conflicts of interest, including a duality of loyalties: to the hospital client and to their own company. As one might expect, the mega-groups tend to view members of their own physician workforce as the best advocates for their employer’s brand name and reputation.

Pros: These groups may deliver more-efficient practice management among multiple specialties, they offer focused and experienced practice-management talent, they have strong physician infrastructure and support, and subsidies for physician compensation can be spread among multiple specialties.

Cons: There is only a moderate level of identification with facility goals, multiple stakeholders need to be satisfied, clinical focus in multiple specialties may lessen overall physician performance, physician recruiting places less emphasis on local and community roots, and competing corporate loyalties may interfere with physician-hospital alignment.

Local practice groups

The past five years have seen fewer independent practice groups in virtually every medical specialty. Much evidence suggests that smaller local practices are being absorbed by hospitals and the large multispecialty companies.

Yet, for several reasons, it would be premature to categorically put small groups on the endangered species list. There are still some markets of considerable size where these hardy survivors continue to thrive, and their hospital clients highly value their community roots.

In certain respects, small-practice management has become less costly. Outsourced service costs such as accounting, charge capture and data processing have been on the decline, although other costs such as compensation and insurance continue to rise.

Many hospitals, particularly in small towns and rural communities, value their relationships with the smaller practices and offer them support services to maintain their viability. Also, the small practice continues to be a sentimental favorite of many physicians, even while their pocketbooks lead them in other directions, at least for now.

Pros: Small practices have good relationships with local referral sources, close-knit ties throughout the community, good working knowledge of other local health care facilities, expertise within a single medical specialty, strong loyalty from physicians who prize independence and autonomy, and generally higher physician retention and satisfaction.

Cons: These practices are frequently underresourced financially, limiting growth options and the ability to respond to some client needs; they are inexperienced in physician training and development; they may struggle with compliance or administrative requirements under the Medicare Access and CHIP Reauthorization Act of 2015 or other quality reporting mandates; and single-specialty focus places an additional management-integration burden on the hospital.

Using multiple staffing strategies

Most facilities settle on a combination of staffing strategies. In some cases, particularly in larger hospitals, all three strategies may be actively employed, even within the same medical specialty. Hospital administrators often justify this approach by arguing it avoids putting too many eggs in one basket; it spreads the risk of any one practice losing stability or effectiveness.

The true costs of maintaining a layered staffing strategy are easy to overlook and sometimes difficult to account for. A patchwork of practice groups large and small may come and go without an overall plan that clearly lays out the roles and responsibilities of the various players over the longer term. Perhaps out of neglect or inertia, an excess of practice groups may simply cohabitate within the hospital’s four walls, each with its own culture and with an agenda that may or may not comport with that of the hospital.

No staffing model has the statistical support to claim an advantage in delivering superior patient outcomes. Each has its share of successes and failures in every specialty and in every market. The key to success is to put into place a long-term strategic plan that will (1) structure a meaningful alignment between the hospital and each of the practice groups; (2) integrate care between practice groups, both within your facility and with the surrounding post-acute care facilities; and (3) build a program that coordinates care with all the community stakeholders who are responsible for population health management.

Todd J. Kislak is a health care consultant based in Los Angeles.

The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.

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