I have shared the quarterly Town Hall Meeting information on my blog in the past. These Town Hall Meetings are an important part of our internal communication and I have included the deck for your review. The majority of the presentation dealt with the results of our employees opinion and there are some neat updates about the community and the economy. However, I want to use this post to share highlights about the survey. My reaction to the results was a combination of disappointment (sadness) and motivation. I wish the results were better and I am energized to improve them next year.

This was the fifth annual survey of employee opinions and the second time that employed and closely aligned physicians were invited to participate. Participation in the survey continued to be strong with 7,842, or 79% of GHS employees completing the survey.

Each year, our survey results are compared to a national health care database including approximately 350 other highly engaged hospitals and systems (comprised of about 850 facilities and more than1.5 million health care workers across the US) answering the same set of questions. When we reference the “National Health Care Average,” we’re talking about the average score of this large database.

Workforce Commitment

Workforce Commitment is the score that we reference in our System-level People Goal and it reflects the degree to which employees are engaged in and committed to the organization. Our workforce commitment score is the combination of a subset of seven questions from the annual survey. Compared to the National Health Care Average, our score of 4.21 (on a 5.0 scale) was higher by a statistically significant difference of 0.05 points. However, the more important story is that compared to our own results from 2010, this score has dropped by 0.08 points. This result is also below the target we set for 2011. This year, GHS ranked in the 72nd percentile of all participating hospitals and our goal was to be at or above the 85th percentile.

Digging Deeper

There’s a lot more information in the survey results that adds perspective and understanding to the overall score. For example, our very highest performing items speak to the how well team members work together; the responsiveness of managers in following-up on concerns raised in rounding; our role as a valued community partner; and our commitment to employee safety. The way our physicians and staff work together is also a real strength for us – and, our employed physicians are one of the most highly engaged professional groups at GHS.

Employees also expressed clear and specific concerns about pay and benefits. Many also reported additional levels of stress related to workload. All three of these issues make sense to me. We’ve made some difficult decisions in the last two years and the Employee Opinion Survey offers every staff member a method for communicating the impact of these tough decisions. In addition, we are an organization that is moving ahead in a rapidly changing environment.

Next Steps

Every year, the survey provides important information that helps focus action planning at the work unit and also for the entire system. I have begun reviewing these results in detail with the senior management team and we’re developing system-level action plans much like many departments are doing with their results. I expect to talk about t system-level planning at the next Town Hall Meetings in August.

I would welcome any thoughts or reactions you may have. If you cannot see the slide presentation above, CLICK HERE to download the PDF.

Several weeks ago I wrote a post about the pitfalls and the opportunities with Hospital Rankings – see Hospital Compare. I think this continues the conversation and reinforces my recommendation to seek multiple and reliable sources when making a decision. In the meantime, enjoy the billboards…Mike

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Evaluating Popular Media and Internet-Based Hospital Quality Ratings for Cancer Surgery
Nicholas H. Osborne, MD; Amir A. Ghaferi, MD; Lauren H. Nicholas, PhD; Justin B. Dimick; MD MPH
Arch Surg. 2011;146(5):600-604. doi:10.1001/archsurg.2011.119

Objective: We sought to determine whether “best hospitals,” as defined by the US News & World Report or HealthGrades, have lower mortality rates than all other American hospitals for cancer surgery.

Design: Retrospective cross-sectional study.

Setting: Medicare database (2005-2006).

Patients:  All patients with a diagnosis of malignancy who underwent pancreatectomy, esophagectomy, and colectomy (n = 82 724).

Main Outcomes: Measures Risk-adjusted mortality rates at best hospitals according to both the US News & World Report and HealthGrades, was compared with all other US hospitals, adjusting for differences in patient factors and surgical acuity. Risk-adjusted mortality rates between best hospitals and all other hospitals was compared after controlling for differences in hospital volume.
Results Risk-adjusted mortality was significantly lower in US News & World Report best hospitals for all 3 procedures: pancreatectomy (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.30-0.58), esophagectomy (OR, 0.48; 95% CI, 0.37-0.62), and colectomy (OR, 0.69; 95% CI, 0.55-0.86). Risk-adjusted mortality was significantly lower in HealthGrades best hospitals for colectomy (OR, 0.79; 95% CI, 0.65-0.95). However, after accounting for hospital volume, risk-adjusted mortality was only significantly lower at the US News & World Report best hospitals for colectomy (OR, 0.79; 95% CI, 0.62-0.99) and was not significantly lower at HealthGrades best hospitals for any of the 3 oncologic procedures.

Conclusions: Publicly marketed hospital rating systems of surgical quality such as the US News & World Report “America’s Best Hospitals” and HealthGrades “Best Hospitals” may identify high-quality hospitals for some oncologic surgeries. However, these ratings fail to identify other high-volume hospitals of equal quality.

The following email was recently sent out to employees at the Greenville Memorial Campus.

“To better fulfill our philosophy of Family Centered Maternity Care and to support the vision and mission of the Women’s Hospital, signage on the 6th floor of Greenville Memorial Hospital will begin changing on Wednesday, May 18. The change will start on the main floor of GMH and follow up to the units accordingly. Please help any visitors who may need assistance getting to the 6th floor units while the sign are being changed.

Maternity Admitting will change to OB Triage Emergency
Labor and Delivery will change to The Family Birthplace
Mother Baby (MB) will change to Family Beginnings

Thank you for your patience as we make these important changes. If you have questions, please contact Terri Negron at 455-7638.”

I often receive information about what is going on at the same time as the rest of the employees and this is an example. It is beyond me to try or even want to control what is going on at all our campuses – we have leaders that do that very well. But, what I do think I have is the ability to set a tone and a direction and to sense when trends are emerging. This email reminded me of a trend I am picking up – we are doing some neat stuff under the leadership of Dr. Chip Wiper and Terri Negon, RN in Labor and Delivery. I get more positive, external feedback about that service than any other – mail, email and conversations on the soccer field, basketball game or Karate tournaments – and it has noticeably increased in the last year or so. I can also see how we are starting to trend up in our volume. We deliver more babies than any other system in the state, but we did see a decline last year. A reduction in births is pretty typical during a recession – women and couples delay having children until there is a sense the economic situation is improving. We are seeing a shift and an increase. Perhaps there is a story here for an economist – another leading indicator that things may be getting better for families, they are having more babies.

I like lists and I like comparing us to organizations around the country. The following is an excerpt from Security Magazine that was shared with me by our Director of Security, Shawn Reilly. Shawn has done a wonderful job elevating the professionalism and effectiveness of Security at GHS on all campuses. When he told me we were #6, I was delighted. I then asked, “how come we are not 5?” He showed great restraint, smiled and nodded – I was grateful!

TROY, MI – Seventy-five hospitals and medical centers have been named to Security magazine’s “2010 Security 500″ list, which recognizes organizations worldwide for best-managed security practices.

Technology was a critical issue recognized by Security this year for hospitals and medical centers.

The 2010 Security 500 List is based on data supplied by the organizations through their participation in a security industry benchmarking survey and from public resources and records. The list, which covers 16 markets, was published in the November issue of Security magazine.

1
New York-Presbyterian – CUMC/MSCHONY/ALLEN*
Richard Irizarry, CPP
Security Director – CUMC
New York
NY

2
Cleveland Clinic*
Randy Stephan
Chief of Protective Services
Cleveland
OH

3
Providence Health & Services*
Eric Cowperthwaite
System Director and CISO
Renton
WA

4
Atlantic Health*
Alan J. Robinson
Director, Protection and Security Services
Morristown
NJ

5
Weill Cornell Medical Center*
Bernard Scaglione
Director of Security
New York
NY

6
Greenville Hospital System*
Shawn Reilly
Director Security
Greenville
SC

7
Aurora Health Care*
Michael R. Cummings, CPP
Director, Loss Prevention Services
Milwaukee
WI

8
Brigham & Women’s Hospital*
Robert Chicarello, CPP
Director of Security & Parking
Boston
MA

9
NYU Langone Medical Center*
Robert Zick
Director
New York
NY

10
Dallas County Hospital District Police Department
Kenneth Cheatle
Chief of Police
Dallas
TX

11
University Health Network*
Todd Milne
Senior Manager
Toronto
ON

12
Childrens Hospital Boston*
Robert Ryan
Director, Security & Transportation
Boston
MA

13
University of Minnesota Medical Ctr, Fairview*
Linda Fite
Director, Security Services
Minneapolis
MN

14
Saint Francis Hospital & Medical Center*
Jack Mayoros
Director of Security
Hartford
CT

15
UC Irvine Medical Center*
Scott Martin
Director, Security/Parking/Emergency Manager
Orange
CA

16
Shawnee Mission Medical Center*
Charles Murray
Security Director
Shawnee Mission
KS

17
Parkland Hospital*
Dr. Ron Anderson
CEO
Dallas
TX

18
Memorial Hospital @ Gulfport*
Paul Bennett
Security Manager
Gulfport
MS

19
Ascension Health
Robert J. Henkel
Pres., Healthcare Operations and C.O.O
St. Louis
MO

20
Community Health Systems
Gordon Carlisle
Vice President, Facilities Management
Franklin
TN

21
Mercy Health Partners*
Leon Conklin
Director Safety and Security
Muskegon
MI

22
Medical City Dallas Management Limited*
Leonard Sullivan
Director of Security
Dallas
TX

23
Catholic Healthcare West
Marvin O’Quinn
EVP/Chief Operating Officer
San Francisco
CA

24
Catholic Health Initiatives
Phillip L. Foster
Sr. VP, Chief Risk Officer
Englewood
CO

25
Exeter Hospital*
Bill Mace
Chief of Security
Exeter
NH

26
Parrish Medical Center*
Deena Ellis
Security Manager
Titusville
FL

27
Massachusetts General Hospital
Bonnie Michelman, CPP, CHPA
Director Police and Security
Boston
MA

28
St. Mary’s Jefferson Memorial Hospital*
Larry Gilbert
Security Manager
Jefferson City
TN

29
Tampa General Hospital
Balaji Ramadoss
CSO
Tampa
FL

30
Robert Wood Johnson University Hospital
Doug Campbell
AVP Operations
New Brunswick
NJ

31
Barnes Jewish Hospital
Margie Brine
Director of Security
St. Louis
MO

32
Geisinger Health System
Scott Biting
Manager Security Services
Danville
PA

33
Henry Ford Health System
Kevin Robinson
Captain Manager
Detroit
MI

34
Lancaster Regional Medical Center*
Jeffrey T. Hatfield
Systems Director of Security
Lancaster
PA

35
Inova Fairfax Hospital
Gary A. Switzer
Director Safety and Security
Falls Church
VA

36
Pitt County Memorial Hospital
Tim Nelson
Chief of Campus Police Dept.
Greenville
NC

37
Hartford Hospital
Lucette Dunlop
Director of Security
Hartford
CT

38
Lancaster General Hospital
Daniel Ford
Director, Security
Lancaster
PA

39
Specialty Hospital of Washington- Hadley*
Melvin Stewart
Security Manager
Washington
DC

40
The MetroHealth System
Thomas P. Miller
Director of Protective Services
Cleveland
OH

41
HCA Centennial Medical Center
Frank Smith
Deputy Chief
Nashville
TN

42
Tanner Health System*
Larry Steed
Senior Vice President
Carrollton
GA

43
Baystate Medical Center
Thomas F Lynch
Director of Security
Springfield
MA

44
Christus Santa Rosa Health Care
Mark A. Hart
Director Security & Environmental
San Antonio
TX

45
Cedars-Sinai Hospital
Corey Hart
Manager, Safety and Security
Los Angeles
CA

46
Scripps Memorial Hospital
Kevin Matsukado
Safety Officer
La Jolla
CA

47
Sarasota Memorial Medical Center
Richard Millar
Captain
Sarasota
FL

48
Georgetown University Hospital
John Bertolotti
Director of Protective Services
Washington
DC

49
Virtua Memorial Hospital
Jermain Rhyens
Director Security
Mount Holly
NJ

50
Grady Memorial Hospital
Dallas Terry
Operations Manager
Atlanta
GA

51
Maricopa Integrated Health Systems
Mark Pecak
Captain
Phoenix
AZ

52
Mayo Clinic Hospital
Steven Dettman
Director, Security/Visitor Support
Phoenix
AZ

53
Akron General Medical Center
Dan Beaver
Assistant Director Security
Akron
OH

54
Kings Daughters Medical Center
Scott Hill
Director Safety-Security
Ashland
KY

55
Parkview Health
Richard Dufresne Sr.
Manager Security & Parkeing
Fort Wayne
IN

56
Advocate Illinois Masonic Medical Center
A. Lee Matthews
Public Safety Manager
Chicago
IL

57
Texas Children’s Hospital
Geoffrey Povinelli
Assistant Director of Security
Houston
TX

58
Henry Mayo Newhall Memorial Hospital
Robert Johnson
Director
Valencia
CA

59
Glendale Memorial Hospital & Health Center
Tom Golden
Manager, Public Safety, parking, PBX
Glendale
CA

60
Concord Hospital
John Charron
Director, Security
Concord
NH

61
Floyd Medical Center
Sonny Rigas
COO
Rome
GA

62
Hoboken University Medical Center
Stephen Guant
Dir. Safety, Security, Parkg, Transportation
Hoboken
NJ

63
Anchorage Neighborhood Health Center*
Tony Lazenby
Manager
Anchorage
AK

64
Elkhart General Hospital
Dale Brown
Manager of Security
Elkhart
IN

65
Beebe Medical Center
Ronald W. Webster
Security/Safety Manager
Lewes
DE

66
St. Agnes College
David Almont
Security Operations Manager
Baltimore
MD

67
Holy Family Hospital
Raymond E. Bush
Security Manager
Spokane
WA

68
Baptist Medical Center Beaches
Edward A. Solustri
Manager, Safety, Security & Emergency Preparedness
Jacksonville Beach
FL

69
BWMC
Stan Mezewski
Security Director
Glen Burnie
MD

70
St. Joseph Hospital
Chad Towner
COO
Ft. Wayne
IN

71
Good Samaritan Hospital
Keith Monroe
Director
Vincennes
IN

72
Sturdy Memorial Hospital
Craig Forcina
Director Safety & Security
Attleboro
MA

73
Hillsdale Community Health Center
Charles Scott Brown
Facilities Manager
Hillsdale
MI

74
Coler Goldwater Hospital
Vito Aleo
Director of Hospital Police
Roosevelt Island
NY

75
Keokuk Area Hospital
Jim Swallow
Director Facility Management
Keokuk
IA

In our car we have satellite radio and one of the stations that plays hits from the 1990′s is channel 9, it is 90′s on 9. I actually prefer the 80′s and 70′s and sometimes the 60′s!

I bring up the 90′s because one of the “hits” back then was for Hospitals to employ physicians and buy physician practices. But, when Clinton-era health reform did not take place, many of those hospitals divested themselves of the physicians and their groups. I wonder if history repeats and the hospital leaders will do the same thing again – some of them for the second time.

Academic Medical Centers and large Teaching Hospitals didn’t behave like many of their community counterparts. I don’t recall hearing about Emory, Duke, MUSC, or UNC getting rid of their faculty. The deeper commitment to the faculty was based on mission-driven reasons – large providers of care for the community, educators for the next generation of care givers, innovators in care delivery and research. Regionally, that was the position GHS took and I think it was and is correct.

The following article reminded me of our strategy and reinforced many of the things we are trying to do to prepare for the future. We have been talking about being physician-led for several years, here is some information suggesting we are on the right track.

Nine in 10 doctors want more say in hospital management, finds PwC survey

More than 90 percent of doctors in a recent nationwide survey by PwC US believe that physicians employed by hospitals should be more involved in executive leadership and management of the hospital, including serving on the board of directors and outlining performance improvement initiatives, according to From courtship to marriage Part II, a new report released today by PwC’s Health Research Institute (HRI).

Healthcare is moving toward a new approach in payment that rewards doctors and hospitals for quality results over volume, and the shift is driving the two closer together. Hospitals must rely on physicians to help them achieve health reform goals, and in return, physicians want not just financial security but also a say in hospital leadership. The prospects for a long-term union between hospitals and physicians will depend on their ability to meet in the middle, says PwC.

PwC’s report is based on a nationwide survey of more than 1,000 physicians, supplemented by in-depth interviews with hospital executives, about their expectations as partners sharing power, resources and outcomes in a post-health reform world. HRI’s research focused on what PwC says are three secrets for a successful marriage of hospitals and physicians: Shared governance, aligned compensation and changing physician-practice patterns.

Hospital employment means physicians may have to give up control of how they practice to comply with standards that emphasize overall system quality and efficiency goals. The trade-off, in their minds, comes with certain caveats. PwC’s survey of physicians found the following:

More than eight in 10 physicians (83 percent) who are considering hospital employment said they would expect to be paid the same as or more than they are now, with increases ranging from 1 percent to 4.7 percent or an average increase of 2.4 percent. Forty-five percent of physicians said they would expect an increase in pay and 38 percent would expect no change.

Realizing the health system is changing to track and reward performance, most physicians agree that half their salary should be fixed and the other half should be based on meeting a combination of productivity, quality, patient satisfaction and cost of care goals, with upside earning potential for performance.

Expectations for compensation varied by physician specialty, with pediatrics, psychiatry and cardiology expecting the largest increase and general surgery, oncology, and emergency medicine expecting the least.

Six in 10 physicians (62 percent) believe that nationally accepted physician practice guidelines should be used to guide the way they practice medicine, while one in three (30 percent) prefers locally developed guidelines.

Hospital executives interviewed for the report, however, said they aren’t ready to “hand over the keys” just yet. They say that in order to pay physicians higher salaries, they will need to find funds elsewhere in the organization through improvements in the healthcare delivery model. They need physicians to not only help reduce supply and infrastructure cost but also to generate additional revenue.

There also is an issue of physician skills. Hospital leaders who were interviewed say that most physicians lack the business management and leadership skills needed to be effective in positions of leadership and governance.

From undergraduate studies through medical school and into residency and fellowship programs, physicians traditionally have focused on the science of medicine. The next generation of physicians, however, is more likely to also receive business training to prepare them for their future careers, says PwC. HRI’s review of the required curriculum of the 10 largest medical schools by total active enrollment in the country revealed that no time is formally allocated directly to business-related training. However, several universities are now offering joint MD/MBA programs.

The report describes how some hospitals are addressing the skills issue by creating educational programs to teach physicians business theory and techniques related to quality improvement, outcomes management and staff development. Beyond skills, the second issue for physicians is time. Physicians who have traditionally been paid to generate volume in a fee-for-service compensation model have been driven to see more and more patients, leaving them little time for anything outside of their medical practice. The question is whether they have capacity to also take on hospital governance and management, at least so long as fee-for-service compensation reigns. A full copy of the survey is available here.

Every 90 days we produce a video update for employees. I use it at the beginning of our Town Hall Meetings. We have been recognized by marketing and Public Relations organizations for GHS 360 News. I like it and have posted it in the past. Even though there are organizational specific terms and references, I think it provides a glimpse into what we are about. We talk about progress as it relates to our Pillars: People, Service, Quality, Growth, Finance and Academics. We also highlight other news from around the system and in the community.

Enjoy and let me know your thoughts. Mike

I was in a conversation with my oldest daughter and I described some sort of problem or issue. I can’t remember what it was, but I can remember her response, ” there’s an app [short for application] for that.” It seems that is the quick and humorous response from her friends about any issue. Even more fascinating is that it is becoming less outrageous. So, the next time you are looking for free apps, search the app store for GHS News to find our first app. And, if your like me, just marvel at how communication and information exchange has transformed – makes sense to me we are playing with it.

Mike

The following is an article that will appear in Trustee Magazine, which is a trade magazine geared towards informing and alerting hospital Trustees and Board members of industry trends.

VIEWPOINT
Begin the Transformation, by C.J. Bolster

Facing an undefined future, two hospitals are homing in on alignment, integration and costs

While much of the work behind reform happens in Washington, D.C., hospitals and health systems are preparing for the future of providing quality care, managing disease, improving community health and being compensated for it. Without complete details of how all the changes will work, organizations are planning for and making fundamental changes in their operations. Their goal not only is to compete effectively, but to optimize payment and, more importantly, to deliver care more effectively and efficiently.

Two organizations highlighted in this article are aggressively preparing for the future and creating solutions while maintaining performance now. Warning: these are not easy tasks.

Integrated Financial Model

The University of Alabama at Birmingham Health System has a long history of success in providing leading research, education and high-end clinical services to the citizens of Alabama and the Southeast. According to CEO Will Ferniany, “the biggest problem we’re having with reform is that it’s almost impossible to keep up with.” To do that, UAB has created a number of task forces, each of which is charged with learning the specifics of reform in its area, imagining future impacts and possibilities, and sharing the findings. “Our job is to make sure we are headed in the right direction,” says Ferniany. “It’s overwhelming, and we’re a sophisticated institution.”

UAB developed as an entrepreneurial, department-based organization focused on teaching, research and fee-for-service reimbursement. According to Ferniany, UAB’s response to reform will be threefold:

Infrastructure. Ultimately, there will be unified supply chain, human resources and support operations across UAB. “Integration is the underlying glue,” Ferniany says. “If you are going to bundle practice units, you need an underlying IT infrastructure to be able to connect all the dots. You’ll obviously need good quality, but you won’t have quality you want unless you have IT support.”

Alignment. UAB will become increasingly aligned as traditional departments and disciplines come together around specific patient- and health-related issues, and become capable of operating in a fully integrated financial environment.

Cost reduction. UAB is evaluating a goal to be profitable under Medicare rates by 2015. “If we can be profitable under that, we will remain a destination for our patients and for medical innovations,” Ferniany says.

This represents a significant cultural change for UAB. “We want to be the Southwest Airlines of academic medical centers,” he says. “We want engaged physicians and staff, consistently high quality, engaged and happy customers, and to be low cost.”

Focus on Prevention

Greenville (S.C.) Hospital System University Medical Center is one of the largest nonprofit health care providers in the Southeast. Long known as a highly successful community and tertiary health system, GHS is rethinking its entire organization and its relationship to its community, region and state. While the impetus is reform, the projected improvements in efficiency and effectiveness have been on its leaders’ radar for years.

Mike Riordan, GHS president and CEO, outlined a number of organizational goals to be accomplished over the next three to five years:

Total health. The emphasis is on preventive disease management, and “all the things we need to do to manage and improve the health status of the population we serve,” Riordan says.

Integration. This isn’t about delivering care from birth to geriatrics, but transforming the system’s doctors into physician leaders, linking financial information between physician groups and the hospital, and using this financial information to advance the efficient and effective delivery of care.

“We have to be highly integrated with our doctors, more than just employing them,” Riordan says. “This is about building and growing a group of physician leaders” as the organization moves toward total health.

Academics. “We’ve been training medical students from the University of South Carolina in their third and fourth years since 1991,” he says. “Now we’re in discussions with USC to expand to a four-year medical campus here in Greenville. We have so much clinical activity here, we can give them the broad range of educational experiences available in a fully integrated delivery system, including the tenets of our total health approach.” GHS plans to do this with no state funding, according to Riordan.

“We’ve worked hard to develop a model that achieves a steady state of funding in about a decade while helping to grow the physicians and other health providers we need,” he says. “This represents an investment in our community and state; and we believe it will strengthen our ability to continue as a critical health resource for our region as reform unfolds.”

Riordan believes that the financial component needs to be aligned with health maintenance. “Right now we get paid for providing procedures and taking care of sick people,” he says. “There is a real volume aspect to it. But we are going down a path to see if there is a way we can look at best practices, evidence-based medicine, how we keep a population healthy [in a way] that doesn’t disadvantage us.”

Two years ago Riordan charged a small group of executives and physician leaders with reading everything that came out about reform, discussing it and developing a white paper. “It was our best guess about what reform will look like,” he says. “That shifted the conversation to what needed to be done to position ourselves, and we set out to do that.”

Many of the ideas mentioned above have been around for years, waiting for technological advances and incentives to enable them. Those advances are here now, and leading organizations will be using them to improve how they serve their communities

C.J. Bolster (CJ.Bolster@haygroup.com) is the national director of the health care practice at Hay Group, Atlanta.