Arkansas Hospitals, Winter 2015

arkansas

hospitals WINTER 2015

www.arkhospitals.org

The Patient Perspective Engaging Patients and Families for Better Care Creating a Positive Culture

A Magazine for Arkansas healthcare Professionals Arkansas Hospitals I Winter 2015

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We’re a knowledgeable connector of people, physicians and health care places.

One way we keep physicians and patients connected is through a Personal Health Record (PHR), available for each Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas member. A PHR is a confidential, Web-based, electronic record that combines information provided by the patient and information available from their claims data.

A PHR can help physicians by providing valuable information in both every day and emergency situations.

To request access, contact PHR Customer Support at 501-378-3253 or personalhealthrecord@arkbluecross.com or contact your Network Development Representative.

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Winter 2015 I Arkansas Hospitals

arkansasbluecross.com

MPI 2003 11/13

11 20 24 38

arkansas

hospitals is published by

Arkansas Hospital Association

419 Natural Resources Drive • Little Rock, AR 72205 501.224.7878 / FAX 501.224.0519 www.arkhospitals.org Elisa White, Editor-in-Chief Nancy Robertson Cook, Editor and Contributing Writer Cindy Lewis, Editorial and Layout Assistant Emily Cavallo, Art Director

Board of Directors Walter Johnson, Pine Bluff / Chairman Darren Caldwell, Newport / Chairman-Elect Peggy Abbott, Camden / Treasurer Ron Peterson, Mountain Home / At-Large Chris Barber, Jonesboro Dorothy Berley, Warren David Berry, Little Rock John Heard, McGehee Ed Lacy, Heber Springs Jim Lambert, Little Rock Corbet Lamkin, Camden Vincent Leist, Harrison James Magee, Piggott Dan McKay, Fort Smith Ray Montgomery, Searcy Robert Rupp, El Dorado Doug Weeks, Little Rock

Executive Team Robert “Bo” Ryall / President and CEO W. Paul Cunningham / Executive Vice President Tina Creel / Vice President of AHA Services, Inc. Elisa M. White / Vice President and General Counsel Jodiane Tritt / Vice President of Government Relations Pam Brown / Vice President of Quality and Patient Safety Lyndsey Dumas / Vice President of Education

departments 4 6 7 8

From the President

Newsmakers and Newcomers

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All About Hospitals

Arkansas Hospitals is distributed quarterly to hospital executives, managers and trustees throughout the United States; to physicians, state legislators, the congressional delegation, and other friends of the hospitals of Arkansas.

Event Calendar

cover stories 10 The Patient’s Perspective:

Distribution

Editor’s Letter

More Than Buzzwords

11 Pioneering Patient Engagement 15 Patient and Family Engagement:

Tools of the Trade

20 Walking in the Patient’s Shoes

quality and patient safety 22 Focus on Quality 24 Culture Through a Patient’s Eyes 32 Crossing the Road to HEN 2.0 pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • dbrown@pcipublishing.com For Advertising info contact Michelle Gilbert • 1.800.561.4686 ext.120 mgilbert@pcipublishing.com edition 93

the coach’s playbook 34 The Growing Evidence of Another

news 37 NewsSTAT 38 Value-Based Purchasing Primer 42 CEO Profile: Harrison Dean –

2015 A. Allen Weintraub Memorial Award Recipient

45 Hospitals Earn Quality

Incentive Bonuses

48 AHA Services Presents:

Is Arkansas Ready for Pricing Transparency?

50 Mega Brain Draws Crowds

for Stroke Education

52 Workers’ Compensation Update

annual meeting 55 56 58 60

AHA Welcomes New Leaders AHA Awards Scenes from the AHA Trade Show See You Next Year

legislative advocacy 61 Patients – Our Moral Purpose

Dimension to Healthcare Quality

Arkansas Hospitals I Winter 2015

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from the President

THE HEART of It All Photo courtesy of Cunningham Photography

On the pages of this issue of Arkansas Hospitals, we’re proud to offer hospital templates and tools to assist in Arkansas’s patient and family engagement efforts. Our hope is to bring the Patient Perspective into full focus in this edition, for though each of us has the patient at the heart of everything we do, we can sometimes lose the patient mindset and viewpoint, perhaps missing opportunities to improve care.

Care improvement is at the forefront of hospital efforts today and is the foundation of the just-launched Phase 2 of the Centers for Medicare & Medicaid Services’ (CMS) Hospital Engagement Network (HEN) program. Forty-nine of our member hospitals are participating in HEN 2.0 through the AHA, in affiliation with the American Hospital Association’s Health Research & Educational Trust.

This effort builds on the first three-year HEN project to gather, document and spread best practices in the areas of quality and patient safety. As we focus on the work of the HENs, we come full circle back to the involvement of patients with their own healthcare, as HENs join with the Partnership for Patients in its major spotlight on patient and family engagement.

To add another layer to the interrelatedness of the patient and healthcare,

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Winter 2015 I Arkansas Hospitals

Each of us involved at any level with healthcare today has heard the words “patient and family engagement” as a growing part of our daily vocabulary. A focus of the national Partnership for Patients’ efforts at quality and safety improvement over the past several years has been an evolution toward more involvement of patients and their families in their healthcare, and in the healthcare process.

… Arkansas hospitals are soon to become the core of Healthy Active Arkansas, a 10-year plan to increase the percentage of adults, adolescents and children who are at a healthy weight.

Arkansas hospitals are soon to become the core of Healthy Active Arkansas, a 10-year plan with the single, overarching goal of increasing the percentage of adults, adolescents and children who are at a healthy weight. The AHA is partnering with Governor Asa Hutchinson’s office, the Arkansas Department of Health, Department of Human Services, Arkansas Municipal League, local chambers of commerce, state and local governments and others in this effort.

So our focus on the Patient Perspective? It’s right in line with the way Arkansas and the nation are

thinking these days. It’s at the heart of AHA’s support of our member hospitals.

And when any one of us has the tables turned and we become the patient, we will be grateful that Arkansas hospitals have our perspective as their cornerstone of action.

Bo Ryall

President and CEO Arkansas Hospital Association

Can Laboratory Testing Improve Patient Care and Lower Costs?

Yes. Let us show you how.

AEL is a medically-led, communitybased laboratory with personal service A partner for hospitals to reduce the cost of referrals and in-house testing by using the most modern technology.

To learn more about AEL and its innovative technology to assist in utilization management call Pam O’Brien at 901.405.8200.

Arkansas Hospitals I Winter 2015

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editor’s letter

A

Family

AFFAIR

It seems counterintuitive to hear so much about working toward “patient-centered care,” when healthcare has always been focused on diagnosing and healing the patient.

Yet the paternalistic model of care developed long ago doesn’t mesh with today’s team-driven approach to healthcare. That old model too often created an environment in which patients felt unheard or ignored. It often led to skilled, dedicated caregivers feeling overworked and unappreciated.

Enter new, team-driven cultures and the age of patient and family engagement.

Myriad studies link a lack of effective communication between patients and their caregivers to ineffective care, or even worse, to medical errors. So, far from being the “flavor of the month,” the move toward patient and family engagement is being embraced by the healthcare community

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Winter 2015 I Arkansas Hospitals

because excellent patient care is the end goal, and intentionally involving patients and family members in that care is a means to that end.

Caregivers have always had patients’ interests at heart, but the journey from assuming we know what is best for patients to truly accepting patients and their family members as valuable partners in care is sometimes a difficult one. To provide excellent care in a patientcentered environment, it is necessary to develop authentic relationships and trust with patients and families.

This often involves significant changes in processes and culture; yet our hospitals are embracing this challenge

in their dedication to the highest standards of excellence.

Recognizing that patient and family engagement is not a “one size fits all” endeavor, this edition of Arkansas Hospitals offers insight from three different hospitals’ initiatives to engage patients in improving care. We believe these articles will provide ideas and support for your own patient and family engagement initiatives. Use these tools, adapt them, let them spur additional conversations and planning … and as you find effective ways to incorporate the patient voice, please let us know so we can share your ideas.

Elisa White, Editor-In-Chief

Arkansas Hospital Association

Event Calendar January 1, Little Rock Arkansas Hospital Association Offices Closed January 6, Little Rock Metro CEO District Meeting AHA Boardroom January 8, Little Rock Arkansas Hospital Association Board Meeting AHA Boardroom January 14, Little Rock Arkansas Hospital Auxiliary Association (AHAA) Board Meeting AHA Boardroom January 15, Little Rock 2016 CPT, HCPCS Level II and OPPS Updates for Hospitals AHA Classroom January 22, Little Rock AHA Workers’ Compensation SelfInsured Trust Board Meeting AHA Boardroom January 29, Little Rock Arkansas Association for Healthcare Engineering Winter Meeting CHI St. Vincent Infirmary February 12, Little Rock Arkansas Hospital Association Board Meeting AHA Boardroom

2016 CPT, HCPCS Level II and OPPS Updates for Hospitals January 15, 2016 Arkansas Hospital Association Classroom This annual update provided by the Administrative Consultant Services team will educate attendees on key issues including regulatory changes, compliance concerns and the latest code updates for 2016. Many of the changes significantly impact hospital compliance and reimbursement.

For more information, contact Anna Sroczynski, 501.224.7878 or asroczynski@arkhospitals.org.

Seating is limited, so please register soon!

February 25, Little Rock Semi-Annual Compliance Forum AHA Classroom March 8, Little Rock Critical Access and Rural Hospital Administrators Meeting AHA Classroom March 10, Little Rock Arkansas Hospital Auxiliary Association (AHAA) Board Meeting AHA Boardroom

March 11, Little Rock Arkansas Hospital Association Board Meeting AHA Boardroom March 14-17, Chicago IL American College of Healthcare Executives (ACHE) 2016 Congress on Healthcare Leadership Hyatt Regency Chicago April 1, Hot Springs Arkansas Healthcare Human Resources Association Spring Meeting Clarion Hotel

COMING SOON!

CMS Conditions of Participation Revised Interpretive Guidelines: What Every Hospital Needs to Know

2-Part Series • Part 1 – CMS Patient Rights Standards: Keys to Ensuring Compliance (webinar) • Part 2 – The 2016 CMS Hospital CoPs: A Clear-Eyed Approach to Ensure Compliance (face-to-face)

Look for an email from the AHA with final details.

Program information is available at www.arkhospitals.org/events.

Arkansas Arkansas Hospitals HospitalsI IWinter Winter2015 2015 7

arkansas

Newsmakers and Newcomers ◼ Gov. Asa Hutchinson has named

Chad Aduddell and Doug Weeks to the Arkansas Healthcare Transparency Initiative Board. Aduddell, CEO of CHI St. Vincent, and Weeks, executive vice president and COO of Baptist Health, will represent hospitals on the Board, which is responsible for establishing parameters for use of data collected through the state’s all-payer claims database.

◼ Stephen Webb, FACHE, has

been named vice president and administrator of Baptist Health Medical Center-North Little Rock, succeeding Harrison Dean, who will retain his role

as senior vice president for regional hospitals and assume responsibility for construction and finalization of the new Baptist Health Medical Center-Conway.

Arkansas Children’s Hospital (ACH).

Her primary responsibility will be to oversee key leadership positions and the on-site construction of ACH’s new Springdale hospital, which is expected to open in 2018. Montague previously was chief nursing officer of Children’s Hospital of San Antonio, where she served as executive leader on a $150 million renovation project for inpatient units and services.

◼ James “Jim” F. Davidson

has been named CEO of Saint Mary’s Regional Medical Center in Russellville. He succeeds COO Mike McCoy, who has been serving as interim CEO since the death of Donnie Frederic last year. Davidson most recently was COO of EASTAR Health System in Muskogee, Oklahoma.

◼ Kevin L. Storey has

been named vice president and administrator for Baptist Health Medical Center-Stuttgart. He most recently served as the CEO for Golden Plains Community Hospital in Borger, Texas.

◼ Trisha Montague, MSN, RN,

NEA-BC, has been named senior vice president of regional services for

all about hospitals Hospital in Benton earned the Achievement Level Award from the Arkansas Governor’s Quality Awards during the organization’s annual awards program September 15.

The goal of the Governor’s Quality Award Program, which partners with the Arkansas State Chamber of Commerce, is to encourage Arkansas organizations to engage Hospitals by State – Arkansas Baptist Health Medical Center – Arkadelphia Valley Behavioral Health System Medical Center of South Arkansas Sparks Regional Medical Center Baptist Health Medical Center – Heber Springs Helena Regional Medical Center CHI St. Vincent Hospital Hot Springs Arkansas Heart Hospital Baptist Health Medical Center – Little Rock Pinnacle Pointe Hospital Methodist Behavioral Hospital Siloam Springs Regional Hospital Sparks Medical Center – Van Buren

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Winter 2015 I Arkansas Hospitals

in continuous quality improvement, leading to performance excellence, and to provide significant recognition to those organizations.

◼ In mid-November, The Joint Commission released its list of Top Performer Hospitals (accredited

by TJC), marking each state’s top performing hospitals and critical access hospitals and the 2014 key City Arkadelphia Barling El Dorado Fort Smith Heber Springs Helena Hot Springs Little Rock Little Rock Little Rock Maumelle Siloam Springs Van Buren

quality measures for which they’re being recognized. Arkansas hospitals making the list include:

Heart Attack Heart Failure Pneumonia Surgical Care Children’s Asthma VTE Stroke Hosp-Based Inpt Psych Immunization Perinatal Care Tobacco Treatment Substance Use

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Cover Story

More Than Buzzwords Three Hospitals’ Patient and Family Engagement Initiatives in Action

by Nancy Robertson Cook, Editor and Contributing Writer, Arkansas Hospitals magazine Involving patients and their families in the important business of their own healthcare makes sense. Engaged patients work with their caregivers to encourage the healing process. They understand more about what is happening with their own care, which means they can be active participants instead of passive recipients. This leads to improved experiences and outcomes, lower costs and fewer complications.

Despite widespread agreement about the value of patient engagement, however, the struggle to translate the relatively simple concept into concrete actions has been daunting for many in the healthcare industry.

How do we engage patients in a constructive way? Will greater transparency actually lead to better care?

How will overworked caregivers find the time to provide patients with the education they need to become better partners in the process? These are only a few questions hospitals have as they embark on their own patient and family engagement (PFE) journeys.

Although numerous resources have been developed to assist hospitals to better engage with patients and their families, sometimes the most helpful knowledge comes from the experience of our peers. The following three articles offer “boots on the ground” perspectives of how a large, metropolitan health system, a medium-sized community hospital and a small, rural critical access hospital each forged their own path to engage patients in improvement efforts. These hospitals share suggestions, lessons learned and results.

Though the details of each hospital’s efforts were different, some common threads ran through each story: 1. Administrative buy-in and support are critical for success.

2. Much of the work depends upon having the right people at the table. Providing dedicated hospital staff with the both the time and resources to properly manage the PFE effort is essential, as is identifying patients who are dedicated to providing constructive input and support.

3. Healthcare providers must be given support and training as they learn to trust the advice of patient advisors and incorporate patient and family perspectives and choices into care processes.

4. Although transparency can be uncomfortable, open communication is a must.

5. Every PFE program will encounter problems and barriers, but the rewards of a successful patient and family engagement initiative are well worth the effort.

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Cover Story

Pioneering Patient Engagement

strategy session

How One Hospital Created Patient Councils to Improve Care

Beth Israel Deaconess Medical Center (BIDMC), a teaching hospital of the Harvard Medical School in Boston, was an early adopter of the patient and family engagement (PFE) model.

“In 2007-08, we made the audacious goal of having zero preventable medical harms in our critical care units across nine ICUs,” says Barbara Sarnoff Lee, senior director, social work and patient/family engagement for BIDMC. “Our medical director knew we could do well in preventing harms, but he wanted to engage patients’ families in helping us achieve our ultimate goal.”

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Lee was asked to create a program to bring families into each ICU patient’s healthcare plan, with the idea that these family members (and after healing, the patients themselves) would offer critical information on how best to improve the ICU healthcare process, thereby preventing harms and improving communication.

“We began to deliberately outline how our patient and family advisory councils (PFACs) would look,” she says, “and started creating the structure we wanted to try.”

It began with the name. “We chose to name our groups ‘councils,’ not ‘committees,’” Lee says. “Councils advise; committees make policy decisions. Our councils were set up to serve in an advisory capacity, to be a valuable voice but not to direct the clinical and professional staffs outright.”

The groups – 7 of the 9 ICUs had formed councils by the 2008 project launch date – were asked to give two hours every other month to meet and come up with suggested solutions for patient-oriented challenges.

“At the end of one year, we wanted to look back and say we had accomplished one thing very well,” she says. “So we decided upon our goals, council by council, and set out to meet them.”

Then, in 2009, Massachusetts passed regulations saying all hospitals had to introduce PFACs into their systems.

BIDMC, with its ICU PFAC program well under way, had a jump on other hospitals.

Again, Lee was asked to coordinate the launch of PFACs throughout the teaching hospital’s many patient care areas.

“When we were broadening our PFAC presence in response to the new regulations five years ago, we again

systematically approached the PFAC design and structure, addressing how long members could serve, how we would recruit and how we could keep our members engaged,” she says. “We knew we needed to have diversity in the age, culture and medical status of our members, as well as have them represent our different service areas (cardiology, ambulatory care, etc.).”

Easing Fears

Meanwhile, back in the PFACs dedicated to the ICU, a particular challenge was being addressed. The Patient Perspective was definitely heard and attended to as answers were sought to this question: What is the hardest thing about being in an ICU at BIDMC? The staff was shocked to discover the answer from patients – the terror of

A New Standard ‘Superset’ from main flows - represents most complex room entry Hands Full

Precaution Room

Provider is carrying something into the room

Patient is on airborne/droplet & contact precautions

Door/curtain must be opened & closed

Room Entry

Final Iteration for Testing Dotted outline indicates that a step has changed sequence in the process as the team iterated.

Explanation provided.

Put stuff down

Mask

Pick stuff up

Introduction should happen immediately after entering the room.

This may happen simultaneously with other steps

Open door/ curtain

Enter room

Close door/ curtain

Introduce to pt & family

Put stuff down

Hand hygiene should happen immediately before donning gloves, and after the potential contamination from the door/ curtain

Gown

Hand hygiene

Will test gowning in the room: •↓ ‘put stuff down’ before entry • Gowns only in patient rooms

A new standard for room entry was established to ease patients’ fears. Patients and families worked with medical personnel in developing this protocol.

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Winter 2015 I Arkansas Hospitals

Gloves

strangers entering into their rooms, without explanation or conversation.

It turned out that, more than 50% of the time during daylight waking hours, members of the caregiving staff would enter into a patient room in the ICU, without a word to the patient, and begin the task at hand.

“Mind you, the patients were awake and responsive,” Lee says. “Yet through observation, we witnessed staff members entering, completing their tasks and leaving the room without once acknowledging the patient or telling him/her what they were there to do.”

From the clinical perspective, the work was being done efficiently. But from a human perspective? Members of the PFAC said it was as if someone unknown to you silently entered your bedroom, saying nothing. “Please tell us who you are and why you are here,” they asked. “Please speak to us,” they said, expressing surprise that there was no existing standard roomentry protocol.

Thus the illustrated room entry guide (shown on page 12) was created, with input from the PFAC working in tandem with clinical and professional staff.

Lee and her team explained that many hospital leaders resist the formation of PFACs, because they feel they will be “dictated to” by disgruntled patients, or they will lose reputation or face because of the level of transparency needed is frightening. “The patients will see our warts and vulnerabilities if we form a PFAC,” is a familiar refrain.

It is a major paradigm shift for caregivers to trust council members 100%. But as the BIDMC program enters its eighth year, more and more staff recognize that the program and the people serving on the councils are helpful, even necessary, to the hospital’s success.

Every meeting requires detailed planning

It’s important to respect the time of your PFAC members, Lee says. “We always get their materials out to them ahead of the meeting so they can pre-study the information.” As topics are discussed, they must be incorporated into a “work log” which outlines the details of every project so nothing is inadvertently forgotten. continued on page 14

Survey Results Establish National Patient/Family Engagement Baseline Results from a first-ever survey of U.S. hospitals on their practices related to engaging patients and their family members as active partners of the healthcare team were published in the July 2015 issue of BMJ Quality & Safety. The survey found a growing body of evidence indicating that a more engaged patient experiences better health outcomes and lower use of healthcare services. Survey results show that hospitals are beginning to implement many recommended practices, but additional areas for improvement remain.

Developed in collaboration with and through funding from the Gordon and Betty Moore Foundation and conducted by the American Hospital Association’s Health Research and Educational Trust, the national survey examined the degree of use of a core set of recommended patient and family engagement (PFE) practices.

Results revealed vast differences in implementation of such practices across the country. Of the 1,427 acute care hospitals completing the survey, only 49% had fully implemented 9 or more of the recommended 25 key PFE strategies.

Here are key findings: • 86% of hospitals had a policy for unrestricted visitor access in at least some units; • 68% encouraged patients/families to participate in shiftchange reports; • 67% had formal policies for disclosing and apologizing for errors; • 68% used teach-back with patients in at least some units; • 38% had a patient and family advisory council (PFAC); • 28% offered online access to personal health information; and • The most commonly reported barrier to adoption was competing organizational priorities.

“This survey offers us a great glimpse into current practices around patient and family engagement and will provide the field guidance for their efforts to continually improve how they provide care to patients,” says co-author Dr. Maulik Joshi, HRET president and AHA associate executive vice president. “Hospitals and clinicians are still learning how best to incorporate patients and families into their care, and a survey such as this offers a unique body of research for our consideration.”

More information on the Moore Foundation survey and its results can be found at http://www.hret.org/quality/projects/ moore_foundation_patient_family_engagement_survey.shtml, and original research findings are available in the online BMJ Quality & Safety at http://qualitysafety.bmj.com/content/ early/2015/06/16/bmjqs-2015-004006.full.

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Winter 2015 I Arkansas Hospitals

And as items are checked off the work log and solutions to challenges are found, both patients and hospital staff can see the win-win nature of the PFAC. It happens that talking about challenges openly can change the way hospitals operate. Engaging staff and patients/families by utilizing their combined expertise – from each side of the table – has yielded great change and a more trusting environment for both patients and clinicians.

BIDMC’s PFACs joined together recently to offer ideas on re-designs of family waiting rooms. Again, some in hospital leadership voiced concern that the advisory council members would ask for over-the-top amenities. “Yet we were all amazed at how modest their requests were,” Lee says.

“Council members helped us design practical spaces that attend to the needs of those waiting for long periods of time,” she says. “What we find is that our PFAC members come to love their hospital. They want the hospital to be at its best and to succeed. Their suggestions are often easy tweaks to the system to improve care and communication.”

The bottom line at BIDMC: eight years in, preventable harms are being stopped in their tracks, patients and families are being folded into the care process and the Patient Perspective is seen by more and more professional staff as a viable voice in creating everything from daily protocols to building designs. “It’s still a process,” Lee says, “but the weight of the patient experience and what it has to teach us is now seen as an asset and is valued by many. The hundreds of people involved in BIDMC PFACs are being heard, and their help is changing the way patients experience healthcare.”

Cover Story

Tools of the Trade: Nuts and Bolts of a Successful Patient and Family Engagement Council Columbia Memorial Hospital is a full-service, 25-bed not-for-profit critical access hospital located in Astoria, Oregon, where the Columbia River meets the Pacific Ocean. Front and center on its website is the commitment to “providing compassionate healthcare in a healing environment, and to providing leadership to improve the health of the community we serve.”

Columbia Memorial subscribes to the philosophy that “we can best serve our patients and the community by providing a healing, nurturing environment. We believe in peaceful, comfortable surroundings, warm and supportive caregivers, and access to health information and education to help our patients get well faster and stay well longer.”

It is no surprise, with these credos at the fore, that Columbia Memorial has a foundational commitment to patient and family engagement (PFE) and operates with an intensely active Patient and Family Advisory Council (PFAC) as a part of its core fabric.

Trece Gurrad, RN, MSN, is the vice president of patient care services of the hospital and serves as the designated facilitator working with Columbia Memorial’s PFAC. “You need to have a board and an executive team that are all in for PFE to work,” she says. “You can’t be half in!

That’s a mistake a lot of organizations make. Some [hospitals] form PFACs just to check the requirement off of a list. Your council will pick up on this and won’t become engaged. Leadership involvement is critical.”

“Having an administration executive meet with our council helps us operate proactively,” says Judy Coleman, cochairman of the hospital’s PFAC. “We

can get executive input and decisionmaking in the midst of our meetings without having to wait days or weeks for C-suite decision-making. It makes our council operate in its most highly effective state.”

The PFAC is four years old this year.

In those four years, the hospital has accomplished a great deal.

As with other PFACs and their members, the longer a council is in existence, the more its members grow to passionately love their hospital and its caregiving work.

This love for the hospital is clearly expressed in presentations by and conversations with Coleman.

“We like to share our PFAC process with other hospitals that want to begin their own patient and family involvement program,” she says. “We have come up with 10 MUSTS learned through our process. Maybe following these will help others in their journey.” continued on page 16 Arkansas Hospitals I Winter 2015

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1. You must have an enthusiastic PFAC Staff Facilitator/Educator to get your council started and keep it operating effectively.

Columbia Memorial’s jump start into the PFAC world came from its affiliation with Planetree, a non-profit organization of hospitals and other facilities dedicated to care centered around the needs of the patient.

Planetree has established a program to formally recognize facilities that have met specific criteria signifying excellence in patient and personcentered care across the continuum.

Columbia Memorial earned the rank of a Planetree-designated hospital in 2013 and credits the Planetree philosophy for much of its PFE success.

Coleman also credits Trece Gurrad as a key contributor to that success.

“Trece is overwhelmingly devoted and dedicated to patient and family engagement; her vision and enthusiasm are invaluable to our group and the work we do,” Coleman says. In fact, Trece has been such an important part of the PFAC’s success that Coleman believes a PFAC “just is not going to work if you don’t have hospital leadership and a hospital staff person dedicated to your PFAC.”

2. Your PFAC needs officers with both the business knowledge and the time to dedicate to the council.

At Columbia Memorial, their facilitator and secretary come from the hospital staff, while their chairman and co-chairman come from community volunteer members. Coleman recommends having co-leaders, rather than a chairman and vice-chairman, as a way to keep the vast work of the council manageable and current.

She also recommends waiting several months into the PFAC’s creation before holding an election of officers. “People need to get to know one another, their strengths and what they bring to leadership. It takes time and working together to develop this knowledge.”

3. Strive for diversified membership, selecting a mix of members who are community volunteers and/or former patients or family members.

“This is an essential element,” Coleman says. “In your interviews for PFAC members, you seek people who are assertive, but not aggressive. You want to know that members will listen to one another, and most important, your biggest concern is that the hospital leadership and staff will listen to your

After only four years in operation, Columbia Memorial’s PFAC can point to a growing list of patient-centered improvements brought about through its efforts in collaboration with hospital administration and staff.

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Winter 2015 I Arkansas Hospitals

input. You want to know that the PFAC voice will be heard. Having a mix of community experience combined with patients’ voices is critical.”

4. Provide education and training for your PFAC members and their committees.

Gurrad established ongoing education for the PFAC members. She recommends starting with hospital terminology so that members don’t feel embarrassed to ask what certain hospital lingo means.

She also stresses that many people who are willing to serve on the PFAC don’t automatically know what’s expected of them. It’s a good idea to educate in the areas of council procedure, organization techniques, how projects will be tracked, HIPAA privacy requirements and each person’s responsibility for the work of the council.

“You may not have professional people as PFAC members,” Gurrad says. “Help your members who don’t have a strong business background acquire the skills needed to operate within the council.”

5. Attempt to keep your membership at a ratio of 15 community members to 5 hospital staff, or 3:1.

“It’s vital to have hospital staff as a working part of the council,” Coleman says. This is an important way to illustrate how the in-house and volunteer staffs knit themselves together into a cohesive unit.

At Columbia Memorial, they set membership terms of 2-3 years to ensure consistency over time. “In the first year or so, people are just getting their feet wet and learning how the council operates,” Coleman observes, “but they become expert as time goes on.” The hospital recognized that having council members serve one-year terms would not allow them enough time to get trained, develop their knowledge base and begin work before their term ended.

Columbia Memorial also suggests holding monthly PFAC meetings and having PFAC members participate on other hospital committees and process improvement projects. “You can’t accomplish a lot if you’re not meeting face-to-face,” she stresses. “That’s why the ability to commit to the actual time

the PFAC requires is important when selecting your members.”

Gurrad notes that she and Coleman work as partners. “Judy and I set the agendas for PFAC meetings,” she explains. “We email [each other] often and meet at least once a month with the co-chair and our secretary. We are both gathering information during the month between meetings, and we keep our communication constant. We check with each other on the engagement of our members with process improvement plans. We constantly think about how the PFAC is included, should be included, can be included … and whether or not the members’ voices are being heard.”

6. Hold a once-yearly goal-setting meeting with hospital staff, and come back to these goals at least quarterly in executive meetings between the PFAC chairs and the staff liaison, to be certain you’re on track.

“I can’t stress enough the luxury and importance of having a hospital administrator as your facilitator,” Coleman says. “It keeps your PFAC in direct contact with administration and alleviates a lot of time lost waiting between meetings for decisions to be brought up and considered.”

Communication is key. “It’s a matter of respecting one another,” Coleman says. “We don’t always agree, and things are not always rosy.” “But we agree to disagree and we often compromise,” Gurrad adds.

7. Keep your work logs current.

Columbia Memorial maintains a detailed work log with the specifics of each project, the individuals assigned responsibility for each task and the status. “Our work logs are the only way our members collectively know what we’re working on, where each project stands, what comes next and so forth,” Coleman says. “It’s a lot of work to keep them current, but it keeps everyone efficient and on track.”

8. Utilize input strategies. Design strategies to get the information your PFAC needs to move forward.

“We use secret shoppers to gather information on how some of our projects

What Makes A Good PFAC Member?

Columbia Memorial looks for PFAC members among their current or former patients or their family members. The best PFAC members satisfy the following criteria: • Are good listeners and respectful of others; • Are interested in more than one issue; • Are willing to draw from their own personal healthcare experiences so others can learn; • Use emotional intelligence; • See beyond their own experience; • Are enthusiastic about patient-centered care; • Work well in groups and interact well with different types of people and different levels of professionals; • Are willing to be good partners; and • Have realistic expectations.

are succeeding once they’re put into practice,” Coleman says. “We don’t want to launch projects and then just assume they’re going well without doing our homework and checking in.”

Other input strategies to consider, Gurrad says, are ways for hospital staff, managers and patients/families to express their questions, their concerns and share their experiences. “It’s very important that patients and families share their experiences, both good and bad,” she says, “and that they have a reliable and consistent way to report their experiences.”

Also consider community meetings, focus groups and manager meetings as ways to gather input for improvement and effectiveness.

9. Explain the PFAC’s role constantly and consistently. Audiences include both the hospital staff (in-house) and the community at large.

“I am an ‘agenda-item’ at several staff meetings and community presentations each year,” Coleman grins. “Constant exposure to our reason for being and the importance of the change we’re helping bring about are necessary. People don’t always remember that there’s a PFAC in existence and that its purpose is to bring the patient voice to the table. Anyone in leadership on a PFAC must be committed to presenting the PFAC story multiple times per year in multiple sites to multiple audiences.”

10. Make your PFAC a part of the overall hospital team … a true partnership.

Coleman says this last “MUST” will take time to implement. “The hospital may, at first, have some reluctant staff members.

It takes time for them to understand that we’re not here to tell them what to do. Our role is to attempt to work with the hospital to show how it, its care and its caregiving team are seen through the patient’s eyes.”

This partnership step goes both ways. “It’s also important for your PFAC members to feel valued and important,” Gurrad emphasizes. “When the feeling of partnership evolves, the boundaries of the working relationship and possibilities for process improvement throughout the hospital are endless.”

“There are a few additional ideas we offer from the staff side to encourage growth and acceptance of the PFAC,” Gurrad says.

The work logs Coleman refers to are a vital piece of that puzzle. “The work logs tell us where we are on each project and keep us on target,” she says. “But we also break down our goals by hospital department. This is an important element.”

Department leaders help the PFAC committee refine general goals to become department-specific goals. These tie in to the organization’s strategic plan, thus vesting the PFAC in the hospital’s strategic activity.

The four years since the Columbia Memorial PFAC’s inception have seen many positive changes. continued on page 18 Arkansas Hospitals I Winter 2015

17

“When we first set out, the transparency issue in individual patient healthcare was tough,” Gurrad says.

“People instinctively relied solely upon what their doctors told them. Today, in the changing medical field, patients are becoming actively involved in their own healthcare. One thing that helped us get the curtain lifted and move toward transparency was our designation as a Planetree organization. This served as the cornerstone for implementing many of our patient-centric care elements such as open chart, bedside care handoffs, patient advocates, no one dies alone, pet therapy and integrative therapy programs.

Because staff worked side by side with our PFAC members on these projects, they became less suspicious of PFAC involvement and more inclusive and open over time. In addition, project outcomes were greatly improved because the patients’ perspectives were considered and incorporated from the beginning. Staff saw the positive outcomes and began to recognize the value PFAC brings to the

organization.” Mutual trust is established and transparency becomes the cultural norm as these projects continue.

As a cancer survivor, Judy Coleman began her work as PFAC co-chair coming from the former patient’s seat.

At that time, the PFAC was seen as a separate organizational unit, and its members were not integrated into other hospital committees. Perception of the PFAC has shifted over time, and now PFAC members are viewed as crucial voices in operational improvement. As evidence of this shift, Coleman cites her current positions on the hospital’s quality and patient safety committee, maintenance committee, and most importantly, the 2016 strategic planning committee. “This has all come about because we trust each other,” Coleman says. “Hospital staff knows we are trained on and understand HIPAA, that we’re true to the conflict of interest and privacy statements we sign, and that we have only the best interests of the hospital at heart.”

“In the beginning, hospital staff members feared that the PFAC members would solely be a source of complaints regarding the hospital and its functions,” Gurrad says. “This really doesn’t happen, and we hope others take courage from what we have found.

The people on our PFAC care about our community and care deeply about our hospital. They want it to be the best that it can be. We continually educate our committee members on their role and encourage them, when bringing a concern, to also bring a solution.”

“We love our hospital,” Coleman concludes. “That’s why we’re doing this.

We always want to bring the Patient Perspective, and we have resolved to act completely out of love for our hospital and its possibilities.”

To receive a copy of the Columbia Memorial charter, work log and other templates, you may contact Nancy Robertson Cook at nrcook@arkhospitals.org.

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Winter 2015 I Arkansas Hospitals

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The Patient Perspective Engaging Patients and Families for Better Care Creating a Positive Culture

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Cover Story

Walking in the Patient’s Shoes: One Patient’s Perspective Leads to Profound Improvements in Care Having a heart attack changes your life. In the case of Arnym Solomon and Health Central Hospital in Ocoee, Florida, his heart attack changed not only his life, but also changed the way his local hospital’s emergency department approaches everyone presenting with heart pain, as well as the hospital staff’s perception of the facility’s Patient and Family Advisory Council (PFAC).

“I came to my hospital, Health Central, with excruciating chest pain,” explains Arnym Solomon, now a valued member of the Health Central PFAC. “The receptionist sent me over to the ER, where a person in a white uniform began to ask me questions.”

Solomon said he tried to answer the questions, but he was in such pain he could hardly get his words out. “Please.

I’m in your system. You can look me up.

I can hardly speak.”

A blood sample was taken, as were his blood pressure and an EKG. He was then put into a wheelchair and wheeled back into the waiting room, with no 20

Winter 2015 I Arkansas Hospitals

explanation of what to expect, what would come next or when he might be seen. Having no one with him, he felt very alone and frightened.

“You can imagine how it was from my perspective,” he says. “There was no one in the room to call for help. I was in extreme pain. I was scared, and I didn’t know if I was dying. The emotional experience was overwhelming. Several times I yelled out for help, but no one paid attention. I spent about an hour in the waiting room, left with all of the other patients and with no idea what the next move would be.”

He repeated the anguish he felt, along with the pain. “Maybe all patients feel they are not being listened to, I don’t know,” he says. “I wasn’t being a jerk. … I was in pain and knew I had a serious problem. I felt totally abandoned.”

Solomon was, indeed, having a heart attack. When he was evaluated, it was discovered that three of his arteries were blocked. He was treated with nitroglycerin and started getting tests and treatment that eventually led to placement of a stent.

“In retrospect, I came as close as I want to come to dying, right there in the hospital ER I trusted,” he says. “I

Arnym Solomon with Patient Advocate Bibi Alley

carefully looked back on that incident and made the decision that I wanted to help other patients who find themselves in the same situation. The physical pain and possible consequences of being passed over and passed off were bad enough, but the emotional and mental stress that accompanied those actions was horrible. I felt there had to be a solution to help those patients in extreme health situations to understand that they were being heard and were not alone.”

When he was better physically, Arnym went to see Bibi Alley, the Patient Advocate at Health South. After hearing his story, she recognized an immediate need and determined to solve a gaping problem (while also inviting him to apply for a seat on the PAFC).

“Bibi knew me because my wife is a volunteer here,” Arnym explains. “I knew she would listen. I told her the story of what had happened, and she got me involved in helping her try to change the situation. She wanted to address the patient experience from both the patient and hospital perspectives, and I’m glad to say both have been addressed.”

Initially, Arnym admits he did not expect a lot of improvement because

he knew there had to be a shift in longstanding processes. But after serving two years on the committee, Arnym can see dramatic changes for the positive. “I am a true believer in Bibi and in her methods. I used to be a real skeptic, but now, I see the results.

When I rang the alarm about the process being inefficient, Bibi listened and responded.”

“Arnym came to see me nearly three years ago,” Bibi says. “There was a litany of things he asked about the process in the ER, so together we went to see the chief quality officer. I felt that after our discussion, Arnym still was not completely satisfied, so we went over his concerns again.” In that discussion, Bibi discovered that in addition to his concerns about receiving slower care than he felt he needed, Arnym was extremely distressed by the fact that he was not being listened to and understood in the midst of extreme physical and mental stress. “That discovery,” says Bibi, “introduced us to a new line of thinking.”

“Bibi saw to it that the training intensity for those working in the ED increased,” Solomon says. “Today, those working in the ED are trained to

address not only the physical being, but also the emotional being who presents to them.”* The new training involves intense role play, where physicians, nurses and other caregivers “experience” a health situation and can then more readily tune in to the emotional and mental stresses that accompany it. “This really closes the gap,” Solomon says. “It helps every caregiver and provider become more sensitive and consider aspects of the patient experience that had not formerly been examined.”

“It’s important for every caregiver to understand the other side of the mirror,” Alley explains.

A checkoff list of not only physical points to address, but also mental and emotional stress points, has been added to the ED’s protocol. “We also now have a nurse who sits with those registering patients,” Alley says. The nurse can fast-track patients, like Mr. Solomon, who need to be seen immediately. “You can’t use a bandaid approach,” Alley says. “We found out you have to look at the throughput process and make the necessary changes in order to effectively connect with your patients, families and the communities we all serve. And we need to really listen without interrupting.”

“Mr. Solomon has helped us redesign our ED process,” Alley says.

“He is a robust lead on the ED Alliance and is helping us address the Patient Perspective as we grow from a 38-bed ED to a 58-bed unit.”

“I have seen a shift in the way doctors and others address patients,” Solomon says. “The attitude toward the patient has changed a lot. Most talk with patients as if talking directly with a family member. For me, I want the physician or nurse or other caregiver to tell me what’s wrong with me and what they’re going to do about it.”

“When you have engaged me, you have my trust, so you can have my body.

It’s like, ‘OK. Now, I feel comfortable.’” *For more on physician and caregiver training, Alley and Solomon recommend the book The Language of Caring, which helps put caregivers into the mindful presence of the patient.

Arkansas Hospitals I Winter 2015

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Quality and Patient Safety A recent blog post by National Patient Safety Foundation president and CEO Dr. Tejal Gandhi reiterated the importance of influenza vaccination for healthcare workers. She quotes the Society for Healthcare Epidemiology of America (SHEA) in detailing the multiple purposes of vaccinating healthcare workers: preventing transmission to patients; reducing the risk of influenza infection in the vaccinated healthcare workers; creating “herd immunity” that protects both health professionals and patients who are unable to receive the vaccine or unlikely to develop an immune response; reducing the impact of workforce absences due to illness during flu season; and modeling how important vaccination is for everyone.

A strain of bacteria resistant to colistin – the antibiotic of last resort for gramnegative bacteria such as E. coli – has been found in China. Scientists in China and the UK reported the discovery November 18 in Lancet Infectious Diseases, describing the emergence of the strain as “the breach of the last group of antibiotics” by plasmid-mediated resistance.

Focus on Quality The fight to wipe out TB globally by 2030 hinges on India, according to the World Health Organization (WHO).

Expressing concern about recent health funding cutbacks in the country that may derail India’s TB program, Mario Raviglione, director of the WHO’s TB program, says, “India is a positive, successful story up to a certain point. From now on, that positive story won’t be sufficient and they’ll need to do more.” India has 23% of global TB cases and the most deaths (220,000 last year). – Reuters

The American Hospital Association/Health Research and Educational Trust is partnering with 34 state hospital associations and more than 1,500 hospitals to improve patient care through the new HEN 2.0 program. To see the states, number of participating hospitals and list of HEN 2.0 organizations by state, go to the map located at http://www.hret-hen.org/about/map.dhtml. To date, the Arkansas Hospital Association has recruited 49 hospitals for the project.

According to Becker’s Hospital CFO, with quality performance having a direct and growing effect on hospital reimbursements, CFOs are stepping out of their comfort zones and taking a closer look at quality metrics that have consequences on revenue. Five key quality metrics identified by CFOs include: rate of readmissions, patient experience, cost per visit, mortality rates and hospital-acquired infection rates. Read more at http://www. beckershospitalreview.com/finance/the-cfos-guide-to-healthcare-quality-key-metrics-to-track-trends-to-follow.html.

Arkansas Hospitals I Winter 2015

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Quality and Patient Safety

Through a Patient’s Eyes

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Culture Connection

By Joe Tye, CEO, Values Coach Inc.

The Pickle Challenge for a More Positive and Productive Culture

This is not the article I had intended to write. When Arkansas Hospitals Editor-in-Chief Elisa White asked me to write a sequel to “Strategies for Positive Cultural Transformation,” (Fall 2014) I’d planned to write about the fact that while culture does indeed eat strategy for lunch (an aphorism coined by the late Peter Drucker), strategy and culture working together in a mutually reinforcing way creates an unbeatable source of competitive advantage. But, as John Lennon once wrote, life is what happens while you are busy making other plans. As I was busy making plans for the sequel article, life intruded.

Winter 2015 I Arkansas Hospitals

Editor’s Note: This is a follow-up to “Strategies for Positive Cultural Transformation,” which appeared in the Fall 2014 issue available at http://www. arkhospitals.org/publications.

On Sunday, October 25, I flew from my home in Iowa to Kenedy, Texas, where I was scheduled to spend three days at Otto Kaiser Memorial Hospital (OKMH), a critical access hospital that currently has a replacement facility under construction. During those three days, we were going to work on creating a “cultural blueprint” for their Invisible Architecture™ of core values, organizational culture and workplace attitude to help make sure that the employee and patient experience will be just as wonderful as their new physical building.

I wasn’t feeling well but did not want to miss a commitment for the first time in my more than twenty years of coaching. That evening though, following a brief meeting with the leadership team in the board room, I was escorted to the emergency room where I was diagnosed with acute diverticulitis. I was admitted, and the CEO went to work cancelling meetings.

After four nights as an inpatient at OKMH, I flew back home where I spent the next ten nights as an inpatient at The University of Iowa Hospitals and Clinics (UIHC).

At OKMH, I was seen in an exam room that would have been familiar to Florence Nightingale (or at least one of her late 20th century descendants); diagnosed on a 16-slice CT scanner that’s probably older than many of the people reading this article; and admitted to a patient room where the shower was down the hall (remember – they have a new hospital under construction).

In contrast, at UIHC, I was seen in an emergency treatment center that would have astonished Captain Kirk from Star Trek; diagnosed with a cutting-edge 64-slice CT scanner; had a procedure performed by a renowned interventional radiologist; and was infused with the most potent cocktail of antibiotics that modern medicine has to offer.

Someone can’t be cynical and negative sitting in the cafeteria or break room and then somehow flip an inner switch and become genuinely caring and compassionate when they walk into a patient’s room.

Patients see right through the fraud.

But if you ask about the care I received at these two hospitals, I won’t even comment on the facilities or technology. In both cases, I’ll tell you that the care was excellent because everyone – from housekeeping to nurse managers – made me feel like I was the most important person in the hospital. And I wandered the halls at all hours enough to appreciate that they made every other patient feel the same way.

I will also tell you that I – like most patients – could distinguish between the people who put their heart and soul into the work and those who are just there for a paycheck. And most of your patients have a better feel than you might think for the sorts of conversations that go on in hallways, nursing stations and break rooms.

Someone can’t be cynical and negative sitting in the cafeteria or break room and then somehow flip an inner switch and become genuinely caring and compassionate when they walk into a patient’s room. Patients see right through the fraud.

The Essential Requirement for Positive Culture Change

A good working definition of organizational culture is that it’s the collective attitudes, behaviors and habits of the people who work there.

Given that, culture does not really change unless and until people change.

And people will not make fundamental changes unless they perceive a personal benefit to doing so – especially if making these changes means running the risk of being criticized, ridiculed or ostracized by coworkers.

This is why so many customer service “programs of the month” fail to have a lasting impact. People memorize their “may I help you?” scripts and wear their happy face pins, but before long they’re parroting the scripts like robots and wearing the happy face pins upside down. There is no lasting change, no perceived personal benefit, so they’re just going through the motions.

The Healthcare Crisis Within

“Backbiting, petty scandal, [gossip], misrepresentation, injustice, bad temper, bad thoughts, jealousy, murmuring, complaining. Do we ever think that we bear the responsibility of all the harm we do in this way?”

Florence Nightingale: Letter to Graduates of the Nightingale School Consider these facts: 1) Gallup, Press Ganey, Modern Survey and virtually every other organization that studies employee engagement find only about one-quarter of all employees are engaged in the work; 2) last summer, the American Nurses Association issued a white paper on incivility, bullying and lateral violence in the healthcare workplace; 3) a literature review I conducted with a colleague showed continued on page 26

Do you have a strong culture of ownership in your organization?

A short quiz from the Values Coach Cultural Blueprinting Toolkit will give you a numerical ranking and brief assessment: assessment.valuescoach.com.

Arkansas Hospitals I Winter 2015

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The Pickle Pledge

the word “bullying” in nursing journal titles 115 times over the past five years (and that doesn’t include the same and similar terms in medical or allied health literature); and 4) when we compiled results from our most recent 15 Culture Assessment Surveys, more people disagree than agree with the statement that they work in a positive and respectful culture (see chart above).

About 1,500 of the 6,281 responses to this question were from participants in a webinar I conducted on behalf of the American Nurses Association Leadership Institute. A majority of the follow-up questions that I received related one way or another to dealing with toxic emotional negativity in the workplace.

That is the healthcare crisis within.

If every employee and provider at every hospital, long-term care facility and outpatient clinic in America strongly agreed with the statement, “Our people reflect positive attitudes, treat others with respect, and refrain from complaining, gossiping or pointing fingers,” we would far more effectively deal with the impositions of the external healthcare 26

Winter 2015 I Arkansas Hospitals

crisis. And that is also why a movement to eradicate toxic emotional negativity from the workplace is almost always the non-negotiable first step toward building a more positive and productive culture of ownership. This culture change inevitably leads to better patient care.

If you are old enough to remember when people smoked everywhere – hospital cafeterias, nursing stations, restaurants, taxi cabs, even airplanes – you know how disgusting and occasionally debilitating it was to be chronically poisoned (and to see your children being poisoned) by other people’s cigarette smoke. And you remember how helpless most of us were to do anything about it, short of causing an unpleasant confrontation.

You might remember that when Dr. C. Everett Koop called for a smokefree society in 1986, many people wondered what he’d been smoking.

After all, cigarettes contain an addictive drug and were being promoted by an industry spending billions of dollars a year to promote smoking and to protect what they called “smokers’ rights.”

Today, of course, virtually every hospital in America has a smoke-free campus. One never hears the term “smokers’ rights” or the question “Mind if I smoke?” The smoking section in most restaurants is out back by the garbage dumpster, and if anyone were to light a cigarette on an airplane, the air marshal’s role would not be to arrest the smoker but rather to save him or her from being assaulted by fellow passengers. The change in our culture has been nothing short of miraculous.

Toxic emotional negativity is the emotional and spiritual equivalent of cigarette smoke. It is malignant – abundant scientific research has proven beyond a shadow of a doubt that toxic attitudes and emotions are detrimental to health and longevity.

And it is contagious – one toxic, negative person can pollute the emotional climate of an entire work unit the way one person lighting a cigarette instantly pollutes the lungs of everyone else in the vicinity.

The Pickle Pledge is a very simple (though by no means always easy) promise that one makes to oneself and to others – to turn every complaint into either a blessing (“my head is killing me” becomes “thank God for modern pharmacology”) or a constructive suggestion (“the first symptom of dehydration is a headache, so I should drink some water”). By taking the pledge, one is also committing to not allow toxic, negative coworkers to ruin their day or to ever do that to anyone else.

In organizations where people really take this to heart, we are seeing phenomenal culture change. We’ve heard stories of people making incredible changes in their personal attitudes, and consequently, in their self-image and self-esteem. People have taken the Pickle Pledge home and shared it with family members. One nurse told me that her house was very quiet for several weeks after she shared the pledge, but then, for the first time ever, family members started talking about things that really matter instead of just whining about the complaint of the day. And we’ve heard from hospital CEOs who have told us that some of their most negative people are leaving – not because of a disciplinary process but because their coworkers simply don’t put up with them anymore.

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12 different client hospitals to raise a certain amount of money – typically $1,000 – in quarters by having employees catch themselves and their coworkers complaining, gossiping or otherwise engaging in toxic emotional negativity (TEN). When this happened, they would be invited to deposit a quarter in a pickle jar. If the hospital hit the target and donated that money to an appropriate charity (typically the employee assistance fund), then we at Values Coach agreed to match the donation.

During the year, we wrote donation checks totaling $10,000.

That represents 40,000 individual episodes of TEN being caught midstream and unplugged. If this were sustained for a full year in those organizations, more than two million incidents of complaining, fingerpointing, rumor mongering and other forms of TEN would be prevented.

Extrapolated to the entire healthcare system, we could eradicate more than a billion individual episodes of TEN every year.

Key Success Factors

In analyzing the most effective culture-changing initiatives, seven strategies stand out. These strategies can apply to any culture change effort and are not just limited to the Pickle Challenge.

Do an objective assessment, and take off the rose-colored glasses.

Research by The University of Iowa Department of Health Management and Policy shows that the higher on the organization chart one’s position is, the more likely they will be to view their culture through rose-colored glasses.1 An unpublished follow-up study shows a strong correlation between cultural clarity at every level of the organization and higher patient satisfaction and quality indicators. No matter how positive you personally think you are, and no matter how great you think your culture is, if you really start paying attention to TEN you will be astonished – and appalled – at how prevalent it really is.

Set a positive leadership example.

One of the most effective tools we have developed at Values Coach is the Self-Empowerment Pledge, which includes seven promises, one for each day of the week: responsibility, accountability, determination, contribution, resilience, perspective and faith. (You can download a poster of the pledge at www.valuescoachinc.com/ pickle-challenge.)

At Midland Memorial Hospital, the CEO and every other member of the executive team wear their daily wristbands signifiying each of the seven promises of the Self-Empowerment Pledge, and every morning one of them leads a large group in reciting both the Pickle Pledge and that day’s promise from the Self-Empowerment Pledge at the beginning of the daily huddle, which is conducted at the front entrance in the main lobby.

Make it fun.

Effective culture change must have more the feel of a social movement than that of a management program. The best way to gain widespread engagement and ownership is to make it fun and even a bit silly. One of the ten core values at Zappos – which has turned teaching others about its culture into a profit center – is “Create fun and a little weirdness.” That’s what the Pickle Challenge does.

Keep it visible.

At Midland Memorial Hospital, you see pickles everywhere. The Pickle Pledge covers the entire 25-foot long glass wall of the Human Resources Department; there are decorated pickle jars in most departments; and for special events the food service department will make Pickle Pledge cakes and cupcakes. After a storm knocked down a big tree, one MMH employee turned a 2,000-pound tree stump into a chainsaw carving that now stands at the employee entrance reminding people to leave their bad attitudes in the parking lot.

Unleash employee (and patient) creativity.

We have seen a variety of creative ways to launch and continue the Pickle

A pickle-shaped chainsaw carving stands at the employee entrance of Midland Memorial Hospital, Midland, Texas.

Challenge, including pickle jar decorating contests, pickle cake baking contests, singing pickles, dancing pickles, pickle statues and even pickle piñatas. The CNO of one of the Indiana University Health System hospitals recently sent me a pickle poem that had been written by a patient. The Pickle Challenge will uncover amazing creative talent, sometimes in the most unexpected places.

Pickles also lend themselves to all sorts of fun food-related activities, including creative cooking contests, pickle eating challenges, trading dill for sweet pickles, celebrating a week (or a month) of being pickle-free and decorating the cafeteria with pickle themes.

And don’t forget to include your patients and their families in the change of culture. Post the Pickle Pledge where patients and their families can see it.

Demonstrate to them that, together, you and they will meet all challenges.

Declare your organization (or workspace) to be a Pickle-Free Zone.

Borrowing a lesson from the movement to eradicate toxic cigarette smoke from public places, people are now declaring their own work areas to continued on page 30 Arkansas Hospitals I Winter 2015

29

be Pickle-Free Zones. The Pickle-Free Zone door hanger that we produce asks people to “leave your gossiping, complaining, criticizing and toxic emotional negativity at the door.”

Nurture and encourage your champions.

It takes courage for someone to step up and be a “spark plug” for positive culture change – especially if that person has not historically been perceived as a positive cheerleader.

One of the most important duties of leadership is to encourage, honor and protect those people who are trying to help foster a better organization by working at becoming better people.

Moments of Truth

On my fourth day at UIHC, the senior resident told me that I would probably need to have part of my colon removed and wear a colostomy bag for as much as a year. I instantly heard the voice of my inner victim whining about the prospect that doing the work I loved, not to mention solo hikes in the Grand Canyon, was about to come to an end. Then I looked over

Do your people own their work, or are they just renting spaces on the organization chart? The truth is, you cannot hold people “accountable” for the things that really matter. Caring, pride, loyalty, fellowship and passion all come from a spirit of partnership that is created by a culture of ownership.

Take the Pickle Challenge … and Challenge Your Co-Workers to Do the Same! A more positive and productive culture will soon follow. Go to http://www. valuescoachinc.com/picklechallenge for details.

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the resident’s shoulder at the Pickle Pledge I’d taped to the wall. It was a mental moment of truth, and I had only seconds to decide which voice was going to win that argument – the victim or the fighter.

Six days later, I walked out of the hospital with an intact colon and a mountain of gratitude for the sophisticated medical treatment and compassionate nursing care I received.

But I am also convinced that the real turning point came when I made the choice to not be a victim of this condition, but rather to do everything in my power to find a constructive alternative to that surgery. Though this can never be proven scientifically, I can feel in my very DNA the way the Pickle Pledge is bolstering my immune system as the fight goes on.

When will the “healthcare crisis” end? You know the answer to that – it won’t. Our jobs today are as easy as they ever will be. Reimbursement levels will never be more generous than they are today. No matter who wins the next election – or the one after that – the challenges will multiply. We can complain about them, or we can focus

on the blessings and create constructive solutions. I invite you to join me in choosing the postitive way forward.

NOTE: 1 Vaughn, T., et al (2014, March/April). Governing Board, C-Suite, and Clinical Manager Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals. Journal of Healthcare Management 59, 110-128.

Joe Tye is CEO and Head Coach of Values Coach Inc., which provides consulting, training and coaching on values-based leadership and cultural transformation. He is the author or coauthor of twelve books, including The Florence Prescription and All Hands on Deck, both of which are about building a culture of ownership. You may reach Joe at Joe@ValuesCoach.com.

Special offer from the author: If you would like a complimentary copy of The Florence Prescription, either email Michelle Arduser (Michelle@ ValuesCoach.com) or call the Values Coach office at 319.624.3889.

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Quality and Patient Safety

Crossing the Road

Arkansas Hospitals Build on Prior Successes to Begin HEN 2.0 The HEN 2.0 project will be the final push to meet the PfP goals of a 40% reduction in preventable hospital-acquired conditions and a 20% reduction in 30-day readmissions by September of 2016. Forty-nine AHA member hospitals have joined HEN 2.0, and will be working directly with AHA quality leaders Pam Brown, Nancy Godsey and Nikki Wallace.

The AHA, along with over 30 other state associations, will again be a part 32

Winter 2015 I Arkansas Hospitals

Quality care champions from hospitals across the state joined the Arkansas Hospital Association’s (AHA) ARbestHealth quality team in a series of four “HEN Huddles” held in the fall to celebrate the state’s achievements during the initial phase of the Hospital Engagement Network project (HEN 1.0) and begin Phase 2 of the Partnership for Patients (PfP) initiative.

of the largest Hospital Engagement Network (HEN) in the nation under the umbrella of the American Hospital Association’s Health Research & Educational Trust (HRET). The AHA also participated in the HRET’s HEN during HEN 1.0.

Thanks to the work and dedication of our hospital quality champions, Arkansas finished 2nd in meeting improvement goals out of the 31 states involved in phase 1 of the HRET HEN.

HEN 2.0 Huddles were held October 27 to November 3 in four different locations in the state – Little Rock, Jonesboro, Fort Smith and Monticello – to kick off participation in Phase 2. Led by the AHA’s quality team, presentations at the HEN Huddles included a look at the successes of HEN 1.0 and a plan for leveraging these successes to reach the goals of HEN 2.0, as well as offering a chance for participants to share ideas and strategies for improving care.

Fort Smith

Jonesboro

Little Rock

Monticello

Arkansas Hospital Association HEN 1.0 Successes • 2,144 adverse events prevented • $10,877,934 saved • Goal met in 9 of 11 topics • Adverse Drug Events related to Warfarin decreased by 47% • CAUTI on tracked units decreased by 71.6% • CLABSI on tracked units decreased by 77% • Early Elective Deliveries reduced by 88.7% • Injuries to neonates reduced by 80.7% • All-cause readmissions reduced by 12.8% • Stage III or greater pressure ulcers reduced by 50.6% • VTE reduced by 80.4%

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the coach’s playbook

The Growing Evidence of Another Dimension to Healthcare Quality

By Kay Kendall As CEO and Principal of BaldrigeCoach, Kay Kendall coaches organizations on their paths to performance excellence using the Malcolm Baldrige National Quality Award criteria as a framework. In each edition of Arkansas Hospitals, Kay offers readers quality improvement tips from her coaching playbook.

It’s impossible to pick up any newspaper or business magazine these days without reading about healthcare, and the stories are rarely positive. However, two recent articles of evidence-based practices gave me hope. Neither article described practices involving sophisticated technology, newly developed medications or costly procedures. Instead, they both focused on the human side of healthcare delivery and its impact on clinical outcomes.

The first article published in the October 9, 2015 issue of Harvard Business Review, “Strong PatientProvider Relationships Drive Healthier Outcomes,” described a twoyear research study conducted

by Erin E. Sullivan and Andy Ellner, MD. They focused on healthcare organizations ranging from individual practices to large healthcare systems that intentionally “prioritize relationships with patients over cost and outcome measures.”

What their study revealed was that not only did these organizations demonstrate benchmark performance in areas such as accessibility, patient satisfaction and engagement, they also achieved notable results in traditional CMS clinical process measures, as well as other indicators such as reduced visits to the ER. The second article published November 1, 2015, in The Boston Globe, “Embracing the Power of Human 34

Winter 2015 I Arkansas Hospitals

Touch,” cited studies in the field of touch research. Among the findings, touch therapy helps premature infants gain weight and develop more quickly.

Consider this finding and its implications for our physicians who face increasing pressure to pack more appointments into every day: “A doctor’s comforting touch left patients with the impression that a visit lasted twice as long.” Another finding we see clearly in the long-term care clients we serve is that touch is key to the quality of life for the elderly residents in nursing homes.

These two articles have really only validated what we have seen working with and observing Baldrige Award winning healthcare organizations. The Baldrige Excellence Framework (formerly the Criteria for Performance Excellence) has always emphasized a balanced approach to managing organizational performance with clinical outcomes, patient satisfaction and loyalty, workforce engagement, leadership and societal responsibility, and financial measures – all required to demonstrate world class performance.

The first Baldrige Award recipient in healthcare in 2002 was SSM Healthcare. Its mission, “Through our exceptional healthcare services, we reveal the healing presence of God,” is supported with the values of compassion, respect, excellence, stewardship and community. However, unlike many organizations where the vision, mission and values are only documents posted in the lobby and laminated on badge tags, in Baldrige Award winning healthcare organizations, we find them to be alive and serving as the underpinnings of a palpable culture of patient-centered relationships.

Another Baldrige Award healthcare recipient in 2012, Southcentral Foundation, was featured in the Harvard Business Review article. Its Nuka System of Care is a relationship-based healthcare delivery system. It is guided by four principles: (1) customers (patients) drive everything; (2) customers must know and trust the healthcare team; (3) customers should face no barriers in seeking care; and

(4) employees and supporting facilities are vital to success.

The article noted that Southcentral “engages all of its 1,700 employees in continuous training in relationship-building skills.” The importance of this is demonstrated by the President/ CEO’s personal role in facilitating the 3-day Core Concepts workshop in which employees learn how to foster relationships with each other and with the customers they serve. It is a required workshop for all employees.

In Baldrige Award healthcare recipients, we see a commitment to relationships that extends beyond its customers. There is a focus on building community health through providing uncompensated care, partnering with local agencies to provide other healthcare services such as dental and mental health, and educating about wellness. For example, North Mississippi Health Services (NMHS), a two-time Baldrige Award recipient (2006 and 2012), operates in one of the most impoverished areas of our country. However, NMHS’s outreach efforts include obesity prevention

services, school healthcare centers that provide nurses to 22 schools in 6 counties, and health fairs that offer free blood pressure screening, flu shots and childhood immunizations.

Hill Country Memorial (HCM) was a 2014 Baldrige Award recipient. This small (86-bed), non-profit community hospital has provided more than $42 million in charity care since 2005. In partnership with the Good Samaritan Center, HCM discounts up to 90% of its fees to meet the needs of patients without health insurance or the means to obtain it. Another 2014 Baldrige Award recipient, St. David’s Healthcare, has provided more than $1 billion of uncompensated care since 2008. It has also provided 81,500 children and adults with preventive and restorative care.

What the Baldrige Award healthcare recipients have demonstrated is that providing world class clinical outcomes isn’t limited to large systems with hefty coffers. They demonstrate what these two articles have shown – relationships are key to delivering sustainable, highquality care across the continuum of healthcare services.

Arkansas Hospitals I Winter 2015

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Winter 2015 I Arkansas Hospitals

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News A group of cybersecurity experts, representing everyone from NASA to academic medicine, recently formed a committee targeting the small but potentially lethal threat in which a hacker takes control of a medical device, an act known by some as “medjacking.” The Cybersecurity Standard for Connected Diabetes Devices steering committee began meeting in July, hoping to determine any possible vulnerabilities in devices and ways to prevent them from being hacked. The initial focus of the committee will be on diabetes-related devices, but committee members eventually hope to spread their knowledge to other parts of medicine.

– Marty Stempniak, in Trustee

The U.S. Occupational Safety and Health Administration (OSHA) recently released its new Field Operations Manual, which contains the field guidance that directs the work of OSHA’s Compliance, Safety & Health Officers, commonly referred to as “OSHA inspectors.” OSHA makes the manual publicly available so that the regulated community can understand the guidelines governing inspectors’ actions at their worksites. The new manual, like its 2011 predecessor, provides enforcement policies and procedures and ensures that federal inspectors uniformly enforce occupational safety and health standards. The new manual increases OSHA’s penalty authority, grants inspectors greater discretion and includes additional revisions.

News STAT A new American Hospital Association guide, “Hospital Approaches to Interrupt the Cycle of Violence,” shows that hospitals and care systems are uniquely positioned to play an integral role in preventing violence in their communities. Evidence shows that hospital-based violence intervention programs reduce violence, save lives and decrease healthcare costs. This guide offers hospital leaders a model for hospital-based violence intervention that can be tailored to each community’s unique needs. Find it at http://www.hpoe.org/resources.

About 36% of the 2.8 million people who made insurance marketplace plan selections in the first five weeks of the third open enrollment period were new customers, the Centers for Medicare & Medicaid Services said in its fifth weekly snapshot of marketplace activity. The snapshot looks at activity on the HealthCare.gov platform, which is used by the federally facilitated marketplaces, state partnership marketplaces and some state-based marketplaces. As of December 5, more than 3.8 million customers had used the marketplace call center, with an average wait time of 6 minutes, 9 seconds. The total number of HealthCare.gov users as of December 5 was 10,823,257 with an additional 263,646 using the marketplace’s Spanish language version, CuidadoDeSalud.gov.

Arkansas Hospitals I Winter 2015

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News

Seeking Balance

Policy perspective

A Medicare Value-Based Purchasing Primer

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Winter 2015 I Arkansas Hospitals

By Paul Cunningham, Executive Vice President, Arkansas Hospital Association Since Congress passed The Patient Protection and Affordable Care Act (ACA) in March 2010, the American healthcare lexicon has been filled with terms that were unfamiliar to most consumers and many providers just five years earlier. We’ve had to get comfortable with the meaning of phrases such as “Accountable Care Organizations,” “Essential Health Benefits” and “Qualified Health Plans.” Yet perhaps the most complex of these new concepts is the Medicare “Value-Based Purchasing” (VBP) program.

Today, anyone involved with healthcare has some familiarity with VBP. But a typical person on the street would come closer to defining how the Internet works, or justifying the mathematical implications of the difference between zero and nothing, than explaining the Medicare VBP program.

While VBP isn’t rocket science, parts of it are complicated, relying on some serious math. So, it’s no surprise that people struggle to understand and see it as something akin to calculating limits using multivariable calculus. Many people would reach their own limits before being able to adequately grasp that particular mathematical concept, wondering out loud, just before their heads explode, “What is it? How does it work? Why is it necessary? Who really cares?” They might ask the same about VBP.

A Little History

Seeds for VBP began sprouting in the mid-1990s, when healthcare costs were skyrocketing. Between 1995 and 2000, the healthcare inflation rate was increasing more than 6.5% per year, on average, more than double the overall inflation rate. Medicare spending was going up even faster. To get a handle on the situation, Congress passed the Balanced Budget Act of 1997, the first $100 billion-plus reduction occurring in Medicare spending. Meanwhile, on the private side, health insurance plans were facing pressure from employers who demanded reductions in premium growth. All sorts of new options for containing costs were being explored.

Concerns about healthcare costs gave way to concerns about healthcare quality in 1999 after the Institute of Medicine (IOM) released its sentinel report, To Err Is Human: Building a Safer Health Care System. The report put the issue of patient safety squarely atop the list of items on the nation’s healthcare agenda. In brief, the report stated that preventable medical errors were at the root of 44,000 to 98,000 preventable deaths each year, and those errors tallied $17 billion to $29 billion in related, but avoidable, costs.

Partially in response to that report, the government made a move to change the game. In 2001, the

Department of Health and Human Services began work on a hospital inpatient quality reporting program, which became part of The Medicare Prescription Drug and Modernization Act of 2003. Under the program, Medicare prospective payment system hospitals were required to report data on ten quality measures related to inpatient care or face a reduction in future Medicare payments. To be paid, hospitals would have to perform! That same year, about 40 private health plans across the country also were experimenting with variations of the pay for performance (P4P) concept.

By 2007, other reportable inpatient quality measures had been added to the Medicare program, outpatient reporting for hospitals had been included, 160 private health plans were digging into individual P4P programs, and Congress was requiring the Centers for Medicare & Medicaid Services (CMS) to submit a plan to implement a hospital VBP program. That plan would eventually be incorporated into the ACA. Meanwhile, the IOM was following up its 1999 work with two new papers published in 2006. Preventing Medication Errors recommended that payers begin to incorporate incentives to ensure that the profitability of hospitals, clinics, pharmacies, insurance companies and manufacturers aligned with patient safety goals; and Rewarding Provider Performance: Aligning Incentives in Medicare linked “the relative value of healthcare services” to “clinical quality, patient-centeredness and efficiency.” It also noted that P4P programs could be used as vehicles to align incentives for performance improvement, but only if clinical information systems in use by hospitals and healthcare providers could be improved to collect data valid for quality assessment purposes.

The stage was set for The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, to promote the adoption and meaningful use of health information technology. HITECH was followed in 2010 by the ACA.

Answering the Questions

What is Value Based Purchasing?

At its core, VBP is simply a carrot and stick approach for holding healthcare providers accountable for both the cost and quality of care they provide. It is aimed at reducing inappropriate care and at both identifying and rewarding best practices and the best-performing providers. Hospitals that do well by meeting certain quality of care and patient safety standards receive incentive payments over and above their Medicare reimbursements. Those that fail lose money.

Why is it necessary?

The easy answer is that VBP offers a way out of a volume-based fee-forservice healthcare system and moves us down the road toward a system based on payment for value. But, the road goes much further. VBP incentives to reduce costs and improve quality are overlain on a healthcare system noted for inefficiencies, variations in cost and quality, and treating illness rather than keeping people well. The theory – and the hope – is that VBP’s focus on quality and outcomes will eventually change the underlying system itself, making it more in tune with keeping people well in the first place. That’s why the public reporting component is so essential.

Many believe that before long, practically all healthcare purchasers will make their choice of providers based on a combination of quality, service and cost, rather than cost alone. So, under this theory, VBP acts as an incentive for healthcare providers to focus on improving and managing population health.

True, if population health is to work, then the people must be engaged. But, those espousing VBP believe the first step forward is to engage providers, and then all else should follow. Rewarding high performing healthcare providers via differential reimbursements is the shiny lure to grab their attention, but the prospect for improved reputations that will come through public reporting will keep them engaged.

As providers focus more on best practices, clinical quality and better continued on page 40 Arkansas Hospitals I Winter 2015

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outcomes, they’ll begin working closer with patients on things like coordination of care and patient interaction with the system. The engaged patients will be more satisfied with their care. The combination of better care and better patient experiences will be reflected in providers’ VBP scores and rankings. Those better rankings will translate to better reputations, raising the potential for increased market share through purchaser, payer and/or consumer selection.

The Chinese proverb tells us, “A journey of a thousand miles begins with a single step.” VBP is that single step.

Whether it’s new construction, refinancings or equipment leasing, contact Paul Phillips at (501) 978-6309 or pphillips@crewsfs.com and let our own team of healthcare professionals prescribe the right capital structure for your organization.

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Winter 2015 I Arkansas Hospitals

Member

How does it work?

VBP is a budget neutral program, meaning that no new Medicare dollars are allocated for incentive payments which serve as the carrot. Hospitals are required to fund their own incentive pool through withholds from every Medicare payment they receive in one year, which are set aside for redistribution the next year. The withhold percentage started at 1% in 2013 and grows incrementally to 2% in 2017 and beyond.

While every U.S. acute care hospital that participates in Medicare’s prospective payment system (PPS) antes up into the incentive pool, they don’t share equally when the incentive payments are doled out. Medicare redistributes the available incentive amount through a complex formula keyed off of hospital performance scores, which ultimately set how much the hospital will gain as a value-based incentive payment, or lose, as the case may be.

That’s the theory behind VBP, but the practice unfolds in a complicated process.

(Here’s where the serious math comes in.) The initial step is for CMS to assess each hospital’s performance, comparing both its achievement and improvement scores for each applicable VBP

If population health is to work, then the people must be engaged. But, those espousing VBP believe the first step forward is to engage providers, and then all else should follow.

measure (for 2016, there will be 24 separate measures, which include things like initial antibiotic selection, heart failure mortality rate and hospital cleanliness/quietness). For each VBP measure, the hospital receives the higher of its improvement score or its achievement score.

Next, the scores are aggregated into specific “domains.” Medicare’s VBP program began with just two domains, clinical process of care and patient experience of care, but new domains covering outcomes and efficiency have since been added. The scores are then multiplied by domainspecific weights (i.e., 20% for clinical process, 30% for patient experience, 30% for outcomes and 20% for efficiency). Adding the weighted domain scores yields the hospital’s total performance score.

Finally, each hospital’s total performance score is converted into a value-based incentive payment adjustment percentage using a complex mathematical formula that ranks all hospitals based on their scores. The higher the ranking, the higher the incentive bonus payment.

However, not every hospital will qualify for an incentive bonus. Ever. Total incentive payments will never exceed the amount in the incentive pool, so

some hospitals suffer financially. This year, 1,714 hospitals received bonus payments in the form of higher Medicare payments due to their VBP scores in 2015. That is 463 more than in 2014.

The posted adjustments ranged between 0.01% and 2.09%, so the payment bumps vary. At the same time, 1,375 hospitals have seen their Medicare payments docked in 2015 between 0.01% and 1.24%, again based on their total performance scores.

Why should we care?

At first glance, you’d think that it’s only healthcare providers who ought to care anything about VBP, but you’d be wrong. There’s a lot at stake for everyone involved in the healthcare system, including providers, insurers, businesses and individuals.

Hospitals already have money on the line and can win or lose financially under VBP. To avoid losses, they must invest in quality management tools and processes to measure and control the care provided to patients, and use them constructively. But it doesn’t stop with hospitals. CMS has now begun a Physician Quality Reporting System that encourages individual professionals and group practices to report information on their quality of care to Medicare with the goal of

helping to ensure patients get the right care at the right time. It will likely morph into full-blown VBP for doctors, and plans are underway for home health VBP, as well.

Major buyers of healthcare services, Medicare, Medicaid and private health plans, should care because VBP offers the opportunity simultaneously to shape the way healthcare is delivered and to improve the quality of care while helping reduce the growth of healthcare costs.

There is already a stated goal for 85% of Medicare fee-for-service payments to switch to value-based purchasing by 2016 and 90% by 2018. Private health plans won’t lag far behind.

And patients, the ultimate consumers of healthcare services, should care because VBP is designed to improve both the appropriateness of their care and the coordination of care they receive from different providers. The end result is they should be more confident in expecting good outcomes. More importantly, patients can expect to be better informed and more actively engaged in order to participate in their care, health and healthcare decision making.

Conclusion

All indications are that VBP is here to stay. It likely will continue to evolve to foster care improvements, especially in relation to care for high-cost, chronically ill patients. However, it is a team effort because no single group alone can make VBP successful.

Hospitals in Arkansas and across America are working to be a part of that effort, taking steps to address issues surrounding the lack of affordable options, inconsistent care quality and poor care coordination. They see the growing body of proof that VBP is the vehicle to get us there and understand that the payment system is on an unalterable track to move toward a system in which payments are earned for integrated patient management, adherence to quality and safety practices, and improved outcomes.

Call it what you want. The end result is that the inner soul of VBP, pay-for-performance, is the healthcare world to come.

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News

Harrison Dean

2015 A. Allen Weintraub Memorial Award Recipient

By Nancy Robertson Cook When Harrison Dean accepted the Weintraub Memorial Award at this year’s Arkansas Hospital Association Annual Meeting Awards Banquet on October 8, he was visibly humbled and profoundly moved. “To be selected for such an award through the nomination of your peers is among the highest forms of recognition and an extreme honor,” he says. “The Weintraub Award is unique in our state. To be named as a recipient, joining well-known hospital executives from throughout the years, is gratifying.”

Harrison Dean’s family was on hand to celebrate his achievement. Pictured from left are daughter Lauren Richmond (Fayetteville); mother-in-law Ada Cook (Rogersville, Alabama); daughter Kelly Dean (North Little Rock); Dean; granddaughter Eleanor Richmond (Fayetteville); wife Janice Dean; daughter Ellen Lazarre (Lincoln, Alabama); and son-in-law Brandon Lazarre (Lincoln, Alabama).

Dean is known for his longtime service at Baptist Health-North Little Rock. His path to the hospital was a straight line resulting from, of all things, attendance of an American College of Healthcare Executives (ACHE) educational event.

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“After earning my master’s in healthcare administration from the University of Mississippi, I accepted a position as assistant administrator of a hospital in Corinth, Mississippi,” he says. “That position helped mold my skills in interacting with others

and taught me valuable lessons in how to communicate with the many audiences we work with in the healthcare field. In my role as assistant administrator, I was attending an ACHE 3-day seminar in Little Rock where I met Don Wallace (from Baptist Health). We struck a cordial relationship, and upon returning home, I sent him my resume.

“Six months later, in the spring of 1983, I interviewed for and accepted the position of vice president of patient services at Baptist Health-North Little Rock (Baptist-NLR); my wife, six-monthold daughter and I made the move to Arkansas. Since then, my family has expanded with the addition of two more daughters. The five of us have always enjoyed living in North Little Rock.”

His new role at Baptist-NLR involved responsibility for all non-nursing areas in the hospital. With the hospital’s administrator, Norman Roberts, away for short periods doing interim hospital missionary work, Dean was often exposed to and carried out the dayto-day duties of managing hospital operations. “These periods allowed me to work with people in all aspects of the hospital, including the physicians and the clinical staff,” he says. “In early 1985, Mr. Roberts accepted an assignment to go to Bangalore, India for several months. As I filled in for him, continued on page 44

• The most challenging thing in healthcare today: It’s the speed at which change is occurring. Economic pressures from federal and state programs undergoing rapid changes, regulatory matters, compliance expectations, the changeover to ICD-10 … the magnitude of all these and other changes is monumental.

• My favorite part of the CEO job: That’s pretty easy. It’s working with people!

• What I’d do if I was not in healthcare: I’d probably focus on people, their development and coaching. And if not that, I’d see whether “This Old House” would let me tag along and help with some of their restorations.

• The best advice I ever received: A college professor in one of my first management classes told me “there are ‘thing’ problems and there are ‘people’ problems. If you solve the ‘people’ problems, usually the ‘thing’ problems resolve themselves.” For me, this has held true more often than not.

CEO Profile:

2015 A. Allen Weintraub Memorial Award Recipient

Harrison Dean

• SOMETHING ABOUT ME THAT WOULD SURPRISE MOST PEOPLE: Many people who know me only in my professional role and the structured world in which I must operate would be surprised at how much of a kidder I can be outside that environment.

• My favorite music: I love the music of the ‘60s and ‘70s.

At times, I will repeat lyrics as “philosophical insights” to my family and my co-workers.

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my exposure to all of our employees and to hospital operations grew. Later in 1985, I was offered the position of senior vice president and administrator at North Little Rock, and I accepted the promotion. The role of senior vice president expanded over the period of 2012 to 2014 to include the four Baptist Health regional hospitals. The expanded responsibilities have enabled me to continue learning new skills, to apply my talents and to share my understanding of healthcare operations which have been developed over several decades.”

The very week Harrison Dean was interviewed for this article, his career continued to evolve as Baptist Health further applied his reservoir of skills, talents and experiences. As of October 19, he had just been appointed to oversee the construction, equipping and start-up of Baptist Health’s newest facility now under development in Conway. Dean will serve in this role through the construction and opening

phases of the hospital, while maintaining his role as Baptist Health’s senior vice president for regional hospitals.

During his time at Baptist-NLR, Dean cited “among the most significant milestones” the hospital’s planning, design, construction and relocation.

Due to the hospital’s new location, its occupancy rate consistently exceeded 90% during the initial twelve month period following its opening. And so, an expansion with more planning and construction oversight began on the heels of the hospital’s relocation. Skills built during these projects will be helpful to Dean in the months to come.

But the “building project” he mentions first among his list of most significant and meaningful accomplishments at Baptist-NLR is focused on his leadership team. “I have been most proud of the leadership group that was assembled and stayed together for 20+ years,” he says. “It has been a group which has worked together very effectively in

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Winter 2015 I Arkansas Hospitals

support of Baptist Health, Baptist HealthNLR and of each other. This has been a great benefit to the patients entrusted to our care, and to the communities which we serve.”

During his career with Baptist Health, Dean has become a Certified Master Coach, work for which he has intense passion. “I became keenly interested in trying to improve my personal leadership effectiveness around several personnel matters in 2010-11,” he says. “While doing that, I was working with our human resource department, sharing my learning around behavioral-based coaching.

Subsequently I was asked to conduct behavioral-based coaching sessions with several leaders within the organization.

I invested time into formal training and am honored to have become a Certified Master Coach. This involved completion of three levels of professional training and certification. As a result, I have been available as a resource to assist leaders within Baptist Health through the use of a formal, structured coaching program for executives.”

With Dean’s move to assume responsibilities at the Conway facility, his coaching role continues.

After the Conway facility opens, he says that combined with his continuing position overseeing Baptist Health’s regional hospitals, he looks forward to the opportunity to do even more executive coaching.

During the week of his transition to the oversight responsibilities at Baptist-Conway, Dean said, “It has been a very special and blessed time for me in North Little Rock for more than 30 years. Now, it’s time for Stephen Webb to utilize his leadership skills at Baptist-NLR, and for me to focus my skills on the new facility at Conway. I will miss my team at North Little Rock but will enjoy being part of our newest facility’s construction and launch.”

And for now, his new office in Little Rock is where his Weintraub Award will reside. It is a reminder of others who have gone before him and of his own dedication to the patients and employees of the Baptist Health system.

News

Hospitals Earn Quality Incentive Bonuses

By Steve Chasteen, MNSc, RN, CPHQ, Director of Practice Transformation, Arkansas Foundation for Medical Care The Arkansas Medicaid Inpatient Quality Incentive (IQI) program offers an exciting chance for Arkansas hospitals to be paid to improve quality of care for Arkansas Medicaid beneficiaries (as well as all Arkansas patients). This quality improvement can contribute to an increase in hospitals’ bottom lines and a heightening of their reputations within the communities they serve.

Arkansas’s acute care hospitals can earn bonus payments if they improve the quality of patient care according to Arkansas Medicaid’s clinical priorities. The IQI program is administered through the Arkansas Department of Human Services Division of Medical Services, which is responsible for the state’s Medicaid program. The program launched in 2007 and will enter its tenth year of operation in 2016.

During state fiscal year 2015, 43 hospitals participated in the incentive program; 39 were prospective payment system hospitals, and four were critical access hospitals. Of the 43 participating

hospitals, 24 received bonus payments totaling $3.7 million. This is an increase over last year’s $2.6 million awarded to 13 hospitals.

The 2015 IQI bonus ceremony was held during the Annual Meeting of the Arkansas Hospital Association at a recognition event occurring October 8, 2015.

Hospitals participating in IQI are required to collect and submit data on all quality measures for which they are eligible to report; data is entered into the Arkansas Medicaid Abstraction and Reporting Tool (AMART) during the third and fourth quarters of the calendar year.

The nationally standardized measures are selected by the

IQI advisory committee, which is comprised of staff members from hospitals, Arkansas Medicaid, the Arkansas Foundation for Medical Care and the Arkansas Hospital Association. The measures submitted to AMART are analyzed, and hospitals receive bonus payments for improving healthcare and patient outcomes based on their performance.

Participation in the IQI program is open to all Arkansas hospitals, but only acute care hospitals are eligible to earn the incentive bonus. The program awards bonus payments of 5.8% of the hospital’s per diem for each Medicaidcontinued on page 46

Recipients of the 2015 Inpatient Quality Incentive program include: Arkansas Methodist Medical Center, Paragould Baptist Health Medical Center – Hot Spring County Baptist Health Medical Center – Little Rock Baptist Health Medical Center – North Little Rock Baptist Health Medical Center – Stuttgart Baxter Regional Medical Center, Mountain Home Chambers Memorial Hospital, Danville CHI St. Vincent Hot Springs Conway Regional Health System Great River Medical Center, Blytheville Jefferson Regional Medical Center, Pine Bluff Johnson Regional Medical Center, Clarksville

Medical Center of South Arkansas, El Dorado Mena Regional Health System Mercy Hospital Fort Smith Mercy Hospital Northwest Arkansas, Rogers National Park Medical Center, Hot Springs North Arkansas Regional Medical Center, Harrison Sparks Regional Medical Center, Fort Smith St. Bernards Medical Center, Jonesboro Unity Health – White County Medical Center, Searcy Wadley Regional Medical Center at Hope Washington Regional Medical Center, Fayetteville White River Medical Center, Batesville

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covered day up to a maximum of $50 per day. Designed as a pay-for-performance tool, the IQI program performance assessment methods include calculating measure rates and performance thresholds, as well as a validation component. All reported measures are subject to data validation, which requires meeting the minimum reliability standard of 80% for data elements.

Individual measure performance is assessed based upon achievement thresholds and improvement thresholds: • The achievement threshold represents the minimum level of performance that must be achieved on an individual measure to earn achievement points. The threshold is set at the top quartile (75th percentile) of all hospitals’ measure data submitted in the previous year.

• The improvement threshold represents the percent reduction in failure rate based on the

hospital’s measure data submitted in the previous year.

Performance thresholds are derived from hospital-reported data that are used to calculate minimum attainment thresholds and benchmarks on individual measures. Performance thresholds for IQI program measures are calculated using the previous year’s Arkansas Medicaid payerreported data. Thresholds are adjusted on a yearly basis to raise performance expectations required to qualify for incentive bonuses.

Currently, hospitals are participating in the performance period of IQI’s program for FY 2016.

To qualify for bonus payments, hospitals must show quality of care improvement in four areas: newborn, obstetrics, tobacco use screening and treatment, and abdomen computerized tomography (CT) scan.

Performance results from the 2015 program year yielded solid

improvements from baseline. Early elective deliveries have declined over 95% since the fall 2009 baseline collections. Exclusive infant breast milk feeding at discharge from the hospital has increased 30% since the initial baseline measurement in 2011.

Cesarean section rates for first-time mothers with low-risk pregnancies have declined 20% statewide.

Since the introduction into the IQI program of the tobacco use screening and treatment measures, the performance results have been notable. Screening of admitted patients for tobacco-product use occurs 99% of the time. A majority of tobaccoproduct-use patients are offered or provided counseling to quit and may access Food and Drug Administrationapproved tobacco cessation medications while in the hospital or at discharge from the hospital.

For more information about the IQI program, contact Steve Chasteen at schasteen@afmc.org, or at 501.212.8737.

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Winter 2015 I Arkansas Hospitals

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News

Presents…

Is Arkansas Ready for Pricing Transparency?

By Troy Brown, Client Services Manager, iVantage Health Analytics The new healthcare is leading consumers to expect unprecedented transparency into the charges and quality of healthcare providers. More and more consumers have high deductible plans that offer incentives and disincentives when choosing providers. As a result, consumers are paying close attention to hospital charges (prices) and surveying the marketplace value proposition when faced with medical decisions.

So called “Narrow Networks” are developing around providers that offer superior service at reduced costs.

Arkansas-based Walmart offers a network of providers for specific highcost interventions such as cardiac surgery and orthopedics where employees are flown to hospitals such as Virginia Mason in the Seattle area.

Recently, it has announced an expansion of this program.

Additionally, Fortune 500 companies are employing new technology such as Castlight Health, which empowers employees to make good healthcare choices at lower costs. The federal government has also mandated the publication of “prices” in hospitals, though this is still being defined.

All of this consumer pressure comes while providers’ payments are being squeezed through tighter regulation and pressures for reduced variation. The bottom line: All of this puts increased pressure on Arkansas hospitals to understand where they stand - their relative cost position, their pricing, and in the end, what they are actually reimbursed for services.

The fifth annual study, “Rural Relevance: From Vulnerability to Value,” which iVantage released earlier this year, looks at the precarious and vulnerable situation many hospitals, particularly rural providers, find themselves in, as well as the value they offer. Our research focused extensively on areas of 48

Winter 2015 I Arkansas Hospitals

We are particularly proud of our work with the Arkansas Hospital Association (AHA) to develop a novel collaboration whereby hospitals may track their actual reimbursements, ultimately the most important metric for hospital viability and pricing transparency. costs and charges as key components of health reform. We believe these areas are even more important as pricing transparency becomes the norm.

Arkansas Costs, Charges and Challenges

Let’s take a closer look at the costs and charges here in Arkansas compared to the national average. Utilizing public data sets, an analysis was done for total and direct costs per case for inpatient DRGs and the top ten DRGs by case volume. Total costs include floor, ancillary, overhead, support and other costs. Direct costs include floor and ancillary costs.

These comparisons will enable providers to better manage charges that are increasingly under scrutiny.

• Arkansas’s average cost and charge rate outperformed the U.S. average for all areas (overall IP, IP cardiology, overall OP and OP imaging).

• Arkansas’s average IP cost rate was beyond one standard deviation from the mean state-level average IP cost rate.

• Arkansas’s average OP cost rate for imaging services was nearly one standard deviation from the mean state-level average OP cost rate for imaging services.

• The NE region of Arkansas has the lowest average OP cost and charge rates for OP imaging services.

Where do you stand?

Consumers expect more transparency from their providers today. In turn, the new standard of transparency provides additional reported metrics consumers use to make care decisions.

• How do your prices (and payments) compare to your peers across the state?

• Are you high in certain outpatient services, like imaging?

Standard Deviations > -2 -1 to -2 0 to -1 0 to +1 +1 to +2 > +2

The average cost rate for inpatient cardiology. Arkansas outperformed the U.S. average.

Standard Deviations > -2 -1 to -2 0 to -1 0 to +1 +1 to +2 > +2

An analysis of the cost rate for outpatient imaging. Arkansas outperformed the U.S. average.

• Are your rates highly variable by payor?

• Are you truly being paid at your contracted rates?

• How do your readmission rates compare to your peers?

• Patients are becoming more sophisticated consumers of healthcare; they also are increasingly directed to narrow networks of providers and incented to do so. Is your hospital positioned to join such a network?

We are particularly proud of our work with the Arkansas Hospital Association to develop a novel collaboration whereby hospitals may track their actual reimbursements, ultimately the most important metric for hospital viability and pricing transparency. Let us know if you wish to join your colleagues already participating in a benchmarking project to compare reimbursements and better negotiate rates.

iVantage Health Analytics is an AHA Services, Inc. endorsed vendor for revenue benchmarking and market data. For information about how you can benchmark your hospital’s cost, efficiency and productivity to be the provider you need to be under the “New Healthcare” described in this article, contact Tina Creel, vice president, AHA Services, Inc., 501.224.7878 or tcreel@arkhospitals.org.

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News

Mega Brain Draws Crowds for Stroke Education

By Lyndsey Dumas, Vice President of Education, Arkansas Hospital Association Arkansas leads the nation in per capita deaths from stroke, and AR SAVES, Arkansas’s statewide telemedicine stroke program, is on a mission to reduce these deaths in our state by ensuring that individuals receive immediate treatment in the event they suffer a stroke.

Know the sudden signs of stroke with

ACT FAST FACE ARM SPEECH

Facial droop or uneven smile

Arm Numbness or Arm Weakness

Slurred speech, difficulty speaking or understanding

TIME

CALL 911

The AR SAVES (Arkansas Stroke Assistance through Virtual Emergency Support) program uses a high-speed video communications system to help provide immediate, life-saving treatments to stroke patients 24 hours a day. The real-time video communication enables a stroke neurologist to evaluate whether emergency room physicians should use a powerful blood-clot dissolving agent within the critical three-hour period following the first signs of stroke.

Part of making sure people get effective treatment is to educate the public about the symptoms of a stroke and the need for immediate medical 50

Winter 2015 I Arkansas Hospitals

intervention. In a world where individuals procrastinate in seeking care when feeling ill, time is of the essence at the onset of a stroke. “For every hour that a stroke goes untreated, the brain ages 3.6 years,” says AR SAVES Health Educator Rick Washam, adding, “32,000 brain cells die per second when blood is cut off from the brain.”

To better engage the public, AR SAVES recently purchased an anatomically correct inflatable model of the human brain branded as the “Mega Brain.” The 18 x 12 foot walkthrough exhibit allows visitors to actually see the effects of a stroke on the brain. Unveiled in July at an event

and get to the hospital immediately

in Mountain Home, the Mega Brain recently made an appearance at Baptist Health Medical Center-Little Rock during its Stroke Symposium held on National Stroke Day, October 29. At the symposium, more than 180 attendees, including visitors from the Arkansas Hospital Association staff, gathered to learn more about strokes and to experience the Mega Brain.

If you look closely at the photo, you will see that the Arkansas Mega Brain has something not all Mega Brains have – AR SAVES requested an Interventional Neuro Radiology addition to the stroke area of the Mega Brain to give onlookers insight into the latest advances in stroke treatment available in the state.

AR SAVES is traveling throughout Arkansas using the Mega Brain to educate Arkansans on the anatomy and functions of the brain, diseases of the brain, trauma and how to protect the brain. Forty-seven hospital and healthcare facilities are part of the AR SAVES telemedicine network in towns and cities statewide.

The program reaches more than 400,000 people at several hundred community events each year.

AR SAVES is a service of the University of Arkansas for Medical Sciences, the Arkansas Department of Human Services and hospitals throughout the state. To help ensure timely treatment of stroke patients, the program links emergency room doctors at participating hospitals to specially trained vascular neurologists via live, two-way video, available 24-hours a day.

Hospitals participating in the AR SAVES Program are equipped with telemedicine technology, training for personnel, support for dedicated telestroke coordinators and ongoing education.

Currently, many of Arkansas’s rural hospitals often forgo administration of a clot busting drug, as they lack the staff resources to accurately identify and manage clot busting drug candidates. AR SAVES has implemented a stroke management system specifically targeting these hospitals by increasing access to subspecialty expertise through telemedicine technology, thereby engineering a coordinated assessment and care-based plan for Arkansas’s stroke patients.

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An Arkansas Family Firm I 40 years of Technical Achievements Arkansas Hospitals I Winter 2015

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News

Workers’ Compensation Update Arkansas Court to Consider Exclusive Remedy Case

By Linda Collins, Chief Operating Officer, Risk Management Resources Division, BancorpSouth Insurance Services, Inc. Nationally, we are starting to see a significant trend of legal challenges to the doctrine of exclusive remedy in workers’ compensation. Often referred to as “the grand bargain,” the exclusive remedy doctrine provides that injured workers receive medical treatment and wage loss benefits in a no-fault system. In return, employers receive exclusive remedy protections so that injured workers cannot sue their employers in civil court. The workers’ compensation system was never intended to provide full compensation for an employee’s injury, and acceptance of that concept is inherent in the nature of the system. The employers’ agreement to make payment for injuries for which they are not legally liable is also a critical component of this system.

There is currently a case pending in the Arkansas court system that seeks to weaken or eliminate exclusive remedy for Arkansas employers. In the case, Hendrix v. Alcoa, the employee’s claim was denied by an administrative law judge at the Arkansas Workers’ Compensation Commission based on 52

Winter 2015 I Arkansas Hospitals

the statute of limitations having already run. The employee died, and thereafter, his heirs filed a lawsuit against his former employer claiming that since it was impossible to obtain a remedy in the workers’ compensation system for asbestos claims, employees similarly situated should be allowed to pursue

liability through the courts instead of through workers’ compensation. This case was filed in the Circuit Court of Saline County.

After hearing the arguments, the circuit court entered an order granting dismissal of the claim. An appeal to the Arkansas Court of Appeals has been filed on behalf of the decedent’s estate, and a request has been made that the matter be considered by the Arkansas Supreme Court as one of first impression.

In response to this potentially farreaching case, there are several entities that have petitioned the court to file an amicus curiae brief (a “friend of the court” brief filed by someone who is not a party to the case but who believes they have a public policy perspective that might be valuable to the court’s deliberations). This case has generated enough statewide interest that there are amicus curiae briefs being filed to argue both sides of this issue.

The significant increase in cases across the country seeking to erode exclusive remedy is a sure sign that the ongoing national debate about the fundamental fairness of the workers’ compensation system will continue for quite some time.

AHA Workers’ Compensation Trust Returns Premiums to Hospitals The AHA Workers’ Compensation Self-Insured Trust Board of Trustees approved at its quarterly meeting in July a $455,797 return of premium for the fund year of 2009. The return of premium was unanimously passed by the Board and will be issued to current Trust members who were also members in 2009.

A percentage of the amount will be returned to members based on each member’s contribution to the surplus of the fund year.

The contribution to the surplus is based on the premium paid and the incurred losses of each member.

Percentages of the Trust’s income returned have averaged 23.92% over the years, while maintaining a healthy fund balance to meet its workers’ compensation obligations. To date, the Trust has returned $8,005,797 to its members.

The Trust is committed to providing a workers’ compensation program of excellence in which its members share the success and profits. As members of the Trust, hospitals benefit as the Trust focuses proactively on controlling losses and maintaining an aggressive workers’ compensation program.

Hospitals interested in participating in the program should contact Tina Creel at 501.224.7878.

We’re building at the center of health

Our Advertisers, Our Friends AHA Services, Inc...............................................18 Arkansas Blood Institute.....................................46 Arkansas Blue Cross Blue Shield...........................2 Arkansas Esoteric Laboratories..............................5 Arkansas Farm Bureau........................................36 Arkansas Foundation for Medical Care.................54 Arkansas Relay...................................................47 Arkansas Spinal Cord Foundation.........................36 Administrative Consultant Services, LLC................9 Baldwin & Shell Contruction Company.................53

BKD, LLP.............................................................31 Central Flying Service..........................................44 Clark Contractors................................................19 Crews & Associates............................................40 EVO Healthcare Environments...............................9 Hagan Newkirk Financial Services, Inc.................51 Harding University...............................................36 Jay S. Stanley & Associates................................51 Nabholz Construction Services............................64 Polk Stanley Wilcox.............................................14

Radiology Associates, P.A...................................31 Ramsey, Krug, Farrell & Lensing...........................27 Rivendell Behavorial Health Services...................14 Southern Paramedic............................................62 State Health Alliance for Records Exchange........63 Strategic Continuity Services...............................31 UALR College of Business...................................22 UAMS.................................................................19 Welch, Couch & Company, PA.............................28 Wieland..............................................................27 Arkansas Hospitals I Winter 2015

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Congratulations!

Arkansas Methodist Medical Center Baptist Health Medical Center – Hot Spring County Baptist Health Medical Center – Little Rock Baptist Health Medical Center – North Little Rock Baptist Health Medical Center – Stuttgart Baxter Regional Medical Center Chambers Memorial Hospital CHI St. Vincent Hot Springs Conway Regional Medical Center Great River Medical Center Jefferson Regional Medical Center Johnson Regional Medical Center Medical Center of South Arkansas Mena Regional Health System Mercy Hospital Fort Smith Mercy Hospital Northwest Arkansas National Park Medical Center North Arkansas Regional Medical Center Sparks Regional Medical Center St. Bernards Medical Center Unity Health – White County Medical Center Wadley Regional Medical Center at Hope Washington Regional Medical Center White River Medical Center

2015 IQI PROGRAM AWARD RECIPIENTS Arkansas Medicaid and AFMC released more than $3.7 million in performance bonus payments to 24 Arkansas hospitals as part of the annual Inpatient Quality Incentive (IQI) program. This year, IQI recognized hospitals that showed improvement in obstetrics and tobacco use screening and treatment. The IQI program has earned national attention for its innovative involvement with the health care community. This program reflects a growing movement toward rewarding hospitals for commitment to quality and providing evidence-based care to their patients.

THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) PURSUANT TO A CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT.

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Annual Meeting

Vision for success Providing resources to help hospitals succeed in a rapidly transforming healthcare world was the focus of the 2015 AHA Annual Meeting. More than 300 attendees heard from experts addressing a variety of topics, including the development of high reliability organizations and motivation of employees through transformational leadership, as well as legislative and policy updates from both Little Rock and Washington D.C. An inspirational presentation from keynote speaker, Ronan Tynan, was a highlight of the meeting.

After overcoming a childhood disability and amputation of both legs at the age of 20, Tynan went on to become a doctor, winner of 18 gold medals as a Paralympic athlete and an international recording star.

In addition to his inspiring message of overcoming obstacles and living life to the fullest, Tynan treated the audience to a singing performance that included a stirring rendition of Leonard Cohen’s “Hallelujah.”

Ronan Tynan

AHA Welcomes New Leaders Members of the Arkansas Hospital Association elected 2015-2016 officers and members of the Board of Directors at the association’s annual business meeting held in conjunction with the AHA Annual Meeting in October.

Directors elected to serve four-year terms include: • David Berry, MS, RPh, FACHE, senior vice president/ COO of Arkansas Children’s Hospital (Little Rock), representing the Metropolitan District; and • Chris B. Barber, FACHE, president/CEO of St. Bernards Healthcare (Jonesboro), representing the Northeast District.

In addition, Vincent Leist, president/CEO of North Arkansas Regional Medical Center (Harrison), was elected to represent the Northwest District through 2018, fulfilling the unexpired term of Kristy Estrem, FACHE.

Newly-elected AHA officers include: • Chairman Walter Johnson, president/CEO of Jefferson Regional Medical Center (Pine Bluff); • Chairman-Elect Darren Caldwell, vice president/ administrator of Unity Health – Harris Medical Center (Newport); • Past Chairman Doug Weeks, FACHE, executive vice president/COO of Baptist Health (Little Rock); and • Treasurer Peggy L. Abbott, president/CEO of Ouachita County Medical Center (Camden).

The members also welcomed Dorothy Berley of Camden, president of the Arkansas Hospital Auxiliary Association, who will serve a one-year term on the AHA board.

The AHA is fortunate to have healthcare leaders throughout the state who are willing to volunteer their time and talents to serve the hospital industry in Arkansas.

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Arkansas Hospital A C.E. Melville Young Administrator of the Year Adam Head (right), FACHE, chief operating officer of Arkansas Heart Hospital, poses with his mentor, Bruce Murphy, M.D., CEO of Arkansas Heart Hospital, after accepting the C.E. Melville Young Administrator of the Year Award for outstanding service to the profession from the Arkansas Health Executives Forum.

Distinguished Service Award Peggy Abbott (left), CEO of Ouachita County Medical Center (OCMC), presented Dr. Lawrence Braden with a Distinguished Service Award for over 30 years of service as a member of the OCMC medical staff and as the Medical Director of OCMC Hospice. Dr. Braden was instrumental in the establishment of The Christian Health Center in 1997 with the purpose of providing primary physical and mental healthcare to the working uninsured, and most recently, in the founding of The HOPE Health Commission which focuses on ways to improve the health of the citizens of Ouachita County and to encourage healthy lifestyles.

Distinguished Service Award Bill Lynch, president (emeritus) of Eagle Bank in Heber Springs, addresses the crowd after receiving a Distinguished Service Award for his service as a charter member of the Cleburne County Hospital Foundation Board and his continuous service on the board since 1993. Lynch was also recognized as an innovator, organizer and supporter of programs to improve the health and wellbeing of the people of Heber Springs and the surrounding community.

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Association Awards ACHE Regents Award John Lieblong (left), vice president of physician services at St. Bernards Healthcare in Jonesboro, received the 2015 Arkansas College of Healthcare Executives (ACHE) Regent’s Early Career Award from Arkansas’s Regent, Brian Barnett, FACHE, assistant vice chancellor, regional programs at UAMS in Little Rock. Donna Harris (not pictured), chief executive officer of HealthSouth Rehabilitation Hospital in Jonesboro, received the Senior Level Healthcare Executive Regent’s Award.

AHAA Administrator of the Year Peggy L. Abbott, president and CEO of Ouachita County Medical Center in Camden, received the Arkansas Hospital Auxiliary Association’s Administrator of the Year Award for hospitals with fewer than 100 beds. Kyle Swift (not pictured), former CEO at the Medical Center of South Arkansas in El Dorado, was named Administrator of the Year for hospitals with 100 beds or more. He currently is the CEO of Woodland Heights Medical Center in Lufkin, Texas.

Passing of the Gavel Douglas Weeks (left), FACHE, executive vice president and COO of Baptist Health, was presented with a special award in appreciation of his service as Chairman of the Arkansas Hospital Association Board of Directors from incoming chairman, Walter E. Johnson, Jr., president and CEO of Jefferson Regional Medical Center.

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Annual Meeting

Scenes from the AHA Trade Show Trade Show Sponsors 2015 AHA Services, Inc. Arkansas Association of Hospital Trustees Arkansas Blood Institute Arkansas Blue Cross and Blue Shield Arkansas Foundation for Medical Care Arkansas Health Executives Forum BancorpSouth Insurance Services, Inc. BKD, LLP Clark Contractors, LLC Correct Care, Inc. EmCare, Inc. Engelkes & Felts, CPAs EXIT Marketing Friday, Eldredge & Clark, LLP Hagan Newkirk Financial Services Merritt Hawkins, An AMN Healthcare Company Nabholz Construction Corporation Provista School & Office Products of Arkansas, Inc. The Estopinal Group Architects Webster University-Little Rock Area

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Trade Show Exhibitors 2015 360 Degree Medicine AAMSCO Identification Products, Inc. Administrative Consultant Services, LLC Advanced ICU Care Advanced Net Providers, Inc. Advanced Ultrasound Electronics AHA Workers’ Compensation SelfInsured Trust ArCom Systems Aris Teleradiology LLC Arkansas Center for Health Improvement Arkansas Trauma Education and Research Foundation ARORA Arthur J. Gallagher & Company Bottom Line Systems, Inc. Cisco-Eagle Commerce Bank, N.A. Community Hospital Corporation CoNexus Solutions, LLC CoreSource Crews & Associates, Inc. Critical Alert Systems Cromwell Architects Engineers, Inc. Curtis Stout A/V DataPath Administrative Services DMI Solutions, Inc. DocuVoice, LLC Dow Building Services Emergency Staffing Solutions Evident Evo Healthcare Environments EZ Way, Inc. Fukuda Denshi USA, Inc.

G & K Services Guldmann Inc. Harding University MBA Program Health eCareers Healthland Heartland Medical Sales and Services Hewlett Packard Enterprise Services/ Arkansas Medicaid Hill-Rom, Inc. Holistic Product Group, LLC HR Pharmaceuticals, Inc. Humanscale Integrated Medical Systems International, Inc. iVantage Health Analytics Jeron Electronic Systems, Inc. JTS Financial Services LaSalle Solutions LearnOnDemand.org LHC Group, Inc. McCarthy Building Companies, Inc. McNeary, Inc. Meadors, Adams & Lee Insurance MediTract Morgan Hunter HealthSearch, Inc. Oxford Immunotec, Inc. Polk Stanley Wilcox Architects Powers of Arkansas PPOplus, LLC, a Stratose Company Press Ganey ProAssurance Corporation Professional Credit Management, Inc. Publishing Concepts, Inc./PCI Revenue Simplified LLC

Roche Diagnostics Rural Health Telecom SHARE/Health Information Exchange Southeast Imaging Southern Paramedic Service St. Bernards Healthcare Associated Regional Providers Stryker Corporation SUNRx TeamHealth TeleHealth Services Tetrasoft Inc. The Austin Company The Medicus Firm The Remi Group The Sessions Group ThyssenKrupp Elevator Americas Tiller-Hewitt HealthCare Strategies Today’s Office Inc. Trammell Piazza Law Firm, PLLC Tri-Tec Medical Inc. UAMS South Central Telehealth Resource Center University of Arkansas at Little Rock MBA Program USDA Rural Development Valley Services, Inc. VSP Vision Service Plan Voice Products, Inc. Wittenberg Delony & Davidson Architects Welch, Couch & Company, PA Xenex Disinfection Services

Educational Exhibitors Arkansas Action Coalition Arkansas Association for Healthcare Engineering Arkansas Chapter of HFMA

Arkansas Department of Human Services, Division of Medical Services Arkansas Gideon Auxiliary Home Care Association of Arkansas

The BridgeWay Hospital UAMS College of Public Health Master of Health Administration Program

Arkansas Hospitals I Winter 2015

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See You Next Year

Arkansas Hospital Association’s 86th Annual Meeting & Trade Show October 5-7, 2016 Little Rock Marriott

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Legislative Advocacy

Patients – Our Moral Purpose

By Jodiane Tritt, Vice President of Government Relations, Arkansas Hospital Association One of my favorite people on the planet and one whom I am honored to call a mentor, Dr. Joe Bates, once gave me advice I will never forget – “Make your career your moral purpose.” It’s something our AHA members do every day. Your careers center on serving our patients, their families and our communities.

Each of our hospitals is important to the Arkansas healthcare system.

When we have an emergency, we just look for that blue “H” sign to find the care we need. Because our hospitals serve people from all walks of life at their most vulnerable times, those who work in our hospitals are often the best ones to speak up for the patient.

And I speak for our hospitals. This is why I often say I have the best job in the world.

Serving as an advocate for our Arkansas hospitals and the patients they serve is my job, but beyond that it is my chosen career, and true to Dr. Bates’s advice, it points directly to my values and purpose.

In debates about reform of our healthcare system, it is sometimes easy to get distracted by discussions of policy, government structure, taxes and state budgets, but it is important to remember that serving patients – our friends, family and fellow Arkansans – must be the ultimate goal.

As the Legislative Task Force continues its deliberations about how best to finance and reform our state Medicaid program, our hospitals are doing a fantastic job of keeping the focus on the individual Arkansans who need care by explaining the importance of hospitals within the healthcare system.

Not only are hospitals the backbone of the healthcare system, they also are large employers and among the strongest contributors to our state’s economy.

When we argue against managed care companies taking over the

Medicaid program, we are serving patients because in other states, managed care companies have ignored the needs of the patient and focused primarily on “saving money” by reducing patient care and creating barriers to appropriate access.

Our hospitals are certainly willing and able to provide care to patients, but we prefer a healthcare system that incentivizes providers to deliver the right care to patients in the right settings at the right times. If other providers are not appropriately reimbursed – both in timeliness of payment and in the payment rate structure – patients suffer because those providers might choose not to see patients who are managed by Medicaid managed care organizations.

When that occurs, the options left for patients are (1) to not get the care that they need or (2) to visit the emergency department, which costs the healthcare

system a fortune when it is used for non-emergent care.

We serve patients by pointing out that Arkansas providers have taken great strides to better coordinate care through the Payment Improvement Initiative and Patient-Centered Medical Homes.

Even though these programs have not been in place for very long, they are provider-led, coordinated care efforts that are already showing cost savings and improving care. No managed care organization can take care of patients better than healthcare providers can.

When we demand that any additional regulations be supported by data showing increased quality of care, we serve patients by ensuring that hospital resources go to patient services rather than to complying with unnecessary, burdensome regulations that do not serve our communities. continued on page 62 Arkansas Hospitals I Winter 2015

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When we support initiatives to protect hospital funding, we serve patients by ensuring that a strong network of hospitals remains available statewide to care for our most vulnerable populations and provide jobs and economic stability to Arkansas communities.

I grew up learning the intricacies of the democratic process in a family that has the utmost respect for the rule of law. Together with my teammates at the AHA, I work with Arkansans from all walks of life and political perspectives to research, explore, debate, and finally, to agree on wording in bills that protect healthcare, hospitals and patients.

We at the AHA consider it an honor to speak for Arkansas hospitals, patients and families. We advocate for you in the legislative world, where small wording choices in the language of our laws matter. We strive for clarity, making certain people know how laws, in concept, will play out for the good or the ill of our healthcare system.

But most of all, we tell the hospital story … and your patients’ stories.

The months ahead will provide many opportunities to continue telling the hospital story. February 1, 2016, is the date that the official general revenue forecast must be presented, with budget hearings beginning on March 8, 2016, and the Fiscal Session starting on April 13, 2016.

While I am fortunate to have found a career with a moral purpose that allows me to highlight the good our hospitals and member institutions do, your AHA advocacy team knows the real heroes are the hospital employees and healthcare professionals who take care of patients every day.

YOUR VOTE COUNTS! One important way supporters and advocates can effectively work for patients and hospitals is to elect officials who are supportive of our hospitals. Primary and general judicial elections are March 1, 2016. Please take the time to learn about candidates for office in your districts. Vote for those who are supportive of your hospitals and your communities. Educate those who are not as knowledgeable as you are about hospital issues. Educate your friends and neighbors, and encourage them to vote!

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Winter 2015 I Arkansas Hospitals

HOSPITAL CHOICE Pricing Model

Offering more flexibility in choosing how to participate in SHARE www.SHAREarkansas.com

Contact SHARE for more information!

Office of Health Information Technology 1501 North University Ave, Ste. 420 Little Rock, AR 72207

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FULL HIE Integration Package

 Minimum Requirement: ADT Feed

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 Minimum Requirement: ADT Feed  Integrated HL-7 and/or CCDs

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Hospitals who agree to send Admission/Discharge/ Transfer (ADT) messages to SHARE.

Arkansas Hospitals I Winter 2015

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Arkansas Hospital Association 419 Natural Resources Drive Little Rock, AR 72205

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