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Kimberly W. Megow, MD, FACHE
CMO
HCA MidAmerica Division
Leawood, Kan.
Q: Tell us about your current position and primary responsibilities at your organization.
I am the division chief medical officer for HCA’s MidAmerica Division. My primary responsibilities include oversight of quality, patient safety, medical staff services, regulatory compliance, risk management and emergency preparedness across the division. This encompasses 16 hospitals and numerous outpatient facilities in the Kansas City area, as well as in the New Orleans/Mississippi area.
Q: What inspired your transition from physician to physician leader?
While in private practice for almost 20 years, I was actively involved in medical staff leadership roles within the hospital in my community. I enjoy the business side of medicine and see it as a way to impact more lives than I could in my solo practice. Moving into a leadership role was a natural progression for me, allowing me to align my skills and interests with my goal of impacting lives.
Q: What is the greatest obstacle to achieving zero harm in healthcare?
The greatest obstacle is the extreme variability that exists in a healthcare system. I'm referring to the variability of patients’ disease processes and socioeconomic statuses, and the variability in processes of care across all of the points of contact in the healthcare system. I'm also referring to the variability in resources and skill sets available at the front lines of care, and to the variability in the practice of medicine, which is both an art and a science. Healthcare is very complex, and the natural variability that exists creates a challenging environment in which reaching zero harm is a difficult but necessary goal.
Q: How is your team working toward improving patient safety?
My team at HCA, both at the division level and at the corporate level, maintains a constant focus on eliminating harm and mitigating risks to our patients. We work hard to maintain a culture of safety, encouraging transparency and reporting potential safety issues without concern for retribution. We are very data-driven and use data to provide solid evidence for decision making. We are also very serious about providing a safe environment for our patients and staff, and we monitor ourselves through our relationship with The Joint Commission, which regularly assesses all of our facilities regarding safety.
Q: What advice would you give to physician leaders seeking to move into higher levels of healthcare management?
First, those physician leaders must have solid clinical backgrounds, with multiple years of experience providing direct patient care. This experience provides the foundation and viewpoint necessary to help lead health care systems. Second, I recommend those interested in advanced leadership roles become involved in medical staff leadership, local and state medical societies, specialty organizations and ACHE. Exposure to leadership through these organizations is critical to development of leadership skills. Last, obtaining advanced education, such as earning an MBA or MHA, is particularly helpful in understanding the world of health care administration and in providing tools for effective leadership.
Q: What role has ACHE played in your leadership professional development?
I was encouraged early in my administrative career to join ACHE, and I have found that helpful for a number of years. I have participated in activities at the local and state levels, and the educational events I have attended have provided solid information that has helped me in my administrative roles. Additionally, the networking afforded by ACHE events has provided a basis for strong professional relationships, which are extremely helpful when I have a question or just want to learn from others.
Clinical Redesign Success Story: Yale New Haven's Approach to High Reliability
By L. Scott Sussman, MD, FACP; Ohm M. Deshpande, MD; Ian Schwartz, MD; and Thomas J. Balcezak, MD, FACHE
Yale New Haven Health began its high reliability journey in 2012. As part of its journey, the organization adopted the generation of value as its overriding strategy to navigate uncertainties in healthcare, and its clinical redesign program has proven extraordinarily successful in implementing sustainable, value-based change.
Since first described in a 2016 issue of ACHE's Chief Executive Officer Newsletter, Yale New Haven's critical redesign program has completed over 170 projects that improved patient outcomes, addressed provider pain points and eliminated wasteful practices. What began with two physicians and two project managers adopting a methodology grounded in meticulously planned rapid cycles, access to data and leadership engagement has matured into the primary process improvement engine for Yale New Haven Health. The program now has seven dedicated project managers and seven physicians, all from diverse specialties, who serve as clinical liaisons for all projects local leads.
Critical redesign is now part of our operational fabric, and its brand is synonymous with high-quality, well-executed and patient-centered solutions that enhance workflows and reduce operational pain points. The critical redesign team, using an impact/feasibility matrix, ranks project ideas submitted by front-line providers and both operational and senior leadership. Once selected, projects are scheduled, a team assembled and the project begins.
Provider Engagement
Physician burnout and engagement are well-documented issues that have many drivers. The critical redesign process addresses those drivers by enhancing physician autonomy, providing control and a forum to voice their concerns, generating meaning in their work and encouraging greater collegiality across the organization. Additionally, each clinical redesign project has local subject matter experts who are sensitive to business operations and benefit from the improvements, thereby enhancing alignment. The critical redesign processes focus on addressing operational pain points has proven so attractive that over 1,000 physicians, advance practice providers, nurses and others have dedicated time to critical redesign projects, even if participation did not result in academic promotion or financial reward.
While critical redesign resources have grown, the need for rigorous and effective process improvement outstrips the organization's bandwidth. To meet that need, critical redesign collaborated with many engaged groups, including trainees, advance practice providers, junior nurse leaders and the patient family advisory council. The goal was to embed the methodology across the health system.
High Reliability
Yale New Haven Health outlined how it began its high reliability journey in 2012 in a 2017 report in Frontiers of Health Services Management. Since the beginning of the journey, the organization has transformed its culture through event reporting, embracing a culture of safety and through a number of other changes. As a result, the system has slashed its annual number of serious safety events by more than 80 percent, despite increasing volume, patient acuity/case mix index, constrained staffing and ongoing programmatic growth. The critical redesign methodology is rooted in high-reliability precepts, including communicating clearly, maintaining an attention to detail, being sensitive to front line operations and deferring to expertise. It is the key vehicle for infusing high reliability across operations.
Clinical Impact
Recent examples of value-generating projects include a fundamental change in pain management practices, resulting in improved patient-reported pain scores and a reduction in opiate utilization. A redesign of flu swab processing resulted in an 80 percent reduction in turnaround time, which in turn has enhanced ED throughput and reduced nosocomial infections, while eliminating 10,000 patients subject to contact precautions. Many other projects have resulted in permanent reductions in length of stay, minimized pain points and reduced waste.
On a larger scale, critical redesign created a capacity coordination center that co-locates critical operational services, providing greater human coordination and displaying meaningful operational data in real time. The CCC dramatically enhanced management of our constrained bed capacity while avoiding operational breakdowns.
Financial Impact
From its inception, critical redesign's success has been measured in expense reduction, enhancement of clinical outcomes and elimination of operational pain points. The use of rigorous financial metrics forged critical redesign's credibility with clinicians and administrators alike. As a result, $50 million in sustained, recurring savings within the first two years has been achieved. As we expanded and multiple projects affected the same patients, we transitioned to a CMI-adjusted cost-per-case reporting structure. Based upon that methodology, critical redesign activities continued to bend the cost curve, allowing us to reduce further the Yale New Haven Health’s CMI-adjusted cost-per-inpatient discharge by $111, which resulted in $14.2 million in incremental and sustained annual savings.
Many organizations focus on enhancing value, but critical redesign's combination of rigorous process improvement, robust analytics, dedication to provider engagement and a foundation in high reliability makes Yale New Haven Health’s approach unique. High reliability and clinical redesign has revolutionized the organization's approach to generating value for patients, and it continues to expand the initiative across the organization.
L. Scott Sussman, MD, FACP, is senior medical director, clinical operations; Ohm M. Deshpande, MD, is executive director, clinical operations; Ian Schwartz, MD, is vice president, clinical operations; and Thomas J. Balcezak, MD, FACHE, is CMO, all at Yale New Haven (Conn.) Health.
NEWS BRIEFS & RESOURCES
2019 Congress on Healthcare Leadership | March 4–7, 2019
Each year, the Congress on Healthcare Leadership attracts the best and brightest healthcare leaders. Join executives from a variety of healthcare settings, March 4–7, 2019, at the Hilton Chicago/Palmer House Hilton.
The Physician Executive Forum Session: “The Future of Physician Leadership,” Wednesday, March 7, from 8:45 to 10:15 a.m. is a cannot-miss educational session where attendees will identify the strategies and skills needed to be an effective physician leader. This panel discussion, moderated by Carson F. Dye, FACHE, president and CEO, Exceptional Leadership LLC, Toledo, Ohio, will cover challenges and solutions to overcoming barriers as a physician executive.
Find your inspiration at Congress.
Register now.
ASA/ACHE Podcast on Establishing a Patient Safety Culture
The American Association of Anesthesiologists and ACHE have developed a podcast discussing leadership’s role in establishing a patient safety culture that extends beyond a grassroots conversation. Adoption of high reliability safety by senior leadership and board members is an absolute requirement for success. A patient safety culture must be clearly supported as a key mission by the governing board. The 25-minute Q&A-format discussion provides perspectives from clinical and administrative viewpoints.
For more information and resources on building a culture of safety, visit our safety learning portal.
Your Partner for Physician Leadership Development
Our physician leader portal is dedicated to addressing the interests and needs of physician executives. The site offers a wealth of resources about ACHE education and membership, as well as books, career development tools and so much more.
Save Time and Money With ACHE’s Self-Study Program
Earn six ACHE Qualified Education credits by completing a course through the ACHE Self-Study Program. Self-study courses are portable and ready for you anytime—at home, in the office and beyond. Topics include finance, human resources, leadership and management. Take advantage of ACHE’s special offer: Purchase one self-study course and receive a second course for a 50 percent off. Review a list of available courses and corresponding Health Administration Press books and place an order here.
Connect With Forum Members
Looking to connect with your Forum colleagues? You can locate them at the ACHE Member Directory. Scroll down to the "CEO Circle/Forums" drop-down menu in the directory, select "Physician Executives Forum" and look for the "PE" icon beside their names.
Liz Catalano
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American College of Healthcare Executives
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Chicago, IL 60606
(312) 424-9374
ecatalano@ache.org
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Please note that any views or opinions presented in this online newsletter are solely those of the author and do not necessarily represent those of ACHE.