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PRESIDENT’S CORNER
Deborah J. Bowen, FACHE, CAE
President and CEO
ACHE
Colleagues,
In recent days we have been privy to rare sights: vacant subway stations, quiet shopping centers, deserted downtowns. Never in our history has such emptiness been so concerning.
During this time, your vigilance is not unnoticed. Indeed, some of the most meaningful actions of the COVID-19 episode are happening beyond public view. Behind the scenes there are thousands of healthcare industry leaders working to tame the crisis with adherence to well-composed plans, a commitment to caring, and an eye to fluid federal and state instructions.
The very core of ACHE—leaders working together to advance health—is on full display during this unprecedented period. We’re receiving reports that our members are tapping their invaluable professional network, connecting with each other to compare best practices, share access to resources, and sometimes just to talk. You are experiencing first-hand the value of our professional community, doing the industry proud while bringing credit to your respective healthcare institutions and our association.
The healthcare system of this country is being tested. Our success will correlate directly with our ability and tendency to surmount barriers collectively, drawing on each other’s skills and experience.
I’m so proud of the work you are doing for patients, for our profession and for our field. Your passion to do what’s right for your communities reflects what’s best about our amazing association.
Now is not the time to celebrate, but I am certain that moment is drawing closer every day. Until then, we live in admiration of our healthcare industry leaders and pray for their well-being and victory over this viral threat. Thank you.
Despina D. Dalton, MD, RPh, FACHE, FAAP
Vice President, Medical Affairs/CMO/Physician Advisor
WellStar Douglas Hospital
Douglasville, Ga.
Q: Briefly describe your current role and professional responsibilities.
A: I work closely with the president of the medical staff and the medical staff office to act as the liaison between the clinicians and administrators for the hospital. I review credentialing of the medical staff, policies and procedures, and new initiatives that pertain to the clinicians. I am involved in all activities related to our quality metrics and patient/staff safety initiatives. As a physician advisor, I work to improve documentation, determine appropriate admission status, review denials and expedite the peer-to-peer process, acting as a liaison between the physicians and insurance payers.
Q. What is one of the biggest lessons you’ve learned about improving care coordination, specifically related to clinicians and pharmacy services?
A: Having experience as a pharmacist prior to attending medical school certainly made my medical education easier. My background also allowed me to see a different perspective related to medication dosing, medication errors, medical appropriateness, cost savings for the patient and the insurance companies, as well as the patient perspective with regards to expense, compliance and side effects or adverse reactions. My pharmacy education has been invaluable even to this day as we try to reduce admissions and readmissions due to prescription issues that affect our patients every day. One example, I helped create a Meds to Beds Program to help patients with the cost of their medications.
Q: Where in the care coordination process do you see breakdowns in communication happen most often? How do you inspire teams to work together to address those issues?
A: The gaps I see in communication in healthcare involve everyone. I believe we need to be better about adopting a culture of open communication. In the past, communication was very siloed or unclear. We have come a long way in the past two decades with communicating between the various levels of healthcare professionals, but we still have a long way to go.
Discussions must be patient-centered, not role-specific. Pharmacists must be able to communicate an error to a physician. A physician must be able to approach a nurse with concerns. A care coordinator must be able to communicate to a physician about patient needs. They are all interconnected with the responsibility of caring for the life and well-being of patients. Barriers to communication must be removed to prevent poor outcomes. Staff shift changes should include better hand-offs. Nonpunitive corrections should be encouraged within the process. I encourage face-to-face discussions whenever possible. No one should be afraid to speak up as a patient advocate. We are all on the same team.
Q: As a physician executive, what are some skills you needed to build to bridge the gap between clinical and administrative roles?
A: The physician executive is a relatively new role. Physicians need to learn "C-suite speak" to build credibility. Physicians had been taught that they had to care for the patient regardless of cost. Now, we must focus of cost-effective, right-sized, appropriate care for each patient as an individual. After all, there is financial responsibility involved in the care of patients. I am a pediatric emergency physician by training and had heard many times over how medications were too expensive. I had to adjust my practice to make sure patients were going to be able to be compliant with their treatment regimen. As a vice president of medical affairs, I learned the principles of medication adherence and cost at a grander scale. I feel my role helps remove barriers and create better workflows at all levels of the healthcare continuum to meet the needs of the patient, as well as for the physician and nursing staff.
Q: What role has ACHE played in your professional development?
A: I love the support I have received from my fellow members. I enjoy hearing about the journey each of us has gone through to get to the point of being a healthcare executive. Everyone has a different story and they each bring a different perspective to the table during discussions. The courses offered are valuable in learning new skills. The local Georgia Association of Healthcare Executives lunches are a great way to connect and reconnect with other healthcare executives. Going through the FACHE® process was educational as well. I thought the process was going to be very difficult or time-consuming, but it turned out to be a great way to strengthen my knowledge base and explore all the areas healthcare executives have an impact, including business, operations, leadership and patient care.
Improving Diagnostic Safety: Five Areas of Focus
By Doug Salvador, MD
Diagnostic error is a leading cause of patient harm in our healthcare system. Additionally, delayed and missed diagnoses represent the most frequent, harmful and costly type of malpractice closed claims. In fact, the National Academy of Sciences, Engineering, and Medicine concluded in their 2015 report Improving Diagnosis in Healthcare that most Americans would experience at least one diagnostic error in their lifetimes, sometimes with devastating consequences.
The healthcare field is taking note of this reality and all physician leaders should work to embed diagnostic safety into their organization’s patient safety programs. However, it is not always immediately apparent how best to effectively proceed. There appear to be some high-value targets to address such as closing the communication loop on incidental radiology findings to avoid delayed diagnosis of lung cancer or closing the loop on specialty referrals in outpatient care to ensure a patient sees the subspecialist who can identify the cause of a confusing set of symptoms.
Successfully reducing harm will require leaders to address both the cognitive and systems contributors to delayed and missed diagnosis. Clinicians, academicians, informaticists, administrators and patients will have to collaborate to build robust diagnostic processes in all settings. In 2018, the Healthcare Research and Education Trust published the Improving Diagnosis in Medicine Change Package, which provides a roadmap with dozens of change ideas for healthcare leaders looking to get started.
Here, we will explore five primary drivers for improvement.
Effective Teamwork
Effective diagnostic teams work together to arrive at the best explanation for a patient’s symptoms. It’s crucial that these teams acknowledge the roles of and include patients, families/caregivers, nurses, physicians, advanced practice professionals and allied health professionals. Team leaders are tasked with creating an environment of psychological safety where everyone is comfortable contributing to or questioning the working diagnosis.
Reliable Diagnostic Process
Established quality improvement methods should be used to ensure standardized diagnostic processes where evidence exists to support specific diagnostic testing pathways. Examples include the diagnosis of sepsis in the ED or a standard testing algorithm for the investigation of solitary pulmonary nodules. Technology and processes should help ensure key communication loops around laboratory and radiology test results and specialty referrals are closed.
Engaged Patients and Family Members
Including patients and family members on the diagnostic team is so important. These teams emphasize great interpersonal communication and use available tools to make decisions. For example, use the teach-back method with patients and families around communication of the diagnosis at the end of encounters or train physicians on active listening and empathy skills. Teach patients about the diagnostic process and ask them to come prepared to explain fully about their symptoms and history.
Optimized Cognitive Performance
Provide effective clinical decision support for diagnosis. This will increasingly involve machine learning algorithms and EHR alerts based on coded or natural language information. Consider providing a differential diagnosis generator to your diagnostic teams. Incorporate clinical reasoning education and practice into the development of your physicians and advanced practice providers. There should be robust offerings in undergraduate, graduate and continuing medical education related to tools that optimize cognitive performance. Identify clinical reasoning experts in your organization and provide them the time to work with colleagues to improve these skills.
Robust Learning Systems
Use your existing incident reporting and patient safety systems to identify diagnostic errors in your organization. Perform root cause analyses on these errors and prioritize continuous improvement resources and time to implement solutions. Identify or grow patient safety or risk management professionals to be a local expert in diagnostic error. If possible, automate providing feedback on local diagnostic errors to providers working in your system.
Doug Salvador, MD, is senior vice president and chief quality officer at Baystate Health and associate professor of medicine at University of Massachusetts Medical School—Baystate in Springfield. (doug.salvadorMD@baystatehealth.org)
New Immersive Physician Leader Training
The new Physician Executive Program is the premier, collaborative learning experience for current physician administrative leaders. During three in-person sessions and in-between virtual learning opportunities, participants will engage with more than 20 thought leaders, visit organizations that are leading the way and develop lasting connections with administrative and clinical peers from across the country.
Designed for current clinical leaders in administrative role(s) or physicians who will be transitioning to an administrative role in the next six months, this program will help you translate your clinical expertise to administrative leadership.
Each in-person session includes interactive working sessions, panel discussions and site visits to healthcare organizations. Here are some of the things you will learn during each session:
Session 1: Chicago, June 15–17
- Site Visit: American Hospital Association, Rush University Medical Center and MATTER Chicago.
- Analyze your personal leadership and communication styles.
- Explore the basics of working with boards of directors and committees.
- Examine the art and science of strategic planning.
Session 2: San Diego, Aug. 10–12
- Site Visit: San Diego County Health and Human Services Agency
- Identify skills needed for tackling difficult conversations and negotiations.
- Discover the critical role clinical leaders play in establishing relationships with internal and external innovation centers.
Session 3: Orlando, Oct. 19–21
- Site Visit: VHA SimLEARN National Simulation Center, Nemours Children’s Hospital and Johnson & Johnson Human Performance Institute
- Hear from a panel of physicians and the different career journeys that lead them to their administrative roles.
- Examine merger considerations with free-standing community hospitals.
Additionally, ACHE is accredited to provide continuing medical education (CME) to physician leaders for completing the Physician Executive Program. Participants can receive a maximum of 50.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Join us today for this premier physician leader training opportunity.
Take the Pledge to Lead for Safety
Leading for safety is an ongoing effort that requires perseverance and dedication. Leaders who are committed to creating a culture of safety do so with intent. They set the purpose and direction within their organizations—they lead for zero harm. Committed leaders do not allow for delays or excuses.
Learn more about establishing a compelling vision for safety by downloading Leading a Culture of Safety: A Blueprint for Success, a resource jointly developed by ACHE and the IHI Lucian Leape Institute. Take the pledge to lead for safety, and you will join a community of healthcare leaders who are committed to lead with intent and prevent unnecessary harm. Access more resources to support your journey to zero harm at ache.org/Safety.
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.
STAFF CONTACTS |
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Anita J. Halvorsen, FACHE |
Shannon N. Barnet |
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Encourage your fellow ACHE physician executive colleagues to join the Physician Executives Forum by sharing this link to the Physician Executives Forum area of ache.org where they can apply immediately and conveniently.
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.