Key strategies to address organizational disruption: 10 executives weigh in

Hospital and health system leaders must continually adapt to organizational change — from EHR rollouts and new patient care technology to significant cost cuts and challenging reimbursement policies. To maintain a positive culture and ensure buy-in from staff during operational transitions, healthcare executives can employ various strategies for managing disruption in their organizations.

This content is sponsored by North American Partners in Anesthesia.

Peter Doerner, executive vice president and chief development officer for NAPA, the nation's leading single-specialty perioperative and anesthesia management company, joined 23 healthcare leaders during an executive roundtable at Becker's Hospital Review 7th Annual CEO + CFO Roundtable in Chicago Nov. 14. (Note: Ten of the 23 participants are quoted in the following article.)

The executives in attendance discussed tactics they employ to address current healthcare market trends affecting their operations, how they encourage their teams to embrace organizational disruption, and using data to drive performance.

Addressing disruptive trends in the healthcare space
Hospitals and health system leaders are challenged to develop strategies and tactics to adapt to disruptive market trends that affect daily operations. When executives discussed organizational disruption, they cited Medicare reimbursement policies, necessary cost cuts and new care delivery methods as some of the most important trends.

"As the healthcare market changes, hospitals and health systems are seeing a need to do a whole lot more with less," Mr. Doerner said. "There's also a lack of clarity around healthcare policymaking, and the way national and local political winds shift, affects hospital policies, especially those involving Medicare and Medicaid."

As CMS regulatory changes cut payments from the government to hospitals, leaders must prioritize solutions that ensure they're proactively collecting as many dollars as possible.

A board member of a five-hospital system in the Midwest said a cost reduction program is helping the organization prepare for cost cuts and new reimbursement policies as the system adjusts to leadership changes.

"Looking at the possibility of lower Medicare reimbursement, we implemented a cost reduction program that is helping us squeeze money out to make up a $40 million gap, which is especially challenging as we transition to a new CEO," the board member said.

Adding to the discussion on recovering revenue, the senior vice president of a Northeastern health system that employs more than 19,000 said it is critical to encourage staff to seek savings in unexpected places.

"My favorite story about encouraging staff to speak up involves one of our food service employees, who asked why there was so much uneaten food in one of our hospitals," said the SVP. Armed with this observation, the employee discovered a food waste problem in the hospital after noticing staff frequently brought uneaten trays of food back to the kitchen. Hospital leaders then realized they could potentially save thousands of dollars by developing a food waste reduction plan, the executive explained.

"What if 19,000 employees each identified places where we could save $10,000?" she asked. "Since we're focusing on reducing expenses, we need to deploy our employees as problem-solvers in every area of our facilities."

Another executive discussed how hospitals must continue innovating to keep revenues up as healthcare shifts toward seeing patients as consumers. "When you think about revenue sources at hospitals, clinical revenue isn't going up," said the CEO of a 14-hospital system in the Northeast. "With that in mind, our issue now is how to best diversify our portfolio. We've done that with innovation technology and philanthropy efforts, but to succeed as hospital leaders in this market, we have to stop thinking of ourselves as hospital companies and start thinking of ourselves as consumer health entities."

The CEO of the children's service line in a Midwestern health system reinforced this idea by discussing several ways her system is adjusting to new care delivery methods. "We're shifting focus away from a purely hospital-centric model and focusing more on how we care for patients after they leave the hospital, which includes home checks, home palliative care and using devices like iPads to consult with patients," she said.

"If we can decentralize the care we provide, it will increase our market share while making treatment more appropriate and more convenient for patients — when they're getting care at home, they'll have a better experience."

Related to care provided outside the walls of a hospital, the CEO of an academic health system in the Southeast thinks CMS will soon fully reimburse hospitals for telemedicine consultations. "Our system, which reaches rural communities, has been investing in a telemedicine portfolio," she said. "Over 15 to 20 years, we've saved about 18 million miles of travel since we placed telemedicine services, most commonly behavioral healthcare, into these communities. Telemedicine allows us to extend our tentacles without needing brick and mortar, and we're bringing our care further into the marketplace," she said.

Encouraging teams to embrace organizational change
Hospital leaders may face pushback from teams who are reluctant to embrace disruption in their workflow. To promote a positive culture during organizational changes, hospital leaders can focus on engaging employees by staying transparent with them about system changes and offering education and training courses.

"The best way our organization prepared staff for organizational changes was requiring everyone to go through training modules," said the senior vice president for human resources at a 14-hospital system in the Midwest. The executive highlighted the system's EHR rollout to illustrate how critical it is to ensure employees are educated during major operational transitions.

It's also worth noting that educational efforts do not always have a clear beginning and end, as his observation illustrates. "Even after our organization's Epic EHR implementation, our operations leaders are requesting additional education," he said. "It's important to make sure leaders are equipped to deal with employees as the realities of transitions come into play and questions arise."

During large system changes like EHR rollouts, it is critical to maintain transparency with all involved stakeholders, said the president and CEO of a $1 billion Midwestern hospital system.

"Our teams have gotten so good at process and change because we engage everyone equally from the ground up in anything we do," she said. "We make sure everyone understands where we're going and how to get there. If everyone is aligned, your employees will be set to succeed."

When implementing a new organizational strategy, frequent meetings are an effective way to accentuate what each employee contributes to a system's larger organizational strategy in their daily work, said the president of a hospital group in the South.

"We use these meetings as a way for staff to see the effect they have on our larger organizational strategy," she said. "We may be able to see our strategies clearly at the executive level, but we need to understand how these strategies are playing out at the unit level. Without these meetings, finding out what's happening in the respiratory unit on a Saturday night shift would be much more difficult."

Using data to drive organizational performance
Although many hospital leaders are eager to make data-driven improvements at their facilities, translating large amounts of data into meaningful and useful information is no easy task, Mr. Doerner said. During the discussion, several executives shared examples of how they are bridging data divides to drive superior performance.

"Our system is so data heavy, we had to ask ourselves, are we really using this data?" said the CEO for the children's service line at the Midwestern health system. "To address this issue, we make an effort to put ourselves in our patients' shoes and ask what's important for them to know."

To do this, the system's executives asked physician leaders what would be important for patients to know and what a patient's perspective on quality outcomes might be.

"A patient might see outcomes very differently than we do, so we're continuing to have data reviews to be more focused on our patients and how we can use data to drive a positive care experience," the CEO said.

The vice president of finance operations at a seven-hospital system in the Midwest said her organization saw success by involving physician leaders in conversations about patient data points and trends right away. "Every week we have a key group of leaders from our hospitals meet to look at a set of data together. It's important to make sure the physician leaders understand and trust the data points before they're put to use," she said.

Another executive pointed out the importance of having physician leaders who have management and finance skills, which inform their observations about where data use can be improved.

"For most healthcare organizations, it is important for leaders to make sure their physicians are finance and management savvy so you can bring them into solving problems around data you may not understand as an executive," said the CMO of a five-hospital system based in the Southeast. "Physician leaders can uncover a lot of inefficiencies in your system that involve physician behavior."

When looking at patient data in a large health system, it is important for executives to recognize that the various markets in which they operate may have different types of consumers with distinct needs, said the senior vice president of the Northeastern health system with over 19,000 employees.

"We interviewed patients who chose our health system and didn't choose our health system, and we found each of our communities have very different needs and reasons for coming to us for care," she said. "Based on this information, we built an urgent care center where it was needed most. Our projects would have been misguided if we didn't understand our consumers and their preferences."

In conclusion
Hospital leaders are working to manage revenue and keep patients and staff satisfied while facing numerous operational and fiscal challenges, including lower Medicare reimbursement, new technology rollouts and an increased emphasis on seeing patients as consumers.

In this environment, hospital and health system executives need to devise strategies that address organizational success at every level. This not only includes efforts to better engage employees and harness their expertise to find inefficiencies in the system, but also involves gathering patient feedback and using the data that's most critical to their care to drive decision-making.

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