For nearly five decades, Susan Constantino has been a tireless advocate for people with disabilities as they fight for their rights to basic needs. And
she’s not done yet.
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“Living alone has been a great experience. It’s an exciting journey seeing my life unfold ahead of me. It’s just amazing.”
Marie Troncoso, resident of Cerebral Palsy Associations of New York State
Enhancing the Human Touch
It’s perhaps no more important for technology and people to work together harmoniously than in healthcare. Discover how these executives leveraged technology to drive improvements to care while always keeping in mind their organizations’ most important people: the patients they serve.
Pulse
Brenton McKinney forged strategic partnerships with key vendors to bring Medecision’s information security to a whole new level of safety.
55
After getting exposed to the complexities of the healthcare industry from an early age, Novartis’s Maureen Ruane has found the key to success at work and at home is balance.
16
The secret ingredient to the New Orleans Saints’ success? Jamie Meeks’s dietary regimen that helps keep players at peak performance for every game.
Over the course of her career, Nikki Sumpter has relentlessly pursued opportunities for personal and professional growth on her way to Atlantic Health System.
Kimberly Lounds Foster’s intentional approach to diversity and inclusion has driven innovation and positive business results at Celgene.
Grant Tarling tackles the unique challenge of helping to administer healthcare in international waters for Holland America Group and Carnival Cruise Line. 24
76
Cass Davis (McKinney), Dave Martin (Sumpter)
Impact Prognosis
Christine Zettlemoyer has made a career out of revitalizing compliance programs and aligning them with a business’s goals, including at CSL Behring.
170
Stephanie Browne is leveraging technology and data analytics to take bias out of the recruiting process at Blue Cross Blue Shield of Massachusetts.
136
Dr. Cole Edmonson has helped essentially eliminate nurse manager turnover after implementing an innovative new approach to talent management at Texas Health Presbyterian Hospital Dallas.
174
Chris Simchick and Scott Barnyak are working to bring together data from healthcare payers and providers at SDLC Partners to streamline data collection and jumpstart innovation in the healthcare industry.
142
AmeriGas’s Andy Rosa understands from family experience that improving access to healthcare is the first step toward improving outcomes for employees.
While working as an oncologist, Jose Barreau realized the way physicians communicated with one another needed to change. So, he cofounded Doc Halo.
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Like most people, I narrowed my search based on budget, location, and the amenities I was looking for in a building. I don’t consider myself too picky, but there is one thing that is non-negotiable: my building needs to be wheelchair accessible. Born with spina bifida, I use a wheelchair to get around the city and complete my day-to-day activities.
After a few weeks of searching, I had managed to schedule four apartment showings for a Saturday afternoon. I went in thinking I was about to find my new home. I did not.
When I arrived at the first building, I shook hands with the realtor and thanked her for showing me around. However, as we turned to go into the building, we stopped. Three steps led up to the front door, immediately eliminating my chances of living in this building. “I’m so sorry; I completely forgot those were there,” the realtor said. Frustrated but still hopeful, I left that property and moved on to the next one.
However, the other three listings also had accessibility issues, and my day, which had started with anticipation, was ending with disappointment. But my struggle to find an apartment is not unique. Every day, millions of Americans with disabilities must adapt to live in a world that is not built for them.
From a lack of accessible housing and public transportation to difficulty getting critical medical care, people with disabilities and their advocates are fighting for change and working to address the inequalities that people with disabilities still face. One of those advocates is Susan Constantino, president and CEO of Cerebral Palsy Associations of New York State (CP of NYS) and American Healthcare Leader’s cover story this issue.
For nearly fifty years, Constantino has been a staunch advocate for disability rights. From her time as a special education teacher in Buffalo, New York, where she spearheaded a revolutionary program for students with disabilities called “Special Friends and Computers” to her current work with CP of NYS, she has pushed to get individuals with disabilities access to affordable and accessible housing, physicians who have the experience necessary to provide them with proper medical care, and transportation throughout New York.
Constantino, like so many leaders featured in this issue, believe that an individual’s quality of life shouldn’t be determined by their circumstances—whether it’s someone’s abilities, socioeconomic status, or race. It’s encouraging to know that people like Constantino are out there fighting for equality, and I’m hopeful that advocates like her will help build a future where everyone may thrive.
Joe Dixon Editor
The Lifeblood of Today’s Industry
McKinney VP of Security Medecision
Brenton
Protecting the Health of Population Health Data
By
How Brenton McKinney is guiding Medecision toward the highest possible cybersecurity standards
Jeff Silver | Photos by Cass Davis
AS A LEADING PROVIDER of population health management technology and services, Medecision maintains and manages data for roughly fifty million lives. Protecting the confidentiality, integrity, and availability of those healthcare records falls to Brenton McKinney, the organization’s vice president of security.
McKinney joined the company to help take Medecision’s security to the next level by pursuing a HITRUST certification.
“The HITRUST certification is comprehensive and specific to the healthcare industry. Depending on the scope, it can range from several hundred to a thousand security controls that have to be met,” McKinney says. “That meant we had to do more than write policies and procedures. We needed to properly implement processes and technologies, measure their effectiveness against the standards, and then make continuous improvements.”
One of the first steps toward those objectives was undertaking a risk-based assessment of the current security state. Understanding the business model, customers’ security requirements, and interpreting HITRUST compliance requirements was imperative to qualifying and quantifying the risk. For example, Medecision needed to recognize that while it has its own third-party vendors, it also acts as a third-party vendor to its clients. McKinney then overlaid the company’s processes, technology, and personnel resources and capabilities. Finally, everything was evaluated against a variety of ever-changing threats that have a likelihood of exploiting vulnerabilities across the enterprise.
All of these efforts resulted in a practical road map that defines how security enables the business to operate in a secure manner without hindering business goals and objectives. For deployment and management, Medecision ultimately decided to develop third-party partnerships rather than create an in-house security team. Typically, service partners are capable of providing greater depth, retention of highly skilled security professionals, and economies of scale to reduce costs, McKinney says.
“Partnering with the right providers offers us flexibility and scale,” McKinney says. “They can respond more quickly to threats and can provide a much broader view of risks and best practices as a result of working with other clients across other critical infrastructure sectors.”
Medecision partnered with Rackspace, a cloud service provider that focuses on infrastructure, networks, and platforms, as well as Armor, which monitors hundreds of devices for the company. Armor also provides alerting and incident response in the event of an attack.
“Between compliance mandates, cyberattacks, and the explosive growth of electronic health records, protecting the privacy, security, and availability of sensitive data is a critical challenge that the healthcare industry can’t ignore,” says Wayne Reynolds, chief security officer at Armor.
Since both partners are also HITRUST certified, they were able to provide almost immediate improvements and recommendations. For example, Rackspace and Medecision underwent a huge software-as-a-service migration. In another example, about eighty of Medecision’s HITRUST security controls are satisfied by the Armor solution.
“We don’t just want new toys because technology can’t solve every problem,” McKinney says. “So we don’t focus exclusively on it as the only solution. We focus on the most effective solutions that serve multiple purposes and offer greater return on investment. Sometimes that may entail simply changing the process.”
In addition to working with Rackspace and Armor, McKinney led the development of streamlined and updated policies and procedures that make it easier for employees to find answers when needed. The policy manual also provides more transparency to customers and potential clients.
“There’s an inherent Catch-22 when explaining policies and procedures to customers because you must be careful not to reveal sensitive implementation details,” McKinney explains. “Now we can share a policy document that comprehensively explains what we do to protect every single part of the business, but that doesn’t risk exposing details on how we do it. Those details are in our procedures.
“Brent’s leadership and impressive knowledge of information security has allowed the quick development of a top-notch information security program at Medecision,” says Cathlynn Nigh, CEO of BEYOND LLC. “What has really led to Brent’s success is his ability to effectively communicate across all levels of the Medecision team.”
A great deal of effort has been put into educating company developers on new security requirements, as well
“Partnering with the right providers offers us flexibility and scale. They can respond more quickly to threats and can provide a much broader view of risks and best practices as a result of working with other clients across other critical infrastructure sectors.”
as into making security considerations part of their everyday work as early as possible in the development life cycle. This began with explaining why changes were being made and the benefits they would provide.
McKinney saw this as addressing the “human part of security, which is often overlooked and underestimated.”
For example, if a policy was rolled out without explanation that prohibits the use of USB drives, employees would be upset about being denied the convenience they provide. However, if details on the risks are provided—such as that it only takes seconds for a drive to launch malware embedded at the hardware layer into the system—there is much greater acceptance of and compliance with the new policy, he says.
On the development side, McKinney has been successful at introducing security solutions as an integral part of the software development life cycle (SDLC).
“If we get security baked in at the beginning of the SDLC process, we can test for vulnerabilities ahead of time instead of finding them just prior to deployment, resulting in delays, or conversely, accepting a high degree of risk without remediating the vulnerabilities.” he says.
By training developers to write code using secure techniques from a project’s inception, it is estimated that thousands of hours of time are being saved, McKinney says. From a practical standpoint, introducing early vulnerability scanning has also enabled the team to address weaknesses almost immediately so that resulting fixes can be included in all future iterations.
As he continues to find ways to strengthen protection of Medecision’s data and infrastructure, McKinney and a team of colleagues have been working on a business impact analysis across the enterprise. This systematic review determines the
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Armor provides managed Security-as-a-Service and compliance solutions for healthcare and healthcare technology providers around the world.
Avoiding the Whack-A-Mole Strategy
Brenton McKinney is careful not to fall into the trap that traditional cybersecurity methods create—constantly trying to catch up with threat actors’ most current schemes. He refers to it as avoiding the whack-amole strategy. “Many companies respond to an attack, make adjustments, then respond to another that uses a different approach, then another, and another, and so on,” he says. “It’s a strategy that doesn’t work and is very expensive to sustain.”
Instead, McKinney has condensed the five-stage framework of the National Institute of Standards and Technology (NIST) to a three-stage process of prepare, respond, and recover. These three areas represent the actions or activities that happen before (prepare), during (respond), and after (recover) a compromise. This enables Medecision to focus on what he says is ultimately an organization’s most important action: recover.
“Despite the best proactive efforts, incidents can still happen,” McKinney explains. “In addition to extensive prevention, it’s equally important to ensure you’re prepared to get the business back up and running as quickly as possible.”
most critical factors for each department, why they are important, and how to adequately protect them. The resulting information will help guide the company in allocating funds, and it will also help prioritize data and prescribe actions in its disaster recovery processes.
Another major project is an identity and access management solution that can be customized to serve the specific needs of each department. It is anticipated that it will be integrated at the API or application layer of each of the company’s more than twenty applications. It will also have the ability to accommodate single sign-on as well as mobile application authentication.
McKinney is also looking into advanced encryption methods that could potentially reduce the footprint of the personal health information the company manages. In turn, this would reduce the amount of sensitive data that needed protection in the first place.
“We want solutions that will increase overall security but not put additional burdens on users,” McKinney says. “This requires a complete understanding of our business ecosystem.” AHL
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The New Gridiron Tactician
NFL dietitian Jamie Meeks reveals how she differentiates fact from fiction to guide the next game-changing era of sports health
By Jenny Draper
JAMIE MEEKS IS CHANGING the culture of health in professional sports, one athlete at a time. As the director of sports nutrition for the New Orleans Saints professional football team, she is on the front line as the industry shifts toward a more personal—and scientific—approach to well-being. “You can’t throw away the book,” says Meeks, a registered dietitian and a board certified specialist in sports dietetics. “But we’re finding evidence to make new recommendations for feeding a football team, and my hope is to continue applying more research-based protocols.”
Meeks is a part of the growing presence of dietitians in the sports world, a trend that she predicts will continue due to the increasing emphasis on more holistic health and wellness regimens. She cites how many of the university-level football teams now have full-time dietitians, some with multiple on staff, to create health plans and monitor new scientific understandings of nutrition and its far-reaching effects. She says the National Football League and Major League Baseball are beginning to adopt that new standard—prior to working with the Saints, Meeks was the first full-time sports dietitian for Louisiana State University Athletics.
“I truly believe we have a major impact on these guys,” says Meeks, the liaison between local food service companies
and the team’s ninety football players. “Being here every day you are helping them build healthy habits and recognize that nutrition plays a major role in their performance. Their body is what makes them a professional athlete.”
For the past three years, Meeks has pivoted the NFL team’s health strategy from reactive diet corrections to proactive wellness plans based on research-based evidence. She dedicates a lot of time to evaluating randomized controlled studies dealing with athletes to make recommendations. “I pull apart research articles and apply it to our daily regimen when it’s practical,” she says. “Not all research is done on football players, but even if it’s cyclists, runners, or weightlifters, we shake out the broader health conclusions.”
When she joined the staff as the NFL team’s full-time dietician in 2015, Meeks knew that developing a good relationship with every department was crucial to the Saints’ engagement in the health programs. “The best part that has evolved is gaining the trust of the players, coaches, and all the staff here,” says Meeks, who adds that her outgoing, friendly approach makes it easier to take that first step toward getting to know individual people within each department.
That dynamic is crucial to the development of the educational function, which is a significant aspect of her
role, according to Meeks. “Players come to me with all their questions and concerns,” she says. “From dietary changes to new supplements, they find the latest internet fad and will ask for my take on it.” Meeks meets one-on-one with the athletes and might adjust team health plans, and protein-carb ratios, to accommodate an individual’s body composition and position on the team.
Meeks’ approach resonates not just with the team but with her suppliers and partners. “Jamie Meeks is among the growing number of sports dietitians that elite level sports teams around the world are relying on to ensure that athletes are performing at their best,” says Filip B. Keuppens, vice president, global sales & marketing at The Pickle Juice Company. “Her understanding of the functional properties of sports nutrition products, like the muscle cramp-
preventing properties of Pickle Juice Sport, is one of the things that sets the New Orleans Saints apart from other sports franchises.”
Being present and available also helps Meeks understand each athlete’s unique health profile so that they can find the optimal solution together. “I’m here before they play and I’m going to be here until they leave,” she says. “I don’t want to shut down their questions, yet at the same time we can’t implement every trend. It’s a balance, but I always sit down with them to talk about it; then we follow what the research says is safe and effective.”
For example, when an athlete approached Meeks to learn more about veganism, she not only reviewed with him the benefits of increasing the amounts of fruits, vegetables, and beans, into his diet, but also educated him on how to stra-
Jamie Meeks Director of Sports Nutrition New Orleans Saints
Michael C. Hebert
tegically incorporate quality protein while on a vegan diet. While Meeks admits that there is no one rule that fits all, she has observed the increased prevalence of a plant-based diet across the sports world—a movement that she predicts will continue to grow in popularity.
Whether the objective is to raise energy levels or build muscle, her comprehensive approach to wellness includes the choices athletes make on and off the field—positive decisions Meeks hopes to continue to influence through cultivating relationships of trust and respect. She maintains that the big picture of health starts with proper portion control and hydration, yet she is creating more and more space for the science of health to lead the team in the best direction.
“We try to reach as many athletes as possible to help them understand and appreciate that nutrition is a major component of the training regimen,” Meeks says. “We want them to take just as much pride in what they put in their bodies as they do when working out in the weight room or doing great work on the field.” AHL
“We try to reach as many athletes as possible to help them understand and appreciate that nutrition is a major component of the training regimen.”
Michael C. Hebert
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A Cultural Approach to Medication Management
Mark
Coggins
looks beyond the pharmacy to transform Diversicare’s medication management program
By Galen Beebe
FOR MARK COGGINS, medication management is about a lot more than medication. As vice president of pharmacy services and medication management at Diversicare Healthcare Services Inc., a provider of postacute services to patients and residents at seventy-six centers in the United States, he has worked to improve medication management by implementing a cross-disciplinary approach to patient care.
“Whether they’re going to be with us for one week or a year or two years, we try to find ways to get patients on the best medication management that we can so that when they go back out to the community, they have a greater chance of living healthily,” Coggins says.
Among Diversicare’s most successful programs are its de-prescribing initiatives, which focus on reducing or stopping potentially inappropriate medications, including antipsychotics. “Often, medication use in the elderly is a result of a prescribing cascade that occurs when one drug is added to treat the side effects of another medication without recognizing that the original issue was
medication related,” Coggins explains. “De-prescribing efforts can improve a patient’s quality of life by reducing polypharmacy, adverse drug events, and medicationrelated problems ranging from falls to cognitive decline and hospitalizations.”
Through the de-prescribing initiatives, Diversicare reduced its antipsychotic use by nearly 50 percent in six months throughout ten states.
Many of Diversicare’s long-term residents live with dementia, and dementia patients have historically been prescribed antipsychotics to address their behavioral challenges. To so dramatically reduce the antipsychotic prescription rate, Coggins helped initiate a cultural shift at Diversicare, starting with how care providers view patients with dementia. “They have dementia, but let’s not define them by having dementia,” he says. “Let’s remember what their likes and dislikes were when they were younger because those haven’t changed.”
“A cultural approach to medication management describes a best practice for the care of our elderly
residents, especially those with dementia,” says Todd King, director of clinical services at Omnicare. “Residentcentered care is a process that allows all members of the interdisciplinary team, including families, to participate in the approach to treatment plans. This approach leads to better outcomes and, from a pharmacy standpoint, more streamlined and appropriate medication regimens.”
Care providers work with family members to learn more about the residents as people, instead of just as patients. They also have increased patient and family interactions at the time of admission to help educate them on what they can expect and learn the family’s goals. “It’s part of our mission or vision as an organization that we’re always striving to exceed our patients’ expectations and to improve outcomes,” he says. “What we’ve done across the board is to take a step back and recognize that we have to include the family and the patients themselves in their care if we’re going to have the ability to enact meaningful change.”
Coggins and his colleagues have also empowered family members to help identify and address medical and behavioral needs. “We do a lot of work with training our families, team members, and prescribers to look at any behavior as a possible unmet need,” Coggins says. Behaviors can indicate pain, discomfort, boredom, or frustration, which are often better addressed through therapy or other non-medication means.
In developing the de-prescribing initiatives, Coggins drew on his seven years of experience at a previous national senior healthcare company, where he launched programs that examined the role of pharmacists in improving medication-related outcomes in nursing homes.
In this previous role, Coggins was nationally recognized for his work to actively integrate board certified geriatric pharmacists (BCGP) within the center’s healthcare team by the Commission for Certification in Geriatric Pharmacy, which awarded him the 2010 Excellence in Geriatric Pharmacy Practice Award. He was also elected to the board of directors for the American Society of Consultant Pharmacists, the professional organization for senior care pharmacists, which he served on for four years. He continues this educational work as a writer for Today’s Geriatric Medicine, where he writes articles on issues that affect the aging population.
Coggins VP, Pharmacy Services and Medication Management
Diversicare’s de-prescribing initiatives begin with senior leadership and the Clinical Practice Committee, which is led by Diversicare’s senior vice president of clinical services, along with content experts, including Coggins, the COO, the national medical director, and the vice president of therapy services. The content experts facilitate the delivery of messaging to their respective disciplines to gain necessary support and momentum for successful program implementation; Coggins promotes the message to consultant pharmacists; the senior vice president of clinical services discusses with nurses; the national medical director includes physicians and prescribers, while the CEO and COO solicit support from operational leadership.
“We bring our bedside care expert leaders together and then roll out programs, gaining buy-in from each discipline,” Coggins says. “From the top down, everybody is on board with doing what’s right for the patient and putting them first.”
Mark
Diversicare Healthcare Services Inc.
Tricia Bartlett
Empirian Health proudly partners with LTC community leaders like Mark Coggins in their efforts to provide cost effective quality care.
“An individual profession can be doing things that they believe is in the best interest of the patient, but it’s siloed. With transdisciplinary professionalism, regardless of which discipline you are, you’re holding each other accountable for the actions and behaviors of each team member.”
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Although the leaders spread the message using the traditional framework of distinct care professions, Coggins and his colleagues emphasize transdisciplinary professionalism, which breaks down the barriers among different functions and emphasizes every team member’s responsibility to total patient care. Traditionally, pharmacists, physicians, nurses, therapists, and other care providers each emphasized their own discipline’s approach to care. “An individual profession can be doing things that they believe is in the best interest of the patient, but it’s siloed,” Coggins says. “With transdisciplinary professionalism, regardless of which discipline you are in, you’re holding each other accountable for the actions and behaviors of each team member.”
To further break down traditional barriers, Diversicare instituted the Care Alignment Program to focus on patient-specific solutions for high-risk patients, with clinical leaders within the nursing center collaborating as a team at the patient bedside instead of working individually within their disciplines. “There is plenty of time for the doctor to be the doctor. We don’t take away what they’re inherently the expert on,” he says. “But we instill in everybody that there’s this mutual respect that has to occur if we’re going to change anything that we’re doing.”
Challenging the status quo is no easy prospect, but the benefits for patients outweigh the challenges. “People don’t necessarily like you stepping into what’s traditionally been thought of as their area of expertise,” he says. “You have to have thick skin to implement change.” AHL
Learning to Bypass Bias
How Kimberly Lounds Foster’s systemic approach to inclusion is improving results at Celgene
By Galen Beebe
A STRONG, INCLUSIVE TEAM DYNAMIC is hard to engineer, but that’s exactly what Kimberly Lounds Foster set out to do when she joined Celgene, an integrated global pharmaceutical company, in November 2016. When she joined the company as corporate vice president, global commercial supply, her team’s business process depended largely on individual leaders. But she knew that leveraging her team’s collective experience would be essential to positioning the organization for future growth. “A team is much more likely to get to an optimized solution than an individual,” she says.
So, Foster focused on defining her group’s processes and creating a more inclusive workflow. Together, they have developed systems that improve both Celgene’s supply chain and the group’s dynamic.
Foster oversees a team of more than four hundred employees, through a leadership team of nine direct reports. She partners closely with other organization leads, including the heads of development and finance. To create opportunities for thought partnership, Foster co-locates with her colleagues whenever possible. They leave their office doors open for others to drop by, and she sets aside time to walk around the office and strike up conversations several times per week. “That is a systemized way of creating unexpected encounters,” she says. “Who you will come across is not necessarily defined, but typically those conversations are the ones that tend to be most pressing.”
Foster also maintains inclusive relationships with the vendors who support her global supply chain. “By extending a level of inclusion to the vendor network, Kimberly gains additional resources to solve challenges,” says Joe Principe, vice president, strategic partnerships at Thermo Fisher Scientific. “Each of our Patheon sites host frequent client visits and often create those ‘unexpected collisions’ so that the client can build relationships with the team who is manufacturing their product.” With a global team, however, creating encounters is not always possible. Although communicating over great distances can pose an additional challenge, it can also create an additional opportunity, she says. “There are ways to make sure you’re pulling people into the discussion,” Foster says. “Whether it’s through technology or planned face-to-face meetings, we can close the gap so our interaction is more intimate and we can come to better solutions.”
Foster’s direct leadership team has faceto-face meetings at least three times a year. When apart, they leverage technology, including video conferencing, to formally create more communication touch points and develop a stronger connection. “We’re creating the space as a team to actually get to know each other—not just your résumé, but how did you get to where you are? What’s a big influence on your career?” she says. “We know each other’s backgrounds and the experiences of what got us to where we are today, and we know that we can leverage those experiences.”
Kimberly Lounds Foster Corporate VP, Global Commercial Supply Celgene
“We know each other’s backgrounds and the experiences of what got us to where we are today, and we know that we can leverage those experiences.”
“If we understand each other a little bit more, we actually are more sensitive to the different biases that influence the decisions we make.”
Among Foster’s influences are her parents, and especially her mother, who worked as a nurse. Her career sparked Foster’s interest in medicine from an early age. “In our household, there were all these nursing books that told you how to do various general medical procedures. That was bedtime reading for me starting, probably, around age ten,” she says. Foster followed that passion, majoring in chemical engineering and premed. Although she ultimately joined a pharmaceutical company, her experience with medicine and her Midwestern upbringing influence her approach to her work.
“Everyone has a different story, and that is an experience that helps them to make a decision,” she says. “If we understand each other a little bit more, we actually are more sensitive to the different biases that influence the decisions we make.”
As part of her team’s change journey, Foster is focusing on confronting unconscious bias—both among her team members and within herself. “I’ve tried to become a more authentic leader and to engage my team in a more authentic way. Part of that is being transparent, both with what I believe are my strengths and which areas are my personal watch-outs,” she says. “One of the reasons for building the team that way is so that they can give you different lenses to that same problem statement we’re all trying to solve.”
One framework they’re using is the SEEDS model from the Neuroleadership Institute. Each letter in SEEDS represents a bias—similarity, expedience, experience, distance, and safety. By collaboratively addressing these biases, Foster’s team is better able to make decisions. “Changing biases is close to impossible,” she says. “But if, from a process perspective, you approach how you solve a business problem in a systematic way, you can minimize the negative effects of those biases in your dayto-day work.”
Team members’ communication styles also influence their collaboration, so Foster and her team have gone through an exercise to better leverage each team member’s approach. “If you have a directive style and you’re speaking to an observer, you may change your approach a bit so that someone with an observer style hears what you’re saying and vice versa,” she says.
Quieter voices are still important, Foster says, whether that voice belongs to someone from her team or a member of a different team. “I can optimize a process, but if there’s some new thinking in the industry around good manufacturing practices that have been cited by health authorities, my quality colleague would know that and bring that to bear,” she says.
Developing these cross-functional relationships and bringing in more perspectives ultimately leads to a better outcome, both for the team’s dynamic and for Celgene as a whole. “Creating an environment where people feel like their voices are heard and their ideas are considered and integrated is very important,” Foster says. “Your question may highlight a blind spot that we may need to address.” But every blind spot presents another opportunity for growth. AHL
Bringing Wellness to the Workplace
Wellness Corporate Solutions makes staying healthy just another day at the office
By Jeff Silver
WHEN WELLNESS CORPORATE SOLUTIONS
(WCS) first went into business, a lot of time was devoted to explaining the importance of wellness to potential clients. Much has changed since then. Wellness programs have become such a standard component of most companies’ HR packages, and many job seekers often won’t consider an employer without them.
Despite all the changes, WCS remains an industry leader by providing biometric screenings, health coaching, and comprehensive wellness programs. Those services are supported by a staff of 8,000 nationwide and more than 1,700 health coaches. All coaches are registered dietitians who provide expert advice to help employees address chronic health issues and set practical goals for adopting healthy behaviors.
“One of the driving factors of our company is a commitment to educating people about their health status and empowering them to reduce their health risks,” says Emily Kolakowski, the organization’s chief operating officer. “We’ve positioned ourselves to offer comprehensive resources to do just that.”
The journey for each individual and their employers typically begins at on-site biometric screening events.
Employees are scheduled for individual appointments and assessed for vital statistics such as height, weight, blood pressure, and glucose and cholesterol levels. (More in-depth screenings are available for blood chemistry panels, A1C, and cotinine.)
Overall participation rates and rates of various risk factors are aggregated and anonymized before being reported back to employers. A variety of associated follow-up activities—such as working with a health coach, participating in wellness challenges, using fitness and nutrition trackers, attending seminars, or accessing health education resources—are also available.
WCS’s transparency and agility set it apart from its competitors, Kolakowski says. Its ScreenSmart tablet technology is the first solution capable of capturing and transmitting all screening data in real time. This enables the company to provide clients with on-demand information and for on-site event staff to be notified about special circumstances, such as when an expected VIP has arrived.
ScreenSmart also gathers immediate feedback from participants. If someone gives a screener a low rating, program managers and event leads are automatically notified so
“One of the driving factors of our company is a commitment to educating people about their health status and empowering them to reduce their health risks.”
they can address the situation. “We have contingency plans in place for nearly every conceivable situation at our events,” Kolakowski says. “We also always use our own staff—never subcontractors—to ensure that we maintain quality and that everything is handled properly.”
That commitment to quality is the same for every client, from the smallest organization to some of the largest Fortune 500 companies. WCS has screened more than 1.5 million people to date and has held more than six thousand events this past year.
Throughout all of its offerings, WCS focuses on customization for consumers. This means the organization has expert program managers design comprehensive plans to coordinate with existing wellness programs, to support clients’ internal cultures, and to accommodate employee needs. No detail is too small. Should participants be addressed as “employees” or “associates?” How can event marketing reflect client branding?
Resulting strategies range from carefully preparing staff to meet desired protocols and adjusting IT architecture, to creating entirely new equipment.
In one instance, a large healthcare client wanted to improve participation and satisfaction rates over previous screening events with another company. One of the challenges was that the majority of participants were clinicians who couldn’t leave their units to attend an event in a different location. WCS built a screening cart that was able to go to them instead. Participation rates increased from less than 30 percent to more than 65 percent, and satisfaction jumped from 80 percent to 98 percent.
WCS also publishes biographies of all its health coaches so that employees who want to pursue follow-up activities after their screenings can address their own personal needs and preferences. They can choose a coach by gender, health specialty, and even according to language abilities and their familiarity with other cultures.
The Commitment Continues
Wellness Corporate Solutions’ commitment to healthy living doesn’t end with its clients. That’s why the company has built its Bethesda, Maryland headquarters to reflect the company’s core value of equipping people with the tools and knowledge to improve their well-being. To do that for employees, plenty of standing desks and treadmills can be found throughout the office so that individuals may stretch and move around, and there is a large communal kitchen space that encourages fresh food preparation.
In addition to ScreenSmart, WCS has developed other custom technology innovations. WellConnect Plus is an online portal that makes it easy for participants to schedule screening and coaching appointments and communicate directly with health coaches. If they can’t attend a screening event, they can find the closest CVS store or LabCorp location, with whom WCS has partnerships for providing screenings. Employees can even download forms directly from the portal for their personal physician to provide screening information. WellConnect Plus can be branded for each specific client, along with customized email and text reminders for employees. Eric Taylor
“Even though we continue to grow, we’re still a very grassroots organization. A big part of that is nurturing relationships with peers. Recognition is very powerful in maintaining those connections and lifting up the entire industry to best serve employers and employees across the country.”
In addition to being responsive to clients, WCS has a strong connection with its own employees. Its daily newsletter includes a “Wall of Wow” where they recognize colleagues who have gone above and beyond to support clients, the business, and each other. Annual awards are given out to individuals and teams who have done exemplary work embodying the company’s core values.
Each year the executive team develops new annual goals represented by an acronym. In 2017, it was BE BOLD: bring your best, exceed expectations, believe in the team, own the innovation, love the data, and drive engagement and revenue. Among other accomplishments, it resulted in the logistics team developing a new inventory management system that tracks event inventory in real time and integrates with UPS.
With revenue expected to grow 25 percent in 2018, Kolakowski highlights the importance of WCS’s culture. “Even though we continue to grow, we’re still a very grassroots organization,” she says. “A big part of that is nurturing relationships with peers. Recognition is very powerful in maintaining those connections and lifting up the entire industry to best serve employers and employees across the country.” AHL
Alere is now Abbott . Abbott is a global leader in rapid diagnostic tests that deliver the right care, at the right time.
A Culture of Appreciation
Corey Jackson understands that the first step toward great patient care is taking care of Parkland Health & Hospital System’s employees
By Joe Dixon
TO COREY JACKSON, human resources reminds him of his days as a college basketball player.
But instead of taking the court with his teammates, Jackson is now crafting policies and a company culture at Parkland Health & Hospital System that ensure employees excel and deliver the premier care that the organization’s patients have come to expect.
“In college basketball, you’re bringing in top players from all over the country to hopefully create a great team,” Jackson, Parkland’s executive vice president and chief talent officer, says. “You also have that with any business environment you’re in. You’re bringing executives in from all over to create a really good C-suite and making sure everything works well together.”
Time as an athlete isn’t the only experience Jackson is leveraging in his HR role. He also spent time working as a legislative assistant in the US House of Representatives and as the NCAA’s director of diversity and inclusion.
“Working on Capitol Hill has been helpful because you deal with competing interests on a regular basis and you
have to compromise and come to solutions on issues that will affect a broad range of people,” Jackson says. “Working in higher education is helpful too, because even though you have presidents and people in administration, they can’t do anything without faculty and student support. You want to make sure everyone has a voice at the table.”
Jackson is now drawing on that experience to create a culture at Parkland where employees feel heard, valued, and appreciated. He and his team have been focusing on shifting the HR department from solely an operationsfocused function to one that has a comprehensive people management strategy. Jackson believes that a more effective people management strategy will ultimately trickle down to Parkland’s patients in the form of more engaged staff and consistent, quality care.
“A lot of people don’t think those two things are related, but if we focus on recruiting, retaining, developing, and engaging the right staff, we’ll have better people making better decisions,” Jackson says. “Then, the result should be better patient outcomes.”
EVP, Chief Talent Officer
Corey Jackson
Parkland Health & Hospital System
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To achieve that goal, Parkland is cultivating a celebratory environment throughout the organization. For example, Jackson helped champion an annual, system-wide event called Celebrate Us, which recognizes all disciplines and staff over the course of ten days with different activities and interactions. Additionally, he’s been an early advocate for the system’s executive rounding efforts, where senior leaders routinely visit different locations and clinics throughout the health system to personally thank employees for their hard work and dedication to patients.
“It could be that a lunch is served. Sometimes it will be breakfast, and sometimes it will be a snack,” Jackson says. “The main thing is having the executive staff go out and tell people how much they appreciate everyone’s work.”
Jackson and senior leadership also make sure to solicit feedback directly from employees in the form of a company-wide engagement survey. Staff members respond to a variety questions: Do I feel like I have a voice in my department? Do I feel like I have input in decision-making? And do I feel like I’m adequately compensated for the work I do? Then, Jackson and his team take the results of the survey and identify areas where employees feel improvements could be made. After that, they create and implement action plans to address any concerns that employees have at the time a survey is taken.
For example, if a survey for a department finds that employees feel communication is lacking, Jackson and leaders within the department will look for the root cause of the feedback.
“We would look at what we can put in place in that department to improve communication,” Jackson says. “We might ask questions like, ‘Are we having regular one-onones with our staff members? Are we putting out a newsletter for the department to talk about some of the things that are happening? Are we having joint staff meetings between different shifts?’ That’s just one example, but everyone is developing a plan around issues in their own department.”
Since these initiatives have been implemented, company leadership has noticed a significant increase in employee engagement and morale, Jackson says. But that doesn’t mean he’s content to rest on his laurels. There are several projects Jackson is working on to continue to improve the employee experience at Parkland.
“We might ask questions like, ‘Are we having regular one-on-ones with our staff members? Are we putting out a newsletter for the department to talk about some of the things that are happening?’”
He would like to start incorporating predictive analytics into his department’s workflow to more quickly identify potential problem areas or other patterns that would be useful to understand. One area where he believes predictive analytics will make a significant impact is on employee turnover.
“If we can get data ahead of time about areas that have high turnover, then we can backfill positions a lot quicker without always having to wait until someone resigns or retires,” Jackson says. “So, having this will let us start recruiting earlier, and because of that, we’re not impacting patient care by being short-staffed.”
And that gets to heart of what Jackson and Parkland are setting out to do: dedicate themselves to the health and well-being of the individuals and communities entrusted to their care. AHL
“As executive director of GroupOne Background Screening , I have been working with Corey Jackson for several years. His work as an executive vice president and chief talent officer at Parkland Health & Hospital System has been exemplary. His efforts toward diversity and talent acquisition are some of the best I have ever encountered on the job.” – Danny Davila, LPI, RACR, Executive Director, GroupOne Background Screening.
Looking out the Window
Michelle Fisher studies the changing healthcare industry, always with an eye toward improving Piedmont Healthcare’s ability to care for patients
By Lior Phillips
MOST DAYS, you’ll find Michelle Fisher in her office, looking out the window—but that doesn’t mean she’s daydreaming. That’s just what Piedmont Healthcare’s chief strategy and performance improvement officer calls her practice of being vigilant of the constantly changing world of healthcare. “I spend a lot of time studying the macro forces impacting our industry, translating those trends into implications for Piedmont, and then educating our board and management team,” she says. And through that work, Fisher has reinforced the importance of agility, openness to change, and empowering women at the Atlanta-area system.
Fisher’s focus on learning and educating leads naturally from the four elements of her work: strategic planning, corporate business development, project management, and performance improvement. As the system has doubled in size over the past four years, the challenge of driving those efforts has required a lot of intentional communication and cohesion. “My responsibilities have changed over my fifteen years at Piedmont, but it’s always been helping to design, implement, and measure progress against our long-term goals,” she says.
The last aspect of that focus is especially important, Fisher notes, as the bigger picture of her role is to help
impart financial sustainability and stability to the organization. To provide the best possible care to patients, Piedmont needs to be able to attract the best clinicians, optimize the best technology, upgrade facilities, and invest in best practice research and implementation. All of those, of course, are going to require financial resources. “We are a nonprofit community asset, and it’s our obligation to provide the highest quality that we can to our patients. But to do so, we have to be financially viable,” Fisher says. “We have an unsustainable cost structure in healthcare in general, so organizations have to make changes, if you want to be around for the long haul.”
Looking out the window involves both identifying opportunities and developing strategies that minimize the effects of negative trends. Fisher first gained an understanding of the full scope of that work when she was asked to organize a system-wide training program to embed a culture of continuous improvement. “We studied improvement programs that taught Lean and Six Sigma, among other approaches,” she explains. From there, she collaborated with Piedmont’s chief medical officer, Dr. Leigh Hamby, and launched “QPI,” Piedmont’s quality and process improvement program.
Scott Wang
Michelle Fisher Chief Strategy and Performance Improvement Officer
Piedmont Healthcare
Since its 2014 launch, more than three hundred employees have earned their black belt, which required learning key principles in improvement work—most prominently, in today’s environment, the importance of managing teams through change. “If you combine a riskaverse or change-averse culture with a rapidly evolving industry, you will find yourself playing catch-up with your competitors,” Fisher says. To change that, the QPI program tries to instill a sense that change is required of all healthcare leaders in today’s environment and what is critical to success is how they go about making the change.
Easier said than done, as change management is a difficult concept to master, but one that Fisher approached with an equal focus on strategy. First, she quickly learned that fully understanding the why behind a need for change was essential for employees to buy in; however, it was better for those employees to determine the what and the how themselves. “Grassroots change is always better than topdown. If you tell effective teams why change is required, they’ll figure out the what and how. More importantly, they will own the change,” she says.
Another lesson that Fisher learned came from trying to “go it alone,” she says. Simply put, she observed that
organizations didn’t have to figure everything out internally. “Knowing when to call in partners is important, and that’s why I credit Deloitte and Accenture as being a big part of Piedmont’s success over the years,” Fisher says.
“Partners like that can accelerate an organization’s transformation, especially with change management expertise.”
One change Fisher is particularly passionate about is creating more gender diversity in Piedmont’s leadership teams. “Most workforces in healthcare are about 80 percent female, but only 10–12 percent of the average executive team is. More confusing is that less than 5 percent of CEOs are female,” she says. There is no silver bullet to create gender balance within organizations; however, there are many strategies available. Fisher stresses the importance of mentorship—something she learned from her own mentor and predecessor in the role, Michele Molden. “She spent time refining my technical skills, but also my emotional intelligence,” Fisher says.
From that experience, Fisher has helped drive the Women’s Leadership Alliance, an employee resource group aimed at developing women leaders throughout Piedmont Healthcare. The program offers mentorship matching, a speaker series, and networking and community service
Scott Wang
Michelle Fisher speaks at Piedmont Healthcare’s annual Service Awards, where she recognized leaders for their contributions related to one of the company’s core values: embrace the future.
opportunities. More than anything, Fisher stresses the Alliance’s abilities to help build relationships throughout the system and connect women with the knowledge and resources they might not otherwise have access to. “Building those relationships, getting to know others, and sharing experiences makes leaders develop faster. It makes you more invested in the company’s future,” Fisher says.
As Fisher herself can attest, inspirational leadership and a focus on doing what is right for the community and the patient can both inspire employees and lead to positive change for an organization at large. Whether through the quality- and process improvement program or the Women’s Leadership Alliance, all of Fisher’s work is done with patients in mind. “It all really centers on communicating, managing change, and building authentic relationships,” she says. She may be looking out her window, but it’s always in order to take care of the people in her home. AHL
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Susan Constantino President, CEO Cerebral Palsy Associations of New York State
ThatSusan Constantino has dedicated her life to fighting for disability rights and helping individuals achieve independence
By Joe Dixon | Photos by Cass Davis
They’re There”
Every summer in Central Park, people gather to participate in the Achilles Hope & Possibility run. Spectators enjoying the four-mile race watch runners with prosthetic legs, people using wheelchairs, handcycle bikes, and able-bodied runners running side by side with one another. Among those runners is Susan Constantino. And although she doesn’t have a disability, the race provides a glimpse of the future Constantino would like to see for people with disabilities.
“When I get out there and I’m running, like if I run by someone who has a prosthetic on, I think, ‘Oh my god, how amazing’ and then we just keep running together,” says the president and CEO of Cerebral Palsy Associations of New York State (CP of NYS). “You know there’s a disability, but then you look at all the abilities around it and the way everyone is living a normal life. I guess that’s what I love about the race; it’s everyone being who they are.”
The event, hosted by Achilles International, is meant to “enable people with all types of disabilities to participate in mainstream running events in order to promote personal achievement,” the organization’s website says. But this race isn’t the first time Constantino had been exposed to people living with disabilities. In fact, she has been fighting for disability rights and equality for nearly five decades.
Early in her career, Constantino pursued a path as a special education teacher, and eventually she became the director of an education program for children with disabilities in Buffalo, New York. Although she enjoyed the work, she quickly noticed how her students were treated differently from the able-bodied students.
“It occurred to me that the children were basically in a separate school; they weren’t getting the same opportunities; they weren’t going to preschool with kids without disabilities, and there was no particular reason why. It was just happening,” Constantino says.
Fortunately, she says, the time was right for a change. In the late ’80s, Apple computers were just getting introduced into the public school system, and Constantino immediately saw how the technology could revolutionize education for students with disabilities.
“Our little kids could do activities on computers that they couldn’t do with their own hands,” Constantino says. “They could build blocks on the computer. They could put puzzles together. Suddenly, they became people that other kids wanted to be with because computers are so fascinating, and kids were really excited about them. And the children without disabilities got to know our kids and really liked them, and friendships were made.”
As a result of the program’s success at her school, Constantino and her team wrote a grant to the federal government for funding of a program called, “Special Friends and Computers.” The initiative’s goals were to give students with disabilities computers, which would give them the resources necessary to join their able-bodied peers in mainstream classes. The government approved the grant for three years. After that, the government approved the grant for six more years, along with funding to train teachers across the country to begin incorporating more integrated educational opportunities for kids with disabilities.
“You could see that if you can adapt materials to give our kids opportunities to participate, the other children would discover what good friends they are. That’s why Special Friends was successful,” she says.
Constantino has since moved on from her days as a public educator, but her advocacy for disability rights hasn’t waned. Now, as president and CEO of Cerebral Palsy Associations of New York State, Constantino fights daily to earn equal access to housing, transportation, and medical care for individuals with disabilities throughout the state.
The organization is a direct service provider for individuals in New York with a wide range of physical and developmental disabilities, including conditions such as cerebral palsy and autism. The organization’s goal is to help people with disabilities lead fulfilling, independent lives. To accomplish that mission, it offers a variety of programs aimed at giving people with disabilities the resources they need to thrive on their own. CP of NYS also advocates for individuals throughout the state through its network of twenty-five affiliates.
Susan Constantino greets individuals at CP of NYS’s office in the Bronx, where people may take advantage of a wide range of services from art classes to dental care.
CP of NYS individuals may participate in a variety of art classes, from painting to ceramics, which are taught in the organization’s new multipurpose art studio.
Viviana Rivera— known to others at CP of NYS as Ms. Vivi—helps a woman paint her nails.
CP of NYS hosts classes on a variety of skills, including a workshop on how to make a bed, to help individuals transition to independent housing.
Constantino, Dr. Rita Billelo, and Dr. Andrei Grun discuss the difficulties of providing proper dental care for individuals with disabilities, which includes specialized equipment and training for staff.
CP of NYS provides apartments throughout New York for individuals with disabilities, including Marie Troncoso.
One of the biggest obstacles to independence for this group of people is a lack of accessible housing, Constantino says. Even in New York City, which she considers to be a relatively accessible city, it can be difficult to find an apartment building without stairs or an affordable space large enough to fit wheelchairs or other medical equipment. Even in buildings with an elevator, folks with disabilities face significant challenges when equipment fails.
“We’ve had people who have been on the eighth floor of an apartment building and the elevator breaks and they can’t come down for two days,” Constantino says. “They’re constantly faced with finding a place where they can feel truly comfortable.”
To combat this, CP of NYS provides several housing options for individuals as a welcome alternative to life in a nursing home or other care institution, Constantino says. For individuals who require some assistance before moving to one of these spaces, the organization offers classes on skills such as cooking and cleaning so they are prepared to take care of their health and hygiene once they move. And depending on a person’s needs, the organization also offers a wide spectrum of support, from twentyfour-hour aid to assisting individuals on an as-needed basis, she says.
Constantino and the organization have helped more than five hundred people move into in these accommodations throughout New York City, with varying degrees of supervision. In upstate New York, Constantino and the organization’s affiliates have built hundreds of one-story homes for people that are spacious enough to meet any individual’s accessibility requirements. But accessible housing is just one barrier that people with disabilities face.
Mei Feng Cheng proudly displays her origami creation to Constantino while they visit in Cheng’s CP of NYS apartment. Cheng has lived independently in this housing for three months, and she is able to work as a teacher.
Constantino visits with Rivera (left) and her roommate, Katrina Wells, in their CP of NYS housing.
Although transportation in New York City is relatively accessible, it’s difficult for individuals living in more suburban or rural areas to access transportation, Constantino says. And, the services that are available for these individuals to use are often cost-prohibitive.
Constantino also points out that for people who use wheelchairs, it’s difficult and expensive to repair the chairs when they break down, which can leave people immobile for days, or even weeks.
To alleviate some of this burden, CP of NYS has partnered with its own transportation company in the five boroughs of New York City and has worked with other companies to offer affordable door-to-door busing services for individuals without access to an accessible form of transportation. But even if some disabled people can find accessible housing and affordable transportation, often one significant challenge remains: access to medical care.
“Providing clinical supports to our folks has been extremely difficult,” Constantino says. “There are many private practices that do not have the expertise or the inclination to serve individuals with disabilities, particularly those with the most complex disabilities.”
In addition to that challenge, some clinics aren’t handicap accessible, and some healthcare providers don’t accept Medicare or Medicaid insurance coverage, which many people with disabilities use to access medical care. But Constantino hasn’t let that stop her from providing access to these services for CP of NYS’ clients.
Constantino has spearheaded the opening of five federally qualified health clinics, called Metro Community Health Centers, throughout New York City, with two more on the way, staffed with medical professionals trained to handle a wide variety of medical concerns and to accommodate a person’s needs for receiving proper care. Every building is also fully wheelchair accessible, offers behavioral health services, and dental or oral health services. She has also led the effort to introduce telemedicine into these clinics,
Wells is one of hundreds of individuals who has received help from Constantino and CP OF NYS to find independent, accessible housing in New York City.
so individuals may see a doctor without leaving their homes.
“Making all the health centers fully accessible, staffed with experienced practitioners and a full range of services has been a major goal. And it has taken a great deal of money,” Constantino says. “It’s taken my board of directors to trust me so that we could do this, too. But we’ve done it, and Metro Community Health Centers are exceptional clinics providing exceptional healthcare.”
Her decades of work have pushed Constantino closer to the future she envisions while she runs the race through Central Park every year. But she isn’t satisfied with the status quo, and she is passionate about continuing to chip away at the inequalities people with disabilities still face.
“I look at some of our homes where neighbors look out for some of our individuals because they really care about them. They’ve been able to see them just as neighbors, not neighbors with a disability,” Constantino says. “I don’t want someone to say, ‘I don’t see their disability’ because of course you do. But the disability doesn’t matter. You need to see that they’re there.” AHL
congratulates and commends Susan Constantino for her deep and steadfast commitment to improving the lives of thosewith cerebral palsy.
your efforts to enhance the quality of life for people with disabilities and their families.
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A Formula for Growth
Sue Mashni is helping Mercy Health develop innovative approaches to business and clinical care
By Jeff Silver
ACCORDING TO AN OLD Jerry Seinfeld routine, the toughest part of a pharmacist’s job is typing all the information on the little labels on pill bottles. Sue Mashni, chief pharmacy officer at Mercy Health, feels that idea perfectly reflects the misconceptions about the profession.
“Most people are completely unaware of the work we do and how they benefit from it,” she says. “Making sure medicines are safe and dosed and used appropriately protects millions of lives and prevents tens of millions of dollars in adverse events every year.”
Mashni and her team of seven direct reports are directly responsible for many of those outcomes. She oversees the pharmacy practice at Mercy’s twenty-three hospitals, twenty-five retail pharmacies, and more than twenty ambulatory pharmacy practices across Ohio and Kentucky. This includes teams for population heath, specialty pharmacy, a mail order facility, and Mercy’s pharmacy benefit management relationship for employee health. Programs in her purview include everything from Mercy’s employee diabetes management programs and Meds to Beds, a program that ensures patients receive the proper medicines and understand their use when they are discharged, to developing an opiate prescription reduction initiative.
Prior to moving into leadership positions, she spent years in clinical pharmacy practice and direct patient care. This began in her first internship at Ohio State University, where she worked side by side with nurses as a drug administration technician. After completing her education, she worked in Johns Hopkins University Medical Center’s neuro-ICU and was later hired to help open the neonatal ICU pharmacy at the University of Cincinnati Medical Center. From there, she went to Cincinnati Children’s Hospital Medical Center’s HomeCare & Starshine Hospice.
These are all impressive medical credentials for someone who had originally planned on becoming an engineer. “My mother was a nurse and my father was a pharmacist, but I fainted around blood and decided I needed to find a different path,” Mashni says. “When I studied biochemistry and medicinal chemistry, though, I thought they were absolutely fascinating. Combined with my love of helping people, I knew I had found my way.”
Eventually, Mashni decided that she could have a greater impact by moving from clinical work into leadership roles. The lessons she learned in her clinical experience, however, continue to serve her well as she strives to balance the
Mashni Chief Pharmacy Officer
Mercy Health
needs of the Mercy system with those of its local hospitals, physicians’ offices, and staff caring for patients.
For example, when Mashni was developing UC Medical Center’s neonatal ICU pharmacy, she was careful about how she approached her relationships with the nurses, who were used to working independently without direct interactions with the pharmacists.
“We had to insert ourselves into the workflow by demonstrating our value and always having an attitude of service toward the nurses,” she says. “We made it clear we weren’t the pharmacy police and showed how we could be supportive by introducing best practices that improved safety, saved time, made their work easier, and benefitted the patients.”
Mashni drew on those interpersonal skills again when she was part of the team that developed Mercy’s standardized system-wide formulary. At that time, the system’s hospitals shared drug suppliers, but had no impetus to coordinate their purchases. The introduction of Mercy’s EMR platform changed that.
“We worked through a three-year plan to review every class of drugs to come up with standard choices based on evidence, quality, cost of care, and availability,” Mashni explains. “It was difficult getting everyone to agree, but we continually collaborated through site visits, included representatives from every department, and later developed drug monographs based on clinical evidence, our use patterns, and proposed utilization.”
“When I studied biochemistry and medicinal chemistry, though, I thought they were absolutely fascinating. Combined with my love of helping people, I knew I had found my way.”
Sue
Four years after launching the initiative, Mercy realized a cumulative savings of $50 million in drug costs.
Mashni was also involved in the development of clinical content for four hundred standard order sets within the system’s EMRs, 70 percent of which consist of pharmaceutical information. She worked with physicians and nurses to create drug and treatment options that streamline care and administration, can be personalized to reflect a clinician’s standard care choices, and improve outcomes.
In addition to spearheading these clinical programs, Mashni is also involved with Mercy’s business development team. Currently, it is exploring ways to provide its pharmacy management and clinical expertise to outside clients. The company is also a joint venture partner with for-profit revenue cycle company Ensemble and is looking for more opportunities for pioneering nonprofit and for-profit partnerships. Mashni credits many of these successes to the organization’s willingness to listen to her and her pharmacy team.
“Mercy’s culture values the pharmacist’s perspective,” she says. “There was recognition from the very beginning of the process that our input was needed to ensure that the medications used in order sets were efficient, safe, and cost-effective.” AHL
Premier is proud to partner with dedicated professionals such as Dr. Sue Mashni, chief pharmacy officer at Mercy Health, to transform the future of the healthcare industry. Congratulations on your recognition from American Healthcare Leader magazine. Premier is a healthcare improvement company uniting an alliance of approximately 3,900 US hospitals and more than 150,000 other provider organizations.
Building
Bridges
to Success
Whether working across multiple business units or carving out work/life balance, Novartis’s Maureen Ruane has mastered the art of working with others to lead an enjoyable and successful career
By Joe Dixon
Throughout her career, Maureen Ruane has never been afraid to take on a challenge. Whether it’s litigating complex federal criminal trials for the US Attorney’s Office for the District of New Jersey—even delivering the government’s closing argument to a jury three days before her first child was born— or spearheading an internal investigation for an Ivy League university, Ruane has honed her legal skills over the years by taking on a wide variety of legal matters. This vast array of experience is serving her well now in her current role as vice president and head of US litigation at pharmaceutical company Novartis.
In her role, Ruane strives to serve as a legal “bridge” for the company’s different divisions by keeping critical stakeholders informed on important matters, and handling and supervising all of the company’s material litigations and investigations, while also making sure not to burden people with unnecessary information.
Ruane sat down with American Healthcare Leader to discuss how her family influenced her career path, the exciting challenges of working at Novartis, and how she maintains her work/life balance.
What does a typical day look like for you?
On a daily basis, I partner with the other Novartis Group lawyers who work alongside me to handle the investigations and litigations that are ongoing at Novartis and its several businesses. As the Novartis head of US litigation, I work for the Novartis corporate organization, which serves as an umbrella organization over the various divisions. We handle all significant Group litigation and investigation matters, which include matters that could pose a material risk of reputational or financial harm to Novartis. I’m also responsible for working with the general counsel of the various divisions, as well as other litigation and compliance colleagues throughout the organization to ensure that we are identifying and addressing any issues that require attention.
What is your strategy for acting as that bridge for the different businesses at Novartis?
I have found the best way to serve as a bridge is to provide helpful assistance where needed, and to avoid interfering in matters and issues that the divisions are well suited to handle on their own. There are various ways to be helpful, including offering to handle difficult matters or supporting others who are already handling them, providing financial support for projects that benefit the greater Novartis organization, and escalating matters that require additional oversight or support from others at the company.
What unique challenges has stepping into that role presented you?
Novartis is a complicated matrix organization, so there are often many individuals and groups who have an interest in decisions or have taken positions in litigations or investigations. Obtaining consensus or even keeping all of the interested parties informed can be challenging. Additionally, we need to remain close to the business at all times to keep them updated on any developments that are material to the operations of the organization; to confer with them about proposed changes to the business model that might be recommended from a legal or compliance perspective; and to ensure that everyone remains focused on the critical mission of Novartis: reimagining medicine to discover new ways to improve and extend people’s lives. Novartis sells products in more than 150 countries, working to provide lifesaving medicines to people who are desper-
ately in need of them. In the process, Novartis must work with and through complicated legal, regulatory, cultural, and other frameworks, and of course is subject to a great deal of scrutiny by various governing enforcement and regulatory authorities. It can be challenging to navigate through these issues in conducting business, but we must succeed in doing so to ensure that patients receive the medicine they need.
Are there any projects you’re working on right now that excite you?
I’m working on establishing a Litigation Center of Excellence to bring even greater structure and organization to my interactions with the general counsel of the divisions and various litigators throughout the company. The Litigation Center of Excellence will focus on ensuring that we have deep knowledge of the various areas of experience and expertise throughout Novartis. That will ensure that we can quickly and efficiently connect the right individuals at the correct times to maximize the use of our resources and to achieve the best possible outcomes. Ultimately, the Litigation Center of Excellence will focus on transparency and information sharing, which are keys to success in any organization.
Switching gears, I was wondering what influenced you to go down your career path?
My career path was strongly influenced by my parents. My mother, unfortunately, was crippled with rheumatoid arthritis for almost all of my life. In spite of her diagnosis, she was a proud and strong woman who always wanted the best for her children, and pushed us hard to be the best people, students, and workers that we could be.
As a young child, I took on the role of her primary caregiver and helped her navigate the complicated issues involving access to medicines and innovative surgeries, managing insurance reimbursements, and keeping up with the latest breakthroughs. And my father died suddenly while I was taking the bar exam—which was a
Maureen Ruane VP and Head of US Litigation Novartis
Larry Bercow
GIVE THEM A HAND.
DLA Piper is pleased to recognize the accomplishments of Maureen Ruane and Novartis. With lawyers in the Americas, Asia Pacific, Europe and the Middle East, DLA Piper is positioned to help companies with their legal needs around the world. We are proud to partner with our clients, such as Novartis, offering practical and innovative legal solutions to help them succeed.
tragic, life-altering event for me—and was the result of medical malpractice. He visited his doctor one day with pain in his left shoulder and arm, where he was diagnosed with tendinitis, and died of a massive heart attack the next. My mother later was diagnosed with, and ultimately died from, complications of Parkinson’s disease. All of these experiences guided me toward the healthcare field and, ultimately, healthcare law.
You mentioned that working at Novartis is your dream job. What are your favorite parts about working at the company?
“Every single day, I aim to set priorities, constantly reevaluate them, and then keep going—no matter what. I believe it’s critically important to be grateful each day for the gift of life.”
Novartis has all the best parts of practicing law. I am working on sophisticated litigation and investigations with extremely smart colleagues and business partners to ensure that the business continues to operate and deliver lifesaving medicines to as many people as possible.
And I’m not involved in the “business of law”—finding clients, billing hours, and collecting receivables—which is very stressful and something that I did not enjoy.
Throughout your career, you have emphasized having work/life balance. How have you maintained that?
Every single day, I aim to set priorities, constantly reevaluate them, and then keep going—no matter what. I believe it’s critically important to be grateful each day for the gift of life. We fill our lives with many important things, including family, friends, work, and service to others. We all decide what to prioritize, and it’s not possible to prioritize everything at once. And when thinking of work, flexibility is the key to success. It’s wonderful that so many employers now offer flexible work arrangements, but I believe it’s also incumbent on employees to be flexible, too. By being flexible in all aspects of life, at both work and home, which often
requires changing plans and making alternative arrangements sometimes with virtually no notice, I have been blessed with a loving family who means the world to me and a professional career that has been incredibly challenging and rewarding. AHL
DLA Piper LLP (US): “Maureen Ruane is an uncommonly talented lawyer. Her experience in prosecuting healthcare fraud as a federal prosecutor and defending life science companies as outside counsel, combined with her sound, practical judgment, make her an indispensable and trusted advisor. We are very fortunate to continue our collaboration with such a skilled attorney.” -Karl Buch, Partner
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Morrison & Foerster is proud to work with Novartis. Maureen’s commitment to excellence is apparent in everything she does. Her keen business sense and legal acumen set a high standard and drive successful, team-oriented results.
Morrison & Foerster is proud to recognize Maureen Ruane for her invaluable insights and exceptional leadership of the Novartis legal team.
Morrison & Foerster is a global firm of exceptional credentials. Our clients are some of the largest and most well-known organizations in the world including Fortune 100 companies in the health care, life sciences, and technology sectors. Our lawyers are committed to achieving innovative and business-minded results for our clients, while preserving the differences that make us stronger.
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Staying Ahead of the Curve
Marge Mayerson brought dental care and nursing programs to PricewaterhouseCoopers before it was commonplace. Here, she shares her favorite initiatives from a forty-year career.
By Randall Colburn
MARGE MAYERSON KNOWS how to stay ahead of the curve. Across her forty-year tenure with PricewaterhouseCoopers (PwC), a multinational firm known for being one of the world’s Big Four auditors, Mayerson and her team have sought to implement benefit programs well before others thought to do the same. Dental plans weren’t always standard benefits, nor were nursing programs for new moms, but, thanks to Mayerson, the managing director of national benefits, and her team, they have become a staple of PwC’s benefits package.
“We’re all about caring for one another, and we want to give our employees the tools and resources to care for themselves,” Mayerson says.
She has seen the firm through numerous changes across her career, most notably during a merger between Coopers & Lybrand and Price Waterhouse in 1998. Still, she asserts that the firm’s values have remained intact through it all.
“As a firm, we foundationally want to build trust in society and solve important problems,” she says. “We care about each other, we work together, we act with integrity, and we want to make a difference in the world. I think that those four tenets are the values that have never stopped being a part of the organization.”
Those values, she explains, have given way to a “highperforming” culture that’s constantly reinventing itself while providing rewarding work for its employees. “There's a lot expected,” she says, “but you get a lot in return.”
Part of that is the benefits. Though she’s had a hand in implementing everything from PwC’s vision care plan to its 401(k), Mayerson says one of the initiatives that sparked a personal passion for her was the New Moms Nursing Program. It came about, she explains, after an employee had premature twins and found herself struggling to produce milk while the children were in the ICU.
“It was horrible,” Mayerson says. “But as a result of her experience, we implemented this program to support nursing moms long before those programs were commonplace.”
The New Moms Nursing Program allows access to a lactation consultant prior to birth, as well as a free, topof-the-line breast pump, access to lactation nurses, and the comfort of nursing rooms within the office. Now these kinds of programs have become normalized, but Mayerson explains that PwC continues to stand out due to the personalized care of its nurses and the high quality of the pump it provides.
Another program of which Mayerson and her team are particularly proud is also one they’re currently working to revamp. The Well-Being Rewards program began in 2008, and, as its name suggests, offered employees incentives in return for getting preventive exams, medical coaching, and engaging in physical activity and community programs. Now, with the prevalence of wearable fitness devices, Mayerson is aiming to tailor the program to better address current advancements in the fitness arena. Other additions to the program include a component incorporating social media, as well as a way to better distribute rewards within these areas.
“When you look at employee benefits, they’re really about helping people to protect themselves. To protect themselves against illness, but also financially in retirement. Our life insurance, too, is there to protect yourself against risk.”
Marge Mayerson Managing Director of National Benefits PwC
“There are a lot of risk protection programs, and this is just one more evolving area in which the firm felt it was important to provide a trusted source for our employees to protect themselves against the risks of what’s happening out there in the cyber world.”
The Well-Being Rewards program is perhaps the best representation of what is a recurring theme throughout PwC’s numerous employee benefits programs: people are responsible for their own health and well-being. This extends not just to physical health, but also financial health.
“When you look at employee benefits, they’re really about helping people to protect themselves,” Mayerson says. “To protect themselves against illness, but also financially in retirement. Our life insurance, too, is there to protect yourself against risk.”
That protection, however, comes with responsibility. “There's a huge component of personal responsibility to our programs,” she says. “I think we've tried to educate people so that they can take care of themselves and their families and have that ability to make a difference not only in their life, but in the lives of their families, their community, and society as a whole.”
That directly coincides with another financial-based program that helps address student loan repayment. Mayerson speaks highly of PwC’s relationship with Gradifi —a leader in employee-based student loan repayment—as part of the student loan paydown benefit. Having collaborated with Gradifi, PwC employees can receive up to $1,200 per year for up to six years that is paid directly to their student loans. Mayerson says PwC was one of the first major companies to incorporate such a benefit for its employees, as the company recognized that student debt has grown into a major issue in society. It also ties directly in with the company’s purpose: to solve important problems.
“PwC recognized early on that student loans are a financial burden and source of stress for young employees,” says Meera
Oliva, chief marketing officer at Gradifi. “By offering this benefit, they’ve raised the bar on what it means to invest in your employees’ financial well-being.”
Mayerson says there’s another area in which PwC is working to protect employees, and that’s digitally. “We just implemented an identity theft monitoring program, which we're offering for free to all of our employees and partners,” she says. “We’re concerned about technology and people using technology appropriately and being digitally savvy. We’re helping employees understand the risks involved and appropriately protecting the security of what's out there within the digital media space.”
“There are a lot of risk protection programs,” she continues, “and this is just one more evolving area in which the firm felt it was important to provide a trusted source for our employees to protect themselves against the risks of what's happening out there in the cyber world.”
That’s a lot to manage, especially in a firm that’s blossomed from 1,000 to 3,500 partners and 12,000 to 45,000 employees during Mayerson’s tenure. But this is the benefit of having someone who’s been with the firm for so long at the helm. Programs like these don’t roll out overnight; they take years of development and refinement.
In helping roll out these programs, Mayerson credits the team with whom she’s worked tirelessly throughout the years.
“It would be remiss of me not to acknowledge the amazing contribution that all of those people have made to my success, as well as to the success of PricewaterhouseCoopers,” she says. “I’m very grateful to have had the opportunity to have spent my career here.” AHL
Gradifi applauds Marge Mayerson and PricewaterhouseCoopers for their leadership and innovative approach to taking care of their most important asset – their people.
Why did she b or row $6 7, 92 8 f or tuition ?
S he did i t t o w or k f or you .
Now there’s a job benefit that helps your employees pay off their student loans.
Gradifi is gratitude.
“Invest in Yourself”
Atlantic Health System’s chief human resources officer Nikki Sumpter found her calling in guiding others toward success as a passionate lover of learning and promoter of well-being
By Lior Phillips
DOCTORS AND NURSES aren’t the only healthcare heroes focused on improving the day-to-day lives of others. As senior vice president and chief human resources officer of Atlantic Health System, Nikki Sumpter knows that firsthand. Each day, Sumpter helps determine the best way to recognize and reward every member of the organization for their contributions, as well as to provide them with opportunities for development. In turn, her work helps Atlantic deliver affordable, inclusive care to individuals in the New Jersey area. Sumpter spoke with American Healthcare Leader about her unexpected route to the C-suite and human resources, how to encourage best practices in a large system, and the importance of a great birthday experience.
In what ways did your journey and experiences prior to joining Atlantic Health System prepare you for your role as chief human resources officer?
When I went off to college I first thought I would be an engineer because my father is an electrical engineer.
I realized that it just wasn’t for me, but luckily my university also had a wonderful business school. I took several HR courses as electives and found I did well in them and loved it. From there, I accepted an internship with Wedge Capital Management and had a great HR mentor there. Upon completion of my bachelor’s degree in business administration, I landed a role with a staffing company. This experience provided me exposure to many industries and careers.
From there I answered a blind ad for a recruitment specialist position. When I received the call about the recruitment position it was with Carolinas HealthCare System (now Atrium Health). I had heard many horror stories about the healthcare industry and wasn’t sure if this was a good move, but I’m glad I ignored the stories. I ended up landing the recruitment position and that role helped to better inform my opinions about healthcare and the great quality of care offered at Carolinas HealthCare. I loved it and worked with an amazing team. I grew my career there for sixteen years, and I hope I ended up making Carolinas an even better place to work.
SVP, CHRO Atlantic Health System
Nikki Sumpter
Dave Martin
How did your career progress at Carolinas? What kind of opportunity were you looking for?
I moved from a recruiter to the senior team leader, to a director, to an assistant vice president of multiple facilities, and then I moved into a more corporate role. I was leading workforce relations and employee engagement in corporate and serving as a business partner to the executive team. During my tenure at Carolinas, I earned my master’s degree from Villanova and was contacted for a position in Texas. Even though Carolinas was one of the best places I ever worked, there was limited opportunity for me to grow quickly there. I went to Texas to join JPS Health Network, which was amazing as well. I led departments outside of HR, and it allowed me to be a more well-rounded business leader and a better executive.
While at JPS Health Network, I learned about the fascinating opportunity at Atlantic Health System. I've been blessed to be able to say that I have set my targets and achieved them.
Can you highlight any turning points that influenced your current role at Atlantic?
One of the major turning points in my career was getting my master’s degree. My parents encouraged me to pursue my master’s immediately after graduation, and I did not listen. When Debra Plousha Moore, chief of staff and former executive vice president, chief human resources officer, joined Carolinas, one of the things that she said to me was, “If you want to continue to grow, you must invest in yourself. It's great that you have a bachelor's degree, great that you've gone on to earn your certification in HR, but you need to go back and get a master's degree.” That was the best advice and reinforcement I could have received.
Why does the world of HR strike a chord with you?
In HR I can be my authentic self. I have a passion for connecting with people in a meaningful way. I view relationships, whether professional or personal, as the best way to understand deeper human behavior. When I was younger, I read Nancy Drew stories where you have to predict behavior to solve the mystery. Applying that to people was so natural for me, and allowed me to help solve business issues. Creativity and innovation are also ingrained in who I am outside of work, and they just naturally spill over. I have been blessed to have a career that is not just work, it is a part of who I am.
What changes did you need to make to the HR function once you joined Atlantic?
I inherited a great team, but there was a need to create a contemporary function to support organizational transformation. In the past, HR had been performing an administrative function, and our strategy was pointing us in a different direction. We needed to have a lens toward the workforce of the future. We have to be really good stewards to help drive down the cost of healthcare and create affordability, access, and inclusion. To do this, I encouraged the team to focus on how Atlantic Health operates, and learn more about the different components of care delivery. I searched for leaders who knew how to build relationships so that we would always deliver exceptional service. The hard work was retooling some ingrained processes. The company is now invigorated by understanding how to support our caregivers and deliver great patient experiences, with the highest quality and safety. That has really been the key to our success.
What have you learned about yourself and the industry since joining Atlantic Health System?
I am the leader responsible for HR at Atlantic Health, but I am not just human resources. I've learned that I have a great strategic mind; I'm engaged in strategic conversations now at a more complex, larger system. I'm constantly learning, and at Atlantic Health I'm learning how New Jersey in particular deals with healthcare. It's a high-cost area for healthcare, and it’s been rewarding to work closely with our CEO and operations team to figure out how we can reduce the cost of care and increase inclusion. We’ve needed to focus a lot more on the disruptors coming into the healthcare environment, and it's causing us to look at things in a different way. We need to not only focus on inpatient settings but also on the wellness component and the move from volume to value. We also need to use our metrics to operate differently.
Can you tell me about the birthday recognition project you recently started?
When I was growing up my grandmother always told me, “No dry cards!” I was told that when you receive a greeting card, one of three things should happen: you should either shout with excitement, you should cry, or something should drop out of the card. When I began with Atlantic, I received a postcard in the mail acknowledging my birthday. The card was redeemable for $5 and
“I am the leader responsible for HR at Atlantic Health, but I am not just human resources. I’ve learned that I have a great strategic mind; I’m engaged in strategic conversations now at a more complex, larger system.”
MERRITT HAWKINS IS PROUD TO SALUTE
it said, “Happy birthday from Atlantic Health.” It was a nice card, but none of those three things happened for me. So, we held a birthday card contest where we asked team members to have a young child in their life draw a birthday card for our team members. We selected twelve winners, and recently I visited one of our medical centers alongside one of those children to celebrate and thank them for being an artist for us. We also decided to box these cards to sell on our website, and proceeds will benefit our employee relief fund.
Generally, I love celebrating with our team and recognizing them for their great work. I have one of the best teams in healthcare, and I am just there to support them and make sure there are no barriers to their success. I feel like I'm their biggest cheerleader. For me it’s about showing love, being a servant leader, and supporting the team. AHL
NIKKI SUMPTER, SENIOR VICE PRESIDENT OF HUMAN RESOURCES AT ATLANTIC HEALTH SYSTEM, AND TO PARTNER WITH HER IN THE RECRUITMENT OF PHYSICIANS AND OTHER KEY HEALTHCARE PROVIDERS.
Think you’re done with digital transformation? New challenges are headed your way as the future of work becomes a reality. Time to get ready for what’s next.
For over 30 years, Merritt Hawkins has been the national leader in physician search and consulting. We are proud to partner with outstanding health care executives such as Nikki Sumpter and to recognize her vital role in achieving Atlantic Health System’s mission of delivering compassionate, quality care.
Meeting Employees Where They Are
Jeremy Galinat takes innovative steps to fuse finance and wellness together to provide the best possible benefits programs to the employees of Caesars Entertainment Corporation
By Lior Phillips
Jeremy Galinat VP, Corporate Benefits
Caesars Entertainment Corporation
Chasman
Photo
THE HEALTHCARE WORLD CALLED to Jeremy Galinat early. His uncle was an orthopedic surgeon, and that connection inspired Galinat to look to a local heart surgeon as a mentor while still in high school. However, his career trajectory changed when he went in to observe surgery for the first time. “I passed out cold,” Galinat says. “I woke up and the nurses were all around me. The doctor looked at me and said, ‘Yeah, I don’t know if this is for you.’” Although surgery may not have been for Galinat, that didn’t mean healthcare wasn’t for him. Instead, he took inspiration from his accountant father and found a way to use a finance background to enhance the well-being of others as the vice president of corporate benefits for Caesars Entertainment Corporation and its affiliated companies.
The world’s most diversified casino-entertainment provider, Caesars Entertainment owns and operates forty-seven casinos in thirteen US states and five coun-
tries, including the world-famous Caesars Palace in Las Vegas. Successfully operating all those properties means employing a massive staff spread across three shifts each day at each affiliated facility, as many of the sites operate on 24/7 schedules. And keeping all of those employees happy and healthy means ensuring that they have a comprehensive benefits package.
Galinat first understood the impact that he could have on the health of an organization when with Wynn Las Vegas, another prominent gaming company. After earning a bachelor’s degree in finance and an MBA, Galinat took on corporate finance roles, but Wynn offered him his first opportunity to take the lessons of the market to the benefits world. “I just fell in love with the work. There is no definitive approach to employee benefits. Each company does things a little different to maximize the efficiency of its program and provide the best benefits they can offer
Chasman
Photo
“Our employee contributions for healthcare are much lower than most national companies. We also have the freedom to try new things such as surgical centers of excellence or expert second opinions.”
employees,” he explains. Instead of conforming to any particular rule, Galinat utilized his extensive understanding of finance and passion for learning to grow in a new direction. By the time he reached Caesars, Galinat had reached a level of expertise within the benefits world necessary to make an impact on a much larger audience. In addition, his experience with executives helped him learn how to prioritize the right projects. Even though he was working in benefits rather than purely finance, the maintenance of strong accounting and financial controls remained critical, as it allowed him to track all spending, easily compare time periods, and analyze information and data from vendors and partners.
Moving to Caesars, a larger organization, meant that focusing on only the most important things became all that much more critical. Managing the benefits of that many more employees meant a lot more work, but it also meant that Galinat could find better rates and have the flexibility to test innovative ideas. “Our size as an enterprise gives us the leverage to provide great benefits for our employees at an affordable cost,” Galinat says. “Our employee contributions for healthcare are much lower than most national companies. We also have the freedom to try new things such as surgical centers of excellence or expert second opinions.”
However, the expanded size also presents its own challenges. First and foremost, it can be more difficult to communicate with all employees when they’re scattered across the country and working at any time in the day. For that reason, Galinat credits his partners in human resources and internal communications for their ability to help bring his messages to the table.
A recent project that required a lot of collaboration and communication was the launch of the Benefits Villa app, a one-stop shop for employees looking for information or hoping to make changes to their benefits plans. “The mobile app came from a need to organize our benefits in a way that members could intuitively navigate to what they were looking for,” he says. Produced in partnership with ClearCost Health, the app connects the organization’s
wellness program, telemedicine, and cost transparency information from multiple carriers. That amount of information may have seemed overwhelming to some employees, but Galinat explains that the team at ClearCost quickly understood the need and delivered a stellar product. “The more they built, the more I envisioned for the app,” he says. “I wanted it to organize all of our benefits, contain digital insurance ID cards, send push notification reminders, and include our annual benefits guide and video.”
Now on version 13.2 of the app, Galinat and ClearCost are always working to make it faster, easier to navigate, and more refined. As a next project, they’re working on developing push notifications that can be activated by ClearCost when an employee could be saving money by using lower-cost providers.
Saving money on the supply side of healthcare is important, but equally essential is impacting the demand. Although many large companies offer comprehensive benefits packages, Caesars’ Wellness Rewards program addresses employee health in a unique way.
Prior to Galinat joining the organization, Caesars brought in nurses and health coaches to circulate within each of its many facilities, as well as established ten medical clinics offering various services. The WellNurses, Galinat says, are the lifeblood of the benefits program. “They’re responsible for not only shepherding employees and their spouses through the program, but also meeting employees where they are in their healthcare journey,” he says. Their passionate contribution to the health efforts of the organization and its employees, he adds, have shown incredible results. In fact, the plan has operated at less than 1 percent inflation over the past five years, a number unrivaled in similar organizations.
Wellness Rewards maximizes the federally allowed 30 percent value of an employer wellness plan. Because it offers such a meaningful contribution, Galinat has seen the plan rise to a participation rate of more than 90 percent. “That’s just unheard of in employer-provided wellness plans. But people are going to participate if it’s very
meaningful for them to do so,” he says. In addition, those participating employees become like ambassadors for the program. “When that many people are participating, there is a snowball effect. They’re talking about it in the hallways, in the employee dining room, and helping one another,” he says. “If somebody has a question, they can ask their coworker and there’s a better than 90 percent chance that person knows about Wellness Rewards.”
“It’s mandatory to empower your members with the knowledge to make informed decisions,” he says. “We genuinely care about our employees. It’s our responsibility as a company to do as much as we can to improve the health of our employees.”
Each year, Galinat hosts a summit at which the nurses and benefits team meet to discuss results from the previous year, learn from recurring challenges, train on best practices, and celebrate successes. “These champions are working on the front lines every day, face to face with employees, and I believe it’s important to pull together for them to see the impact of their efforts at a macro level as well as to take a break and recharge,” Galinat says. Communication and transparency are essential when working with the sorts of innovative ideas that Galinat has brought to Caesars employees. Having those ideas tied to financial incentives lays a strong groundwork, but the Wellness Rewards program endeavors to make as big a difference in employees’ health as their wallets.
All of these decisions, Galinat explains, are made in order to help the many employees of Caesars find their own connection to health and wellness, much like he did. “It’s mandatory to empower your members with the knowledge to make informed decisions,” he says. “We genuinely care about our employees. It’s our responsibility as a company to do as much as we can to improve the health of our employees.” AHL
Jeremy’s pragmatic and thoughtful approach to Caesars’ innovative and comprehensive wellness program, Wellness Rewards, has ensured its sustained success. His willingness to partner with Cigna to invest in and refine the program, has led to exceptional engagement, a significant return on investment and, crucially, demonstrably improved the health of Caesars’ employees and their families.
UMR, UnitedHealthcare’s TPA solution, is the country’s largest third-party administrator for self-funded employee health benefits.
Learn more about UMR at umr.com
www.clearcosthealth.com
Every Product Is an Opportunity
How Rekha Hanu’s tailored approach to patent law is putting Akorn Pharmaceuticals ahead of the competition
By Alison Ver Halen
THE TRADITIONAL VIEW of patent attorneys is of in-house lawyers whose job is to seek patent protection for their products. But, Rekha Hanu, executive director and chief IP counsel for Akorn Pharmaceuticals, works on the other end of the spectrum. Hanu’s job for Akorn, which manufactures generic versions of brand medications, is to defeat brand companies’ patents so Akorn can put its own versions of those medications on the market.
When brand companies launch a new product, they have to list all the patents for that product in a database called the Orange Book. If a generic company wants to launch its generic before these patents expire, it must give the brand company notice of its intention to challenge the patent. This kicks off a sequence of litigation in which the brand and generic companies litigate the validity of the patents.
The alternative to this high-stakes litigation is to simply wait for the patents to expire, at which point generic companies can put their own version of the medications on the market, but that comes with its own risks. Although that route doesn’t involve litigation, it does come with more heightened competition from other generic pharmaceutical companies.
Challenging existing patents is an integral part of Hanu’s strategy for beating the competition, because if you’re the first company to challenge a patent by filing an abbreviated new drug application and you succeed, you get what’s called 180-day exclusivity.
“You can be the first generic on the market, and you can be in the market by yourself for six months,” Hanu says. “That’s a lot of dollars, and it’s a huge benefit.”
When Hanu first came to work at Akorn, the company was more risk averse, choosing to wait until patents had expired before launching new products, but she decided to shake things up. “I treated each product opportunity we had on the books as a case study to highlight the various provisions of the law, including the rewards and pitfalls the law affords the generic company,” Hanu says. “Fortunately, senior management listened, and they started supporting
Rekha Hanu Executive Director, Chief IP Counsel
Akorn Pharmaceuticals
Michael Delott
proposals to employ all the tools we have in this space to help us launch products before patent expiration.”
There are times when Hanu would like to be more aggressive in challenging existing patents and pursuing litigation, but she recognizes that doing so is not always in the best interests of the company, so they’ve had to make some compromises. “We’ve begun to take calculated risks, identify some low-hanging fruit, and engage in the high-profile litigation as warranted,” Hanu says. “Through it all, what I’ve learned is that it’s important to listen and respect the company’s philosophy at any given time.”
Hanu is not the first in-house attorney to note the importance of understanding the intersection of the law and business, but her path there was unique. Having achieved a PhD in neuroscience, Hanu was in her final year of her postdoctoral fellowship when she realized the world of research was not for her.
“There were a lot of management consulting firms on the lookout for PhDs, but partly I believe they thought that this group was smart, driven, and had a lot of problemsolving skills, and they knew these skills would translate to any environment,” Hanu says. “So I was able to completely pivot and make a jump into a management consulting firm that catered to sales, marketing, and strategic consulting for the pharmaceutical industry. It opened my eyes and started my transformation from an academic to a business professional.”
But it didn’t take long for her to realize that the number crunching necessary to work in sales and marketing was not her strong suit, which brought her to another crossroads. “It led to a lot of soul searching and tons of informational interviews,” Hanu says. “I must have availed myself of every alumni network I had at that point, and I was introduced to patent law.”
Hanu decided to go back to school to get her law degree. After graduation, she worked for a private practice firm before finally moving to Akorn. “It’s been a journey that has had stops and starts, but I’m very glad I took that journey because I love where I am right now,” Hanu says. “It’s been a journey with building blocks for the role I have right now and the career I aspire to.”
Most of all, Hanu appreciates that her journey gave her the opportunity to work with a diverse group of people, from scientists to business consultants to executives. “With each phase, you have a whole different category of people that you interact with and you understand the different skills each industry and each function requires,” Hanu says. “I’m convinced that at the core of it all is really how you develop and maintain your relationships and that people are the heart of it all.” AHL
Polsinelli is proud to recognize Dr. Rekha Hanu, Executive Director, Chief IP Counsel for Akorn, Inc.
Polsinelli is honored to partner with Dr. Hanu and Akorn, Inc. to provide straight forward, business oriented legal advice.
Navigating Healthcare for 8 Million Travelers
Grant Tarling oversees the healthcare needs of Holland America Group and Carnival Cruise Line’s eight million travelers and eighty thousand employees on land and at sea for the global cruise and tour company
By David Levine
NOT MANY PEOPLE are lucky enough to say they turned a vacation into a calling, but Grant Tarling can. He has combined his medical background with a love of international travel into a thirty-year career. Now, he is in charge of the medical and public health services of about eight million travelers and employees on sixty-five ships sailing to more than four hundred ports of call every year as Holland America Group and Carnival Cruise Line’s group senior vice president and chief medical officer.
Needless to say, Tarling’s is not the typical doctor story. “I took a convoluted path to where I am today,” he says. Born in Zimbabwe, Tarling moved to South Africa as a
child. After high school, he entered the University of the Witwatersrand Medical School in Johannesburg, and graduated as an MD at the age of twenty-five. From there, he traveled to the United Kingdom and worked in several hospital systems. “I was considering entering a clinical specialty program, but I decided to take time off to work on a cruise ship as a physician for what was going to be a four-month working vacation,” he says. “I found the work in the remote locations and lifestyle fascinating and ended up staying.” Working every day for four months, followed by a two-month vacation, he was able to travel to every continent and immerse himself in different cultures
Greg Tarling Group SVP and Chief Medical Officer Holland America Group and Carnival Cruise Line
and experiences. “This deeply shaped my view of the world and helped me better understand people and their diversity, but more importantly, also see our many similarities,” he says.
In 2001, he moved to Los Angeles and became the vice president and fleet medical officer for P&O Princess Cruises. In 2006, he was promoted to group senior vice president and chief medical officer. To further his education, he earned an executive master’s degree in healthcare administration and policy at UCLA in 2012. He is also an active member of the American College of Emergency Physicians (ACEP) and is entering his second two-year appointment as chairman of the ACEP cruise ship medicine section.
“Shaped by my upbringing in South Africa, I developed a passion for public health, which is a big part of my job. To strengthen my knowledge in this field, I obtained a global health certification from UCLA and became a Fellow of the Royal Society for Public Health,” he says.
Taking care of guests and employees in international waters presents quite the unique challenge and ensures that no two days are the same, Tarling says. “Most guests care needs are largely urgent or emergency medicine,” he says. “In contrast, our employees require mostly primary or preventive care, which requires us to have relationships with care providers globally and to coordinate the care provided onboard with that in an individual’s home country,” he says.
Tarling says many people envision a cruise ship’s medical facility as a firstaid clinic staffed by a retired doctor. But that perception couldn’t be more wrong. “Each ship’s modern medical center has a physical infrastructure that allows provision of a broad range of both ambulatory care services and inpatient hospital services,” Tarling says, including an ICU. It has a self-contained pharmacy, lab and imaging, which is staffed by a small physician-led clinical team. There are about eight hundred clinical staff working at sea
Congratulations to DR. GRANT TARLING A leader
and visionary
whom are supported by about fifty staff in the United States distributed between offices in Los Angeles, Miami, and Seattle. “Of course, I cannot oversee all this without my great team, who are also diversified in terms of skills and experience,” he says.
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“I lead the enhancements to our highly customized EHR platform, and I oversee the governance functions to maintain our international healthcare accreditation through internal and external audit.”
Tarling’s day-to-day responsibilities encompass a wide variety of issues involving leadership, operations, clinical, financial, compliance, and public health matters. “It’s fantastic that we are building so many new ships, and I work on designing the next-generation cruise ship medical centers,” he says. Land-based chief medical officers, he says, have the primary responsibility of managing their health organization’s physicians, including hiring, evaluating, and training them to provide safe, effective medical services to the public. “However, my responsibilities are far broader,” he says. In addition to physicians, he oversees the nursing team and paramedics. He is responsible for all clinical operations, including medevacs, formulary, supplies, equipment, laboratory, and imaging. “I lead the enhancements to our highly customized EHR platform, and I oversee the governance functions to maintain our international healthcare accreditation through internal and external audit,” Tarling says. “Developing policies and procedures to support our more than four hundred quality standards is a continuous process.” He also oversees population-based public health services, including communicable disease prevention and control and environmental health, including food and water safety. Along with getting to travel around the world, he is energized by the diversity of the guests and staff under his care. “We have more than one hundred different nationalities on our ships at any one time. I don’t know any other business that has that mix in such a small environment. It is inspiring to see how well everyone gets along in order to deliver memorable vacation experiences. This is the path I took into the industry, forged on travel and diversity, and I feel very much at home here.” AHL
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Don’t Be a Roadblock,
How changing the corporate culture was merely the first step of Roberta Loomar’s work to establish Apotex Inc.’s in-house legal department
By Clint Worthington
Be a Facilitator
WHEN ROBERTA LOOMAR FIRST ARRIVED at the international pharmaceutical company Apotex Inc. in 2013, she had her work cut out for her in building an entire in-house legal department from scratch. Having been founded in 1974 in Canada, Apotex lacked a concerted legal presence in the United States, Loomar says. “The risks in Canada tend to be different than in the US,” Loomar explains. Therefore, the company had not previously required a dedicated legal staff.
But now in her time as vice president, general counsel— US for Apotex, not only has Loomar built her department into an effective team, she has also found ways to incorporate them organically into the larger corporate culture.
As a lawyer with more than three decades of experience in a variety of legal areas, including pharmaceuticals, Loomar refers to herself as a generalist. In that time, in addition to her experience as a trial lawyer at a number of firms—including Hughes Hubbard & Reed, Gilbride Heller & Brown, and Hogan Lovells—Loomar says she was able to garner an abundance of experience in many different fields of law.
She was eventually approached by a former colleague to work for Andrx Corporation. She joined the company in 2000 as litigation counsel and then soon thereafter, was promoted to assistant general counsel. While there, she expanded the scope of her responsibilities, overseeing employment law, corporate, transactional, and securities matters, and investor relations work, until she collected a comprehensive body of knowledge in pharmaceutical law. She later created the company’s compliance program and was also appointed its chief compliance officer. Watson Pharmaceuticals acquired Andrx in 2006, and she was the organization’s only in-house counsel asked to stay and work at Watson. While there, she acted in dual roles, continuing her pharmaceutical and compliance work, which included litigation, transactional, administrative, and privacy matters.
Now at Apotex, she says that her level of expertise aids her in providing informed advice to the company’s leaders. “I don’t think you can do a good job as an in-house lawyer without understanding how the business works,” she says.
But establishing an in-house legal department for the US division of Apotex was no easy task. “The first thing I did was build a culture of acceptance that established the
need for a lawyer,” Loomar explains. She quickly saw gaps in business leaders’ understanding of many legal issues. “It was clear to me that there were things they didn’t know and didn’t know to ask,” Loomar adds.
Understanding how much more risk and complexity exists in the American legal system, Loomar hired additional lawyers and established an infrastructure for the company’s in-house counsel. The biggest challenge Loomar faced, though, was integrating this new department more organically into the rest of Apotex’ s corporate culture, and the first task was to break old habits.
For example, many members of Apotex were not used to going to in-house counsel first in regard to legal issues. Loomar needed to fight the company’s initial resistance to these changing patterns. “My job was helping them to understand that I was not there to be a roadblock, but a business partner and facilitator,” she says. While Loomar says many in-house lawyers are viewed as naysayers, she views the role in a different light. “I’m an advisor. I’m someone who identifies risk and makes sure that the business partners understand and know that risk,” Loomar adds.
Roberta Loomar VP, General Counsel–US Apotex Inc.
John Fotopoulos
“I’m an advisor. I’m someone who identifies risk and makes sure that the business partners understand and know that risk.”
Despite the challenges of this process, Loomar is heartened by the progress the company has made in adjusting to the need for in-house counsel. She admits that at first the volume of the work was immense, and what’s more, the pharmaceutical industry in general is constantly evolving, forcing Loomar’s team to constantly adapt. But whether it’s the shifting nature of state pharmaceutical laws, or reactionary rules and changes to policy based on political events, Loomar notes that the team is “extremely nimble.”
In fact, she says that as the department has matured, the legal department has learned to better prioritize urgent tasks, as well as gain the trust of Apotex’ s existing departments. “We started implementing more structured processes and templates to make life easier,” says Loomar, adding that this has led to better trust between departments and improved outcomes.
Looking back on all she’s accomplished thus far at Apotex, Loomar says her only regret is not having implemented some of these initiatives sooner, but the admiration she has for her team and the respect her legal department has earned at Apotex, in the United States, and around the globe has set the bar for any company in any industry. And for Loomar, it’s about more than helping the company run smoothly. She believes in Apotex’s mission to provide affordable pharmaceuticals to those who need them. “I never planned to be in this industry, but I’m proud and grateful that I am,” she says. “It’s a job, but it’s more than that, which always helps when you’re working in an industry like this.” AHL
By Jenny Draper
April Andrews-Singh discovered her mission on the surgical floor during her fourth year in nursing school.
That’s where she met a young father with a glioblastoma tumor, which spreads its tentacles through the brain like an octopus. She watched the family grieve with his terminal diagnosis. The man, who was in his early thirties, had developed symptomology earlier in the year, but his insurance company denied the claim because the tumor was a preexisting condition.
“I kept thinking, ‘This is unbelievable,’” says AndrewsSingh, general counsel at Nicklaus Children’s Health System. “I remember having to maintain a professional decorum, but knowing someday I would find out how the game was played and that I would change it.”
For Andrews-Singh, the road to change was paved with professional twists and turns. In 2001, after graduating law school, she started in a midsize private practice. During that time she became a lobbyist.
Two years later, Andrews-Singh began feeling the need to get closer to healthcare and became the associate general counsel and chief compliance officer at Cleveland Clinic Hospital, a joint venture at the time with Tenet Healthcare, with Tenet’s operations based in Weston, Florida. Then, she joined Pediatrix Medical Group (now MEDNAX) as its eastern regional director of compliance, which exposed her to children’s healthcare. “The patient is the entire family, not just the patients themselves,” she says. “The passion people have to take care of pediatric patients is second to none.”
Andrews-Singh followed that passion to Miami Children’s Hospital, now called Nicklaus Children’s Health System, in 2012 as its senior vice president of compliance. Three years later, she stepped into the role of general counsel, where she’s amplifying the role of advocacy in healthcare. The organization houses a fundraising arm, Nicklaus Children’s Health Foundation, and a nonprofit physician practice subsidiary, in addition to the hospital and fifteen outpatient centers in South Florida that house a medical staff of more than seven hundred physicians and 4,200 employees.
The legal leader brought her advocate mind-set with her, and her efforts have revolutionized the organization. Until 2017, Nicklaus was the only children’s hospital in the United States that had the highest volume of pediatric cardiovascular surgery and intervention but did not have a corresponding heart transplant program. After long negotiations with the state and competitors, Nicklaus intends to start pediatric heart transplants this year.
Andrews-Singh also considers the opening of a ten-bed maternal fetal unit for high-risk babies with low-risk mothers an impactful personal victory. Previously, a baby with a pre-existing condition that needed imminent lifesaving surgery upon birth would immediately need to be taken via Life Flight to Nicklaus while mom waited in the birth hospital. However, due to restrictions of the state pediatric specialty license held by Nicklaus, an obstetrics program was not feasible. But Nicklaus was able to persuade the state that in these circumstances, the baby should be born there. “It was one of those moments where you realize that you changed a law that’s actually going to be saving people’s lives,” she says.
There is a whole spectrum of communication and a psycho-social dynamic to pediatric medicine that doesn’t exist in adult care, according to Andrews-Singh. If a child is sick with appendicitis and the family comes out of surgery, staff must help the parents understand the process and must ensure the child understands it in a way that is age appropriate, whether that child is three years old or seventeen years old. The Child Life department creates tools in order to help to decrease anxiety, communicate information, and minimize pain in an appropriate manner.
“We won’t do certain things at the child’s bedside because that’s their safe environment, and we want them to know they’re not going to have painful things like needles,” she says. “Although they might get scared, they’re much quicker to bounce back and not let it bring them down. Children, even in the middle of chemotherapy, have this resilience and zest for life that you would never see in an adult oncology patient with the same diagnosis.”
Andrews-Singh has also restructured her teams to reflect that versatile approach. She brought in an administrative
GIVE HER A HAND.
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“We’ve taken it to a whole new level here. We have technology that allows a doctor here to use an otoscope or a stethoscope on a patient sitting in Ukraine, and the practitioner in real time can see into their ear or hear their heartbeat as clearly as if they were in the same room.”
director as a liaison across legal, risk management, infection control, and quality departments. They meet weekly to debrief and identify trends and preventively mitigate potential issues. Better interdepartmental communication pinpoints outstanding issues and enables her team to provide tools for clinicians, such as a sepsis protocol. Nicklaus differentiates itself through the best innovation technology resources available for patients and their families. “We’ve taken it to a whole new level here,” AndrewsSingh says. “We have technology that allows a doctor here to use an otoscope or a stethoscope on a patient sitting in Ukraine, and the practitioner in real time can see into their ear or hear their heartbeat as clearly as if they were in the same room.”
The hospital also utilizes technology to improve sanitation throughout the facility. Historically, staff would conduct rounds to monitor hand washing: the number one way to stop infection. Now, technology is utilized to tell if a person has passed through to the patient without stopping at the sink. Her team is also developing a safety alert system set to be in the testing phase by the end of the year. The mobile platform provides the ability
to report a safety concern and then dispatch someone to fix the problem on the spot. Everybody in the institution— employees, patients, family members, visitors, and volunteers—become the eyes and ears of safety.
Data from the safety alert system and EMRs will direct risk mitigation systems, and clinicians may use data points to know when to watch a patient more closely. Andrews-Singh references the example set by the airline industry. Pilots are allowed to fly or not based on previous flight hours because they get tired. She is measuring how, for example, a team of nurses with varying levels of experience—say two years and fifteen years— versus a team of nurses all with twenty years of experience can impact risk.
Nicklaus is at the intersection of technology and advocacy, and that’s not just in Florida. After the earthquake in Haiti in 2010, the organization sent about twenty teams to help. They saw firsthand how natural disaster response resources are not prepared for children, such as splints and IV needles that were too large for children. Now, her team has met with the Federal Emergency Management Agency as well as the state of Florida and local governments to create standards around pediatric disaster response and field hospitals.
“We’re often in situations where disaster is the reality. People all the time say to me it must be so sad to work there, and I think actually quite the opposite,” Andrews-Singh says. “There are some moments that make you really sad, but we do miracles every day.” AHL
Greenberg Traurig congratulates April Andrews-Singh for her many accomplishments and outstanding leadership at Nicklaus Children’s Health System. It is our privilege to work with April and we look forward to supporting her continued success.
Assembling the Right Team
How Kevin Donovan is continuing Otsuka America Pharmaceutical Inc.’s century-long culture of collaboraton
By Joseph Kay | Photos by Gillian Fry
IN HIS EARLY YEARS in the financial services industry, Kevin Donovan had been a promising prospect. However, at twenty-three years old, sponsored for management training by a mentor in the credit services division, he decided to take the path less traveled and specialize in human resources for Chase Manhattan Bank. According to his mentor, that was a serious blunder.
“He said, ‘That’s a terrible career decision. Human resources people work for me,’” laughs Donovan, now the senior vice president of people, communications & business services at Otsuka America Pharmaceutical, Inc., where he supports Otsuka Group affiliates globally. “But it was the first major career decision I made. I loved everything about it,” Donovan says.
But it turns out that twenty-three is a great age to make illuminating mistakes. He discovered that the ability to shape the business—to have a finger on the genuine human pulse of the enterprise—spoke to him and drove him to excel. He followed the path out of finance and into the
pharmaceutical field via DuPont Merck Pharmaceuticals, having the opportunity to shape a uniquely different research and development team that successfully brought a new class of HIV/AIDS products to the market.
After seven years, DuPont Pharmaceuticals was acquired by Bristol-Myers Squibb (BMS), and Donovan chose yet another unlikely path. He did not pursue roles with BMS but instead joined the newly merged AstraZeneca. He entered his first global role as he led HR for the global supply chain and had colleagues in Sweden and the United Kingdom. When he later relocated to London for several years in a global HR strategy role, he experienced firsthand the scope and magnitude of challenges and decisionmaking on a worldwide scale. Upon return to the US, Donovan led the human resources team for the US sales division, representing a portfolio of multiple brands that achieved about $12 billion in annual revenue. Leaving AstraZeneca was difficult, but another opportunity to choose the path less traveled was in his sights.
Services
Kevin Donovan SVP, People, Communications & Business
Otsuka America Pharmaceutical, Inc.
Donovan interviewed with Otsuka America Pharmaceutical, Inc. in 2008, and Otsuka’s distinct organizational culture, part of a storied Japanese conglomerate, spoke to him immediately.
“One of our founders said, ‘The purpose of the company is to stay in business forever.’ If you have that type of statement in front of you, you have an opportunity and an expectation to make decisions for the long-term,” Donovan explains.
Otsuka is preparing for its hundred-year anniversary, and its long-standing culture has been what drives the operating model of today. Freed from the immediate pressures of daily stock fluctuations and quarterly shareholder earnings he experienced at prior organizations, Donovan uses his position to care for Otsuka’s culture. The approaches to hiring, onboarding, and performance evaluation are uniquely intuitive and people-focused, he says.
For example, when Donovan sits down with a candidate, he sets out to evade all the traditional interview questions: What are your strengths? Why do you want to work here? These questions are convenient, familiar, and between a seasoned interviewer and a prepared candidate, they reveal practically nothing. Besides, in an environment as unique as Otsuka, they might miss the point.
“We’re looking for people who are learning agile, who challenge convention, and who are able to adapt,”Donovan says.“Do they have ideas that are different? We believe that debate and discussion produce better outcomes than total alignment,” Donovan explains.
He adds that one of the company’s strengths is its willingness to hire on factors outside of the résumé. A person’s potential value-add to the company is greater than their paper summary; and, as Donovan can attest, some non-pharma leaders and associates can thrive here.
In fact, Donovan typically asks new leaders to unlearn much of their past. New recruits, especially executives, often come in with a task list or a ninety-day plan but
they’re asked to put those ambitions aside for a moment to learn the intricacies of a company that’s thrived for a century on its culture.
Once they’ve found their sea legs, though, Otsuka team members find an unusual degree of flexibility in their roles. The themes of shared responsibilities and freedom to operate emerge at Otsuka as colleagues explore ways to make a difference in the future of the company. Donovan recalls last year’s innovation challenge, a company-wide call for fresh organizational proposals. Fifty groups developed presentations around hidden opportunities and dream projects. Finalists presented in front of senior leadership; four of them received seed money from the company and took charge to implement their ideas.
But that was just one prominent example of a company-wide ethic, Donovan says. “If you have an idea, you can quickly bring it up to the most senior-level people and get support behind it. We blur the lines between people’s roles,” he says.
Ironically, Donovan’s experience with data-based approaches has led him away from traditional, ratings-based performance reviews. Without numerical ratings, evaluation is a process of continuous coaching. Managers are
freed from the pressure to group their performers into a bell curve; raises and bonuses, while still performancedependent, aren’t tied to a number.
“No empirical data I’ve found over the past twenty years says that rating people produces better outcomes than a conversation,”Donovan says. “Most companies have done it for the past fifty or sixty years, but I think it has done a great disservice,” says Donovan. He believes that ratings can foster unhealthy competition by emphasizing short-term individual efforts over the continued success of the team. And he’s not alone: “We have quite a few advocates in this organization that believe the we is more important than the me.”
“If you have an idea, you can quickly bring it up to the most senior-level people and get support behind it.”
“A lot of people look at Otsuka and say, ‘Oh, they’re different because they’re a Japanese company,’” he says. “I would say that’s probably sixth or seventh on the list of things that make us uniquely different.” AHL
Enhan the Touch Human
cing
There’s no question technology is becoming an increasingly important part of healthcare today. But despite technology’s growing prevalence, personal connection also remains a critical aspect in delivering high-quality patient care. These four executives understand this evolving dynamic and have spearheaded initiatives that marry the efficiency of technology to the relationships their staff members have developed with patients. In turn, they’re fundamentally changing how care providers interact with the people they serve.
More Than Just an
Ivor Horn, MD, MPH Chief Medical Officer Accolade
How Dr. Ivor Horn takes a human-centric approach to population healthcare
By Jeff Silver
Algorithm
Ivor Horn’s path to medicine was set long before she became chief medical officer at Accolade,
which is a personalized health and benefits solution for employers, health plans, and their members. Her father experienced a traumatic brain injury when she was a child, and she remembers feeling disempowered from the lack of resources available to help her family ask questions when dealing with the healthcare system—let alone know the right questions to ask.
That is why she decided to become a pediatrician and research the dynamics of communication between patients and providers.
“Knowing what my family experienced during my father’s diagnosis and treatment, I wanted to find ways to improve how patients and providers interact,” Horn says.
Her research found that trusting relationships and patient self-efficacy—confidence that their goals will be met—are key factors. After joining Accolade’s advisory board, she realized that the company was already applying her theoretical findings to its work with clients.
In an age when healthcare is often treated as a commodity, Accolade acts as an advocate and advisor to help personalize the experience. This is accomplished by engaging
with individual members to gather information that helps create a holistic context for better understanding their needs and developing a trusting relationship.
The process begins with dedicated health assistants, who are the first points of contact that can grow to include specialty nurses, behavioral health teams, pharmacists, medical directors, and integrated medical teams. These assistants can help with everything from explaining medical bills, health benefits, and making recommendations during open enrollment to explaining diagnoses, locating a specialist or primary care physician, and suggesting questions to ask clinicians during appointments.
“We work from an influence model that doesn’t just focus on clinical conditions, diagnoses, or procedures,” Horn explains. “Health situations are often stressful and confusing, so we listen and engage with our members ahead of time so they understand what’s going on and can make better decisions.”
“It’s like having a doctor in the family who can give you medical advice, but also knows what your health benefits cover,” she adds.
“It’s like having a doctor in the family who can give you medical advice, but also knows what your health benefits cover.”
For example, traditional population health analytics frequently look at where patients live, their gender, or socioeconomic status to gain insights into their health and to determine appropriate recommendations. But they may miss that the distance someone lives from the nearest clinic has less to do with their access to medical attention than the fact that they have to take care of their grandchild during clinic hours. Or that seasonal employment determines whether they can afford to fill a needed prescription medication.
“By developing holistic views of our members, we’re able to truly personalize their care,” Horn says. “That’s why health systems are starting to engage more and more with their communities. They can’t just operate within the walls of the healthcare setting. They have to be where people work, play, and pray.”
She refers to quality healthcare as a “team sport,” and believes that better informed patients enable clinicians to deliver better care. If patients can provide “the right information” and ask appropriate questions, medical professionals can then make recommendations that are better suited to the individual’s condition, concerns, and lifestyle.
The Accolade team takes an active role throughout extended processes, such as hospitalizations and scheduled surgeries. They educate members about the procedure in advance; explain the admission and recovery processes; suggest questions to ask during hospitalization; interact with them, their family, and the care team during the admission; review discharge plans; follow up on progress after discharge; and report issues to the care team, if needed.
Accolade also engages with members before health events occur, which creates ongoing opportunities to guide members to the most appropriate healthcare resources. Outcomes and patient satisfaction with the experiences are greatly improved as a result of such extensive support and interactions between the provider, care team, and member.
As much effort as the company puts into building personal relationships, it also strives to strike the right balance between human interactions and technology. Its online platform enables members to find benefit information and to securely communicate with their health assistants.
The same capabilities have been designed into the Accolade mobile app. In addition to supporting tasks such as researching medical conditions, requesting a replacement insurance card, or getting information on a medical claim, Accolade Mobile connects members to a health assistant via text or phone call. Other team members can be added to a group chat in real time to provide additional expertise for more in-depth questions.
“Technology enables us do incredible things, but an algorithm and chat bot aren’t enough without personal interaction,” Horn says. “The latest innovations can provide analytics and data, but humans have to be part of the equation to create a meaningful context for understanding each individual’s unique situation.”
Accolade’s approach is in sync with the changing medical environment. The doctor-patient relationship has evolved from a one-way interaction in which clinicians simply expected patients to follow their recommendations into a partnership. With so much available information, Accolade helps ensure that both providers and patients have the knowledge and understanding they need to make decisions that lead to the best possible outcomes.
“The healthcare environment has changed tremendously since the experience I had with my father,” Horn says. “It’s exciting to help spur on and maintain that shift—and why I continue to be passionate about the work I do.” AHL
TechPatient Care savvy
Bennett Cheramie VP, Information Systems
Hospital
Bennett Cheramie on the four technologies he’s implementing to revolutionize patient care at Baton Rouge General Hospital
By Galen Beebe
Baton Rouge General
When Bennett Cheramie began working as a nurse in the 1990s,
healthcare was not a technologically savvy industry. Computer programs were used more by the organization than by clinicians, and clinicians hardly used email. When the health system where Cheramie worked began introducing EMRs and patient scheduling, he volunteered to help the IT department understand operations and train clinicians.
“Originally, we tried just saying, ‘Here’s a technology. Start using it.’ And we failed miserably,” he says. “We realized that, like with most technology, we needed some sort of middleware. That’s really where I found my niche: aligning the operation with technology.”
As Cheramie shifted toward technology, his experience in operations proved invaluable. Now, he’s vice president of information systems at Baton Rouge General Hospital, where he uses technology to streamline clinical processes and individualize patient care.
Visualizing Process
As a former nurse, Cheramie knows that being able to quickly identify patients’ needs is key to keeping the hospital running smoothly. To improve transparency and communication, his team installed screens throughout the hospital that show a map of the nursing units with each room tagged using color-coded symbols.
The same board appears in the emergency department, allowing emergency department nurses to better coordinate with nurses on the floor. When a patient is admitted,
an emergency department nurse quickly assesses which room is available based on the screen’s colors.
“When we discharge a patient off the floor, the room on the visualization board turns brown,” Cheramie explains. “That notifies housekeeping to clean the room. Once they’ve cleaned the room, they click the button and it turns green, thus allowing the patient and the nurse in the emergency department to know that the room is ready.”
These automatic updates reduce unnecessary wait times, and patients recognize the change. “It’s exciting to walk through the hospital and see the transport guy picking up the patient and the patient saying, ‘That was fast.’ I know that in the background we have technology powering his work to help him expedite care,” Cheramie says.
With the help of this program, the hospital has improved discharge times by an average of five hours, and they have raised their Hospital Consumer Assessment of Healthcare Providers and Systems scores to the ninetieth percentile. “We’re constantly looking for new adaptive ways that this technology can aid the organization,” he says.
Improving Communication
To further improve communication, Cheramie’s team introduced the secure texting application Imprivata Cortext. With this software, clinicians can send messages from any cellular device or computer directly to a patient or family member’s texting app. For example, a nurse might text a
patient’s family member to let them know that the patient is out of surgery and that the surgery was successful. “It’s giving that one personal touch to the patient or the patient’s family when they need it,” Cheramie says.
The system also saves crucial time. Using Imprivata Cortext, the hospital has reduced the time it takes to transfer a patient having an active heart attack from an ambulance into the catheterization laboratory. The hospital aims to complete the process, which includes multiple assessments in the emergency room and preparing the lab, in under ninety minutes.
Previously, clinicians communicated using a variety of technologies, including pagers, landlines, cell phones, and email. “Now, this communication is done through Cortext in a cascade of secure text messages,” Cheramie says. The hospital has dropped the time it takes to get a patient who is having a heart attack into the cath lab to an average of sixty to sixty-five minutes. “Imprivata didn’t do that— our people did that for our patients,” he says. “But the technology helped catalyze the change.”
Unifying Care
After leaving the hospital, patients continue to communicate with Baton Rouge General through the patient portals they use to pay their bills, review their doctor’s office visits, and see information about their hospital stays. Historically, these portals were separate, but this proved challenging for patients. “When you have different electronic medical records or different bill paying systems, it causes a lot of angst,” Cheramie says. “What we are trying to do is create a unified patient portal.”
The hospital has partnered with the company eClinicalWorks, whose platform supports interoperability with most EMR vendors. “Partnering with a company that promotes interoperability is paramount to what we’re trying to do here,” Cheramie says. “If you’re from California and went to the hospital in California, and you moved to Baton Rouge and see the doctor in Baton Rouge, he should be able to access your medical record from California without having to call the hospital in California. It should be easily portable over to this platform.”
“It’s exciting to walk through the hospital and see the transport guy picking up the patient and the patient saying, ‘That was fast.’ I know that in the background we have technology powering his work to help him expedite care.”
“The toughest thing about what we do in developing solutions for healthcare folks is the ability to change, and we’re going to be asking a lot of people to change a lot of things. But it’s all about what’s best for our patients.”
Predicting Change
In 2017, Baton Rouge General began implementing artificial intelligence and machine learning technologies to identify and prevent sepsis. Using Wolters Kluwer Health’s clinical intelligence platform POC Advisor, physicians will be able to prevent and treat the life-threatening infection.
POC Advisor’s algorithm assesses physical symptoms, health conditions, and social determinants of health and compares individual patient information with data from healthcare facilities across the country. The system then informs the physician of the patient’s risk of developing sepsis, the factors that contribute to that risk, and a suggested treatment plan.
“This project, I believe, is going to be the model for the future of healthcare at Baton Rouge General, leveraging analytics, machine learning, and clinical decision support,” Cheramie says. “The toughest thing about what we do in developing solutions for healthcare folks is the ability to change, and we’re going to be asking a lot of people to change a lot of things. But it’s all about what’s best for our patients.”
AHL
When he was confronted with budget cuts, Mark Farrow reduced costs and improved patient care by combining in-house IT with outside consulting
Grow ing Against the Grain
By Galen Beebe
VP & CIO
Mark Farrow
Hamilton Health Sciences
The technology landscape has changed significantly
since Mark Farrow joined Hamilton Health Sciences (HHS), a multicampus, academic teaching hospital in Ontario, in 1999. “The system that we installed that helped make this a fully computerized, automated hospital had less horsepower than what I’ve got in my iPhone today,”
Farrow says.
In the nearly two decades since he joined, Farrow, vice president and chief information officer, has implemented new systems across the organization; however, his budget has not grown accordingly. After optimizing contracts and increasing efficiency to adhere to budget cuts, the only thing left for Farrow to reduce was staff. But that was one sacrifice he wouldn’t make. “I’ve invested in this talent pool, and I really wasn’t willing to give that up and lay off people,” he says.
So instead of decreasing the department’s size, he transformed its approach.
His team reimagined itself from an IT department to Health Information Technology Services, an IT consulting and hosting service. With this rebrand, the team began taking on more clients. In addition to supporting HHS, Farrow’s group now offers hosting, security, application
support, strategic planning, and other services to outside organizations. “We found that a lot of organizations that don’t have our depth and breadth can contract with us, they can get access to an entire department of skill sets,” Farrow says.
One program the organization implemented to aid in this transformation was ClinicalConnect, a clinician-facing portal that pulls together patient information from across Southwest Ontario in a single, easy-to-use platform, in real time. Farrow launched the program internally in 2007, with the goal of connecting patient information within HHS. The organization had previously stored information on a number of different systems, leading to dangerous miscommunications among the systems’ branches. By connecting patient information quickly and consistently, the program improved patient care across the organization.
As other hospitals in the area learned of the portal, they sought to connect it to their own system. Farrow saw how this could serve both the patients’ needs and his department’s. “Hamilton is a tertiary referral center. We have patients going back and forth, so they thought this would be a much better way to help get patients to us as well as
repatriate patients back to their home hospitals,” he says.
“The more that we can put the patient at the center and share that information, the better it is for the patient, and the easier it makes it for our clinicians. Access to good information is what healthcare is all about.”
ClinicalConnect works so effectively in part because the data is stored in the host systems, allowing individual organizations to securely share information with the platform while maintaining its system’s backend code. “We’ll treat any hospital’s host system as the source of truth, and we point to the source of truth,” Farrow explains. The only information that HHS stores is the patient’s registration information, which is used to create a pointer to the host system. “When you go in to call up the patient, you’re not having to go out and search all of the points where that patient could have been registered. We know where the patient is and we put the calls out only to those systems to grab the data back. It keeps that level of efficiency, but it’s not creating another repository,” he says.
In 2010, Farrow and his team began to roll ClinicalConnect out to other organizations. With funding from eHealth Ontario and Canada Health Infoway, they have
Because of the implementation of ClinicalConnect, Hamilton Health Sciences employees are able to access patient medical records with extreme efficiency.
scaled ClinicalConnect to include information from all acute care hospitals, Local Health Integration Networks’ Home & Community Care Services, and regional cancer programs in Southwest Ontario, as well as various provincial data repositories.
Now that the connections are in place, Farrow and his team have begun to implement a patient-facing portal, which will allow patients to access their data from across healthcare systems in one secure platform. The system will especially benefit patients with chronic diseases who might see multiple clinicians in various organizations, each with its own patient portal. “You don’t want to have to go into each one of those different portals and try to stitch the information together yourself,” Farrow says. “Where we’ve created the largest federated access on the clinician side, we plan to do the same thing on the patient side now. I think that is going to be a game changer for how we can interact with our patients within the province.”
Programs such as ClinicalConnect have allowed Farrow to grow his team, which now has more than one hundred members. Through consulting, the group learns how other organizations operate and works on a wider scope
“The more that we can put the patient at the center and share that information, the better it is for the patient, and the easier it makes it for our clinicians. Access to good information is what healthcare is all about.”
of responsibilities, as well as a wider scale. “It helps my team build their overall skill set, and I end up with a better workforce,” Farrow says. “My staff is happy because they’re being given opportunities that they might not have had, and my clients are happy because they’re getting healthcare professionals that are helping them move forward, and we can do it in a very cost-effective manner.”
Thinking of HHS as a client, rather than an employer, required Farrow’s team to shift its approach to its work, and this might be the biggest change of all. “It has made them take more ownership and be more focused on what they’re doing,” he says. “For me, it’s been a win across the board.” AHL
ClinicalConnect is a comprehensive, fast, easy-to-use, and highly visible web-based enterprise solution that gives healthcare providers on-demand access to patient data enabling them to make informed diagnostic and treatment decisions. This patient priority system comes with highly customizable workflows designed to optimize access and performance to patient clinical data. ClinicalConnect is powered by the aptean ClinicalLink solution.
Easy-to-Use Interface
A highly configurable user interface and workflow allow the application to best suit the needs of individual providers and processes. ClinicalConnect® is also accessible on tables and mobile phones.
More Detailed Data
ClinicalConnect® instantly retrieves patient data stored in disparate systems and displays it in one comprehensive view for care team members across the connected health system.
Affordable
As the best value for your budget, ClinicalConnect® saves you the cost of having to replace existing IT systems or consolidate EHRs.
Now Versus
By Jeff Silver
David Kaercher SVP & CIO
Blue Cross and Blue Shield of Kansas City
Mark McDonald
The challenges facing healthcare insurers are daunting.
In the midst of structural changes that are altering reimbursement levels and how care is provided, customers are also demanding affordable, accessible, personalized coverage that produces quality outcomes. Insurers must also find ways to accommodate their preferences, which range from traditional face-to-face exchanges with nurses and physicians to patients who prefer to do online research and get diagnoses through telehealth appointments.
David Kaercher, senior vice president and chief information officer of Blue Cross and Blue Shield of Kansas City (Blue KC), has led several significant technology initiatives to help the organization address these issues and more—all of which are helping Blue KC evolve into a primary care partner.
“When I worked in banking, we had financial advisors dedicated to ensuring personal customer guidance and service,” Kaercher says. “The IT team is establishing a foundation that enables us to bring that same kind of attention and facilitation to our Blue KC customers.”
To do that successfully, Kaercher first had to build trust within the organization. In the past, IT had not produced results commensurate with the amount of investment that had been made in the department. In the Show Me State, that left people skeptical.
To alleviate concerns, Kaercher’s first step was to cultivate a “Yes We Can” culture, which began with benchmarking the organization. The early data revealed that peer organizations were spending eight times more on innovation. They were also spending 20 percent less on maintaining their legacy systems.
To effectively address such issues, Kaercher shifted how the organization views its processes and the model on which it runs. “Creating a new culture has enabled us to build an agile and sustainable operating model that strikes a healthy balance between agility, execution, and cost,” he explains. “The results range from clinical enhancements to
infrastructure improvements that patients will never see but will still have a positive impact on their experiences.”
The new culture has already produced noticeable results. In 2017, 32 percent more successful projects were delivered than in 2016, and in 2016, 23 percent more successful projects were delivered than in 2015.
Much of that success was made possible by embracing Vijay Govindarajan’s 3-Box Approach to Innovation and Change, Kaercher says. The approach helps manage change through Box 1: Manage the present or “The Now;” Box 2: Selectively forget the past; and Box 3: Create the future, or ”The Next.”
The following five projects illustrate what Kaercher and the new culture are helping Blue KC achieve.
Spira Care Centers
In January, Blue KC entered the primary care market by opening its first Spira Care Center, and others are planned to open in the near future. Each is expected to accommodate several thousand patients, who will work with individual care guides to help them navigate the healthcare system and to understand their treatment options while achieving high-quality outcomes. “If Spira helps drive down the cost of care while maintaining positive outcomes, that’s a success,” Kaercher says.
Catalyst Teams
As part of the new culture—and among the reasons IT productivity has increased so dramatically—Catalyst Teams assess business priorities and aggressively pursue opportunities. In one recent instance, team members attended a three-day Microsoft Technology Center (MTC) hack-a-thon, where they created a Spira Care mobile app that can schedule appointments, show locations, and provide contact information for care guides. Kaercher estimates that it previously would have taken up to six months to get the same results.
Cloud-First Initiative
Blue KC is the first of the Blue plans to retire its mainframe data system without outsourcing or BPO contracts. It may also be the first with more than five hundred thousand members to retire its data center. The center is now only 20 percent of its previous size. Its two off-site colocation systems and full cloud migration—which is expected to be completed in the first quarter of 2020—will save the company 20–30 percent of its current operating costs.
Workday Cloud Platform
This program, known internally as BlueLink, is serving as the benchmark for Blue KC’s future efforts. It rationalized and consolidated six autonomous, fragmented, and disconnected applications into a single integrated platform that handles all finance, HR, and learning management functions. It has also introduced automation that has eliminated all manual data processing and shortened the time required to complete many payroll and HR functions. In many cases, what took days to accomplish now takes only minutes or hours. In addition to more accurate and efficient reporting, Kaercher conservatively estimates that the Workday platform will save more than $1.3 million annually in maintenance costs.
Apigee API
Kaercher sees Google’s Apigee platform—the Blue KC API engine—as the “digital glue” that replaces traditional extract, transform, and load development. “API’s go hand in hand with our enterprise data and cloud-first models,” he says. “In addition to reducing the time to access or integrate data from weeks and months to hours and days, it’s critical that we are able to securely integrate and share data with our Blue KC customers and partners.”
While all of these implementations and initiatives position the organization for an increasingly digital healthcare environment, they have an even greater significance for Kaercher.
“These are the kinds of challenges that drew me into healthcare as a career,” he points out. “Part of our job is to act as counselors and educators. If we can leverage data and analytics to help our customers make proactive, positive changes, those are opportunities for us to help them live happier, healthier lives.” AHL
David is a true business-driven CIO with a solid grasp of the healthcare ecosystem as well as its associated business models and opportunities. His deep understanding of the business gives him the ability to rapidly deploy IT to solve business problems and innovate on today’s toughest healthcare and consumer challenges.
Making a difference in the world.
Procuring a Healthier Future
Jeff Scott is helping PRA Health Sciences keep pace with unprecedented growth
By Jeff Silver
Jeff Scott VP, Global Procurement
Health Sciences
PRA Health Sciences has experienced explosive growth in the past several years. Business has expanded from about $700 million and five thousand employees in 2012 to $2 billion and more than fifteen thousand employees. Its contract research clients span the world—throughout eastern Europe and Asia, as well as parts of South America and Africa. To help keep pace, PRA added Jeff Scott, vice president, global procurement, to its staff in 2017.
“Our strategic third-party partners are integral to our success,” Scott says. “As business increased, we not only recognized the need to invest in additional resources to support procurement, but also that more specialized expertise was needed to optimize the processes. Those strategies have allowed project staff to keep their focus on science and a separate team of professionals to focus on procurement.”
Much has changed in procurement since Scott began his career, including the development of formal college-level classes to train practitioners. Although he believes it is important to introduce well-trained professionals who are familiar with the technologies and can keep up with the pace of change, he knows there’s a limit to what individuals can learn in a classroom; they need real-world experience to learn about things such as negotiating, reading contracts, interpreting terms and conditions, and—something Scott learned the hard way—attention to detail.
Early in his Lockheed career, he ordered a round rubber spacer needed for a supersonic spy plane the company was building. However, the specifications called for a square one.
“Something that I didn’t think made much difference resulted in a plane that couldn’t fly and an unhappy program manager standing at my desk,” Scott says. “The moment you see in the notes that it’s because of a mistake you made, you learn very quickly to appreciate that there’s no such thing as a small detail.”
Scott’s operational strategies depend on whether he is handling clinical, research, or infrastructure projects, as well as any associated regulatory guidelines, client requirements, and project locations. To address these details, he and his team frequently work with external third parties that offer highly specialized expertise and have proven themselves to be reliable, long-term partners.
The three-to-five-year agreements that are typical in these scenarios help transactions occur more efficiently and help support his objective to provide service that is consistently quick, nimble, and the best value.
Scott has prioritized creating working relationships in which partners are expected to be proactive and to take ownership of their performance. And, unlike many other
companies, part of that approach is to encourage them to challenge PRA requests and requirements if they believe they can offer a more effective or more efficient solution. In one instance, a partner the company has worked with for more than fifteen years recommended a complete outsourcing of a particular service that PRA traditionally performs internally. As a result, this strategy is being implemented on projects where it helps support the stated objectives and the partner is clearly able to add additional value.
“We foster an environment in which partners can suggest alternatives if they can explain why we should be doing something differently,” he says. “They are the experts, so it makes sense to encourage them to play a role in our efforts to do what we do better.”
“We foster an environment in which partners can suggest alternatives if they can explain why we should be doing something differently.”
“The beauty of partnering with PRA is their willingness to engage their domain experts,” says Elena Logan, senior vice president, Eurofins Central Lab. “As their laboratory specialist, we’ve contributed to critical items pertaining to laboratory solutions and the use of leading-edge technology that ultimately provides value to sponsors.”
From the beginning of his relationship with PRA, Scott brought an outside perspective that helped highlight the benefits of introducing specialized procurement expertise. Even during his interview, he made the case for investing in new technology that would help optimize operations, potentially delay the need to hire additional staff, and drive additional savings. One of his current initiatives is researching and evaluating a range of best-in-class contract management and vendor management tools that will assist with tasks such as supplier onboarding, vendor management analysis, procurement, and creating a supplier portal.
He anticipates that once the final choices are made, a staged implementation strategy will be coordinated with a comprehensive communication plan to help support an ongoing transition to the new platforms.
Scott and his team have already leveraged existing policies to develop standard procedures and scalable,
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I M P E R I A L D E L I V E R S
Your passion for excellence means you’ve consistently adapted to the ever-changing environment in clinical trials. That’s our story too, and after four decades we remain a strong leader in clinical trial services.
“We don’t expect our growth to level off anytime soon, so all our planning and ongoing changes will help support the company as we move forward.”
repeatable processes. Contract templates for third-party agreements, for example, have already produced results by significantly reducing the time to execute agreements compared to the time required to develop each individual contract from scratch.
Imperial actively meets the challenges that CROs and sponsors face every day when globally procuring and distributing ancillary supplies and equipment.
“We don’t expect our growth to level off anytime soon, so all our planning and ongoing changes will help support the company as we move forward,” Scott points out.
For start-to-finish clinical trial support, call on Imperial.
As the procurement team has developed and expanded, it has been able to offer some unexpected capabilities. One example is Scott’s coworker Angela Tabick, a new addition who is able to offer expert advice on import/export regulations and logistics. Her input has become a corporate level resource, and she now sits on PRA’s internal committee that focuses on import/export regulatory compliance.
Scott believes that Tabick illustrates the kind of value that procurement can provide. “Our department recognized import/export compliance as a potential area of risk, so we took action that now benefits the entire company,” he says. “Making sure that kind of issue is addressed is what we’re here for.” AHL
With more than forty years of experience, Imperial Clinical Research Services optimizes clinical trial outcomes for study sponsors through evidence-based patient engagement programs and robust site support. Imperial specializes in patient engagement, ISO-certified clinical translation services, and site readiness and support through study material production and global fulfillment of ancillary supplies.
NET(net) congratulates Jeff Scott and the entire PRA Health Sciences team on being recognized for their achievements and innovations. We place tremendous value in our relationship and look forward to many more successes together in optimizing PRA’s technology supply chain. To learn more about NET(net), please visit: www.netnetweb.com.
Relationships Built to Last
When Singulex decided to relocate its lab 1,800 miles away, Byron Clendenen relied on relationships to ensure a successful transition
By Galen Beebe
ALTHOUGH BYRON CLENDENEN joined Singulex Inc. in 2014, the move was twenty-five years in the making. It began when, early in his career, he met Bill Hammack, vice president of human resources at the medical imaging pioneer, Diasonics, Inc., who would go on to become his mentor.
Clendenen’s and Hammack’s professional paths split when Diasonics sold its MRI division, but they maintained their relationship over the next two decades. When Hammack, Singulex’s original vice president of human resources and now its executive advisor, approached Clendenen about joining Singulex, he quickly agreed to come on board. “What I have found in business is that the efficacy of the business model is important, but doing business is fundamentally about relationships,” he says. “It was a relationship that was twenty-five years in the making that brought me here.”
This relationship-focused approach has defined Clendenen’s work as vice president of human resources at
Singulex. For example, when the company decided to relocate its clinical lab testing services from California to Texas in 2017, he knew that his team would have to leverage relationships with both current employees and outside partners to complete the transition.
Singulex Inc. comprises two separate businesses. Singulex is an immunodiagnostics company at the forefront of Single Molecule Counting technology, a novel immunoassay technology recognized for unprecedented ultrasensitivity in the precision measurement of biomarkers. And then there’s Veridia Diagnostics, which is a clinical lab that services physicians across the country and provides exclusive access to Single Molecule Counting technology. The results of these tests enable physicians to diagnose conditions better and thereby transform patient care from reactive disease treatment to proactive health management.
Veridia Diagnostics represents one-third of Singulex’s workforce. Because many employees chose not to relocate with the lab, the human resources team, in partnership
with Veridia’s management team, had to simultaneously build a new workforce in Texas while supporting outbound employees in California. “That was a herculean task of putting one foot on the accelerator with respect to hiring a workforce at the new location, and at the same time gently tapping the brakes with the existing workforce,” he says.
As always, Clendenen began by establishing relationships—this time, with the local players who would help to ensure the company’s success. Veridia executives and HR partnered with the Round Rock Chamber of Commerce and Workforce Solutions of the Texas Workforce Commission to source and interview qualified candidates. “It was a fruitful partnership all the way around,” he says.
With the guidance and support of its CEO and executive team, Singulex HR leveraged existing relationships among managers and employees to ensure Veridia’s retention of its veteran lab talent throughout all phases of the transition. The company emphasized transparency, which meant clearly communicating the terms for those employees who chose to relocate and for those who didn’t. For employees who chose to pursue other opportunities, Singulex provided outbound employee services, including job search training and job leads. “Our management team took all steps necessary to ensure that everything we communicated to our impacted employees bore fruit,” he says. “There weren’t any gotchas. There wasn’t any fine print.”
This was critical because much of the transition’s success hinged on maintaining veteran employees’ trust. These individuals would be crucial both in seeing Veridia through its relocation process and in preparing the new workforce to assume lab production responsibilities at the new location, Clendenen says. New hires traveled from Texas to California for multiweek trainings that were guided by their outbound colleagues. Initially, Clendenen wondered how outbound employees might respond to needing to train their replacements. Ultimately, however, “there was a great deal of camaraderie,” he says. “In the most challenging moments, our people rose to the occasion and really demonstrated their character as aligned with the business need.”
This year, Clendenen plans to build on Singulex’s history of internal advocacy by implementing a mentorship program that will advance professional development opportunities for employees across the country. He and his team are pursuing adoption of an online platform that will enable employees to meet with mentors remotely. “Because of the newly distributed nature of our workforce, this initiative will enable employees from one business to exchange
Bryon Clendenen VP, Human Resources Singulex Inc.
BYRON CLENDENEN
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From Business to Beekeeping
After more than two decades in human resources, Clendenen aspires to someday manage a different kind of workforce: bees. “Bee colonies are one of nature’s original workforces,” he says. With beekeeping, as with human resources, Clendenen’s role would be one of helping. “I’m not going to be scaling the colony. The bees are going to need to do that work. But I’ll be working to establish the conditions so that the colony can flourish.”
ideas and be mentored by more experienced colleagues in our other business hundreds of miles away,” he says.
EPIC is proud to be the employee benefits consulting partner of Singulex and to support your mission to develop and deliver revolutionary immunodiagnostics driven technology to the healthcare industry.
Another HR initiative will be the adoption of a platform for providing online learning opportunities that employees can attend on their own time and at their own pace. “It’s about ensuring that we have methods and processes that are consistent and that place a premium on shared experiences,” he says. “We find that shared experiences and a shared vocabulary leads to better focus and better team execution.”
After more than a year of preparation, Singulex’s California lab closed its operations on a Saturday in January 2018, and the Texas lab began clinical testing just three days later. “It was literally lights off at one facility and lights on at another,” Clendenen says.
As Singulex evolves, Clendenen’s focus remains on supporting the business by supporting its employees. “This HR team is all about facilitating relationships—one employee at a time—so that our people can focus on what they’re really here to do, which is to do their very best work,” he says. “The business is never about HR; HR has to be about helping the business advance.” Cultivating and honoring relationships is what makes those advances possible. AHL
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By Danny Ciamprone
David Whitehead gazes out across his farm in Cavendish, Vermont.
Complete with an orchard and vineyard, the eighty-five-acre landscape is about a three-hour drive north from his hometown of Norwich, Connecticut. It’s almost ironic that Whitehead has chosen this place as his retirement destination, whenever that time comes, as his entire life has figuratively been rooted in giving back to his community.
From seeing his parents volunteer in the community to working as the president and publisher of his hometown newspaper to then serving as president and CEO of The William W. Backus Hospital, it’s fair to say that his tireless involvement in his community is ingrained in his DNA.
“That concept of giving back just rooted itself within my core. So intrinsically, I have this deep motivation to give back to the community,” he says.
Today, Whitehead still lives in Norwich, a small city forty miles from Hartford, Connecticut, where he serves as executive vice president and chief strategy and transformation officer of Hartford HealthCare—Connecticut’s most comprehensive healthcare network. Since joining Hartford HealthCare after Backus Hospital’s affiliation with the system in 2013, his roles have varied somewhat, but no matter his title or responsibilities, he lives by a key mantra: the patient always comes first.
“Everything we do must center around the patients we serve,” Whitehead says. “The support mechanisms that we put in place for them and for their families need to tie together with all of the service provisions that we have clinically.”
David Whitehead EVP, Chief Strategy and Transformation Officer
Hartford HealthCare
Chris Rakoczy
“Everything we do must center around the patients we serve. The support mechanisms that we put in place for them and for their families need to tie together with all of the service provisions that we have clinically.”
Whitehead has been in the healthcare industry since 1999, and although he has always had a focus on putting patients first, it was in 2007 when he became a patient and survivor himself that emphasized his focus on the patient journey. That year, he was diagnosed with prostate cancer at forty-seven years old, and he experienced everything from diagnosis to the mental and physical preparation for treatment. But it wasn’t just his journey as a patient that shaped him. He and his wife have five children, who at the time ranged in age from ten to twenty-five years old, so the journey was shared with his family.
“It helped me to gain a deeper understanding of what we could do at Backus Hospital, what we needed to do, and what we must do to better serve patients and their families as they’re on that particular journey of achieving survivorship,” Whitehead says.
Whitehead experienced that journey again shortly after, when his mother had a severe heart attack. Then, during her triple bypass surgery, it was discovered that she had stage IV lung cancer and died three days before Whitehead took over as president and CEO of Backus.
“To lose her that quickly just further motivated me around this issue of what can we do for members of our community both preventively, diagnostically, and procedurally,” Whitehead says. “And then from a survivor perspective, it’s making sure we’re moving their health status in a positive direction, or at the very least, maintaining their health status without further decline.”
Whitehead brought that same mind-set with him to Hartford HealthCare after the affiliation. He describes Hartford HealthCare’s approach as an ongoing and engaging relationship between the health system and the people it serves, both for patients and nonpatients. For example, a person can be engaged with the health system by being enrolled in Hartford HealthCare’s weekly news updates, being subscribed to one of its digital media platforms, or attending one of the health system’s community or health education events.
“At some stage, that customer relationship generates the patient interaction,” Whitehead says. “That’s because we’re engaged. We’ve created that relationship that they’re looking for us to be the provider of care for them when they find themselves in the patient condition.”
That is an extension of Hartford HealthCare’s vision to be the most trusted provider in personalized, coordinated care. For Hartford, that takes place both within the healthcare system and in the community at large. In the past, understanding the root cause of health status within a community had been difficult when trying to assess social determinants such as health, housing, food access, food quality, security, and education. Now, with data and analytics, Whitehead and his staff at Hartford HealthCare can hone in on root causes of these determinants and then provide further healthcare education and support.
For example, diabetes education programs can take place throughout the system, but now hospitals may be able to
Different Industry, Same Mission
Before entering healthcare and later becoming the executive vice president and chief strategy and transformation officer for Hartford HealthCare, David Whitehead was in an unlikely industry: newspaper publishing. But as Whitehead shares, the two industries have more in common than many realize.
While working with the Gannett Company, Whitehead had the opportunity to return to his hometown of Norwich, Connecticut, to become the president and publisher of his hometown newspaper. As the voice of the newspaper, he cherished the opportunity to become more involved in the community, sharing news of accomplishments, and showcasing the residents who are bettering the area.
“A lot of people said to me, ‘How did you ever move from newspaper publishing to healthcare?’ For me, it wasn't about the industry. It was really about caring for people,” Whitehead says. Whitehead then had the opportunity to join his hometown hospital, The William W. Backus, as vice president of corporate communications. It was also the hospital where he was born and where his family had worked and volunteered at for a number of years. Even then in his column for the weekly employee newsletter, Whitehead would finish each one with: Patients first. Always. “All of that connects back to this intrinsic motivation to be engaged in supporting, helping, shaping, nurturing, and caring for the community,” he says.
focus on a particular area, even a particular zip code, where diabetes is rated highest. From there, they can assess what the social determinants are and understand the root cause of diabetes within that community to provide care and education.
“To me, that is the work that we have underway that I believe will help reshape health status within the communities that we serve throughout Hartford HealthCare,” Whitehead says. “It’s not going to happen overnight. It’s a journey, but you have to start by looking at it from that perspective.”
Having an ingrained concern for the community doesn’t stop with Whitehead, though; he says it’s the culture at Hartford HealthCare that cultivates those values of giving back. In fact, on any given morning, there could be close to six hundred daily huddles that take place in work units across Hartford HealthCare recognizing staff achievements and focusing on process improvement for patients.
“It’s about giving Hartford HealthCare’s team—which is nineteen thou-
sand strong—an operating model in which they’re informed and they’re problem-solving at the closest point of contact to the patient,” Whitehead says. “We have embraced lean daily management within this organization. It is part of our daily operating model.”
It’s clear that much has evolved in the healthcare industry since Whitehead first entered it in 1999. But whether it’s when he first started, now as an executive leader, or in a few years when he settles down in Vermont, one truth has always been apparent: the desire to serve others.
“The thing I love about the people I have worked with in the past, the present, and I know in the future when it comes to healthcare, is the intrinsic calling to want to serve people,” he says. “I have not come across anyone I’ve worked with in my nineteen years in healthcare who I believe came into this industry just because they needed a job. They really came into healthcare because they have this tremendous calling to serve.” AHL
“The thing I love about the people I have worked with in the past, the present, and I know in the future when it comes to healthcare, is the intrinsic calling to want to serve people.”
The task of the leader is to get people from where they are to where they have not been.
~ Henry Kissinger
Thank you to Dave Whitehead, Hartford HealthCare’s executive vice president and chief strategy and transformation officer, for your leadership. Your clear and compelling vision of where we need to go, coupled with the innovative strategies and skills needed to guide us there, are building a better future for Hartford HealthCare and the people we serve.
Compliance
Never Stops
CSL Behring’s Christine Zettlemoyer came to the company with one compliance overhaul under her belt and another challenge on the horizon
By Will Grant
Mike Allebach
Christine Zettlemoyer Global Head, Business Integrity & Compliance CSL Behring
TWENTY YEARS INTO A BROAD-BASED healthcare legal career, later with an emphasis on compliance, Christine Zettlemoyer took a yearlong sabbatical to spend time with family. She’d built an extensive résumé at Merck as a reliable legal business partner with increasing responsibilities and an ever-expanding scope, including a stint as Merck’s first general counsel to its fledgling global vaccines business, before retiring as head of global compliance oversight, monitoring and audit for the pharmaceutical company.
Zettlemoyer’s expertise in managing government investigations and corporate integrity agreements, in addition to building out a global compliance program, made her a perfect fit for the new compliance role at CSL Behring when she returned to the workforce. “I walked into this role knowing that it would be very important that we custom fit the compliance program here to CSL’s unique business, products, and people,” Zettlemoyer says. “That’s exactly what we’ve done since I’ve been here.”
Since joining CSL in 2013, Zettlemoyer has, in collaboration with her colleagues, successfully enabled CSL’s compliance program refinement starting in North and South America and then extending out to the rest of the world. In recognition that business collaboration would be key to business ownership and accountability for compliance, most compliance program elements were designed and implemented through joint compliance efforts with the affected business teams.
Zettlemoyer came to CSL with a clear understanding of the challenge ahead. Although the existing compliance program had taken positive steps around policies, employee compliance training, and hotline support, like many pharmaceutical companies, the compliance function was competing for resources in a cost-conscious company with a strong focus on efficient operations. What may have seemed like a daunting compliance challenge for many was the opposite for Zettlemoyer. “I think that because of my previous Merck experience, I looked forward to the challenge,” she says. “I was actually excited at the prospect of applying all I’d learned previously about what works—and what doesn’t— in support of CSL’s unique journey toward establishing a robust global compliance program.”
Early compliance risk assessments, both for North America and international markets, were invaluable in
identifying and prioritizing both known and unknown risks. These assessments also helped frame priority resourcing and remediation plans for the company. “In the first year or two, there was a significant focus on our US compliance program in light of the continued growth of CSL’s business here as well as heightened US pharmaceutical compliance and enforcement risks, both civil and criminal,” Zettlemoyer says. “We spent time partnering with the organization at all levels, really focused on setting up solid policies and procedures, improved training, and developing processes and tools custom fit to the way CSL operates.”
Zettlemoyer says CSL purposefully didn’t take a traditional big pharma approach to any elements of the compliance program. The goal was to instead go lean and set aggressive but achievable targets, with a heavy focus on priority risk areas. “We were able to step back and take a more strategic approach and be successful in part because we were able to capitalize on CSL’s strong values and management’s dedication to doing the right thing,” she says. “We’ve had a strong, well-articulated Code of Responsible Business Practice for some time now, with integrity representing a core value here at CSL.”
Tapping into CSL’s resulting company-wide compliance IQ has served the company well on multiple fronts. “Over time, I have definitely observed the fruit of our compliance endeavors,” she says. “Employees here have greater confidence today in approaching their own responsibilities with a compliance mind-set and engaged employees are CSL’s greatest asset,” Zettlemoyer says.
CSL’s overarching business integrity function also includes significant data protection endeavors, managed primarily from Europe. The data protection function is currently focused on meeting the new regulatory bar set by the recently passed European Union General Data Protection Regulation (GDPR) that went into effect in May. “The GDPR distilled the need for every company in our industry to rethink how we manage personal data across our businesses to ensure readiness in advance of the GDPR go-live date this year,” Zettlemoyer says. “I suspect, as many do, that GDPR is the first of several new data privacy regulations that challenge businesses to prioritize data privacy by design as we develop new business practices, systems and processes into the future.”
“We were able to step back and take a more strategic approach and be successful in part because we were able to capitalize on CSL’s strong values and management’s dedication to doing the right thing.”
The next phase of CSL’s compliance plan will further establish and refine its global and regional program structure around the globe to accommodate the company’s growing business needs. “Securing quality talent to efficiently staff our function is essential to assuring that we understand and can stay in tune with the business’s most important needs on an ongoing basis,” Zettlemoyer says. With the build-out of CSL’s compliance infrastructure now well underway, the organization expects to more effectively engage the business at all levels globally.
When gauging success, Zettlemoyer returns to the support she’s received from senior management at CSL and the open dialogue she believes lies at the core of company values. “The quality of that dialogue speaks volumes in terms of how effective and embedded our compliance program is becoming,” Zettlemoyer says. With two major compliance challenges under her belt, Zettlemoyer might be posed to write the book on compliance, but according to her, there is only one critical chapter that needs to be written on the subject. “You can’t impose compliance on an organization; it needs to be part of the fabric or DNA of the company.” AHL
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Creating Opportunities for Innovation
How Michelle Martin’s passion for progress inspires her to create new initiatives for CBS Corporation’s employees
By Galen Beebe
MICHELLE MARTIN DIDN’T PLAN to go into human resources. In college, she studied sociology with plans to become an adolescent therapist, but she found herself on a new path when she took a position at a retirement plan consulting firm and learned about employee benefits. She moved to manage retirement benefits at a new company, and when her counterpart in health and wellness left, she asked to take over that job. As new responsibilities appeared, she took them on, and with each new opportunity, she expanded her role and passion for human resources.
As vice president of employee engagement at CBS Corporation, Martin continues to connect across the organization, assuming new responsibilities and bringing new resources to CBS’s employees. “When I look at different things, talk to different people, and get exposed to different areas, I can understand employees’ jobs better, and I understand the challenges that they’re facing better,” she says. Through this process, she creates new, innovative initiatives that connect employees with the resources they value most.
Among Martin’s initiatives is the annual health campaign, which centers on a different issue each year. The 2016 campaign addressed mental health, with the aim of reducing its stigma and improving education on the topic. Martin and her colleagues found that employees often skimmed over mental health concerns in conversations, and this realization led to the campaign’s slogan: I’m Fine. “I’m Fine was developed out of conversations where we asked people, ‘How are you doing?’ Everyone’s answer was, ‘I’m fine. I’m okay.’ And not everybody’s okay,” Martin says. The campaign included webinars, workshops, and a mailer that was sent to employees’ homes. The mailer contained a brochure with phone numbers for CBS and national mental health services, conversation starters for employees to use with their friends, family members, and coworkers, and information about the mental health issues that employees and their loved ones might be facing. “We wanted people to understand what mental illness was and what it was not,” she says.
The campaign’s theme extended into other annual programs, including CBS’s health fairs, which Martin’s team organizes at locations across the country. For those locations where they cannot bring the program on-site, they created the health fair in a bag. Martin and her team send bags with information, discounts, and gifts to each location. The gifts are an important way to add some levity to a serious topic. During the I’m Fine campaign, the health fair bags included coloring books to help promote mindfulness. “It is one of the things that employees wait for each year,” she says. “I think the employees feel like we really thought about them. And we did.”
To connect the annual campaign beyond the office, Martin and her team engage with community partners, including the National Alliance for Mental Illness. These partnerships demonstrate CBS’s commitment to community health and wellness and provide an opportunity for employees to develop bonds across the organization, Martin says. “I want employees to feel pride in the company, to know CBS cares about them and their families, and to really feel connected,” she says. “No matter what you do in our business, it’s supporting the full business.”
Partnerships are key to many of Martin’s initiatives. In 2016, CBS partnered with Memorial Sloan Kettering Cancer Center to implement MSK Direct, an initiative that streamlines the process by which employees and their families access cancer screenings and treatment. The program is available to employees and their parents and in-laws, giving employees a way to support family members through a difficult time. For those located outside of the New York City area, CBS has a cancer support program that will help employees find covered care providers. “It’s such a complicated system, and they really need someone to walk them through it,” Martin says. “Having that immediate resource is amazing.”
“‘I’m Fine’ was developed out of conversations where we asked people, ‘How are you doing?’ Everyone’s answer was, ‘I’m fine. I’m okay.’ And not everybody’s okay.”
Michelle Martin VP, Employee Engagement CBS Corporation
As part of their effort to raise employees’ screening numbers for cancer and other diseases, Martin and her team identified the issues that were preventing people from getting screenings. “For our employees, it was time,” she says. And although she can’t create more time, she can create more access.
Martin brought skin cancer screenings to the workplace and partnered with local health centers to set aside days for CBS employees to schedule mammographies. She created a lung cancer screening awareness campaign to educate employees about their lung cancer screening options and worked to have a special screening program with MSK Direct. “I can’t do a lung cancer screening on-site,” Martin says, “But we did what we could in the community and got our screening numbers up.”
“There’s always something you can do. You may not be able to change the entire world, but you can probably change one person’s world.”
Martin’s continued push for innovation hasn’t gone unnoticed. In 2017, she was awarded both the Cable Telecommunications Human Resources Association’s “Aspiring Leader” award and the Outstanding Leadership in Workplace Health Award from the Northeast Business Group on Health. “Sometimes, to get an award for something outstanding you have to have one big program,” she says. “It was nice to be recognized for my persistence, my commitment to the industry, and my commitment to healthcare in general.”
As meaningful as this recognition was, it’s the unsolicited feedback she receives from CBS employees that inspires Martin from day to day. “Employees will call and say, ‘You saved my life. I never would have done this. We can’t thank you enough,’” she says. “When it’s unsolicited, I think it really is special.”
Hearing these responses drives Martin to continue envisioning new initiatives, even when she knows that there she won’t be able to implement every idea. “There’s always something you can do. You may not be able to change the entire world, but you can probably change one person’s world,” she says. She doesn’t always know when the next opportunity to help will arise, but when it does, she’s ready.
“If it comes across my desk, it’s my job.” AHL
Change Agent
In a short amount of time, Lilicia Bailey has taken big strides to transition Wake Forest Baptist Medical Center’s HR department to a more people-centered function
By Joe Dyton
WHEN LILICIA BAILEY JOINED the Wake Forest Baptist Medical Center human resources department in 2016, she had no intention on things being business as usual.
No, Bailey, the vice president and chief human resources officer at the university’s medical center had other plans. Those plans included changing the way the department was viewed. The first change on the list—rename Human Resources to the People Team.
“The primary reason for renaming the department is centered on nomenclature,” Bailey says. “I believe nomenclature is important and what you name something should signify the vision and the mission and the key objective. For a couple of reasons, the HR department doesn’t have a great reputation; not just here, but across the board. HR tends to be made up of administrators, and in some regards, they are viewed as a necessary evil. That was not too dissimilar to what I found when I joined the organization.”
It was Bailey’s opinion that the department needed to be more focused on people than on the administrative side of
the job: dotting the I’s, crossing the T’s, creating forms, and worrying about processes and policies. Although those are all necessary, Bailey believed what people really wanted is an HR function that understands the needs of the institution and delivers on those needs in partnership, instead of operating like a personnel function. And so the new name— the People Team—was appropriate.
Some of the staff praised the name change; people applauded the move and felt they could rally behind the vision and direction and where the change was going to take people. However, while there weren’t many negative reactions, there was confusion. Some people weren’t sure if they could still call the department Human Resources. For Bailey, the label didn’t matter as much as the department coming together as one unit working with the faculty, staff, physicians and nurses.
“I don’t get worked up if people call us HR,” Bailey says. “It takes time, and it’s not necessarily about that for me. We’re seen as a critical contributor to the mission of the institution, regardless of what you call us.”
Bailey’s transition has not stopped with a departmental name change. She also created a three-year journey that will transition the department from an administrative, compliance-oriented HR function to a truly integrated people strategy division.
To that end, an initiative called People Strategy 2020 was created with Wake Forest Baptist’s leaders and will be rolled out in three separate waves. The initial wave is about building trust and will be followed by operational effectiveness and strategic contributors to the mission. Each wave could take about a year to complete.
When she first came to Wake Forest Baptist, she did a quick assessment to see what the medical center’s state of affairs was and to identify any gaps. She realized if the department were going to shift into the People Team, it would have to rebuild trust so that it could do what was promised and on time.
Completing that first wave of building trust will require putting together a high-performing team, and that starts with having the right leaders in place. Wake Forest crafted its leadership core by recruiting talent and by developing talent internally. Then, those leaders assessed their talent capabilities, figured out the competencies that they needed, and started to bring in team members to augment where the company has gaps.
“People want to be engaged; they want to be a part of this belongingness. I’m kind of tapping into the element that creates engagement across the enterprise. I’m just taking incremental steps as I listen, learn, and lead to make changes.”
“One of the things that I found to be important is you have to have the right people,” Bailey says. “It’s kind of like Jim Collins’ Good to Great. You have to have the right people on the bus.”
Another component in the People Team’s transition will be to look at how the department engages with the entire Wake Forest Medical Center organization. To do that, Bailey and her team work to be transparent about what they’re doing, and they’re willing to be vulnerable enough to admit when it’s not doing well.
The engagement strategy will also include asking staff members to partner with others and establish a People Advisory Counsel, similar to a board of directors but for Bailey’s department. The goal is to give the department a cross section of leaders who can help be a sounding board for the organization and advise new talent.
“People want to be engaged; they want to be a part of this feeling of belonging,” Bailey says. “I’m kind of tapping into the element that creates engagement across the enterprise. I’m just taking incremental steps as I listen, learn, and lead to make changes.”
After only a little more than a year with Wake Forest, Bailey has made some sweeping changes. She, however, has the credentials to justify putting her vision for the department into action so quickly. As the vice president and chief people officer at Belk, Inc., she built the company’s change management and centralized its HR field division with a focus on career development, training, employee engagement, and workflow efficiencies.
Bailey also held a similar position at Manheim Auctions, a division of Cox Enterprises. Her work in those roles led to her being named one of the 50 Most Powerful Women in Corporate America by Black Enterprise and of the Top 100 Most Influential Blacks in Corporate America.
In other words—she’s good at what she does. But she had plenty of people who helped her become the dynamic leader she is today.
“It’s been a journey of continuous learning,” Bailey says. “I think the other thing is knowing who you are. There are leaders who have mentored me and people I look at that have their act together. They are making a difference, and in some regards, you want to say, ‘If I emulate that individual, I’ll have some success.’” AHL
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UP.
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Culture of Engagement
Dr. Cole Edmonson, chief nursing officer at Texas Health Presbyterian Hospital Dallas, found that putting nurse manager leadership theory into practice created benefits that ripple throughout the hospital
By Peter Fabris
NURSE MANAGERS ARE EXTREMELY important to the mission of the organization, according Dr. Cole Edmonson, chief nursing officer at Texas Health Presbyterian Hospital Dallas, one of the largest facilities in the Texas Health Resources system of twenty-nine hospitals. As clinical leaders, nurse managers connect the entire interprofessional team to the patients and their families, and they have a great impact on patient outcomes and hospital performance. “It’s also one of the highest-pressure jobs in healthcare,” Edmonson says.
That said, Edmonson says that hospitals that devise policies, training, and a culture that allow nurse managers to thrive will be well positioned to achieve high-quality care and create a workplace with high employee engagement. The 875-bed Dallas hospital realized notable gains in those areas after putting Dr. Barbara Mackoff’s Nurse Management Engagement Theory into practice. The hospital’s employee engagement ratings have consistently ranked in the 98th and 99th percentile for the past four years after the program kicked into high gear. Surveys measuring nurse engagement and job satisfaction also got a big boost. In fact, that number jumped from 55th percentile to 98th percentile in just over four years. Today, controllable nurse manager turnover is virtually unheard of at Texas Health Dallas, Edmonson says. This is reflected in the number one reason nurse managers leave their position: getting a promotion. Edmonson says this is related to the strong succession planning model in nursing and leadership development at the facility.
Dr. Cole Edmonson
Chief Nursing Officer
Texas Health Presbyterian Hospital Dallas
YoungDoo
M. Carey
Edmonson spearheaded the initiative that reformed several aspects of the nurse manager role. Nurse managers scopes and spans were right-sized, and nurse managers were given guaranteed uninterrupted time each day to spend on the floor with patients and staff, allowed more ability to effect change in patient treatment, provided more opportunities to influence institutional policies, and given better support to deal with the stresses of the job. Edmonson believes other healthcare organizations can learn from these practices and policies that if widely implemented would improve healthcare nationwide.
The roots of the initiative came from research by Mackoff, a professor, psychologist, and researcher. Mackoff studied the habits, attitudes, and backgrounds of a couple dozen high-performing nurse managers. She wanted to know what made them perform well and what kept them enthused. The key findings were that they managed to remain engaged with clinical activities, received quality leadership training based on an emotional mastery curriculum, and felt that they were building a legacy of the next generation of nurses and leaders. These high-performing nurse leaders also exhibited a sense of being mission-focused, which she says always came from an affirming, appreciative perspec-
tive, and had true boundary clarity. Mackoff developed the nurse manager engagement theory based on this research.
Intrigued by the findings, Edmonson reached out to Mackoff seven years ago to help develop a plan to put the theory into practice at Texas Health Dallas. The first pillar of the plan was to build in protected rounding time (The Sacred Sixty) into every nurse manager’s schedule.
“We set aside one hour per day,” Edmonson says. “That is protected, sacred time: no meetings, phone calls, or emails during that time—except for urgent issues.” It gives nurse managers devoted time to stay connected to what drew them to the profession in the first place: patients. This measure has proven its value over time, Edmonson says, as it has helped nurse managers to enrich their relationships with nurses they lead, physicians, and other professionals including technicians and clinical managers. Having this line of site directly to patients provides the opportunity to create relationships through an authentic, caring presence with patients, families, and their nurse colleagues.
The daily protected rounds enable nurse managers to regularly share their expertise with other healthcare professionals, see firsthand how staffing and other management decisions are impacting their patients and colleagues, keep
Dr. Cole Edmonson has cultivated a close-knit team of nurse managers, a result of low turnover at the organization.
tabs on new treatment options, witness patient outcomes, and understand what is impacting the morale of nurses. This produces, Edmonson says, more engaged and better leaders with a stronger sense of professional fulfillment and attunement. In fact, the strategy proved so valuable that senior leaders decided to double the daily protected rounding time to two hours and roll the concept out to all of the hospital’s leaders, as Sacred Sixty Plus.
Edmonson also believes that reflection is a crucial part of every leader’s development. Putting this into practice means that every nurse manager is now eligible to spend one day per month working from home to reflect on their own leadership characteristics, practice mindfulness, reflect on where their unit is and how it contributes to the success of the organization, and strengthen their leadership by learning new skills.
“Changing lives for the better is what we do as nurses. So why not care for ourselves with the same passion, dedication, and love we give to our patients and families?”
Another key component of the engagement theory plan was to enshrine the emotional mastery concepts into monthly leadership training. One of the keys to this approach is understanding one’s moral code and ethical framework to glean insight into situations that cause moral distress. Edmonson’s doctoral work focused on how nurse leaders uniquely experience moral distress. Situations are never simple, but Edmonson says that leaders must be encouraged to find an appropriate way to voice and act on their moral concerns.
Moral distress for nurse managers comes in many forms: clinical, financial, human capital, and quality. For example, nurse managers are expected to maintain productivity standards for their units. This can create moral distress when there is a perceived conflict between the benchmarks and the practicality of staffing. Organizations must provide a safe space for concerns to be elevated and resolved. Building a culture that supports crucial conversations, safe disagreement, and effective resolutions decreases moral distress and improves outcomes. Having a safe space and respectful conversations reduces moral residue that can create burnout, turnover, and fatigue in leaders.
To broaden the support base for nurse managers, a peerled, peer coached group of nurse managers meets monthly, which gives them an opportunity to connect with and learn from others facing similar challenges. In addition, that group has been participating in a year of SelfCare, a
structured program by nurse recruitment expert LeAnn Thieman that focuses on their own well-being. Leaders who model healthy behaviors and lifestyles can assist others in doing the same by their example. Early results indicate a 15 percent increase in participants balancing their lives with exercise after the program, which is just one measurement of success. “Changing lives for the better is what we do as nurses,” Edmonson says. “So why not care for ourselves with the same passion, dedication, and love we give to our patients and families?”
In a separate development, the health system is on a journey to become a high-reliability organization. Over the past three years, leadership has worked to build a culture that strives to put all healthcare workers on an equal basis when it comes to serving patient needs. Employees throughout the organization use error-prevention tools to advance quality and safety and to voice concerns they might have about a diagnosis or treatment plan. “People feel safe speaking up to people who have real or perceived higher authority or are in a different position,” Edmonson says. “This creates circles of care around the patient, flattening the traditional hierarchies that can exist in healthcare. Everyone strives to provide their expertise at the right time in patient care to get the best outcome for the patient, the family, and the community. It creates a community of collaborators, not just colleagues.” In turn, the nurse manager engagement program has been able to thrive in this environment because of the intentional design, inherent support, and respect it fosters for all healthcare professionals. This culture took years of building but has paid off in many ways, Edmonson says, including improved resilience. “Resilience is about how fast you can bounce back from a negative event or negative situation,” Edmonson says. Rather than seeking to pass the buck and assign blame, the culture is more likely to yield people attuned to learning when something goes wrong, he says. It makes for more positive, respectful cultures of engagement for nurse managers—and the entire organization. “If I could remove the title of nurse manager from healthcare, I would, as I believe these are nurse leaders,” he says. “We manage processes, but we lead people and these leaders need unique support if they and the organization are to flourish.” AHL
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Changing the View From the Top
Nicole Streeter played a key role in transforming Harris Health System’s board of directors’ view of its own responsibilities and the organization’s future
By Jeff Silver
HARRIS HEALTH SYSTEM HAS provided a healthcare safety net to the Houston area’s most vulnerable populations since 1965. That was when Harris County Commissioners appointed the Harris Health System Board of Trustees to be stewards of the health system. For years, the board executed their duties by simply reviewing materials from management, approving the minutes and financials from the past meeting, listening to historical reports from management, and, occasionally, making decisions that were important for the future of the organization. This left the board entrenched in an outdated mode of operation that lacked the strategic thinking needed to address the evolving healthcare environment. CEO George Masi saw that a broader perspective and more efficient decision-making were both necessary to ensure Harris Health’s continued effectiveness and long-term viability.
As part of the efforts to make changes, Nicole Streeter was promoted from director, board affairs to vice president, chief governance officer to advise and support the board chair and the CEO in establishing an intentional governance structure. Her background as a William Randolph Hearst Philanthropic Fellow at the Indiana University Lilly Family School of Philanthropy and experience working with a variety of mission-driven organizations and their boards had helped prepare her to assist in driving this dynamic shift. A major part of her responsibilities was to educate Harris Health’s board members on how to change priorities and why the transformation was so critical.
“The fiduciary mode of governing is about stewardship of the tangible assets and risk mitigation,” Streeter says. “The board was actively engaged in operational oversight, which fulfilled their fiduciary responsibility. But we needed a generative approach that would creatively focus on identifying what questions needed to be asked to clarify the vision for the future of the organization.”
As expected, there was some resistance to making changes. Several of the volunteer board members had served for decades, and it wasn’t surprising that they had become accustomed to a particular process and focus in their work.
To help persuade them of the value and importance of adapting to the new approach, Streeter worked with the CEO and the board chair to develop an authority matrix that detailed the board’s governance responsibilities and laid out a codified process for executing them, including delegating some tasks to internal stakeholders. For example, the board identified routine items related to operational oversight that could be approved as consent agenda items. Grants and contracts under a specific threshold would be handled by the CEO rather than being subject to board review and approval as they had in the past. This made valuable meeting time available for engaging in generative and strategic discussion.
“The authority matrix was an aha moment for the board members,” Streeter says. “Once they had a formal structure with a master calendar and mechanisms in place to help execute their fiduciary roles, they began to embrace the idea of letting go of managing operations and, instead, guiding the organization through generative discussion and strategic planning.”
Completing the transition took about two years and included a number of additional steps: the executive staff began tracking board decisions and presenting that record back to the board, which helped keep subsequent actions consistent and aligned with other strategic plans; a new governance committee was created; the board reduced the frequency of its monthly meetings, which helps provide clearer perspectives to recognize and address broader trends; a governance retreat is held annually; and, in keeping with the new focus, the board’s name has officially changed from Board of Managers to Board of Trustees.
The County Commissioners Court also recognized the need to revitalize the board. It has appointed six new members—out of nine—in the past two years. Streeter works with the Court on an ongoing basis so it can recruit members with the experience and expertise needed to address Harris Health’s current strategic needs and priorities.
And the board’s transition has created tangible results. In addition to reaffirming its mission, Harris Health’s
Nicole Streeter VP, Chief Governance Officer Harris Health System
“We’re
in a position to take on larger initiatives. We can engage with key community stakeholders, convene focus groups, and draft plans to implement what they need from us.”
finances have improved. This is due, in part, to an organizational realignment and utilizing county funding more efficiently. The organization has just been given a mandate by the Commissioners Court to provide medical care to the area’s incarcerated population and to improve access to behavioral health care across the county.
This all supports Harris Health’s original mission—to provide care to Harris County residents who are most in need. In this regard, the organization not only acts as a care provider, but also makes extensive referrals to address other associated issues, such as food insecurity and violence. It staffs a case management department of nearly two hundred to handle such wrap-around services.
“We’re in a position to take on larger initiatives,” Streeter points out. “We can engage with key community stakeholders, convene focus groups, and draft plans to implement what they need from us.”
Streeter now works with CEO George Masi to maintain the board’s forward-looking vision and the resulting improvements. She continues to draw on her previous mission-driven and board-related experience, which helped her develop skills in cultivating personal relationships and understanding the expertise and drivers of the people she engages with.
“Getting the right people in the right positions is critical to help move the organization forward and to ensure transparency, accountability, and to enhance public trust,” she says. “But it’s also important to understand board members’ personal motivations and to structure our relationships so they benefit from the experience as much as we do.” AHL
Over half of healthcare boards are spending their time together unproductively, and as a result, their organizations are suffering.
The Governance Institute provides essential tools and resources to help boards thrive in an increasingly complex healthcare landscape. Harness the power of the largest healthcare governance network.
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Why Employee Wellness Is Its Own Natural Resource
AmeriGas’ Andy Rosa is moving employee wellness from the back burner to the forefront by ensuring employee health, wellness, and medical support are always top of mind
By Jacob Winchester
IT’S FAIR TO SAY that many people don’t grow up with their sights set squarely on a position in human resources. But Andy Rosa isn’t most people. There was always something in his background, perhaps unexplainable, that allowed him to see HR as a vital component of a business. “I feel like many HR folks fall into it, but this is actually something that I chose to do as my profession and chose as my major early on in business school,” Rosa says. Perhaps his first experience with the importance of advocacy came when he attended the signing of the Americans with Disabilities Act (ADA) in 1990 with his aunt. After being diagnosed with polio as a child, she became a prominent advocate and activist for people with disabilities and was instrumental in helping the ADA get passed. Rosa was left with the profound impression that working tirelessly to educate a group of people around an issue could bring major, beneficial changes on a potentially large scale. Barry
Andy Rosa Director of HR, Benefits, and Workforce Health AmeriGas
“I feel like many HR folks fall into it, but this is actually something that I chose to do as my profession and chose as my major early on in business school.”
“Thinking about my aunt drives me, and her story as a powerful and influential woman drives me too,” Rosa says. “Despite all of the challenges she faced, she always put others first and was able to accomplish so much.”
Today, as the director of human resources, benefits, and workforce health for AmeriGas, the nation’s largest retail propane marketer, Rosa is carrying over his firsthand knowledge by ensuring AmeriGas’s workforce is both informed about their health benefits and insurance coverage, as well as supported by next-level healthcare options.
As Rosa explains, in years past, AmeriGas had programs in place that had some success, but that success was not sustained. “Ultimately, the programs didn’t correlate to our employees making better healthcare decisions, nor did we see better health outcomes or improved costs for employees,” Rosa explains.
So, drawing on experience from his previous position with the tech-savvy telecom titan Comcast/NBCUniversal, Rosa and his HR team set out to implement a series of wellness-oriented initiatives that could put expertise directly into AmeriGas employees’ pockets.
One of the first priorities was to reduce the out-of-pocket healthcare costs employees paid for unnecessarily, such as expensive emergency room and doctor’s office visits, and cut back on the necessity of having to take a day off for a two-hour appointment. Because propane companies such as AmeriGas generally service rural areas, many of the company’s employees also live in rural areas, which can be a distance from a doctor’s practice. Oftentimes, the only option for any medical visit is an expensive trip to the ER. That has led the company to partnering with Doctor-on-Demand, which is similar to a virtual doctor’s office that employees can access via a computer, smartphone, or tablet.
“For minor things such as a sinus infection, a sore throat, or a rash, they can see
Willis Towers Watson congratulates
Andy Rosa on his distinguished career
a doctor within a few minutes from anywhere. And the company pays for that virtual visit, so they can use it without a copay,” he says. “It also saves them time and a commute back-and-forth to a doctor’s office waiting room, where there is more time taken from their day.”
AmeriGas also wanted to discover how to engage employees so that they could better use the healthcare system. “I wanted to have a platform that any employee could access at any time, for any reason, and have all benefits information available,” Rosa says.
“When our employee or employee’s family has an issue with an insurance claim, they are able to call Accolade and have a personal conversation with a human being instead of sitting on hold with an insurance company.”
That led Rosa and his team to partner with Accolade, a leading medical personalized advocacy company that pairs employees’ families with a personal health assistant via phone or text who is capable of finding doctors, scheduling appointments, and filing insurance claims, as well as supporting clinical diagnoses, lifestyle changes, and more.
“Healthcare is something that needs to be individualized. It’s so personal,” Rosa says. “We do offer a couple of options for health plans, but we can’t just give all of our approximately 8,100 employees their own health plan. But everyone’s situation is different. When our employee or employee’s family has an issue with an insurance claim, they are able to call Accolade and have a personal conversation with a human being instead of sitting on hold with an insurance company. It’s the same health assistant every time, and they know about the family—including their claims information, benefits, 401(k) plan—and can help them figure out the issue and connect the family to any resources.”
Services such as Accolade, Rosa says, have allowed employees to build palpable, trusted relationships with people. Rosa says that 65 percent of families on AmeriGas health plans have engaged with Accolade in the past two years.
“Our employees have reported a net promoter score of 81, which demonstrates their satisfaction with this service,” he says. “The value is real, from both an employee and a company perspective. Our employees get help staying
healthy and happy, which means they are able to work. As a result, we’ve seen our healthcare spending go down tremendously, whereas in previous years it was more than 15 percent, last year it was in the low single digits.”
“The savings and satisfaction achieved by AmeriGas demonstrate the power of a new approach to employee healthcare,” adds Rob Cavanaugh, president of Accolade. “When compassion, clinical expertise, and intelligent technology work together, you can personalize the member experience and influence better healthcare decisions.”
“When compassion, clinical expertise, and intelligent technology work together, you can personalize the member experience and influence better healthcare decisions.”
Rosa and his team have also implemented an interactive software product called Jellyvision, which allows employees to engage with their disability packages in a witty and entertaining way.
“When most people are reviewing their benefits, or choosing the health plan that would best work for them, it’s in very dry, blackand-white terms,” Rosa says. This can then cause employees to avoid the task altogether and essentially stay unaware of their benefits, Rosa says. “Jellyvision alleviates that by leading our employees through all of this information in a fun way and with an easy online interface that presents information as they need it,” he adds.
Rosa says the future will see even more technological advancement in all aspects of business. While he is in support of that, he is equally in support of the strength in human connection and establishing trustworthiness among employees and HR.
“Part of what I want to do in my role now—and what I can help to deliver—is to make a better healthcare experience for the people that I support and the families here,” Rosa says. “If I can make the healthcare plan easier to use and impact somebody’s life for the better because they were able to make a phone call that helped them make a better decision, then the value of that returns tenfold to our employees and our business.” AHL
Living and Breathing CAPLICO
Core values drive Debbie Miller’s compliance efforts and all other Ensign Services operations
By Jeff Silver
Even though Debbie Miller left her role as a bedside registered nurse nearly twenty years ago, she still approaches her responsibilities as chief compliance officer at Ensign Services with a clinician’s perspective. It allows her to address compliance issues from a hands-on point of view while supporting the company’s client facilities and service lines, such as in-house therapy, skilled nursing, senior living, and home health and hospice care.
“If you’re not a clinician, the practical applications of how regulations apply can be hard to grasp,” Miller says. “I automatically think of care plans and key factors that need to be covered in staff education to promote compliance. It all adds up to a more comprehensive clinical picture and better insights.”
It also leads to process improvements and protocols and policies that are specific to the business lines and culture of client facilities. Miller says that is one of the most basic tenets of effective compliance: making sure programs fit the size, scope, and function of the organization and the communities it serves.
She makes sure that compliance partners (the company’s term for compliance team members) are matched to the specialties in which they work. Nurses train and audit nurses; rehabilitation therapists train and audit rehabilitation therapists. This supports customized instruction and recommendations.
“For effective results, you have to communicate in terms your audience understands,” Miller says. “You also have to know the practice and demands of the environment where they work. Otherwise, you get ‘check box’ compliance, which is relatively meaningless.”
Aside from state and federal regulations themselves, Ensign’s core values are the most important driving forces behind its compliance efforts and, in fact, its entire operation. Represented by the acronym “CAPLICO,” they include:
Customer Second
If employees are the top priority, they provide better care. This means taking their concerns seriously, resolving issues without fear of retaliation, and ensuring that staff is paid for annual code of conduct and compliance training.
Accountability
Everyone at every level has a voice and is empowered to speak. They are expected to act responsibly in addressing
requirements and areas that need improvement.
Passion For Learning
Educating employees promotes better care for patients and residents who cannot care for themselves.
Love One Another
Miller characterizes this as one of the most important values. It enables staff to approach each other about problems from a caring perspective. “If you don’t believe someone cares, it feels like they’re just trying to tell you what to do,” she explains.
Intelligent Risk-taking
Fully understanding potential consequences and rewards of an action leads to better decisions, improved safety, and increased benefits.
Celebration
The company highlights large and small victories. A successful outside audit might lead to a compliance teamhosted cookout, for example. Contests are often held to reward the first client facility in a state to complete its annual training.
Ownership
Everyone should be responsible for making improvements and how they can be actively engaged in implementing them.
The CAPLICO values are very real and personal throughout the company. Miller herself feels a deep connection to the value of Passion for Learning because of her personal experience with it. Her spouse of twenty-three years, Paula Parson,
Debbie Miller Chief Compliance Officer
Ensign Services
was discharged from the hospital with stage-four cancer. She was told she should find suitable hospice care, but that was an option she wasn’t ready to consider. Instead, the couple selected an Ensign Services’ client rehabilitation facility where Parson was taught how to conserve energy while living with oxygen support. She also worked with therapists to achieve specific goals that would help her go home sooner and stay safe outside the facility.
Two years earlier in collaboration with therapy resources, the compliance team had specifically addressed standardizing and improving how therapists administered the very tests that were measuring Parson’s progress toward those goals. “That was an aha moment for me,” Miller says. “It showed how what we do at Ensign Services has a direct impact on helping improve the quality of life for the patients of the people we serve.”
Since joining the company, Miller has come to believe that she has never worked for an organization that honors its core values as much as Ensign Services, and has seen them put into action in a number of other instances. For example, after Hurricane Harvey, staff from around the country, in collaboration with compliance partners, launched an adopt-a-family program to help support individuals and facilities in the affected areas. Donations included everything from airline miles and hotel points to cash contributions and volunteering to unload shipments of supplies. The same program and an existing employee emergency fund also assisted families and facilities in need after fires in Northern California.
Miller addresses the core values as part of the hiring process for her team. She asks applicants—most of whom are former clinicians—which value is most important to them and why, and what they miss most about being involved in direct care. “If they don’t miss it, they’re not a good fit for the job,” she says. “I still miss it after all these years.”
Without exaggeration, Miller is quick to say that she feels she has never worked with a finer group of people.
“My colleagues aren’t just auditors and investigators— they’re cultural ambassadors who live and breathe Ensign’s core values,” she says. “It’s very important to me that I’m serving in an organization that believes in doing the right thing, which, in many ways, makes this the easiest compliance job I’ve ever had.” AHL
Consulting Inc. (LWCI) is pleased to recognize Deb Miller with Ensign as a Compliance Champion, propelling the industry forward in embracing a culture of compliance.
The Value of Insourcing
Kuldip Patel’s value analysis team has helped Duke University Health System save millions of dollars by insourcing certain medications
By Lior Phillips
WHILE PURSUING RESIDENCY TRAINING
,
Kuldip Patel came across a report from the Institute of Medicine that changed his life—and the lives of countless patients. The aspiring pharmacist learned of the frequency of medication errors, and knew he’d not only found the right career path, but that he’d need to take steps to make a big difference. “I knew I needed to help hospitals and health systems get better at reducing errors,” he says. But rather than a lone maverick revolutionizing the field, Patel knew the best way to make change would be for the industry to constantly learn, share, and improve together. “Collaboration is extremely important,” he says. “If you standardize and limit the number of variations and focus on the customer, you decrease the possibility of medication errors.”
An important early step of those efforts for Patel came at Hospital Corporation of America, where he acted as assistant director of pharmacy. The facilities operator was an early adopter of pharmacy technologies such as bar-coded medication administration and computerized order entry. Patel was able to get involved and gain expertise in these
Kuldip Patel Associate Chief Pharmacy Officer
innovations on the ground floor, which led to a role as pharmacy operations coordinator at Orlando Health. The Florida facility hired him specifically for his tech insights, as it was only just embarking on implementing EHRs and other technologies. Sharing knowledge was an essential part of his career goal, so the move made perfect sense.
After four years at Orlando Health, Patel found the opportunity to make an even bigger impact on patients at Duke University Health System (DUHS). Founded in 1998, the system comprises three hospitals, as well as physician practices, home hospice care, and other support services spread across North Carolina. As associate chief pharmacy officer, Patel has taken every measure possible to standardize, ensure quality, and make safe the system’s pharmacy procedures—both by collaborating internally and by looking externally to positions on boards and committees across the country.
One prominent project was the launch of a value analysis team at DUHS. The team is composed of the system’s pharmacy directors, as well as leaders from contracting and procurement, and other medication stewardship managers. Upon its founding, the team set a benchmark against other health systems, and found that DUHS had a significant opportunity to help manage drug expenses, and in turn offer better care to patients. This involved, in part, identifying advantageous contracts with drug manufacturers and using those advantages as leverage to get manufacturers to bid against each other for the system’s business. By working together across the entire organization, the team was also able to peg formulary items that were being purchased consistently across the system and determine the best costs and how best to utilize supplies. “That’s really ultimately what cost savings is all about: bringing value in using drugs the way they have been studied and intended to be used,” Patel explains.
Duke University Health System
“If you standardize and limit the number of variations and focus on the customer, you decrease the possibility of medication errors.”
As drug costs continue to rise, finding ways to manage that expense and utilize savings to better serve patients can make a big difference for an organization. Since the team identified the places they could manage costs and implemented their plan, DUHS drug expenses have remained flat, a major achievement for an organization of its size.
That cost stabilization comes, in part, from the decision to insource certain drugs that had previously been purchased from manufacturers. “We purchased a lot of drugs that were compounded, and when you purchase premade products, specifically sterile preparations, there is a premium to that cost,” Patel says. But although DUHS had the facilities and expertise to produce the sterile preparations themselves, it needed to update infrastructure and add resources such as additional staff to make the move feasible. The potential savings long-term, though, were deemed more than sufficient to justify the investment. “We were able to efficiently bring thousands of sterile preparations that we used to purchase from the outside compounding pharmacies and prepare them in-house,” Patel explains.
Not only have these efforts gone a long way toward improving outcomes for patients, they have also made a big impact on reducing drug costs for the health system. In fact, the team’s focus program alone has saved the Duke University Health System more than $6.5 million in just five years.
Patel’s highly collaborative leadership style has been a key driver throughout all of these efforts. “You have to maintain laser focus on being consistent and standardized, which can be difficult across a system with multiple hospitals,” he says. “Sometimes compromises had to be made, and at other times we had to make executive decisions to determine a single best option, rather
than having three different ways of delivering a particular medication.”
Following consistent standards throughout the entire system became even more important at the onset of the drug insourcing program. The focus in the past had been following chapters 797 and 800 of the United States Pharmacopeia’s guidelines, which govern sterile preparations and hazardous medications (such as chemotherapy), respectively. As chair of the sterile preparations oversight committee, Patel can help ensure that the pharmacy staff, nursing staff, providers, and other team members coming into contact with the insourced drugs will be doing so by the book in order to maintain safety for patients and the providers themselves. “My team makes sure we’re monitoring and documenting all that on a consistent basis to remain compliant, and it also maintains that documentation electronically,” he says. “We have a deep interest in continuing to build that service line, and we’re investing additional funds to build the necessary infrastructure to expand the program to become a registered 503B facility. We would get inspected by the FDA, and we would need to comply with CGMP (current good manufacturing practices) standards.”
Maintaining high quality and safety standards, of course, gets back to the inspiration that started Patel on the course to his role in the first place: sharing ideas to make a difference in the lives of patients. “I learn so much from others facing similar challenges. Learning from others gives me the ability to know what I don’t know,” Patel says. “The network helps build knowledge and covers gaps I might have, and at the same time, I get to share some of my experiences with others. It’s a reciprocal relationship that drives the profession and drives the practice.” AHL
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Priming the Leadership Pump
How Carolyn Swanson built a steadfast revenue cycle team to benefit Aveanna Healthcare
By Jenny Draper
THE EVER-CHANGING healthcare industry often provokes a transient workforce, and that’s why revenue cycle leader Carolyn Swanson considers her team’s dedication at Aveanna Healthcare among the top accomplishments of her twenty-five-year career. Since her arrival in 2015, Swanson’s team has achieved almost all quarterly cash goals, even during several mergers.
“There is a lot of pressure to make sure we bring in enough money to pay and support our nurses who are taking care of fragile babies,” she says. “At the same time, our company is growing so rapidly that if you have constant staff turnover it just will not happen.”
Today Aveanna provides high-quality care for more than forty-seven thousand patients and their families across twenty-three states each year. In addition to skilled nursing and therapy for all patients, Aveanna offers autism and developmental services for children as well as personal care and behavioral health services for adults. Its home medical solutions span enteral nutrition, respiratory, specialty pharmacy, and medical supplies.
Aveanna formed last year when Epic Health Services merged with PSA Healthcare to create the largest pediatric home health provider in the United States. Prior, Epic had grown exponentially in 2016 through acquisitions
in Michigan (Pediatric Special Care), Virginia (Rehabilitation Associates), and Georgia (Pediatria Healthcare for Kids).
That process redoubled her conviction that strategic leadership is crucial to company-wide success in an era when it’s likely generations are more loyal to each other than the organization.
“It’s easy for individuals to lose their identity when they’ve watched people come and go so quickly during consolidations,” she says. “My grandfather’s generation stayed because they loved the company, but nowadays people follow the leaders they respect and can learn from.”
The generations at work now pursue added goals on a more personal level, not just company-driven initiatives, according to Swanson, who explains that this dynamic differs from the historical precedent.
Therefore, now more than ever it is crucial that leaders are the leaders of the future for their companies. By
Carolyn Swanson VP, Revenue Cycle
Aveanna Healthcare
mentoring them into strong directors or managers within an organization, businesses are guaranteed the stability that each team needs to succeed with its goals, Swanson says. The key is to mentor and keep the strong candidates focused on outcomes and success both personally and professionally.
For the vice president of revenue cycle, scaling that goal-oriented mind-set inspired her to restructure her own department to develop and retain talent.
She revamped the flat organizational chart and bonus structure, creating a rotational system for staff members to grow upward within the company. Coordinator roles hone their specific expertise, and it cultivates a pipeline of effective leaders. The new arrangement also significantly reduced staff turnover. She explains that formerly people trained in a silo for a few years before moving to another company for a promotion.
“Now we create roles that both support the company’s direction and allow them to move up,” says Swanson, adding that her team comprises about a hundred individuals just in the Dallas market alone. “And you don’t necessarily need someone with a master’s in healthcare administration. One staff member came from a management position in retail. His drive and the environment we’ve created to elevate him here allowed him to succeed.”
“What I have found in every environment is that it boils down to good leaders within the organization who work together as a team.”
Swanson, who also presents insights as a revenue cycle leader at forums for the Healthcare Financial Management Association and the American Association of Healthcare Administrative Management, benefited from her own multifaceted career path.
She earned a bachelor’s degree in business from Montreat College before starting her career as a director for the Hospital Corporation of America before moving to Novant Health. Then she joined CHS as director of PFS before arriving at Tenet Healthcare, where after six months she was promoted from regional director to senior revenue cycle service director at subsidiary Conifer Health Solutions. Later, she served as the corporate director of client services at Medical Data Systems.
“My path working in several states helped me better understand the different dynamics of patient care across the country,” she says. “What I have found in every environment is that it boils down to good leaders within the organization who work together as a team.”
In 2014, Swanson founded C Swanson Consulting. As an tal facilities with AR management processes for maximum ship a year later. The company, entering high-growth mode at the time, sought top talent to fortify its infrastructure for seamless acquisitions. Swanson came aboard as the vice president of revenue cycle services and strategic planning
“We have a wonderful blend of genders, nationalities, and generations on our team. It creates the openmindedness and trust needed so we can help each other get to the next level.”
In her first year, Swanson focused on setting up the revenue cycle department for positive
formance indicators and hired a senior analyst to design and translate revenue cycle reports. In her first three years at the company, Swanson’s revenue cycle department met eleven out of twelve goals established by the
“Only once have we not made our goal, which is unheard of in healthcare regarding cash goals,” she says. “If you are good to your team and encourage them to improve their skill sets, it is
During her tenure, the company has doubled in size with little change in the amount of people Swanson has hired to support Aveanna’s more than 150 branches. She strives to ensure the right people are in the right positions, and she
“We have a wonderful blend of genders, nationalities, and generations on our team,” she says. “It creates the open-mindedness and trust needed so we can help each other get to the next level. It’s not just about me or you; the team is what makes a great company.” AHL
Waystar is the combination of Navicure and ZirMed, two top-rated providers of revenue cycle technologies. Waystar simplifies and unifies the healthcare revenue cycle with innovative technology allowing clients to collect more with less stress and cost, so they can focus on their goals, patients, and communities.
Communication Is the Best Medicine
Iron Mountain has leveraged data analytics, smartphones, and plan improvements to save money and help employees stay healthy amid rising costs in the healthcare industry
By Russ Klettke
LARGE
EMPLOYERS OFFER healthcare benefits to employees for fairly straightforward reasons: to help with recruitment and retention, and to have healthy, productive employees. But two megatrends affecting the country as a whole proportionally affect those larger employers: an older, less-healthy workforce and increasing healthcare costs. Companies such as Iron Mountain, a leading global supplier of storage and information management services, illustrate the difficult math of employee healthcare.
Servicing 225,000 customers from 1,400 facilities, the Boston-based company has eight thousand employees in the US alone, plus another eleven thousand in the more than fifty countries where it operates. With people constituting so large a portion of the company’s assets, healthcare is both a competitive and financial factor.
To Iron Mountain’s credit, their employees tend to stick with the company over years and even decades, which means it’s successful on the recruitment and retention front. But the growing company has wrestled with how to improve employee well-being and its implications for
productivity. The company’s director of benefits strategy, Scott Kirschner, has as good an understanding as anyone about the rising costs of healthcare as well as the increased expenses associated with an aging workforce.
One fairly common chronic disease tells the story. The prevalence of diagnosed Type 2 diabetes mellitus ranges from 6–9 percent among employees in large companies. A 2013 report from the American Diabetes Association itemized what this single disease costs American businesses: $5 billion in increased absenteeism and $20.8 billion in reduced productivity while at work, with an additional $7,900 in medical expenditures per employee (more than double the costs of employees who are not diabetic).
Aside from the health and financial issues caused by diabetes, the disease offers one advantage: the more patients know and adhere to mitigating strategies, the less sick and costly they are. Proactive communications and education programs—aided by smartphones, data analytics, and artificial intelligence—can reduce those costs and improve the health outcomes for affected individuals.
“Prior to bswift, we had only 1 percent of employees do employee selfservice. Now, 87 percent of employees now go online to sign up and manage their benefits packages.”
But few companies have all the resources needed to manage these tasks in-house. Therefore, Iron Mountain engaged several benefits management firms in just the past couple of years to provide these analytical, communications, and education tools.
One firm is Livongo Health, a diabetes management start-up launched in 2014 by former Allscripts CEO Glen Tullman. The company provides coaching and management around diabetes, in addition to other chronic diseases. With the use of artificial intelligence and blood glucose monitoring, connected via smartphones, Livongo’s program coaches patients on real-time dietary adjustments to manage the disease on an ongoing basis. In an efficacy study, the Livongo program reduced patients’ mean HbA1c (a measure of long-term blood sugar levels) from 7.8 to 6.9 percent in one year, which reduces the likelihood of such debilitating and expensive complications such as kidney failure, blindness, heart attacks, and strokes.
“Livongo has really connected with our people who have diabetes,” says Kirschner. “We’re seeing improved clinical results and cost savings, which have been documented by independent consultants.”
Another firm working with Iron Mountain is bswift, a human resources and benefits administrator that offers streaming video to explain Iron Mountain’s benefits program to its employees. “We have a very dispersed workforce, so it’s virtually impossible to physically be out there and enroll every employee,” says Kirschner. “Prior to bswift, we had only 1 percent of employees do employee self-service. Now, 87 percent of employees now go online to sign up and manage their benefits packages.”
Kirschner credits the usability of the technology for this high adoption rate. “Our employees find it very easy to navigate, very easy to find things,” he says. “Key for us—because most employees are expected to be doing records manage-
ment, with many of them on the road—is that we don’t want them to spend too much time searching for things. Something else the video gave us is it reduced the number of calls into our employee service center about open enrollment. We actually saw the number of tickets decline, which allowed our team to better respond to the tickets that came in.”
The provider network offering is another key element of Iron Mountain’s health strategy. In contrast to most companies, Iron Mountain offers a high-performance network plan through Aetna, which is called Aetna Premier Care Network Plus. It is a national network of high-quality and efficient providers, which includes ACOs. On average Aetna Premier Care Network Plus can save an Iron Mountain employee with a family on the plan $3,300 per year. With close to three-quarters of employees earning about $38,600 per year, their savings are proportionally significant under this plan. Prior to transitioning their plan to Aetna on January 1st, 2018, only 32 percent of employees had access to Iron Mountain’s high-performance network plan. That number skyrocketed to 76 percent in 2018 with Aetna Premier Care Network Plus. Such an advance illustrates both better offerings and better communications in the overall benefits package.
“Aetna is excited to partner with and provide industry-leading solutions to Iron Mountain to help them achieve healthy, happy, and productive ‘Mountaineers,’” says Bill Leahy, Aetna’s vice president, business development. “It takes a progressive benefits leader like Scott Kirschner to adopt emerging solutions that will accomplish that goal.”
The business imperative at Iron Mountain may be to reduce costs, improve productivity, and improve on recruitment and retention. But for employees lucky enough to work there, the result can be a healthier, happier, and even longer life—with lower healthcare costs. AHL
Aetna is proud to partner with Scott Kirschner and Iron Mountain for their innovative leadership.
The Complex Navigation Between Culture and Corporate Law
Although the latitude and longitude of its operations changes, Alcon’s moral compass is unwavering
By Charlene Oldham
AS THE GLOBAL HEAD OF LITIGATION and government investigations for Alcon, Chris Cook’s job might be akin to that of a traffic cop trying to help people avoid collisions at a bustling crossroad where the signals aren’t always synced.
“I derive great joy and personal satisfaction from navigating the intersection between legal systems, cultures, and languages in different countries. It’s something that really animates me,” says Cook, who joined Alcon in November 2017 after serving as the general counsel to Walmart’s subsidiary in Central America.
Since its founding in 1945, Alcon has evolved from a small ophthalmic shop in Fort Worth, Texas, into a global business that operates in seventy-four countries and serves patients in more than 140 nations, with roughly half its sales coming from outside the United States. Alcon’s product offerings include surgical devices and equipment as well as vision care products for the consumer market. Although those remain the same regardless of the market, that certainly can’t be said of the corporate climate from country to country. Phil Robbins
Chris Cook Global Head of Litigation and Government Investigations
Alcon
“Legal systems may differ, but ethics do not. While it is critical to know that certain conduct is commonplace or even legally permissible in a country, it is equally important to know that these facts do not relieve you of your ethical obligations within the company,”
When a company operates offices and manufacturing facilities and serves customers around the world, its employees and executives must grasp the complexities of everything from court systems to contract execution to competition laws in every country they do business. So, some things are bound to be lost in translation, both literally and figuratively. Among other functions, Cook and his team provide legal advice on corporate compliance, and those issues are not always clear-cut across borders. Making sure meanings and messages are clear when it comes to legal matters can be frustrating, but Cook also finds it fun.
“In any cross-border legal issue, there’s a necessary point where a translation has to occur, whether it’s language or law or business or policy or politics,” he says. “I find that translation point to be absolutely fascinating.”
The key to negotiating in so many different systems is understanding your own limits and educating yourself as thoroughly as possible when it comes to local laws and regulations, he says. That could even mean reconciling with the fact that a company might not be able to seek support from a country’s courts at all.
“The reliability of the judicial system is not uniform between countries. In the US, we are accustomed to a high degree of fairness and predictability in the court system,” he says. “On the other end of the spectrum, some countries have virtually no rule of law, so obtaining justice in court is not even an option.”
Even in countries that offer consistency in the courtroom, there’s no way to grasp every nuance of another nation’s justice system. In fact, it’s crucial for legal teams to recognize that they might not know every peril and pitfall when it comes to foreign financial laws and regulations, Cook says.
“One of the greatest dangers to an in-house lawyer in a global company is allowing your own legal education to
cloud your judgment about the risks in other countries,” Cook says. “You cannot act as if the US legal system is the only correct one, or even that common words or concepts have the same meaning in one legal system as in another. Success lies in learning to protect your client’s interests without letting your own perspective warp your advice.”
To offer a few examples, the laws that govern contracts and competition vary greatly from country to country, so it might be not only be permissible, but legally required, for the company to execute agreements differently or to change standard practices to adhere to local laws. At the same time, basic ethical principles are non-negotiable regardless of region. Cook says Alcon’s ethical training emphasizes that you have to operate your business with honesty and integrity and treat patients, customers, and employees in a way that’s consistent with corporate values.
And Cook’s business partners have come to value his approach to tackling legal issues in this manner, as well.
“Chris brings tremendous perspective to Alcon—he is equal parts practical and creative in approaching complex legal issues, says David R. Marriott, partner at Cravath, Swaine & Moore LLP. “His experience in government, private practice, and corporate America make him an extraordinary leader, and it is a pleasure working with him.”
And for Cook, a steadfast focus on ethics has also helped him to excel in his global legal work.
“Legal systems may differ, but ethics do not. While it is critical to know that certain conduct is commonplace or even legally permissible in a country, it is equally important to know that these facts do not relieve you of your ethical obligations within the company,” Cook says. “There, you must have, if not rigidity, an absolute clarity on where your company’s moral compass points.”
Healthcare companies often are targeted by regulators or private lawsuits, sometimes justifiably but often not, he says. Cook spent a significant slice of his career defending pharmaceutical companies, device manufacturers, laboratory testing companies, hospitals, doctors, executives, and public officials in government investigations and in civil litigation. In the worst cases, he saw employees and executives judged and penalized for actions that were deemed questionable or illegal only after the fact.
In that time, he’s realized that the complex and constantly changing rules governing the industry can make enforcement murky. Although he expects the debate to continue in this country surrounding the role regulators, lawsuits, and public policy all play in governing the healthcare industry, he added that the current situation isn’t ideal for anyone.
“Regulation through enforcement is sometimes unfair and always expensive,” he says. “Ultimately, that cost is borne by taxpayers and consumers.”
At this juncture in his career, Cook is happy to play a global role in a company that makes a clear difference in people’s lives through its products and charitable contributions, which includes outfitting a mobile operating room in Orbis’s Flying Eye Hospital, an MD-10 jet used to bring eye surgery to patients in the developing world.
“Our surgical business literally saves people’s eyesight from such conditions as cataracts and glaucoma. Our vision care business makes the industry’s most advanced contact lenses. The company spends a half billion dollars every year on R&D and millions more on charitable donations and medical missions,” he says. “If I can represent my client as well as Alcon has built its business, I’ll be really proud. Being a lawyer at a great company can be a heavy burden to bear because the primary goal is simply to live up to the high standards of the organization that it is your privilege to represent.”
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Transforming Healthcare IT
Chuck Deckert is helping make IT an ongoing business partner at Sharp HealthCare
By Jeff Silver
WHEN CHUCK DECKERT first interviewed with Sharp HealthCare and heard about the Sharp Experience, he thought it was a clever public relations idea. Now, as the organization’s vice president, health information technology solutions and fifteen years later, he views the concept very differently.
“The Sharp Experience is a commitment to providing patients with the best possible care across all domains, including the clinical experience, and really does shape everything we do,” Deckert says. “When I started working here, we were making system configuration decisions, and the first question was, ‘Which option is going to benefit patient care and safety the most?’”
Because Sharp offers care in underserved and less affluent communities, the same mind-set is directed at developing cost-effective solutions that maintain patient access to care.
The Sharp Experience has also added to the ongoing evolution of IT becoming an active business partner within the organization. Sharp Community Medical Group (SCMG) CEO Paul Durr helped provide the vision of IT having a seat at the table rather than simply being given work orders after critical decisions have already been made.
“Paul wants us in nearly every conversation so we can contribute to creating solutions,” Deckert says. “Once we present a strong rationale for a particular approach, he’s also very good about providing necessary resources. He never pulls out a spreadsheet to point to what our budget was supposed to be.”
Instilling the idea of IT as consultants and partners wasn’t an easy sell when Deckert started managing his first medical IT team at SCMG. He estimates that although a quarter of the original group welcomed the idea, another quarter took a skeptical wait-and-see attitude and half the team looked for opportunities elsewhere.
Since then, they have been able to develop a cohesive and highly effective department.
“At the end of the day, no one has a deep sense of satisfaction from installing software or building a server,” Deckert says. “But if you create a solution that helps a practice see twenty more patients a month, you can feel good about improving access to care.”
SCMG’s IT group has also taken on more extensive communication responsibilities that sometimes go beyond the typical role of technology specialists. In one instance, the
Andrew Burns
Deckert VP, Health Information Technology Solutions
HealthCare
“At the end of the day, no one has a deep sense of satisfaction from installing software or building a server. But if you create a solution that helps a practice see twenty more patients a month, you can feel good about improving access to care.”
team implementing a new clinical system at a particular practice reported that the project was not going to be successful due to interpersonal issues between the practice physician and medical assistant. Deckert had to deliver the message that the implementation wouldn’t continue until the issues were resolved.
“In the old days, we would have simply blamed system implementation problems on the practice since the system would have been installed properly,” he says. “As partners, though, we’re providing a solution, not just the technology. So, I have to address the underlying issues.”
Three months later, the staff resolved its issues, the project resumed and was, in fact, quite successful.
To help gain broader acceptance of IT’s new role, Deckert makes every effort to explain why and how its recommendations align with Sharp’s overall objectives. For example, physicians generally hated an electronic prescription application when it was introduced because each entry took much longer to enter than using a traditional paper prescription pad. The project team was able to win them over when they demonstrated the improvements the new system made in everything from compliance and transparency to phone calls from pharmacists attempting to decipher prescribers’ handwriting.
He’s able to offer that kind of reasoning and support because of IT’s broad reach throughout the organization. The IT team is in contact with nearly every department and visits community practices on an almost daily basis. That enables the IT team to develop firsthand insights into business challenges and to gain clients’ trust, Deckert says.
Those abilities will certainly be called on as the IT team introduces additional innovations to further improve the Sharp Experience. They are working toward implementing a new patient portal and shared patient charts that will build collaboration between patients and clinicians.
Chuck
Sharp
Divine IT Inspiration
As a former pastor, Chuck Deckert brought an unusual background to his IT career. However, he sees many similarities between the two worlds, especially as IT has come to be viewed as a business partner, not just a tech specialist.
“I went into ministry to help build supportive communities,” Deckert says. “In my current role, I still try to make the whole greater than the sum of its parts.”
His congregational work taught him valuable lessons about change management, sales and marketing, collaboration, project and conflict management, and effective communication—all skills that help develop effective solutions for, and with, his clients.
They are expected to greatly increase patient understanding of and compliance with treatment plans, but will require physicians to adjust the way they complete their clinical documentation, being mindful that the information is shared across the health system and with patients themselves.
The introduction of enterprise medical records will also benefit care team collaboration. They will eliminate siloed information by creating a single record of care that is available to all offices, clinicians, and departments. Because the records will provide prior notice, for example, primary care physicians will no longer be surprised by a patient visit on Monday morning after a weekend trip to the hospital emergency department.
“The changes and challenges we’re facing in healthcare are huge and complex,” Deckert says. “To create effective solutions, we have to enlist people, processes, and tools that everyone uses so we can work together.” AHL
Galen Healthcare Solutions is an award-winning, number one in KLAS healthcare IT technical and professional services and solutions company providing high-skilled, cross-platform expertise. Galen has partnered with more than 300 practices, hospitals, and health systems to deliver strategy, optimization, data migration & archival, project management, and interoperability. Learn more at www.galenhealthcare.com.
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The Cutting Edge of Care
Decoding the Data of Diversity
Stephanie Browne is upgrading the talent strategy at Blue Cross Blue Shield of Massachusetts to eliminate bias in recruiting
By Jenny Draper
AFTER TWENTY-ONE YEARS in IT, Stephanie Browne made the switch to human resources with a clear purpose: eliminate recruitment bias and rebrand the diversity strategy at Blue Cross Blue Shield of Massachusetts (BCBSMA). “Talent acquisition is probably one of the most bias-laden processes in business,” she says. Now, almost two years into her role as vice president of talent acquisition and chief diversity and inclusion (D&I) officer, Browne is using technology to revolutionize how the health insurance company hires internal and external candidates. Browne, who led IT and operations strategy for most of her career at BCBSMA, immediately got to work building an application tracking system to mine the talent pools according to skills first without names or faces. The broader view of diversity also applies to various backgrounds, experiences, and skill sets, and her lean team leverages the aggregation methodology to meet a 50 percent diversity target in every candidate search. Monthly reports ensure they are heading in the right direction.
“We’re talking about diversity from an innovation perspective, which is exciting because talent management is becoming more data driven,” she says. “Adding metrics to the strategy allows us to know that we’re progressing and maturing.”
When she officially stepped into the role in October 2016, she saw that there was already a pretty diverse C-suite and a culture that was beginning to match, yet more work was needed on the administrative level. To improve diversity within that middle layer of the Boston-based company, Browne integrated the previously siloed talent acquisition and D&I departments to create more internal opportunities for the almost four thousand employees at BCBSMA. “It gives people the ability to see how they fit in anywhere and what value they bring to the table,” she says. “I’m constantly looking at ways that I can make a better place for everybody to have a career.”
The holistic approach to diversity goes beyond race, from LGBTQ to veterans to people with disabilities and
& Chief
and Inclusion Officer
more, according to Browne. Her team collaborates with eight employee resource groups (ERGs), each comprising a particular demographic, to improve employee access and engagement across the company. Her team conducts regular engagement surveys and recently facilitated a seminar for the healthcare management department about understanding different ideologies and cultures to partner more effectively with different groups. Ultimately, Browne believes these proactive efforts will improve the healthcare space overall.
“For example, the black professional network is helping change healthcare both from a provider perspective and cultural competency perspective around quality of care,” Browne says. “And our disability group has helped the facilities team understand what they need in the workplace. It fuels me to see those changes in our organization, and we’re looking more and more like the demographics of the marketplace.” Browne’s team gathers these insights into diverse consumers to inform strategic initiatives, including the design of the company’s mobile app.
“We’re talking about diversity from an innovation perspective, which is exciting because talent management is becoming more data driven. Adding metrics to the strategy allows us to know that we’re progressing and maturing.”
Stephanie Browne VP, Talent Acquisition
Diversity
Blue Cross Blue Shield of Massachusetts
Stephanie Browne facilitates a panel called “Diversity Dialogue: Being Out in the Workplace.”
“We built an algorithm for skill mining and had the team learn how to use those tools over top of other databases like Indeed and LinkedIn.”
Training is the foundation of Browne’s strategy, in which she implements best practices around the sourcing strategy as well as the individual social, cultural, and professional needs of each employee. It’s part of the transformation Browne’s leading within human resources, changing its brand within the company from advisors to true strategic business partners. Her team recently launched a new initiative called Talent Ambassadors, brand ambassadors working hand in hand with recruiting and D&I to attract new talent at all levels for the company, a feat amplified by technology.
“We have thousands of folks apply for jobs every day, so we were sitting on a wealth of data, but still starting every single recruiting effort from scratch,” she says. “So we built an algorithm for skill mining and had the team learn how to use those tools over top of other databases like Indeed and LinkedIn. It significantly shortened the time from requisition to finding and hiring the right candidate.” Browne’s emphasis on efficiency and training is reflected in her own educational journey.
Sips of Success
While Stephanie Browne diversifies talent at Blue Cross Blue Shield of Massachusetts, she has also spent about fifteen years on another venture—wine education. She didn’t know much about wine growing up, but that changed in 1999 when she invited friends to learn more about it. “I patterned the group after my mother’s bridge club,” Browne says. “I saw it as a way to expand my circle of friends.”
The Boston-based group evolved into Divas Uncorked, an international wine education society. The mission: Make viticulture more accessible for women and people of color—two groups that were significantly underrepresented in the wine community at the time, according to Browne. “Women are huge consumers, the number one buyers of household items, so it didn’t make sense,” says Browne, who also owned an upscale wine shop.
Divas Uncorked met with top US wineries to advise market expansions, traveled to vineyards from Napa Valley to South Africa, and created a private label chardonnay with the Mendocino Wine Company. It hosts Vintner Dinners, annual national conferences, and the Martha’s Vineyard Wine and Food Festival. “It was an idea that ran amok,” Browne says. “And I believe we’ve really changed the industry.”
Since 1996, Professional Staffing Group (“PSG”) has been committed to excellence in staffing services. PSG is one of Massachusetts’ largest staffing firms. While we have the deep resources which allow us to manage large staffing programs, we also have a structure which allows us to get to know each job seeker individually, and a culture which drives us to match candidates with jobs they love. PSG is the only staffing firm in Massachusetts to be named to the Best of Staffing list for 7 years in a row.
She earned a master’s degree in education from Cambridge College, a small college in Boston that targets adult learners. Cambridge College used Browne’s work and life experience plus three years of undergraduate studies as the pre-requisite for her master’s degree. Her blend of technical expertise and people-first philosophy enable her to apply a more comprehensive retention and D&I strategy at BCBSMA, such as the implementation of Robert Rodriguez’s “4C ERG Assessment Model”: culture, communication, commerce, and careers at the enterprise level. While in her previous IT role, the technology liaison implemented software application releases seamlessly, and now she’s continuing to optimize the business through diverse, world-class talent that is as engaged at work as she is every day. “I did great work in IT, but if I retired there would be ten people right behind me that could do the same thing,” she says. “In my role now, I feel like I can leave a legacy. I love how the changes make differences in people’s lives in ways that they will remember.” AHL
Bringing Payers and Providers Together
SDLC Partners breaks down traditional silos to create transformational digital healthcare solutions
By Jeff Silver
NEW MODELS OF PAYMENT AND CARE
, such as integrated delivery networks and population health management, are driving innovation. In addition to needing concrete ways to control costs, personalize care, and improve outcomes, new approaches are blurring the lines that traditionally existed between payers and providers. Collaboration, communication, and information sharing means that every player in the ecosystem can better manage complex, high-risk patients while achieving better outcomes and improving member or patient experiences.
SDLC Partners knows how to leverage all that data by creating customized solutions that work with an organization’s existing infrastructures, including systems such as Epic and PEGA.
“Traditional systems aren’t agile enough to rapidly produce the information needed to address individual needs of those in specific cohort groups,” says Chris Simchick, SDLC cofounder and CEO. “We can customize solutions that identify the most appropriate information and then repurpose and reintegrate it to support specific, practical actions.”
Scott Barnyak, cofounder, chief sales and marketing officer, goes further to explain how working with both payer and provider information creates a whole that is greater than the sum of its parts.
“If we aggregate medical data with payer records, such as claim histories, we can link compliance requirements, clinical patterns, and individuals’ preferences and behaviors,” he says. “One data set without the other is inadequate since the real value is created at the intersection where they come together.”
Personalized solutions can be developed surprisingly quickly—in as few as ninety days. This is particularly significant for health systems that are struggling to develop protocols to address issues such as the nationwide opioid epidemic or the increase in the number of Type II diabetes patients. These are often tackled through spreadsheets and manual calculations to identify patterns and best practice treatments and strategies.
SDLC Partners can automate those types of tasks, as well as produce custom, actionable recommendations for the next best action needed. This could mean that rather than standard monthly reminders to each patient about physician appointments, one patient is contacted weekly, another monthly, and yet another only once a quarter.
Barnyak is quick to point out that such solutions are intended to complement existing IT systems. “We’re not looking to replace EMRs or larger traditional care management platforms,” he says. “We add capabilities and custom functionality that integrates with them so that care can be facilitated more efficiently and in more concise ways.”
Scott Barnyak Founder, Chief Sales & Marketing Officer
SDLC Partners
“If we aggregate medical data with payer records, such as claim histories, we can link compliance requirements, clinical patterns, and individuals’ preferences and behaviors.”
–Scott Barnyak
This is accomplished through a collaborative design process based on clients’ clinical flow and processes, compliance requirements, patient environments, and desired outcomes. Targeted discussions with executives and clinicians follow human-centered design best practices to gain firsthand perspectives on the immediate challenges.
“We have the advantage of looking in objectively from the outside when we develop recommendations and solutions,” Simchick says. “We can act as a catalyst to help clients uncover the best opportunities for addressing their most pressing needs.”
In one instance, this resulted in a mobile application for clinicians making in-home visits to Medicare patients. The tablet-based solution was flexible enough to accommodate the natural flow of conversation by accepting answers to required questions in any order that patients raised them, whereas older technologies were only capable of working through the questions in a gated, consecutive order. In the rural areas where many of the patients lived, internet access was unreliable, so the application could function offline with results uploaded when clinicians return to their offices.
In addition to improving workflow and data access at the point of care, SDLC Partners can provide technologies to address performance, quality, and compliance issues. Along with gaps in care and their potential impact on ratings, dynamic suggestions for how best to address them can also be identified. “Death by Dashboard” is avoided by visualizing performance and delivering insights for each user in ways that fit his or her workflow and priorities, Barnyak and Simchick say.
Such details have practical and immediate consequences, according to Simchick. “From a Centers for Medicare & Medicaid perspective, you can monitor spikes in claims for a specific timeframe or region, or other trends,” he says. “Triaging those issues then results in fewer ER visits, lower overall costs, better outcomes, and improved Stars ratings and payment advantages.”
Evolving capabilities in artificial intelligence and machine learning can also provide transactional benefits in very specific circumstances. For example, solutions can support both payers with claims management systems and providers with physician reporting or patient logistics. This
Alan Freed
is accomplished by automating simultaneous data entry into multiple systems, creating communications that can be sent automatically, as well as populating multiple systems with reporting metrics.
Last year SDLC Partners created a center of excellence focused on robotic process automation. Through that center, the company has ramped up certified resources to accommodate the demand for artificial intelligence that yields practical returns on cost and efficiency. The company is currently engaged in several projects to develop applications that leverage these evolving technologies.
In addition to techniques and technologies, SDLC Partners is tackling the critical security, privacy, and compliance aspects of digital transformation. It created CyLumena, its HITRUST CSF certified security arm. Its focus is on protecting health information that may be
Chris Simchick Founder, CEO
SDLC Partners
stored in medical devices, as well as security vulnerabilities those devices might create.
From developing practical solutions to harnessing cutting-edge digital transformation, SDLC Partners is able to help clients manage the exponential pace of changing technology. Simchick points out that in any change effort, alignment is important. “If you don’t have a road map to help guide incremental change that’s based on value, you can actually wind up not achieving any movement at all,” he says.
His cofounder agrees. “Having an outside perspective to help identify the optimal path to ROI is very advantageous,” Barnyak says. “What SDLC can do is provide innovative ways to leverage client information, then develop unique insights and tailored digital tools to address the most pressing challenges.” AHL
“We can act as a catalyst to help clients uncover the best opportunities for addressing their most pressing needs.”
–Chris Simchick
By Will Grant
Jose Barreau remembers the exact moment he knew that something had to change.
Barreau, an oncologist at the time, tried calling another doctor at his hospital to no avail. The doctor paged Barreau later, and a game of phone tag ensued. “All I needed to tell him was three words,” Barreau says. But they were necessary words that can often have life or death consequences in medicine, and Barreau’s frustration at what some seemed like an antiquated communication system had reached its peak. “I have always loved all forms of communication,” Barreau says. “To not have that in healthcare is crazy to me.”
Tina Gutierrez
Barreau cofounded Doc Halo in 2010 with the mission to “create the highest-quality secure messaging and care coordination system for healthcare by having physicians, nurses, and technology experts working side by side.” Its flagship communication platform, Halo Spectrum, is a cloud-based platform that spans system-wide and connects hospital professionals using secure messaging, voice-over-internet calling, system-wide scheduling, and mobile alerts. Based on the platform’s deployment success, Barreau and company are first to a party that was long overdue.
Halo Spectrum aims to not just improve, but to fully replace healthcare systems’ means of communication that are often pieced together haphazardly using bits of technology from the past thirty years: everything from landlines to pagers to Google Spreadsheets to wall calendars. The platform provides every healthcare professional a clean and easy-to-use interface via their mobile device that allows real-time communication across a unified platform. The system is capable of encompassing electronic health records, documentation, revenue cycle management facilities, and even entire organizations, allowing for instant communication. Barreau says that the platform also helps guard against alert fatigue, a common phenomenon in a hospital setting. “EHRs come with tons and tons of messages that don’t have any value,” Barreau says. “We want to reboot what’s important for dealing with right now.”
One of the initial concerns Doc Halo worked to overcome was healthcare systems’ reluctance to place such sensitive information in the cloud. Doc Halo’s partnership with Amazon Web Services was crucial in making sure the platform would allow for secure communication and data management. Barreau says the rigid HIPPA compliance protocol as well as Doc Halo’s own constant security maintenance put clients at ease.
Jose Barreau CEO, Cofounder
Doc Halo
“Once you start getting the level of users that we have on the platform across the nation, you have to make sure that the system scales well. Healthcare has no tolerance for poor performance.”
Collaborating with new clients often involves working to redefine entrenched ideas. Healthcare systems used to purchasing and coding their own software might find Doc Halo’s approach unconventional. Although Doc Halo doesn’t customize its software, it is highly configurable. “Our software maintains scalability, feature-rich environments, and a constant modern version with every health system because we’re software-as-a-service,” Barreau says. “That’s the way it should be; healthcare should be on the cutting edge at all times.”
Barreau says that just like Doc Halo, a health system’s implementation of Halo Spectrum begins with those who know their system’s needs the best: the CMIO and the chief nursing information officer. “That relationship starts with medical leadership and expands to tech leadership,” Barreau explains. “We like to partner with organizations that want to modernize their communications.” Barreau admits that a full spectrum implementation is not easy but the benefits are enormous. “You modernize your entire real-time communication system with one platform.”
Maintaining Halo Spectrum is an ever-evolving process in terms of technological innovation, security, scalability, and performance. “Once you start getting the level of users that we have on the platform across the nation, you have to make sure that the system scales well,” Barreau says. “Healthcare has no tolerance for poor performance.” SOC II certification and security policies are updated constantly, and managing different mobile device user experiences and those operating system updates are a full-time monitoring process of their own. “If healthcare is going to go mobile, it can only do that with a company with a platform based in the cloud that is used to navigating the necessary mobile environment,” Barreau says.
The clinical communications mind-set of Doc Halo starts with “clinical” for a reason. “I didn’t really see healthcare IT coming from the doctor and nurse perspective,” Barreau says. “I wanted to fuse clinical knowledge and tech together and have doctors and nurses and developers working hand-in-hand-in-hand to create products.” Working with those medical professionals instead of merely hiring consultants is what Barreau believes makes Doc Halo different. That core difference means approaching communications solutions from a much different vantage point, especially for a company specializing in technology solutions. Barreau is the first to insist that all problems are not solved by tech. “Being a doctor allows you to look at problems and see if this is a problem that will be solved by better process and better communication in the health system, or can it be aided by technology?” Barreau asks. “We like to apply tech to get maximum value to doctors, nurses, and patients and not just because we can apply tech to a problem.”
That clinical-first mind-set has paid off in ways that Barreau says really speak loudly by barely speaking at all. The company didn’t even have a marketing department until late in 2017, which meant that almost all of Doc Halo’s clients were coming to them by word of mouth alone.
As those clients mount and implementations occur, Barreau remains unimpressed by the day a deal is made. “I’m not really interested in selling software, I’m interested in a great user experience and implementation,” Barreau says. “I get excited about changing healthcare, saving lives, and reducing delays in care.” Barreau and his team’s excitement about Doc Halo comes from being there, and from knowing the value of the problems they’re solving. “That’s just the doctors and nurses in all of us here,” Barreau says. AHL
Verizon’s Embrace of IoT
Verizon’s Michael Brander and Rajesh Vargheese walk through how their work with IoT is impacting the healthcare space and beyond
“What we do is take a human-centric approach. Even though we are a technology company, customers don’t ask for technology science. They ask for business outcomes.”
–Rajeesh Vargheese
WHEN TALKING ABOUT TECHNOLOGY , it’s easy to forget that there’s still a human component to consider. It’s not productive to innovate for the sake of innovation; rather, innovation is ideally spurred by need. To listen to Verizon’s Michael Brander and Rajesh Vargheese speak on the next-generation technologies they’re developing at Verizon is to also hear about the ways they work directly with the customer to recognize demand, because Verizon is more than just a communications company.
In his role as the managing director of IoT, Brander helps foster emerging technology at Verizon. IoT, or the internet of things, is a broad concept referring to the network of physical objects that can be connected via digital means. This can encompass devices, sensors, or, as Brander puts it, “anything that has the ability to be aware.” With the ability to connect and transmit via WiFi, Bluetooth, CATM and 2G/3G/4G cellular networks, products like a 3G/4G enabled temperature sensor, Amazon Echo, the Fitbit, and any brand of smartphone are examples of IoT sensors.
“These devices have to be able to send and receive data on their own, without human intervention,” he explains. “They also have to be actionable, meaning that the data could be integrated into business processes so that better decisions can be made.”
That process begins, however, with a conversation. “What we do is take a human-centric approach. Even though we are a technology company, customers don’t ask for technology science. They ask for business outcomes,” says Vargheese, who heads the emerging technology technical professional services group. “Technology is an enabler, but it always has to start with the question of what is the customer looking for. It starts with the customer’s experience. What are the outcomes that they hope to achieve?”
Vargheese offers up a few examples of projects they’ve embarked upon in the healthcare space, which can center around both the patient experience and enabling care delivery. On the former, Vargheese discusses the ways in which mobile apps and location tracking technology can facilitate smoother navigation and quicker checkins at the hospital. In terms of enabling care delivery, he touches on telehealth and streamlining access to disparate sets of data for machine learning and artificial intelligence (AI) applications.
And then there’s Verizon’s humanability initiatives. For Brander, humanability represents a “philosophy that we’re using to better articulate what our company stands for” in terms of providing not just technological solutions but also a better way of life for people. Brander mentions the use of sensors and video monitors to reduce traffic congestion and related CO2 emissions, and, in terms of healthcare, he touches on intriguing, in-development concepts such as “enabling remote surgery,” as well as means of increasing healthcare accessibility.
Cold chain IoT sensors are another key tool in Verizon’s arsenal, with Brander and his team adopting the temperature monitoring gadgets to enable better transport and handling of food products, medicine, and other temperature sensitive medical necessities. Not only can this help prevent spoilage and foodborne illnesses, but it can also make the process easier for those doing the transporting.
“This technology enables the ability to monitor end to end,” Brander says.
The difficulty of staying on the cutting edge of technological innovation is that technology can outpace you. Currently, Verizon has been emboldened by the development of the 4G LTE Cat M1 network. Verizon was first to launch this network nationwide in 2017 and continues working to make 5G a reality, which will only accelerate the promise of IoT and bring the above solutions closer to accessibility.
Still, this is a field that exists in a constant state of fluidity. “What you see and what we’ve talked about today is still an evolution, so the way that we’ve built this organization and this culture is to be very flexible and adaptive,” Brander says.
It’s also why Brander, Vargheese, and their teams are so focused on a human-centric approach. In the end, it’s all about the experience.
“The solutions that we’re building are really driven by what the customers need and what they’re telling us,” Brander adds. “So whether it’s the IoT tracking sensors or the intelligent hospital solutions, it’s a platform that has the ability to interact with different networks, different devices, and different applications. It’s not set in stone. It’s very adaptive and scalable.”
Technology may change, after all, but basic human needs never do. AHL
“The solutions that we’re building are really driven by what the customers need and what they’re telling us.”
–Michael Brander
Michael Brander Managing Director, IoT Verizon
We wanted to know:
What steps can be taken to make healthcare more inclusive?
Susan Constantino, p. 42
President, CEO
Cerebral Palsy Associations of New York State
Training for clinicians on diagnosing and treating people with disabilities, particularly those with complex needs, should be mandatory. There needs to be recognition that people with disabilities have multiple conditions, many of which might go untreated, because of the unfamiliarity of the clinician. Training for the clinicians will enhance the development of innovative and multidisciplinary treatment models benefiting all patients in our healthcare systems.
Stephanie Browne, p. 170
VP of Talent Acquisition, Chief Diversity and Inclusion Officer Blue Cross Blue Shield of Massachusetts
As healthcare organizations struggle to find ways to improve patient engagement, thinking about how to take bias out of the patient relationship model might help. Organizations should consider training staff at all levels of the system to recognize their own biases. This will help employees know how to use cultural competency tools and the right language to embrace differences by learning to probe and ascertain how to reach customers where they are. At Blue Cross Blue Shield of Massachusetts, we have begun to offer this type of training for our employees who interact with our members on a regular basis.
Mark Coggins, p. 20
VP, Pharmacy Services & Medication Management
Diversicare Healthcare Services Inc.
Cultural demographics are quickly changing across healthcare. For healthcare organizations to effectively grow and achieve the highest level of care, organizations must be inclusive of people— including care team members and patients—who are assimilated from a variety of cultural backgrounds, and reflective of the populations for whom they provide care. This allows organizations to respond swiftly to changing cultural differences and belief systems, and in doing so, they are able to help people feel valued while meeting their individualized needs.
Kimberly Lounds Foster, p. 24
Corporate VP, Global Commercial Supply Celgene
Healthcare organizations can improve inclusiveness by employing a teambased approach focused on identifying biases. As individuals, it is tough for each of us to be aware of our biases. However, organizations can practice collective team-based approaches to identify biases as they emerge and mitigate their effects in real time. These decisions can result in a chain reaction, and breaking the effect of unhelpful biases can result in more inclusion along with better outcomes for patients.
People & Companies
50%
The percent decrease in antipsychotic drug usage by patients at Diversicare Healthcare Services Inc. facilities over a six-month time period due to its de-prescribing initiatives. (Diversicare, p. 20)
$6.5M
The estimated savings Duke University Health System earned as a result of its drug insourcing program. (Duke University Health System, p. 150)
8M
The number of annual travelers—and potential patients—aboard Holland America Group cruise liners. (Holland America Group, p. 76)
98
The percentile score for Texas Health Presbyterian Hospital Dallas’ employee engagement ratings after implementing Nurse Management Engagement Theory throughout the organization. (Texas Health Presbyterian Hospital Dallas, p. 136)
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