Cooperating for better care.

Robert Whitcomb

Author Archives

6 reasons your management strategy isn’t working, especially in COVID-19 time

Michael Beer, writing in the Harvard Business Review, lists the reasons as:

#1: Unclear values and conflicting priorities.

#2: An ineffective senior team.

#3: Ineffective leadership styles

#4: Poor coordination.

#5: Inadequate leadership development.

#6: Inadequate vertical communication.

To read the article, please hit this link.

How a Madrid hospital modified management in COVID-19 crisis

Read how a public institution, Rey Juan Carlos University Hospital, in Madrid, acted swiftly to modify spaces, staffing and responsibilities to treat both COVID-19 patients and those without the disease to provide the critical staffing and material resources, and information, that hospital leaders have needed to manage during the COVID-19 crisis in Spain, among the world’s worst.

In an article in NEJM Catalyst, four physician leaders at the hospital say:

“During the Covid-19 pandemic, we have continuously evaluated and adapted to our circumstances. This was initially done on a daily basis, enabling us to quickly adjust staff roles as of the fourth day of the state of alarm declared in Spain. For example, we managed our physician corps by adding or transforming roles, including the addition of reserve personnel, while respecting rest times.”


“To most effectively organize these changes in physician roles, we defined needs (‘COVID-19 shifts’), the daily tasks to be carried out under each position, and the person assigned to that activity. This information is contained in a document available to all physicians via the hospital intranet. Updated in real time, it sets out the plan for the following week.”

“Members of our Covid teams have gradually become opinion leaders and role models of best practices.”

“Every day, a multidisciplinary crisis management team made up of hospital managers, the office of the medical director, the nursing director, preventive medicine, microbiology, and leaders in internal medicine, the ICU, and critical care gather to discuss problems and solutions around spaces and staffing. Meetings like these have helped to build the ONE TEAM concept, reminding us that we depend on each other to deliver the best possible care.”

They conclude:

“Looking back over the past two months, we have met the challenges posed by this pandemic thanks to the great capacity for coordination and plasticity shown by our health care professionals and to the leadership of our centralized hospital management team. We are now working to update all the resources we have been using in case there is a new curve.”

To read the article, please hit this link.

Unifying two business concepts to improve care

An article ((subscription required to read) in NEJM Catalyst argues that unifying the Shingo Model and the Baldridge Excellence Framework can help health-care leaders formalize management practices and improve care.

Please hit this link.

Many ACO’s may bail out of program because of pandemic

FierceHealthcare reports that a recent survey of risk-based Accountable Care Organizations found that “56 percent are likely to leave the program due to concerns about having to repay losses stemming from the COVID-19 outbreak.”

“The survey released Monday by the National Association of ACOs comes as health-care facilities are struggling to stay afloat due to financial pressures from the outbreak. Risk-based ACOs also have a major deadline of May 31 to give notice to the Trump administration to avoid paying losses or get any shared savings.”

“Medicare’s decade-long effort to change how we pay for health care to better reward quality and outcomes may be lost unless Washington acts quickly to throw these providers a lifeline,” said NAACOS president and CEO Clif Gaus.

To read the full article, please hit this link.

COVID-19 and the new practice of medicine

A new article in NEJM Catalyst discusses some ways in which medicine will be dramatically affected by the COVID-19 pandemic.

The authors write: “Covid-19 changed everything. Suddenly it is time to move past reimagining and begin recreating. In this article, we provide insights into the perceived impediments that led to slow adoption of telemedicine, the changes that came with the Covid-19 pandemic, and advice on how to most easily implement a telemedicine program rapidly if you do not have one. We also caution that established telemedicine programs should not embrace the short-term easing of federal restrictions and divert from best clinical practices unless absolutely necessary.”

To read the article, please hit this link.

‘Social innovations’ are needed to transform care

From NEJM Catalyst:

“Hopelab’s CEO outlines an approach to innovation that takes into account the systemic and social factors that individuals and communities face as they try to achieve and maintain good health, an approach that builds bridges between sectors and takes risks to think big about human-centered design at scale — especially for those the current health care system doesn’t do a great job of reaching or engaging.

“When getting ready for {last fall’s} NEJM Catalyst event,’Care Delivery Innovation: Why, How, and the Impact,’ Margaret Laws, MPP, President and Chief Executive Officer of Hopelab, a San Francisco-based nonprofit, reviewed lists of innovations. One list from Cleveland Clinic in 2018 predicted the top 10 medical innovations for 2019, such as artificial intelligence, robotic surgery, and immunotherapy. But while those medical innovations are important, ‘they don’t have a lot to do with most people’s experience of the health care system,’ Laws says. ‘I got to thinking, what if we put this much focus on addressing some of the areas in which our health system and the people it serves are desperate for innovation, areas where we see glaring disparities in access and outcomes?”’

“’What if we also asked what social innovations will transform care?’ Laws suggests to the audience. She outlines the need for an approach to innovation that takes into account the systemic and social factors that individuals and communities face as they try to achieve and maintain good health. These challenges call for an approach that focuses on more than the ‘silver bullet’ drugs, devices, and technologies, an approach that thinks about human-centered design, how innovations get to and are used by people — including and especially those people our current health care system doesn’t do a great job of reaching or engaging.”

To read the whole article, please hit this link.

Pointers in developing physician leaders

In a Medical Economics essay, Steve Quach, M.D., CEO of  CarePoint Health and author of The DNA of Physician Leadership, writes about how to develop physician leaders of health-care organizations.

 Among the factors he cites are the need for an appetite to take risks; the need to rigorously prioritize tasks and do heavy delegation, even leaving some low-priority things undone;  understanding the difference between being authoritative and influential, and avoiding a short-term mindset.

To read his essay, please hit this link.


Report looks at why rural hospitals are closing

FierceHealthcare reports:

“The number of U.S. rural hospitals that shut their doors reached a record-setting 19 last year, according to a new report that aims to pinpoint why hospitals are closing.

“The Chartis Center for Rural Health and iVantage Health Analytics released a report (PDF) … that found 120 rural facilities have shut their doors since 2010. The study also explored indicators that can lead to a rural hospital’s demise.

“’The accelerated rate at which rural hospitals are closing continues to unsettle the rural healthcare community and demands a more nuanced investigation into rural hospital performance,’ the study said.”

“The report identified nine indicators to measure whether a hospital is ripe for closure. Some of the indicators include occupancy rates, age of the facility, system affiliation, total revenue and case mix index, which is the ability to handle a broad mix of services.”

“Another key indicator is whether the state expanded Medicaid under the Affordable Care Act.”

To read the whole article, please hit this link.

CEOs had expected more progress on value-based care

FierceHealthcare reports:

“Healthcare CEOs admit they thought they’d be farther along in the transition to value-based care than they are today, a new survey shows. 

“Consulting firm Deloitte polled 25 hospital CEOs and 6 payer CEOs, all running companies with at least $1 billion in annual revenue, on their perspectives on a slew of industry issues and found that they’re shifting investment focus to consumer tech and improving care coordination, including through virtual health. 

“Many CEOs in our prior studies predicted that they would be much further along in adopting value-based payment models than they are today,” the analysts wrote. “They admit now that progress was much slower because efforts were much harder than they anticipated.” 

To read the full article, please hit this link.

Leadership development needs ‘mentors-of-the- moment’

In a Harvard Business Review article, W. Brad Johnson and David G. Smith argue that an organization’s culture, not specific mentoring programs, is most important in developing leaders.

Among their observations:

“Here is the problem: Mentoring programs typically rely on single mentor-mentee matches, pairings that by nature are quite formal and hierarchical, when all the evidence shows that many employees — especially women — prefer mentorships with a more reciprocal and mutual character. Single mentors are also less career-enhancing than robust developmental networks or mentoring constellations. What’s more, even the best mentoring programs are unlikely to achieve intended outcomes when the surrounding workplace is competitive and individualistic, and when senior members of the organization only engage in developing junior talent when pursued by a prospective mentee or “voluntold” to participate in formal program.”

“Mentoring programs alone won’t sufficiently engage or develop your junior talent, especially if your culture doesn’t encourage mentoring on a regular basis. What your company needs instead are mentors-of-the-moment.”

Among their conclusions:

“Genuine mentoring values and daily mentoring behaviors must be embedded in the workplace DNA. Not only can mentor-of-the-moment exchanges offer a less-threatening alternative to an assigned ‘relationship,’ they also fuel inclusion. Actively engaging colleagues with diverse experiences in frequent, transparent, affirming conversations may be less daunting than a formal assignment, especially when it is a clearly articulated performance expectation.”

To read the whole article, please hit this link.

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