While at HIMSS I presented at a session that discussed the relationship between costs and patient satisfaction, a collaborative research project done with ARAMARK Healthcare and Deirdre McCauhgey, Ph.D., Assistant Professor form Penn State.  Dr. McCaughey and I are pictured at left at our session.   The session looked at outline an approach for analyzing the  relationship between costs and patient satisfaction, described the creation of a value equation linking expenses to outcome metrics, and explain how to apply this approach to hospitals.

On another note, as I spoke to people (many of whom symbiotically connected to their IPads) I began to get a feel for the way that clinical technology is moving closer and closer to information technology. The complexity of medical equipment has increased so significantly that the relationship between clinical engineering and IT has become very intertwined.

For example, I was talking to one hospital CIO who was telling me how he needed to perform a software upgrade on 600 medical devices. His quandary was who should do this … the clinical engineering team or the IT department?

The solution turned out to be both, led by a clinical engineering team that is integrated with the IT department as a partner.  What is happening is that more and more clinical engineering teams are reporting to the CIO. This is a trend that will surely gain momentum as equipment continues to become more sophisticated and highly networked.

What does this mean? From my perspective it means that clinical engineers and biomed technicians will need more and more of the right kind of training and nurturing as they perform service under this strengthening partnership with IT.

No question that technology has both advanced and complicated the healthcare industry, even in the service sectors, but unlike the Matrix movies  I believe it is ultimately good for human kind, even if we are getting closer to science fiction.

As a graduate of a health policy and management program, the chance to sit down with Ireland’s leading CEOs to discuss healthcare over lunch in the Guinness Storehouse, was one of those moments I knew I would never forget. The private, guided tour of the storehouse didn’t hurt either!

Enjoying a Guinness following an insightful lunch and learn with leading CEO's and healthcare executives in Ireland.

Although I had an ever-increasing list of questions popping into my head, it seemed the questions and dialogue we shared over lunch were equally exchanged. The initial conversation starter came from an administrator who couldn’t wait to validate what he heard about my hospital; although I am paraphrasing the words were something to the effect of “so tell me about your new hospital, is it true what I hear about the bed count”. I explained that yes, Capital Health (the two hospital system in New Jersey where I am completing my fellowship) had just opened a brand-new roughly half-a-billion dollar facility with 237 beds. This may seem somewhat common to someone who works in a US healthcare organization, but to this audience that was shocking. As I came to learn, most hospitals in Ireland have 700-900 beds and cost about the same amount to construct. That puts our major differences into perspective.

Soon our conversation turned to the idea of private vs. public healthcare systems. Ireland’s healthcare funding is publicly based (as Deb mentioned in her blog) but like many other countries it has a growing private sector. Lucky for the other fellows and I, there were a variety of administrators from both sectors at the table. We were successfully able to discuss the pros and cons of our countries’ healthcare environments and discuss ideas for improving (if you know me, than you know I love rational and civilized debate!). 

After two hours of discussion I felt as I had learned a year’s amount of coursework in healthcare policy. As it turned out all of us came to the same conclusion: despite having different economic climates, political dynamics, and fundamentally different healthcare systems we all faced the same exact challenges. Both countries face increasing chronic disease, pressure to reduce costs, misuse of the emergency departments (“A&Es” as they are referred to in Ireland), and the list continues. That lesson is by far my big take away from our visit to Ireland, and I know that it will remain ingrained in me as I strive to improve the US healthcare system little by little. (Do I hear a doctoral dissertation calling my name??).

At this point you may be wondering why ARAMARK would take us to the Guinness Storehouse. ARAMARK provides many of the operations for the storehouse and many hospitals across the country alike. ARAMARK is helping each of these clients meet their goal of providing high-value, cost-effective food services to take the burden off of the client site and provide customer and patient satisfaction.

A leader sets the pace for the organization.  If the top person is optimistic and upbeat, and believes in a positive future, then the organization moves that way.   What the top person is thinking about influences the direction of an organization.   In healthcare, much has focused on government and politics.  ARAMARK Healthcare’s Group President, John Babiarz, once said to me, “Anthony all of that politics matters, but not that much.  It’s what the hospitals are doing that is key to keep our eyes on.”  Just like Job’s brick analogy, our nation’s CEOs are getting hit in the head not just with one brick, but a whole dump truck full of them.  Where they focus is key.

Since 2002, the American College of Healthcare Executives (ACHE)  has conducted a survey of hospital CEOs.  This survey provides a sense of where our nation’s hospitals are headed.    ACHE  recently released the results of this year’s version of the annual survey where 514 hospital CEOs responded.

Key takeaways:

1)     Financial Challenges remained the highest concern, with 75% of CEOs listing them as one of the top 3.  No statistically significant difference was seen in the scores for the past 4 years

• Chief among the sub-issues under financial challenges are Medicare reimbursement (89%), Government funding cuts (88%), Medicare cuts (78%), and Bad Debt (71%).  Note that CEOs can check as many of these “sub-issues” as desired.

2)     Healthcare reform implementation dropped 10 percentage points, but still ranks as the second highest score.  Government mandates (many of which are a result of reform) increased to the third highest item, with a score of 39%.  This is the highest score ever for Government Mandates.

• Included among the leading issues with government mandates are RAC audits (79%), implementation of ICD-10 (74%), and CMS regulations (66%).

3)     “Care for the Uninsured” and “Patient Safety and Quality” tied for fourth with 33%.

4)     “Physician Relations” is next with 30%, unchanged from 2010, and lower than the 2006 high of 40%.

5)     “Patient Satisfaction” trends at a three year high, but is below the 2008 score of 22% when HCAHPS was being implemented.

6)     “Capacity” was not asked.  It had historic low scores in 2009 and 2010.

7)     “Technology” remains statistically unchanged at historic low scores since 2005.

8)     CEOs were asked about their implementation of an ACO.  Only 6% rated that as one of the top 3 items on their list.

Here’s a link to ACHE’s summary of the results and a chart that I’ve compiled annually to compare results year over year. Top CEO Issues ACHE_2011

Steve Jobs said, “You’ve got to find what you love. The only way to be truly satisfied is to do great work.  And the only way to do great work is to do what you love.”  This posting is dedicated to those hospital CEOs who are making a difference in health care because they love what they do, and realize that importance of doing what they love for all of us.

ARAMARK Healthcare Fellow, Deborah Daniel, a Canadian, leads discussion with Irish healthcare CEOs at the Guinness Storehouse facility in Dublin.

We started the ARAMARK Healthcare Fellowship in 2009 and boy have we seen some great success to date!  Our fellows come from some of the finest CAHME-accredited graduate programs in North America.  Upon completion of the program, nearly all of our fellows have been placed in top-notch healthcare facilities.  It’s great to see and know that the core facets of the program which include traditional hospital project work, academic based translational research, and experiential learning really provide the foundation for a rewarding career in the healthcare industry. Earlier this month our current class of ARAMARK Healthcare Fellows took a trip to Ireland to encounter firsthand what their health care system.  From what I hear, we may be offering the fellowship in the Emerald Isle in 2013.

I’ve asked our fellows to be guest bloggers, to give you their impressions.  Today’s posting is by Deborah Daniel, an MHA graduate from the University of Toronto, who is serving as the ARAMARK Healthcare fellow at Vancouver Coastal Health, British Columbia, Canada.Health Care in Ireland

By Guest Blogger:  Deb Daniel, ARAMARK Healthcare Fellow

As a Canadian in Health Care Administration, post-Master Fellowships are not common. I am very lucky to have been given the opportunity to do a Fellowship with ARAMARK in a Canadian System. Part of my experience included a trip to Ireland to experience not only a different health care system but also to see how ARAMARK helps create positive experiences for their clients in different lines of business such as food services at universities and tourist destinations including the Guinness Brewery. Part of our trip included visiting different health care facilities and hospitals as well as learning the structure and function of the system and how ARAMARK exists within this context.

Ireland has a socialized health care system where all citizens have access to specific medical services – such as hospital visits. There are both private and public run hospitals within Ireland – all citizens have access to the public hospitals, but each person or family has to pay out-of-pocket for access private hospitals either through purchased private insurance or personal expense.  What I found interesting was the initial “fee” that had to be paid whether you sought care at a public or private facility – in contrast to Canada were accessing public hospitals is at a zero cost.

The private hospitals we visited were beautiful – most were very new and extremely clean. I unfortunately had to visit a hospital due to a personal medical issue and chose a private facility as I was told I would get care quicker because I had private insurance. And right they were! I was seen quite quickly at a cost of $110 Euros. In contrast, if I attended a public facility, I would have had to pay $100 Euros and my wait times would have been much longer. However, at the public facility my other tests and services would be covered at no charge, but on the other hand I would have had to pay at the private hospital.

I can see why people would prefer the private hospital, and found it interesting to speak to locals who say that for major trauma and illness they would rather attend the public facility. From the people we spoke to, they said the care in either type of delivery is excellent; however, private facilities are good for more minor incidents such as the one I was having.

Being able to experience the health care system first hand and not just hear about it from locals and affiliates was interesting – I saw, and I believed.

When preparing for the Joint Commission, depending on people that have been through inspections many times provides a better probability for success.  For example, I was talking to our hospitality team and they were telling me that Joint Commission surveyors are focusing on a number of physical environment features, including multiple settings, layout and space and air balance differences.  Here are three areas that they pointed out:

1. Multiple settings

In addition to operating rooms, surveyors are looking more closely at the peri-operative environments, such as central sterile processing, endoscope cleaning areas and patient prep areas.

2. Layout and space

Design requirements in places like the central instrument processing areas are being examined more carefully.  Surgical instruments must be decontaminated in one room and sterilized and processed for reuse in another environmentally separate room.  Sometimes work flow optimization can compromise required physical separations.

3. Air balance differences

To maintain proper environments, the air handling equipment must be operating differentially so that clean, filtered air is supplied under positive pressure to sterile areas, and air is purged under negative pressure in potentially contaminated spaces.

One of the most efficient ways to keep infection rates low and stay in compliance is to test and inspect for these new focus areas regularly.  In advance of a Joint Commission survey, you can proactively identify any issues and resolve them.

Most hospitals experience the Joint Commission survey once every few years, but across ARAMARK Healthcare’s portfolio of more than 1,000 hospitals, my team told me that we participate in a regulatory or accreditation survey more than once per week!

It helps to work with a partner who knows how to carry the load, whether it is a load of wood, or the pressure of having surveyors in house.

As Kate Winslet’s character explains, the average person touches their face three to five times every waking minute.  In between, they’re touching doorknobs, ATM machines, handrails, water fountains, and each other.  All this contact means you could go from Patient Zero to a billion in 30 steps, or 120 days.  The point is that infection is easily spread.

There is nowhere that infection prevention is more vital than in a hospital, where patients are already susceptible to infection due to illness, weakened immune systems, recent surgery, or other genetic factors.  At ARAMARK we take infection prevention very seriously and the primary concern of our Environmental Services group is to keep patients safe and healthy.

To highlight the importance of infection prevention, October 16^th – 22^st marks International Infection Prevention Week, first proclaimed by then-President Ronald Reagan in 1986.  Since then, the event has vastly expanded its reach across the globe.  The Association for Professionals in Infection Control (APIC) make it their mission to educate people and prevent infection, and International Infection Prevention Week (IIPW) is their chance to highlight the infection prevention profession and its work in educating healthcare professionals and administrators, legislators, and consumers.

As part of that commitment, our EVS employees are adding to our existing infection prevention efforts by performing random inspections to confirm that all high-touch areas in patient rooms (like bed rails, tray tables, call buttons, and phone) are being cleaned and sanitized regularly and effectively.  While those surfaces are not direct causes of infections themselves, they can transfer organisms that cause infections.  Check out this video to see ARAMARK’s approach.  In addition, our staff is trained to make sure the patient’s needs are met and that rooms and bathrooms are cleaned effectively at least once a day.

ARAMARK Healthcare EVS employees perform vital tasks each and every day to create efficient, safe, comfortable, and clean environments for patients, visitors, nurses, physicians, and employees, minimizing the risk and spread of infection.

Oh, and If you go and see “Contagion,” try not to panic.  It’s only a movie.  (But remember to wash your hands when you leave the movie theater).

The need to evaluate expenditures in terms of value – and how to define that value – is more important in the business of healthcare.  I’m very proud of ARAMARK Healthcare’s sponsorship of the HFMA Value Project which found that hospitals and health systems are recognizing the shift to a value-based healthcare system and are preparing for changes in the payment system.

A webinar that features Valley Baptist Health System’s Stephen W. Hill, Administrative Director of Nursing and Cynthia Gray, VP of Finance, along with Michael Morgioni the CFO of ARAMARK Healthcare, will focus on how Valley defines value.  This HFMA Value Project webinar will share strategies providers can implement to build a culture of performance and efficiency to prepare for healthcare reform. It will specifically discuss collaboration efforts among support services and nursing so that nursing has more time for patient care. Outcomes will be highlighted from activities instituted by ARAMARK Healthcare  known as I Impact. Those outcomes include higher patient satisfaction, better employee retention, and safety outcomes that drove profitability and productivity. The application of operational benchmarks and standards to reduce variability while improving quality outcomes will also be discussed.

If you want to learn how you can accelerate organizational change using collaboration tools, leverage employee engagement, and engage operations in value creation, this webinar may help provide you with some good approaches.  In addition, the webinar qualifies for 1.5 CPEs.

I’ll be tuning in – on October 4, 2011 at 3:00 to 4:30 Eastern;  2:00 to 3:30 pm Central.

The program had more than 140 applicants last year.  Promoting diversity in healthcare is one of the main goals. In fact, The Institute of Diversity in Health Management is a co-sponsor and my colleague and friend, Fred Hobby, president and CEO of the Institute, has articulated the Institute’s interest as to promote diversity at the executive level in healthcare leadership.

The fellows are placed at top hospitals … and some very well respected healthcare executives have served as preceptors in mentoring the young adults who have completed this program. I can say with pride that many of the graduates have gone on to work in leadership roles within their hospitals. Tony Amada, CEO of Advocate Health Care, talks about his experience in this video.

As a former college teacher, this is one of the parts of my job that I love the most. We are now looking for five smart, diverse and dynamic candidates to join our program for the 2012-2013 class. For more information on how to apply click here.

Healthcare Clinical Technology is one of those areas where a lot of “myths” arise.  I believe that these myths are perpetuated due to the accelerated rate of innovation from multiple scientific disciplines and evolving patient expectations.  Coincidentally, these myths are coming at a time when medical equipment is coming under increased scrutiny in the popular media and even in academic publications.

I’ll be co-presenting with Dr. Binseng Wang in a webinar presented by the Asian Health Care Leaders Association (AHCLA) on Thursday, September 15, 2011, from 12:00 to 1:00 pm Central Time.   When we put together this presentation, we felt that, arguably, technology is the key contributor to health care improvement in the last several decades–bringing miracles in prevention, diagnosis, treatment and rehabilitation.  However, healthcare technology, especially medical equipment, is often misunderstood by healthcare leaders.  This lack of understanding has led to myths, or ways to rationalize behavior.

The webinar is entitled:  MYTHBUSTERS: THE TOP-TEN MYTHS OF HEALTHCARE CLINICAL TECHNOLOGY. Through this session, you will be able to more accurately address quality improvement and cost containment in your institution. It is available at no charge through ARAMARK Healthcare’s participation with AHCLA.

My co-presenter is Dr. Binseng Wang, Vice President of Quality and Regulatory Compliance for ARAMARK Healthcare Clinical Technology Services.  Dr. Wang brings a broad set of experiences in medical equipment management, including executive positions at MEDIQ/PRN Life Support Services.  He was a visiting scientist with the National Institutes of Health, and with the Secretary of Health’s Special Advisor on Medical Equipment in Brazil.

Click Here to Register.

The article details the approach CHRISTUS Santa Rosa (San Antonio, TX) used to develop a five year implementation plan for improvement activities and system replacement initiatives.