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).

As I was watching the pregame show, studio analyst Tony Dungy gave his overview of the game.  Dungy is a retired NFL head coach who won the Super Bowl in 2007 with the Indianapolis Colts.  All told, he spent 12 years as a head coach in the NFL, making the playoffs a record ten times in a row.  He’s known best for his quiet demeanor and a coaching philosophy that encourages teaching and supporting his players, rather than screaming at or belittling them.  He is known as a “good guy,” but it was his part of this past Sunday’s mortality play that the casual fan didn’t appreciate.

You see, he had a leading role in the rehabilitation of Michael Vick when he was released from prison.   Watching him reminded me of what he was credited with saying to Vick:  “Integrity is what you do when no one is watching; it’s doing the right thing all the time.”

Now some could never forgive Vick, and I’m not going to get into that now.   But I think that there is a lesson in Tony Dungy’s approach to life.  The real person you are is revealed in the moments when no one is watching and you’re not attempting to impress anyone.  Your true nature comes out when you’re just being yourself and doing the right thing.  I’ve stressed to my kids that in moments when no one is watching is how you conduct yourself with integrity.

This same idea is ingrained in a lot of our people at ARAMARK.  I’m always impressed by the stories I hear about the great things ARAMARK employees are doing every day – often when no one is looking.  Sometimes it’s just a small gesture on a random day that only affects one person – but makes a huge difference.

At the San Martin campus of St. Rose Dominican Hospital in Henderson, NV, Environmental Services (EVS) Director Robert Stewart took it upon himself to help a patient who most people might not give a second thought.  As a result, Robert was honored as the hospital’s Star Performer for August, which is a monthly employee recognition that is voted on by San Martin’s case managers.  Even more impressive, according Hospital President Rod Davis, this behavior is pretty typical from Robert. 

Joni Kurata, a Licensed Social Worker at San Martin, told us about a homeless patient who came in with chest pain.  Obviously, he wasn’t in the best condition, and his clothes – the only clothes he owned – were extremely dirty.  Robert overheard several individuals discussing the patient during the daily bed placement meeting. 

Just to provide some background, ARAMARK’s EVS directors handle a number of tasks, including managing the cleaning and housekeeping services, maintenance, and waste disposal, all while using environmentally conscious processes and equipment.  While the work our EVS group handles does affect patient safety, comfort, and confidence, they aren’t directly responsible for patient well-being.

Well, except in this case.

While the patient was receiving tests, Robert went and personally found the patient’s clothing, pretreated the stains, and ran them through the washing machine and dryer, having them back to the patient within a couple hours.  The patient was extremely grateful and the entire staff appreciated his unsolicited effort.  “I could tell he (Robert) was really busy that day, but he still went out of his way to help,” said Joni.  “I am so impressed by ARAMARK’s staff and their willingness to help, no matter what the circumstance.”

“What can I say other than Robert does a fantastic job?” mused GM Lee Timothy.  “He always takes ownership, steps in, takes initiative, and makes things happen.”

He makes things happen.  Even going so far as to tackle what clearly wasn’t an enjoyable task, when no one was watching.  Robert went out of his way to ensure that this patient’s stay would be as pleasant and comfortable as possible.  Employees like Robert Stewart are our unsung heroes, and they are who make us successful.

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.

So with all of the cost constraints on hospitals, some may question about why we should care about what a hospital looks like? 

Well, I think it reflects on the management of the hospital.  When an organization cares to make itself look good, then there is an underlying statement that they are good.  I’m reminded of the story about the rock legend Van Halen, who demanded that promoters provide a bowl of M&Ms with the brown ones removed.   You see, Van Halen was one of the first rock bands to bring truly massive concerts to mid-size cities like Macon, Georgia.  The arena staff in these smallish cities was used to bands coming to town with, at most, three tractor-trailers full of equipment.  Van Halen’s equipment took up nine tractor-trailers.  It was a lot of stuff, and the staff at these venues was frequently overwhelmed.  And when people are overwhelmed, they make mistakes.  At a rock concert, “making a mistake” during setup has a large number of possible outcomes.  Some mistakes don’t have any effect at all.  Other mistakes can make the band sound awful, which only hurts the band’s image.  But more serious mistakes can kill people… which is exactly what the band was afraid of.

The band said that was a trick to make sure promoters read the contract carefully.  If they showed up and found brown M&Ms, they would know the promoter might have been sloppy about more important things like sound and lighting… and safety.

For patients going to a hospital… seeing a beautiful facility that is clean and organized, and well-dressed staff, reflects on the degree of pride that people have in the organization.  There is a comfort in knowing that if the hospital got the “little things right” – like clean floors – then it may get the big things right – like surgery. 

Gale Yochum, a five-year Soliant operating room travel nurse said, “There is a special feel to hospitals with inviting public spaces and soothing private rooms.  Patients who feel satisfied with the facility may recover faster and have shorter stays, which is good for both hospital and patient.”  I’ve got to reinforce that the patient’s perception becomes a reality.

So what makes a hospital beautiful?  Any number of things… the building design, the location, patient rooms and amenities, or outdoor spaces.  Some of the hospitals on the list feature modern architecture, public atriums, entertainment systems, leather furniture, wraparound windows, individual fireplaces, ornate landscaping, outdoor sculptures, and lobbies that look more like they belong in five-star hotels.  Some are located near water, mountains, lakes, or parks, which provide a more tranquil environment for the patients.

And most importantly, I believe that in all cases, the beauty of facility goes far beyond the bricks and mortar to the people who work inside the walls. 

I’m especially proud of the ARAMARK Healthcare services provided at Sumner Regional Health System (Gallatin, TN), Thomas Memorial Hospital (South Charleston, WV), Union Hospital (Terre Haute, IN), and  Bon Secours St. Francis (Midlothia, VA).   I know our team helps make a difference in those places.

North Region DM Rick Bremer agrees:  “ARAMARK has been serving at Union Hospital since 1969… that just goes to show that how much the client values and demonstrates commitment.  And that commitment extends to their partners, employees, AND patients.  ARAMARK is very proud to serve such a fine partner that has been recognized with this great mark of distinction.”

An environment that benefits both patients and the individuals who work there?  That’s a win-win for everyone!  

Congratulations to all the hospitals selected.  For more information, click here for the complete list and photos.