Volume 6 (2021-22)

Each volume of Management in Healthcare consists of four quarterly 100-page issues.

The Articles published in Volume 6 include:

Volume 6 Number 4

Editorial
Simon Beckett
Papers
The divides that health organisations experience on their journey towards high reliability: Moving from theory to practice
William Patterson, Chief Executive Officer, VA Heartland Network and David Isaacks, Chief Executive Officer, North Florida/South Georgia Veterans Health System

Organisations, specifically in the healthcare industry, often find themselves in a state of ‘Reliability Divide’. This is a concept that the authors have developed to explain why most organisations never realise the culture change needed to become highly reliable. In an organisation there is a variable time frame to get to daily work. Because of the time involved, some of the front-line staff who participated in theory, academics and now operations have become mid- or lower senior level leaders. Along the journey they become the vector that infiltrates the organisation to reach Fabric. Multidirectional high reliability organisation (HRO) adoption starts to occur here, which further drives an organisation towards zero harm (nirvana).
Keywords: high reliability; zero harm; process improvement; leadership commitment; maturity; journey
The rising cost of healthcare system complexity, and what can be done about it
Jean-Pierre Stephan, Managing Director, Health North America; Customer Engagement Lead, Accenture

It is no secret that the US healthcare system is notoriously complex. The numerous product features and options offered by health plans are difficult to understand. Pricing transparency is non-existent. That complexity, in turn, has a detrimental impact on consumers’ access to care, quality of experience and health outcomes. Unfortunately, the problem is getting worse. Consumers are frustrated when trying to determine whether their providers are in the plan’s network, why they got an expensive bill for a routine service they expected to be covered by insurance, or how to decipher unfamiliar language in their insurance policies. Federal and state regulation has ramped up as health benefits offerings have proliferated, further driving complexity, especially for providers and health plans. This paper explores the findings and implications of recent Accenture research that gauged consumers’ understanding of the healthcare system and their ability to navigate it to meet their needs. It also proposes ways to address the complexity of the healthcare system to ease the burden on consumers, payers and providers alike.
Keywords: health literacy; healthcare engagement; patient experience; product innovation; healthcare costs; health insurance products
People, process and technology: A model for Digital transformation of healthcare
Harold Wolf, President and CEO, Healthcare Information and Management Systems Society and Anne W. Snowdon, Professor of Strategy and Entrepreneurship, Odette School of Business, University of Windsor

COVID-19 has brought forward unprecedented challenges for healthcare systems worldwide. As healthcare moves into a state of COVID-19 recovery, we must reflect on lessons learned from the COVID-19 pandemic to create a more resilient future. One of the most critical outcomes this pandemic has highlighted, is the role of digital technology and digital health in transforming health care services. We suggest that by focusing on people, processes and technologies, healthcare systems can not only recover from the impact of COVID-19, but also transform healthcare from the traditional disease management system of today into the post pandemic health system of tomorrow, one that is modernised to align with the needs of the populations that health systems serve. Currently, health care systems are predominantly transactional, delivering care focused on disease management to restore health and/or manage acute health conditions. A digital health ecosystem offers a strategy to realise the full health potential of every human everywhere, from the smallest village to the most complex health care environments in health systems. Digital health ecosystems identify and track progress towards health goals, tracking outcomes and health risks at the individual and population level, which informs care approaches that are personalised to people and populations and are focused on mitigating risks in order to support and sustain health and wellness. The sustainability of healthcare systems and the health of global populations will be influenced by the rate of adoption and scalability of digital health. This paper will examine digital health transformation as a strategy to overcome the challenges health systems are facing and to advance the sustainability of health systems globally.
Keywords: Digital transformation; digital health framework; leadership strategy; digital health
Leading strategic change
Jim Austin, Adjunct Assistant Professor, Brown University

Most strategic change initiatives are never implemented. While one cannot guarantee a strategic result, two steps are essential for reducing risk and improving outcomes in Leading Strategic Change: firstly, adapting a strategic mindset that is open to more than just incremental change; secondly, execute, execute, execute. In the author’s experience, most strategic initiatives fail not for their poor strategic choices but for being unable to expand on prior mental models and for poor execution. This paper examines four common mental model pitfalls and proposes means of overcoming them, from frame narrowness to confirmation bias, groupthink and finally attribution bias. Execution depends on clear priorities; understanding stakeholder needs; and clear, simple, consistent communication.
Keywords: strategic change; strategy; organisational change; strategic execution; healthcare organisational change; healthcare change management; leading change
Implementation guide to improve accuracy and efficiency for outpatient referrals using EHR functionality
Archana S. Shinde, Principal Health Systems Engineer, Department of Management Engineering and Consulting, Mayo Clinic, et al.

Mayo Clinic adopted one electronic health record (EHR) across all 70 locations in five different states in 2017 and 18. A post-implementation review addressed concerns, and new workflows, processes and functionalities were adjusted. A common issue raised by multiple departments related to difficulty in accessing the right referral orders. Referrals between departments at Mayo Clinic are orders driven; scheduling is dependent on accurate ordering. Mayo Clinic’s vast size and number of specialties resulted in a very large catalogue of referral orders mapping to appointment types specific to each specialty. Providers found ordering in the new system time-consuming and looking for specific orders tedious. Often, wrong orders were selected, resulting in scheduling errors, reordering, rescheduling and staff and patient dissatisfaction. To solve this problem, an innovative functionality, EZ Panels, was created, which uses a panel-within-panel approach to group orders by speciality, displaying a much shorter list to providers. This functionality improved ordering capabilities, making it easier for providers to access the correct orders and make referrals accurately and efficiently. All 70 practices built and implemented EZ Panels in less than one year. Our fast-paced build and implementation approach can be modified and used by any healthcare system experiencing similar issues.
Keywords: EHR; implementation; ordering; scheduling; staff satisfaction; agile
Pharmacy services across the continuum: Leveraging opportunities and organisational strategies to improve market competitiveness
Thomas J. Johnson, Vice President, Avera Health and David Chen, Assistant Vice President, ASHP

Medication utilisation is one of the ubiquitous modalities of medical interventions in our healthcare system and an area of high complexity and high cost for many patient populations. Assessment of the use of medications both in acute and ambulatory care settings has become increasingly important for hospitals and health systems as organisations become larger and more integrated and must manage the payer and external provider changes in the marketplace. The COVID-19 pandemic emphasised the critical nature of the drug supply chain for essential medications and the strategic imperative for health systems to have an enterprise-wide medication use strategy. This strategy must ensure evidence-based use of medications to improve patient safety, outcomes, effective cost management, as well as secure and expand revenue-generating patient care services to support the overall health and sustainability of the organisation. Essential to accomplishing these goals is having a pharmacy executive as part of the health systems’ enterprise strategic planning to ensure that patients’ clinical needs, organisational revenue cycle, and new ventures are integrated across the continuum to optimise patient outcomes and patient retention.
Keywords: pharmacy; leadership; hospitals; strategic planning; delivery of health care; medication therapy management
Impact of intensive peer coaching on physician performance
Naim El-Aswad, Chief Medical Officer and Founder, VSVS, et al.

Physician performance in patient experience varies broadly. Physicians who are otherwise excellent clinicians may have lower than average patient experience scores and more frequent patient complaints. This raises the question, how do we assist physicians in improving their skills to provide a better patient experience? To address this problem, a team of physician peer coaches were matched with clinicians who were underperforming to local standards as measured by individual patient experience scores or by number and type of patient complaints. The peer coaches worked with their colleagues for six months, meeting on average every other week to review motivation, skills and performance barriers. Clinicians who were paired with trained peer coaches showed significant, sustained improvement in performance as measured by patient experience scores of the coached cohort. Clinician retention also outperformed manager estimates, and clinicians were highly satisfied with the process. It was concluded that physician performance can be positively impacted through peer coaching in a process that is satisfying to the client, improves estimated retention and reduces turnover costs. Peer coaching benefits patients, clinicians and hospitals by improving the experience of both patients and clinicians and supporting a stable clinician group. Coaching programmes are reproducible and measurable and produce short- and long-term results. Emergent themes recognised by coaches included not only skill development but also professional well-being and personal renewal activities. As clinicians face increased challenges to professional well-being personal and employer-based coaching programmes are one way to mitigate the risk to patients and clinicians.
Keywords: patient experience; coaching; performance; well-being; retention; engagement
Inspiring and leading change in turbulent times: The role of resilience in healthcare leadership
Amer Kaissi, Professor & Director of Executive Program, Trinity University

The recent COVID-19 pandemic has magnified the chronic stressors that healthcare leaders deal with, which can lead to significant burnout. This paper argues that leaders have the ability to influence and impact their teams’ and organisations’ resilience through their words and actions. But in order to do that leaders first have to build and maintain their own self-resilience. Drawing on the latest research and compelling case studies based on his executive coaching experience, the author proposes a practical model of resilience that he has used with numerous leaders. This evidence-based model focuses on the importance of optimism, empathy and gratitude, on the one hand, and selfcare behaviours such as strategic resting, taking time for reflection, realistic boundaries between professional and personal lives, and healthy sleep habits, on the other. The paper recommends practical behaviours that can enable leaders to manage the extreme demands on their time in order to build and maintain their own resilience, as well as that of their teams and organisations. It ends with a short case study describing the importance of resilience for a healthcare leader that the author has coached.
Keywords: resilience; self-care; optimism; empathy; appreciation; rest

Volume 6 Number 3

Editorial
Simon Beckett
Papers
More than a call centre: Creating a family-centric experience to increase access and revenue
Connie Lee, Director, Children’s Hospital Los Angeles, et al.

The journey towards centralising any business support function in any organisation is challenging and often marked by turf battles and the inclination to lean towards the status quo. For healthcare organisations, in particular, to move towards centralising any support function is to confront the complexities of a care delivery system. There is sensitivity with every part of the patient’s journey before the patient is seen at their appointment (with referral management, scheduling and financial clearance), to ensure that critical care needed is not delayed. Especially for organisations that have traditionally run a decentralised model with departments operating under their own rules, hearing the word ‘centralisation’ is often not well received and is met with resistance from faculty and staff. This paper provides an overview of one organisation’s journey towards building an efficient, centralised model, in a healthcare organisation managing complex subspecialities, and describes how the COVID-19 pandemic provided a platform to showcase the strength of centralisation, a transition into a remote work environment and a fast track for ambulatory operations to ‘buy-in’ to the centralised model. Although there is still a long road ahead to fully centralise services in the organisation, several successes and strategies (such as establishing dashboards, key performance indicators and a culture of performance accountability) will be shared to help lend ideas and insight to other organisations looking to move towards centralisation. Building a strong foundation that maximises efficiency while remaining resource neutral serves as a win for both the organisation and the patients and families served. Ultimately, the investments made to establish and optimise The Appointment Center at Children’s Hospital Los Angeles has improved referral turnaround time, call abandonment rates, increased access, utilisation and revenue for the organisation.
Keywords: call centre, cost-effectiveness, organisational efficiency, centralisation, remote work
Effective response strategy to a hospital cluster of the B.1.617.2 delta variant during the COVID-19 pandemic
Eugene Fidelis Soh, Deputy Chief Executive Officer (Integrated Care), National Healthcare Group and Chief Executive Officer, Tan Tock Seng Hospital & Central Health, Singapore, et al.

In Singapore a hospital cluster of COVID-19 occurred owing to the highly transmissible SARS-CoV-2 B.1.617.2 variant. To contain the outbreak, a three-pronged response strategy of containment, segregation and reset was adopted. These strategies resulted in the successful control of the cluster within a month. The cluster was followed by a review process, which yielded two important insights. The first was to strengthen lines of defence by early identification of COVID-19 cases through the principles of test, monitor and protect. The second was to develop an enhanced preparedness protocol, categorised into contingency, communications and care (3Cs), that could be readily activated should another hospital cluster of COVID-19 occur.
Keywords: hospital cluster, outbreak, COVID-19, containment, segregation, reset, variant of concern
Remote video auditing in healthcare: A powerful tool for patient and clinician safety culture and operational efficiencies
Michael H. Goldberg, Former Executive Director, Long Island Jewish Medical Center and Sheldon B. Newman, Area Vice President, North American Partners in Anesthesia

Medicine struggles to effect meaningful improvements in patient safety that do not come at the expense of efficiency. Rarer still are evidence-based tools that can provide sustained safer care while delivering operational efficiencies that produce better clinical and financial outcomes. This paper describes how Northwell Health, New York’s largest health-care provider, has instituted innovative remote video auditing (RVA) technology in its operating rooms, intensive care units and hospital floors, and the results it has achieved in nearly a decade of progressive applications and expanding adoption across its 23 hospitals. The paper demonstrates that implementation of this technology, which is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and associated change management, has improved culture and productivity in the operating room and hospital-wide. Benefits achieved through the RVA-with-feedback methodology include increased capacity, improved first-case starts, higher compliance with hand hygiene and the surgical safety checklist, reduced surgical site infections, shorter room turnover and expedited patient flow. The associated increases in patient and surgeon satisfaction, and significant financial savings, have substantial implications for hospitals seeking new pathways to enhanced patient safety and profitability.
Keywords: patient safety, remote video auditing, surgical safety checklist, hand hygiene, operational efficiencies, surgical site infection
Activating a large foreign outpatient facility using a systems-based approach to dry runs
Hugo Pariseau, Health Systems Engineer, Department of Management Engineering and Consulting, Mayo Clinic, et al.

The value of dry runs as a tool to assess operational readiness when activating healthcare facilities is well documented. However, this paper analyses how the application of this tool is often limited to isolated teams or processes. The paper describes how, 2019, Mayo Clinic was engaged in a consulting capacity to activate a large healthcare facility in the Middle East. A short activation timeline and limited staff exposure to the new facility meant there was a need to conduct a systematic assessment of operational readiness. The systems-based approach to scenario development and dry run execution relied on the involvement of 28 outpatient specialties and 16 support functions. These teams collectively executed dry runs for 74 integrated scenarios and actively participated in the resolution of findings. Integrated scenarios served to validate operations at a systems level, while team-specific scenarios served as supplemental validation for isolated processes. Dry runs exposed a total of 231 findings. High, medium and low priority findings made up 36%, 42% and 22% of total findings, respectively. Prior to activation, 75% of findings were resolved, 9% were no longer applicable and 16% were prioritised as post-activation projects. During activation, no serious patient safety, regulatory or compliance issues were reported, and no major security events occurred. This is evidence that dry runs were successful in exposing latent gaps in workflows; training and education; and infrastructure, equipment, supplies and technology.
Keywords: activation, in situ simulation, simulation, dry run, interdisciplinary, commissioning
Building a stronger patient safety and quality improvement system
Ana Pujols-McKee, Executive Vice President, Chief Medical Officer and Chief Diversity, Equity and Inclusion Officer and Mark G. Pelletier, Chief Operating Officer and Chief Nurse Executive, The Joint Commission

All people should always experience the safest, highest-quality, best-value healthcare across all settings. This paper analyses how, in keeping with its vision, The Joint Commission works with healthcare organisations to continuously improve healthcare quality and patient safety. It holds its accredited organisations to the highest standards by inspiring them to excel and achieve zero harm. To effectively help healthcare organisations positively transform, The Joint Commission shares with them its high-reliability framework for achieving zero harm. In addition, it provides strategies on how to reorganise healthcare organisations’ structures to integrate all improvement efforts, including performance improvement, infection control, regulatory, accreditation, patient safety and environmental services. The Joint Commission survey is designed to assess risk and identify potential harm that an identified risk poses to a healthcare organisation’s patients, staff and visitors. Healthcare leaders are provided with valuable tools and data analytics that prioritise risk and identify those areas that are most likely to lead to serious harm. Although all identified areas of risk must be addressed, these tools and analytics allow leaders to prioritise their resources and focus their initial efforts on areas that matter most. These electronic tools are available to healthcare systems regardless of size, and are of benefit to leaders in assessing those organisations that may need greater support and/or more resources to perform better. The Joint Commission has positioned itself as a leader in quality improvement and patient safety solely in order to partner with healthcare organisations to help them advance their improvement efforts while at the same time inspiring organisations to aim to eliminate all forms of harm.
Keywords: patient safety, accreditation, quality improvement, survey readiness, data driven
So, you want to form a healthcare network - now what?
Melody Danko-Holsomback, Vice President of Education, National Association of ACOs

Healthcare networks are rapidly developing owing to the rising costs of maintaining independent practice while complying with changing rules and regulations. As groups are looking to create a network, a thorough evaluation completed in preparation for participation will assure their new venture greater success. The experiences of current networks, including those associated with accountable care organisations (ACOs), provide a road map for others. Keystone ACO, LLC has more than eight years of network experience in value-based contracting within the Medicare Shared Savings Program. (Keystone Accountable Care Organization, LLC is a Medicare Shared Savings ACO currently participating in the Basic Track E risk track. Information on Keystone ACO can be found at Keystoneaco.org.) This paper presents experiences of management consideration and staffing structures within Keystone ACO. Observations that are both positive and negative, coupled with policy and regulatory statutes, can assist new networks in selecting participants, evaluating opportunities and providing the staffing resources to create a successful healthcare network. The content of this paper provides examples and thought processes behind building a successful network.
Keywords: network development, network staffing, network road map, data needs evaluation, value-based care, accountable care organisation
Advancing equity in US health and healthcare: Health systems’ actions in seven major domains
Susan Dentzer, President and Chief Executive Officer, America’s Physician Groups

A focus on equity has risen to the fore in many US healthcare systems, in reaction to the May 2020 murder of George Floyd and its repercussions, and to the many racial and ethnic disparities highlighted anew by the COVID-19 pandemic. Both senior management and boards of directors of healthcare systems across the country have undertaken new efforts, or redoubled existing ones, to address equity, first, in the context of provision of care and the fundamental operations of health systems and, second, in addressing the broad upstream drivers of social and economic inequity that are largely extrinsic to healthcare. This paper describes some of the actions taken by health systems in seven main categories: speaking out publicly against inequity; taking larger steps internally to address diversity, equity and inclusion (DEI); examining themselves through the lenses of structural racism and critical race theory (CRT); widening their traditional equity lens to encompass widespread discrimination against multiple population groups; ramping up efforts to address the quality of care and reducing undesirable variation as a means of reducing inequity and disparities; harnessing data and information technology to assist in these quality-improvement efforts; and using their resources to address upstream health drivers, including those in priority areas of the social and economic determinants of health. All told, a growing number of US health systems now recognise and accept that they must play a dominant role in a process of social and economic transformation to eliminate structural and institutional racism and other forms of discrimination and place the nation on the road to better health.
Keywords: equity, health equity, racism, race, ethnicity, social determinants

Volume 6 Number 2

Editorial
Simon Beckett
Case Studies
Innovation in healthcare: How Houston Methodist focused disruption inward
Roberta L. Schwartz, Houston Methodist, et al.

Innovate or die. Or, as Charles Darwin said, ‘It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change’. Healthcare is changing. The triad of hospital, doctor and payer has been disrupted by telemedicine providers, concierge medicine companies, digital medicine providers, consumer product company turned providers and pharmacy company providers. The site of care and the means of providing care have changed from patient and provider in a physical office location to consumer with digital, telephonic or on-demand, in-person access to a provider. Healthcare has now joined many industries in the digital age of consumer-focused services. Consumers have switched loyalty: from the yellow cab to Uber, hotels to Airbnb, TV to Netflix. Healthcare organisations want patients to see them as being as customer-obsessed as Amazon and simple as Netflix. Healthcare must help consumers in the way they want to be helped: an easy format with institutional memory, preserving a patient’s history and empowering care providers with the information necessary to treat the patient. Innovative use of technology to meet the needs of a changing patient population and workforce will drive healthcare into the future. At Houston Methodist, a core team of Digital Innovation Obsessed People formed the Center for Innovation that drove new pilots and programmes, facilitating success across the healthcare spectrum.
Keywords: telemedicine, digital innovation, technology, patient satisfaction, workforce satisfaction, automation, natural language processing
Staffing models for integration of virtual visits into clinical operations
Amrika Ramjewan, Mayo Clinic Innovation Exchange, et al.

The demand for telehealth services in the United States saw an unprecedented increase following the 2020 COVID-19 pandemic. Prior to the pandemic, intake and virtual rooming functions for scheduled, synchronous video appointments at Mayo Clinic were supported by a small centralised team of virtual agents within its Center for Connected Care (Connected Care). In response to the pandemic-generated demand, Connected Care leveraged its existing model and the support of temporary staff to rapidly scale support for the increased video visit demand across the enterprise. Once demand stabilised in the summer of 2020, Mayo Clinic’s destination medical centres in Minnesota, Florida and Arizona, and Mayo Clinic Health System’s sites in the Midwest, launched pilots to evaluate alternative telehealth delivery models. The goal of these pilots was to test the flexibility of alternative intake models for supporting long-term scalability and growth. Through these pilots, each site developed unique workflows and staffing plans with the overall intake function remaining standardised across all locations. The workflows delineated responsibilities between clinical departments and virtual agents, leveraged current infrastructure and maximised best practices from the original model. This paper outlines the models implemented, and presents lessons learned and best practices garnered from each implementation.
Keywords: telehealth delivery, telemedicine, staffing models
Practice papers
It’s about people: Caring agents and satisfied patients are key to a successful healthcare call centre culture
Erinne Dyer, EVP, Growth, Envera Health

Although healthcare is the fifth largest industry in the United States, it ranks 25th and last for simplicity of experience, according to the Siegel+Gale World Simplest Brands report. Wait times, paper forms, complex language and complicated insurance plans have created a significant gap between the engagement experience patients want as opposed to what they receive. As patients transform into demanding healthcare consumers, they expect the same experience from healthcare providers that they receive in other aspects of their everyday life. Patients become frustrated when they compare their healthcare interactions with the attention and ease of use they encounter with most online retailers. One recent study revealed that 75 per cent of consumers want the same experience in healthcare that they get from other industries. The key to providing the type of experience patients want begins on the front line — with the people at the other end of the phone who first engage with the patient. In many cases, this is the healthcare’s call centre agent, trained to help a patient that is looking for an appointment and could be anxious and in need. In the following paper, discover how to find, attract, train and retain the best talent for your healthcare call centre and understand why being able to do this consistently is a critical link to ensuring patient satisfaction and loyalty.
Keywords: healthcare call centre, patient satisfaction, training and culture, staffing
Tackling the healthcare acquired condition (HAC) of workforce harm: Lessons learned from COVID-19
Patricia McGaffigan, Vice President, Institute for Healthcare Improvement and President, Certification Board for Professionals in Patient Safety, Mary Beth Kingston, Chief Nursing Officer and Rev. Kathie Bender Schwich, Chief Spiritual Officer, Advocate Aurora Health

Leaders have a duty to ensure the safety and well-being of their most important asset, the workforce. Yet, while providing harm-free, quality care to patients across all settings, the healthcare workforce (HCW) experiences higher rates of occupational harm than do many industries, including those that are typically deemed dangerous. These longstanding and persistent harms are physical, psychological and emotional in nature and have broad consequences not only for the worker but also for patients, families, organisations and the healthcare industry. While attention and action by healthcare leaders to HCW harms has been gaining in recent years, the COVID-19 global pandemic has exponentially magnified workforce safety risks and implications, as well as the critical role and responsibilities of leaders to ensure that workforce safety is urgently and systematically addressed. This paper details the extent, nature and consequences of ‘healthcare acquired conditions’ to the workforce and, elaborates the added impact of the pandemic on harms experienced by the HCW and outlines the critical role and actions for leaders at all levels, in all healthcare settings, to improve the safety and well-being of the HCW. Specific illustrations of lessons learned and paths forward from one major healthcare system for preventing and addressing workforce harm and restoring well-being to the workforce are shared. Additional resources for healthcare leaders are highlighted and provide in-depth perspective on recommendations and tactics for creating a core value of unified safety, where both patients and those who care for them are free from harm and can thrive.
Keywords: workforce safety, pandemic, physical and psychological harm, health and well-being, psychological safety, leadership
Safer Together: A national action plan to advance patient safety
P. Jeffrey Brady, Director, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, et al.

Healthcare leaders have a duty to ensure that their organisations are safe for those receiving care and for those providing it. Despite the efforts of many organisations across the United States, progress in patient safety improvement remains limited. Lack of a unifying strategy and challenges with coordination have limited substantial improvements in patient safety. In response, the Institute for Healthcare Improvement convened a group of national organisations that formed the National Steering Committee (NSC) for Patient Safety. The NSC’s charter was to develop ‘Safer Together: A National Action Plan to Advance Patient Safety’ (Safer Together). Guided by core principles, Safer Together focuses on four foundational and interdependent areas: culture, leadership and governance; patient and family engagement; workforce safety and the learning system. Safer Together provided 17 recommendations and related tactics across each of the four foundational areas. The recommendations are supported by an organisational Self-Assessment Tool and an Implementation Resource Guide. The Safer Together action plan highlights important interdependencies among the foundational areas and the coordination and collaboration that are necessary to drive safety improvement, as well as the importance of ensuring equity in all four foundational areas. Patient and healthcare worker safety should garner more attention as the US healthcare system continues to shift from fee-for-service to value-based payment. As a result, organisations that maintain safety as a core value will be better situated to respond to the changing reimbursement landscape. Leadership must establish safety as a core value of the organisation, then leverage their influence to foster and sustain the implementation of the foundational areas and the recommendations. Organisations that devote resources towards ensuring safety are better positioned to improve value because of less harm to both patients and staff. The following sections of this paper describe in more detail the foundational areas outlined in Safer Together, provide practical examples of what success looks like and underscore the role of the healthcare leader as a structural linchpin.
Keywords: patient safety, leadership, culture, workforce safety, learning systems, patient and family engagement
Managing the Blockchain-enabled digital transformation of the healthcare supply chain
Joseph M. Woodside, Associate Professor of Business Systems and Analytics and Shahram Amiri, Professor of Business Systems and Analytics, Stetson University

Healthcare organisations are currently in an era of significant digital transformation further accelerated through the COVID-19 pandemic. Organisations are seeking to adapt within a globalised environment with the ever-increasing supply chain disruptions, complexity of care and regulatory requirements. To be successful in this new era, organisations must re-envision their supply chain to improve patient outcomes and reduce costs and be flexible and adaptable in their ability to respond to the competitive marketplace. The combination of traditional production and cyber-physical production will indicate the evolution from traditional business models to the emerging non-linear supply chains with a patient-centric focus. The aim of this article is to review the healthcare supply chain in the context of digitally enabled technologies such as hyperledger and Blockchain, which have the potential to extensively alter healthcare organisations. The management contributions include the development of a reusable hyperchain artifact, construct development and understanding of the shift from the traditional healthcare supply chain to the industry 4.0 digital healthcare model instantiation of the hyperchain.
Keywords: digital transformation, Blockchain, supply chain, healthcare, hyperledger, hyperchain, COVID-19
Research paper
Exploring African Americans’ perceptions of electronic personal health records
Tamara D. Sanders, Business Analyst, BlueCare Tennessee

Statistics from the Centers for Disease Control and Prevention show that African Americans experience a higher death rate due to chronic diseases compared with White Americans. The purpose of this qualitative, exploratory, single-case study was to explore how African Americans perceive electronic personal health records (ePHRs) and thereby improve the ePHR adoption rate. Fifteen participants were selected for this study through purposive criterion and snowball sampling. Semi-structured interviews were used to collect data from two groups of participants. The first group comprised people who worked in the healthcare industry, and the second, people who worked outside the healthcare industry. NVivo 12 Plus was used to analyse the data and formulate the themes for this study. A majority of the participants were concerned about the security of ePHRs. Participants indicated that ease of use was important. Finally, some participants believed that they did not need to use ePHRs. The study may help healthcare management professionals address the problem of low ePHR adoption rates among African Americans in the United States and improve the security of ePHRs.
Keywords: electronic personal health records, adoption rate, perception, African Americans, ePHR

Volume 6 Number 1

Editorial
Simon Beckett
Case Studies
Incorporating health systems engineering into COVID-19 vaccine planning and administration
Tarin A. Casadonte, Principal Health Systems Engineer, Mayo Clinic, et al.

The COVID-19 pandemic has created unique logistical challenges for vaccine transportation, inventory management, allocation and distribution at multiple levels — the federal government, states and healthcare institutions. Unpredictable weekly vaccine allocation from state health departments, changing population priorities, stringent vaccine requirements for ultracold storage, transportation, reconstitution and 2-dose administration intervals have presented challenges never seen before in the history of mass vaccination programmes, including those at Mayo Clinic. To meet the challenges, an efficient system of allocation and administration for COVID-19 vaccines was developed through collaboration with process engineering. To understand the challenges, ten health systems engineers from the Department of Management Engineering & Consulting at Mayo Clinic facilitated the institution-wide COVID-19 vaccine project, collaborating closely with diverse multidisciplinary teams that included physicians, nurses, pharmacists, administrative services, information technology, human resources, scheduling operations and public affairs. The internal consultants designed tools and solutions based on systems and process engineering methodologies to solve a myriad of complex problems, including identifying priority populations, using resources efficiently and minimising vaccine waste. Tools designed included a vaccine resource playbook; dynamic staffing models based on vaccine allocation, storage, inventory and distribution processes using a hub-and-spoke model; workflows and staffing models for face-to-face and drive-through vaccine administration sites; and end-of-day workflows to reduce vaccine waste. Through the collaboration, modelling and engineering, multiple sites across Mayo Clinic have implemented successful COVID-19 vaccination programmes that are efficient in resource utilisation and have minimal waste. In this paper, we share what we have learned to help other healthcare organisations prepare for future mass vaccination scenarios.
Keywords: collaboration, COVID-19 pandemic, process engineering, staffing model, systems engineering, vaccine allocation, distribution, workflows
sekTOR-HF: A research project for cross-sectoral needs based care for patients with heart failure and for the development of an alternative remuneration model - Part 1
Dominik Walter, Project Manager, sekTOR-HF, RHÖN-KLINIKUM AG, et al.

Heart failure (HF) is one of the most common hospital admissions diagnoses and causes of death in Germany. In the care of HF, there are false incentives owing to quantity-based remuneration and separate remuneration models for inpatient and outpatient care. The research project of RHÖN-KLINIKUM AG, ‘sekTOR-HF’, has been promoted by the German government’s innovation fund and is intended to ensure better care for HF patients in Germany with the help of optimal coordination of the cross-sectoral care process and new incentives in remuneration. Part 1 describes the initial situation and concept that paved the way for the project in 2020. Patient inclusion began in March 2021. After the project has been completed, in November 2023, a second part will present the project evaluation and the results.
Keywords: integrated care, network medicine, campus-concept, coordination platform, cross sectoral, network office, process management, full supply model, compensation model, bundled payment
Leveraging management engineering and business consulting for rapid response, mitigation and recovery during a pandemic
Michele R. Hoover, Clinical Practice Section Head, Mayo Clinic, et al.

The novel severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has presented healthcare delivery challenges the world has never encountered before. Healthcare and its practitioners, while finding themselves in difficult situations, must still care for patients with emergent needs and ensure the safety and well-being of all patients and staff. At Mayo Clinic, effective navigation of the dynamic and complex situation created by COVID-19 required unique multidisciplinary collaborations to design and implement solutions quickly. Frontline care providers and staff of ancillary services and other critical healthcare functions partnered with the Department of Management Engineering and Consulting (ME&C) team to organise and re-engineer operations to iteratively adapt to the dynamic ‘new normal’. Health systems engineers (HSEs) and project managers (PMs) accelerated the implementation of innovative interventions by leveraging advanced engineering and consulting frameworks, models and methods. Utilising a patient and staff-centric systems approach to align electronic systems, operational processes, staffing resources and organisational infrastructure has been invaluable for speed and effectiveness. Harnessing the promise of digital technology and advanced analytics was imperative and set the stage for a broader set of possibilities to transform healthcare. These possibilities include scaling of consumer-focused virtual services in multiple and unfamiliar settings, new assets that could be reused for future emergencies, accelerating the implementation of time-sensitive solutions, applied analytics and modelling to predict clinical, financial and community impacts and reimaging the healthcare supply chain. As more has been learned about the trajectory and management of COVID-19, the need to rapidly evolve and pivot interventions for short-, medium-, and long-term applications continues. This article addresses the unique contributions of ME&C during the COVID-19 crisis and the results-oriented collaborations with staff in critical business functions. We believe that the experiences, outcomes and lessons learned through this journey are broadly transferable to other healthcare and non-healthcare organisations.
Keywords: business consulting, COVID-19, healthcare, management engineering, pandemic, rapid intervention
Practice paper
Humanising healthcare through COVID-19 and beyond
Christine Holt, Executive Vice President & Chief Operating Officer of Life Care Division and Cindy Rose, Interim Chief Experience Officer, Redeemer Health and Justin Wartell, Managing Principal, Monigle

COVID-19 has transformed the world of healthcare, while acting as a catalyst for change on an unprecedented scale. Healthcare and hospital leaders have had to reinvent processes and develop new solutions to combat the virus and adapt to the new reality. In this paper, healthcare brand strategists and management consultants explore how the pandemic has driven innovation that is humanising healthcare on a structural, organisational and experiential level. Drawing from a series of in-depth qualitative interviews (IDIs) conducted with healthcare experience executives across the United States during Fall 2020, this contribution outlines how the industry’s leaders are implementing strategic changes in their organisations to embrace a more empathetic, human model. Supported by the 2020 Humanizing Brand Experience report quantitative survey data from more than 25,500 healthcare consumers, readers will consider the spectrum of shifts that have occurred and will learn about why these changes are likely to stay relevant in the post-pandemic era. This paper concludes with a set of strategies and considerations, including defining strategic brand experience objectives, creating cross-functional experience coalitions, focusing leadership on important experiential areas, hiring for ‘soft skills’, including empathy and communication, aligning incentives with targeted changes, and so on. These recommendations are designed to continue building on pandemic-driven management and leadership innovations in order to foster improved healthcare experiences for consumers, physicians and employees.
Keywords: COVID-19, healthcare management, workplace flexibility, organisational models, brand strategy, brand experience, consumerisation, humanising healthcare
Research papers
Promoting culturally and linguistically appropriate services (CLAS): Core leadership competencies
Natalie S. DuMont, University of Phoenix

Health disparities and inequitable care adversely affect diverse populations, are significant among racial and ethnic minorities and cost health-care organisations over US$400bn per year. This paper provides actionable recommendations on using culturally and linguistically appropriate services (CLAS) standards as a management tool to reduce costs and improve quality of care in behavioural health-care organisations. The qualitative Delphi study, on which the paper is based, documented the consensus of opinion from experts identifying core leadership competencies conducive to creating and sustaining CLAS standards competent organisations. Twenty-one expert executive behavioural health leaders located in the United States identified 15 leadership competencies critical to leading a CLAS standards competent organisation. The two most vital competencies were (a) cultural competence and adaption and (b) collaboration and teamwork. Effective executive behavioural health-care leaders use these unique competencies to provide clear plans and strategies to guide collaborative efforts to address health disparities. This study may promote best practices for organisations that hire and train executive behavioural health leaders by validating selection and training criteria predicted on these 15 competencies.
Keywords: CLAS standards, core leadership competencies, executive behavioural health leaders, health disparities, executive selection, health-care management
Benchmarking healthcare quality in the United States
Archie Lockamy III, Margaret Gage Bush Professor of Business, Professor of Operations Management, Brock School of Business, Samford University

The COVID-19 pandemic has brought the quality of healthcare in the United States under increased scrutiny. The Agency for Healthcare Research and Quality (AHRQ) within the United States Department of Health and Human Services (HHS) is charged with improving the safety and quality of the US healthcare system. The purpose of this study is to benchmark healthcare quality in the United States using data provided by AHRQ. The study consists of quality measures compiled by AHRQ that are utilised by the 48 contiguous states comprising the United States along with Alaska, Hawaii and the District of Columbia. The measures are set against achievable benchmarks to assess US healthcare quality at the national, regional, divisional and state levels. The results of this study show that the Northeast region has the highest average number and percentage of healthcare quality benchmarks achieved in the United States. At the divisional level, New England leads the country in healthcare quality. An analysis at the state level reveals that Maine is the leader in healthcare quality in the Northeast region, Wisconsin and Iowa in the Midwest region, Delaware in the South region, and Colorado in the West region. The results of this study can be used by policymakers at the national, state and local levels to target healthcare quality improvement initiatives in the United States.
Keywords: healthcare quality, US healthcare system, benchmarking, COVID-19, healthcare improvement