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SPECIAL ANNIVERSARY ISSUE
MH >> 45th Anniversary Issue >> August 2, 2021
AUGUST 2, 2021
CONNECTION & COLLABORATION
2766+0) 6*'2'4510 $'(14'6*' 241%'&74' %114&+0#6'&6'#/5%766+0) '&)' 64'#6/'0652'4510#.+
S P E C I A L A N N I V E R S A RY I S S U E
CONTENTS
FROM THE PUBLISHER Keeping the industry connected 2
CONNECTING TO: THE PATIENT Interoperability challenges linger 4
FEATURES
CAREGIVERS They’re humans first, employees second 16
EACH OTHER Still working to bring value to relationships 30
THE COMMUNITY Achieving greater cultural competency 42
THE PLANET Health systems go it alone on sustainability 54
REFLECTING ON THE PAST, LOOKING TO THE FUTURE
DR. REGINA BENJAMIN on who can fix U.S. healthcare 14
ESSAYS
GEORGE HALVORSON on a golden age in healthcare 26
CHIP KAHN on being connected during, past the pandemic 40
DR. KAREN DESALVO on a new future for public health 52
RICK POLLACK on what hospitals, communities can achieve 66
CHRISSY FARR on what Gen Z’s experiences can teach us 76
DR. BILL FRIST on the value of public-private cooperation 78
THE COLLABORATIVE Recognizing 45 leaders behind innovative partnerships 68
A CONVERSATION with Marilyn Tavenner and Joseph Swedish 74
AU G U ST 2 , 2 0 2 1 | M H 1
FROM THE PUBLISHER
Keeping the industry connected
O
ver the past 45 years, Modern Healthcare has witnessed this dynamic industry
transform itself.
First, leaders responded to the driving forces around consumerism and cost.
Then last year, the industry morphed again in reaction to a global crisis.
In 1976, Modern Hospitals became Modern Healthcare: the go-to for timely,
comprehensive, unbiased industry news. Our newsroom has reported on vital healthcare
milestones. Our reporters analyzed how policies like the Affordable Care Act changed your
operations or how emerging trends like digital health pushed care outside of the hospital.
Fawn Lopez, But the industry mostly remained fragmented.
Vice President
Then came COVID-19.
and Publisher
Despite having to pivot overnight to remain financially viable, I saw you join forces in
service of the patient.
The collaboration built during the pandemic made healthcare leaders more resilient than ever.
At Modern Healthcare, this year gave us a reinvigorated mission: to combat misinformation that
threatens to dismantle gains in care quality, costs, access and equity.
Our newsroom has built connections to sources to detect and refute misinformation and provide the
context that is so often lacking in mainstream media coverage of healthcare.
We found new ways to connect with you during the pandemic, using online platforms, providing
data, and harnessing events and virtual experiences to connect you with peers and share best
practices.
We launched MH, a new magazine that offers business strategies, case studies and learnings that
create a more holistic educational opportunity for leaders.
That includes our “Breaking Bias” column, which provides blueprints for pushing forward on
diversity, equity and inclusion as well as social justice.
We continue to provide you the best healthcare business news every day on ModernHealthcare.com.
Our coverage is balanced, accurate and curated to relate specifically to our subscribers’ needs.
We also honor you for your achievements. In 2005, Modern Healthcare launched the Top 25 Women
Leaders awards program to salute women executives who bring vision, character and commitment to
healthcare innovation. The Women Leaders in Healthcare conference has built a thriving community.
Our Top Diversity Leaders in Healthcare program honors executives and organizations that
influence policy, re-engineer care delivery, and advance DEI.
Having been with Modern Healthcare for nearly 20 years, I’ve never felt more privileged to serve
alongside one of the nation’s preeminent teams of journalists whose work has contributed to some
much needed and significant changes for this exciting and essential industry.
Count on Modern Healthcare to be your partner for the news analysis, research and events you need
to navigate policy and regulatory changes, make evidence-based business decisions, and accelerate
clinical and financial performance.
We all succeed when we work together. We are grateful for your continued support.
2 MH | AUGUST 2, 2021
Congratulations to
Modern Healthcare
for 45 years.
From the people in America’s hospitals and health systems
who care, innovate and advance health for us all.
21mh0085.pdf RunDate: 08/02/21 Full Page Color: 4/C
CONNECTING TO
THE PATIENT
YEARS
Interoperability,
social
determinants
challenges
linger
BY J E SS IC A K IM C OHEN
H
ealthcare executives are planning
for a future that revolves around
delivering care to patients where
they are in their daily lives,
rather than expecting patients to visit a
clinic or a physician’s office. But while
the technology might be there, a host of
challenges still stand in the way of this
vision becoming mainstream.
4 MH | August 2, 2021
Clinical staff at Intermountain Healthcare use telehealth to bring specialists from afar into patient visits.
INTERMOUNTAIN HEALTHCARE
Au g u st 2 , 2 0 2 1 | M H 5
CO N N E C T I N G TO T HE PAT I E N T
YEARS
“Everyone’s trying to move toward what I call “It’s probably no
‘healthcare at the doorstep,’ ” whether that means surprise that things
telehealth and virtual care, or a move toward hospital- like better exchange
at-home and house calls from clinicians, said David of data, open systems
Chou, chief information officer at Harris Health System
and interoperability
in Houston. That’s “where the future lies,” he said.
Kevan Mabbutt, a senior vice president and will be key to
chief consumer officer at Salt Lake City-based (patient-provider connectivity).”
Intermountain Healthcare, agrees.
Jeff Johnson, vice president of innovation and
“Clearly a lot of what people will expect … is care in digital business at Banner Health
the home and care on the go,” Mabbutt said. “Some of
this already is beginning to come to healthcare.”
Patient engagement and connectivity—particularly
connecting to patients at home—has been a growing increasingly seeing parents from the Millennial
area of focus for healthcare organizations. Fifty-two generation, and Gen Z—those born in the mid- to late-
percent of chief information officers from hospitals ’90s—won’t be far behind.
and health systems indicated patient engagement “They want convenience,” Davis said.
would be their biggest focus for 2021 outside of Younger patients tend to be more open to virtual
COVID-19 response, according to a survey by care than their older counterparts, according to a
Stoltenberg Consulting. 2020 report from consultancy Accenture. While only
That connectivity is moving beyond central 19% of total patients indicated they preferred virtual
patient apps and portals that patients might check or digital experiences with providers over in-person
intermittently, and toward more regular and appointments, 41% of Gen Zers and 33% of Millennials
personalized interactions. said they preferred virtual or digital interactions.
Healthcare experts who spoke with Modern Healthcare organizations should continue to think
Healthcare painted a vision of using apps to become about meeting patients where they are through virtual
more deeply integrated into patients' lives, wearable care, whether one-off telehealth visits or apps for
sensors and devices to continuously monitor patient certain issues, or sensors and wearable devices that
health, and other technologies like video visits to meet continuously monitor patients for follow-up care, she
patients where they are, at home, work or on the go. said. That can make care more convenient for patients
“Really, on the horizon is more connections with the who no longer need to travel or take time off work.
patient,” said Adam Seyb, a director in the healthcare But it’s not as easy as just deploying new digital
practice at consulting firm West Monroe, moving away health tools. While wearables can help to monitor
from an “episodic relationship” to a “true relationship patients and provide insights into their health, there
on an ongoing basis with their patients.” needs to be a way to connect that data to clinicians’
But to get to there, the industry will have to do some existing workflows so they can easily act on it.
heavy lifting over the next few years. Executives face Unless apps, wearables and other remote patient-
a number of major hurdles to see this vision come monitoring tools are interoperable with a hospital’s
to fruition, including interoperability, payment, and electronic health record system, they can’t truly
underlying social determinants and patient preferences. become part of a patient’s care plan.
Such technologies need to be “tied back into their
care team,” with a clear outline of what to do with the
LINKING I T AL L TOGETHER data so that it becomes a real point of connection—and
Myra Davis, chief information and innovation officer not just a self-monitoring tool that a patient uses on
at Texas Children’s Hospital in Houston, envisions a their own, said Jeff Johnson, vice president of innovation
future where we don’t “assume all patients will need to and digital business at Phoenix-based Banner Health.
come into a hospital.” “It’s probably no surprise that things like better
That’s “the overarching theme,” she said. exchange of data, open systems and interoperability
As a children’s hospital, Texas Children’s is will be key to this,” he added.
6 MH | August 2, 2021
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CO N N E C T I N G TO T HE PAT I E N T
YEARS
Intensivists and critical-care nurses at Intermountain Healthcare remotely monitor intensive-care patients across
the system’s sites through its tele-critical care program.
That’s why Banner this past spring rolled out a new ACR O SS T H E CO N TI N U U M
platform through which clinicians can assign digital There’s also the matter of coordinating and
health programs to patients and monitor the patient’s exchanging data across different sites of care.
data via the health system’s EHR. There’s an emerging market of options for patients
The first digital therapeutics program Banner seeking convenient care, including urgent care, retail
Health added to the new platform is for expectant clinics and direct-to-consumer telehealth services.
mothers, and involves prescribing a mobile app called Millennials and Gen Zers, in particular, have expressed
Babyscripts to help patients manage pregnancy. The dissatisfaction with traditional healthcare services, and
app shares educational content and remotely monitors are less likely to have a primary-care physician and
data like weight and blood pressure, which are shared more likely to turn to virtual care and retail clinics for
with clinicians through the EHR. many of their health needs.
Such digital programs will fuel more connections Consumers are now “getting more portable, more
between the patient and care team, which organizations personalized, more convenient experiences in other
will have to learn to manage, according to Johnson. aspects of their lives,” said Intermountain’s Mabbutt,
Even though patients may not be coming into who previously worked as global head of consumer
the clinic as frequently, they’ll more frequently be insight for the Walt Disney Co. Those expectations
interacting with and constantly sending data through have spilled over into healthcare, where more patients
system-branded apps, chatbots and other programs. may prefer a one-off urgent care or telehealth visit.
“We might have thousands of interactions, some To solidify their positions, health systems can carve
of them being just really small pieces of data,” which out a space at the center of a patient’s healthcare journey
providers will have to bring together for personalized by integrating data from those outside experiences into a
care and outreach, Johnson said. He said Banner “full healthcare journey,” Mabbutt said.
is looking into adding digital health programs for That’s historically been complicated, since various
behavioral health, heart failure and follow-up care care settings may not have an easy way to share patient
after bariatric surgery to the platform. data with one another—often sending that information
8 MH | August 2, 2021The TeleSitter® Solution to
address staffing shortages,
hospital falls and isolation.
The nation’s top hospitals and health systems rely on AvaSure’s
24/7/365 continuous care TeleSitter solution to keep patients
safe, protect staff and conserve vital resources. AvaSure delivers a
proven, scalable, and integrated model for video monitoring in all
inpatient facilities. AvaSure consistently lowers the cost of care
while providing safer, more efficient healthcare for everyone.
www.avasure.com
21mh0090.pdf RunDate: 08/02/21 Full Page Color: 4/CCO N N E C T I N G TO T HE PAT I E N T
YEARS
on paper and still using fax machines. New data- the option to do sophisticated things that integrate
sharing regulations could ease that burden, as many those data elements because they’re hiding in an
healthcare organizations will be forced to adopt attachment, so to speak.”
common ways to share data electronically.
Tying together data from various organizations can
also help care teams to inform care and outreach. ‘ O P P O RT U N I TY C O ST ’
Outreach “really depends on two things: intuition Hospitals and other healthcare providers will need
and data,” said Dr. Emily Maxson, chief medical officer support from outside their walls to create the care
at Aledade, a company that partners with primary- systems of tomorrow—chiefly, through new payment
care practices to form accountable care organizations. mechanisms.
While physicians who have longitudinal relationships In the next five years, Dr. Shafiq Rab, chief digital
with patients are skilled in the first area, they may and information officer at Burlington, Mass.-based
run into challenges with the second if data isn’t sent Wellforce Health System, said he expects most patients
electronically and using common data standards. will be part of programs that let clinicians monitor
Even if a practice gets sent relevant data from patients’ health from the home, either through
providers and insurers as part of value-based care the patient’s traditional care provider or through a
arrangements, it can be difficult to get the information company that provides the service.
in a way that easily integrates with clinical systems. That could involve tracking health metrics with voice
“If you still have messages coming in on a fax assistants, mobile apps, or devices and sensors that
machine, they have to be updated and scanned—and gather and share data with care teams.
those PDFs aren’t searchable,” Maxson said. “You lose “Things have to be catered to (the patient),” Rab said.
“Whoever does that will have that patient.”
Much of that technology exists today, and will get
better with emerging technologies like 5G wireless
internet, which promises to speed data transmission
A move toward sharing and allow multiple connected devices to operate
data electronically without slowing down internet connection, Rab said.
Improvements in artificial intelligence, so that digital
Starting in December 2022, electronic health programs can automate messages to patients
health record vendors and other software based on their data, could also bolster such programs.
companies will be forced to make application But for this technology to become more widely
programming interfaces that meet specific used in healthcare, the industry needs to move away
standards available to customers if they from the fee-for-service payment system and toward a
want to receive certification from HHS’ value-based care environment, so that preventive care
Office of the National Coordinator for and care that keeps patients home is rewarded.
Health Information Technology, because of “Our payment structure needs to change,” Rab said.
interoperability and information-blocking Such technologies likely won’t be fully adopted until
regulations from the agency. healthcare moves to pay for programs that reduce
APIs are protocols that allow different emergency visits, preventable surgeries and worsening
applications to communicate and share data chronic conditions.
with one another. That said, even without reforming the payment
Ideally, if two healthcare organizations are system, there are reasons for providers to start moving
using EHR systems capable of exchanging toward a more connected environment.
data through the same standard API, it will When weighing financial risk and reward, it’s
be easier to electronically send information important to keep in mind there’s an “opportunity
on shared patients from one organization cost,” according to Mabbutt. If health systems don’t
to the other, as well as to subsequently invest in tools and services that make it easier and
integrate that information directly into the more convenient for patients to access care, those
patient record. patients might turn to competitors like urgent-care
clinics, concierge medical practices and telehealth
10 MH | August 2, 2021“If you still have
messages coming in Keeping it simple
on a fax machine … you
lose the option to do Phoenix Children's has found success with
sophisticated things.” using text messages to connect with patients,
as some just prefer not to use a new-fangled
Dr. Emily Maxson, chief medical artificial-intelligence chatbot or mobile app.
officer at Aledade
Phoenix Children’s sends to-do lists to patients
before and after appointments, which can
startups—leaving hospitals behind. include forms to fill out, educational videos to
But while technologies like apps and virtual care watch or discharge instructions. The tasks are
sound like a promising future—one many patients and sent via text message with a link to a web app;
providers got a taste of during the COVID-19 crisis— data, such as intake forms, are then integrated
healthcare executives will have to grapple with the fact into the hospital’s EHR system.
that not everyone has access to internet and devices If a patient doesn’t want to receive text
that underpin many of these programs, a reality the messages, they can instead opt for email
pandemic exposed as some struggled to access virtual messages or phone calls from the hospital.
healthcare, online schooling and remote work. “What the families like (about texting) is it’s
While a large majority—95.6%—of the U.S. all in one place,” said David Higginson, executive
population had access to broadband that met the vice president and chief innovation officer at
Federal Communications Commission’s speed Phoenix Children’s. The process doesn’t force
benchmark in 2019, according to the agency’s most patients to download a new app or check a
recent report on the subject, that continues to leave patient portal that isn’t part of their daily routine.
14.5 million people without access to such services. It’s “interacting with (patients) the way they
That’s especially pronounced in rural areas, where want to be interacted with,” Higginson said.
82.7% of people had access to broadband at speeds
that met the FCC’s benchmark.
“There are a lot of areas that don’t have access
to broadband,” said Brian Gragnolati, CEO of The startup’s community health workers reach out
Morristown, New Jersey-based Atlantic Health System. to patients in person through its hubs and clinics and
While the number of people in areas with mobile by visiting members at home, as well as through phone
wireless internet is higher—99.9% for the U.S. call and text messages.
population as a whole and 99.4% specifically for rural Simply text messaging members to ensure they have
areas—not everyone has a device to access it. medications and food has proven particularly effective,
Ninety-seven percent of Americans have a cellphone according to Dr. Sylvia Romm, chief health officer for
but only 85% of Americans own a smartphone, virtual care at Cityblock.
according to a report issued by the Pew Research “Almost all of our members have phones,” she said.
Center this year. “The baseline access to text messaging is very high.”
Older adults (29%) and those making less than While many members have smartphones, too, they
$30,000 a year (19%) are more likely to own a may not have a data plan that covers enough internet
cellphone that’s not a smartphone, compared with the access for the entire month or may not have enough
population at large (11%). storage on their devices to download as many apps as
That’s a challenge that Cityblock Health, a spinout they’d like. And it isn’t just about the technology they
from Google parent company Alphabet, has tackled have access to. It’s also listening to understand what
by reaching out to patients in a variety of ways, based they prefer and are most comfortable with.
on ability and preference and often less dependent on Atlantic Health is in the midst of building up its
smartphone or internet access. patient portal—adding a so-called “digital front door”
Cityblock, which describes itself as a “value-based that links in services like billing, remote monitoring
provider,” contracts with health insurers to provide and other programs—but still lets patients reach a call
services to low-income and other underserved center to schedule in-person visits.
members that improve health, whether through better Hospitals can’t “abandon what our patients are
coordinated medical care, getting access to behavioral used to,” Gragnolati said. “We have to meet patients
healthcare or addressing social determinants. where they are.” n
Au g u st 2 , 2 0 2 1 | M H 11RAISE VOICES RAISE HOPE RAISE HEALTH When the status quo actually makes us sick Raise Health When where we live determines how long we live Raise Health When thoughts and prayers aren't enough Raise Health It's time to raise our expectations Because when we Raise Health we raise everyone Be a Health Raiser at RaiseHealth.com 21mh0103.pdf RunDate: 08/02/21 Full Page Color: 4/C
Advertorial
A VISION FOR WHAT
HEALTH CARE CAN BE
By Michael J. Dowling, President and CEO, Northwell Health
Post COVID-19, industry leaders are strategically planning for the future—
while facing growing demands and ever-changing trends that require
immediate attention. Now is the time to collectively sharpen our vision for
the future of health care and create a meaningful public health agenda.
Lessons from the pandemic Becoming advocates of change
The pandemic showed the importance of having hospitals to Addressing the underlying causes of health disparities
treat the severely ill and injured. Yet the delivery of care in also requires having honest discussions about personal
remote and ambulatory settings continues to trend upward, responsibility. As Americans, we—and the food, beverage,
even as the complex clinical demands posed by aging baby tobacco and alcohol industries that profit from us—have been
boomers will present unprecedented challenges—to individuals complicit in causing chronic illness and driving up health care
and families, our economy, governments and providers. It'll costs. We need to advocate for a public health agenda that
also challenge our values and willingness to invest time and promotes healthy nutrition and lifestyles—and challenge the
resources into caring for older people in dignified ways. food and beverage industries that contribute to an obesity
rate of more than 42% among American adults. And we need
to provide the public education, support and services that can
Shifting priorities help empower individuals to take control of their health.
Speaking of values, all health systems should aggressively
seek solutions to narrowing the life expectancy gap in
communities of color, considering the extraordinarily high Focusing on the future
death rates from COVID-19. Expanding access to high-quality In shaping a progressive vision, we confront numerous
care must be a priority, but we should also recognize challenges and risks as health care leaders. Among the
that “health” goes beyond medical services. It's important most imposing are the threat of COVID-19 variants and future
that socioeconomic issues (like substandard housing, pandemics, the need to improve efficiency with Medicare and
unemployment and neighborhood violence) be viewed through Medicaid, and figuring out how to hold onto our organizations'
the prism of health, and that health care leaders inspire cultural values as digital care accelerates.
government, businesses and community-based organizations
to work collaboratively to produce meaningful changes. Over the past year and a half, the health care community
has built public trust, credibility and admiration. Let's use this
momentum to create a new vision for what health care can be
by becoming more vocal advocates for wholistic reforms.
21mh0104.pdf RunDate: 08/02/21 Full Page Color: 4/CE S S AY B Y D R . R E G I N A B E N J A M I N
Who can fix the U.S. healthcare system?
It will take all of us
F
rom my days in solo practice in rural
Alabama, to organized medicine, to
U.S. Surgeon General, to not-for-profit
and corporate boardrooms, I have been
working to improve the health of our patients and
our communities. Throughout my career, I have
discovered that trying to move our healthcare
system from one focused on sickness and disease to
one based on wellness and prevention is easier said
than done. Following are few of my observations
over the years.
After completing residency, the National Health
Service Corps sent me to Bayou La Batre—a shrimping
village on Alabama’s Gulf Coast. It’s a pretty place but
it’s a poor place.
I found a community of working poor—too poor
to afford medical care, but too rich to qualify for
Medicaid. I liked the people. I liked the community.
I wanted to practice medicine there, but I quickly
learned that practicing medicine wasn’t just sewing
up shark bites. I had to deal with the land sharks—the
regulators, the reviewers and the red-tape dispensers.
I also learned that my patients had problems that
my prescription pad alone could not solve. I became
involved with every organization and every group that
I could to help bring services to our community. I tried
to improve healthcare, one patient at a time, but it
became clear that I could not do it alone. I would need
connections and partnerships if I were going to bring
Dr. Regina Benjamin served as additional programs and services to the town.
the 18th U.S. Surgeon General.
Physicians/AMA: As a family physician who
was the first person under age 40 and first African-
American woman to be elected to the American
Medical Association board of trustees, I agreed with
a former AMA president’s mantra regarding health
reform: “Physicians have to be in the driver’s seat with
patients riding shotgun.” AMA policy and positions
still follow that premise. Doctors are a central part of
healthcare improvement and healthcare teams, but
physicians cannot do it alone.
14 MH | August 2, 2021Catholic healthcare: In the 1990s, I joined Healthcare finance/venture capital/
the board of Eastern Mercy Health System. This M&A: Some in this sector believe that if you throw
gave me a front row seat to witness the Sisters enough money at the healthcare system its problems
of Mercy from various regions come together, can be solved. While we know this is not true, it
and later join with other religious congregations certainly can get people thinking. Others feel a moral
to form the stronger and the more sustainable duty and genuine desire to use their gifts and talents
Catholic Health East, which subsequently to make a difference in overall health. However,
became Trinity Health. Other Catholic founders of startups are often pushed by their
hospitals also began to partner and merge, investors to scale up quickly and to improve ROI. This
resulting in strong systems with more can be beneficial, especially in population health, but
services available to the communities can also overlook those who are not traditionally seen
they serve. as significantly adding to increased profit margins—
the poor, the underserved, the underinsured.
Government: When President Barack Obama Today, decades after arriving in the Bayou, I have
nominated me as the18th U.S. Surgeon General, come to understand that it takes all of the above
I learned that there are those in government who components—and all of us—to work together for
believe all healthcare problems can be solved by the common good in order to improve the U.S.
a regulation or a law. While this can be true in healthcare system.
some cases, especially in public health, it is not the One thing that COVID certainly has taught us is
complete answer. that the social determinants of health are major
contributors to health outcomes. Your ZIP code
Technology: As I joined governing boards should not be a better predictor of your health than
or advisory boards to Silicon Valley startup your genetic code. SDOH can only be adequately
companies, it became clear that there is a general addressed by cross-collaboration.
feeling that every healthcare problem can be Additional groups and sectors also need to be
solved by technology and/or automation. While part of these partnerships, including insurers,
much of this innovation can be positive and game pharmaceutical companies and the strong
changing for healthcare, unfortunately it is also leadership of not-for-profits such as the Robert
not the single solution. Wood Johnson Foundation, American Heart
Association, March of Dimes, W.K. Kellogg
Corporate boards: Joining corporate Foundation and many others.
boards, I learned that there seems to be is a As we move toward more value-based care as a
consensus that healthcare can be solved with a funding mechanism, there will be more demands
strong business plan, improved efficiency and for improved health outcomes. This requires that
improved operations. The commercialization we no longer be simply transactional, but that we
of healthcare has led to more emphasis on partner and collaborate with each other and with
attracting customers and employer clients, our communities.
which in turn is beginning to bring the patients’ To make this happen, it will require a unified
and employees’ experience and opinions into plan of action, similar to the “National Prevention
consideration. While improvement in healthcare Strategy: America’s Plan for Better Health
is often the common goal, the responsibility and Wellness” that we released in 2011. Most
of the corporation by design is to improve importantly, we will need a dedicated group of
stockholder wealth. leaders, like you, to lead the charge. n
“Your ZIP code should not be a better predictor
of your health than your genetic code.”
Au g u st 2, 2 0 2 1 | M H 15CAREGIVERS
CONNECTING TO
YEARS
Healthcare
workers
are
humans
first,
employees
second
BY AL EX K AC IK
16 MH | AUGUST 2, 2021AU G U ST 2, 2 0 2 1 | M H 17
CO N N E C T I N G TO CA R E GI V E R S
YEARS
S
anford Health started coordinating
indelible mark on healthcare employees, personally
virtual meetings in April 2020 for its and professionally, and health systems need to adapt
medical staff, who shared how they were accordingly, experts said.
coping with the COVID-19 pandemic. “These initiatives are typically seen as an expense
The psychologist-led discussions aimed to rather than an investment,” Garcia said. “This can’t
be informal outlets for clinicians to learn from each just be a one-and-done conversation—we need a
other, as well as how the Sioux Falls, South Dakota.- consistent and comprehensive engagement strategy
based health system could take better care of its that applies to not just physicians, but all employees.”
front-line staff. Hopefully, they recognized that it was The pandemic resurfaced long-standing issues
OK to not be OK, said Dr. Luis Garcia, president of in healthcare. Prior to COVID-19, about two in five
Sanford’s clinic division. critical-care nurses reported symptoms of depression
“One of the realities of mental health inside and while about half said they were anxious, according to
outside of medicine is we don’t talk much about a study of nearly 800 nurses from mid-2018 to mid-
it,” he said, adding that many are worried about the 2019 by the Ohio State University College of Nursing.
repercussions of sharing that they are depressed. “But That was linked to an increase in self-reported medical
in the midst of an extremely difficult situation—people errors.
dying and the uncertainty of the disease—there were “We know a burned-out physician has a statistically
moments of bonding, strengthening and recognition.” higher risk of adverse outcomes related to medical
Those meetings, town-hall events and one-on-one errors,” said Garcia, adding that Sanford is comparing
conversations shaped a more comprehensive strategy employee satisfaction data to patient satisfaction and
around Sanford’s identification and prevention of outcomes.
mental health issues, Garcia said. The health system, The pandemic exacerbated those symptoms across
for instance, has invested more in its wellness council, all healthcare employees, and permanently impacted
where physicians and advanced practice practitioners staffing models and day-to-day operations.
meet monthly to relay how its employees are feeling “This is a year of healing and renewal for our
and how the organization can adapt. workforce,” said Greg Till, chief people officer at
“The stigma is real,” said Karoliina Slack, senior Providence, adding that the Renton, Washington-
director of operations for Sanford World Clinics. “The based system has tripled its in investment in employee
willingness to ask for those resources is one of the well-being resources. “That’s not going to stop in 2021.
barriers we have been working hard to break down.” There is a real sense of PTSD, and the loss felt among
Health systems often respond to trauma with the workforce is incredible.”
initiatives to improve communication across their
workforce. But it’s difficult to justify the return on
investment on these programs, which can limit their SLA SH A N D B U R N
longevity and impact. Healthcare leaders say that That sense of loss deepens as many healthcare
the pandemic has more than justified the sustained organizations laid people off, cut hours and pay or
investment in employee wellness programs, but only reduced benefits during the pandemic.
time will tell. More than 60% of healthcare organizations
Health system executives are hopeful that the furloughed staff and 43% suspended or postponed
pandemic will have a permanent impact on how they retirement plan contributions last year, according to
interact with employees. COVID-19 has made an NEPC’s recent survey of 51 companies.
“This can’t just be a one-and-done conversation—we need
a consistent and comprehensive engagement strategy that
applies to not just physicians, but all employees.”
Dr. Luis Garcia, president of Sanford Health’s clinic division
18 MH | August 2, 2021AMN Healthcare applauds Modern Healthcare for 45 years of serving
the healthcare industry. With trusted, wide ranging reporting, rich data,
exceptional events, and recognition for leading professionals and
organizations, Modern Healthcare is required reading.
The team at AMN is proud to support, partner, and subscribe to this cornerstone publication.
Like Modern Healthcare, we strive to be a trusted and innovative partner to healthcare
professionals and organizations. We are driven to provide the talent, technology, and
expertise that supports a quality patient care experience that is more human, more
effective, and more achievable.
We are committed to actively engaging in building an organization and society
where equality is the norm, equity is achieved, and inclusion is universal so that we
may all thrive.
To learn more, please visit at AMNHealthcare.com.
21mh0087.pdf RunDate: 08/02/21 Full Page Color: 4/CCO N N E C T I N G TO CA R E GI V E R S
YEARS
PROVIDENCE
Providence St. Joseph Hospital wellness coordinator Kristyna Maurin, background, and Patty Huizar, a scheduler in
electrocardiology, work out in the hospital’s caregiver gym. Caregivers receive free personal training sessions and access to
in-person and virtual exercise classes, including yoga, body sculpting and high-intensity interval training.
“We can’t have swings of slashing and burning the is a realization, especially as staffing is short, of the
workforce and maintain commitment and loyalty,” Till need to retain the current workforce if you want to
said. “Healthcare unemployment is around 2%, there’s advance strategic initiatives.”
a staffing crisis and attrition is increasing. We need to At one recent health system board meeting, seven out
invest in our workplace infrastructure more than ever.” of 10 topics were about the workforce, said Liz Bickley,
Burnout and affiliated issues such as inadequate senior client partner at staffing firm Korn Ferry.
supply chain inventory, are taking on a broader “That wasn’t the case 18 months ago,” she said,
importance within the C-suite and boardrooms, said adding that hiring is a huge priority, along with
Lauren Rewers, a research consultant at Optum’s engagement and burnout. “Healthcare workers
Advisory Board. probably have more options than ever right now.
“A focus on workforce is shared more broadly Organizations that are more thoughtful around
among the C-suite,” she said. “There will be a individually tailored reward packages are going to win
reluctance in decreasing labor costs because there in the war for talent.”
2 0 MH | August 2, 2021Investing in People,
Quality and Innovation -
with PURPOSE.
11 Ardent hospitals received
an “A” Hospital Safety Grade
from Leapfrog in Spring 2021.
5 Ardent entities were
named “Best Places to Work
in Healthcare” by Modern
Healthcare in Spring 2021.
Our commitment to caring for others never wavers. It’s our PURPOSE.
ArdentHealth.com
21mh0088.pdf RunDate: 08/02/21 Full Page Color: 4/CCO N N E C T I N G TO CA R E GI V E R S
YEARS
and allow us to provide personalized benefits,
engagement tactics and retention strategy for
every caregiver.”
Organizations that were once an all-registered-
nurse environment are using licensed practical
nurses or medical assistants in a team-based
nursing model, said Erin Shipley, a coach at
consultancy Huron, who is also a licensed RN.
“That’s a workforce they can tap into, and
naturally there is a shift in dollars,” she said.
Replacing an RN can cost around $65,000;
if an organization has 12% RN turnover, that
can add up, Shipley said. Organizations are
beginning to break down first-year versus third-
year turnover and what that means for their
operations, she said.
“Most front-line leaders haven’t been trained
in understanding what turnover means for the
department,” Shipley said. “Organizations could
get a lot of lift by innovating their onboarding.”
R EMOTE MO N I TO R I N G
Providers are also using digital tools to keep in
touch with their increasingly mobile workforce as
more administrative employees are working from
Paul Makarewicz, chief mission integration officer at Providence home than ever before. Telehealth has afforded a
PROVIDENCE
St. John’s, blesses the hands of caregivers during Hospital Week,
similar luxury for some clinicians.
an annual ritual of gratitude for the work they do to heal patients.
Rather than losing an employee, managers
are more willing to give them more flexible
schedules, change departments or bump up pay,
said Neil Faux, a managing director at consultancy
Providence maintained full salaries for clinical Berkeley Resource Group.
staff the first several months of the pandemic, which “There is a lot of hesitation to reinstitute pre-
cost around $600 million, Till said. The system pandemic productivity expectations, which could
also offered unlimited childcare reimbursement, increase turnover,” he said, noting that it’s taking
an array of virtual mental health services and longer to fill positions as certain types of staff run
closely incorporated front-line workers into the short, which has increased job openings by 20% to 30%
decision-making process, Till added. For instance, at many healthcare organizations. “They are moving
Providence leaders worked closely with their clinical people around instead.”
staff to design remote working models across the Still, healthcare workers are leaving the workforce,
system, he said. both young and old. Senior employees fast-tracked
Providence is looking at the staffing mix rather their retirement plans while younger workers are
than staffing reduction. It is ensuring that clinicians opting for less-stressful careers.
are practicing at the top of their license and using Westmoreland Manor, a long-term care facility
gig workers, advanced practice practitioners and in Greensburg, Pennsylvania, has tried to keep
predictive scheduling tools to fill in any holes, he said. employees invested during the pandemic by offering
“AI will be worldview-changing over the next 10 lotteries, free meals, counseling sessions and other
years, especially for healthcare,” Till said. “Data and perks, said Nancy McCune, healthcare system
automation will help us deliver better outcomes administrator at Westmoreland.
2 2 MH | August 2, 2021HE’S ONE OF OUR FAVORITES TOO. Thank you for recognizing Dr. Anthony Slonim, President and Chief Executive Officer of Renown Health, as one of this year’s Modern Healthcare 50 Most Influential Clinical Executives. The entire Renown family and community would like to congratulate Tony for once again “making the list” and being honored among this deserving and prestigious group of leaders. renown.org 21mh0105.pdf RunDate: 08/02/21 Full Page Color: 4/C
CO N N E C T I N G TO CA R E GI V E R S
YEARS
“Management is more open to listening to
employees and changing things to make their lives’
easier,” she said, adding that Westmoreland has
changed reporting structures, offered them iPads and
adjusted its time-off request process to ease workers’
burden. “That has made a big difference.”
Employers are more cognizant of employees who are
working extra hours, and proactively checking in on
them. Some providers have eliminated prerequisites
for certain jobs, like education requirements,
prioritizing cultural fit.
The knee-jerk reaction to staffing shortages is to
double down on recruiting. But executives should
rethink their value proposition so they can hang on to
top talent, Rewers said.
“Executives need to make sure they are not
overlooking their current workforce,” she said.
If healthcare providers don’t create internal
opportunities to advance, employees will find other
options, Faux said.
“If they do leave and want to return, they will likely
be welcomed back. So there is not a lot of risk,” he said.
Caregivers at Providence St. John’s Health
LISTEN UP
PROVIDENCE
Center in Santa Monica, Calif., welcomed the
Whether it’s informal check-ins or wellness town complementary haircuts and manicures provided
halls, providers are expected to continue the dialogue. by the Beauty Bus team.
Some health systems have created a diversity forum
that allow employees to discuss social and racial
unrest, said Neville Bilimoria, partner at law firm Healthcare executives are worried about breaching
Duane Morris. that trust if they force their staff to get vaccinated.
“Doing that on a regular basis throughout the While some have made official decrees, most are
pandemic went a long way and staff reported that tiptoeing around the issue as they balance workplace
attendance at these meetings by leadership was safety with employee preferences. Houston
powerful, demonstrating a caring and concerted Methodist, for instance, suspended more than 170 of
understanding by the employer of important issues the its employees who refused to get vaccinated, which
employees were facing on a daily basis,” Bilimoria said. spurred a lawsuit.
Many managers huddled with their teams multiple “Employers will continue to struggle with that,”
times a day during the pandemic to discuss the latest Faux said.
regulations, supply chain management or workloads. Outside of the pandemic, change rarely comes
Proactive organizations will continue that daily quickly in healthcare. But managers and executives
practice, albeit less frequently, so employees feel need to recognize and honor the fundamental shift in
heard, Shipley said. employer-employee discourse.
Those check-ins could reveal that an employee Employees are human first, employees second,
wants to go to grad school or switch departments, Faux said.
which could help carve out workforce development “It’s about being human first,” he said. “Beyond the
programs and boost retention, she said. public outcry of people recognizing healthcare workers
“Employees need to feel that they are informed,” as heroes, they are asking employers to put their money
Shipley said. “That conversation is centered where their mouth is—‘show me you mean it with
around trust.” higher pay, flexibility, career pathways.’ ” n
2 4 MH | August 2, 2021E S S AY B Y G E O R G E H A LV O R S O N
W
e are moving into what could
How science be a golden age for both health
systems and healthcare.
and education We will have electronic
information on every patient. That data, funneled
through artificial intelligence, care algorithms
can bring and connected caregivers, can significantly
enhance and improve diagnosis, treatment plans,
a golden age care coordination, and an extremely wide range
of settings for receiving care.
We have learned much more how DNA and
of healthcare RNA coding works and we can use those tools for
both better diagnosis and more targeted, effective
treatments. When the next pandemic hits, we
should be able to respond much more quickly.
We also should be able to use blood markers to
anticipate and do very early diagnosis on cancer,
and we should be able to build chronic disease
plans that fit each patient individually.
The links between scientific code-based
biology and care are strengthening—and we need
to make them even stronger by taking advantage
B Y G E O R G E H A LV O R S E N
of the knowledge of epigenetic impacts. Some
of the learning here, and the interventions that
follow from them, will have to wait for future
science. But we already know plenty, and society
must step up to use that knowledge if we are to
truly reach the golden age for systems of care.
We now know that the first 100 days after a
child is born influence which sets of epigenetic
programs for emotional context are activated in
each child.
We also now know that the children whose
brains are exercised in first three years of life
build billions and even trillions of neuron
connections, and that lacking that stimulus
George Halvorson is now chairman the brain begins to purge itself of unused
and CEO of the Institute for InterGroup connections at age 4.
Understanding. He served as chairman We know that the children who have missed
and CEO of Kaiser Permanente from that magnificent and golden neuron linking
2002 to early 2013. Here he’s meeting with opportunity cannot make those links later.
President Barack Obama to disccuss the That isn’t fair. It also isn’t equitable.
Affordable Care Act. We have massive racial and ethnic inequities
happening today for too many of those children—
and we need to work together to stop it.
B Y G E O R G E H A LV O R S E NBooks might seem cliche, but they are often
ignored early on to the detriment of us all on a
massive scale.
Reading books to a developing child creates
2 6 MH | August 2, 2021billions of connected neurons. Children in homes of Black males in this country in their 30s who
in America with no books tend to have fewer than dropped out of high school are in prison today.
5,000 words spoken to them in the first years before Ten percent of Black males in their 30s who
kindergarten. Meanwhile, children who are read graduated from high school are in jail as well.
to even once a day hear more than 200,000 spoken That’s a horrible and painful number—but 10 is
words by age 5. lower than 60.
Over half of births in America this year will We know with over 60% accuracy by age 4 which
be in our Medicaid population—and the huge, people are on that track—and we need to do the
painful, dysfunctional, unacceptable and ethically right things to help every child and we need to
unforgivable inequity is that more than half of get books into every home and support other
those Medicaid homes do not have a single book. interventions to change those trajectories.
Low-income families too often need to spend all We need to understand the issues and impact of
their money on food, housing and on clothing. racism and prejudice and discrimination and we also
That’s just plain wrong. Medicaid should be need to work with those epigenetic opportunities to
providing supportive and engaging books to every help all of our children get that neuron connectivity
child. Those books should include numbers and support in those key time frames to give us a chance
counting games and number-related stories, for future success as a nation.
because another sad truth is that our math literacy It will be our own fault if we screw it up
is abysmal. In Milwaukee, for example, only 16% of because we know what needs to be done and it’s in
the children do adequate math at 15 years old. our hands. n
We are not going to change the hugely
inequitable earning gaps and the painful wealth
gaps we have in this country today if children in
the low end of that gap can’t count or read when
they finish school.
Why have I kept using “we” as I write this?
Because it’s a healthcare issue.
Data on adverse childhood experiences shows
us that patients with four or more ACEs are 60%
more likely to get cancer as adults. They are also
twice as likely to have a heart attack, three times
more likely to have lung diseases and 12 times more
likely to attempt suicide as an adult.
That’s not 12% more likely—it’s 12 times
more likely.
That’s Kaiser Permanente data, so the patients
who were studied were all in the same care system
with the same doctors and the same patterns of Smarter,
care and the same neighborhoods and the same
basic economic status—and the patients with
more intuitive
four or more ACEs are still 60% more likely to get and open.
cancer as an adult.
That’s also clearly the epigenetic impact of stress For everyone.
on our physiology in our early years and we need to
factor that information into our care plans and into
our life plans for every patient.
We also have more people in prison than any
country on the planet. We disproportionately To learn more, visit
www.allscripts.com
imprison minority Americans. Sixty percent
Au g u st 2, 2 0 2 1 | M H 2 7STAGE 1
FOUR (RE)DEFINE THE BRAND
STAGES OF A CHANGE THE CULTURE:
A priority for the team was to shift the internal culture
HEALTHCARE throughout the system - an inside-out approach. By
focusing on quality and safety, along with the priority
to be a great place to work, the goal was to create a
SYSTEM new internal culture that would help with retention,
recruitment and eventually external public perception.
(RE)STARTUP
One of the first steps was to set the roadmap. The
system’s mission, vision and values were recrafted
to support the values of trust, respect, compassion,
community and excellence.
What do you do with a health care brand that
has evolved over four decades into a loose-knit
Leaders reviewed the overall compensation and
collection of hospitals and clinics spread across a
benefits offering and created new rewards and
wide geography and whose main commonality is
recognition programs to celebrate good work – both
the “Regional Health” name?
inside the organization and within the communities
they serve. It takes time, but progress is well underway.
That was the challenge for Paulette Davidson
in 2018 when she became President and CEO
REINVENT THE BRAND:
of Regional Health, the health care system
Over the years, as new hospitals and clinics came
serving western South Dakota. Her answer: Act
aboard and the system expanded, leaders worked to
like a startup, or in this case a (re)startup. This
unite the system under the Regional Health umbrella.
thinking has propelled the health care system
However, the Regional name was very generic, and the
into a dynamic, collaborative organization where
brand had a lot of baggage.
everything is measured against one simple
mission: Make a difference. Every day.
A big move, led by the Board of Directors, was to make
a clean break from the past. After months of research,
She and her leadership team launched a strategic
focus groups and discussions with community leaders,
plan to change the system’s internal culture, its
the nonprofit adopted the name Monument Health and
focus on quality and safety, its public perception
a five-diamond M-shaped logo. Each of the diamonds
and its role in the community. The team also
represents one of the five priorities,
launched a significant master facilities plan across
and the three filled-in diamonds
the health system.
form a heart, representing the
beginning of the vision statement:
It starts with heart.
VISION
It starts with heart.
Our vision is to be one team, to listen, to be inclusive, STAGE 2
and to show we care.
To do the right thing. Every time. (RE)BUILD THE OFFERING
VA L U E S NEW FACILITIES:
Trust Even before Davidson became President and CEO,
Respect leaders recognized that the system needed a major
Compassion infrastructure investment. Building maintenance had
Community
been deferred, and new construction hadn’t kept up
Excellence
with the health care needs of the communities.
PRIORITIES
Deliver high-quality care In quick succession, Regional Health/Monument Health
Provide a caring experience constructed a new clinic at its hospital in Sturgis, a
Be a great place to work new hospital and clinic in Custer and a new specialty
Impact our communities
hospital, Monument Health Orthopedic and Specialty
Be here for generations to come
Hospital, in Rapid City. In addition, the main hospital
MISSION in Rapid City underwent a massive $200 million
expansion that included a new Emergency Department
Make a difference. Every day.
and an expanded Heart and Vascular Institute.4QPOTPSFE$POUFOU
STAGE 3:
GET PEOPLE (RE)EXCITED
With more than 5,500 physicians and caregivers, every
e resident of the region is related to, friends with or being
treated by a physician or caregiver at Monument Health. To
y strengthen those relationships, Monument Health officials
set out to raise its profile in the communities it serves.
n. VOLUNTEERISM:
Leaders knew that Monument Health caregivers have
always spent a lot of time doing volunteer work in their
Rapid City Hospital Expansion communities. They pick up trash, coach little league teams,
read to hospice residents, plant community gardens and
The work continues. The Monument Health Cancer Care participate in a variety of events.
Institute is currently undergoing a major expansion to
double the size. Later this year, construction will begin By tracking volunteer hours, the impact could be
on a Long Term Acute Care Hospital, to be operated in recognized and celebrated. In the past four years,
partnership with Vibra Healthcare. Future projects include Monument Health caregivers have contributed more than
ay. expansion of the Women’s and Children’s Department 70,000 hours of service to their communities - this is the
at Rapid City Hospital and new hospital and clinic space equivalent of 34 full-time employees dedicating a year of
in Spearfish. their working hours to the community.
ELECTRONIC HEALTH RECORD SYSTEM: THE MONUMENT:
During its years of growth, the health system absorbed a In July 2021, the Black Hills’ most prominent gathering
e number of smaller hospitals and clinics. By 2017, physicians place, the Rushmore Plaza Civic Center was renamed
and caregivers were working with no fewer than nine The Monument, part of a naming agreement awarded to
separate electronic health systems (EHR) for tracking Monument Health. This facility is home to a new 12,000
ke patient information. The team chose Epic Systems Corp., seat arena that will help bring larger events to the area.
h, the world’s largest EHR system. It was a major undertaking
s, to convert all of these systems into one EHR, but the The new partnership was an important part of the
nd project was a success and it has brought countless benefits rebranding strategy, and it also brings new quarterly
s to patients and their families, along with significant community health fairs offering convenient, free or
business management advances for Monument Health. low-cost health screenings and health information to
Black Hills residents.
FOCUS ON QUALITY:
In 2020, Monument Health built a quality and safety
framework, established a performance improvement
structure and developed a new physician leadership
structure to lead the work. New medical staff bylaws STAGE 4
were developed and approved, centered on quality and
safety. The entire organization adopted daily tiered safety
KEEP MOVING FORWARD
huddles, a bottom-up system of quickly identifying and Monument Health has more physicians delivering care
addressing issues that need prompt attention. within more specialty areas than ever before. This allows
patients to receive the care they need, close to home.
Monument Health actively tracks patient experience.
The “top box” scores (the percentage of respondents
“Every decision we’ve made and the
who rated their care either 9, 10, Very Good or Always)
work we’ve completed has been with
have risen to 80.1 percent, up from 78 percent in 2017.
the best interest of our communities
Additionally, Google Reviews have grown from an average
in mind. This work has resulted in
rating of 3.3 in 2019 to 4.7 in 2021 on a 5-point scale.
significant growth of our health
MAYO CLINIC CARE NETWORK: system even throughout a pandemic
th In 2020, Monument Health joined the Mayo Clinic Care year,” said Davidson. “As we move
Network, becoming part of a select group of health forward, we will find other ways to
systems carefully vetted by Mayo Clinic. Local physicians Paulette Davidson (re)invent Monument Health, always
y have special access to Mayo Clinic’s knowledge, expertise President and CEO with the goal of benefiting those who
and resources and can quickly access Mayo’s latest chose to live and work in our beautiful
research, diagnostic and treatment resources. Additionally, part of the country.”
nt this relationship allows Monument Health to learn best
practices from the Mayo Clinic team, which has led to
efficiency and quality improvements. www.monument.healthYou can also read
