South Florida Hospital News
Monday May 25, 2020
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November 2014 - Volume 11 - Issue 5

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Leading the Pathway to Better Health

Many healthcare executives have seen their share of challenges in the health care industry these days. But Calvin Glidewell, CEO of Broward Health Medical Center, is hard-pressed to remember a time in his 30+ year career when the issues are more daunting and pressing than they are today.

Forget the ambiguity associated with the bumpy roll-out of the Affordable Care Act or the ever-constant reimbursement pressures brought about by governmental and private payers alike. Now some of the things that keep him and his peers awake at night are true public health challenges like the diagnosis, treatment and containment of Ebola and the alarming incidence of the D68 enterovirus among children, along with more long-term, chronic issues like the growing prevalence of obesity (particularly among children), chronic diabetes, heart disease and cancer.

“One of the things we have been challenged with recently is our ability to respond effectively to public health outbreaks to make sure we have the training, tools and techniques that really allow us to be first responders and protect the safety of the public as well as taking care of those who might be sick or injured,” says Glidewell.

Glidewell notes that some of these issues are the result of the inevitability of demographics—an ever-aging population combined with a growing shortage of primary care physicians, nurses and other skilled caregivers.

“Although certain trends seem to be moderating somewhat—like the cost of lifesaving pharmaceuticals and technology and the lack of financial and geographic access for the underserved—we are not out of the woods yet,” he says.

What really concerns Glidewell is that many governmental and private payers are now trying to shift patients out of an inpatient status into an outpatient status, essentially paying hospitals less for providing the same care and using the same resources. Add to that the increasing competition in the healthcare provider industry from traditional players, such as Ambulatory Surgery Centers, Diagnostic Imaging Centers and Urgent Care Centers, as well as surprising and even disruptive players like Walgreens, CVS and insurance companies.

“Unfortunately, our industry is plagued by the historical inability and/or unwillingness to communicate—electronically or otherwise—among the disparate members of the health care continuum, including physicians, hospitals and other mental health and ambulatory providers,” Glidewell says. “Together, these challenges present a tsunami of unprecedented proportions which we, as health care providers and stewards of our communities, need to address pragmatically and collaboratively.”

Addressing today’s health care challenges
The good news is that there are new models and constructs for addressing some of the challenges facing health care organizations. Glidewell points out that there is now the emergence of a new breed of health plan (accountable care organizations), value-based purchasing of care by insurers, clinical integration initiatives among providers, the development of electronic health insurance exchanges to facilitate greater access, and new care coordination models with health care extenders acting as personal navigators between patient and providers.

“We also have new tools in our arsenal: telemedicine, patient engagement portals, performance improvement methodologies, such as Lean and Six Sigma,” Glidewell says. “We also have electronic health records with improving interoperability among systems, quality and utilization monitoring software to improve the quality and the access of the care we provide.”

To further ensure they are offering clinical quality of care and delivering the best patient experience at Broward Health Medical Center, Glidewell implemented a very refined system of metrics which his team monitors.

“We meet weekly as an entire management team to review any opportunities for improvement as an organization,” says Glidewell. “For example, after reviewing our patient satisfaction scores and untoward incidents from that particular week, we come up with a lesson learned that we might do differently next time to avoid an untoward incident from occurring. We also have formal performance improvement teams to examine throughput in the emergency department. So it’s a combination of focusing weekly on what’s happening and looking at overall metrics to see what we might do to improve ourselves.”

Support by professional societies and organizations are also critical to face today’s health care challenges. Glidewell mentions the “Choosing Wisely” campaign endorsed by over 60 medical societies and organizations to encourage candid conversations between providers and patients about the best course of care for the patient’s condition, and the “Partnership for Patients” campaign endorsed by the Hospital Engagement Network, with a goal of reducing patient harm by 40% and readmissions by 20% over a two-year period.

“These new tools, models and inter-societal support will help us achieve our community and institutional goals of better health,” he says. “This is more popularly known today as ‘population health,’ manifested in a reduction in hospital readmissions, the minimizing of hospital-acquired infections, the optimization of core process measures—doing the right thing at the right time to the right patient, every time—and the eventual improvement in community public health indicators.”

Breaking down of silos
But one of the fundamental changes that Glidewell emphasizes must occur in the health care continuum is the breaking down of the silos in today’s health care delivery system.

“We need to work with the state and federal government to develop and align the incentives of providers as we change our model of care,” he explains. “We need meaningful conversations, not just among providers, but with the financiers of care; that is, governmental payers, commercial payers, and, yes, even with business leaders and employers, who are often the ultimate payers of care.”

Considering today’s proliferation of emails, texting, social media and impersonal mass media, Glidewell says face-to-face discussions with one another, key stakeholders and customers on how to improve the health of our community, is critical.

Thirty years ago, administrators sat in their offices and figured out how to maximize their cost thereby maximizing their reimbursement from the government. The whole game has changed and the focus now is on the quality of care delivered and the patient experience.

“You can’t make those improvements by issuing edicts from an ivory tower,” says Glidewell. “You have to be much more attuned to getting ideas and information from the frontline. The only way I learn to become better is by listening to our physicians and to our frontline caregivers who give me ideas on a regular basis on what we could do to provide a better experience to be more efficient and to deliver better quality.”

The development of partnerships and affiliations based on mutual trust and a shared vision is also important in the breaking down of the silos in the health care delivery system, according to Glidewell.

“Part of being a healthcare leader is understanding what the community expects from their hospital and health system and working with businesses and civic leaders to be sure we are meeting those needs on a regular basis,” he says. “As we do so, let’s not forget the central element in all of our discussions: the patient and his or her family support systems. Let’s be deliberate about educating them on their roles on the health care team and including them in our brainstorming and our planning for the future.”

Glidewell knows this will require bold action and innovation by health care executives to demonstrate leadership, commitment, open-mindedness, a healthy dose of humility and perhaps a bit of sacrifice. “This is our real challenge and, hopefully, our pathway to better health.”

For more information on Broward Health Medical Center, visit www.browardhealth.org/BHMC.
 

 

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