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Board Communication, Teamwork, Spell Success at Yoakum Community Hospital

by Karen Barber, CEO, Yoakum Community Hospital


Leveraging Resources for Change


When I joined the Yoakum Community Hospital team in 2006, one of the biggest hurdles I faced was improving board-management relationships. I realized that addressing this challenge would be essential to paving the way for a better, more secure financial and operational future for the hospital and community. Elorine Sitka, Yoakum Board Trustee and Chair, shared this vision, and together, we turned ideas into reality.

As a 25-bed critical access hospital in rural Yoakum, Texas, it became apparent that trustees had not been receiving all the information they needed — in a timely way — to make well-informed decisions. We realized that trustees were challenged in performing their basic fiduciary and financial duties, and change was necessary to inspire and create a high-performing board dedicated to the hospital’s success.


As partners, our goal was to improve the hospital for the good of the community. We developed recommendations on ways to improve board relations and engagement – laying a solid benchmark for success for many rural hospitals.


Five Steps to Success


Certain basics are “must-haves” for continuous improvement in board-management relationships, including:


1. Clarify expectations regarding roles and responsibilities

Governance and management are distinct functions. At Yoakum today, board members view their role as strategists and overseers. They leave management and operations to hospital leaders and managers, although that wasn’t the case previously. Board members provide direction. Managers create and implement tactics to support board strategies. One significant consideration is to provide board members with updates to keep them in the loop.


Identifying specific responsibilities in written form can also help prevent confusion related to roles. Discussions about mutual expectations are important, too. What do trustees expect of the CEO? What types of things can a CEO do without prior board approval?


2. Foster open, consistent communications

Regular, informal phone calls and a weekly newsletter are great tools to keep board members informed. An online portal provides members with meeting materials to review at least a week in advance. Trustees are encouraged to reach out to leaders if they have a question or concern, as well as participate in meeting discussions and respectful debates.


3. Make meetings purposeful

Make board meetings organized and action-oriented. Take informational items off the agenda for trustees to read on their own. Focus face-to-face time on several major issues that require voting at board meeting time.


I strongly suggest that everyone “stick to the agenda.” The entire team is busy, so keep meetings short and on point. And set aside time to socialize. Sharing a meal together before getting down to business inspires fellowship and teamwork.


4. Create resourceful onboarding and continuing education

New trustee orientation is vital and should include meetings with key stakeholders, including the CEO and CFO, as well as important partner organizations. A tour of the hospital and distribution of educational materials including an organizational chart and a glossary of healthcare industry terms and acronyms are part of the process.


5. Identify potential trustees

A specific recruitment process for new trustees is key. At Yoakum, we maintain a running list of potential board members, keeping in mind leaders and colleagues with diverse backgrounds. Another consideration is to identify potential board members without any sort of personal agenda. The focus should be on improving the hospital for community health.


We also encourage board members to listen to presentations offered by hospital staff, and take advantage of state and other sponsored trustee education programs. At Yoakum, we also invest in an annual board retreat and involve trustees in monthly birthday celebrations and other hospital events.


Building on Success


Looking back, the difference at our board meetings today is obvious. Today we have a strong board and dependable, trustworthy leadership committed to a common purpose.


To learn how Yoakum Community Hospital developed a high-performing board, read this CHC case study.

Tags: Hospital Board Advisory, Hospital Performance Improvement, Operational Improvement, Strategic Direction
Staffing and Productivity: Tips for Success

By Jill Bayless, CHC SVP Clinical Services


Improving a hospital’s financial performance seems relatively simple – it’s driven by decreasing costs and increasing revenue. In reality it’s quite complicated to optimize these factors while keeping quality care top of mind. One of the biggest challenges for hospitals is managing staff productivity, which means maintaining the right number and mix of clinical staff based on patient diagnoses and volume. Optimizing productivity is critically important because the cost of labor is the greatest expense for a hospital.

In our experience, almost every hospital has some room to improve staffing productivity. Here are some top-line recommendations to help a hospital department run more like a successful business.

  1. First of all, take a look at the numbers. Compare staffing levels to patient census information for the hospital as a whole and for each specific department. Reviewing staffing data over time will help identify trends and opportunities for improvement.
  2. Next, investigate the reasons for any discrepancies. Bring key players to the table – department managers, administrators and others - to discuss possible alternatives. Would shifting and flexing based on time of year or physician activity be advisable? Invite questions from everyone engaged in the process.
  3. Set an acceptable productivity target standard. Use the data review, input from personnel and national benchmarks to establish a standard staffing ratio for the hospital overall and for each department.
  4. Establish ongoing tracking system. A plan to maintain this productivity standard is critical for success. Successful hospitals make department managers responsible for meeting staffing benchmarks and for implementing flexible staffing based on patient census figures.
  5. Review the standard. On an ongoing basis, set up a regular time for managers and leaders to review departmental staffing guidelines and make necessary changes.

Some additional tips on staffing and productivity:

  1. Look at total hours paid vs. hours worked, which excludes PTO and holiday time. Hours worked is the best benchmark to use for the purpose of improving staff productivity. Each department will have a unique work standard; for example, the number of procedures in the OR, or patient census on an inpatient unit.
  2. Consider work process redesign. The best department managers and CNOs manage staffing levels from shift to shift and cross-train personnel across departments, especially in smaller facilities.
  3. Rethink span of control. It may be possible for one director to manage several departments.
  4. Analyze compensation practices across the organization for standardization and consistency.
  5. Always monitor quality of care – HCAHPS, patient perception, and employee and physician satisfaction. Examine readmissions and other quality of care metrics regularly to ensure quality of care.
  6. From an operational perspective, consider the potential impact of external factors. For example, if one surgeon is leaving the hospital staff, how might that affect OR staffing requirements until a new surgeon comes on board?
  7. Help to educate hospital board members on the potential impact that managing productivity will have on the hospital’s financial performance. In many cases, where there is marginal financial performance, a focus on productivity will allow the facility to maintain viability.

CHC offers a comprehensive assessment to help clients take an in-depth look at productivity and staffing concerns. Learn more about CHC Operational Assessment Services.

Tags: Hospital Performance Improvement, Hospital Staffing, Operational Assessment , Operational Improvement, Productivity Assessment
Best Practices for Effective Physician On-Boarding

by Stephanie Hobson, Director of Physician Recruitment, CHC


You’ve successfully recruited the physician you need to serve your community. What comes next? The hiring process is just the first step in retaining these professionals you have worked so hard to recruit. Equally important is physician on-boarding — the process of familiarizing and orienting physicians to a new healthcare facility or practice, and to the culture of your organization. On-boarding introduces new physicians to the community, integrates them into the medical staff, helps them establish their practice and achieve a firm financial foundation in the first year.


The case for on-boarding


An effective on-boarding process can help retain physicians in an increasingly competitive and challenging environment. The candidate pool is shrinking and the number of medical students continues to decline. In the year 2020, the expected shortage of practicing physicians is estimated to be 91,000.


Physician replacement costs are significant. The average cost to turn over a physician is $1.2 million. This impacts hospital revenue and patients’ perceptions of care. Replacing the productivity of a retiring internist will require 1.6 younger physicians, according to a 2014 Truven Analytics study. A systematic, well-organized on-boarding process can increase retention (avoiding the costs associated with physician replacement), stabilize access to care, and reduce outward migration.


Lack of an organized on-boarding process has added ramifications: physicians could lose confidence in the hospital or their group by a perceived lack of interest in their success resulting from poor on-boarding; and a delayed practice ramp-up period would increase the time needed to see positive ROI on an income guarantee or employment.


On-boarding recommendations


Here are some best practice tips to improve the physician on-boarding process.


Create an effective on-boarding program customized to your facility. Survey existing physicians to obtain feedback about the current on-boarding program and create a small task force to outline an ideal state process. Assign project leaders to assemble support teams including community members and volunteers, and measure results.


Set up Phase I (signed agreement to orientation) and Phase II (orientation to 90 days) action plans.

  • Phase I should include the completion of credentialing and enrollment; weekly communication from a designated hospital liaison; and personal/family assistance, such as house hunting, connecting with local service providers (Internet, phone, etc.) and getting kids in school. Welcome the entire family to the community.
  • In Phase II, complete the orientation process and review guidelines and expectations; market physicians to the community and other providers; and help integrate the physician and their family into the community by linking them to resources, groups and organizations.

 Additional best practice tips include:

  • Integrate new providers into your culture. Tell them what makes your culture and mission unique. Explain your hospital/health system goals.
  • Ensure basic resources are provided ‘day 1,’ including a lab coat, prescription pad, an ID badge and a tour of the facility.
  • Give them time to set up their office and meet their team before they start seeing patients.
  • Bring in their spouse to help them fill out benefits elections.
  • Give them flu shots and vaccinations etc. to meet 100 percent of employee wellness goals.
  • Have hospital leaders visit/eat lunch with them during orientation.
  • Train them on the EMR/how to log in to email/how to access resources; have them complete education modules during orientation.
  • Assign an administrator as a point of contact for each new physician and have them meet regularly during the first year.
  • Send out a postcard to your primary and secondary service area introducing the new physician. Include photos, address, phone number, and a ’now accepting patients’ message.

Making it work


Physician on-boarding doesn’t “belong” to the CEO alone. It should be a shared responsibility across hospital leadership, HR, the group or physician the doctor is joining, physician leadership, community members such as Chamber representatives, and hospital Board members.


On-boarding is the benchmark for physician engagement. An effective process can reduce physician turnover and recruitment costs, establish continuity of care, increase hospital productivity, and positively affect patient and employee satisfaction scores.


Learn more about CHC Physician Recruitment Strategies for community hospitals.

Read the CHC Physician Recruitment services overview.

Tags: Hospital-Physician Alignment, Physician Recruitment, Strategic Direction
Building Successful Hospital-Board Relationships

by Craig Sims, SVP, Southwest Hospital Operations, CHC


Community-based hospitals put the “care” in healthcare, and

meaningful hospital-Board partnerships based on trust and mutual goals drive this mission. Board members make important decisions to serve the community , and help develop strategies to ensure the hospital’s long-term sustainability.


Here are some best practice tips for positive, productive Board-CEO relationships.

  1. Develop a Trustee recruitment and retention process. Recruiting and retaining Trustees is too important to be left up to chance. In fact, “retention” begins in the recruitment phase and never ends. Initial orientation for new Board members should include one-on-one time with the hospital CEO and CFO, as well as the Board Chair and Finance Committee Chair. After six months, ask Trustees about their orientation and education experience. Seek ways to improve.
  2. Foster open communication. Communicate with candor. Facilitate two-way dialogue and encourage open communication. Create an environment of trust to help everyone tackle tough decisions. Even if there are dissenting opinions, a collegial atmosphere allows Board members to say to one another, “I value your input — tell me more.”
  3. Communicate frequently with Board members. Share timely information on hospital and community events, along with local, regional and state issues impacting health care. Provide educational articles and links, send out Board packets in a timely fashion prior to Board meetings, and utilize current technology to facilitate communication (electronic Board packets and Board portals, for example).
  4. Make meetings meaningful. Start with the “why” instead of the “what.” Begin Board meetings by reading the mission, vision and values of the organization instead of jumping into reports. Productive meetings require engagement; move informational items off the agenda for Trustees to read on their own. Focus on three to five issues that require voting. In closing the meeting, the Board chair should ask the group:

    -     Did we focus on the right issues?

    -     Did we participate in an active way? 

  5. Understand the difference between governance and management. The role of the Board is governance. The Board governs and sets policy; hospital administration manages and implements policy. Hospital Boards should focus on strategy, not operations.
  6. Facilitate continuous learning. Effective boards are well-educated. Budget for Board education, including learning opportunities such as:
    -     Comprehensive Board orientation
    -     Annual Board self-assessment
    -     Planned continuing education
    -     Board retreats

 CHC offers a variety of advisory services depending on client needs — including board education — to help enhance hospital CEO-board relationships. Learn more about CHC Hospital Board Advisory Services

Tags: Hospital Board Advisory, Hospital Performance Improvement, Strategic Direction
Six Months In: Preparation Eased Community Hospital Transition to ICD-10

by Beth Kim, VP of Revenue Integrity, CHC


October 1, 2015, was a much-anticipated day for the U.S. healthcare system. It was the final compliance date for the shift from ICD-9 to ICD-10, a set of codes used to report diagnoses and inpatient procedures to identify health trends and track morbidity and mortality. The Centers for Medicare and Medicaid Services (CMS) characterized the change as “more than an update, a leap in how we define care.”


Physicians, hospitals and health insurance companies rely on these codes for diagnosing patients and billing for services. ICD-9 had been used since 1979 with periodic updates. ICD-10 would introduce 69,000 diagnosis codes from the previous 14,000. Originally set to take effect on October 1, 2014, the deadline for implementation was pushed to Oct. 1, 2015.


How It Fared


Despite some trepidation and anxiety, transition to ICD-10 went more smoothly than expected on both the provider and payor sides. Many billing elements remained fairly constant pre- and post-transition, including claims submissions, rejections and denial rates. Early reports suggest there have been no major disruptions in claim submissions and payment for providers, or a significant productivity drain. The delay in the implementation date allowed extra time for preparation, communication and training, decreasing the risk of major problems.


Readiness Makes All the Difference


To help hospitals get ready for the change, CHC’s support focused on communication, education and teamwork. Preparation and collaboration would be critical in making the move to the new system. Some of the steps to a less worrisome ICD-10 implementation included:

  • Formation of interdisciplinary hospital teams with representatives from various departments — not just medical records coders;
  • Monthly group calls for hospitals to share and discuss information and best practices;
  • Monthly meetings with individual hospitals to discuss project and action plans prior to the go-live date;
  • Collaborative testing with payors;
  • Development of contingency plans including safety net resources built into hospital budgets, such as contracting with coding companies to handle any potential work overload;
  • Online ICD-10 health education not only for coders but all affected parties;
  • Offering user-friendly apps for physicians;
  • Dual-coding exercises, focusing on hospitals’ highest-volume cases.

Looking ahead


Although data related to the actual impact of ICD-10 (positive or negative) is currently limited, one thing is clear: the critical role of documentation in the ICD-10 coding set. For instance, similar injuries on opposite limbs cannot be accounted for in ICD-9; with ICD-10, different injuries or varying severities of medical conditions can be coded. The bottom line is that enhancing documentation can lead to better, more efficient patient care. Documentation also gives valuable information to health care providers providing follow-up care to patients. Clinical document improvement (CDI) programs can be added to a hospital’s tool kit for staff education.


Finally, change is constant. A code freeze has been in effect to help manage the transition to ICD-10; however, regular updates to ICD-10 code sets will begin on Oct. 1, 2016, to account for new technologies and diseases. Implementation of an estimated 1,900 diagnosis and 3,600 new procedure codes are scheduled when the freeze lifts.


CHC takes a collaborative approach with clients to help them navigate change, such as ICD-10 implementation. Learn more about CHC Revenue Cycle Assessment offerings including coding and related support services.

Tags: Coding, Electronic Health Record, Healthcare Reform , ICD-10

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