HELP WHERE HOSPITALS NEED IT ®
HELP WHERE HOSPITALS NEED IT ®
Community Hospital Blog
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.
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.
Some additional tips on staffing and productivity:
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.
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.
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.
Additional best practice tips include:
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.
by Craig Sims, SVP, Southwest Hospital Operations, CHC
Community-based hospitals put the “care” in healthcare, and
Here are some best practice tips for positive, productive Board-CEO relationships.
- Did we focus on the right issues?
- Did we participate in an active way?
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.
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:
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.
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