FALL 2011

CONTENTPresident’s Remarks 4Brad Simmons, FACHE

Recruiting Physician 5Talent for the Future

Contemplating 6a Just CulturePatient Safety Perspectivefor Leadership

Welcome New Members 8

US Hospitals Facing 9New Medicare Penalties Show Wide Room forImprovement at ReducingReadmission Rates

...And The Survey Says 11

News From National 13

Event Encore 14

Event Encore - Extras 16

Calendar 17

ofACHE

North TexasACHE

North Texas

The ACHE of North Texas e-magazine, The Executive Connection, is published quarterly (Spring, Summer, Fall and Winter) and includes information on the latest regulatory and legislative developments, as well as the quality improvement and leadership trends that are shaping and influencing the healthcare industry. Readers get indepth reporting on the issues and challenges facing hospital and health system leaders today. We make it our job to tell you about the great things the organization and Chapter are doing every day to ensure the health of our community. If you have any news and updates that you want to share with other members, please e-mail your items to info@northtexas.ache.org. Microsoft Word or compatible format is preferable. If you have a graphic or picture that you’d like to include, please send it as a separate file. The following are the types of information that our members shared in past ACHE of North Texas magazines: Advocacy Issues, Legislative Issues, Educational Opportunities, Awards / Achievements, Promotions (Members On the Move), Committee Updates, journal submissions, conference submissions, and workshop participations, sharing mentoring experiences, etc.

Meet Your New ACHE Regent forTexas-Northeast:Britt R. Berrett, PhD, FACHE

Britt is president of Texas Health Presbyterian Hospital Dallas. He previously served on the Council of Regents from 2007 to 2010. He will be serving on an interim basis until 2013. Britt can be reached at brittberrett@texashealth.org.

Welcome back!

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2011 3

Editor-In-Chief Susan Edwards, FACHE

Managing Directors Joan Clark, DNP, RN, FACHE Angela CJVincent, MHS

Contributing Editors Felicia McLaren Caleb O’Rear Lisa Cox Brad Simmons Forney Fleming

Contributing Writers Megan Harkey Christine Hammons Charmaine Christiansen Allison McCarthy Beth Guyton, CPHQ

Production Kay Daniel

Advertising/ Subscriptions info@northtexas.ache.org

Questions and Comments: ACHE of North Texas Editorial Office, c/o Executive Connection

511 E. John Carpenter Freeway | Suite 600 | Irving, TX 75062 p: 972.256.2291 | f: 972.570.8037 e: info@northtexas.ache.org | w: northtexas.ache.org

2011 Chapter Officers

President Brad Simmons, FACHE Parkland Health & Hospital System

President-Elect Scott Schmidly, FACHE Medical City and Medical City Children’s Hospital

Past President J. Eric Evans Lake Pointe Medical Center Chair, Nominating Committee

Secretary Ron Coulter, MHA, FACHE Texas Health Cleburne

Treasurer Jania Villarroel, MHA Pediatric Associates of Dallas

2011 Board of Directors

Britt R. Berrett, PhD, FACHE Texas Health Presbyterian Hospital DallasEx-Officio, Regent

Beverly Dawson, RN, CCM, FACHEChair, Education Committee

Forney FlemingUniversity of Texas at DallasEx-Officio

Jay Fox, FACHEBaylor Medical Center, Waxahachie

Jonni Johnson, CPSMRTKL Associates Inc.Chair, Sponsorship

Winjie Tang MiaoTexas Health Harris Methodist Hospital Aliiance

Michael J. Ojeda, MHA, FACHEVA North Texas Health Care SystemChair, Mentoring Committee

Caleb F. O’Rear, FACHEDenton Regional Medical CenterChair, Communications Committee

Rick StevensMethodist McKinney HospitalChair, Advancement Committee

Pam StoyanoffMethodist Health System

Matt van LeeuweParkland Health & Hospital SystemEx-Officio, Student Council

Demetria WilhiteThe University of Texas at ArlingtonEx-Officio

Bethany WilliamsZirMedChair, Networking andMembership Committees

Lisa CoxThe Health Industry CouncilACHE Coordinator

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President’s RemarksBrad Simmons, FACHEACHE of North Texas Affiliates:

I had the opportunity to represent our Chapter, along with Scott Schmidly, President-Elect, at this year’s ACHE Leadership Conference. It was great to meet other chapter leaders and learn what they are doing to encourage leadership development and networking within their region. It was also good to be part of a strategic planning session with the national organization to help develop future initiatives for ACHE and the role of local chapters. Though, the best part of the conference was having the opportunity to showcase all of the networking, education, advancement, and sponsorship activities that we are creating here in North Texas.

I was asked to present on our Chapter’s Sponsorship initiatives and how we engage our sponsors in chapter events. Since then, I have received numerous calls and emails from chapter leaders wanting to develop similar education, networking and sponsor programs. The North Texas chapter is very unique and I am very appreciative of the hard work our committee chairs and volunteers do each month to develop the programs for our membership.

I would also like to take this opportunity to personally thank John Haupert, FACHE, North Texas Regent. As many of you know, John has taken a position in Atlanta as CEO of Grady Memorial Health System. With this move John has resigned his role with ACHE. We

are grateful to him for the time, dedication and leadership he has offered our chapter over the past few years.

There are some great events in the coming months. Please come out and take advantage of the networking and educational offerings. We will be planning for 2012 soon, so if you have feedback for the Board please let me know. I hope you join me at the next ACHE of North Texas event.

Thank you for your involvement in our chapter.

Brad Simmons, FACHEPresident, ACHE of North Texas

ofACHE

North TexasACHE

North Texas

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2011 5

Many organizations have reached the bottom of their cost-cutting efforts and now need to maximize revenue growth. While health care reform prompts concerns about patient volume versus panel size, there is an undeniable need for more providers to fulfill future care needs.

However, going forward, recruitment needs to focus on more than just finding a provider. Rather, emphasis needs to be on finding the right “care team” compliment to ensure a positive patient experience and care enhancement.

The ability to select the “desired” physician or extender means having enough candidates to create “choice”. That requires soliciting enough prospects and having an attractive enough offering to generate both qualified and interested candidates. Organizations need to diligently review the market attractiveness of their offerings and ensure a solid recruitment process to find a good match, for both the recruit and the organization. Here are a few suggestions.

Practice Opportunity: Review what you have to offer. Prospects evaluate each opportunity to identify the one they believe will most likely convert into a successful practice. This includes assessing existing demand for that specialty, operational support systems, clinical support from pre-and-post referrals and a balanced call schedule. Market-Competitive Offer: Signing bonuses and loan repayment are becoming popular and for the cash-strapped resident or fellow can be a real draw. For seasoned physicians, it’s about their ability to enhance both salary and benefits to make a change worthwhile.

Solid Presentation:Candidates evaluate every exposure they have to the organization - in every meeting, every phone call and every communication. Observe messages the practice, prospective partners and the organization are sending to candidates. Even what’s not said can be telling.

The internal team needs to be oriented to the message and the process. Help them to be positive contributors by offering both questions and content they can use in candidate interactions. Have a good mix of “colleague’s involved – in the end it’s the physicians that recruit new physicians to the medical community.

Physicians expect flaws in every organization. But they pay particular attention to how honestly and sincerely the organization communicates with them. Be upfront about shortcomings and plans to rectify going forward. Knowing the truth up front may even tip their interest in your favor as well.

It would be great if we could wave a magic wand and have the perfect candidate appear before us. But in the absence of that, do your best to nurture an environment where discipline, diligence and a lot of diplomacy come together to bring the desired results.

Allison McCarthy is one of the founding principals of Barlow/McCarthy. The firm provides consultation for various aspects of hospital-physician strategies including medical staff development, physician recruitment, relations, retention and practice marketing. Please feel free to contact her at amccarthy@barlowmccarthy.com

RecruitingPhysicianTalentfor theFutureSubmitted by Allison McCarthy

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Contemplatinga Just Culture:Patient Safety Perspectivefor LeadershipSubmitted by Beth Guyton, CPHQ

In aiming to enhance patient safety, one has to recognize the significance of a Just Culture. In August of 2009 Joint Commission released Sentinel Event Alert #43 entitled “Leadership Committed to Safety”. In this alert, TJC put forth several salient concepts, defining the role of both leadership and the front line. Joint Commission insisted that leadership be held accountable for a safety culture and also recommended that the front line be utilized in identifying opportunities for improving processes and systems that can enhance safety for both the patient and the employee. It was suggested by the Joint Commission that the focus be on learning and improving rather than on blame and retribution. The importance of building processes and systems to promote open and honest risk assessment was also emphasized. Value was placed on clear communication defining behaviors that warrant disciplinary action. Joint Commission also acknowledged the value of the patient’s experience by encouraging leadership to listen to the patient’s perspective.

These mandates are strong support for a Just Culture. Although a Just Culture is desirable and seemingly concrete at first glance, in reality, constructing a just culture has many nebulous gaps. These gaps or holes remind me of Swiss cheese, which brings us to James Reason and his theory. Reason argues that defenses and systems put in place to control risks have holes; much like Swiss cheese. These holes are the latent hazards and weaknesses of our systems. In his March 2000 British Medical Journal article entitled “Human Error: Models and Management”, Reason compares defensive layers of risk management to layers of Swiss cheese that continually shift; creating the potential for holes in our defensive systems to momentarily line up allowing for a dangerous event. As Reason explains, our philosophies for error management are rooted in our view of human error. Do we see human error as an individual issue or as a system issue?

Reason compares system thinking to individual thinking. He explains that in a system’s approach “Countermeasures are based on the assumption that though we cannot change the human condition, we can change the conditions under which humans work.” In the individual or person approach, the view is of “unsafe acts arising primarily from aberrant mental processes such as forgetfulness, inattention, poor motivation, carelessness, negligence, and recklessness.”

Reason argues that the person approach has serious shortcomings and is not well-suited for medicine. One fundamental problem is that blaming an individual undermines trust and reporting. Without open reporting and open discussion of what went wrong, the root cause is

continued on page 7

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not likely to be addressed. As Reason states, “Trust is a key element of a reporting culture and this, in turn, requires the existence of a just culture- one possessing a collective understanding of where the line should be drawn between blameless and blameworthy actions.” Joint Commission’s recommendation for clear communication defining behaviors that cross the line also details this key element of a just culture. It allows for accountability while at the same time acknowledging the need to focus on systems.

Additionally, Reason argues that mistakes are not as random as they may appear. Mishaps tend to fall into recurrent patters. If these patterns are ignored in favor of assigning blame to an individual, the root cause goes unidentified.

Reason refers to organizations that have created a Just Culture as “high reliability organizations.” They are systems thinkers. These organizations have fewer than normal adverse events and offer models for resilience. One significant trait of high reliability is embracing a mindset of constant, intelligent wariness. These organizations are aware of the human condition and the reality of process flaws. They anticipate error and train their workforce to recognize error. These organizations create a reporting culture through trust, by supporting their people and by knowing how to recover from mishap.

A Just Culture is desirable, yet difficult. Creating a Just Culture is a challenging task that requires huge shifts in thinking and behaving. It affects so many constituencies; the patient, the co-worker, the employee, the manager, the administrator, the community, and the patient’s family.

While the ultimate responsibility for establishing a Just Culture lies with leadership, I would argue that Quality Professionals have a key role to play in supporting a Just Culture. In order to support a Just Culture it is essential to fully understand what a Just Culture is and how an organization develops a Just Culture. Clearly trust, accountability, systems thinking, transparency and learning are fundamental elements.

I recently read Sydney Dekker’s book entitled Just Culture, Balancing Safety and Accountability. This book offers concepts worth contemplating along the journey to a Just Culture. Dekker gives his reader much to think about as he defines the balance between justice and accountability.

Dekker, like Reason and The Joint Commission, acknowledges how important it is for all parties to know where the line is drawn. But Dekker also argues that “who” draws the line is just as important as “where” the line is drawn.

He explains that accountability is fundamental to human relationships. Being able to offer an account for our actions is the basis for a decent, open, functioning relationship. Believing that at the core of a Just Culture are solid trusting relationships, Dekker offers the following positive cycle for a Just Culture. Trust > Reporting > Discovery > Learning > Improving

Dekker also discusses the role of the legal system and how it can take us far from justice because it is impossible for those in the legal system

to accurately judge what happens in the medical realm. Although many believe the legal system will deliver justice, it rarely does. It can be emotionally rewarding to blame someone when things go wrong and the legal system offers a nice venue for achieving that goal. Unfortunately, the legal system rarely encourages discovery of system errors and ultimately hinders reporting. Dekker argues that legal involvement can actually compromise safety.

Dekker encourages honest accountability and disclosure because failing to disclose gives the appearance of guilt. He claims that often family members sue because they believe that it is the only way to reach the truth. He also emphasizes the importance of protecting data within an organization in order to preserve reporting and support a Just Culture. This, too, is a balancing act that requires careful consideration and planning.

Cautioning against judging those involved in an incident, Dekker skillfully describes hindsight bias. “There is almost no human action or decision that cannot be made to look flawed and less sensible in the misleading light of hindsight. It is essential that the critic should keep himself constantly aware of that fact” says Dekker. He introduces the concept of “a view from nowhere.” The view from nowhere would be completely unbiased. In reality, this view does not exist. Dekker sees great value in “domain experts” reviewing incidents to shed light on system errors and promote accountability.

Dekker poses three crucial questions for a Just Culture. They are:1) Who draws the line?2) What and where should the role of “domain expertise” be in judging whether behavior has crossed the line?3) How to protect safety data against judicial interference?

As he approaches his conclusion, Dekker encourages deeper thought. He challenges the reader to think past “individuals versus systems”. He shows that a Just Culture recognizes how the individual fits within the system. A truly Just Culture considers how critical work is channeled through relationships between human beings working within a system. He emphasizes that relationships and roles of individuals within systems drive safety and learning.

Dekker argues that beyond the capability of systems there is a discretionary space. This is the space where the individual stretches and the system in which he works reaches its limits. It is a space filled with ambiguity, uncertainty, and moral choices. This space embodies the responsibilities and freedoms of the individual. Out of this space rises the human impact of a job well done. This is where the individual shines; where a job becomes meaningful; where there is pride in taking responsibility; where the patient is touched by the human elements of exceptional care. In closing, Dekker brings us back to the importance of relationships. Both justice and culture are two very large concepts and both are highly contested subjects. We see both as unmanageable. A relationship, on the other hand, is manageable. Dekker wisely suggests that if you want to do something about a Just Culture, relationships are a great place to start.

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2011 8

JULY Jestin Alancheril, N Richland Hills

Michael P. Aslin, Fort Worth Margaret Base, Dallas

Todd Baxter, RN, Dallas Francis A. Brooks III, Dallas

Julia S. Cash, RN, Richardson Lydia G. Henderson, Dallas

John J. Klitsch III, Dallas Cathy E. Knoff, RN, Dallas

Gerald R. Lewis, Fort Worth Rick Oros, Dallas

Carolyn Palsky, RN, Grand Prairie Carlos A. Saenz, Dallas

Steve Schaumburg, Farmers Branch Jontae M. Shepherd, Irving

Lee K. Smith, Dallas Felton Stevens Jr., Lancaster Barbara J. Weinberger, Dallas Jeremy Wilmington, Coppell

AUGUST Joana Adams, RN, Fort Worth Howard R. Burgess, Mansfield

Charmaine C. Christiansen, Dallas

Congratulations to the following members who advanced to Fellow status

Welcome New MembersLee C. Drinkard, Grapevine

Meagen A. Driskill, Grapevine Gary Fullerton, RN, Duncanville

Evelyn N. Gardner, Dallas Raj Grover, Irving

Greg Hackney, Plano Daniel Iliff, Irving

Ashley N. Land, Grand Prairie Cherie L. Newman, RN, Fort Worth

Cynthia K. Paris, RN, Rockwall Michael Roehrig, Frisco

Darlene A. Stanford, Wylie Christina Thomas, Dallas

Amber S. Wilson, Flower Mound Kevin Yarrow, Dallas

SEPTEMBERElizabeth Abderrahman, Murphy Georgetta C. Baptist, Arlington Kevin Blackburn, RN, Arlington

Don Dillahunty, Dallas Shannon Kingman, Arlington

Theresa Meadows, RN, Fort Worth Jessica D. Panko, Dallas

Leslie L. Phelps, McKinney Kyle Shafer, Aledo

Nichelle Shillingford, Arlington Michele R. Sibila Burnett, Dallas Gabriela Stephenson, Murphy

Rich Thomas, Dallas Mark Troxler, DO, McKinney

Alireza K. Ullah, Dallas

OCTOBER Adam B. Brown, Dallas

Allison Clemmons, Dallas Andrew L. Hansen, Dallas

Clint D. Magee, Fort Worth Nathaniel P. Miller, Haslet Terri D. Nuss, Richardson Russel G. Panko, Dallas Tiana Schmitt, Celina

JUNEJonas P. Barisas, FACHE

AUGUSTLynn Benjamin, FACHE

SEPTEMBERJeffrey L. Canose, MD, FACHE

Vivian D. Leopold, FACHE

JULY Robert W. Blum, FACHE

Ernest C. Lynch III, FACHE Sharon L. Riley, FACHE

Niels P. Vernegaard, FACHE Dennis L. Wade, FACHE

AUGUSTGreg W. Johnson, FACHE

Janine A. May Hand, FACHE Scott B. Ransom, DO, FACHE

Betty P. Scriber, FACHE Nancy E. Simon, FACHE

Congratulations to Recertified FellowsSEPTEMBER

Jerri J. Garison, RN, FACHE Dalton Stewart, RN, FACHE

OCTOBERDouglas R. Talkington, FACHE

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continued on page 10

First report on recent trends in the effectiveness of care coordination for Medicare patients discharged from hospitals shows stagnant national performance and variations in care.Published: Sep 28, 2011 Lebanon, N.H.

As scorekeeping begins for new Medicare penalties for hospitals with excessive numbers of patients returning shortly after they are discharged, a new Dartmouth Atlas Project report shows little progress over a five-year period in reducing these hospital readmissions and improving care coordination for Medicare patients. On the contrary, readmission rates for some conditions have increased nationally and for many regions and hospitals, including some of America’s most elite academic medical centers. The report shows that roughly one in six Medicare patients wind up back in the hospital within a month after being discharged for a medical condition.

In an examination of the records of 10.7 million hospital discharges for Medicare patients, researchers found striking variation in 30-day readmission rates across regions and academic medical centers. Researchers also found that more than half of Medicare patients discharged home do not see a primary care clinician within two weeks of leaving the hospital, and that facilities and regions with general patterns of high use of hospitals for medical conditions were frequently the same places with high readmission rates, an indication that some communities are more likely than others to rely on the hospital as a site of care across the board.

“The report highlights widespread and systematic failures in coordinating care for patients after they leave the hospital,” said David C. Goodman, MD, MS, lead author and co-principal investigator for the Dartmouth Atlas Project, and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice. “Irrespective of the cause, unnecessary hospital readmissions lead to more tests and treatments, more time away from home and family, and higher health care costs.”

The readmission rate to a hospital is increasingly seen as a marker of a local health care system’s ability to coordinate care for patients across care settings, and readmissions are often a sign of inadequate discharge planning and the lack of effective community-based care. Centers for Medicare & Medicaid Services (CMS) has estimated the cost of avoidable readmissions at more than $17 billion a year. In hopes of decreasing these costs, Medicare plans to reduce payments for readmissions, exposing hospitals to considerable financial risks. In fiscal year 2013, hospitals face a penalty equal to 1 percent of their total Medicare billings if an excessive number of patients are readmitted. The penalty rises to 2 percent in 2014 and 3 percent in 2015.

“The need to develop more efficient systems of care that include discharge planning and care coordination is clear,” said Elliott S.

Published: Jun 23, 2011Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, NJ

Fisher, MD, MPH, report author and co-principal investigator of the Dartmouth Atlas Project and director of the Center for Population Health at the Dartmouth Institute for Health Care Policy and Clinical Practice. “The report shows the opportunity for improvement, and the importance of aligning efforts to reduce readmissions with other policy and payment initiatives.”

Trends over time in 30-day readmission rates

Nationally, there was relatively little change in 30-day readmission rates from 2004 to 2009, regardless of the cause of the initial hospitalization. Readmission rates following surgery were 12.7 percent in both 2004 and 2009, while readmission rates for medical conditions rose slightly from 15.9 percent in 2004 to 16.1 percent in 2009.

Similarly, most regions across the country did not experience significant reductions in readmissions from 2004 to 2009. Readmissions decreased after medical discharges in 11 regions, with Bismarck, N.D. experiencing the largest decrease, from 16.3 percent in 2004 to 14 percent in 2009. There was an increase in readmissions in 27 regions, the highest in Aurora, Ill., which increased from 14.3 percent in 2004 to 18 percent in 2009. Readmission rates after surgeries varied as well, with 28 regions experiencing a decrease, most notably in Elyria, Ohio, which decreased from 19 percent in 2004 to 15.2 percent in 2009. White Plains, N.Y. was among the 18 regions with increases in readmission rates following surgical discharges, with an increase from 13 percent in 2004 to 17.4 percent in 2009.

Only seven academic medical centers had significant changes in 30-day readmission rates following medical discharge from 2004 to 2009. Northwestern Memorial Hospital in Chicago, Ill. showed the most decrease, from 19.9 percent in 2004 to 16.7 percent in 2009, while the University of Connecticut Health Center in Farmington, Conn. increased from 13.1 percent to 17.9 percent. Among patients discharged after surgery, 11 academic medical centers experienced significant changes in 30-day readmission rates between 2004 and 2009. The University of Missouri Hospital and Clinic in Columbia, Mo. decreased from 19.7 percent of patients in 2004 to 14.5 percent in 2009, while Montefiore Medical Center in the Bronx, N.Y. increased from 15.6 percent to 19.4 percent.

Regional variation in 30-day readmission rates

In 2009, the percentage of patients readmitted to the hospital within 30 days of an initial discharge varied markedly for both medical and surgical discharges across regions of the country. Among patients who first visited the hospital for medical treatment, 16.1 percent were readmitted to the hospital within 30 days. The highest rates occurred in Michigan, including Pontiac (18.9%), Royal Oak (18.8%), Dearborn

U.S. Hospitals Facing New Medicare Penalties Show Wide Room for Improvement atReducing Readmission Rates

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(18.0%) and Detroit (17.9%), while far lower rates were found in Utah, including Ogden (11.5%), Provo (13.0%) and Salt Lake City (13.6%). For patients who were discharged from the hospital after having surgery, 12.7 percent were readmitted to the hospital within 30 days. However, there was more than twofold variation in these rates in regions across the U.S., from Rapid City, S.D. (7.5%) to the Bronx, N.Y. (19.0%).

Primary care follow-up after discharge

Overall, 42.9 percent of patients who were released to go home from the hospital after medical treatment had a primary care visit within two weeks in 2009. Patients in New Orleans, La. were far less likely to see a primary care clinician after discharge home, with 25.6 percent having a visit to a primary care clinician within two weeks of medical treatment in a hospital, compared to 61.4 percent of patients in Lincoln, Neb.

Among academic medical centers, the range of variation was somewhat higher. Less than 20 percent of patients discharged from New York University Medical Center in Manhattan, N.Y. saw a primary care clinician within two weeks of a medical discharge, while the rate was nearly three times higher at the Mayo Clinic’s St. Mary’s Hospital in Rochester, Minn.

These findings highlight the pervasive problems with patient care after hospital discharge, and underscore the importance of primary care systems in reducing avoidable hospitalizations. While there are many different reasons for higher readmission rates across regions and hospitals, prior research has documented the failings of current care coordination and the high proportion of readmissions that can be avoided by improving care.

“It’s very important that patients and health care providers communicate clearly so that all questions are answered and everyone understands what will happen when the patient leaves the hospital,” said Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, a longtime funder of the Dartmouth Atlas Project. “Everyone—patients, doctors, nurses, caregivers—has a role to play in ensuring quality care and avoiding another hospital stay. They need to work together to create a plan for how care will proceed when the patient returns home. This should include a clear understanding of the patient’s medical problems, a schedule for follow-up appointments, a list of medications and instructions for taking them.”

As part of the Care About Your Care initiative, the Dartmouth Atlas Project and Robert Wood Johnson Foundation have co-produced a companion to the report with tips for patients when they leave the hospital. Additional information can be found at www.dartmouthatlas.org.

MethodologyResearchers studied 100% of fee-for-service Medicare beneficiaries with full Part A and Part B coverage during the study periods. Hospital claims from short-term acute or critical access hospitals were identified among the study population for each cohort, with the first period of index discharges as July 1, 2003 to June 30, 2004 and the second as July 1, 2008 to June 30, 2009. Because of the way hospitals are paid under Medicare in Maryland, readmission rates for Maryland hospital referral regions were suppressed. Data was adjusted for differences in age, sex and race.

Sometimes making a community healthier is about building parks. It’s about

supporting local schools and stocking food banks. As the largest not-for-profit,

faith-based health system in North Texas in terms of patients served, we value

our relationships within our communities. We are proud to continue a tradition

of being a responsible, major employer in every city we serve and to building

healthier communities beyond our walls. 1-877-THR-Well • TexasHealth.org

SHOULDN’T A HOSPITAL’S

COMMITMENTTO A HEALTHIER COMMUNITY EXTEND

BEYOND ITS WALLS?

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2011 11

...And The Survey SaysEach year our members are surveyed on key areas of interests. The results are used by the Board to glean insights of the chapter members, assist in future planning as well as make the improvements and enhancements that will best serve the professional development of our members and sustained growth of the North Texas Chapter.

ACHE of North Texas Number Surveyed: 818 Number of Responses: 341 2010 Response Rate: 35.1% 2011 Response Rate: 41.7%

All Chapters Number Surveyed: 24,725 Number of Responses: 10,330 2010 Response Rate: 40.2% 2011 Response Rate: 41.8%

Individuals (Percent) Mean of All Chapters 2010 2011 (Percent)

1. How familiar are you with your chapter’s activities and services? Completely unfamiliar 8.6 8.8 12.2 Somewhat unfamiliar 20.8 18.8 24.6 Somewhat familiar 49.4 52.8 45.1 Completely Familiar 21.2 19.6 18.1

2. Overall how satisfied are you with your chapter? (Of those who did not answer “Completely unfamiliar” to Q. 1) (1=very dissatisfied, 10=very satisfied) Mean 7.7 7.5 7.2 Median 8 8 7.2 Percent “don’t know” 5.6 4.8 9.0

3. In the past year, were you able to attend any of your chapter’s meetings or events?

Yes 61.9 55.8 44.9 No 38.1 44.2 55.1

4. In general, how satisfied have you been with the meetings or events you attended? (Of those who answered “Yes” to Q.3)

Very dissatisfied 1.3 0.6 0.6 Dissatisfied 3.9 2.2 1.2 Neither satisfied nor dissatisfied 6.5 3.4 7.3 Satisfied 58.4 55.6 51.3 Very satisfied 29.9 38.2 39.6 Mean (1 to 5 scale) 4.1 4.3 4.3

5. How much advance notice do you need to attend a chapter meeting or event? (Of those who answered “Yes” to Q.3) Less than 30 days 23.7 29.8 17.9 30-60 days 69.9 63.8 69.2 More than 60 days 6.4 6.4 12.3 I do not attend chapter’s meetings or events 0.0 0.0 0.5 6. How could the meetings or events you attended be improved? (Of those who answered “Yes” to Q.3) Less expensive pricing 26.3 20.1 16.4 Less distant location 33.8 37.8 31.0 More interesting or more current topics 27.8 30.5 29.6 Longer sessions 2.3 4.3 5.5

Individuals (Percent) Mean of All Chapters 2010 2011 (Percent)

6. Continued

Shorter sessions 7.5 6.7 4.9 More in-depth material (more specifics) 31.6 32.9 31.7 Less in-depth approach (more general) 0.8 1.2 1.1 More credible faculty 13.5 6.1 6.2 More advance notice 6.0 3.7 10.0 Other (please specify) 21.1 17.1 22.4 7. What are some of the main reasons you did not attend any chapter meetings or events? (Of those who answered “No” to Q.3)

I was not informed about them 3.1 6.0 14.3 I was not given sufficient advance notice 3.1 5.3 11.2 Too busy with my work 71.1 62.0 56.5 I was out of town 39.2 24.7 20.6 Other (personal) reasons 18.6 26.0 15.4 Too expensive 13.4 10.0 7.1 Location was too distant 27.8 27.3 30.6 Uninteresting or irrelevant topic 13.4 12.7 12.3 Session planned was too long 1.0 0.0 0.6 Session planned was too short 0.0 0.0 0.6 Needed more in-depth material (more specifics) 4.1 5.3 4.4 Needed less in-depth approach (more general) 0.0 0.0 0.2 Faculty was not credible 2.1 2.0 0.5 Other (please specify) 15.5 16.7 13.8

8. Are you familiar with the newsletter published by your chapter?

Yes 79.0 79.1 66.4 No 21.0 20.9 33.6

9. Overall, how satisfied are you with your chapter’s newsletter? (Of those who answered “Yes” to Q.8)

Very dissatisfied 0.5 0.4 0.6 Dissatisfied 0.5 0.4 1.4

continued on page 12

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Individuals (Percent) Mean of All Chapters 2010 2011 (Percent)

9. Continued

Neither satisfied nor dissatisfied 22.1 23.1 25.6 Satisfied 55.4 50.8 53.5 Very satisfied 21.5 25.4 18.9 Mean (1 to 5 scale) 4.0 4.0 3.9

10. How could your chapter’s newsletter be improved? (Of those who answered “Yes” to Q.8)

More local news 51.3 50.7 42.9 More on upcoming chapter events 25.0 23.9 36.9 More frequent publication 6.6 10.0 16.3 More thought pieces 30.3 27.4 28.7 More polls of chapter members 20.4 22.4 13.7 More interviews 27.6 20.9 19.6 Other (please specify) 14.5 9.5 11.9

11. Have you served as a volunteer for your chapter in the past two years?

Yes 21.4 20.6 18.7 No 78.6 79.4 81.3

12. Which of the following contributed to your not volunteering? (of those who answered “No” to Q.11)

My professional commitments were too extensive 51.5 48.1 45.2 I was not interested in the volunteer activities offered 6.6 3.8 4.4 I was not committed to the chapter enough to volunteer 20.9 18.6 17.6 I was an active volunteer for other organizations 20.4 17.8 22.5 I was not asked to volunteer 28.1 32.2 31.1 I was not informed about specific volunteer opportunities 27.6 33.7 34.3 I was not a member of my chapter 2.6 1.5 5.4 My chapter was just being organized 0.0 0.0 1.0 I just relocated to this area 6.6 4.5 5.5 Other (please specify) 13.8 16.7 14.9

13. Would you be interested in serving as a volunteer for your chapter in the next two years?

Yes 46.6 49.4 39.9 Not sure 37.8 36.4 42.2 No 15.5 14.2 17.9

Individuals (Percent) Mean of All Chapters 2010 2011 (Percent)

14. Which of the following factors contribute to your plan not to volunteer in the next two years: (Of those who answered “No” to Q. 13) My professional commitments are too extensive 78.9 66.0 62.7 I am not interested in the volunteer activities offered 10.5 8.5 7.9 I am not committed to the chapter enough to volunteer 21.1 8.5 15.9 I am an active volunteer for other organizations 10.5 23.4 27.7 I plan to leave this area 0.0 17.0 6.2 I will retire 0.0 6.4 8.3 Other (please specify) 23.7 12.8 17.6 15. What would you be interested in doing as a volunteer? (Of those who answered “Yes” or “Not Sure” to Q. 13)

Governance: Serving as a chapter officer 28.8 26.6 25.7 Serving as a member of the chapter board of directors 40.0 38.0 42.3 Marketing/Planning: Planning chapter educational or networking events 31.8 36.3 29.0 Promoting chapter educational or networking events 30.6 27.0 23.9 Organizing parties and celebrations 12.4 17.3 11.2 Publishing: Providing content for your chapter’s newsletter 17.6 11.8 16.2 Providing content for your chapter’s website 8.2 8.4 9.0 Editing the newsletter or website 12.9 16.9 14.1 Presenting: Providing educational content as faculty for a chapter educational program 20.0 17.3 20.6 Serving as a panelist for a chapter educational program 25.3 27.8 28.3 Helping other members study for the Board of Governors’ examination 5.3 8.0 9.6 Serving as a mentor to other healthcare executives 35.3 30.0 41.9 Assisting other chapter members with career development 27.6 24.5 33.0

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2011 13

NEWS FROM NATIONAL

ACHE’s Congress on Healthcare Leadership brings you the best in professional development, opportunities to network with and learn from peers, and the latest information to enhance your career and address your organization’s challenges in innovative ways.

More than 4,500 healthcare leaders attended the 2011 Congress on Healthcare Leadership. Join us in 2012 and experience the energy of an event that draws the top healthcare leaders from across the nation and around the world.

This premier healthcare leadership event brings: • Education on current and emerging issues• Opportunities to connect with your peers• More than 140 sessions of practical learning from healthcare’s top leaders• Career-enhancement workshops

SAVE THE DATE!

Registration and LodgingOpen November 10, 2011

Introducing ACHE’s New Online Postgraduate Fellowship AreaGive back to the field by offering a postgraduate fellowship in your organization. The new Postgraduate Fellowship Area on ache.org gives healthcare leaders the resources and tools they need to design and post a postgraduate fellowship, attract qualified candidates and develop future leaders. The site includes information related to formatting a fellowship, compensation and benefits, recruiting, onboarding and assessing the fellow. Organizations may also post their postgraduate fellowship on ACHE’s online Directory of Postgraduate Administrative Fellowships.

Visitors are now directed to choose from three categories: Students looking for postgraduate fellowship listings, organizations seeking information on how to create a postgraduate fellowship, and organizations that wish to post a postgraduate fellowship. For more information see ache.org/Postgrad.

Job Listings Wanted for ACHE’s Free Job BankACHE’s Job Bank contains more than 1,000 healthcare management listings at any given time with new jobs posted daily. ACHE is seeking to expand the Job Bank to include more positions for early careerists, who are actively seeking new opportunities.

Advertise your open healthcare management positions in ACHE’s Job Bank to target the most qualified candidates—from early careerists to senior-level executives. ACHE looks to you to post open positions to help ensure the Job Bank continues to be a vibrant resource for ACHE affiliates.

Jobs are posted free of charge and are only accessible to ACHE affiliates. To post positions, visit ache.org/Careers. For more information, contact Maxine Ellison at (312) 424-9446.

EVENT ENCOREA Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2011 14

After Hours Networking EventSubmitted by Megan Harkey

On Thursday, September 8, 2011, an After Hours Networking Event was held at Komali Restaurant in Dallas, Texas. John Haupert, FACHE, Executive Vice President and COO, Parkland Health & Hospital System graciously hosted the event. The event was well attended by approximately 74 ACHE members and guests, who shared in conversation over free appetizers. The assorted attendance represented students, early, mid, and advanced careerists allowing all those that attended a diverse range of conversation and networking. The event was organized by Ashley Sadlon, Children’s Medical Center, Mallory Johnson, JPS, and Richa Shah.

For more information on future events, please visit us at northtexas.ache.org or send us an email at info@northtexas.ache.org.

Managing for Morale Effective Management Techniques to Retain Your StaffSubmitted by Christine Hammons

On Thursday, September 15th, Methodist Richardson Medical Center hosted the Managing for Morale – Effective Management Techniques to Retain Your Staff educational event for the North Texas ACHE chapter. The event was organized by Bill Ashcraft, Tina Larsen, Charmaine Christiansen Moore, and Stephan Moore, FACHE. It was moderated by Kevin Stevenson, FACHE, and attended by 37 members of the organization.

Matt Chance of Baylor Medical Center Uptown, Shari Conway of Southwest Airlines, Stephen Maffei of Methodist Health System and John Self of JohnGSelf Associates presented their perspectives of effective management practices. Shari provided enlightening views of how to grow and manage employees from her experience at Southwest.

Although each guest speaker served a different role in their organization, all were in agreement on key management principles. Successful organizations will be those that hire the right people for the right job. They will develop, coach and mentor their staff continually. They will provide open, honest communication and will be employee facing, from the initial on-boarding process through performance evaluations. Healthcare organizations and leaders that are able to embrace these core competencies will be better positioned for future success in an evolving environment.

For more information on future events, please visit us at www.northtexas.ache.org or send us an email at info@northtexas.ache.org.

Speakers Shari Conaway, Southwest Airlines andJohn Self, JohnGSelf Associates

ofACHE

North TexasACHE

North Texas

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2011 15

EVENT ENCORE

Early CareeristsDevelopment Seminar Submitted by Charmaine Christiansen

On Saturday, September 24, 2011 ACHE of North Texas held its Early Careerists Development Seminar at Texas Health Resources in Arlington. The event was organized and moderated by Madhu Rao, Doctorial Candidate at Northcentral University, along with Panelists Bethany Williams, VP of Corporate Business Development at ZirMed and Kristina Witmer, Marketing Director of the Witmer Group.

Bethany Williams discussed the value of “Building A Personal Brand One Step At A Time.” She explained that discovering your personal brand begins by identifying your strengths and focusing on them to set you apart from others. As with all branding, Bethany also touched on the importance of the packaging. Your actions are in essence your personal branding packaging because everything a person does sends a message and those messages are the basis of the opinions of others. In conclusion, Bethany reinforced that the key’s to personal branding are to Define it, Make it Unique, Messaging and Enforcing it.

Kristina Witmer discussed the “Steps to Leveraging Social Media.” She emphasized the importance of utilizing LinkedIn, Facebook, Twitter and Google. All four types of social media are great ways to promote your personal brand and to get noticed by those searching for talent. Kristina also emphasized the value of LinkedIn connections and recommendations stating that both have the ability to promote and sustain you in an economic downturn.

Madhu Rao, then ended the seminar with a segment on “Steps to Overcoming The Fear of Public Speaking.” He spoke on the three steps to remove fear: pre-plan logistics, using a process and speaking clearly. Madhu also allowed the participants an opportunity to overcome their fear with an impromptu public speech of their own where they were critiqued on their technique and presence.

Overall, the seminar was a great success with several valuable take aways. ACHE of North Texas extends appreciation to the hosts and the members for participating. For more information on future events, please visit us at www.northtexas.ache.org or contact us at info@northtexas.ache.org.

Attendees Cynthia Nguyen and Demetris McDowell

Presenters Bethany Williams, Madhu Rao and Kristina Witmer

Presenter Kristina Witmer and Attendee Kevin Wright

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2011 16

EVENT ENCORE-EXTRAS

ACHE President/CEO Tom Dolan andMember Scott Manis, Doctors Hospital

Executive Round Table

Panelists Tom Dolan, Stephen Mansfieldand Attendee Mike Waters

Panelists Stephen Mooney and Tom Dolan

Speaker, Kevin O’Connor

Executive Session

Xavier Villarreal, Ann Marie Huddleston,Speaker Kevin O’Connor

Team Building Activity

Organizer - Jamie Pacillio, Jenifer Greenwayand BOD Member Winjie Miao

Jenna and Colt Hatcher

Ranger Game Networking Event

Leon Nguyen, Ryan Dugan, Jontae Shepherd

Tre Douglas, Kellee Bowers and Debbie FrattoJontae Shepherd and KeShia Simmons

CALENDAR

ACHE of North Texas thanks the following Corporate Sponsors for assisting the organization’s mission. By sponsoring various events throughout the year, these sponsors are provided local and national exposure with an opportunity to showcase their organization, brand, career opportunities, products and services to the ACHE membership and its affiliates.

We are currently working on new educational and networking opportunities for 2011. For the latest updates please check our website or watch your inbox for the event guide.

November 17th, Thursday

General Membership Meeting

Time: 5:00-8:00 pm

Location: NYLO Hotel | Irving

Keynote: Jennifer Bagley and

“The Fusion Marketing System”

December 1st, Thursday

Holiday Networking Event

Time: 5:30 - 7:00 p.m.

Location: Sambuca | Dallas

Host: Board of Directors

Organizer: Madhu Rao and Heather Vines,

EmCare

December 15th, Thursday

Cat I: Quality Management Systems

Time: 5:30-7:30 pm

Organizers: Janet Nelson, EmCare

Bill Ashcraft, AmSurg

Maitri Vaidya, Children’s Med. Center