the executive connection of north texas: spring 2011

WINTER 2011

CONTENTMessage fromthe Regent 4John M. Haupert, FACHE

President’s Remarks 5Brad Simmons, FACHE

Physician Connections 6Earning Time and Attention

News from National 7

Meaningful Use 101 8Series Part 2

Forward Together 11 Congress on Healthcare Leadership

Variations Grids 12The Human Variable

Event Encore 14

Calendar 16

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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 [email protected]. 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.

Congratulations to the followingmembers who advanced toFellow status in 2010!

Christopher P. Boone, FACHE David E. Domingue, FACHEJon T. Duckert, FACHEWilliam C. Henning, FACHEAlice Masciarelli, RN, FACHEAshley R. McClellan, FACHEShelly Miland, FACHELarry W. Olive, FACHEMichael R. Korpiel, FACHENancy A. Vish, PhD, FACHEBeverly Dawson, RN, FACHE Jessica C. Rangel, FACHEBrandy J. Frawley, FACHE, Edwin K. Hutchenrider Jr., FACHEBrad S. Morse, FACHE, Lynn J. Pappas, CPA, FACHEMatthew V. Alva, FACHEBrenda K. Blain, FACHE

Gail E. Seaman, FACHEMaureen M. Washburn, FACHEJohn P. O’Neill, FACHELinda S. Chappell, FACHE Dale G. Hutchins, FACHEPhilip W. Young II, FACHE Glenn W. Bodinson, FACHE Jarvis J. Morgan, FACHE Denise B. Elliott, FACHE John M. Hayes, FACHE Janet P. Nelson, FACHE Ellen M. Pitcher, RN, FACHE Terry J. Fontenot, FACHE Patricia B. Johnston, FACHE Fran Laukaitis, RN, FACHEMichael D. Sanborn, FACHE, Suellen M. Smith, FACHE

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

Editor-In-Chief Susan Edwards, FACHE

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

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

Contributing Writers Pamela Doughty, Ph.D. Joseph Barcie, MD, Ph.D., MBA Kriss Barlow, RN, MBA Megan Harkey Joan Shinkus Clark Melissa Reichardt

Production Kay Daniel

Advertising/ Subscriptions [email protected]

Questions and Comments: ACHE of North Texas Editorial Office, c/o Executive Connection 3001 Skyway Circle, Suite 100, Irving, Texas 75038 p: 972.256.2291 | f: 972.570.8037 e: [email protected] | 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 Tenet Healthcare Corporation Chair, Nominating Committee

Secretary Ron Coulter, MHA, FACHE Texas Health Cleburne

Treasurer Jania Villarroel, MHA

2011 Board of Directors

John Haupert, MHA, FACHE Parkland Health & Hospital SystemEx-Officio, Regent

Beverly Dawson, RN, CCM, FACHEElder Care LPChair, 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 Hospital Azle

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

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

Rick StevensJPS Heath NetworkChair, Advancement Committee

Pam StoyanoffMethodist Health System

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

Demetria WilhiteThe University of Texas at ArlingtonEx-Officio

Bethany WilliamsPricewaterhouseCoopers, LLCChair, Networking Committee

Lisa CoxThe Health Industry CouncilACHE Coordinator


Message from the RegentJohn M. Haupert, FACHE

The Texas Hospital Association Annual Leadership Conference will be held February 2 and 3, 2011. Once again this year, the ACHE will be hosting the Horace Cardwell ACHE Affiliates Breakfast from 7:00 a.m. to 8:30 a.m. on Thursday, February 3. Christopher D. Van Gorder, FACHE, president and chief executive officer of Scripps Health, San Diego, and Chairman of the American College of Healthcare Executives will be joining us at this breakfast and will be speaking on the topic of “Physician Relations in an Era of Healthcare Reform”.

Also at this breakfast I will be presenting the Regent’s Award to two of our outstanding ACHE affiliates from Northeast Texas. The Early Career Healthcare Executive Award will be given to Mr. Scott Schmidly, FACHE. Scott is the Senior Vice President, Chief Operating Officer, and Ethics & Compliance Officer for Medical City Dallas Hospital and Medical City Children’s Hospital. In his capacity, Scott assists with the daily operation of Medical City, a 680-bed medical center that includes more than 2,600 associates and a medical staff of nearly 1,200 physicians.

In addition to his professional responsibilities, Scott actively serves the community and healthcare industry. Scott serves on the THA HOSPAC board, the North Texas ACHE board, is on the inaugural Advisory Council of the Nelson Rushe College of Business at Stephen F. Austin State University, is a past board member of the North Dallas Chamber of Commerce, and the former chairman of THA’s Leadership Development Council.

Scott began his healthcare administration career with the Methodist Healthcare System in San Antonio, and has served in various administrative capacities with the SETON Healthcare Network, the St. David’s Healthcare Partnership, and the HCA North Texas Division before assuming his role at Medical City. Scott received his master’s degree in healthcare administration from Trinity University and his undergraduate degree from Stephen F. Austin State University. He and his wife Tamara are the proud parents of twin girls Hannah and Kate.

The Senior-Level Health Executive Regent’s Award will be given to Ms. Paula R. Brandon, RN, MSN, FACHE. Paula serves as the Senior Vice President of Patient Care Services at Good Shepherd Medical Center in Marshall. In her role she oversees all clinical services at Good Shepherd in Marshall. Among Paula’s many accomplishments at Good Shepherd Marshall has been the redesign of the care model in the Emergency Department that has reduced total ED length of stay to one-hour.

Prior to assuming her current role, Paula served in numerous clinical and nursing executive positions at Marshall Regional Medical Center, Crawford Memorial Hospital in Van Buren, AR, Veterans Administration Medical Center in Memphis and St. John’s Hospital in Springfield, MO. Paula has also served as an instructor in several nursing school programs while serving in her various executive roles.

Paula has been extensively involved in supporting the East Texas ACHE Forum. She served as president of the chapter in 2010 and led the chapter to receive the ACHE Chapter Distinction Award in 2010; one of only six chapters to receive such distinction. In addition, Paula individually received the ACHE Service Award in 2010. In addition to her support of the East Texas ACHE Forum, Paula is also involved in numerous professional and community activities that serve her community and our profession. She is also widely published on the topic of nursing practice and management theory.

Please join me in congratulating Scott and Paula.


President’s RemarksBrad Simmons, FACHEDear ACHE of North Texas Members:

Happy New Year. I would like to start by thanking the membership for granting me the opportunity to serve as President of our chapter. I am very excited about what we have planned for the coming year and committed to finding new ways to provide our membership opportunities for professional development, networking, and best practice educational offerings.

Before we can move on to 2011 we must look back at our success in 2010. The chapter increased the number of fellows by 43, had a membership growth rate of 7.7%, and achieved a member satisfaction rate of 7.7 on a 10 point scale. All three of these goals were record achievements that we made in 2010. Our chapter took a giant leap forward in 2010 much of that driven by our now past President, Eric Evans. Eric did a phenomenal job directing the board and developing a strategic direction for our chapter. Eric implemented a new Chapter scorecard for tracking goals and developed a new sense of accountability to our chapter.

A couple of months ago Eric, John Haupert (our ACHE Regent), and myself attended the ACHE Chapter Leaders Conference in Chicago. It was great to verify that our chapter is one of the most progressive ACHE chapters in the country. By the end of the conference several other chapter leaders were approaching us to discuss how we had been so successful in North Texas. This success comes from the strategic direction driven from the Board as well as members getting involved in committees to help develop the programs we offer each year.

Please take a moment to review our chapter’s 2011 calendar of events and make plans to join us at this year’s events. Attendance at chapter events grew tremendously last year and we expect this trend to continue. Not only has attendance grown but the level of support from our Sponsors has also grown. Within the last few weeks of 2011 we received sponsorship commitments from Baylor Health System, Texas Health Resources, HDR, Perkins & Will, Hunt Construction, RTKL, Tenet Healthcare, HCA Medical City Hospital, CCRD Partners, Walter P. Moore, and HKS. I would like to recognize these sponsors because without them we would be unable to provide the caliber and frequency of educational, networking, and professional development sessions we offer each year.

We have several avenues for members to volunteer and participate in one of the many committees this chapter offers. I highly encourage you to get involved and become a part of the one of the largest chapters in the country. If you have feedback or ideas for the chapter please do not hesitate to contact us at [email protected].

I look forward to seeing you at one of our upcoming events.

Sincerely,Brad Simmons, FACHE2011 Chapter President

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The ability to contact prospective physicians has gotten more challenging, more complex and at the same time, much more important for organizations. It starts with the battle to connect; getting a quality face-to-face meeting with a new prospect is just plain tough. I am reminded of the song, Old McDonald, with our rhyme, “Here a rep, there a rep, everywhere a rep, rep….” There is little indication that this will soon change. The best option is to fine tune your approach, recognize the clutter – but don’t let it control you and make certain that you maximize your potential with each physician interaction.

Make It Worthwhile

Start by defining a quality visit from your perspective. Write down the attributes that indicate a meeting is successful – get specific; consider amount of time, questions asked, the answers provided, and of course progress made. Now, do the same from the physician’s perspective. While this is not easy, it is very important that we consider what they expect to gain in exchange for 10 or so minutes of their time. My goal is a ratio of two times the value for time spent. If you are not providing the 2:1, they will find other uses for that time. By the way, most of the time, telling them about your services is rarely worth more than a 0.5 on the value scale!

Let Me In Again

Successful appointments are about earning the right to get back in. With all the time and energy spent on getting through the gatekeeper, attention may be shifting away from ensuring that the visit is successful and that the rep- once in, earns the right to return.

Create a solid reason for that first meeting and make certain that the conversation adds the value we talked about above. At the end of the conversation, let them know that you’d like to return and the reason why. Set the stage with them and then work with the gatekeeper from the inside perspective.

It’s Personal

Assuming you can produce value, it is important to create good synergy and a strong relationship. Knowledge is important, but not a stand-alone. The prospective physician has to like to meet with the rep. This is the human connection side of the relationship. Consider the attributes of those with whom you like to spend time. Of recent, have you had a purchasing experience that was pleasant? Why? Find a style

PhysicianConnections:Earning Timeand Attention

Kriss Barlow, RN, MBA

continued on page 7


that both demonstrates who you are, and that makes others want to have a conversation with you. Good relationships with physicians also include being honest and straight forward.

Sell What They Will Buy

Many organizations rely too heavily on internal leaders to tell them what to position. While leaders, especially service line leaders, understand profitability, technology and volume potential, they often do not have a strong sense of the marketplace. Their sales recommendations should not be the only consideration. Use field intelligence and physician need when selecting the right products and services for growth. To be successful, the representative must be able to talk about topics that interest the prospective referring physician. Study History

One final suggestion – our minds are likely to reject knowledge

which does not match prior information or experiences. If our goal is to connect and earn more time with the physician to grow more referrals, it is essential that we understand their experiences and their expectations. Take the time to understand past referrals to your facility and to the competitor. Ask the physicians about their background, how the group functions, what would make for an ideal experience.

Getting their time and attention is really about earning it with knowledge, a style and approach that suits them. Once the rep is prepared with the right message for the doctor the gatekeeper battle becomes a one-time issue instead of an every-time challenge!

Kriss Barlow RN, MBA is a principal with Barlow/McCarthy, a training and consulting firm focused on hospital- physician solutions. Contact Kriss at (715) 381-1171 or [email protected]

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ACHE Call for Nominations for the 2012 SlateACHE’s 2011–2012 Nominating Committee is calling for applications for service beginning in 2012. All affiliates are encouraged to participate in the nominating process. ACHE Fellows are eligible for any of the Governor and Chairman-Elect vacancies and are eligible for the Nominating Committee and Regent-at-Large vacancies within their district. Open positions on the slate include:

• Nominating Committee Member, District 4 (two-year term ending in 2014)• Regent-at-Large, District 4 (three-year term ending in 2015)• 4 Governors (three-year terms ending in 2015)• Chairman-Elect [District 4: Alabama, Arkansas, Kansas, Louisiana, Mississippi, Missouri, New Mexico, Oklahoma, Tennessee and Texas]

Candidates for Chairman-Elect and Governor should submit an application to serve, a copy of their resume and up to 10 letters of support.

Candidates for Regent-at-Large and the Nominating Committee should only submit a letter of self-nomination and copy of their resume.

Applications to serve and self-nominations can be submitted by U.S. mail and postmarked between Jan. 1 and July 15. Mail applications to serve to: Charles R. Evans,

FACHE, chairman, Nominating Committee, c/o Julie Nolan, American College of Healthcare Executives, 1 N. Franklin St., Ste. 1700, Chicago, IL 60606-3529. Materials also can be sent via e-mail to [email protected] or faxed to (312) 424-2828 by July 15.

The first meeting of ACHE’s 2011–2012 Nominating Committee will be held on Tuesday, March 22, 2011, during the Congress on Healthcare Leadership in Chicago. The committee will be in open session at 2:45 p.m. During the meeting an orientation session will be conducted for potential candidates, giving them the opportunity to ask questions regarding the nominating process. Immediately following the orientation, an open forum will be provided for ACHE affiliates to present and discuss their views of ACHE leadership needs.

Following the July 15 submission deadline, the committee will meet to determine which candidates for Chairman-Elect and Governor will be interviewed in person on Oct. 27, 2011. All candidates will be notified in writing of the committee’s decision by Sept. 30, 2011.

To review the Candidate Guidelines, visit the Affiliates Only area of ache.org and select the “Candidate Guidelines” link on the left-hand side of the page. If you have any questions, please contact Julie Nolan at (312) 424-9367 or [email protected].


The criteria for hospitals and physicians for 2011 will begin like a Chinese menu, one from column A and one from column B. The first set of meaningful use objectives will be fairly simple compared to years 2013 and 2014 as each year is a little more advanced than the last. Eligible hospitals and critical access hospitals (CAHs) must choose 19 of a possible 24 objectives. These include 14 required core objects and 5 menu set objectives that are chosen from a list of 10. All hospitals and providers track the objectives for 90 days and report the results to CMS for their incentive payments.

Most of the 2011 meaningful use criteria are valuable information that physicians and hospitals may already be interested in collecting, but paper information made it more difficult to aggregate and compare patient progress than the new electronic EHR. With EHRs being implemented all over the North Texas Area it will be important to track certain information that will not only be useful to CMS, but to the

Meaningful Use 101(Series Part 2)

hospital, patient and the provider. Much of the information will be safety and quality information as well as more in-depth information about the patient.

The first six objectives concerns are safety measures; medication ordering/recording, drug interactions/allergies, and problem/diagnosis list. Objectives 6-7 are patient demographics and vital signs. Objective 8 is about smoking for patients 13+. Objective 9 concerns reporting of quality measures to CMS. Objective 10 requires hospitals to implement a clinical support rule and then track the compliance of that rule. Objectives 11-12 require hospitals to provide patients with an electronic copy of their health information and/or their discharge instructions. Objectives 13-14 require hospitals to exchange key clinical information with providers and patients and protect the privacy of that information. The table shows the objectives and how they should be reported.

Pam Doughty, Ph.D.

continued on pages 9 and 10

Eligible Hospital and CAH Core Objectives Attestation Requirements

(1) Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local, and professional guidelines.

(2) Implement drug-drug and drug-allergy interaction checks.

(3) Maintain an up-to-date problem list of current and active diagnoses.

DENOMINATOR: Number of unique patients with at least one medication on their medication list.

NUMERATOR: Number of Numerator is the number of patients in the denominator that have at least one medication order using CPOE.

Yes/No Hospitals must attest YES to having enabled drug-drug and drug-allergy interaction checks for the length of the reporting period.

DENOMINATOR: Number of unique patients admitted to an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.


(3) Continued

(4) Maintain active medication list.

(5) Maintain active medication allergy list.

(6) Record all of the following demographics: (A) Preferred language. (B) Gender. (C) Race. (D) Ethnicity. (E) Date of birth. (F) Date and preliminary cause of death in the event of mortality in the eligible hospital or CAH.

(7) Record and chart changes in the following vital signs: (A) Height. (B) Weight. (C) Blood pressure. (D) Calculate and display body mass index (BMI). (E) Plot and display growth charts for children 2–20 years, including BMI.

(8) Record smoking for patients 13 years old or older.


NUMERATOR: Number of patients in the denominator who have at least one entry or an indication that no problems are known for the patient recorded as structured data in their problem list. The resulting percentage (Numerator ÷ Denominator) must be more than 80 percent in order for an eligible hospital or CAH to meet this measure.

DENOMINATOR: Number of patients admitted or seen in ED.

NUMERATOR: Number of patients from the denominator that have a data entry for medication including “no Medication”. Result must equal 80%.

DENOMINATOR: Number of patients admitted or seen in ED.

NUMERATOR: Number of patients from the denominator that have a data entry for medication allergy or “No known allergy”. Result must equal 80%.

DENOMINATOR: Number of unique patients admitted to the eligible hospitals or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

NUMERATOR: Number of patients in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data. Result >50%

DENOMINATOR: Number of unique patients age 2 or over admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

NUMERATOR: Number of patients in the denominator who have at least one entry of their height, weight and blood pressure are recorded as structured data. Result > 50%

DENOMINATOR: Number of unique patients age 13 or older admitted to the eligible hospital’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

NUMERATOR: Number of patients in the denominator with smoking status recorded as structured data.

EXCLUSION: An eligible hospital or CAH that sees no patients 13 years or older would be excluded from this requirement. Eligible hospitals or CAHs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. Result > 50%



Eligible hospitals and CAHs must attest YES to reporting to CMS hospital clinical quality measures selected by CMS in the manner specified by CMS to meet this measure.

Eligible hospitals and CAHs must attest YES to having implemented one clinical decision support rule for the length of the reporting period to meet this measure.

DENOMINATOR: Number of patients of the eligible hospital or CAH who request an electronic copy of their electronic health information four business days prior to the end of the EHR reporting period.

NUMERATOR: Number of patients in the denominator who receive an electronic copy of their electronic health information within three business days.

EXCLUSION: An eligible hospital or CAH that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period would be excluded from this requirement. Eligible hospitals or CAHs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. Result > 50%

DENOMINATOR: Number of patients discharged from an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) who request an electronic copy of their discharge instructions during the EHR reporting period.

NUMERATOR: The number of patients in the denominator who are provided an electronic copy of discharge instructions.

EXCLUSION: An eligible hospital or CAH that has no requests from patients or their agents for an electronic copy of their discharge instructions during the EHR reporting period they would be excluded from this requirement. Eligible hospitals or CAHs must enter ‘0’ in the Exclusion box to attest to exclusion from this requirement. Must be > 50%

Eligible hospitals and CAHs must attest YES to having performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information during the EHR reporting period to meet the measure.

Eligible hospitals and CAHs must attest YES to having conducted or reviewed a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implemented security updates as necessary and corrected identified security deficiencies prior to or during the EHR reporting period to meet this measure.

(9) Report hospital clinical quality measures to CMS or, in the case of Medicaid eligible hospitals, the States.

(10) Implement one clinical decision support rule related to a high priority hospital condition along with the ability to track compliance with that rule.

(11) Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures), upon request.

(12) Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request.

(13) Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.

(14) Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.


Join us in Chicago March 21–24 for ACHE’s 2011 Congress on Healthcare Leadership, the premier education event for healthcare executives.

Congress allows you to make the most of your membership in ACHE and get the best value for your educational dollar. In the current reform environment this prime networking opportunity not only provides you with key opportunities to learn from experts in the field—it will help you connect with other healthcare leaders and advance your career.

Join more than 4,000 of your colleagues for an event that brings education on current as well as emerging issues, more than 140 sessions of practical learning from healthcare’s top leaders and career-enhancement workshops.

The 2011 Congress will also feature:

• Tactical Approaches to the Challenges of Health ReformSee how the field’s best thinkers are positioning their organizations to provide better patient, staff and community outcomes using limited resources. Key approaches to patient access, revenue enhancement, technology integration, workforce enhancement and high-quality clinical outcomes will be explored. All 2011 Congress faculty were asked to incorporate tactical approaches to address health reform into their presentations.

• The Masters SeriesNew to Congress for 2011, The Masters Series is designed to showcase the approaches and outcomes of some of the healthcare field’s most successful leaders in four critical areas: physician integration, information technology, clinical quality management and leadership. The Masters Series includes four, 90-minute sessions, each featuring two presenters. Participants will learn from the expertise and real-world experiences of these “masters” of healthcare leadership.

• Emerging TopicsIn 2011, ACHE is purposely leaving a handful of seminars open to make room for late-breaking topics. Please refer to ache.org/Congress for more information on what these topics will be. This ensures that ACHE’s 2011 Congress is on the leading edge of changes as they occur.

• Congress ExpressACHE also has created Congress Express, an innovative way to experience many of the benefits and features of healthcare’s premier education and networking event at a reduced cost—Wednesday and Thursday only. Congress Express participants still enjoy Hot Topic sessions, a luncheon session and a networking reception while earning up to 12 Category I (ACHE education) credits. With Congress Express, you can leave home after work on Tuesday, enjoy a full Congress experience on Wednesday and Thursday, and be back in the office on Friday morning.

Join your ACHE colleagues as we move forward together!

Watch for the complete Congress brochure in the mail or view it online at ache.org.


As you would expect, hospitals are places where many procedures are performed daily by highly skilled professionals. In fact there are so many different procedures done by so many different people in hospitals, that the hospitals even have policies, procedures and committees on how best to update and improve these procedures. Despite all the energy spent identifying best practices and consolidating this knowledge into policies and procedures, there is still great variation among outcomes. Yes outcomes do vary, even when performing the same procedure.

Variations in outcomes can translate to decreases in quality and increases in costs. Today hospital administrators are constantly looking for consistency and predictable, replicable outcomes. The variable element we will consider here is ourselves, the human variable.

I began my work in healthcare as a researcher, and part of my job entailed obtaining bacterial DNA for further testing. The procedure was simple enough and yet the team leader always commented that each specimen always had different levels of contamination depending on the researcher providing the DNA yield. Even with ongoing in-service, newer equipment, tools, and cleaning agents the variance between research assistants remained. My own personal contamination levels were as disappointing as they were unpredictable. I asked if I could observe the researcher with the lowest contamination levels in an attempt to learn something from watching someone else perform the procedure. I watched a researcher who happened to be proficient and quick; she would hold a specimen test tube with one hand, remove and hold the test tube stopper with two fingers from her opposite hand, remove the specimen while never allowing the stopper to touch anything, then flame the test tube opening before reapplying the stopper again. Her movements were as graceful as they were simple; she

consolidated all the necessary steps into a single fluid motion. This technique was not outlined anywhere in the procedure manual but was something she had learned during her years of experience. I began to practice the same technique and within a few days, my contamination rates fell dramatically.

We sometimes accept that different people have their own way of doing things, but these variations can impact the overall outcome of any procedure. There are many examples of this principle: Why can Team-A turn around an OR room after procedure X in 30 minutes, when it takes Team-B forty minutes after the same procedure? Why is there such a variance in time for different medical record coders to close out a medical record chart of a patient with the same diagnosis code? Why does one housekeeping team finish their tasks on time every time while the second team is consistently tardy?

But, how do we begin to understand the differences between trained professionals? One must identify the differences in every step performed before, during and after each process as it is performed by various individuals. This process is not as difficult as you may imagine, and it’s done with simple boxes and lots of colors.

Let’s see an actual example of a Variations’ Grid for drawing blood from a central line that resulted in a 90% CLAB infection reduction within 30 days. The first step is to write down every step done to perform a blood draw from a central line by each person doing the procedure.

After observing the participants and recording how they each perform the same procedure, one must then place each step in a block and assign it a color (ie. use of glove is light blue); finally organize these steps from left to right, stacking them one on top of the other.

Variation Grids: The Human Variable Joseph S. Barcie, MD, Ph.D., MBA

continued on page 13


It soon becomes very clear that these individuals have a variety of different ways of performing the same procedure, although they have the same goal, the order of their actions varies greatly. If every individual did this procedure exactly the same way the colors would align top to bottom, perfectly. After identifying which person has the best outcome, one can easily identify how their results were achieved. This behavioral process can now be taught to others to improve their outcome as well.

This is a very simple and easily executed program that reduces the variability of any existing process, leading to more consistent results. For more information about Variation Grids go to the Value Capture Policy Institute’s website www.valuecapturellc.com

Dr. Barcie is the President, Centralized Operations for International Hospital Corporation (IHC) in Dallas, Texas.

HUP Blood Draw Activities

Sequence of observations Steps 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Observation 1 (3/13/08) (Vacutainer draw) Enter Glove Visual Set up Wipe Flush Draw Wipe Vac Draw Draw Prob. Vac Wipe Flush Prob. Wipe Cap Discard Glove FlushObservation 2 (3/13/08) (Vacutainer draw) Glove Gown Enter Alarm Set up Cap Wipe Vac Draw Draw Draw Alarm Vac Wipe Flush Wipe Alarm Glove Label Docum. sendObservation 3 (3/13/08) (Syringe draw) Enter Set up Wipe Flush Waste Draw Wipe Draw Trans. Fill Fill Fill label Seal Docum. Seal Glove ExitObservation 4 (3/17/08) (Vacutainer draw from a port)) Labels Supplies Enter Set up Purell Alarm Disc. Tubalcohol Un- Cap BD Wipe Vac Draw Draw Draw Draw Vac Wipe Flush Discard labelObservation 5 (3/27/08) RP7 (5:40 am) Supplies Labels Glove Enter Med Set up Wipe Flush Alarm Vac Draw Draw Draw Vac Wipe Flush Prob. (untag- line)Discard Glove Alarm LabelObservation 6 (3/27/08) RP7 (5:16 am) Supplies Enter Glove Unwrap Alarm Flush Vac Draw Draw Draw Vac Wipe Flush Rec. TubDiscard label Wash sendObservation 7 (3/27/08) RP7 (4:20 am) Enter Glove Visual Set up Wipe Flush Wipe Vac Draw Draw Draw Wipe Vac Wipe Flush Cap Discard Glove Label Seal WashObservation 8 (3/27/08) RP7 (4:30 am)(MRSA patient) Enter Glove Visual Alarm Wipe Flush Prob.( no blood)Flush Vac Draw Draw Draw Vac Wipe label DiscardObservation 9 (3/27/08) RP7 (5:55 am) Supplies Enter Glove Visual Set up(bed) Alarm Flush Vac Draw Draw Draw Draw Vac Wipe Flush Wipe Flush Glove Docum. Label SealObservation10 (3/27/08) RP6 (4:10 am) PIC Labels Supplies Purell Glove Enter Alarm Set up(bed) Disc. TubUnwrap Wipe Flush Draw Wipe Discard Draw Trans. Fill Fill Discard Wipe FlushObservation11 (3/27/08) RP6 (4:19 am) Portacath Labels Supplies Glove Enter Alarm Set up clamp Disc. TubWipe Flush Draw Wipe Vac Fill Fill Fill Fill clamp Vac Wipe Flush

Observation12(3/27/08) RP6 (4:19 am) PIC Labels Supplies Label Docum. Gown Glove Enter Set up (TOWEL ON BED)Alarm Wipe Flush Draw Wipe Draw Needle Wipe Draw Needle Wipe Flush Discard

Observation 13 (3/27/08) RP6 5:14 (PORT) Labels Supplies Unwrap Docum. Wash Enter Set up(bed) Glove Wipe Flush Vac Fill Fill Fill Fill Fill Fill Vac Wipe Flush DiscardObservation 14 (3/27/08) RP6 Picc line Labels Supplies Enter Unwrap Set up(bed) Wipe Flush Discard Wipe Draw Trans. Fill Fill Discard Wipe Draw Trans. Fill Fill Fill DiscardObservation 15 (3/27/08) RP6 PICC (5:36) Labels Supplies Wash Unwrap Gown Glove Enter Alarm Wipe Flush Draw Draw Wipe Alarm Discard Syr Fill Fill Fill Syr FillObservation 16 (4/9/)8) MICU (A-Line?) Enter Gown Purell Glove SuppliesProb. Glove (off)Gown (off)Wash Exit SuppliesEnter Set up(podium) Purell Gown Glove Stock Explain Alarm Un- Cap StopcockObservation 17 RN (4/9/)8) MICU (A-Line?) Gown Enter Glove SuppliesAlarm Set up(bed) StopcockUn- Cap Vac Fill Fill Fill Fill Fill Syr Flush with green tube)Vac Cap Discard label GownObservation 18 (4/9/)8) MICU (A-Line?) Supplies Un- Cap Wipe Syr Fill Fill Wipe pump Discard Syr recap

Observation 19 (4/17/08) ABG draw A-line Order Label Purell Glove SuppliesExplain Alarm Line Set up(bed) (ABG &4x4)Un- Cap Draw wasteDraw ABGWaste (gauze)Flush Cap Flush Discard Purell Spec/gloveLabels Label SealObservation 20 (4/17/08) Blood draw CBC Purell Labels SuppliesGlove Alarm Line Set up(bed) 4x4)AssembleVacUn- Cap Cap/gauzeVac Draw wasteFill (purple)Flush with green tube)Discard label Discard Wash Spec/gloveProb. Tries to sendObservation 21 (4/17/08) Blood draw Glove Supplies Set up(bed) 4x4)Un- Cap Vac Draw wasteFill red tubeAlarm ABG syrCap ABGFlush Discard Vac Glove Spec/glovePurell Labels Label Seal send SealObservation 22 (4/17/08) Blood draw Central line Comp. Purell SuppliesAssembl VacAlarm Glove StopcockUn- Cap Cap/ infusion pumpVac Draw wasteFill (tiger top)Vac Flush Discard stop in vacCap stopcockAlarm Discard Glove Purell LabelsObservation 23 Blood draw 1:55 Pm Set up Flush Vac Fill Fill Flush Un-GownSuppliesWipe Draw Fill Flush Wipe Syr Fill Discard Observation 24 Blood Draw from culture 4/3/09 RP3 Enter Wash SuppliesWipe Unwrap Draw Trans. Wipe bottleFill Wipe bottle 2Fill Wipe Vac Fill Wipe Unwrap flushWipe Flush Wipe Syr Wipe

Observation 25 3 Supplies Gown Glove Wipe Flush Wipe SuppliesGown Glove Wipe Vac Fill Syr Wipe Flush Discard bed TPA


Observation 26 MICU4/8/08 Labels Supplies Gown Glove Set up Explain SuppliesAlarm Line StopcockUn- Cap Assemble vacVac Fill Fill Fill Stopcockvac Gauze on portSqueezeCap

Observation 27 MICU Lab draw, 4/17/08 Glove Gown Enter

Prob.(look for pen) Alarm Glove

Supplies

Set up (bed)

Unwrap Visual Vac

Waste (tube) Fill Fill Fill

Discard (vacutainer) Syr Flush Cap

Discard (sharps)

Discard (red)

Observation 28 MICU, ABG/VBG draw, 4/17/08 Glove Gown Enter

Prob.(look for pen) Flush Visual Alarm Flush

Waste (10 cc.) Draw StopcockCap Flush

Alarm (restart)

Discard (sharps)

Discard (red)

Discard (white) UN-Glove

De-Gown Wash Label

Observation 29 MICU , ABG draw, 4/17/08 Order Gown Glove EnterSupplies

Set up (bed) Visual

Stopcock Syr Waste

Cap (hold)

Syr (remove)

Prob. (cap on pump)

Syr. (in stopcock) Draw

Prob. (dirty cap on syringe Unwrap 4x4Flush

Cap (back on) Flush

Discard (sharps)

Observation 30 RP7 , Type & Screen, 4/16/08 Wash Supplies Glove

Set up (bed)

Unwrap

Remove air Wipe Vac Fill Fill

Vac (remove) Wipe Flush Clamp Alarm

Discard (sharps)

Discard (red)

Discard (white)

Label (pink, supply cart)

Label (pt., at desk) Docum.

Observation 31 MICU observed Blood Draw (CVP) 4/30/08

Prob. (look for labels) Glove

Supplies

Stopcock

Set up room (Move iv pole -

assemble vac

Stopcock

Cap (remove) Vac Fill Fill

Stopcock Flush Cap Flush

Stopcock

Observation 32 MICU observed , Blood Draw 4/28/08 Purell Glove

Supplies

Prob. (look for ABG) UN-Glove

Supplies (Omnicell ABG) Purell Glove Alarm

Set up (bed) Cap

Syr (3 cc)

Prob. (diff. draw blood)

Prob. (manipulate wrist)

Syr (ABG) Draw

Unwrap 4x4 Flush Waste Cap

Clear air from ABG

Observation 33 MICU R, ABG Blood Draw 4/30/08 Order Label Purell

Prob. (wait for label) Purell Glove Alarm BD

Set up (bed) Cap

Unwrap 4x4

Syr (3 cc) Waste

Syr (ABG)

Cap (hold)

4x4 (hold) Waste Cap

Clear air from ABG

Discard (sharps)

Discard (red)

UN-Glove

Observation 34 MICU , Blood Draw 4/29/08 Purell GloveSupplies

Unwrap 4x4

Unwrap 4x4 Cap Waste Fill Fill Fill

Prob. (manipulate wrist)

Cleared line at pressure tubing

Cleared line at pressure tubing

Discard (sharps)

Discard (red)

UN-Glove Purell Label Seal send

Observation 35 RP3 SuppliesSet up (table) Wipe Vac Waste Fill Fill Fill

Vac (remove) Wipe Flush Clamp label BD Seal send Docum.

Observation 36 observed by RP3 Enter Explain Alarm Wash Glove Set up room (Move iv pole - move chair)Supplies (wipes in room)Unwrap

Remove air Wipe UN-Cap Flush

UN-Clamp Vac

Fill (waste)

Supplies (student )

Set up (bed) Fill Fill Vac Flush

Observation 37 observed by (4/24/)8) Purell Wipe Clamp Attach Flush unclampFlush

Fill (waste)

Discard (sharps) Explain

Assemble Vac Fill Fill Fill BD Wipe Flush Clamp Docum. Wipe Disconnect tubingExplain


Observation 38 observed 4/24/08 Supplies Wash Glove Set up room (Move iv pole - move chair)Wipe Flush

Fill (waste)

Discard (sharps) clamp Fill

Discard (sharps) Flush Reconnect tubingDocum. Cap Explain label Seal Prob- no tubes sec calling for tubes

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

Strategic Marketing: Winning the Battle for Markets and ShareSubmitted by Megan Harkey

On Thursday, December 16, 2010 Texas Health Harris Methodist Fort Worth Hospital hosted the Strategic Marketing: Winning the Battle for Markets and Share educational event for the North Texas ACHE chapter. The event was organized by Ms. Maria Murray, and was attended by 55 members of the organization.

The panel for the event was comprised of Robert Early, President and CEO, John Peter Smith Hospital; Winjie Tang Miao, President, Texas Health Harris Hospital Azle; and Tim Hanners, Senior Vice President, Corporate & Community Affairs, Cooks Children’s Medical Center. Moderated by Dr. David Klein, M.D., COO, Baylor All Saints Medical Centers and Administrator Baylor Medical Center Southwest Fort Worth, the panelists discussed the importance of a comprehensive marketing strategy, with each panelist sharing specific initiatives used in their respective organizations.

The panelists emphasized the importance of knowing your customer and designing appropriate strategies for the right market. Additionally, the panelists agreed that the message should be delivered using an effective form of media for the customer. In particular, all panelists discussed the use of electronic media and social networking, and the impact that has had on their marketing strategies.

For more information on future events, please visit us at northtexas.ache.org or send us an email at [email protected].

Laura Irvine and Jay Kleinman

Maria Murray and Lisa Cox

Sustaining a Financially VibrantHealthcare OrganizationSubmitted by Melissa Reichardt

On Thursday, November 18th, 2010, Methodist Mansfield Medical Center hosted the Sustaining a Financially Vibrant Healthcare Organization educational event. This event boasted a notable panel including Jay S. Herron, Senior Vice President and Chief Financial Officer, at CHRISTUS Health, David Nosacka, Vice President and Division Chief Financial Officer, at LHP Hospital Group, Norma Zeringue, Senior Vice President, Strategy and Revenue Cycle Management, at Conifer Health Solutions, moderated by the gracious host Laura Irvine, FACHE, President, Methodist Mansfield Medical Center.

Thirty-five ACHE members attended the event and participated in the discussion highlighting strategic methodologies for breaking even on Medicare, balancing between revenue growth and expense reduction, identifying and executing on key metrics and ways to prepare for highly anticipated Accountable Care Organizations. The audience followed up the panelist discussion with several questions focusing on electronic medical records and HCAHPS participation.

In addition to Methodist Mansfield Medical Center providing a beautiful location, their five star dinner allowed members to enjoy fine dining over and above the robust discussion. ACHE of North Texas wants to acknowledge Laura Irvine for hosting the event and send a special thank you to the members that attended.


EVENT ENCORE

General Membership Meeting

Doug Hawthorne and Ron AndersonMike Turner, Jeff Guest and Justin Stokes

On Thursday, November 4th, 2010, the General Membership Meeting was held at the Palomar Hotel in Dallas. Over 100 guests attended the event to participate in the 2010 ACHE Member Recognition and Awards, the Student Council Case Study Competition Awards, the Chapter Performance Updates, the CEO Roundtable Discussion and lastly, vote on the 2011 Chapter Officers and Recommended New Board Members.

The CEO Roundtable discussion featured Dr. Ron J. Anderson, President and CEO, of Parkland Health & Hospital System, and Mr. Douglas D. Hawthorne, FACHE, CEO, of Texas Health Resources. The dynamic discussion centered around two themes including general healthcare specifics such as healthcare reform and implementation of electronic medical records, in addition

to a more personal perspective on obtaining your first job and individual growth and development. Examples of this expert advice included Dr. Anderson’s approach to living a “value laden life” and Mr. Hawthorne’s strong believe that healthcare is a “relationship business”.

ACHE of North Texas would like to extend our appreciation to those that came in support of the event, as well as the members that were recognized and honored, the participating panelists Dr. Anderson and Mr. Hawthorne, and the newly appointed 2011 chapter officers and board members.

For more information on future events, please visit us at ww.northtexas.ache.org or send us an email at [email protected].

Dan Thomas, Lynne Meers, Belva Lowryand Huiling Zhang

Children’s Hospital Team Takes Prize for Student CompetitionThe Children’s Hospital Team received the top honor for the 2010 Student Completion. This annual competition allows area graduate students an opportunity to compete by submitting case studies on current healthcare trends and issues.

Carlie Gotlieb led the team, and was joined by Farhana Abdullah and Nicholas Taylor. Their executive coach was Michael Mayo.

The Children’s Team competed against four other groups working on case studies on a broad range of topics that included; physician recruitment/retainment and access to pediatric psychiatry care in a rural setting, public health initiatives, and controlling adherence to medication regiment specifically in the jail population.

A three person panel of Board members including Brad Simmons, Eric Evans, and Bethany Williams judged the entries based on specific criteria.

In addition to the plaque that was award at the General Membership Meeting, the winning team also received a $3,000 cash award. Carlie Gotlieb and Matt Van Leeuwe


EVENT ENCORE

Member Recognition and AwardsACHE Recognition Program celebrated the North Texas chapter’s commitment to the healthcare management profession during the November 2010 General Membership meeting. Recognition is bestowed at three levels based on a range of specific volunteer activities that demonstrate leadership and contributions to furthering excellence” Exemplary, Distinguished and Service. Congratulations to each winner for their outstanding service and support of our chapter and the healthcare management profession.

Paula Zalucki received the top honor of Exemplary Service. Elizabeth McGrady, Janet Henderson, Scott Schmidly and John Self each received Service Awards.

Paula Zalucki, FACHE receives theExemplary Service Award

Gail Maxwell, FACHE receives the Service Award Janet D. Henderson, FACHE accepts theService Award

Scott Schmidly, FACHE is presented with theService Award

Brad Simmons, FACHE is presented theService Award by Eric Evans

John G. Self accepts the Service Awardfrom Brad 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.

April 29th, FridayBOG Exam PrepTime: 8:00am-5:00pmLocation: THIC, 3001 Skyway Circle N., Suite 100, Irving, 75038

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.

February 9th, WednesdayCEO BreakfastTime: 7:30-9:00am Location: Children’s Medical Center DallasHost: Chris Durovich, CEO/President, Children’s Dallas

March 17th, ThursdayCat I: #29 Green Hospitals and Healthcare Time: 7:30-9:00amLocation:Speakers:

April 7th, ThursdayAfter Hours Networking EventTime: 5:30-7:00pmLocation: Jasper’s | PlanoHost: Mike Williams, CEO, Community Hospital Corp

April 13th, WednesdayCEO BreakfastTime: 7:30-9:00amLocation: Host:

April 21st, ThursdayCat I: #40 Medical Tourism: The Globalization of HealthcareTime: 7:30-9:00am Location:Speakers:

April 28th, ThursdayWomen’s BreakfastTime: 7.30 – 9.00amLocation:Speakers:

the executive connection of north texas: spring 2011

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