Hawaii - Pacific Chapter of ACHE

Spring 2014

Message from your ACHE Regent, Spring 2014

Coral T. Andrews, FACHE

March has just past and spring is in the air. March signified the beginning of a new ACHE “year” as the Congress on Healthcare Leadership commenced, typically over spring break.

 

Spring is In the Air

March has just past and spring is in the air. March signified the beginning of a new ACHE “year” as the Congress on Healthcare Leadership commenced, typically over spring break. (I do, however, remember 2012 when the event dates coincided with the week of St. Patrick’s Day. The entire city of Chicago embodied spring: Green everywhere…green rivers, green clothing, green hair, etc. You get the picture.)

Healthcare is complex, dynamic and filled with opportunity. The dynamics of “change” can be subtle, as with spring, and at other times it may feel like turbulent and very visible change.

The following quote from Mark Twain resonated with me when contemplating and reflecting on the Springs of Health Care:
“In the spring, I have counted 136 different kinds of weather inside of 24 hours."

How many of you have felt that just when you get things figured out in healthcare, something changes? A new season arrives? Is there truly ever a time when healthcare doesn’t change?

In order to be prepared to weather the changes and remain relevant, healthcare executives need to keep up with their industry. You do this through a number of ways: employment, ongoing education, networking, etc. All the while, striving for mastery of your skills.

Attending the 2014 Congress on Healthcare Leadership was a perfect way to begin the spring. Chicago was buzzing with the happenings as the ACA continues phases of implementation while accommodating new flexibility in the existing law. What’s next? What leadership role will you play in readying your organization? How are you preparing the human capital assets to lead in the wake of reform? These are just a few examples of what constitutes “Congress Chatter.”

Apply for a Tuition Waiver

To reduce the barriers to ACHE educational programming for ACHE members experiencing economic hardship, ACHE has established the Tuition Waiver Assistance Program.

ACHE makes available a limited number of tuition waivers to ACHE Members and Fellows whose organizations lack the resources to fund their tuition for education programs. Members and Fellows in career transition are also encouraged to apply. Tuition waivers are based on financial need and are available for the following ACHE education programs:

  • Congress on Healthcare Leadership
  • Cluster Seminars
  • Self-Study Programs
  • Online Education Programs
  • Online Tutorial (Board of Governors Exam preparation)
  • ACHE Board of Governors Exam Review Course

All requests are due no less than eight weeks before the program date, except for ACHE self-study courses; see quarterly application deadlines on the FAQ page of the tuition waiver application. Information can be found on ache.org/TuitionWaiver.

The Chapter has many wonderful events planned this year which seek to engage members from Hawaii and Guam. Thank you for your continued support.

As I close, I encourage you to embrace the spring. While this signals the coming of a new season in healthcare (filled with knowns and unknowns) where the “weather” may change 24 times a day, there will always be a summer that follows.

Message from the Chapter President

Darlena Chadwick, BSN, MSN, FACHE

Aloha Everyone,

We have some very exciting things happening in our chapter and I want to mention a few. We had the very successful meeting with Ian Lazarus speaking on total quality management and six-sigma, he is an outstanding speaker and we had great attendance.

 

Aloha Everyone,

We have some very exciting things happening in our chapter and I want to mention a few. We had the very successful meeting with Ian Lazarus speaking on total quality management and six-sigma, he is an outstanding speaker and we had great attendance.

Additionally we have opened a dialog with the University of Hawaii, Shidler School of Business, for co-developing a MBA in Healthcare Management degree/concentration to satisfy the unique market needs of our community. Coral Andrews, FACHE; Martha Smith, FACHE; and LTC Tanya Peacock, FACHE are leading this project. They have shown incredible leadership and vision and are helping build community interest in the program. 

We had our ACHE chapter social and FACHE discussion which was a great session that offered members an opportunity to learn and ask questions about the road to fellowship. I want to thank LCDR Robert Rawleigh, FACHE, and his committee for the exceptional job lining up educational sessions for the chapter. Our goal continues to be to bring relevant educational opportunities here in Hawaii that satisfies face-to-face credit requirements. We also want to thank all of our great sponsors for making this possible. 

We have a need for volunteers for several committees—newsletter, sponsorship, and education. This is an excellent time to get involved in our chapter.  We want your voice heard so please come share your innovative ideas! We have two members leaving Hawaii this summer and they will be greatly missed. Thank you to LCDR Rawleigh and LTC Tanya Peacock for all the dedication and commitment they have provided to our chapter.

We are very proud of our outstanding newsletter. We hope you are enjoying it and we welcome ideas for articles and feedback from you. This quarter's articles are focused on healthcare challenges faced in Hawaii. Thanks to all of you for your continuing support and participation. Please take advantage of our educational offerings and don’t hesitate to let us know how we can be of service to you.

Respectfully,

Darlena Chadwick, BSN, MSN, FACHE

 

 

Guam Local Program Council

Lieutenant Joseph M. Fromknecht, Medical Service Corps, United States Navy, President, Guam Local Program Council

An election was held in January to select the Guam Local Program Council (LPC) leadership for 2014. Please welcome the new leadership.

An election was held in January to select the Guam Local Program Council (LPC) leadership for 2014. Please welcome the following leaders:

  • Chair: LT Joe Fromknecht, USN, Department Head, Staff Ed & Training, U.S. Naval Hospital Guam
  • Chair-Elect: John Ray Taitano II, MBA, Special Projects Coordinator, Guam Economic Development Authority
  • Treasurer: Fabrienne C. Reyes, Clinic Manager, Guam Surgical Group, Tamuning, Guam
  • Secretary: LTJG Matthew C. Gallagher, USN, Assistant Department Head, Human Resources, U.S. Naval Hospital Guam

A very special THANK YOU to all of the outgoing leadership for their service during the past year; particularly LCDR Daren Verhulst, USN, FACHE for his service as the Guam Local Program Chair; Chuck Tanner, as the Chair-elect; Serena Darity as the Treasurer and Maryann Cabrera for her service as Secretary.


Last week the new leadership hosted a highly successful, informative, and enjoyable social and networking event.  The event was held at Meskla on the Cove in downtown Tamuning on March 21, 2014. The social event was well attended by 15 guests with various levels of professional experience in healthcare related organizations. This provided a rich environment for networking, exchanging of thoughts, and the introduction of the 2014 leadership team. 

Social and networking event, Tamuning, Guam

Joe Fromknecht, the newly elected ACHE Guam-Pacific Chapter President, introduced the new leadership team and gave a short speech on the importance of collaboration amongst local healthcare administrators. Members were asked to provide input on future events such as lunch-and-learns and leadership development programs. 

We look forward to a very exciting year ahead!!

Recent Chapter Events

Lieutenant Colonel Hugh McLean Jr., FACHE; Lieutenant Colonel Tanya Peacock, FACHE; Gidget Ruscetta, and Micah Ewing

The Hawaii-Pacific Chapter of ACHE hosted an event for 1.5 qualified education credits on February 6, 2014. Mr. Ian Lazarus, managing partner at Creative Healthcare (CHC) in San Diego, provided an interactive session regarding “Lean, Six Sigma and Culture Change: Ingredients for Success in the New Era of Reform” at the Queens Conference Center, Honolulu, HI. 

 

The Hawaii-Pacific Chapter of ACHE hosted an event for 1.5 qualified education credits on February 6, 2014. Mr. Ian Lazarus, managing partner at Creative Healthcare (CHC) in San Diego, provided an interactive session regarding “Lean, Six Sigma and Culture Change: Ingredients for Success in the New Era of Reform” at the Queens Conference Center, Honolulu, HI. 

  
Lean Six Sigma training with Mr. Ian Lazarus:  From Left to Right - Robert Rawleigh, 
Ian Lazarus, and Coral Andrews at the Queen's Conference Center

 

A Hawaii-Pacific chapter social event took place on Thursday, March 13 from 5:30-7:00 p.m. at the Queens Conference Center. We had a great dialogue on pointers for preparing and taking the BOG Exam. Thanks to the many members who recently passed the exam for sharing thier experiences and tips. As you can see from the picture, we had a great turnout. Please look for the link in a follow up correspondence that will include study questions, contact information and additional tips, as we promised. Also, feel free to contact any board member for further assistance!


 
Board of Governors Exam Social Event Attendees


Future events


Another local ACHE event will be held in conjunction with the HFMA conference, consisting of a panel discussion about physician-hospital integration in the 21st century. Approved for 1.5 face-to-face education credits, this event take place on April 21, 3:00-4:30 p.m. at the Ala Moana hotel. Panelists include Dr. Whitney Limm of the Queen’s Medical Center; Mr. Money Atwal, CFO/CIO HHSC East Hawaii Region; Dr. Gerard Livaudais, HPH Executive Director Hawaii Health Partners and a panelist from Castle Medical Center.


An ACHE Hawaii Program will take place September 15-18, 2014 at the Hyatt Regency Waikiki Beach Resort & Spa. More detailed information will follow in subsequent newsletters.

 

Regent Awards presented to Martha B. Smith, FACHE, CEO

Martha B. Smith, FACHE, CEO Kapiolani Medical Center receives Healthcare Executive Award 

Martha B. Smith, FACHE, CEO Kapiolani Medical Center, Honolulu, HI received the American College of Healthcare Executives Senior-Level Healthcare Executive Regent’s Award yesterday.

Ms. Smith served as the 2013 Chapter President where she provided superior leadership support to the Chapter and value to its members. She is board certified in healthcare management as a Fellow of the American College of Healthcare Executives, demonstrating commitment to professional excellence. 

The Senior-Level Healthcare Executive Regent’s Award recognizes ACHE members who are experienced in the field and have made significant contributions to the advancement of healthcare management excellence and the achievement of ACHE’s goals. Members are evaluated on leadership ability; innovative and creative management; executive capability in developing their own organization and promoting its growth and stature in the community; contributions to the development of others in the healthcare profession; leadership in local, state, or provincial hospital and health association activities; participation in civic/community activities and projects; participation in ACHE activities; and interest in assisting ACHE in achieving its objectives.

The award was bestowed on Ms. Smith by Ms. Coral T. Andrews, FACHE, ACHE’s Regent for Hawaii-Pacific, which includes members from Hawaii and Guam.

 
Coral Andrews, FACHE (Left) presents to Martha Smith, CEO- KMCWC (Right)

 

 

 

 

News from the Education Committee

Commander Robert Rawleigh, FACHE, Medical Service Corps, United States Navy

Chapter education/networking opportunities are off to a very strong start in 2014.

Chapter education/networking opportunities are off to a very strong start in 2014.  On February 6, 2014 34 ACHE and non-ACHE members gathered at the Queen’s Conference Center (QCC) located on The Queen’s Medical Center campus to hear from Mr. Ian Lazarus, FACHE (Principal Creative Healthcare Solutions) regarding “Lean, Six Sigma and Culture Change: Ingredients for Success in the New Era of Reform.” Mr. Lazarus conducted a dynamic, well enjoyed 1.5 ACHE Qualified Education program that discussed the principles of Lean Six Sigma. In addition to providing these fundamentals, Ian helped solidify concepts with illustrations from his firm’s consulting engagements that dramatically enhanced his clients’ healthcare operations and the patient and staff environment.  Thank you, Ian. Thank you as well Queen’s and the QCC staff for hosting the event.  Mahalo!

As mentioned during the Winter Newsletter, your input from chapter surveys clearly spoke of the desire for FACHE advancement assistance.  Thank you VERY MUCH for your input… we heard you and took action to meet your needs. The chapter hosted a social and networking event (again, thank you QCC) on Thursday, March 13 at 5:30 – 7 p.m. The event provided an opportunity for colleagues to network, discuss what’s happening in the local healthcare industry, engage other members who recently passed the ACHE Board of Governors (BOG) exam and received the FACHE credential, and, of course, enjoy delicious pupus. The cornerstones of ACHE are networking and educational opportunities so this social was an excellent venue to meet local healthcare executives and colleagues as well as gain insight into what others have done to pass the rigorous BOG exam and obtain the status as a Fellow in ACHE.  More to follow during the next Newsletter regarding this event.

Mark your calendars as other credit earning events are on the horizon:

April 21 - 22: Hawaii Chapter Healthcare Financial Management Association (HFMA) Annual Conference at the Ala Moana Hotel. 
Earn 1.5 ACHE Face-to-Face Education credits during the chapter’s panel discussion on “Physician-Hospital Integration in the 21st Century.” ACHE members are welcome to attend the Monday, April 21 panel discussion at 3:00 – 4:30 p.m. at no charge.  Earn additional ACHE Qualified Education credits if you register for the two-day program and pay the requisite conference fees.

September 15-16 and 17-18: ACHE Hawaii Program.
Earn ACHE Face-to-Face Education credits during the two, separate clusters. Contact ACHE for details and registration requirements.

Finally, please feel free to submit applications for the Chapter Education Assistance Program (CEAP) to earn financial assistance for educational opportunities in support of passing the BOG exam and earning the FACHE credential.

Thank you,

Commander Robert Rawleigh, Medical Service Corps, U.S. Navy (FACHE)

Chair, Education Committee

Hawaii-Pacific Chapter of ACHE partners with the Shidler College of Business

Lieutenant Colonel Tanya Peacock, FACHE, Medical Service Corps, United States Army
According to the official policy position of the American College of Healthcare Executives (2013), “a graduate degree is a minimum requirement for entry to executive healthcare management.” Graduate degrees in healthcare administration are of varying quality.

According to the official policy position of the American College of Healthcare Executives (2013), “a graduate degree is a minimum requirement for entry to executive healthcare management.” Graduate degrees in healthcare administration are of varying quality. Unfortunately, some programs do not adequately prepare students for future challenges. To assist students and future healthcare leaders, ACHE has developed the Higher Education Network, which is a tool that students may use to identify programs which are regionally accredited and offer an identifiable degree in Healthcare management. http://www.ache.org/faculty_students/higher_education.cfm

To date, the universities within the state of Hawaii do not offer a graduate-level education program accredited by the Commission on Accreditation of Healthcare Management Education (CAHME). There is demand for executive healthcare education in Hawaii, as evidenced by the 125 member organizations of the Healthcare Association of Hawaii.

To meet the needs of healthcare executives within the state, the Hawaii-Pacific Chapter of ACHE has partnered with the Shidler College of Business, University of Hawaii at Manoa, to offer a Distance Learning Executive MBA in Health Care Management Program beginning in August of 2014.

The Shidler College of Business was selected as a partner for a number of reasons. Many physician and nurse leaders, as well as future healthcare administrators, are already pursuing a Master's of Business Administration through the Shidler College of Business. The College is regionally accredited by the Western Association of Schools and Colleges (WASC) and is fully accredited by the Association to Advance Collegiate Schools of Business (AACSB). In addition, the Shidler College of Business is highly ranked among the nation’s international business programs by U.S. News and World Report.  

Efforts to initiate a conversation with the Shidler College of Business began in November 2013. Based on guidance received by Martha Smith, Chapter President, and Darlena Chadwick, incoming Chapter President, preliminary research was done and an initial meeting was organized for February 2014. The Regent, Coral Andrews, FACHE, was instrumental in facilitating the discussion and leveraging resources between the American College of Healthcare Executives at the national-level and the University of Hawaii. The initial meeting, attended by the Dean of the Shidler College of Business, Professor V. Vance Roley; the Associate Dean for Academic Affairs, Professor John E. Butler, the Assistant Dean for Student Services; Robin Hadwick; and the Director of Custom Executive Programs, Alice Li Hagan, set the conditions for establishing a partnership between the Hawaii-Pacific Chapter of ACHE and the Shidler College of Business.

Working together, the Distance Learning Executive MBA in Health Care Management Program was established. A rigorous and relevant curriculum for the five Health Care Management Program electives was developed using the ACHE Competencies Assessment Tool: https://www.ache.org/pdf/nonsecure/careers/competencies_booklet.pdf

The faculty members at the Shidler College of Business have a wealth of experience in the area of Healthcare management. Professor Dana Alden was selected to serve as the initial Faculty Director for the program. A distinguished professor of Marketing, Professor Alden's research interests include Health Care Marketing services theory and application. He has received a $60,000 Grant from the Keck Foundation (2011) to pursue a project in Patient-Physician Decision-Making and has taught extensively at the executive level at the Hawaii’ Pacific Health Program, UH CBA; Taipei Physician Social Marketing Course, Johns Hopkins/UH CBA; Social Marketing, Hanoi School of Public Health; and the Johns Hopkins/UH Winter Institute, APCED.

 
Alice Li Hagan,  Director of Custom  Executive Programs (Left)
  Professor Dana L. Alden, Faculty Director, DLEMBA Program,
Health Care Management (Right)

 

The Shidler College of Business is interested in developing an Advisory Board to serve as a mechanism for community outreach. The Advisory Board would consist of 15-20 Hawaii-Pacific ACHE chapter members and would ideally be comprised of the various types of healthcare organizations (such as  hospital systems, community health organizations, Department of Defense, and Veterans Affairs) and constituents (such as administrators, physician leaders, nurse leaders, etc.) on Oahu, the Neighbor Islands and Guam. If you are interested in serving as part of the advisory board or if you are interested in hosting an information session for your organization please contact the Hawaii-Pacific Regent, Coral Andrews at andrewsc@hawaii.rr.com.

The establishment of this program required extensive coordination and, in particular, we would like to acknowledge the efforts of Professor Kiyohiko Ito, Management Professor, Shidler College of Business; Professor John E. Butler, Assistant Dean for Student Services; Professor Lee W. Bewley, FACHE, Program Director, Army-Baylor Program in Health and Business Administration; Professor Peter Hilsenrath, Chair of Healthcare Management and Economics at the University of the Pacific; Professor Errol L. Biggs, FACHE, Director of Programs, Health Administration, University of Colorado Denver; Mark Stevenson, FACHE, Regent-at-Large, Region V; Desmond Ryan, FACHE, Associate Director, Regional Services, ACHE; and Gerard J. Berish, Director of Regional services for ACHE, for their contributions to the establishment of the program.

 

Shidler College of Business launches Distance Learning Executive MBA Health Care Management Program

Alice Li Hagan, Director, Custom Executive programs, Shidler College of Business

 Learn about the Distance Learning Executive MBA in Health Care Management Program.

To address the complex business challenges of a rapidly changing healthcare system, the University of Hawai'i at Manoa (UH) Shidler College of Business, in consultation with the Hawaii-Pacific Chapter of the American College of Healthcare Executives (ACHE), is launching the Distance Learning Executive MBA Health Care Management Program. The program is enrolling students who aspire to transform individual institutions and influence how the industry functions.

The Distance Learning Executive MBA Health Care Management Program includes Shidler’s unique integrated core curriculum with an in-depth study of the healthcare sector. The twenty-two month program will begin in August 2014 with an intensive five-day residential session consisting of day and evening classes.  The program is delivered as a hybrid format consisting of online and in-person sessions.  This learning approach allows participants to continue working and developing practical expertise with the flexibility of distance learning technology.

Information sessions for the new program offering will be held during April and May. The application deadline is June 1, 2014. Detailed information may be found at http://www.shidler.hawaii.edu/distance-emba/healthcare.

The University of Hawaii at Manoa Shidler College of Business

As the flagship campus of the University of Hawai'i System, the University of Hawai'i at Manoa (UH) celebrated its centennial anniversary in 2007.  Classified as a Carnegie Doctoral/Research University-Extensive institution, the UH offers professional degrees in law, medicine, and architecture.  As one of the most diverse campuses, UH’s special distinction is in its Asia-Pacific orientation enhanced by our strategic location and multicultural heritage, which creates opportunities for international leadership and influence. 

The UH Shidler College of Business was established in 1949 as the College of Business Administration and was renamed in 2006 following a $25 million gift from alumnus Jay H. Shidler.  U.S. News & World Report’s 2014 edition of “America’s Best Colleges” ranked Shidler’s undergraduate program 14th in the International Business specialty area.  As the only AACSB accredited MBA program in Hawaii, the Shidler College of Business equips its graduates with the ability to learn and to lead throughout their professional career.

Contact Information:

Alice Li Hagan
Director, Custom Executive Programs
Executive Education Center
Shidler College of Business
808.956.8870
aliceli@hawaii.edu

Spring 2014 Calendar of Events

Micah Ewing

The Spring 2014 Calendar of Events for ACHE, Hawaii Chapter.

 

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EVENTS THIS QUARTER

2014 Congress on Health Care Leadership

March 24-27, 2014

Healthcare Financial Management Association (HFMA) – Hawai‘i Chapter Annual Conference

April 21-22, 2014, 8AM

Ala Moana Hotel

HFMA Annual Conference Panel Discussion:  “Physician-Hospital Integration in the 21st Century”

April 21, 2014, 3-4PM

Ala Moana Hotel

 

 

 

 

 

 

FUTURE EVENTS:

 

Health care Association of Hawai‘i (HAH) Chapter Breakfast – Hawai‘i Prince, Haleakala/Kilauea Room

August 21, 7-9AM

ACHE Hawai’i Cluster, Hyatt Regency, Honolulu, HI

Sept 15-18, 2014

Spring 2014 Education Calendar

Spring 2014 Education Calendar of Events.  Get your FACHE credits!

EVENTS THIS QUARTER:

 

Link to HI Legislature Bills pertaining to HealthCare:

StateTrack HealthCare Bills

 

Kiawah Island Cluster

4/7 – 4/8

Online Seminar: Physician Alignment: Dos and Taboos

 

4/2 – 5/14

Webinar:

Managing Clinical Crises

 

 

4/15

Online Seminar:

Strategic Planning that Works

 

4/23 – 6/4

Special Program:

Board of Governors Exam Review Course

 

4/28 – 4/30

Online Seminar: Digital Revolution:  How Health IT Can Improve Access...

 

5/14 – 6/25

New Orleans Cluster

5/19

Seattle Cluster

6/23

Washington D.C. Cluster

8/11-12

 

 

 

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Spring 2014 Financial Report

Gidget DG Ruscetta

What a great start to 2014!!

What a great start to 2014!! The Hawaii Pacific Chapter has a current balance of $46,230.34. We are well positioned to continue to fund events for our members throughout 2014.  

Gidget

 

Membership: New Fellows, Members, and Recertified Fellows

Art Gladstone, FACHE

The Hawai'i-Pacific Chapter would like to recognize and congratulate all new Fellows, recertified Fellows, and new members. 

The Hawaii-Pacific Chapter would like to recognize and congratulate our recertified Fellows:

December

CDR Thomas W. Halliwell, FACHE, Honolulu

January

Steve Robertson, FACHE, Honolulu

February

BG Dennis D. Doyle, FACHE, Honolulu

Kenneth D. Graham, FACHE, Palo Alto

March

MAJ Dan M. Wood, FACHE, Honolulu 

 

Congratulations to the following member who recently passed the Board of Governors Exam:

February

Laura B. Bonilla, Honolulu

 

A warm welcome to our new chapter members:

January

2LT Justin R. Lumen, Pearl City 

Natalie Pagoria, MD, Haleiwa

February

Jonathan Pantenburg, Kahuku

Brandon Wong, Honolulu

March 

CDR Patrick Fitzpatrick, Santa Rita

Col N.T. Greenlee, Honolulu

Kathleen K. Morimoto, Honolulu

Amata M. Taifane, Honolulu 

 


 

 

National News - Spring 2014

2014 Fund for Innovation in Healthcare Leadership Education Programs

The 2014 innovations program, “Healthcare Innovation: Taking Action, Improving Care and Reducing Costs 2.0,” will focus on key initiatives introduced by the Center for Medicare and Medicaid Innovation (the Innovation Center). The program will highlight three organizations that are working with the Innovation Center and organization representatives will describe their experiences in implementing projects to develop better healthcare in communities with the highest care needs. This special program will be offered Aug. 11, 2014, in conjunction with the Washington, D.C., Cluster. Full details will be available soon at
ache.org/Innovation.

The 2014 ethics program, “Ethical Leadership in Uncertain Times,” will be led by Jack Gilbert, EdD, FACHE, on Oct. 28, 2014, in conjunction with ACHE’s Salt Lake City Cluster. The half-day session will feature Gilbert’s remarks on ethical leadership in the era of reform and a panel of healthcare executives who will explore effective, intentional and practical ways for healthcare leaders to strengthen their organization’s focus on doing the right thing. For those already attending the Salt Lake City cluster, continue your professional growth with this important session. Or, just participate in the morning workshop and leave with a renewed sense of commitment. Full details will be available soon at
ache.org/Innovation.

Both programs qualify for ACHE Face-to-Face Education credits.

The Fund for Innovation in Healthcare Leadership, a philanthropic initiative of the Foundation of the American College of Healthcare Executives, was created to bring innovation to the forefront of healthcare leadership. The Fund works to inspire and develop future leaders, promote diversity and inclusion among healthcare leaders, explore emerging complex ethical issues and encourage innovations in healthcare management.


ACHE Senior Executive Program

The Senior Executive Program prepares senior healthcare leaders for complex environments and new challenges. Past participants have been senior directors, vice presidents, COOs, CNOs and CFOs—many of whom aspire to be a CEO and believe the Senior Executive Program has assisted them in achieving that goal. It consists of three sessions, each two-and-a-half days in length. Locations and dates are as follows: Chicago (June 2–4), San Diego (Aug. 18–20) and Orlando, Fla. (Oct. 13–15).

Participants grow professionally in a supportive learning environment over the three sessions. The Senior Executive Program includes relevant topics such as reducing medical error, improving board relationships, increasing personal influence, financial management in the era of payment reform, confronting disruptive behavior and influencing public policy.

Enrollment is limited to 30 healthcare executives. For those individuals whose organization lacks the resources to fully fund their tuition, a limited number of partial scholarships underwritten by Toshiba American Medical Systems, Inc. are available. For more information, contact Darrin Townsend, program specialist, at (312) 424-9362 or visit
ache.org/SeniorExecutive.


ACHE Executive Program

The ACHE Executive Program is designed to help healthcare middle managers refine their knowledge, competencies and leadership skills. Participants will have the opportunity to learn, share and grow professionally together over the three multi-day sessions. The program will cover relevant topics such as improving patient safety and clinical quality, physician integration strategies, appraising personal leadership, managing disruptive behavior, talent development, understanding hospital governance, conflict management and measuring financial success.

The Executive Program, a three-part series of sessions, will be held at the following locations and dates: Chicago (June 2–3), San Diego (Aug. 18–20) and Orlando, Fla. (Oct. 13–15). Participants will attend all three sessions.

Enrollment is limited to 30 healthcare executives. For those individuals whose organization lacks the resources to fully fund their tuition, a limited number of full scholarships underwritten by Toshiba American Medical Systems, Inc. are available. For more information, contact Darrin Townsend, program specialist, at (312) 424-9362 or visit
ache.org/Executive.


Physician Executives and Healthcare Consultants Forums


ACHE’s Physician Executives Forum and Healthcare Consultants Forum enhance value to physician executive and healthcare consultant members through a package of benefits tailored to their unique professional development needs.

The Physician Executives Forum offers education, networking and relevant information that address the top issues physician executives face such as leading quality initiatives and enhancing interdisciplinary communication skills. Benefits include a special designation on ACHE’s online Member Directory, e-newsletter and an exclusive LinkedIn Group. Physician executive members with an MD or DO credential are encouraged to visit
ache.org/PEForum to learn more about the Forum’s benefits and to join.

The Healthcare Consultants Forum can help healthcare consultants stay ahead of the curve and more effectively meet client needs through targeted resources designed with their needs in mind. Benefits include a special designation on ACHE’s online Member Directory, e-newsletter and an exclusive LinkedIn Group. More information is available on
ache.org/HCForum, where interested consultant members can join.

The cost of membership in either the Physician Executives or Healthcare Consultants Forum is $100 annually in addition to ACHE annual dues.


ACHE is pleased to offer once again the Board of Governors Exam fee waiver promotion to ACHE Members who apply for the FACHE® credential between March 1 and June 30, 2014. Eligible Members must submit their completed Fellow application and $250 application fee during the promotion period. Pending application approval, ACHE will waive the $200 Board of Governors Exam fee. All follow-up materials (i.e., references) must be submitted by Aug. 31, 2014, to receive the waiver.

For more information on the promotion, go to
ache.org/FACHE


ACHE Call for Nominations for the 2015 Slate

ACHE's 2014–2015 Nominating Committee is calling for applications for service beginning in 2015. All members 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 vacancies within their district. Open positions on the slate include:

  • Nominating Committee Member, District 2 (two-year term ending in 2017)
  • Nominating Committee Member, District 3 (two-year term ending in 2017)
  • Nominating Committee Member, District 6 (two-year term ending in 2017)
  • 4 Governors (three-year terms ending in 2018)
  • Chairman-Elect


Please refer to the following district designations for the open positions:

  • District 2: District of Columbia, Florida, Georgia, Maryland, North Carolina, Puerto Rico, South Carolina, Virginia, West Virginia.
  • District 3: Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin.
  • District 6: Uniformed Services/Veterans Affairs.


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 the Nominating Committee should only submit a letter of self-nomination and a copy of their resume.

Applications to serve and self-nominations must be submitted electronically to 
jnolan@ache.org
  and must be received by July 15, 2014. All correspondence should be addressed to Gayle L. Capozzalo, FACHE, chairman, Nominating Committee, c/o Julie Nolan, American College of Healthcare Executives, 1 N. Franklin St., Ste. 1700, Chicago, IL 60606-3529.

Following the July 15 submission deadline, the committee will meet to determine which candidates for Chairman-Elect and Governor will be interviewed. All candidates will be notified in writing of the committee's decision by Sept. 30, 2014, and candidates for Chairman-Elect and Governor will be interviewed in person on Oct. 30, 2014.

To review the Candidate Guidelines, visit
ache.org/CandidateGuidelines. If you have any questions, please contact Julie Nolan at (312) 424-9367 or
jnolan@ache.org.


Tuition Waiver Assistance Program

To reduce the barriers to ACHE educational programming for ACHE members experiencing economic hardship, ACHE has established the Tuition Waiver Assistance Program.

ACHE makes available a limited number of tuition waivers to ACHE Members and Fellows whose organizations lack the resources to fund their tuition for education programs. Members and Fellows in career transition are also encouraged to apply. Tuition waivers are based on financial need and are available for the following ACHE education programs:

  • Congress on Healthcare Leadership
  • Cluster Seminars
  • Self-Study Programs
  • Online Education Programs
  • Online Tutorial (Board of Governors Exam preparation)
  • ACHE Board of Governors Exam Review Course

All requests are due no less than eight weeks before the program date, except for ACHE self-study courses; see quarterly application deadlines on the FAQ page of the tuition waiver application. Incomplete applications and applications received after the deadline will not be considered. Recipients will be notified of the waiver review panel's decision not less than six weeks before the program date. For ACHE self-study courses, applicants will be notified three weeks after the quarterly application deadline.

If you have questions about the program, please contact Teri Somrak, associate director, Division of Professional Development, at (312) 424-9354 or
tsomrak@ache.org. For more information, visit ache.org/Tuitionwaiver.

ACHE’s 2014 Premier Corporate Partners


ACHE would like to recognize our 2014 Premier Corporate Partners, whose year-round support helps ACHE further its mission and adds value to our membership. Our Premier Corporate Partners demonstrate commitment to ACHE and its members. We are proud to recognize the following 2014 ACHE Premier Corporate Partners:

 

 

Got Measles?

Richard G Giardina, RN, MPH, CIC, Quality and Infection Control Coordinator- KMCWC

Got Measles? What to do when a measles exposure occurs at your facility!

Measles is a highly contagious, acute viral illness that can lead to complications and death. Although measles elimination was declared in the United States in 20001, importation of measles cases from outside the United States continues to occur. In fact, Hawai‘i has measles in its history involving past royalty. In 1824, King Kamehameha II and Queen Kamamalu traveled to London seeking an audience with King George IV. The entire royal party developed measles within weeks of arrival, 7 to 10 days after visiting the Royal Military Asylum housing hundreds of soldiers' children. Within the month the king and queen succumbed to measles complications2.

Measles elimination has been maintained in the United States since it was declared in 2000. However, an estimated 20 million cases of measles occur each year worldwide, and cases continue to be imported into the United States. The increase in measles cases in the United States in 2013 serves as a reminder that imported measles cases can result in large outbreaks, particularly if introduced into areas with pockets of unvaccinated persons3.

The intent of this article is to: 1. describe the background work performed by the facility’s Infection Preventionist (IP) during a measles exposure and, 2. inform leadership how they can support operations to prevent further cases.

First, your facility must have a process for outbreak investigation according to the 2014 Joint Commission Hospital Accreditation Standards, IC.02.01.01, EP 5  and CMS Condition of Participation: Infection Control §482.424.  According to the Association for Professionals in Infection Control and Epidemiology (APIC), the primary components of the initial investigation include the following5

  1. Confirming the presence of an outbreak
  2. Alerting key partners about the investigation
  3. Performing a literature review
  4. Establishing a preliminary case definition
  5. Developing a methodology for case finding
  6. Preparing an initial line list and epidemic curve
  7. Observing and reviewing potentially implicated patient care activities
  8. Considering whether environmental sampling should be performed
  9. Implementing initial control measures

These steps are in sequential order with the most important being confirming the presence of the outbreak. For convention’s sake, an outbreak can be defined as

an increase over the expected occurrence of an event.  Given that measles is a rare event geographically in Hawai‘i, one case can be considered an outbreak.

Confirming the presence of an outbreak

The initial step in the investigation is to confirm that what is being reported indeed represents an increase in the outcome. Nothing should be done until you have scientific evidence, in this case, presence of signs and symptoms of measles and supporting lab tests. Only a physician can diagnose measles, and consulting a pediatrician or infectious disease physician is extremely important for an accurate decision. Your IP and Chair of Infection Control will work together and confirm the diagnosis.

Alerting key partners about the investigation

At the outset of an outbreak investigation, it is critical to inform key partners of the situation. Facility administration should be notified so that resources can be made available and so that risk management and public affairs staff can prepare to assist. In regard to measles, alerting public affairs this early can help communicate news to patients and families, staff, and the reporters. Measles is rare and exciting to put in the news so be sure to watch your local news each night for facts and rumors.

Daily huddles with key stakeholders are essential for clear, effective communication and follow-up of action items. Minimally they should include the infectious disease physician in charge of the outbreak, the IP for your facility, hospital administrators (both inpatient and outpatient), emergency department leadership, laboratory, employee health, public affairs, bed control, security, information technology, supply chain management and risk management. The State Department of Health Epidemiologist must be made aware of your plan for investigation and follow-up.  They are responsible for contacting any patient in the public sector; vis-à-vis, not in your hospital at the present time or difficult to reach by phone.

Performing a literature review

There are many reports summarizing outbreak investigations published in the literature, and hence a literature review is a critical early step in any investigation. The literature review will help identify possible sources that might merit further investigation and might also provide important insight into optimal investigative methodology. Another excellent resource for reviewing previous investigations is the Outbreak Worldwide Database (available at http://www.outbreak-database.com). This free database contains summaries of published outbreak reports, including information on the source of the outbreak and control measures implemented to terminate the outbreak.

Establishing a Preliminary Case Definition

The initial case definition should be narrow enough to focus investigative efforts but broad enough to capture the majority of cases. In outbreaks of infectious diseases, the decision on how broad to make the case definition is often driven by the pathogen.  In this case, measles may have a broader definition (meaning, just rash and fever) to cast a wide net over suspect cases, with confirmatory testing to follow. This allows for prompt isolation of suspect cases. The physician in charge of the investigation must make this definition.

Developing a Methodology for Case Finding

A variety of sources can be used to find additional cases that might be related to the outbreak. If the case definition includes a laboratory result, laboratory records are a logical place to start and can facilitate rapid identification of possible cases. With measles, the case finding is biphasic: first signs and symptoms are assessed by a physician followed by confirmatory testing performed by the hospital lab and the State Department of Health Disease Investigation Branch. In Hawai‘i, the State Epidemiologist will unleash his/her field team and they collect specimens to be sent to the State Lab.

Preparing an initial line list and epidemic curve

The line list is, arguably, the single most important tool in any outbreak investigation and hence merits considerable early discussion and effort. In general, information that can be helpful on a line list can include details on patient signs or symptoms, or if the patient’s family and primary care physician is aware. This is a living document from the beginning of the investigation through the reporting to your facility’s Infection Control Committee. The IP for your facility is the point person for case documentation and communication to the leadership team and to the Health Department. With measles, hopefully the epidemic curve stops at the index case.

Observing and reviewing potentially implicated patient care activities

In most outbreak investigations, it is the observations of practices that ultimately identify the cause.  With measles, this step is important if your facility experiences any secondary cases or failure to recognize and isolate suspect cases. The IP should check all new admissions daily for suspect cases and also round with the Emergency Department staff to ensure early recognition and containment processes are actually working versus solely on paper. Leadership must plan for modification of patient placement if your system is challenged by an influx of the worried well. This issue should be discussed early on and a threshold established.

Considering whether environmental sampling should be performed

Sampling the environment for measles is not indicated. Your facility’s Engineering Department can provide a list of negative pressure rooms and air balancing readings.  Before a patient with known or suspected measles is admitted to a negative pressure room, the Engineering Department must check the airflow to determine negative pressure in respect to the hallway or adjacent areas.

Implementing initial control measures

It is important to remember that the ultimate goal of any outbreak investigation is to prevent secondary cases. Thus, it is not only acceptable, but important, to implement a variety of infection prevention measures throughout the course of the investigation. These control measures might be driven by findings from the line list and observations. Measles is very contagious, with a 90% secondary attack rate. The incubation period begins as early as 8 days after exposure, which, given the amount of time it takes to confirm the index case, is a race against time to identify exposed and susceptible patients6.

This is where the rubber meets the road. Your IP and physician in charge of the outbreak are your key players. At this point as hospital administrators and leadership, you must realize all other routine duties required by your IP will be placed on hold. In my 25 years of experience in infection prevention, I can estimate the time interval for measles follow-up to be about 14 calendar days. Additional resources should be considered.

Below is an action list I compiled from our recent exposure in February 2014. Use this as a guide and understand that some points may not be applicable to your facility.

Got Measles?  What to do when a measles exposure occurs at your facility.

  1. Verify the diagnosis.  Immediately call the Chair of the Infection Control Committee and discuss the case.
  2. Locate the patient. If the patient is in the hospital, ensure that he/she is in a negative pressure room on airborne precautions.
  3. Notify the Department of Health.
  4. Determine when the patient developed the rashThe rash is the timestamp for calculating incubation periods.
  5. Contact hospital executive leadership and present known data.
  6. Identify key stake holders and hold an emergency meeting to discuss plan.
  7. Determine a time and place to meet minimally once a day to review interventions and facts.
  8. Compile a list of all exposed patients for each area the patient traveled while in your facility. If you have an EMR then contact the IT Department for assistance.
  9. Contact employee health and request MMR or immune status of staff working in exposed areas.
  10. Contact primary care physicians of exposed patients and determine measles immune status. If non-immune suggest social distancing and provide name and number for the Department of Health for additional information.
  11. Craft three statements describing exposure and risk: one for PCPs, one for families, and one for staff. Public Affairs is expert at this function.
  12. Identify method to alert PCPs and families. Consider the time interval for the incubation period. Identify any patients exposed who have been admitted each day. Document measles exposure in their record and be mindful that they will need to be placed in negative pressure rooms on airborne precautions during the incubation period. Consider a plan for multiple patients being admitted with known or suspected measles.
  13. Compile an alphabetical list of exposed and susceptible patients for any area that admits patients (ex. Emergency, clinics, admitting, bed control, pre-surgical clinics). Require that each admitted patient be checked against this list. Any patient considered exposed and susceptible must be placed in a negative pressure room on airborne precautions immediately.
  14. Plan for an MMR vaccine clinic at your facility if patients need to get vaccine.  Work with the Health Department; they may assume this role early on.
  15. If a hospital MMR vaccine clinic is in your plan, ensure that the pharmacy has enough vaccine on site.  Make every attempt to conduct the clinic outside your facility such as a parking lot or adjacent building that is not being used. Consider vaccine storage requirements and needle disposal containers for syringes.
  16. The IP for your facility should round each day in areas where patients may be admitted (ED, clinics, etc.) to ensure staff can identify suspected measles and place in isolation promptly.

Costs of a Measles Outbreak

In addition to requiring a lot of work, containing a measles outbreak is expensive. A study reviewing the impact of 16 outbreaks in the United States in 2011 concluded that "investigating and responding to measles outbreaks imposes a significant economic burden on local and state health institutions7. Such impact is compounded by the duration of the outbreak and the number of potentially susceptible contacts."

For example, it cost:

  • $130,000 to contain a 2011 measles outbreak in Utah
  • $24,569 to contain a 2010 measles outbreak in Kentucky
  • $800,000 to contain a measles outbreak at two hospitals in Arizona
  • $176,980 to contain a 2008 measles outbreak in California
  • $167,685 to contain a 2005 measles outbreak in Indiana - unvaccinated 17-year-old catches measles on church mission trip to Romania, leading to 34 people getting sick, including an unvaccinated hospital worker who was on a ventilator for 6 days
  • $181,679 (state and local health department costs) to contain a 2004 measles outbreak in Iowa triggered by a unvaccinated college student's trip to India

The 2013 Texas outbreak cost $50,758.93 to contain. With 16 cases of measles in that outbreak, that comes to about $3,100 for each case of measles. And while that may seem like a bargain when you look at some of the other outbreaks, that was only for the direct public health costs to the county health department, including staff hours, the value of volunteer hours, and 240 syringes.

Additional costs that come with a measles outbreak can also include direct medical charges to care for sick and exposed people, direct and indirect costs for quarantined families, and outbreak–response costs to schools and hospitals, etc.

We should also consider what happens when our state and local health departments have to divert so much time and resources to deal with these types of vaccine-preventable diseases instead of other public health matters in the community.

There were 220 cases of measles in the United States in 2011. To contain just 107 of those cases in 16 outbreaks, "the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars."

In contrast, the MMR vaccine only costs about $567.


References

1.  Katz SL, Hinman AR. Summary and conclusions: measles elimination meeting, 16–17 March 2000. J Infect Dis 2004:189(Suppl 1):S43–7.

2.  Shulman ST, Shulman DL, Sims RH. The tragic 1824 journey of the Hawaiian king and queen to London: history of measles in Hawaii. Pediatr Infect Dis J. 2009 Aug;28(8):728-33. doi: 10.1097/INF.0b013e31819c9720.

3.  Gregory Wallace, MD, Susan Redd, Jennifer Rota, Paul Rota, PhD, William Bellini, PhD, Div of Viral Diseases, National Center for Immunization and Respiratory Diseases; Emmaculate Lebo, MBBS, EIS Officer, CDC. Morbidity and Mortality Weekly Report. September 13, 2013 / 62(36);741-743

4.  2014 Joint Commission Hospital Accreditation Standards. Accessed  March 18, 2014.

5.  APIC Text Online.www.apic.org. Accessed March 14, 2014.

6. 
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf. Accessed  March 14, 2014.

7.  Ortega-Sanchez, Ismael R.The economic burden of sixteen measles outbreaks on United States public health departments in 2011. Vaccine, Available online 14 October 2013

 

 

 

 

 

 

 

Hospitals and healthcare organizations throughout Hawai‘i and the rest of the nation are feeling the effects of a normal saline (NS) shortage.

by William "Bill" Richter, RN; Authorized for reprint by Toby Clairmont, RN, CHEP, Introduction submitted by Jen Dacumos, PharmD, MBA

 Keeping you the Healthcare Reader Informaed: CURRENT STATUS REGARDING NORMAL SALINE SHORTAGE

Hospitals and healthcare organizations throughout Hawai‘i and the rest of the nation are feeling the effects of a normal saline (NS) shortage.  The manufacturers state increased demand as the cause of the shortage.  The shortage of NS has also caused the other IV fluids to become in short supply, including Lactated Ringer’s (LR) and Dextrose 5% (D5W).  The three main manufacturers of NS (Baxter, B Braun and Hospira) have their supply on allocation and supply is estimated to return to normal levels sometime in April.  Hospitals and healthcare organizations are encouraged to adopt aggressive conservation efforts outlined in the attached Healthcare Association of Hawai‘i (HAH) memo.

CURRENT STATUS REGARDING NORMAL SALINE SHORTAGE

Hospitals and healthcare organizations across the nation are experiencing shortages of 0.9% normal saline says a February 11, 2014, press release from the American Society of Health-System Pharmacists. The findings show that "more than 75 percent of the U.S. hospitals and other health care settings" are being affected. In addition, other products, including those used to conserve stocks of normal saline, are increasingly becoming scarce. Hawaii’s healthcare organizations are feeling the effects of this nationwide shortage as well.

HAH Emergency Services is monitoring the situation and is actively engaged in trying to work with local distributors and mainland manufacturers to secure additional supplies of normal saline. However, despite this effort, we believe that it will be unlikely that additional supplies can be obtained in the near future. Therefore, we are suggesting aggressive conservation efforts by all organizations that routinely use normal saline.

Below is a list of some of the actions your organization can take to conserve the current supplies of normal saline:

  1. Locate all remaining product in centralized and access controlled location (pharmacy)
  2. Review current IV orders and convert TKO or maintenance rate IV to Saline locks and PO where possible
  3. Review current order sets for "routine" IV starts, maintenance rates, and all other orders where IVs started per "routine" or "protocol"
  4. Switch IV solutions to D5W when possible
  5. Utilize Lactated Ringers or D5/0.45% NS solutions as a substitute for NS and D5W whenever feasible.
  6. Discontinue continuous IV fluid orders when clinically feasible and utilize oral hydration.
  7. Nursing staff should be encouraged to:
    • Not spike fluids until needed.
    • If fluids are spiked and not used, make an effort to use them elsewhere instead of discarding.
    • Utilize 10 mL saline flush rather than liter bags to prime IV lines.
    • Evaluate the need for keep vein open (KVO) fluids.
    • Not change IV bags until entire contents of fluids used.
    • Limit amount of IV fluids placed in warmers to avoid waste of unused bags.

The American Society of Health System Pharmacists also recommends the following strategies:

  • Consider using oral hydration whenever possible.
  • Consider using commercial dialysis solutions whenever possible instead of compounding with normal saline.
  • Use smaller bag sizes for low rate infusions when possible. See the table below for suggestions. Use smaller bags and low flow rates as sodium chloride 0.9% is often used to keep an intravenous line open.
  • Switch products to match availability. Consider using alternative fluids such as dextrose containing solutions or lower concentrations of sodium chloride that may be available (0.45%).

Suggested Bag Sizes for Specific Rates of Infusion:
 

Infusion Rate

Bag Size

20 mL / hour or less

250 mL

21 mL/hour to 40 mL/hour

500

Military Health System (MHS) Governance Reform and the Establishment of the Enhanced Multi-Service Market (eMSM) Hawaii

Art Wallace, FACHE, Special Assistant for Asia-Pacific Affairs, Navy Medicine West
During the past 66 years, there have been 18 commissions or studies commissioned by either Congress or the Department of Defense (DoD) that have evaluated the Military Healthcare System (MHS). 

During the past 66 years, there have been 18 commissions or studies commissioned by either Congress or the Department of Defense (DoD) that have evaluated the Military Healthcare System (MHS).   In 1948, the Committee on Medical and Hospital Services of the Armed Forces appointed a panel to standardize preventive medicine practices and procedures across all the Service Components.  Fast forward to the second decade of the 21st century, MHS reform is now being mobilized to control and reduce the growth of a military health budget that has skyrocketed from $19 billion (FY01, 5.9% of DoD budget) to $51 billion (FY13, 10% of DoD budget).  Based on DoD estimates, it is on track to reach $77 billion by FY22 without significant and aggressive MHS optimization and reform initiatives.  On 11 March 2013, the Deputy Secretary of Defense published a DoD Memorandum implementing MHS Governance Reform with far reaching consequences and expectations, along with regular progress updates to Congress.  It reflects the final recommendations of an internal DoD task force appointed in 2011 that identified future MHS terminal objectives that included cost containment, greater integration across the Services, and increased shared services and unity of effort.

In 2009, the MHS adapted a civilian model and created the Quadruple Aim as a strategic performance measurement framework.  In addition to better care, better health, and reduced costs, the military health system added “increased readiness” as the fourth aim. More recently, articles in the influential Journals Health Affairs (Feb 2013) and Harvard Business Review (Oct 2013) have promoted integrated health systems and standardized, evidence-based clinical approaches to improve outcomes and reduce costs. 

The foundation of MHS Governance Reform lies in the establishment of a Defense Health Agency (DHA), transitioned from the former TRICARE Management Activity (TMA).  The DHA will also be designated as a Combat Support Agency with oversight and linkage with the Chairman, Joint Chiefs of Staff.  The DHA will also assume responsibility for shared services, functions, and activities in the MHS, including (but not limited to) the TRICARE Health Plan, pharmacy programs, medical education and training, medical research and development, health information technology, facility planning, public health, medical logistics, acquisition, budget and resource management, and other common business and clinical processes.  The first uniformed DHA is LtGen Chuck Robb, MC, USAF who assumed his position on 1 Oct 2013. 

The other two governance reforms mentioned in the DoD Memo include: 

  • the establishment of enhanced multi-service markets (eMSMs) which usually include overlapping catchment areas and appointment of a Market Manager to establish and sustain a cost-effective, coordinated, high quality health care system that will focus on recapturing private sector costs and maximize enrollment at the military treatment facility.
  • the establishment of the National Capital Region (NCR) Medical Directorate as a subordinate organization of the DHA and successor to the Joint Task Force national Capital Region Medical (JTF CAPMED).

Presently, there are six identified eMSMs (NCR, San Antonio, Tidewater, Colorado Springs, Puget Sound, and Hawaii) that account for approximately 30% of MHS direct care workload and 22% of all private sector costs.   Recent DHA guidance has also included two “dominant” single Service Market MTF catchment areas (Womack/Ft Bragg, NC and Naval Medical Center, San Diego, CA) for further expansion under a single eMSM model.  Each Service MTF in the eMSM catchment area will ultimately incorporate the eMSM Lead Service Market Manager’s “enhanced authorities” that will include:

  1. a market approach to population health;
  2. a joint, synchronized 5-year business performance plan to improve efficiencies, reduce cost, and recapture private sector care;
  3. allocate market funding via a single financial management process;
  4. direct the movement of workload and workforce – as needed -- among the medical treatment facilities
  5. disseminate and integrate best clinical and business practices.

Each eMSM will eventually operate under an eMSM Charter and CONOPS signed by the principal Federal Stakeholders (MTF Commanders) on the Joint Executive Council (JEC).  At present, the DHA expectation is that the designated eMSMs will have fully implemented five-year market business performance plans and eMSM offices to support the plan in place by 1 October 2014 (full operating capability).

Due to its remote island location, presence of a DoD/VA Joint Venture GME regional referral medical center, and geographic proximity of the Service MTFs, the eMSM Hawaii has an enrolled population of approximately 165,000 beneficiaries which translates into an impressive 82-86% capture rate.  The Army eMSM Market Manager leads the Hawaii JEC which includes the MTF Commanders from Naval Health Clinic Headquarters and the 15th Medical Group; DCCS, Tripler Army Medical Center; and Director, VA Pacific Islands Health System.  Another influential non-voting JEC member is the Hawaii Director of the United Healthcare and Veterans managed care support contractor team.  This important partner has been a mainstay during similar leadership roles with HealthNet/Foundation and TriWest, along with being an excellent source of historical issues and proven solutions from the past.

A major challenge facing the eMSM Hawaii is the small contingent of dedicated staff focused on supporting the Market Manager and DHA suspenses and taskers to support the development of the five-year market business plan.  The current eMSM staffing plan identifies a core staff of 10-15 staff.  The Hawaii eMSM currently has four fulltime staff while awaiting recruitment staffing for two additional staff.   Temporary military staff have been provided on 3-6 month support stints but the focus is on recruiting specific business, clinical, and analytical skill sets that will monitor the DHA Market Metrics and Dashboard, and ensure compliance with the performance plan measures.   In the interim, the eMSM has established over eight market Working Groups (WGs) with MTF staff from each facility to leverage skill sets, data collection, and analysis.  And to monitor compliance with clinical initiatives and business processes projected to recapture workload and improve ambulatory and inpatient efficiencies.

At the DHA levels, the evolution and introduction of “core and driver measures” that support the Quadruple Aim are developed, discussed, and reviewed by a growing array of senior uniformed, civilian, and contractor working groups like the Medical Operations Group (MOG), Medical Deputies Action Group (MDAG), Medical Business Operations Group (MBOG), Analytics Group, and Senior Military Medical Action Council (SMMAC).  The former “bridge” to the eMSM was the eMSM Leadership Council which is now transforming to a new eMSM Senior Leader WG.  As one can see, the need to have visibility of the operational definitions and scope of work for each group are a growing concern since there is obvious potential for conflicting guidance or impediments with timely staff guidance/feedback to the eMSM staff who face deadlines for MDAG briefs, Performance Plan Briefs, data submissions, etc.

Working closely with DHA Strategy Management; Chairperson, DHA Analytics Group; and other DHA and Service leaders, the eMSM Hawaii has developed a preliminary eMSM Hawaii Strategy Map that links the Quadruple Aim’s goals with Army, Navy, and Air Force Market Unity of Effort objectives and lines of effort.  Its focus is on: 

  1. integration and optimization of patient centered medical homes;
  2. standardization of business processes;
  3. integration and optimization of ancillary and specialty services;
  4. strategic marketing, education, and rebranding of a Single Integrated Health System and what this means to the Line Leaders and beneficiaries.

Even though the eMSM Hawaii market is leading the way with an increasing trend with Per Member Per Month cost savings, it is facing future challenges with “unfolding” deadlines and guidance which will affect the “dynamic” five year market business plan productivity targets, updated business plan templates, and incorporating MGMA (adjusted) baseline standards as goals to exceed (and not just meet).  Additional challenges persist with MTF analysts still expected to work on separate Service and DHA business plans (goal is synchronization and standardization) in the same market and a MHS workload tool that will probably change in the next year or two.  There will be ongoing education of MTF staff on new management strategies that will impact core measures and staffing.  This will include enrollment and workload optimization, improved internal referral management, retail pharmacy recapture, and updated guidance on the enhanced management authorities that, ideally, should be in place by the eMSM Full Operating Capability (FOC) on 1 Oct 2014.

At the MHS Governance Off-Site, it was announced that key measures and targets have been agreed to among the Shared Service Working Groups, along with the further development and refinement of a Production Plan and Business and Financial Plan for the eMSMs that will serve as future planning tools.   The prime objective remains “optimization and utilization” of the eMSM structure to recapture workload (and costs) and to also identify measures that focus on readiness, health, and healthcare efficiency and quality (and patient safety).   A growing influence in the markets will be the “trickle down” from the MHS Modernization Study that will generate indicators and measures of underutilized capacity and underperforming MTFs in each market.  Ultimately, these will be utilized as political, business, and financial pressures force the MHS to forecast the optimal health care infrastructure and delivery model that will evolve in five years.

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