Hawaii - Pacific Chapter of ACHE

Fall 2015 Newsletter

Message from your ACHE Regent, Fall 2015

Jen Chahanovich, FACHE

I wanted to thank all the members that attended the Chapter’s annual breakfast on July 13th.  Christine M. Candio, Immediate Past Chairman of the ACHE was our guest speaker....  Two of our chapter members received the Regent Early Career Healthcare Executive Award.

Aloha – I wanted to thank all the members that attended the Chapter’s annual breakfast on July 13. Christine M. Candio, Immediate Past Chairman of ACHE, was our guest speaker and shared with the group the importance of accepting change in health care – a topic we all can relate to in today’s health care world.

Two of our chapter members received the Regent Early Career Healthcare Executive Award at our annual breakfast. The criteria for the award includes:

  • Demonstration of leadership ability
  • Demonstration of innovation and creative management
  • Executive capability in developing his or her organization and promoting its growth and stature in the community
  • Participation in local, state, or provincial hospital and health association activities
  • Participate in civic/community activities and projects
  • Demonstration of participation in ACHE activities and interest in assisting ACHE in achieving its objective

Both of our awardees exceeded the criteria - congratulations to Major Charlotte Hildebrand, FACHE, and to Micah Ewing for their outstanding commitment supporting and moving the Hawai‘i /Pacific Chapter forward. 

As of January 2015, the ACHE total membership is 46,455 including student associates. Early membership is beneficial to the students and as a chapter we are helping to support the higher education network (HEN) in Hawai‘i. There is only one HEN in Hawai‘i and that is Shidler College of Business at the University of Hawai‘i at Manoa. Gidget and I attended a Saturday session in July to raise awareness and share the benefits of being a member of the ACHE. If you are interested in learning more – please contact me.

As a chapter, we will be finishing out the year with more networking and educational opportunities for our members. I look forward to welcoming new members and congratulating the new Fellows at the upcoming events.

I am available for questions about the chapter or ACHE – please feel free to contact me on my cell or e-mail.

Jen H. Chahanovich, FACHE
Wilcox Memorial Hospital
Office:  808-245-1122
Cell:      808-524-6644

Message from the Chapter President

Gidget Ruscetta, BSN, MBA, FACHE

It’s only September! I must say as your chapter president time has been flying by. There were many exciting activities this last summer.

Aloha Members,
It’s only September! I must say as your chapter president time has been flying by. There were many exciting activities this last summer.
July was a very busy month. Thanks to all chapter members who were able to join our 2015 Chapter breakfast on July 13. I think we can all agree, Chris Candio’s presentation, “Leading Through an Evolving Health Care Landscape,” rang true as we are all faced with accepting change in the world of healthcare. Congratulations to Micah Ewing and Charlotte Hildebrand on their very deserving Regent Early Career Healthcare Executive Awards.
As members of the only HEN in Hawai‘i and the Pacific Region, Jen Chahanovich, Regent, and I had the pleasure of spending time with a group of Healthcare Management Executive MBA students in late July sharing the benefits of joining ACHE and the opportunities to learn, grow and network with health care leaders in Hawai‘i. The group of 9 students were very engaged and committed in advancing their knowledge of healthcare.
Art Gladstone, Incoming President and I hosted a new members breakfast for 10 new members on August 27. It was very successful and rewarding. This was a very engaged group with many questions about ACHE, our local chapter, advancing their knowledge, study groups for the BOG exam, etc. A big mahalo to our board members who joined us and our Regent who joined via VTC from Kaua‘i .
Your board has been busy this year creating new educational opportunities for members. As we move in the last quarter of 2015, we look forward to seeing you at our first Educational Sessions, Diversity Panel and / or our partnership event with our local AONE Chapter.
Updates on our 2015 Chapter initiatives:

  • Growth in Chapter Membership – increase over 6% thru the 3rd quarter
  • Educational Opportunities – increase in offerings of face to face and qualified credits
  • Diversity Initiative – Offering one Diversity Panel in 2015 

We encourage you to get involved and stay involved. Please feel free to contact me or any board member to discuss getting involved, membership, or details regarding an upcoming event. Watch for emails, read your newsletter and follow our website postings for updates on our fall schedule.
Thank you and we look forward to your continued engagement with the Hawai‘i Pacific Chapter- ACHE. As always, please let us know what we can do to make your experience more beneficial, we are here to serve you.


Recent Chapter Events

Micah Ewing
The Hawaii Pacific Chapter of ACHE held the Annual Breakfast on July 17 with special guest speaker, Chris Candio, immediate Past Chairman for ACHE and President and CEO of St. Luke's Hospital in St. Louis, Missouri.  

Hawaii-Pacific Chapter of ACHE Annual Breakfast - July 13, 2015

The Hawaii Pacific Chapter of ACHE held the Annual Breakfast event on July13, 2015 at the Hawai'i Prince Hotel in Waikiki. Of the approximately 53 members and guests present, there were many familiar faces but also a number of new faces to welcome. 

Our special guest speaker at this year's Annual Breakfast was Ms. Christine Candio, President and CEO at St. Luke's Hospital in St. Louis, Missouri. She is also the Immediate Past Chairman for the American College of Healthcare Executives, currently serves on the Board of Governors, and is a 32 year veteran in both acute care and ambulatory settings. 

Christine Candio, President & CEO, St. Luke's Hospital and
Immediate Past Chairman, ACHE

In her presentation entitled, "Leading Through an Evolving Healthcare Landscape: ACHE Update," Christine touched upon her experiences as a leader and the critical aspects that are changing in the health care landscape today. Christine touched upon some important points during her discussion:

  • Health care is a challenging environment today and can be likened to a "burning platform" of unsustainable costs and a "sea of change." This sea of change consists of a more educated consumer needing pricing and outcomes transparency as well incentive-aligned preventive care being a required competency for HCOs. 
  • In this environment, we must maintain integrity, because ultimately that is all we have.
  • Slash and burn of key services was, and is a mistake. She experienced having to bring back the services at increased cost and impact to the community.
  • The bar must be changed from volume to value.  
  • She believes LEAN principles are extremely important to achieve value, and cited an example where her organization changed the average ED visit from 4 hours to 2 hours using these principles. 
  • As leaders, we need to assess our strengths and weaknesses and step back from the minutia--while keeping our minds open for change, looking at the future direction and always knowing which direction is TRUE NORTH.
  • A key strategic initiative of the ACHE is more physician involvement.
  • Another key strategic initiative of the ACHE is developing each individuals career development with each chapter's assistance and using tools like Career Edge. 

Members received 1 unit of qualified educational credit toward their FACHE credentialing goals.   

New Member Breakfast, August 27, 2015

On August 27, 2015, all new chapter members over the past year were invited to a breakfast hosted at First Insurance Center, Suite 1045 by President Elect, Art Gladstone and President, Gidget Ruscetta. It was a great opportunity to network and orient new members to the various opportunities provided by our local chapter.  Approximately 15 new members were acquainted with the variety of educational and credentialing opportunities as well as committee volunteering and networking opportunities. 

Future Events

The Diversity Panel Discussion on October 7 is an example of a free networking and educational event offered to the entire chapter. Please take advantage of this free opportunity to get 1.5 qualified educational credits! At the same venue is our October 7-8 Educational Program, featuring Carson Dye and his program on Practical Leadership Strategies. This is a rare opportunity to earn 12 face to face credits for only $500.00. If you are interested, please contact a board member. Be on the lookout for more opportunities in the future. 

Chapter Awards

Richard Giardina, FACHE

Charlotte Hildebrand and Micah Ewing receive the 2015 Healthcare Executive Regent's Awards. 

Early Career Healthcare Executive Award

At the 2015 Annual ACHE Breakfast on July 13, two Regent's Awards were presented to outstanding Hawai’i Pacific ACHE chapter healthcare executives. The Early Career 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. Potential recipients are evaluated on leadership ability, 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, participation in local, state, or provincial hospital and health association activities, participation in civic/community activities and projects, and the participation in ACHE activities with a strong interest in assisting ACHE in achieving its objectives. The awards were presented by Ms. Jen Chahanovich, FACHE, ACHE Regent for Hawaii-Pacific, to two recipients this year:


Charlotte Hildebrand.  Major Charlotte Hildebrand serves on the chapter board as a Director and has served a variety of key leadership roles that have been pivotal in the development of the Hawai'i Pacific Chapter of ACHE's growth and educational initiatives.  Charlotte now serves as the chair of the Diversity Committee and has been instrumental in developing this our Diversity program.



Jen Chahanovich, CEO and ACHE Regent (left) presents the first Regent
Award to Major Charlotte Hildebrand (right)


Micah Ewing.  The second Regent's Award was presented to Micah Ewing. Micah is the Director of Technical Architecture at Hawai'i Pacific Health and serves as a Director in the Hawai'i Pacific Chapter of ACHE. Micah has been instrumental in the leadership and development of the chapter and demonstrates his commitment and participation by serving as the chair of both the Communications and Newsletter Committees.




Jen Chahanovich, CEO (left) presents Regent's Award to Micah Ewing (center) with
Gidget Ruscetta, Chapter President (right)


News from the Education Committee

MAJ Clint Cobb

Fall 2015 promises to be action-packed in terms of educational opportunities for our members!

The education committee worked tirelessly to coordinate a Level 1 educational event for members requiring this type of credit for Fellow status. The first event of its kind sponsored by the Hawai'i Pacific Chapter and local partners, we hope this becomes an annual opportunity for our members on island. The event is set to take place 7-8 Oct 15. This two-day, on-site location training is worth 12 Face-to-Face credits. The maximum capacity for attendees is 40. Our guest facilitator, Mr. Carson Dye, will present a two-day session titled "Practical Leadership Strategies in an Age of Change." He will speak on the rapid changes occurring in the health care workplace today and provide leaders with practical tools they can use immediately within their organizations. The program will cover strategies for dealing with a changing workforce and provide suggestions on transformational leadership that can enhance quality and outcomes.

We are currently coordinating a co-sponsored event with the American Organization of Nurse Executives (AONE) to take place on 5-6 Nov 15. ACHE members will receive 8-10 Qualified Education Credits for attending this two-day session. The theme for this event is "Leadership in Action". Leadership experts, both locally and from across the nation, will gather to share their thoughts on this important topic. Please see your education committee for more information.

The education committee is looking for energetic members to help with our coordination efforts. If you have a passion for education, event coordination, volunteerism, or simply just want to get involved, please
contact me at


Clint Cobb
Chair, Education Committee
Hawaii Pacific Chapter
American College of Healthcare Executives

Membership: New Fellows, Members, and Recertified Fellows

Nick Hughey, RN, MBA

Our efforts in recruiting and providing educational programs toward credentialing are making a difference. We are continuing to have great membership growth through our third quarter.  

The Membership Committee will be establishing a study group for members preparing for the Boards of Governors Exam. We will host an information kick- off meeting in the near future. Please be on the lookout for information.


I am available to present if you or your organization ever wants information on ACHE and benefits of membership. If individuals are interested, I can certainly make time to follow up and discuss and provide information as well.

Our efforts in recruiting and providing educational programs toward credentialing are making a difference. In the 3rd quarter, our membership growth continues to follow the same trend, with 8 new members, a new Fellow, and 3 recertified Fellows. 


      CAPT Kimberly D. Davis, MD, FACHE, Honolulu




       Michael W. Weimann, Honolulu




        Emiline G. Buhler, Kaneohe 
        LaVerne Jackson, PhD, Honokaa 
        Richard Kishaba, Kaneohe 
        Haywood L. Pittman, Honolulu 
        Pam Roth, Honolulu

        LeAnne M. Lovett-Floom, DNP, Kailua

        Kathleen Higa, Honolulu 
        Charles A. Jones III, JD, Honolulu


         Jennie H. Chahanovich, FACHE, Kapolei


         Charles K. Tanner, FACHE, Barrigada


         LTC Charlotte L. Hildebrand, FACHE, Kailua


Calendar of Events for Fall 2015

Tamara Pappas

The Fall 2015 Calendar of Events for ACHE, Hawaii Chapter.

September 2015 September       
Su  Tu  Th  Sa  09/07/15 (Mon)  Labor Day  Holiday 
      1 2 3 4 5 09/28/2015 (Mon) San Diego Cluster (4 Day)  ACHE Education 
6 7 8 9 10 11 12 09/29/15 (Tue) San Diego Cluster (4 Day)  ACHE Education 
13 14 15 16 17 18 19 09/30/15 (Wed) San Diego Cluster (4 Day)  ACHE Education 
20 21 22 23 24 25 26 10/01/15 (Thurs) San Diego Cluster (4 Day)  ACHE Education 
27 28 29 30         
October 2015 October               
Su  Tu  Th  Sa  10/07/15 (Wed) Diversity & Inclusion Panel 4:30p to 6:30p HST
            1 2 3 10/07/15 (Wed) Seminar by Carson Dye Other
4 5 6 7 8 9 10 10/08/15 (Thur) Seminar by Carson Dye Other
11 12 13 14 15 16 17 10/08/15 (Thur) Hawaii ACHE On Location Chapter Education
18 19 20 21 22 23 24 10/09/15 (Fri) Hawaii ACHE On Location Chapter Education
25 26 27 28 29 30 31 10/12/15 (Mon)  Columbus Day  Holiday 
                     10/19/15 (Mon) Atlanta Cluster (4 Day)  ACHE Education 
10/20/15 (Tue) Atlanta Cluster (4 Day)  ACHE Education 
10/21/15 (Wed) Atlanta Cluster (4 Day)  ACHE Education 
10/22/15 (Wed) Atlanta Cluster (4 Day)  ACHE Education 
10/24/15 (Sat)  United Nations Day  Holiday 
November 2015 November      
Su  Tu  Th  Sa  11/02/15 (Mon) Austin Cluster (4 Day) ACHE Education 
1 2 3 4 5 6 7 11/03/15 (Tue) Austin Cluster (4 Day) ACHE Education 
8 9 10 11 12 13 14 11/04/15 (Wed) Austin Cluster (4 Day) ACHE Education 
15 16 17 18 19 20 21 11/05/15 (Thur) Austin Cluster (4 Day) ACHE Education 
22 23 24 25 26 27 28 11/05/15 (Thur) AONE Education Event ACHE Education 
29 30           11/06/15 (Fri) AONE Education Event ACHE Education 
                     11/11/15 (Wed) Veterans Day Holiday
11/26/15 (Thur) Thanksgiving Holiday
December 2015 December              
Su  Tu  Th  Sa  12/07/15 (Mon) Hanukkah Holiday
    1 2 3 4 5 12/14/15 (Mon) Orlando Cluster (4 Day) ACHE Education
6 7 8 9 10 11 12 12/15/15 (Tue) Orlando Cluster (4 Day) ACHE Education
13 14 15 16 17 18 19 12/16/15 (Wed) Orlando Cluster (4 Day) ACHE Education
20 21 22 23 24 25 26 12/17/15 (Thur) Orlando Cluster (4 Day) ACHE Education
27 28 29 30 31     12/25/15 (Fri) Christmas Holiday

Education Calendar for Fall 2015

Tamara Pappas

Fall 2015 Education Calendar. Take advantage of numerous educational opportunities!


Chapter education events, webinars, and cluster events! Use this calendar to plan out your educational and credentialing opportunities. Cluster events are highlighted in blue and chapter education events in red.  

Click on events for more details.


September 2015
Su  Tu  Th  Sa 
09/07/15 (Mon)  Labor Day  Holiday 
      1 2 3 4 5
09/09 - 10/21 Exceptional Leadership Online Seminar
6 7 8 9 10 11 12
09/16 - 10/28 A Review of Health Law Online Seminar
13 14 15 16 17 18 19
09/23 - 11/04 Physician Alignment and  Online Seminar
20 21 22 23 24 25 26

Engagement: Dos and Taboos
27 28 29 30         
09/28 - 10/1 San Diego Cluster (4 Day)  ACHE Education 
09/30 - 11/11 A Digital Revolution: How Health Online Seminar

IT Can Improve Access, Quality,

Safety and Efficiency

October 2015
Su  Tu  Th  Sa 
10/07 - 11/18 Superior Productivity in Online Seminar
            1 2 3

Healthcare Organizations
4 5 6 7 8 9 10
10/10/15 (Thu)  Physician Executives Forum Special Program
11 12 13 14 15 16 17

18 19 20 21 22 23 24
10/12/15 (Mon)  Columbus Day  Holiday 
25 26 27 28 29 30 31
10/14 - 11/25 Population Health: The Road to Online Seminar


10/15 - 10/16 CEO Circle Forum (2 Day) Special Program

10/19 - 10/21 Executive Program III Special Program

10/19 - 10/21 Senior Executive Program III Special Program

10/19 - 10/22 Atlanta Cluster (4 Day)  ACHE Education 

10/21 - 12/2 Strategic Planning that Works: Online Seminar

Integrating Strategy With


10/24/15 (Sat)  United Nations Day  Holiday 

10/28 - 10/30 Board of Governors Exam Special Program

Review Course

November 2015
Su  Tu  Th  Sa 
11/2 - 11/4 Leadership Development  Special Program
1 2 3 4 5 6 7

8 9 10 11 12 13 14
11/2 - 11/5 Austin Cluster (4 Day) ACHE Education 
15 16 17 18 19 20 21
11/11/15 (Wed) Veterans Day Holiday
22 23 24 25 26 27 28
11/26/15 (Thur) Thanksgiving Holiday
29 30          


December 2015
Su  Tu  Th  Sa 
12/3 - 12/4 COO Seminar (2 Day) Special Program
    1 2 3 4 5
12/07/15 (Mon) Hanukkah Holiday
6 7 8 9 10 11 12
12/14 - 12/17 Orlando Cluster (4 Day) ACHE Education
13 14 15 16 17 18 19
12/25/15 (Fri) Christmas Holiday
20 21 22 23 24 25 26

27 28 29 30 31    


Fall 2015 Financial Report

Selma Yamamoto


We are maintaining strong financial performance as we are ending the third quarter of 2015



We are maintaining strong financial performance as we are ending the third quarter of 2015. The Hawaii Pacific Chapter has a current balance of $52,877.72 and the Guam account has a balance of $374.00 as of 9/15/15.


National News - Fall 2015

Richard Giardina, RN, MPH, CIC, FACHE

The Fall 2015 National News from ACHE.org. 

Join the Rainbow Healthcare Leaders Association
The Rainbow Healthcare Leaders Association is a national organization whose mission to enhance the representation of lesbian, gay, bisexual and transgender healthcare executives and to promote high-quality care for LGBT individuals and their families. RHLA is committed to focusing on disparities in care and preparing the next generation of LGBT healthcare executives. RHLA and ACHE have a shared interest in fostering the development of diverse healthcare leadership.

Join RHLA now and you will have access to the RHLA Mentorship Program and RHLA Forums, both of which will enable you to connect with other members in a meaningful and confidential environment. Members can share and receive feedback on business and personal issues as they navigate their careers in healthcare.

For more information about RHLA membership or any of its programs, visit rhla.org.

Exam Online Community Offers a Complimentary Interactive Learning Platform
Members preparing for the Board of Governors Examination can access the Exam Online Community as a complimentary and supplementary resource that can boost their confidence and help them succeed. The interactive platform gives Members the opportunity to learn and glean study tips from others taking the Exam. It also provides an opportunity to discuss Exam topics with experts for better understanding and the option to participate in study groups. Join the Exam Online Community at bogcommunity.ache.org.

Postgraduate Fellowship Area of ache.org Provides a Vital Resource to Healthcare Organizations and Entrants
Postgraduate fellowships are essential to attract and develop highly qualified healthcare management professionals. ACHE offers robust online resources regarding postgraduate fellowships at ache.org/PostGrad. The materials are for those seeking to develop a postgraduate fellowship, organizations that want to find the best candidate and new healthcare management entrants looking for a fellowship opportunity. The site includes the Directory of Fellowships in Health Services Administration in which organizations post their fellowship offerings and for students to find opportunities they want to pursue. Additionally, there are resources for organizations seeking to start a fellowship—these include sample manuals, templates and checklists.

Save the Date: Physician Executives Forum Programs
The Physician Executives Forum launched two years ago to provide added value to physician executive via tailored resources to meet these groups’ unique professional development needs. A one-day education program is a cornerstone benefit of the Forum that offers an affordable learning and networking opportunity. Date and location for the program is as follows:

Physician Executives Forum Education Program
Oct. 10, 2015
Hyatt Regency Washington on Capitol Hill


More details available at ache.org/PEForum

If you have questions about this Forum program or Forum membership, please contact Erika Joyce, CAE, assistant director, Division of Member Services, at (312) 424-9373 or ejoyce@ache.org.

Tuition Waiver Assistance Program
To reduce the barriers to ACHE educational programming, ACHE makes available a limited number of tuition waivers to Members and Fellows whose organizations lack the resources to fund their tuition for education programs through the Tuition Waiver Assistance Program. Members and Fellows in career transition also are 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.

Take Charge of Your Career
Kenneth R. White, PhD, RN, FACHE, and J. Stephen Lindsey, FACHE, share teaching tips and a sample syllabus and course schedule in their Health Administration Press Book Take Charge of Your Healthcare Management Career: 50 Lessons That Drive Success. In the book, you will find 50 lessons that will help students navigate the bridge to a successful career in healthcare management and help them obtain success and professional development regardless of their position. Each lesson describes traits, behaviors and skills needed to maximize strengths, master career success and achieve the perfect career fit for them. Find an excerpt here. This book will be of particular interest to recent master’s programs graduates and early careerists.

To access the complete September 10, 2015 edition of the ACHEe-news, click View

Articles of Interest

Micah Ewing


Checking In With Employees

Communicating and checking in on employees on a regular basis is important for a successful workflow. One-on-one meetings are a great way to consistently discuss duties, deadlines and questions and to keep in touch. The below will ensure the meetings are productive and necessary communication is shared in an effective manner.

Stick to a Specific Time

Consistency is key to beneficial communication. Connect with the employee regarding the day and time that would work best for both of you to meet on a weekly basis, and create meeting reminders for the discussion that extend far in advance. This ensures you will both be on the same page and that the meeting won’t be easily forgotten. Additionally, don’t cancel a check-in meeting at the last minute. There are exceptions, but sticking to a schedule shows your employee you value their time and creates a pattern that is easy to adhere to.

Create a Safe Space

Although constructive criticism on projects and management of workload is helpful for success, being respectful in delivering this feedback is a must. Employees should not be punished for speaking their mind. Make sure to answer their questions with respect, and try sharing something they’ve excelled in that week while offering suggestions for improvement in other areas. Such a gesture can boost morale and build trust. Creating a trusting environment will strengthen the bond between you and your employee.

Value Honesty


When chatting with an employee, strive to answer his or her questions as honestly as possible. If you can’t share something, explain why. And if you don’t have an answer, admit it and try to find out after the meeting.


Coach Employees


Instead of telling employees what to do, collaborate with them to help them find their own solutions and answers. This will help build their own confidence and their trust in you. Help them develop their skills so they feel empowered and engaged instead of dependent on you for advice.


Ask for Feedback


One-on-one discussions should not solely be a question-and-answer sessions. Engage in a real dialogue and ask employees what they desire from you and how you can help to manage them in a stronger way. They’ll welcome and appreciate the opportunity to give you their thoughts on your performance and other matters.


End on a Positive Note


At the end of each meeting, share at least one way in which the employee excelled that week. Thank the employee for his or her questions and the discussion itself, and express confidence in his or her abilities. Workers will feel better about meeting with you if you close on a high note. 


—Adapted from Communication Solutions May 2015 newsletter, www.communicationbriefings.com




The Failure Modes Effect Analysis Process in Healthcare

Richard Giardina RN, MPH, CIC, FACHE

The FMEA has been used widely in the military and the Aeronautics field for many years. Its recent use in healthcare has been recommended by the Joint Commission.

Failure Mode Effects Analysis (FMEA) was first used by the military in 1949, NASA in the 1970s, and the Automotive Industry Action Group in the 1990s. (1)  The Joint Commission has recommended that health care facilities use the FMEA process to identify risk and develop an action plan for any new process before it is implemented.


FMEA is a structured way to identify and address potential problems, or failures and their resulting effects on the system or process before an adverse event occurs. In comparison, Root Cause Analysis (RCA) is a structured way to address problems after they occur; the FMEA addresses problems before they occur


FMEA is effective in evaluating both new and existing processes and systems. For new processes, it identifies potential bottlenecks or unintended consequences prior to implementation. It is also helpful for evaluating an existing system or process to understand how proposed changes will impact the system. Once you have identified what changes need to be made to the process or system, the steps you follow are those you would use in any type of performance improvement plan.

Below are the steps of the FMEA:
1. Select a process to analyze
2. Charter and select team facilitator and team members
3. Describe the process
4. Identify what could go wrong during each step of the  process
5. Pick which problems to work on eliminating
6. Design and implement changes to reduce or prevent problems
7. Measure the success of process changes


If not careful in selecting the correct process to analyze, an FMEA can be daunting and cost considerable time. Narrow the scope of FMEA as much as possible. For instance, when facilities try to do a project on a complex process such as medication administration the team often finds there are too many variables to take into account. The administration process can vary by unit, by type of medication, by time of day, and so on. It is best to narrow the focus. For instance, do FMEA on administration of a particular type of high-risk medication or a project on medication administration for a category of residents vulnerable to safety problems.

The Institute for Healthcare Improvement (IHI) website contains a template for the FMEA process. (http://www.ihi.org/resources/pages/tools/failuremodesandeffectsanalysistool.aspx  ). Risk factors and likelihood of their occurrence are entered onto a worksheet.  Higher-scored items are given priority for an improvement plan. (2) 

1. https://en.wikipedia.org/wiki/Failure_mode_and_effects_analysis  last accessed 9/14/15.
http://www.ihi.org/resources/pages/tools/failuremodesandeffectsanalysistool.aspx last accessed 9/14/15.

Back to Basics: Emphasizing Progressive Mobility in the Inpatient Setting

Emiline Buhler
Evidence suggests that inpatient mobilization, defined as an individual’s ability to walk, stand, or sit in a chair without assistance during a hospital stay, is an essential part of recovery.

Evidence suggests that inpatient mobilization, defined as an individual’s ability to walk, stand, or sit in a chair without assistance during a hospital stay, is an essential part of recovery. Emphasizing mobility has proven to yield physical, psychological, and social benefits for patients, including: fewer post-operative complications, increased levels of patient autonomy, and decreased anxiety and stress among caregivers (Kalish, Lee, & Dabney, 2014). Despite this, mobilization has been identified in peer-reviewed literature as one of the most frequently missed elements of inpatient nursing care (King, 2012). During an extensive observational study conducted by Kuys, Dolecka, and Guard (2011), patients were documented as “inactive” for more than 75% of their hospital stay.

Best-practice for mobilization, depending on the patient’s condition and baseline activity level, is to ambulate patients (i.e., move from one place to another) at least three times per day with incrementally decreasing levels of assistance (Pashikanti & Von, 2012). Bedrest, the common alternative to consistent ambulation, can have detrimental effects to nearly every body system. Inpatient mobilization is particularly important among the geriatric population. Functional decline (or decrease in patient’s baseline mobility status) can occur as early as the day two of a hospital admission among patients aged 65 and older (Pashikanti & Von, 2012). Among this group, one-third of hospitalized older adults will encounter decreases in activity of daily living (ADL) during their time in the hospital; half of these individuals will never regain that lost function (Liu et al, 2013).

Measuring and improving levels of inpatient mobility, particularly among the geriatric population, is a pretty consistent quality improvement priority among hospitals in developed nations. Large-scale, multi-site studies on inpatient mobilization have been conducted in the United States, Canada, Australia and the United Kingdom (Kneafsey, Clifford, & Greenfield, 2014; Liu et al, 2013; Cattanach et al, 2014). We need to ensure we are replicating these processes at our local facilities. Currently, older adults currently represent 15.6% of the state population, proportionally 2.6% more than the rest of the nation (Hawaiʻi Health Matters, 2013).  Compared to our mainland counterparts, older adults in the state of Hawaiʻi are more likely to live at home because of the limited of skilled-nursing facility resources and because of the regional norm of multi-generational homes.  Accordingly, mobility efforts need to not only focus on patients’ in-house ambulation, on but educating their caregivers on post-discharge physical activity expectations as well.


There is an abundance of evidence-based literature available that shows that ambulation is a cost-effective way to improve patient outcomes regardless of their age, diagnosis, or level-of-care (Kalish, Lee, & Dabney, 2014).  There are qualitative studies to assess: how nurses decide to whether to mobilize a patient, how often patients expect to move during hospitalization, and what motivates providers or family members to take responsibility for mobilizing patients (Doherty-King & Bowers, 2011, Cattanach et al, 2015, Doherty-King & Bowers, 2013).  Despite this, there are several remaining gaps in the literature around the inpatient mobilization process. Most notably, there are very few studies that examine the sustainability of these interventions at the individual, interpersonal, and organizational levels.   


To address this gap, we should seek to understand who currently responsibility for mobilization and challenge providers to consider how ambulation can be seamlessly integrated into their workflows. We need to pursue creative ways to measure and document ambulation in electronic record systems; this will allow us to more definitively attribute mobility efforts to improved patient outcomes and cost-savings. We need to understand how to best equip patients and families to comply with activity recommendations post-discharge, so that the patients’ functional status is maintained.  As healthcare executives, we should strive cultivate a lasting culture of mobility throughout the continuum of care.


Cattanach, N., Sheedy, R., Gill, S., & Hughes, A. (2014). Physical activity levels and patients' expectations of  physical activity during acute general medical admission. Internal Medicine Journal, 44(5), 501-504.

Doherty-King, B., & Bowers, B. J. (2013). Attributing the responsibility for ambulating patients: a qualitative study. International journal of nursing studies, 50(9), 1240-1246.

Doherty-King, B., & Bowers, B. (2011). How nurses decide to ambulate hospitalized older adults: development of a conceptual model. The Gerontologist, 51(6), 786-797.

Hawaiʻi  Health Matters (2013). The Healthy Communities Network. Available at:  http://www.Hawaiʻi healthmatters.org/modules. Honolulu, Hawai‘i: Hawai‘i Department of Health. Accessed: 08 September 2015.

Kalisch, B. J., Lee, S., & Dabney, B. W. (2014). Outcomes of inpatient mobilization: a literature review. Journal of Clinical Nursing, 23(11-12), 1486-1501.

King, Lisa (2012). Developing a Progressive Activity Protocol. Orthopaedic Nursing, 31 (5), 253-261.

Kneafsey, R., Clifford, C., & Greenfield, S. (2015). Perceptions of hospital manual handling policy and impact on nursing team involvement in promoting patients’ mobility. Journal of Clinical Nursing, 24(1-2), 289-299.

Kuys, S. S., Dolecka, U. E., & Guard, A. (2012). Activity level of hospital medical inpatients: An observational study. Archives of Gerontology and Geriatrics, 55(2), 417-421.

Liu, B., Almaawiy, U., Moore, J., Chan, W., Straus, S, and the MOVE ON Team (2013). Evaluation of a multisite educational intervention to improve mobilization of older patients in hospital: protocol for mobilization of vulnerable elders in Ontario. Implementation Science. 8 (76), 1-8.

Mundy, L. M., Leet, T. L., Darst, K., Schnitzler, M. A., & Dunagan, W. C. (2003). Early mobilization of patients hospitalized with community-acquired pneumonia. CHEST Journal, 124(3), 883-889.

Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a Nurse‐Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults. Journal of Nursing Care Quality, 24(4), 325-331.
Pashikanti & Van (2012) Impact of Early Mobilization Protocol on the Medical-Surgical Inpatient Population: An Integrated Review of the Literatrue. Clinical Nurse Specialist, 26(2), 87-94.


Semper Gumby: Leadership Lessons Learned Aboard the World’s Largest Floating Hospital

Stefan Fedusiv, RN



Imagine running the world’s largest floating hospital, staffed with people who have never worked together, who do not know their way around the ship, and who are culturally unaware of the people and places they are about to visit.

Imagine running the world’s largest floating hospital, staffed with people who have never worked together, who do not know their way around the ship, and who are culturally unaware of the people and places they are about to visit. 

Now, imagine having them working together as a cohesive unit within about nine days. Each time the US Navy deploys the USNS Mercy, this is precisely what happens. I could not think of a leadership situation with more moving parts or more challenges. After touring the Mercy in July 2014, I was compelled to find a way to board the ship and learn what leadership skills are necessary to accomplish such a task. Persistence and tenacity finally paid off.

I am a graduate student at the University of Hawaii pursuing a Masters in Nursing with Executive Leadership focus/MBA dual degrees, and try to never let an opportunity pass me by. This summer, I had the opportunity to learn about leadership, logistics, and resource management while living aboard the Mercy during a portion of Pacific Partnership 2015. I attended top-level meetings which literally took place behind locked doors. I met with Captains and Commanders and Master Chiefs of the US and Australian militaries. I had private conversations with and received advice from two Australian parliamentarians and one Australian commodore. I observed how plans were devised, communicated, executed, and evaluated.

After reflecting on these discussions and observations, I concluded strong, effective leadership has four components, beginning with the creation of a vision. This is followed by the development of a detailed plan of how the vision will be achieved and always includes timely, frequent communication with appropriate personnel. The fourth and, in my opinion, the most important component is flexibility. For example, my personal leadership vision for this experience of a lifetime is to be known and respected as a leader who will take advantage of every opportunity to increase my capacity to better serve others. To achieve this goal, I will share core leadership lessons learned from one of the most unique and interesting venues imaginable, supported by personal experiences, in the form of a written article for the Hawaii/Pacific chapter of the American College of Healthcare Executives. I will communicate with appropriate members to ensure the message is germane, useful, and timely. Moreover, I am prepared to revise, edit, or entirely rewrite the article to flex with any unforeseen circumstances.

The motto of the US Marine Corps is “semper fidelis”, a Latin phrase meaning “always faithful.” While aboard the Mercy, I frequently heard a variation, “semper gumby”, which means “always flexible.” As one might expect, situations can change suddenly and frequently when your hospital is afloat. When we arrived in Fiji, a cruise ship was in our “parking spot” so we had to wait until the following morning before we could dock. Another example was when changing weather conditions resulted in unexpected delays in transporting personnel from ship to shore because high winds prevented the use of our transport vessels. These delays affected site visits as well as event set-up, start, and end times.

I had the opportunity to test my theory on leadership strategy when I was honored with the responsibility of planning, executing, and supervising community health education events in Savusavu, Fiji and Arawa, Bougainville, Papua New Guinea. In Savusavu, the venue was an open rugby field with a small grandstand so site layout was crucial for efficient patient flow. On opening day, the weather was a complicating factor because it was very windy and rainy. Tents had to be secured with rope and concrete weights. Despite this, some were still blown over. The rain collected in big pools on top of many tents, occasionally resulting in waterfall-type spills due to high winds. Many times, these waterfalls landed on the backs of unsuspecting health fair workers. This resulted in less than ideal patient interaction. For the following day, I decided to relocate in front of the grandstand. Although it did not rain, I did not plan for the mud and deep puddles which were everywhere. This adversity was overcome by the decision to cut down palm fronds and use them to create walkways so all attendees could visit each table with minimal fear of slipping in the mud or wading through pools of standing water.

The next education event took place in Arawa, Bougainville, Papua New Guinea approximately one week later. I used the travel time to reflect on lessons learned in Fiji to redesign my education event. I needed to overcome new adversities including: a new country with different cultural and health concerns needing to be addressed, a lack of internet access to perform adequate research, new education topics requiring creation of new displays, as well as the need to educate and motivate personnel who would be presenting at the upcoming event.
To address these issues, I organized a meeting with personnel scheduled to present in Arawa. I communicated my vision for the event, the theme of the event, the topics to be covered and the fact we were lacking display information for the new topics. I also presented a cultural and educational briefing regarding the people of Arawa who were likely to attend. Perhaps one of the most important changes I made was the requirement that each person was to be prepared to present on every topic. By communicating this information clearly and specifically, relationships were managed and behaviors were influenced because those present at the meeting were energized and excited about the challenges we were about to face and confident in the vision.

I capitalized on that excitement and energy by planning a working party that same evening for people to come and help design and create new displays. This shared decision-making step proved wildly successful as people arrived and began dividing themselves into groups and planned, designed, and constructed new displays and binders.

As a result, the community health education event in Arawa was a success. We saw more than 2,000 people during the five day event, significantly more than the number of people we educated in Savusavu. Moreover, because each person was able to present on every topic, we were able to successfully operate with only five people per day instead of the 14 people per day used in Savusavu.

In conclusion, I lived aboard the world’s largest floating hospital to learn what I expected to be a unique leadership skill set. Before embarking on my adventure, I was cautioned the skill set I would learn might only be applicable to the military and not necessarily translatable to non-government organizations. As it turns out, the skill set was neither unique nor organization-specific. After all, organizations are composed of people and strong, effective leadership is always necessary. Create a vision, design and communicate a detailed plan, and always be flexible. These leadership skills are equally important regardless whether you are in charge of a small department or the largest floating hospital in the world. 


Career Development

Richard Giardina, FACHE
We are happy to provide a link to the new Career Edge link to the ACHE career development resources. We hope that you will find this helpful in the development of your career at any level. 

With the daily grind and the frenetic environment of health care, it is very easy to overlook a very important aspect in our lives: our careers. Time and time again, successful leaders achieve their career goals with well thought out and planned career paths.   

It is a focused initiative at ACHE to focus this year on the career development of our members and great effort has been spent to provide resources to help in this area. As a result, in each newsletter we will include a career-development related article, with links to career-related resources. Our goal is to provide you with information and resources to to assist you in the planning and development of your career path. 

There are 3 primary resources we would like to present you with:

  1. Introducing CareerEDGE™  (available as a complimentary benefit to ACHE members). 'CareerEdge' is a resource available to assist in this planning process. Check it out!
  2. The ACHE Job Center is a database of employment opportunities and positions in Healthcare.
  3. The Career Resource Center.

If you have any questions, please contact one of the board members or send an e-mail to our Chapter e-mail account: hawaii@achemail.net


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