Hawaii - Pacific Chapter of ACHE

Summer 2018 Vol. 2

Messages from Chapter Leadership

Message from the Regent

Over the next three years my focus will be on Lifelong Learning, Diversity and Strengthening Dyad Partnerships.


Aloha Hawai‘i Pacific ACHE Members!

I cannot believe the year is flying by so quickly. As your Regent, I am looking forward to meeting everyone at this year’s Annual Breakfast and talking story about the many challenges and opportunities facing each of us in our roles as “Leaders of Change” in the current healthcare environment.

As I have been diving into this role as your Regent, I have realized the power of our ACHE website ache.org and the many tools and information available to each of us ranging from various career assessments, job bank, career development, up to date articles on healthcare transformation, resume updating and mentoring. While reviewing the website, I ask you to draw your attention to the link provided for national news. Exciting changes are happening in healthcare and we are fortunate to be a part of that change. I encourage all of you to link in and take advantage of the many tools available to you on your local ACHE website hawaii.ache.org.

I want to thank Micah Ewing, FACHE, President of Hawai‘i Pacific Chapter of ACHE, and his team for continuing to value and prioritize lifelong learning for the chapter with the upcoming “face-to-face” educational opportunities. These opportunities are for all members to gain and/or maintain their FACHE credentials without leaving the state of Hawai‘i. I encourage you to sign up and join in on these opportunities scheduled for August 13-14, 2018 at the Queen’s Conference Center from 8:00 a.m. - 3:30 p.m. Keep an eye out for the save the date and enrollment information. Scholarships will be made available.

Over the next three years as your Regent, I plan to focus on:

- Lifelong Learning,
- Diversity, and
- Strengthening Dyad Partnerships.


Gidget Ruscetta, FACHE
Regent for Hawaii/Pacific
Pali Momi Medical Center/Hawaii Pacific Health


Message from the Chapter President

As this year continues to move forward at 'warp factor 9', much has transpired since our last newsletter.  The week of March 26-29, I had the opportunity to attend the 2018 Congress on Healthcare Leadership in Chicago, IL. The event was well-attended, the sessions very informative, and the networking and professional opportunities were countless.  For any of us in a healthcare leadership capacity, I would highly recommend attending.

Aloha Hawai'i-Pacific Chapter Members!
Is it just me, or does time feel like it has accelerated this year? Much has happened and is in the works since our last newsletter.  
The week of March 26-29, I had the opportunity to attend the 2018 Congress on Healthcare Leadership in Chicago, IL. The event was well-attended, the sessions very informative, and the networking and professional opportunities were countless. For any of us in a healthcare leadership capacity, I would highly recommend attending.

It was my honor and privilege to accept the Award of Chapter Distinction on behalf of our Chapter at the Awards Reception event on March 27. This award reflects our performance as a chapter in the areas of membership growth, leadership educational opportunities, credentialing, and member satisfaction. This is a reflection of our 2017 work and the leadership of our Immediate Past President, Nick Hughey and I want to--once again, thank Nick and our leadership team in 2017 for all their hard work. Only a select 'several' chapters receive this award annually and this is our 3rd year in a row receiving this award!

Chapter Awards Reception and the 2018 recipients of the Award of Chapter
Distinction  with current ACHE Chairman, David Olson (bottom center)

Monday evening, March 26 we had our annual chapter dinner at Congress which is open to all Hawai'i-Pacific chapter members attending Congress.  This year, our Regional Director Gerry Berish attended with us and it was a great opportunity for networking and fellowship. We enjoyed the evening, very efficiently fitting 15 individuals in a room designed for only 14.  We couldn't get Gerry to 'shaka', we will continue to work on him.  

The 2018 Annual Chapter Congress Dinner at Quartino's Ristorante

Overall, the 2018 Congress on Healthcare Leadership this year was well attended and a tremendous opportunity for networking and achieving career goals in Healthcare Leadership. If you are not already aware, Congress offers many resources such as career counseling, advice, C-suite bootcamps, resume development, and even professional portraits. Also remember that you can take your Board of Governors exam for FREE at the conference. The educational sessions are very informative and range the gamut from Opioid abuse and Legislation Updates to Data Analytics and Cybersecurity in Healthcare--and many offer credit towards your FACHE requirements. To me, the following themes were prevalent:
  • Despite some uncertainty in future governmental policy, the direction and momentum towards value-based care and transition from FFS is firmly in place.  
  • Next generation data analytics tools are a valuable asset in support of the transition to value-based care
  • Ever-increasing challenges:  ie., Cybersecurity, Physician Satisfaction, and Opioid Abuse; transformational and strategic leadership is needed now more than ever.  
Please do attend our Annual Chapter Breakfast on July 24 as we welcome our special guest speaker, David Olson, ACHE Chairman and Chief Strategy Officer at Froedtert Healthcare. This is a well-attended event, the food is good, and we will be presenting some awards as well--we look forward to seeing you there.  
We are excited to offer face to face credit opportunities closer to home and simplify the process of obtaining credits for our members. Whether you are re-certifying your Fellow credential or applying for your Fellow for the first time, please take advantage of the 12 Face-to-Face credits we are offering August 13-14 at Queen's Conferencing Center. The cost is only $400 for the 2 days--please check your email, the banner on this page, or our website for details.  
Micah B. Ewing, MBA, FACHE
President, Hawai‘i-Pacific Chapter of ACHE
Hawai'i Pacific Health
Office: (808) 535-7063   


Diversity within ACHE

Delma Guevara, MBA, MHRM, PHR

Hawai'i-Pacific Chapter's "Statement on Diversity and Inclusion" call us to value and actively promote diversity.

Over the last several decades we have seen a shift in demographics across the United States population, and understand that the shift in landscape can have an impact in the community we serve. Our local chapter’s Statement on Diversity and Inclusion calls us to value and actively promote diversity in our chapter leadership and membership because, “diverse participation serves as a catalyst for improved decision making, increased productivity, and competitive advantage.” With that in mind, it is important that as a chapter we evaluate how we compare to the ACHE National demographics, and take this opportunity to focus our efforts to promote diversity while keeping in mind the composition of the community we serve. Below is a side by side comparison of the Hawai‘i Pacific Chapter and the ACHE National demographics for age, race and membership category.

In addition to the age, race and membership categories our chapter has also studied how our membership compares to the ACHE National membership data in several other categories such as organization category, position type, and membership tenure. In the category of membership tenure the Hawai‘i Pacific chapter has 4% more than the national average for members with less than 5 years of membership, and fall 8% below the national average on representation of member with over 15 years of ACHE membership.  
Our membership position type is comparable to the national membership. Fourteen percent of both the Hawai‘i Pacific Chapter and the ACHE National membership hold a CEO or equivalent position, and 5% hold a COO or equivalent position. Our VP representation is under the national numbers by 5% but our Department Heads and Directors representation is 6% better than the national.
As we continue to look for ways to strengthen our chapter and work towards attaining our goals, we will continue to look for opportunities to strengthen diversity and inclusion, and we ask our membership to do the same. 

Articles of Interest

Essential Leaders Skills: Critical Thinking

Kelly Wheeler, Army Regional Health Command-Pacific, Lean Six Sigma Master Black Belt

The current ever changing healthcare environment requires agile and adaptive leadership including excellent critical thinking skills.

Healthcare executives face the challenging task of decision making and reasoning on a daily basis. The environment in which healthcare leaders work is becoming more complex and uncertain while the speed at which change is happening and needs to happen is increasing. This environment requires agile and adaptive leadership including excellent critical thinking skills. This article will discuss why and how the Army is redesigning its civilian leader development approach, explore intellect and critical thinking, and discuss what healthcare leaders can do to develop critical thinking skills in themselves and others. 
Why and How Develop Army Civilian Leaders
The Army relies more and more on its civilian employees to provide continuity, expertise and support to Soldiers in the field and garrison. Much like the landscape of healthcare, the landscape for the Department of the Army and future battles that leaders will face, are more complex and uncertain. Army civilians, in some units such as medical treatment facilities, make upwards of 50% of the workforce. Civilians have technical capabilities required by job descriptions but in many cases lack leadership skills since those skills may not have been developed. As a result, the Army determined that it must develop civilian leaders to take on greater levels of responsibility and increased leadership roles in ever changing and complex conditions. To achieve these ends, the US Army Training and Doctrine Command redesigned its Civilian Education System (CES) to align with the Army’s leader development model and strategy. The Army CES seeks to develop leader attributes defined in the Army Leadership Requirements Model including character, presence, and intellect1
Intellect and Critical Thinking
St. Thomas Aquinas believed that the intellect and the will are the two greatest powers of the human mind. Intellect is the ability to reason and understand objectively, particularly with abstract matters. Components affecting intellect defined in Army Doctrine2 include:
a. Mental agility
b. Sound judgment
c. Innovation
d. Interpersonal tact
e. Expertise
Mental agility as a component of intellect is a flexibility of mind, an ability to anticipate or adapt to uncertain or changing situation. It relies upon inquisitiveness and the ability to reason critically3. Reasoning critically is applying critical thinking to a problem or situation and is a component of intellect that can be developed.  
Critical Thinking Explored
Linda Elder and Richard Paul dissected critical thinking into standards applied to elements which develop intellectual traits. The common intellectual standards identified can be applied to thinking to assess the quality of reasoning about a problem or situation. These universal standards are clarity, accuracy, precision, relevance, depth, breadth, logic, and fairness. The explanations below are adapted from the Foundation for Critical Thinking4
Clarity:  If a statement is unclear, we can’t determine if it is accurate or relevant. For example, a question “What are we going to do about rats in Hawaii?” The question does not have enough clarity to assess what the problem is. A better question might be “What can the Oahu sugar cane farmers do to control the rats eating and destroying sugar cane fields?
Accuracy: A statement can be clear but not accurate as in “Mongooses males become sexually mature at 12 months.”  (Mongoose males become sexually mature at 4-5 months). 
Precision: A statement can be both clear and accurate, but not precise, as in "There are too many mongooses on Oahu.” (We don’t know how many mongooses there are, 1 or 100.)
Relevance: A statement can be clear, accurate, and precise, but not relevant to the question at issue. For example, “A Desert Locust adult can consume roughly its own weight in fresh food per day or about two grams every day.”  The statement is clear, accurate, precise, but as stated has no relevance to the question of rats. 
Depth: A statement can be clear, accurate, precise and relevant but superficial.  “Mongoose are found throughout Hawaii. They are a danger to the islands.” Adding depth can provide meaning and insight. A better example could be, “Almost immediately after mongooses were  introduced to Hawaiʻi, residents saw their impacts  on their chickens, game birds, and native ground-nesting Nene geese. The Nene population was estimated at 25,000 at the time of Western contact in 1778, but by the 1950’s ground nesting Nene had dwindled to just 30 birds due largely to predation by mongooses and rodents. One study conducted in Hawai`i Volcanoes National Park demonstrated that 77 percent of Hawaiian goose eggs lost between 1978 and 1981 were lost to mongooses5. ”
Breadth: A line of reasoning may be clear accurate, precise, relevant, and deep, but lack breadth (as in an argument from either the conservative or liberal standpoint which gets deeply into an issue, but only recognizes the insights of one side of the question.)
Logic: When we think, we bring a variety of thoughts together into some order. When the combination of thoughts are mutually supporting and make sense in combination, the thinking is "logical." When the combination is not mutually supporting, is contradictory in some sense or does not "make sense," the combination is not logical. 
Fairness: Thinking is often biased in the direction of the thinker – what are the interests of the thinker and how is the argument in support or not in support of those interests.  
Intellectual standards are applied to elements of thought that include: the purpose, question at issue, information, interpretation, concepts, assumptions, implications, and point of view. Practicing the standards applied to such elements of critical thinking  contribute to intellectual traits of humility, autonomy, fairmindedness, courage, perseverance, empathy, integrity, confidence in reason. 
Developing Critical Thinking
Leaders throughout healthcare organizations should seek to mature their own critical thinking skills and those with whom they work. Actions that you can take today to become a better leader, developing your intellect are:
1) Be self-aware: Assess your own critical thinking using the above standards of thought
2) Practice makes perfect: Share the standards with those with whom you work and assess each other’s thought. Practice critical thinking and the assessment of your thinking and the thinking of those around you.  
3) Training: Providing for formal training in a safe learning environment will provide time for you or those with whom you work to take time to assess your thinking.
4) Ask questions: Socratic inquiry helps others to learn by asking facilitating questions.    
Healthcare leaders at all levels of the organization require skills that propel the organization to be a learning organization that is highly reliable while being adaptive to the complex challenges facing the industry. Army Regional Health Command-Pacific is currently incorporating Paul and Elder’s model for critical thinking into its formal process improvement training to better develop critical thinking in process improvement practitioners and their teams.  
To gain a better understanding of intellectual standards, elements and traits visit the Foundation for Critical thinking at https://www.critical thinking. org/
1. Army Stand To. (2015, April).  Accessed 15 Jun 2018 at http://tradocnews. org/stand-to-civilian-education-system/. 
2. U. S. Department of the Army. (2012, August).  Army Leadership, Army Doctrine Publication 6-22. 
3. U. S. Department of the Army. (2012, August).  Army Leadership, Army Doctrine Reference Publication 6-22. 
4. Paul, R. and Elder, L. (2010, October). Foundation For Critical Thinking, www. criticalthinking. org. 
5.  “Impacts of Rodents and Mongoose. ” Remove Rats and Restore Hawaii, http://dlnr. hawaii. gov/removerats/home/impacts-of-rodents-mongooses/. 

Drug Pricing: Transparency, Affordability and Access...Who will lead the charge?

Sally M Belles, MBA/HCM, RDN, CDE

Key players and their role in influencing drug costs

Determining the cost and access to life changing drugs is multifarious and wrought with complexity.  Rising drug costs and bottlenecks in getting affordable drugs to market have consequences.  Chronically ill patients or those with potentially untreatable conditions are casualties of this larger issue.  Between 2002 and 2013, the cost of insulin in the U.S. nearly tripled with $15 billion spent on insulin annually to treat persons living with diabetes1.  During his testimony before the U.S. Senate Special Committee on Aging on May 8, 2018; Dr. William T. Cefalu, American Diabetes Association (ADA) Chief Scientific, Medical and Mission Officer fielded questions and shared findings of the ADA white paper, "Insulin Access and Affordability Working Group:  Conclusions and Recommendations" recently published in Diabetes Care V 41, Issue 6, June 2018.  Cefalu made mention of ADA's resolution calling on all entities in the supply chain to significantly increase transparency in pricing.  The resolution, unanimously passed in November of 2016, also made demands upon Congress to hold hearings with all entities involved to identify the causes for such dramatic price increases as insulin.  According to the ADA, over 30 million Americans live with diabetes, and approximately 25% of them require life-sustaining insulin, including 1.5 million persons diagnosed with type 1 diabetes2.  Since its discovery in 1921, insulin has saved countless lives and no alternative exists for those who require the drug.  

The Centers for Medicare and Medicaid Services (CMS) published a new Medicare Part D Drug Spending Dashboard & Data resource.  The CMS drug spending dashboard
(https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Information-on-Prescription-Drugs/MedicarePartD.html) is dated to 2016 and revealed $174 billion was spent on prescription drugs, approximately 23 % of the insurance program's budget.  This represents an increase from the $ 109 billion Medicare spent in 2012 representing 17% of its budget for such medications.  Patients and health care providers are increasingly aware and there is a demand for more transparency and accountability of drug costs.  Along with price list increases comes an increase in out of pocket costs.  The annual growth rate between 2012 and 2016 under Medicare Part D for Lantus (insulin glargine) and Januvia are 18.6% and 12.7% with average yearly spending per beneficiary of $2,514 and $2,822 respectively.  The CMS dashboard highlights 2016 sales of $2.53 billion for Lantus Solostar, making the drug one of the Part D program's highest expenses covering more than 1 million beneficiaries.  Because the dashboard focuses on price lists and does not integrate market forces or the role of pharmacy benefit managers (PBMs) in setting drug prices based on negotiated rebates some argue the dashboard data is inflated.  The dashboard is the result of the increasing pressure to make more drug pricing data available to the public and has potential to build on the development of market-based metrics.


Many specialty and chemotherapeutic drugs have a single manufacturer which significantly affects the cost of such drugs and negatively impacts access.  The CMS dashboard shows the total spending in 2016 of Velcade (Bortezomib) at $15 million and average yearly spending per beneficiary of $28,059.  [cost per dosage unit = $1,620.36].  This represents approximately 544 beneficiaries in need of targeted chemotherapy for the treatment of multiple myeloma and mantle cell lymphoma.  Revlimid, another drug used to treat multiple myeloma has no generic counterpart.  The current cost per beneficiary in 2016 was $75,200 and cost Medicare Part D nearly $3 billion.  The absence of a generic alternate for Revlimid resulted in a price hike of 40 percent since 2012.  Harvoni, a drug used in the treatment of Hepatitis C cost Medicare Part D $4 billion in 2016 with a $1,118.58 per dosage unit price tag.  The availability of specialty and experimental drugs such as those to treat certain types of cancer is of national concern which is why the US Food and Drug Administration (FDA) established its˜expanded access program" which allows the use of an investigational medical product outside the constraints of a clinical trial.  This is also termed "compassionate use3." In addition, house lawmakers voted 250 to 169 passing the "right-to-try" bill which was then signed into law by President Trump on May 30, 2018.  Proponents of the law argued that it may provide an alternative means for individuals to get access to experimental and potentially life-saving medications outside of a clinical trial.  Patients living with a terminal illness who cannot enroll in a clinical trial often run out of options during discussions with their health care provider.  Thus, "right-to-try" allows patients and their treating physician to work directly with drug companies to obtain such drugs.  The law indemnifies physicians and drug companies with the exception of "reckless or willful misconduct" or "gross negligence."  Yet the law is controversial and has been met with criticism including that of the American Cancer Society (ACS) and the American Society of Clinical Oncology (ASCO).  Those who opposed the legislation expressed safety and ethical concerns that the legislation removes vital patient safeguards in bypassing the FDA.  Many, including drug companies assert that investigational drugs are available through the FDA's expanded access program and that more than 99% of physician requests received by the FDA are eventually approved.  Whatever the case, disputes over the trade-offs between access to treatment and safety protections remain.

The FDA's Office of Generic Drugs (OGD) has a role to ensure development of and accessibility to generics.  Studies of samples test for quality, potency, purity and effectiveness in order to demonstrate bioequivalence of a generic drug to its branded counterpart.  To be "bioequivalent" means the generic drug must reach the specific part of the body where the drug is intended to work at the same time and equal amount.  The FDA requires and oversees a rigorous drug review process to ensure safe generics get to market.  In fact, 9 out of 10 prescription refills in the U.S. are for generic drugs.  The introduction of generics into the marketplace creates and encourages competition that supports fair pricing.  Affordable treatment in turn creates and expands access for patients.  In contrast, the alleged withholding of bioequivalence testing by drug companies results in soaring prices of branded drugs, costs Medicare and Medicaid billions each year, and burdens the health care system.  Broadening the manufacture of generic drugs increases product distribution, availability and competition; simultaneously lowering pricing albeit gradually.  FDA analysis of retail sales data for single-ingredient brand name and generic drug products sold in the U.S. from 1999 through 2004 reveals generic competition is associated with lower drug prices, with the entry of the second generic competitor being associated with the greatest price reduction4.

Although the attention of the U.S. Congress is divided between domestic and international priorities, health policy issues remain at the forefront for the current (WH) Administration.  The FDA, headed by FDA Commissioner Scott Gottlieb, is leading efforts to promote availability of testing samples to encourage generic competition.  In a press release on May 17, 2018, Gottlieb reiterated previous statements made by U.S. Secretary of Health and Human Services (HHS) Alex Azar that "no patients should be priced out of medicines they need to support their health."  In his statement, Gottlieb emphasized this as "one of the Administration's highest priorities."  Advancing health policies to improve new and generic drug competition and pave the way to make drugs more affordable and accessible requires innovation.  Political, economic, technological and regulatory influences can serve to help or hinder policy advancement.  The FDA is taking a multi-pronged approach and focusing on specific abuses when it comes to drug costs.  "One such abuse, says Gottlieb is a practice by brand companies to create obstacles for generic developers in purchasing samples of their brand drugs.  A generic drug developer needs 1,500 to 5,000 units of the brand drug to perform what are often relatively straightforward studies for FDA approval5."  Generic drug manufacturers are less able to develop generic alternatives without such testing samples.  In response, the FDA posted a list of companies identified as potentially blocking access to samples of their brand drugs.  Drug companies objecting to the list complain of the lack of both appropriate context and responses from companies represented on the list.  FDA's list is available here.  Meanwhile, Congress is reviewing the CREATES Act sponsored by Senator Patrick Leahy (D-VT) and co-sponsored by Senator Chuck Grassley (R-Iowa).  CREATES stands for "Creating and Restoring Equal Access to Equivalent Samples".  The legislation aims to promote competition and serve as a strong deterrent to drug companies that employ anticompetitive practices as a tactic to delay low-cost generics from getting to market.  The FDA has not commented publicly in support of CREATES although there appears to be evidence regarding such practices by drug makers6.

Perhaps in the future we will see voluntary price cuts for prescription drugs, more uniform formularies, or a significant overhaul in the supply chain.  Innovations and the potential disruption occurring outside of healthcare may very well influence the industry.  Recall January 30, 2018 when Amazon, Berkshire Hathaway, and JP Morgan announced their plans to start up an independent company with the overarching goal of reducing the burden the cost of healthcare places on the economy while improving outcomes for its 1.2 million employees and their families.  Offering healthcare services at lower, more affordable costs will involve more transparency, including drug pricing.  

In conclusion, soaring costs of prescription drugs including generics, current FDA initiatives, and increasing public awareness have all spurred the drive for more transparency and less restrictions.  Patients and their families are not in a position to negotiate for themselves.  Diverse groups have a stake in managing drug prices with some wielding more power and influence than others.  Pharmaceutical companies, pharmacy benefit managers (PBMs), insurers, employers, and government all have an important role to play in the process that ultimately affects drug prices.  

1.    Hua X, C. N. (2016). Expenditures and prices of antihyperglycemic medications in the United States. JAMA, 315: 1400-1402.
2.    Newsroom/press-releases. (2018, May 8). Retrieved from American Diabetes Association: http://www.diabetes.org/newsroom/press-releases/2018/insulin-affordability-white-paper-release.html
3.    Expanded Access. (2018, May 23). Retrieved from US Food & Drug Administration: https://www.fda.gov/NewsEvents/PublicHealthFocus/ExpandedAccessCompassionateUse/default.htm
4.    About the Center for Drug Evaluation and Research. (2018, May 29). Retrieved from U.S. Food & Drug Administration: www.fda.gov
5.    FDA Press Announcements. (2018, May 17). Retrieved from U.S. Food & Drug Administration: www.fda.gov
6.    Lupkin, S. (2018, May 29). Pharmaceuticals. Retrieved from Kaiser Health News: https://khn.org/topics/pharmaceuticals/


Calendars and Recent Events

2018 Congress on Healthcare Leadership

Local chapter member MAJ Angel L. Vargas shares his experience at and highlights the recent 2018 Congress on Healthcare Leadership.


Team Hawai’i,

ACHE Congress is the most significant networking and educational experience made available to healthcare administrators! 2018’s was no different. From a networking perspective, ACHE is highly touted with the highest membership of all administrator centric professional organizations. At Congress our education sessions covered the entire continuum of care, from front line enhancements to strategic development ideas, the speakers at this year’s gathering continue to amaze. In fact, there were several topics that can no doubt aide Hawaii’s healthcare leaders. Specifically, sessions on leveraging technology, post-acute care services and access improvement strategies in lieu of healthcare reform changes.  

The 2018 Congress on Healthcare Leadership - Chapter Awards Banquet

Hawaii is unique, but not immune to the changes in law or care delivery on the mainland. On top of the educational opportunities, ACHE Congress reminds us of the high prestige and value of our ACHE board certification. With very stringent acceptance requirements, the FACHE credential was on full display this Congress with a substantial amount of mid-level and senior-level members out and about.  
So what does this mean for the local Hawaii chapter? It means, get involved. It means, show up to the social events. It means, show up for the educational events. Build your networking and educational depth locally, so when you attend Congress in 2019 and beyond, you will be more prepared and ready to a) represent Hawaii’s healthcare executive group and b) meet exceptional leaders from the mainland to pull ideas from!  Education and continuous learning is the foundation for achieving great success, but networking opens up your options for even more success. Be sure to focus on both, get to a Congress and build/market your brand!  
In closing, thank you for what you do. With over 12 years’ experience as a healthcare administrator, I have never been more proud to be a member of ACHE. I have attended at least six Congresses over my career and learn something each and every time. If your goal is continuous growth and development, attending an ACHE Congress is a good way to help make that a reality!  
Thank you for what you do and may you have continued success in the future! 
Board of Director, Hawai’i Pacific Chapter of ACHE
Administrator, 15th Medical Group

Calendar of Events

Calendar of events

July 2018
Su M Tu W Th F Sa
07/02/18 (Mon) Congress Proposals Application Deadline
1 2 3 4 5 6 7
07/04/18 (Wed) Independence day Holiday
8 9 10 11 12 13 14
07/09/18 (Mon) Executive Diversity Program Application Deadline
15 16 17 18 19 20 21
07/10/18 (Tue) Lifetime Service Award Application Deadline
22 23 24 25 26 27 28
07/16/18 (Mon) Young Healthcare Executive Application Deadline
29 30 31        
07/24/18 (Tue) ACHE Chapter Breakfast Local Chapter Event

August 2018
Su M Tu W Th F Sa
08/16/18 (Thu) National Board Nominations Application Deadline
      1 2 3 4
08/17/18 (Fri) Gold Medal Award Application Deadline
5 6 7 8 9 10 11
08/21/18 (Tue) Board of Governors Review ACHE Special Program
12 13 14 15 16 17 18
08/22/18 (Wed) Board of Governors Review ACHE Special Program
19 20 21 22 23 24 25
08/23/18 (Thu) Board of Governors Review ACHE Special Program
26 27 28 29 30 31  
08/24/18 (Fri) Board of Governors Review ACHE Special Program

September 2018
Su M Tu W Th F Sa
09/03/18 (Mon) Labor Day Holiday
09/17/18 (Mon) Sutter Health Fellowship Application Deadline
2 3 4 5 6 7 8
09/28/18 (Fri) Kaiser Permanente Fellowship Application Deadline
9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29


Calendar of Educational Events

Upcoming Calendar of Educational Events

July 2018
Su M Tu W Th F Sa
07/04/18 (Wed) Independence day Holiday
1 2 3 4 5 6 7
07/11/18 (Wed) Leading for Safety ACHE Online Seminar
8 9 10 11 12 13 14
07/30/18 (Mon) New York Cluster ACHE Education Event
15 16 17 18 19 20 21
07/31/18 (Tue) New York Cluster ACHE Education Event
22 23 24 25 26 27 28

29 30 31        


August 2018
Su M Tu W Th F Sa
08/01/18 (Wed) New York Cluster ACHE Education Event
      1 2 3 4
08/02/18 (Thu) New York Cluster ACHE Education Event
5 6 7 8 9 10 11
08/03/18 (Fri) Physicians Executive Forum ACHE Special Program
12 13 14 15 16 17 18
08/13/18 (Mon) Chapter Educational Conference Chapter Education Event
19 20 21 22 23 24 25
08/14/18 (Tue) Chapter Educational Conference Chapter Education Event
26 27 28 29 30 31  
08/27/18 (Mon) Washington D.C. Cluster ACHE Education Event
08/28/18 (Tue) Washington D.C. Cluster ACHE Education Event

08/29/18 (Wed) Washington D.C. Cluster ACHE Education Event

08/30/18 (Thu) Washington D.C. Cluster ACHE Education Event

September 2018
Su M Tu W Th F Sa
09/03/18 (Mon) Labor Day Holiday
09/05/18 (Wed) Exceptional Leadership ACHE Online Seminar
2 3 4 5 6 7 8
09/12/18 (Wed) Big Data and Analytics ACHE Online Seminar
9 10 11 12 13 14 15
09/19/18 (Wed) Management Mistakes ACHE Online Seminar
16 17 18 19 20 21 22
09/24/18 (Mon) Vancouver Cluster ACHE Education Event
23 24 25 26 27 28 29
09/25/18 (Tue) Vancouver Cluster ACHE Education Event
09/26/18 (Wed) Vancouver Cluster ACHE Education Event

09/27/18 (Thu) Vancouver Cluster ACHE Education Event

News & Committee Updates

News from the Education Committee

Josh Carpenter, Education Committee Chair

Aloha Hawai’i-Pacific Chapter!

This year is proving to be a busy one filled with a variety of education offerings. ACHE's 2018 Congress on Healthcare Leadership recently wrapped-up followed by the Healthcare Financial Management Association (HFMA) Conference. ACHE/AONE 2018 Annual Conference - Leadership in Action will be held for a single day this year on Friday, November 9 at the Royal Hawaiian Hotel. The education committee has been hard at work planning the chapter's first On-Location education program to be held on Monday and Tuesday, August 13-14 at the Queen's Conference Center. The program focus is on Leadership Strategies.

If you have any recommendations for future events, please reach out to one of our education committee co-chairs! Contact information is provided at the bottom of this article.

Advancement to Fellow Local Study Options:

A key part of our Chapter Mission is to not only grow active members, but also to support the advancement to Fellow as well. Bottom line: we are here to support you! 

To meet this end, in 2016, our chapter purchased three sets of the Board of Governors (BOG) Exam Study set as found on the ache.org website (a $240 value). We currently have them staged at Wilcox Medical Center (Kauai), Queens Medical Center (Oahu) and Hawaii Pacific Health (Oahu). Recently, we received a donation set available for us at Kaiser Medical Center! To sign-out for usage, you simply have to be a current member of ACHE, a member in our Hawai'i-Pacific Chapter, and be eligible (or near eligible) to test for the BOG Exam. Simply send me an email and I will connect you with the right POC. Direct POC information will be posted on our website soon! 

NOTE: If any other member wishes to donate or share their books with ACHE Hawai’i-Pacific members, please contact me anytime. 

Advance to Fellow/Recertification Reminders:

Education Requirements are 36 credit hours (12 Face-to-Face & 24 Qualified Education Credits), every three years if recertifying.

Below are some direct ACHE links to make your advancement to fellow a whole lot easier:

As always, the education committee seeks energetic, detail-oriented individuals to help create, coordinate and/or volunteer at events. If interested, let us know!

With regards,

Charlene Rueben, Capt, USAF, MSC
Co-Chair, Education Committee
Email: charlene.rueben@us.af.mil

Josh Carpenter
Chair, Education Committee 
Phone: (808) 220-2078

News from the Guam Committee

Chuck Tanner, FACHE

Guam Council Representative Chuck Tanner welcomes new members to the GLPC and shares his reflections on the value of membership.

Hafa Adai from Guam!

Well, I lied! Last edition I mentioned that it would be my last contribution to the newsletter… well… guess not! There is good news though as I would like to introduce you to some new members to our GLPC. First is a “young” old friend, John Ray Taitano… John and I have worked together in the past and he is stepping up to hopefully be part of the new leadership here. Also Nicole Dhanraj whom I recently met and wow what a great addition to Guam and our program! Finally a very new face, Felix Esquibel who is changing careers and wants to explore health care administration! Welcome to Guam and our GLPC. As I hand off the organization we will better introduce these new faces to the group and I look forward to wonderful things.
This month we will say farewell to another good friend and classmate, CAPT Dan Cornwell, the Commander of USNH Guam. Dan and I met back in Baylor and yes it is a small world. He served our nation for like a hundred years in the Navy and will be returning back to the states near the end of the month. Sadly I don’t know specifically when his change of command is but I know his retirement date is June 29. Best wishes my friend and welcome to the blue card club!
In my Inbox I was happy to reconnect with a friend that is now in Hawaii and she too is looking at life after the military. Why I bring this up is another value added item about membership in the ACHE and in my opinion probably the most valuable. That is the relationships and friendships that you form. Healthcare Administration is a relatively small group of professionals and it sure is comforting when you can network and share ideas. In this case, I am hoping life for her may include staying in the Pacific! We are sorely in need of qualified and motivated healthcare administrators, especially in the remote islands. So, if you are reading this and are interested in staying out here in the deep blue Pacific feel free to contact me and I will share, to the best of my ability, opportunities that you can explore for your future. Hmm…life in Kosrae, Pohnpei, Chuuk?
We are also in PCS season so we will start to reach out to new members at Navy and Air Force to include in our GLPC. I hope to meet with the new Commander too as soon as I can find out when the change of command is...Argh!

As mentioned, it is a political year here on Guam. Healthcare is a lead issue here and everyday there is a media article or interview. There is good and bad to that of course, but it does illuminate the need for professionals in the islands. There are some great advances being made, such as high speed cabling that will allow for increased telecommunications. This will allow for greater outreach to the remote islands and increased educational opportunities. The University of Guam is already moving forward on many fronts in that area. We are also starting to engage in cancer clinical trials and hope to expand into more Micronesian specific medical research. It is truly an exciting time for us. With the change of governance in the leadership of Guam, there is an opportunity to relook what we do. It is a time of optimism but also a time of uneasiness. We shall see what our future will bring.
In closing, I am not going to say this will be my last article, simply because I don’t want to lie again! But, I look forward to bringing on our new members and hold an election soon so we can put in place a solid leadership team! God bless you and God bless Guam.  

Updates for Students

Denise Della, MPH MHA

Congratulations to our graduates!


Congratulations to our Graduates

Congratulations to all our ACHE Hawai’i Pacific Chapter student members that have recently graduated from their graduate programs this year. We had a large amount of our ACHE student members graduate from the University of Hawaii Executive MBA Health Care Management Track. Congratulations to each one of you! ACHE Hawai’i Pacific Chapter is proud of you and commends you all for your dedication and commitment to the healthcare field.



Postgraduate Fellowship Spotlight: Kaiser Permanente

Denise Della, MPH, MHA

Postgraduate fellowships offer unique opportunities for early careerists looking to get first-hand experience working in a healthcare system.

As an early careerist, postgraduate fellowships are unique opportunities to get first-hand experience working in a healthcare system while developing your healthcare management and leadership skills. This quarter, we are featuring the Kaiser Permanente Administrative Fellowship Program.

Kaiser Permanente Administrative Fellowship program seeks talented masters-trained individuals who are passionate about healthcare operations and who want to develop their management skills and leadership potential in a dynamic and unique environment.

The Administrative Fellowship program is designed to:

·      Identify and foster promising candidates for management and future leadership positions within Kaiser Permanente.

·      Provide Administrative Fellows with an educational, interactive, and enriching experience that will contribute to their professional development, as well as to their understanding of Kaiser Permanente.

·      Create opportunities for Administrative Fellows to enhance skills in project development, strategic implementation, and operations management.

This quarter, I had the honor and privilege of interviewing Lee Colburn, an ACHE Hawai’i Pacific Student Member and Kaiser Administrative Fellow working at the Maui Health Systems. Lee Colburn is a 2016-2018 Fellow that graduated from the University of Washington Master of Health Administration Program.


Interview with Lee Colburn, Kaiser Administrative Fellow and ACHE Hawai’i Pacific Student Member.

Q: What does the Kaiser Permanente Administrative Fellowship Program involve?   

The fellowship is 24 months long with three 8-month rotations: two at a medical center (choice of inpatient or outpatient setting) and one at the regional offices. I spent my first year in the Southern California Region. I was placed in KP San Diego in 2016 getting exposure in Ambulatory / Clinical Medical Group. I am currently working in a Maui Health Systems, a Kaiser Foundation Hospital comprised of Maui Memorial Medical Center, Kula Hospital, and Lanai Community Hospital. I worked with Ray Hanh former regional chief operating officer and hospital administrator for Kaiser Hawaii Region. I also worked with Mike Rembis, the CEO of Maui Health Systems. Additionally, I participate in a monthly and quarterly call for my fellowship and participate in our fellowship exchange.

Q: As a fellow, what are some of the benefits of the Kaiser Permanente Administrative Fellowship program?

Along with receiving formal mentoring from senior executives and informal mentorship from mid management through both project and operational work, fellows receive a full-time salary and strong professional network within KP and within the alumni community. Fellows also receive paid holidays and accrue both vacation and sick leave. Fellows and their dependents are eligible for full medical and dental benefits.

Q: What did you learn from the Kaiser Permanente Administrative Fellowship Program?

The health administrative fellowship program taught me skillsets to translate healthcare administration theory into action. The health administration fellowship provided me with a vision of the vast possibilities in healthcare and how I can make an impact in a community. This administrative fellowship reinforced my belief that I am in the right organization. Through this fellowship, I was able to learn, grow, and transition from graduate school to a career path.

Q: What are your plans after the Kaiser Permanente Administrative Fellowship Program?

My plan after the fellowship is to stay in the Kaiser Permanente system by working full time in either operations management, consulting, or project management. I am also open to any position after this fellowship.


To learn more about the Kaiser Permanente Administrative Fellowship Program and their application process go to https://adminfellowship.kp.org/.


The new application will be open in August 2018. Applications are due on September 28, 2018, at 5 p.m. PDT. A final decision is made by early November.

Membership Report: New Fellows, Members, and Recertified Fellows

Kecia Kelly, FACHE

On behalf of the membership committee, I wish to thank all of you for your engagement and support to our chapter.  We have many more upcoming and exciting events planned.  It is my honor to serve as your Membership Chair!

Congratulations to all of our New Members!


1Lt Myranda K. Quinata, Hagatna, Guam
Carolyn M. Voulgaridis,Kailua
HMCM Michael J. Bagley, Kaneohe


SSgt Austin T. Gregg, Yigo, Guam
SFC Benjamin J. Heimstead, Honolulu
Congratulations to our Recent Fellows!

January - Beau Nakamoto, MD, PhD, FACHE - Honolulu 

February - MAJ Daniel Gilardi, FACHE - Honolulu  

March - Thandiwe Nelson-Books, RN, FACHE - Honolulu

April - Capt. Brandt W. Higley, FACHE - Honolulu

We are pleased to welcome 5 new members who joined our local chapter during the months of May and June. As a member of the Hawai'i Chapter of ACHE you have access to local and national resources as well as opportunities to volunteer on various committees.
Please attend our Annual Breakfast! This event is sure to energize and motivate. RSVP here:  2018 Annual Chapter Breakfast.
Looking forward to meeting more members and potential new members at future social and educational events happening in 2018!

ACHE Resources

ACHE National News

ACHE National News Press Release from June, 2018.



2018 Physician Executives Forum Program

August 3, 2018 | Grand Hyatt New York

High-impact leaders recognize the importance of self-awareness, collaboration, communication and connection, the essential skillsets underlying influential leadership. Communication that is clear and precise reduces wasted efforts and resources, ultimately leading to improved healthcare outcomes. This program utilizes tools and techniques to help participants learn how to build on their leadership communication strengths, and also exposes the “blind spots” that can prevent personal advancement and organizational success. Using the fundamental elements of the Profile Performance Indicator (PPI) Assessment, participants will gain valuable insight into how to operate at peak performance and motivate others.

What You Will Learn:

  • Gain insight into the principles of effective communication skills.
  • Identify and apply key elements of self-awareness and essential behavior patterns.
  • Discover behaviors necessary to connect with others and build stronger personal relationships.
  • Explore how to match or adapt key communication styles with different audiences to optimize healthcare outcomes.

Register online today!

ACHE Joins National Steering Committee for Patient Safety

The Institute for Healthcare Improvement has announced formation of a National Steering Committee for Patient Safety, and ACHE is taking part. Over the coming months, ACHE will be part of a diverse group creating a national action plan to accelerate progress in patient safety across systems and settings. Learn more about the National Steering Committee for Patient Safety here.

New Seminar: Professional Burnout in Healthcare

Approximately one out of three physicians is experiencing professional burnout at any given time. Equally troubling, burnout is on the rise and exists among all healthcare professionals. Join Harjot Singh, MD, and Michael E. Frisina, PhD, for “Professional Burnout in Healthcare: Lead Your Organization to Wellness,” the new two-day seminar that will help you develop a plan to recognize, reverse and prevent burnout in yourself and others.

Dr. Singh and Dr. Frisina will be teaching at the Washington, D.C. Cluster on Aug. 27-28 and at the Orlando Cluster on Dec. 10–11.

Don't miss out on this exceptional opportunity–register today.

Prepare for Board Certification in Healthcare Management With Expanded BOG Exam Study Set

Are you planning to take the ACHE Board of Governors Exam? ACHE offers several resources to help you prepare for the exam, including a study set of HAP books that covers healthcare management, human resources, financial management and information systems. The four-book BOG Study Sethas been specially assembled to help you prepare for the final step toward board certification in healthcare management and becoming a Fellow of ACHE.

Recently expanded to include Information Systems for Healthcare Management, Eighth Edition, the set also features: Introduction to the Financial Management of Healthcare Organizations, Seventh Edition; The Well-Managed Healthcare Organization, Eighth Edition; and Human Resources in Healthcare: Managing for Success, Fourth Edition.

Learn more about the BOG study set and place your order today.

Career Corner

We are happy to connect you with valuable ACHE career development resources. We hope that you will find this helpful in the development of your career at any level. 

Career Development Season Has Arrived

Summer is the perfect time to revisit your career plan. June, July and August can be less hectic for many executives, making it the ideal time to take a break, reflect on professional goals and revamp career development efforts.

To help keep you accountable during the summer months, ACHE CareerEDGE® has an action tracker you can use to monitor your progress and set reminders. The ACHE Career Resource Center recently updated the CareerEDGE platform with resources such as an organizational benefits analysis tool and the annual salary survey. Students can access updated information about salary and job placement via ACHE CareerEDGE SE, the student edition.

Maximize the value of the career management tool with a limited CareerEDGE Coaching option designed to help you optimize your strategic career development plan.

CareerEDGE CoachingCareerEDGE Coaching

CareerEDGE is ACHE’s unique and comprehensive career planning tool designed to help you take a more strategic look at planning your career. To maximize the value of CareerEDGE to you, ACHE is offering a limited coaching option to assist you in bringing your plan to life. The service will include two one hour virtual sessions to review the necessary pre-work you’ve completed in CareerEDGE. We will focus on your career goal, what you need for fulfillment, the value you contribute, competencies required for success, and how your goal aligns with your needs. Our team of career coaches will provide you with advice on enriching your career plan, and taking a more strategic approach to identifying developmental goals and the actions needed to position yourself for success. In the process, we will offer resources to help you articulate your value proposition and refer you to additional ACHE’S Career Resource Center tools that can help you gain a competitive edge and even facilitate resume development and interview preparation.




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Many thanks to our Sponsors!

The ACHE Hawai’i Pacific Chapter is pleased to announce our valuable sponsors for this year. Our sponsors allow us to continue to offer high quality continuing education and leadership development to prepare Hawai’i’s healthcare leaders for the ever changing and challenging health care landscape.


Platinum Sponsors

Hawai’i Pacific Health
Kaiser Permanente

Gold Sponsors

Adventist Health, Castle Medical Center
Nihon Khoden
TRANE (Ingersoll Rand Company)

Silver Sponsors

Queen’s Medical Center


Many thanks to our sponsors: