Communications Connection: Maximizing Relationships in a Technology-Centered World
Trustees Invited to Attend KHA Annual Convention and Trade Show – Sept. 10-11
Hospital Board Members Encouraged to Donate to the KHA-PAC
KHA-PAC Golf Scramble – Aug. 25, 2015
Health Affairs' Studies Support Medicaid Expansion
Trustee Governance Manual Is an Essential Tool
Seventy-Five Kansas Hospitals Sign on to Healthy Kansas Hospitals
Impact of the Supreme Court's Decision on King vs. Burwell
The Power of Data
AHA Releases Value-Based Care Webinar for Boards
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New York Times bestselling author Joseph Grenny recently conducted an online survey in which 89 percent of those surveyed indicated that insensitive or inappropriate uses of technology - Electronic Displays of Insensitivity - were hurting their relationships by creating "digital divisiveness." Others report that while technology can improve communication between physicians and patients, how it's used (for example, breaking eye contact, turning one's back to face a monitor or screen, or stopping to navigate the electronic health record or type notes) can create barriers to effective communication.
Whether it's an everyday social interaction, patient-physician communication or interaction between hospital leaders and board members, technology increasingly plays a role. Technology is an unparalleled tool for enhancing and strengthening communication, one that is rapidly changing our culture. Hospitals and health systems must be adept and innovative in leveraging the benefits technology offers across a variety of settings and for any number of purposes. But like many things, our greatest strengths and benefits also can be our Achilles heel. Technology can enhance communication, but it isn't always able to replace the connections essential to strong and effective governance leadership and can detract from or undermine relationships and leadership potential.
You Can't Always Just "Call In"
Today's health care environment with all its changes, challenges and complexity, requires boards of trustees who not only communicate, but who ensure they are engaging in the deeper dialogues that matter most. Governance conversations should be vibrant and vital, with trustees engaged in the verbal back and forth volley of constructive challenges to conventional thinking and the exploration of new alternatives. Through deep discussion, decisions are negotiated by wrestling with concepts, ideas and potential solutions. The creative energy that evolves during a hearty debate around the board table can't happen, or can't happen as easily, without the ability to read other trustees' non-verbal cues. We know the cues that signal a truste's engagement vs. disinterest, buy-in vs. dissention, and misperception vs. understanding. These signals are essential to the effective communication necessary to conduct the critical work and leadership of the board.
Attending every meeting in-person isn't always realistic. But many of the complex issues, negotiations and decisions that trustees must address require the clarity of communication that happens best with face-to-face interactions. It is the job of every trustee to consider the commitment he or she made to the hospital and its leadership, and determine whether that commitment can be fulfilled by calling in via telephone or video conference to a meeting, or if it requires in-person attendance. Busy schedules and long travel times may prevent this attendance at times, but if connecting to meetings remotely is a regular occurrence for some trustees, the board may need to re-evaluate its policies and practices for in-person meeting attendance.
When Presence Takes Precedence
A key concern with email, texting and tweeting is the opportunity for misperception and miscommunication. At the board level, the stakes are too high to allow misinterpretations and misunderstandings to happen. However, despite the value of face-to-face interactions, time, distance, cost-savings and convenience make electronic communication an important and useful reality. The trick for trustees is discerning when face time should take precedence over technology and ensuring that technology remains a tool, not a default. Being present and taking part in face-to-face discussions may be the most important in the situations outlined below.
Building new relationships and establishing trust. Strong working relationships and trust are especially important not only between trustees, but also with the CEO and members of the community. Being present provides an opportunity to add depth to a relationship by putting names with faces and adding knowledge of one another through the non-verbal communication that is exchanged.
Strengthening unity of purpose. Diverse opinions, ideas and perspectives among trustees is critical to avoiding "groupthink" and identifying new opportunities, but must be focused on moving the organization in the same direction. For boards of trustees, that unity of purpose should be rallied behind fulfilling the hospital or health system's mission.
The stakes are high and decisions are critical; or when issues are complex and solutions are not readily apparent. Critical conversations and dialogue are the foundation for well-informed and innovative solutions. Without constructive challenges to conventional wisdom and give-and-take debate, the best solutions may never surface.
Issues are sensitive and the potential for conflict is high; or when conflict resolution is needed. When handled with respect and purposeful dialogue, short-term tension and disagreements can be constructive opportunities to building stronger understanding and appreciation for the disparate views among board members.
Seeking the engagement and views of others; or when seeking commitment, priority or sense of urgency from others. Miscommunication and misjudgment are often the result of inadequate listening, which can happen easily when separated by technology. To ensure strong, effective communication and connection, trustees should listen attentively without distraction or rushing to judgment to absorb information and acquire new ideas.
Persuasion and negotiation are required. The board's success is highly dependent on how trustees interact with each other, with the CEO and with members of the community. The ability to influence outcomes is highly dependent on the ability to connect personally with others, to understand their perspectives and to respond effectively.
Confidentiality is critical. Board members are in a position of trust, and in recognition of the sensitivity of the information entrusted to them, have a fiduciary responsibility to keep certain information secure and confidential.
Organizational performance is lagging and motivation, inspiration and leadership must be evident. Hospital boards must value creativity and innovation, and leverage change for strategic advantage. They must lead an organization that can capitalize on the new opportunities emerging from the rapid change occurring in health care today. Leadership that inspires and motivates others to succeed is driven by an authentic message that connects the organization in a personal way to a compelling vision and mission.
The issue, event, organization or purpose is important. Showing up and being present is a demonstration that a person or persons, event, organization or purpose is important to the trustee and worthy of investing personal time to support.
It's the job of the board to set the tone for the rest of the organization. Interacting with other board members in person helps foster not only a better knowledge and understanding of other trustees and their viewpoints, but can fuel a stronger unity of purpose and synergy among board members, and lay a foundation of trust within the board. By their presence and engagement, board members demonstrate the importance of the hospital's mission and its commitment to the organization and the community. Through its presence, the board has the opportunity to lead and inspire others.
Special thanks to The Walker Company for use of: Putting Communication Connection: Maximizing Relationships in a Technology-Centered World. Additional trustee resources from KHA are available in the Trustees' Section of the KHA website. Additional resources from Larry Walker can be found at: www.walkercompany.com.
Mark your calendars and plan to attend the Kansas Hospital Association Annual Convention and Trade Show, Sept. 10-11, at the Hyatt Regency Wichita/Century II Convention Center in Wichita. KHA's convention provides attendees with excellent education and a number of opportunities to network with your peers. Our keynote speaker will be Shawn Achor. General session speakers include David Frum; Marty Makary, MD; Nicholas Webb; Tiffany Christensen; and Jeff Havens. Video clips of the speakers, the convention agenda, registration materials and hotel information are available on the Convention page of the KHA website. Online registration also is available. An advanced registration discount is available to all participants who register by 5 p.m. on Friday, Aug. 21.
The Kansas Hospital Association Political Action Campaign has raised nearly $34,000 toward this year's goal of $74,000. Thank you to the many trustees who have contributed to the KHA-PAC, your participation is essential. During the 2015 election year, the KHA-PAC Steering Committee has challenged EVERY hospital to contribute in the KHA-PAC at some level. Kansas hospitals need representatives on the state and federal level who support hospital issues. Please join us, we need your help to make a difference. Contributions can be made online. Additional information and solicitation materials are available on the KHA website.
The Kansas Hospital Association Political Action Committee is excited to invite hospital trustees and their administrators to our inaugural KHA-PAC Golf Scramble at Mariah Hills Golf Course, Dodge City. It has been a number of years since KHA has hosted a golf event, so we hope you will join us. All proceeds raised will support candidates who champion health care issues. We are pairing this golf fundraiser with one of our congressional roundtables on Tuesday, Aug. 25. This will allow hospital trustees and executives to impact our advocacy efforts in one day. Registration includes your PAC donation, green fees, cart, prizes and lunch. Registration fees and donations can be made in advance or onsite; a check, cash or credit will be accepted.
Medicaid expansion has had a positive impact in those states that have elected to take advantage of that option. Most recently, Health Affairs published two new studies focusing on Ohio and Connecticut.
The Ohio study looked at approximately 28,000 adult Medicaid enrollees with chronic conditions who received care through a waiver demonstration program that actually predated Obamacare. Diabetes patients enrolled in the program received better care and had significantly better outcomes compared to uninsured patients with diabetes. While the results for the hypertension portion of the program weren't as good, patients in the program did have better rates of maintaining good blood pressure. Across all enrollees, costs came in nearly 29 percent lower than expected, "providing cause for optimism that a prepared safety net can meet the challenges of Medicaid expansion." The study also suggests that the attributes of such a "prepared safety net" are increasingly apparent nationwide; and therefore, the concept deserves further attention.
In the other recent Health Affairs study, researchers examined changes in Medicaid volume and uncompensated care between 2007 and 2013 in Connecticut compared to other Northeastern states. Their conclusion was that uncompensated care in Connecticut was roughly one-third lower than what it would have been without early Medicaid expansion. However, the study also warned that hospitals will continue to face uncompensated care costs "as long as there are uninsured patients."
These two studies certainly won't change the politics of the situation, which are challenging to say the least. But with these kinds of results being reported on an almost regular basis, the substance of the issue is becoming clearer. While expansion is still voluntary, it's increasingly difficult to look at the experience in other states and consider Medicaid expansion "optional" anymore.
Trustee education and orientation has never been more important. Health care is the most complex, demanding, fast-paced and rapidly changing industry in America. Early this year, the Kansas Hospital Association's Hospital Governance Task Force revised the Board of Trustees Governance Manual. The manual can easily be customized to your hospital's unique needs. Thank you to The Walker Company who assisted this task force in revising this online governance manual. A PDF version highlighting the areas of major content change is available to help you update your current manual. New sections address:
KHA commends hospital trustees for their dedication to Kansas hospitals and the health care of Kansans. We hope you find this resource helpful. Additional resources to help hospital trustees in their important leadership positions can be found on the KHA website.
The Kansas Hospital Education and Research Foundation has received signed pledges from more than 75 hospital CEOs across the state committed to examining their current food and beverage practices and taking steps toward implementing new policies to provide healthier food options in their hospital cafeterias and throughout the facility. This enhanced access to healthy food aims to positively impact not only hospital patients but employees, visitors and the communities served.
The 75 participating hospitals represent 34,234 employees and 184,625 patient discharges each year who utilize the on-site amenities at the hospitals. With this initiative, health care settings have the potential to take the lead in creating a road map for other work sites to navigate the challenges associated with implementing healthier environments.
Hospitals make their own decisions related to changes to the food and beverage environment based on an individualized assessment. Examples of changes to food and beverage policies being made at some facilities as a result of participation in the initiative include adding nutrition labeling for meals in the cafeteria, adding healthier snack items to vending machines and increased employee education around the topic of nutrition and diet. For more information, visit HealthyKansasHospitals.org.
This summer, the United States Supreme Court handed down the long-awaited decision in the King vs. Burwell case, upholding the use of federal subsidies under the Affordable Care Act in those states, like Kansas, that do not have a federal exchange.
It is worthy of note that the case was decided by what these days could be considered a strong majority of the court. The vote was 6-3, instead of the 5-4 decision that many expected. It also is significant that the Chief Justice, John Roberts, who also wrote the opinion upholding the constitutionality of the ACA, authored the opinion. Justice Roberts' opinion follows a pretty clear path. He notes the history of the ACA and how the different parts of it are all "intertwined." He concludes that the actual statutory language concerning subsidies to states with federal exchanges is ambiguous, and the words must therefore be read "in their context and with a view to their place in the overall statutory scheme." He then spends time examining the purpose, structure and content of the law. He succinctly states "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter."
Another significant point about the decision is that the court itself interpreted the statute. This means that a future administration cannot simply reinterpret the statute and command the Internal Revenue Service to write different regulations removing the subsidies. That fact, which has not been widely reported, may be one of the biggest wins for the Obama administration as a result of this decision.
Did this decision resolve all the legal and political questions about Obamacare? Clearly, the answer is no. Full and partial repeal efforts will continue and may intensify as we move toward the 2016 elections. There also are additional legal challenges on the horizon, although probably none as significant as the first two. While this case comes closer to settling the legal status of the law, it doesn't remove all the uncertainty about the ACA's future.
"Big Data" has become a tired buzz word. However, in this electronic digitized world that generates new forms of data into information at the speed of light, we should probably take a moment to consider the data we have and how we are using it.
The Kansas Hospital Association appreciates the need of our member hospitals to have current, reliable data for strategic and financial planning. Towards that end, a variety of products and services are offered as part of membership. For the most part, our hospitals submit data electronically, and we provide a variety of Web-based reporting tools designed to turn that data into useful information.
The biggest set of data compiled by KHA is the inpatient and outpatient data submitted monthly by our hospitals. The data are used to develop market share, patient origin and payer reports. This information is critical to developing a meaningful strategic plan for any facility.
Understanding the demand on hospitals to report quality data to so many different programs, KHA offers the Quality Health Indicator project. QHi, originally developed by Kansas hospitals in 2003, provides the opportunity to use that data to support your own internal initiatives and to be leveraged to support quality initiatives across the state like the very successful Hospital Engagement Network through the Kansas Healthcare Collaborative.
As we continue to partner with the Kansas Medical Society and KAMMCO on critical programs like the Kansas Healthcare Collaborative and Kansas Health Information Network, the needs and use of data by those organizations become an important part of the picture.
In addition to patient activity, hospitals are monitoring workforce salaries, benefits, vacancy and turnover. Through Compdata, KHA provides an online survey and reporting tool that collects compensation data for 500 plus health care positions, including executive staff. Vacancy and turnover rates are trended in reports KHA publishes to KHASTAT.org. More on data products and services can be found on our website.
The American Hospital Association's Center for Healthcare Governance has released a free, on-demand webinar to help hospital boards prepare for value-based care. The webinar provides an overview of value-based care and critical factors for boards to consider, as well as practical advice on how to evaluate changes within the context of their unique market factors and internal response capabilities.
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