Gwen MacKenzie,

Senior Vice President and Michigan Market

Leader, Ascension Health
Opening Keynote Address
TheChangingFaceofHealthcare
Sheryl Sandberg: The 3 Biggest Mistakes Working
Women Make - Oprah's Next Chapter OWN
Video:
https://www.youtube.com/watch?v=FXpsX3sZow0
The Most Electrifying Moment in Justice Sonia
Sotomayor's Life - Oprah's Next Chapter OWN
Video:
https://www.youtube.com/watch?v=9iUW84jPCHI
Morning Session - ConsolidationtoIntegration
Kathryn J McDonagh,
PhD, RN (moderator),
Vice President, Executive
Relations, Hospira, Inc.
Christine Candio, RN,
FACHE, Chief Executive
Officer, Inova Alexandria
Hospital/Senior Vice
President, Inova Health
System/Chairman, ACHE
Ruth W. Brinkley,
President and CEO,
KentuckyOne Health
Gwen MacKenzie, Senior
Vice President and
Michigan Market Leader,
Ascension Health
Afternoon Session I - CareerandLifeBlending
Sydney Scarborough
(moderator),
Managing Director,
Healthcare Solutions,
Jones Lang LaSalle
Ninfa Saunders, DHA,
MBA, MSN, FACHE,
President and CEO,
Central Georgia Health
System
Ann Scott Blouin, Ph.D.,
RN, FACHE, Executive
Vice President, Customer
Relations, The Joint
Commission
Lynn Simon, MD, MBA,
President, Clinical
Services & Chief Quality
Officer, Community
Health Systems
Career-Life Blending
August 14, 2014
10
Source: Harvard Business Review: Manage Your Work, Manage Your Life by Boris Groysberg and Robin Abrahams, March 2014
Defining Success for Yourself
11
Professional Success Means
Source: Harvard Business Review: Manage Your Work, Manage Your Life by Boris Groysberg and Robin Abrahams, March 2014
Defining Success for Yourself
12
Personal Success means
Source: Harvard Business Review: Manage Your Work, Manage Your Life by Boris Groysberg and Robin Abrahams, March 2014
13
The Framework years Our 20s
Key Decisions
14
Hitting our Stride Our 30s
Increasing complexity
15
Our 40s, 50s and beyond
The Sandwich Generation
Source: Pew Research, 2013
42%
of Generation Xers have a
parent 65 or older and a
financially dependent child
15%
of adults age 40 59 provide financial
support to a parent aged 65 or older,
as well as either raising a minor child
or supporting a grown child
47%
chance that at some point in life,
you will responsible for caring for
an aging parent or another elderly
family member
Questions
- What were you doing at each stage work and life roles?
- What were your aspirations life and career goals at that stage?
- Key issues you faced and the decisions / compromises you made?
- How did you make those decisions?
- What challenges did you face that you believe were unique to you as a woman?
- Did the advancements in technology lend a hand?
- What lessons did you learn to take you forward to the next stage?
- What do you wish you had done differently?
Tell us about your life story through the lens of lifes stages
16
For further information
Harvard Business Review article: Manage Your Work, Manage Your Life by Boris Groysberg and
Robin Abrahams, March 2014.
Design or Default? On Becoming a Big Six Partner by Ann Scott Blouin, Seminars for Nurse
Managers, 1998
The Aspen Institute - video clip (start at 22:12):
http://www.youtube.com/watch?v=xTjKDzocX4w&feature=player_embedded, June 2014
Work-Life "Balance" Isn't the Point by Christine M. Riordan http://blogs.hbr.org/2013/06/work-
life-balance-isnt-the-poi/, June 2013
Forget Work-Life Balance: Aim for Blend Instead by Rebecca Fraser-Thill, March 2014
http://www.huffingtonpost.com/rebecca-fraserthill/success-and-motivation_b_4889295.html,
17
Afternoon Session I - CareerandLifeBlending
Sydney Scarborough
(moderator),
Managing Director,
Healthcare Solutions,
Jones Lang LaSalle
Ninfa Saunders, DHA,
MBA, MSN, FACHE,
President and CEO,
Central Georgia Health
System
Ann Scott Blouin, Ph.D.,
RN, FACHE, Executive
Vice President, Customer
Relations, The Joint
Commission
Lynn Simon, MD, MBA,
President, Clinical
Services & Chief Quality
Officer, Community
Health Systems
Afternoon Session II - LeadingSystemWidePatient
SafetyandQualityInitiatives
Ann Scott Blouin, PhD,
RN, FACHE (moderator),
Executive Vice President,
Customer Relations, The
Joint Commission
Nancy G. Pratt, RN, MSN,
Chief Operating Officer,
Executive Vice President,
Clinical Effectiveness
Jane Englebright, PhD,
RN, CENP, FAAN, Chief
Nurse Executive & Patient
Safety Officer, Hospital
Corporation of America
Lynn Simon, MD, MBA,
President, Clinical
Services & Chief Quality
Officer, Community
Health Systems
Afternoon Session III - TheVanderbilt
TransformationJourney
C. Wright Pinson, MBA, MD,
(co-presenter), CEO, Hospitals and Clinics
at Vanderbilt University Medical Center
Marilyn Dubree, MSN, RN, NE-BC
(co-presenter), Executive CNO,
Vanderbilt University Medical Center
The Vanderbilt Transformation Journey
C. Wright Pinson, MBA, MD
Deputy Vice-Chancellor for Health Affairs
Chief Executive Officer, Vanderbilt Health System
Senior Associate Dean for Clinical Affairs
Marilyn Dubree, MSN, RN, NE-BC
Executive Chief Nursing Officer
Senior Associate Dean Clinical Practice
Not-for-profit Academic Medical Center with 139 year history in Nashville
(Middle Tennessee)
Vanderbilt University Hospital
Monroe Carell Jr. Childrens Hospital at Vanderbilt
Vanderbilt Psychiatric Hospital
The Vanderbilt Clinics
1000+ beds combined
Middle Tennessees only Magnet designated organization
Second designation received April 2012
About Us
19,600 employees
6000 nurses
Largest private employer in Middle
Tennessee and second largest in the state
Vanderbilt is unique in the region with
the only:
Level 1 Trauma Center in the area
Level 4 Neonatal ICU in the area
Comprehensive Cancer Center for adults and
children
Dedicated Burn Center in the region
Largest and most comprehensive transplant
program in the region
Provides $770 million a year in
uncompensated and charity care
(FY 2014)
Economic impact on community of
over $6.5 billion annually (FY 2012)
Most comprehensive childrens
hospital in the multi-state area
(serves as a regional referral center)
Agenda
The Imperative for Change is Unrelenting
Leadership
Leading through Change
Paired leadership
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
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Per Capita National Health Expenditures
$8,000 per person
$151
1960
$605
1975
$4,781
2000
$13,654
2019
Source: CMS
For the entire U.S., this is ~$2.5
trillion, or ~17% of GDP
$200
1965
6% annual
growth over
last decade
Expenditure Trend is Not Sustainable
We are smart people right?
Insanity: doing the
same thing over and
over again and
expecting different
results. Albert
Einstein
http://www.brainyquote.com/quotes/quotes/a/alberteins133991.html#xC1u6Gsf
u50wfO0l.99
https://plus.google.com/+AboutAlbertEinstein#+AboutAlbertEinstein/posts
FOCUS has
been on the
10%
$2.8 trillion
of
Health Care
Spend
Simple Math
10% of the Cost is the Healthcare System
Lower the cost of the healthcare system by 20% you only impact 20% of the 10%
20% of 10% is 2%
Hard to beat inflation at this rate
90% of the Problem and therefore the Solution sits elsewhere
Continual Focus on Cost Cutting in the Healthcare System could be
described as Insane
TN: Rank
40-50
TN
11-22
New Model: Blurred Lines but Clear Focus
Roles Merge & Align to Hit the Sweet Spot
Patient/
Population
Insurance
Commercial or GVT
Provider/
Network
Rewarded when
they care for Patients
their Patients are Healthy
cradle to grave affordable care
taking on more responsibility
for the health/education of
the population
Rewarded when
they care of themselves
seek care when
appropriate
Find alternatives to unsafe
habits
Rewarded when
manage healthcare revenue
responsibly and effectively
ensure access and equity across
the population
Provide Policy that creates
health incentives
The Sweet Spot
Appropriate Health Care
at a cost we can all afford
Articulate a vision.
Devise and implement strategies.
Think ahead; decisions are not in isolation.
Assemble resources and deploy incentives.
Adjudicates conflicts.
Leadership is contextual. In urgent circumstances, people
follow certainty versus deliberation.
Nannerl Keohane: Leadership
Leaders
Determine/clarify goals for a group of individuals
Mobilize energies of group to accomplish these goals:
Selecting Clinical Leaders
Respected colleague
Day to day behavior consistent with service excellence
Articulate
Relentless commitment
Higher vision level
Leadership and Management Skills
Technical/Functional/
Managerial Skills
Financial Management
Process Analysis & Redesign
Performance Management
Operations Management
Business Planning
Written, Oral & Computer
Presentation Skills
Humanistic/Charismatic/Leadership
Skills
Ability to Conceptualize & Articulate
Values & Vision
Pride Building
Change Management
Inspiring & Mentoring
Team Building
Political Acumen
Risk Taking
Relationship Skills
What uniquely characterizes a relationship is TIME and ATTENTION
Build the intangible asset of goodwill
Build the feeling of team
Nurture and cultivate personal as well as professional relationships
Know the culture & politics
Institutionalize pride & relationship efforts
oInspire
oHumanize
oRecognize & Reward
Relationship Key: Compliment to Criticism Ratio
Negative
1 compliment
1 criticism
1 to 1
Neutral 2 compliments
1 criticism
2 to 1
Positive! 3 compliments
1 criticism
3 to 1
What Do Colleagues Want/Need?
A good supervisor
Opportunity for personal development
Appreciation
To know the organization has purpose and is moving
in the right direction
Good interdepartmental relationships
Efficient work systems
Tools and equipment or know why not available
Changing the Direction of Businesses, Organizations or
People is no different than changing the direction of any
body or object.
They all obey Newtons Laws of Motion
1
st
Law: every organization in a state of uniform motion tends to remain in
that state of motion unless an external force is applied to it
2
nd
Law: the rate of change in motion of an organization is proportional to
the force acting upon it and inversely proportional to its mass/size
3
rd
Law: for every action there is an equal and opposite reaction
Change Equation for Organizations
Change will only occur when the following primary elements are in
place:
Dissatisfaction with the present state
Vision of the future
Clear First Step towards the future
Change Equation: Successful change takes place when you elect to
be change DRIVERS
Change Equation
D: Dissatisfaction with the current state
R: Recruit critical mass/Re-align Key influencers
I: I
st
step: what will be different tomorrow?
V: Vision (Aim/Goal) New Direction
E: Ethical : Change must be evaluated in relation to values
R: Remove Resistance
S: Sponsor visible, especially when things get tough
D: Dissatisfaction with the present state
Communicate what happens if you dont change
Draw parallels to other groups, companies or organizations
If you cant move people out of their comfort zone change is
very difficult
Consequences if we dont change
oLose market share
oLose customers
oLose jobs
oLoss of benefits
oLoss of face/credibility
1
st
Law: every object (person/organization) in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it
2
nd
Law: the rate of change in motion of an object (person / organization) is proportional to the force acting upon it and inversely proportional to its mass / size (tradition we
have always done it this way)
Curious and Crazy
will try anything -
even if it will not
work not always
the best people to
hang out with often
lose interest before
change complete
Curious and Clarify
they invest some time
in understanding
the value and
can spread the word
Flexible
Can be convinced
based on logic
value and benefit
Find the Skeptics Avoid the Cynics
Listen to them as they see things
early Adopters miss. Your job is to
address
Real potential problems
that skeptics see
Cave People
leave them alone
youll never convince them
to change so dont waste
your time trying
Rogers: In 1962 Everett Rogers, a professor of rural
sociology published Diffusion of Innovations
Share of hearts
and minds
R: Recruit Critical Mass/Re-align key influencers
2
nd
Law: the rate of change in motion of an object (person/organization) is proportional to the force acting upon it and inversely proportional to its mass (tradition we have always done it this way)
2
nd
Law: the rate of change in motion of an object (person/organization) is proportional to the force acting upon it and inversely proportional to its mass (tradition we have always done it this way)
Force Field
Analysis
Support Drive Engaged/
Let
Oppose Action
Adult
Hospital
o x
Loss of revenue for VUH need to develop a share mechanism
COO
o x
COO needs to support project and not drive it too involved
Project
Leader
o x
Project leaders needs to drive program and get COO to move out of day to
day activities
Charge
Nurse
x o
Charge Nurse causing confusion by driving the project in his own direction
rather than the agreed direction
The Mass of the organization will reflect the Force needed for a particular rate of change needed.
Large Organization > Large Force or Pivot Point> to get things moving
R: Recruit Critical Mass/Re-align key influencers
I: I
st
practical step for people to take
What can individuals do differently tomorrow that puts you on the path to
change?
Make it simple
Make it action
Makes sense has to tie to the vision
Today
Future
Navigation Map Key Milestones
Wash your hands, Be on Time
1
st
Law: every object (person/organization) in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it
2
nd
Law: the rate of change in motion of an object (person / organization) is proportional to the force acting upon it and inversely proportional to its mass / size (tradition we have always
done it this way)
V: Vision (aim, goal, objective, mission)
Vision without action is merely a dream. Action without vision just
passes time. Vision with action can change the world. A true leader must
first see an idea as opportunity, then choose to act upon it. Joel Barker
If you believe it, youll see it. Dewitt Jones
Every project, mission, organization needs to have something it is aiming
for
If you dont know where you are going any road will do
1
st
Law: every object (person/organization) in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it
E: Ethical
Without Ethics some changes although successful are inappropriate
Genghis Kahn
Enron
Make sure what you are asking for is consistent with culture/values of
the organization or society
Psychological Contract
Above and Beyond the employment, sales, legal contract
Factors in value statements and behaviors
3
rd
Law: for every action there is an equal and opposite reaction
R: Remove resistance
For every action there is an equal and opposite reaction
Change the Operating Hours in OR People like the hours they work
Hospital builds fewer ORs
ORs run more efficiently
We can see more patients
We cant run efficiently as it is
Patients will just get crammed into a tighter schedule
We are already stressed out
Listen to objections, work to remove
them, and the change will happen
Dont pile it on over here resistance will
naturally rise to meet anything you add to this
side of the argument
3
rd
Law: for every action there is an equal and opposite reaction
S: Sponsor
Someone who can influence across departments/functions/access to
customers
Is respected and recognized by the organization/customer
Invested in the change will roll up sleeves and get down and dirty if
needed
Not involved in the detail
Removes resistance that the team cannot remove on their own
Summary
Change is difficult and Newtons 3
rd
law will apply regardless of
how good you are at the change equation or applying Newtons 1
st
or 2
nd
law
Be Change DRIVERS
oEasy to say, difficult to do
People naturally resist change
oOnly 2% of the population are crazy enough to accept change without
question
oSo you have to constantly work on getting the critical mass on board
Remove resistance you will be amazed at how much forward
motion can be achieved when there is no resistance
Change Leader
Identify time for change
Share the vision so others understand
Design comprehensible changes that staff can implement
Clearly communicate
Convert anxiety and resistance into energy
Create excitement and get people moving
Keep staff focused on priorities during change
Source: www.thechangeforum.com/Leading_Change.htm, pulled August 7, 2013
Lead Successful Change
Build the case for change
Create buy-in with staff
oProvide information
oAddress individual concerns
oAddress implementation concerns
Provide feedback measure & report impact
Speak with One Voice
Solicit cheerleaders from early adopters
Continually refine and improve
Source: Blanchard, Ken, Mastering the Art of Change, www.trainingjournal.com, January 2010
1% inspiration, 99% Perspiration
If you want to make enemies, try to change something.
Woodrow Wilson
"At every crossroads on the path that leads into the future,
tradition has placed 10,000 people to guard the past Materlink
If you dont like something change it; if you cant change it, change
the way you think about it. Mary Engelbreit
If you want to truly understand something, try to change it.
Kurt Lewin
Preserve the Good
Preserve and nurture the uniqueness of the organization, while
adjusting the cash generating core business.
Maintain Service Standards Patient Promise, access,
coordinating care, connecting and communicating well.
Patient Safety and Quality Must maintain patient safety
without incurring a major error
Must keep growing
oBuild products people want and need
oProtect high margin income lines from competitors
Maintain the Culture
Keep central and support the mission and vision of the
organization
Must maintain corporate integrity
Must keep work force motivated
Treat people as well upon leaving organization as on hiring
Focus on stellar communication with your doctors and your staff
Manage the Change
Move at a pace to preserve power and performance of the
institution. Change is certain; the speed of change is an important
consideration.
Must develop confidence in the organization
Must develop enough management band width
Calculate accurate savings--noting inevitable unintended
consequences
Leading Through Change
70% of all change initiatives fail
29% of change initiatives have no formal structure
The simplest definition of leadership is
the ability to produce change.
Peter Senge, Director, Center for Organizational Learning at the MIT
Sloan School of Management
How We Got There
Performance
Excellence
A Culture of
Excellence
Paired
Management
&
Governance
Continuous
Quality
Improvement
Supportive
Work Place
Infrastructure
& Tools
Foundation of
Science
Paired Management & Governance
A Shared
Direction
Progress
Tracking
Goal
Setting
Performance
Excellence
Culture of
Service
Excellence
Paired
Management &
Governance
Continuous
Quality
Improvement
Supportive
Work Place
Infrastructure &
Tools
A Shared Direction
Paired Management
Ensures the pairing of
experienced administrative
leaders with experienced
clinical leaders
Direction for the organization
is maintained with both
medicine and business in
mind
Clinical Enterprise
Executive Committee
& Clinical Enterprise
Group
Set direction and goals for the
clinical enterprise
Review performance and set
budgets
Goal Alignment
Establishes consistent
behavior and language within
the organization
Identifies action items needed
at all levels of the organization
and drives ownership
Performance
Excellence
Culture of
Service
Excellenc
e
Paired
Managem
ent &
Governan
ce
Continuo
us Quality
Improve
ment
Supportiv
e Work
Place
Infrastruc
ture &
Tools
In Conclusion
Performance
Excellence
A Culture of
Excellence
Paired
Management
&
Governance
Continuous
Quality
Improvement
Supportive
Work Place
Infrastructure
& Tools
Leadership in Informatics &
Technology
Education & Professional
Development
Evidenced Based Medicine
Vision & Strategy
The Elevate Program
Collegiality
A Shared Direction
Goal Setting
Progress Tracking
Leadership & Governance
Process Reengineering
A Systematic Approach to Care
Afternoon Session III - TheVanderbilt
TransformationJourney
C. Wright Pinson, MBA, MD,
(co-presenter), CEO, Hospitals and Clinics
at Vanderbilt University Medical Center
Marilyn Dubree, MSN, RN, NE-BC
(co-presenter), Executive CNO,
Vanderbilt University Medical Center
Ninfa Saunders, DHA, MBA, MSN, FACHE,
President and CEO, Central Georgia Health System
Closing Keynote Address