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The “After Burn” of Lessons Learned in Hospital Administration

Simon Bragg – Executive Director of Finance and Resources, East Coast Community Healthcare 

Now back in the UK, reflecting on my recent participation in the GHLI Health and Social Care Strategic Leadership Programme at Yale – I am thoughtful of the takeaways from my experiences with both the mental – and physical – aspects of my visit. 
I could wax lyrical about the softer benefits of the programme; the contacts made, the relationships forged and the cathartic nature of shared experiences.  It can be incredibly reassuring to meet like-minded individuals battling similar issues elsewhere in the health system. There is nothing like applying raw theory to a practical situation to embed the learning – and from the presentations provided by the course participants it was evident that our class had taken away a great deal from the course – not only about each other, but more about themselves!
The UK and the US are rather languidly referred to as nations divided by a common language, which works on the level of two health care systems divided in their foundations but united by a common purpose and sharing common issues.  The excellent site visits to regional health care facilities demonstrated that although hospitals seem to face some of the same challenges in both countries, the patient experience is at the heart of everything that we do.  The systems appear to be as similar as they are disparate.

I was inspired by the demonstrable, and personally evidenced, the important link between physical health and mental wellbeing on my professional performance in a leadership role.  Early morning exercise sessions were arranged for course participants and both me and my rapidly tightening muscles were heartened to learn that my invigorated metabolism continues to burn calories for many hours after exercise itself has ceased.  Like the continued burning of calories following exercise – the GHLI programme promotes the survival of mental acuity by delivering both an immediate intellectual perspective as well as a slower burn of on-going inquisitiveness; in short a full-on cerebral workout.

Why We Do What We Do: Marguerite M. Callaway

Growing up in Southern Arizona near the Mexican border, Marguerite Callaway was exposed to many cultures, which ultimately influenced her decision to pursue graduate education in international nutrition, cognitive and developmental psychology, and business. Her career includes position in executive leadership and and partnerships in several international management consultancies, which led to Callaway founding her own leadership institute. 
Callaway currently partners with the GHLI on the Advanced Health Management Program in South Africa.  In this role, Callaway says she had to find the balance with her sphere of concern (global) with her sphere of influence (local).
Callaway shares three insights she has learned in her years as a health care professional:  1) Unfamiliar circumstances often cause discomfort. The more aware we are of how core beliefs affect our personal and professional behavior, the greater our capacity to excel in the global community; 2) When working across cultures, our preferred method may seem efficient, but these assumptions can create barriers to ingenuity; 3) Good intentions and the right motivation are important, but practical skills are a necessity in the health care field.
Callaway emphasizes that the success of any health care initiative depends on how well we listen and adapt to meet the needs of our beneficiaries. She notes that GHLI staff hear what our partner’s goals are and don’t apply ‘cookie cutter’ solutions to its various programs around the globe.  She says that workers/educators “from the outside” can offer insight, tools, and, especially, encouragement to help local partners carry the work forward.   She cites GHLI’s South African partner, the Foundation for Professional Development, of which several of the training course graduates have gone to leadership positions with the provincial departments of health.

When asked what she likes most about her work, she offered: “being involved with GHLI long enough to see many of the graduates of our programs move into ever-greater positions of responsibility and impact. I am inspired by each new group of men and women who enroll in our management training programs. I know the GHLI model of engagement works.”

Moving Research Beyond Journals

Leslie Curry, Ph.D., Senior Research Scientist, Yale Global Health Leadership Institute

Well-intentioned and smart scientists devote their careers to generating new knowledge they hope will benefit the health and well-being of the population, and ultimately, save lives.  The discouraging reality is that only a small fraction (14%) of original research findings are published in scientific journals, and those findings take an average of 17 years to integrate into health care practice and policy. 

Scientists are growing impatient with the gap that currently exists between moving research into practice, and have begun to question whether traditional journals are the best way to accomplish this goal, especially in an era of rapid information dissemination through online and social media outlets. Long publication processes can render findings obsolete before they are even known, the narrow readership of journals consists mostly of like-minded scientists and the static, one-way medium publication format prevents constructive critique and debate that is essential for good science. 

What can be done to best reach appropriate and wider audiences with research findings in a timely manner? The good news is that, in addition to journals reinventing themselves, there are emerging alternatives. First,  the digital communication revolution provides extraordinary opportunities to reach large diverse audiences through dynamic formats such as social media, websites, blogs and online platforms like Tumblr and YouTube. 
In addition, the emerging new scientific disciplines of knowledge translation and implementation science focus on how to move science out of the lab and into the world. Finally, where advocacy has historically been forbidden among scientists, many are mobilizing to bring pressure for research to be more transparent and widely accessible. As a research community, it is our responsibility to leverage these three trends – digital communication, the field of implementation science, and advocacy — to shrink the gap between research and practice and make our research matter. #Reachingwideraudiences.

Redefining the Concept of Health Leadership

Itumeleng Ntatamala, M.D., Community Service Medical Officer

Working in a lower income country’s public health sector is usually fraught with challenges, but this work can be equally fulfilling when a smile is shared…or a life is saved. It was in my first year as a medical intern at Mokopane Regional Hospital in rural South Africa that I found myself faced with either giving into an inefficient system or helping to transform it. Being selected to partake in the Advanced Health Management Programme (AHMP) and Yale University’s GHLI, was life changing as it jump-started an exciting journey of profound self-discovery and professional development.

The AHMP approach to health management is the concept of action research, which requires identifying challenges and then conducting research and continuous self-inquiry to solve those challenges. It was this approach that forced me to reflect on why I was concerned about health systems and how my own values tied into this work — a far cry from my previous notion of leadership that oft times neglected the self and only focused on “getting the job done.” I undertook a collaborative hospital renovation project that saw our hospital’s pediatric ward — which was originally designed for adult patients — morph into a conducive healing environment for children with the support of colleagues, local business and interested community members. Colorful murals and paintings adorned previously dull walls, a kitchen was built to teach parents about healthy ways to prepare children’s food and a secure playground was erected to the children’s delight. The Limpopo Province recognized the transformation of the ward with the Limpopo Province Premiers’ Service Excellence Silver Award for “Innovation in the Public Service.”  

As I reflect on this past year, I started out as a frustrated young health professional in a small town and am now a confident professional with the skills and capacity to lead an award winning team to help improve hospital efficiency and patient care. I am grateful for this work and the group of people with which I get to work. Each day I have the opportunity to redefine my concept of health leadership.

When Every Minute Counts, Even Minor Details Matter to Patient Care

Kim Miyauchi, Chief Nursing Officer
Kingman Regional Medical Center, AZ 

Saving the lives of heart attack patients is one of the biggest challenges for hospitals. When every minute counts, we all need to be looking at the same clock…that is one of the key messages our hospital learned when we examined mortality rates of patients with acute myocardial infarction (AMI). 

Kingman Regional Medical Center (KRMC) discovered that sometimes the simplest solutions can be the keys to saving lives. As part of the Leadership Saves Lives program, KRMC partnered with the Yale Global Health Leadership Institute and we were challenged to examine our hospital culture and treatment methods for patients with AMIs. We were part of 10 U.S. hospitals involved in the two-year program to determine causes of high AMI mortality rates.  

To reduce the AMI mortality rate at KRMC, we examined several possible determinants and honed in on three: 1) timeliness of EKGS; 2) protocols, pathways and guidelines; and 3) discharge process. We first addressed the causes by encouraging more teamwork. We created committees to examine each of the three causes contributing to our high AMI mortality rate. As teams engaged with each other and with other hospital staff they were better able to understand how and why goals weren’t being met and how to improve the results.

For example, a large number KRMC patients arrive at the hospital by private vehicle – delaying the electrocardiogram (EKG) process that normally would take place in an emergency vehicle. Kingman Regional Medical Center strives to complete EKGs within 10 minutes of an AMI patient’s arrival. However, when we reviewed patient charts, we discovered our EKG completion times were inconsistent and recorded times depended on which clock a staff member was using. We had eight clocks in the ER and they were not synchronized. This had to be addressed to improve patient care.

Our hospital replaced all of the ER clocks and synchronized them with our computer system.  This simple, inexpensive solution, along with its other efforts ended up significantly improving timeliness of care. Although all of KRMC’s process changes were not as simple as replacing clocks, we have already seen the efforts paying off with a decrease in AMI mortality rates.

Hospital Change — How to Make it Stick

Amanda Brewster, Ph.D., GHLI research and education associate 

Health care professionals constantly invest time, effort and expense trying new methods to improve care only to see promising innovations evaporate rather than become part of everyday work habits. When this happens, hospitals miss potential performance improvements, waste money and time, and feed quality improvement fatigue among staff.

New evidence published in Implementation Science from the Yale Global Leadership Health Institute shows that there are predictable patterns in what it takes to make change “stick.” Reviewing data from hospitals that participated in the State Action on Avoidable Rehospitalizations (STAAR) initiative, GHLI researchers examined different strategies hospitals tried to reduce readmissions.

The research showed that getting new practices integrated depended on how the integration process was executed. When hospitals appointed staff to oversee that a new practice was performed regularly for several months up to a year, more permanent integrating mechanisms had time to start working. Staff had a chance to feel direct benefits from the new practice – like greater job satisfaction or less stress – which motivated them to keep doing it even without close oversight. Or failing that, job expectations had a chance to catch up with the new practice, making it a non-negotiable part of work.

What should hospital leaders make of these results? Truly integrating a new practice takes patience and extended effort over time. And, staff members’ own desires to improve patient outcomes can give a powerful boost to quality improvement. Ensuring that staff responsible for implementing a new practice have the opportunity to see the positive impacts – through data feedback as well as personal interactions – can enlist them as partners in integrating the innovation into the permanent fabric of the organization.  Finally, the work does not ever go on auto-pilot, but incorporating the effort into ongoing management oversight efforts allow champions to move onto the next burning platform.