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.

UK and US Health Systems: Can we Learn From Each Other?

Brittany Stollar, 2015 GHLI Fellow

Before this summer, I had almost no knowledge of the structure, the effectiveness, or the political implications of the National Health Services — the United Kingdom’s health care system. When I joined GHLI as an intern, that quickly changed. My first project involved researching the impact of NHS reform on the recent elections in the UK. What really made this experience special was not just that I was learning about the NHS in greater depth, but I got to hear about certain details first-hand when our UK colleagues visited the Yale campus this summer. 

During the week-long Forum, I was surprised to realize how little I really knew about health care systems outside of the U.S. I knew our health care expenditure per capita was much higher than most other countries, but never truly understand to what degree and that we spend more than $2000 beyond that of our closest competitor while still having health outcomes consistently below the average of our peers. I was also shocked by how partisan the Affordable Care Act has been. Unlike in the UK, there is no agreement between the parties on any of the issues raised within the ACA.

Coming from a country that has practiced universal health care coverage since 1948, the UK delegates struggled to understand our political conflict over the ACA. I found myself struggling to understand as well. I hadn’t realized that I’d grown accustomed to debates over the basic human right of available, accessible, affordable, and acceptable health care. While the delegates learned about how to improve the NHS by looking at our system, I learned how we could improve our system by looking at the NHS. During this week, the concept of national agreement on universal health care became less of a myth and more of a feasible possibility.

“Providing Equitable Health Care the U.K. Way”

Modupeore Shenbanjo, 2015 GHLI UK Fellow

Before becoming a graduate student at Yale, I worked as a research assistant in adolescent medicine where I observed multidisciplinary teams caring for patients struggling with eating disorders, drug addictions and teen pregnancy. I often heard in my classes at Yale about how the National Health Services (NHS) provides equitable health care at the point of service. And, now I’m able to see firsthand how the East and North Hertfordshire NHS Trust ensures that no one “falls through the cracks” of health care. 

In my role as a GHLI Fellow, I have been able to interact with the trust management, divisional directors, general managers, service coordinators as well as consulting physicians to assess surgical theatre efficiency such as investigating reasons for late start times for the first patient of day and blockages to quick turnovers in between patients. 

Through various conversations within the trust, it is evident that not only health professionals, but also the general public are proud of their health system and are determined to ensure they continue to meet the expectations of their citizens. 

While observing a surgical procedure, I was impressed at how nurses as well as clinical support workers ensured that each surgery had all the necessary equipment and anticipated possible complications. I also noted that even in a specialty as busy as surgery, senior staff members understood the value of good management and leadership to ensure the needs of each staff member is met and to ensure they create an environment that continues to support learning. 

I have been able to utilize my past research skills, as well as my knowledge gained from my courses in order to collaborate with consultants and investigate the root causes leading to surgical starts and cancelations. It’s been an exciting, informative journey thus far.

“To be amongst the best…”

Drew Weil, 2015 GHLI U.K. Fellow
You don’t have to go far to find a British citizen that is proud to receive health care through the National Health Service. It is one of the country’s sparkling achievements and a system that people from every social class and demographic endear. 
My fascination for how the U.K. can care for literally every member of their society so well was what drove me to this GHLI fellowship working for the 12 weeks with the East & North Hertfordshire NHS Trust. And subsequently, I wanted to understand what can we learn and apply to improve our own U.S. healthcare system. 
My work here is largely focused on improving the care and services provided for frail and elderly people. I believe that the way a country and health system cares for their most vulnerable populations is a good test of its conviction to humanity and civility. In this Trust, there are many stakeholders eager to work towards and progress forward with this aim. 
However, with a more diverse stakeholder group, also comes opportunities for redundancies and inefficient work processes. I am able to work with each of these groups – which include community health care providers, social service leaders, NHS commissioners, hospital administrators, physicians, government representatives, and others – to find a common approach to improving care and healing that is provided. I’m excited and feel a sense of accomplishment when I can apply concepts I’ve learned in my Health Care Management coursework and past work experiences. Whether it is interpreting data, discussing the economics of the NHS, or watching the hospital operations in real-time, it is an amazing feeling to see the pieces begin to come together.

Although the weather is typically grey and overcast, the people have been warm and cheerful. It is an inspiring group of people to work with, and it makes it very easy to wake up, be motivated and want to contribute-to and improve their community! “Cheers!” 

Learning Beyond the Lectures

Joan Rhee, 2014 GHLI Intern

Last week, Yale welcomed United Kingdom National Health Service visitors for the International Health and Social Care Leadership Programme (IHSCLP). The IHSCLP is a partnership between GHLI, the South Essex Partnership Trust, and Health Education East of England. Participants learn different problem solving strategies and explore public health issues in their respective home institutions for nine months, eventually presenting their final findings to Yale faculty. I had the amazing opportunity at GHLI to help organize this program and attend it as part of my internship here this summer.

The delegates’ visit was filled with lectures from Yale faculty on various issues as well as field assignment presentations from program participants. We also visited local healthcare facilities, which promoted an enriching exchange of ideas between health management experts from the UK and US. After learning details about the Affordable Care Act, delegates were visibly dazed by the scope of our problems. They asked if I thought there was hope for the American health care system, and I said I honestly wasn’t sure.

During the celebratory final dinner on Thursday night, I was asked again–do I think there is hope? I reflected on everything I learned this week through conversations, lectures, and the delegate presentations showing how each participant had managed to make a difference, ranging from better budgeting for specialized services to improving efficiency in acute hospitals. I DO have hope.

Despite my having much to learn, this internship has shown me that the American healthcare system is on an upward trend and there is a continuous desire to improve. The experience of working on IHSCLP has solidified my desire to work in global health, and I am extremely thankful for the opportunity and learning this internship has brought me.

GHLI Hosts U.K. Visitors for Training Conference

In July the Global Health Leadership Institute hosted the International Health and Social Care Leadership Programme, a partnership between GHLI and the South Essex Partnership University NHS Foundation Trust (SEPT).  SEPT provides health care services to U.K. communities and has a partnership with GHLI to strengthen the capacity of health and social care leaders.  The 18 delegates worked with GHLI on  field assignments tackling public health issues, and presented their final assignments at the conference.  Delegates also heard lectures from Yale faculty and visited health care facilities in and around New Haven.

GHLI faculty director, Elizabeth Bradley, Ph.D., provided a history on health care systems in the U.S. including community health care centers and health maintenance organizations.  Dr. Bradley highlighted the physician-led Geisinger Health System in Pennsylvania as a model of high quality integrated health care services.  She ended her presentation with a charge to delegates to continue brainstorming ways in which health care systems can be improved.

Site visits to health care facilities are a key part of this program.  Delegates visited the Smilow Cancer Hospital, Yale-New Haven Psychiatric Hospital, Connecticut Valley Hospital and the Cornell Scott Hill-Health Center.  Following the site visits, delegates shared their experiences.  They were impressed by the investment several of the facilities made in their employees, from their interview stage to ongoing reinforcement for employees throughout their careers.  “We struggle to get staff feedback and retain employees for any length of time,” said one delegate.  “The investment in employees we observed set up a strong system for employee engagement and long-term retention and that is something we can do better.”  Delegates also noted that the U.K. seemed to be better at long-term follow-up with patients after they left a hospital.  This type of follow-up helps them rate the quality of care, which is something they felt could be improved in U.S. hospitals.

The SEPT delegates said they felt re-energized to tackle challenges they face as health care leaders and plan to continue working together.

Health Care Administrators Present Cost- Saving Innovations to U.K Visitors

At the Yale-SEPT International Healthcare Management Programme session last week, a panel of three health care administrations from Connecticut and New York presented cost-saving innovations that have been implemented in local health management systems.
The first panel member to speak was Gayle Capozzalo, executive vice president, strategy and system development, Yale-New Haven Health System (YNHHS). She explained how the YNHHS – which encompasses three hospitals in diverse demographic regions of the state – was charged with cutting costs that would have resulted in lost jobs. Instead, they hired consultants to observe the hospital staff and determine what changes could be made to increase productivity. Their discoveries – including the fact that more than 50 percent of nurses’ time was wasted on administrative duties – led to an overhaul of procedures, implementation of more efficient technology and standardization of the shift change process. Although administrators faced some resistance to change, staff time is now more productive and patient satisfaction has increased.
Next, on the panel was William Gillespie, senior vice president and chief medical officer of Emblem Health, a not-for-profit health care provider. Mr. Gillespie shared with the audience that Emblem Health is faced with the question of how a health insurer can add value during this time of health care reform. He explained that health care providers need to be patient advocates; helping people coordinate their care and navigate through the sea of information received during medical treatment. Emblem Health’s began by designating nursing personnel, clinical advisors and social workers to assist patients who are transitioning from in-patient to home care. These advisors develop personal relationships with patients and help insure that there are no oversights in a patient’s care. The program has resulted in a reduction in preventable hospital readmissions, saving both money and manpower.
The third panelist was Steven Merz, vice president of administration, Yale-New Haven Hospital (YNHH). Mr. Merz discussed an issue that YNHH faced regarding the care of mentally unstable patients throughout the hospital. The costs of behavioral health services are largely not covered by insurance. Add to those costs, the numerous hours spent by staff trained to service medical and surgical issues trying to assist patients with mental health issues while still trying to keep a safe environment for other patients on the floor. Patients in need of behavior health care were being caught in the middle — they couldn’t stay in the hospital because insurance wouldn’t pay, and they had nowhere else to go. So, YNHH created Behavioral Intervention Teams. The teams are comprised of psychiatrists, nurses and social workers who accompany the medical and surgical team on rounds to observe patients from admission, essentially upending the consultation process. After a month, the new progress of this innovation was reviewed and revealed that in cases where the behavioral team was involved; there was a significant reduction in the length a patient stay and there haven’t been any denied days by the insurance companies. The team’s involvement also affords each patient better integration between physical and mental health care provision.

Nina Gumkowski, GHLI Intern