Someone once told me you can't go wrong invoking big names to bolster your content. So I'm invoking an old stand-by for this week's article: Aristotle.

Aristotle - and the Greeks, in general - did a lot of what we don't seem to do much of - thinking about their thinking.

Ari also came up with an idea that is foundational to personal success and happiness - a principle that eludes us more and more as we negotiate a helter-skelter, tweet-based culture.

It's another big word - eudaimonia.

Read the Full Article and find out what this twelve-cylinder word means - and then let me know your thoughts.

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How are you taking care of your employees during the holidays?

The holidays are considered a time of year when families gather the most. Consider this: are your newer employees able to enjoy this time with family? Is the time off policy equitable in your organization or are you, as a leader, shackled to the “way we’ve always done things” mentality of your organization’s culture? Are new employees offered the same time off considerations as those with seniority, or are they just the “low man on the totem pole” and have to wait for another new employee to come before enjoying the luxuries of seniority? Are you having problems retaining employees?

When you round on your employees (and as a leader you should be rounding regularly on your employees), ask them if they feel they get enough time off during the holidays. Ask them if they feel the culture of holiday time off requests are equitable for ALL employees. Then, look at your holiday PTO policies. Oh! You don’t have a separate one for holidays and regular time off? Interesting. Have these policies kept up with the newer workplace standards and the expectations of current generations? Studies have shown that current generations value time off. It does not mean they will work any less hard or be unproductive. They are just looking for that work-life balance.

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With increased calls for healthcare pricing transparency from consumers and government entities alike, hospitals’ chargemasters are moving from proprietary information to public knowledge. However, putting chargemasters under the microscope has not led to the clarity that patients are seeking regarding quality care at a price they can afford.

Nearly two-thirds of physician respondents in a 2019 NEJM Catalyst survey said that patients do not have enough information to affect the cost of their own healthcare–related decisions, and more than three-quarters of respondents say that assessing the total cost of care is extremely challenging for patients.

Rather than increasing understanding and empowering the consumer, hospitals’ efforts to be open with their charges have highlighted a fundamental misunderstanding between hospitals and payers, and the patients they serve: the definitions of the terms “charges,” “payments,” and “costs.”

A difference in terms

In public discussion of healthcare costs, these terms are used interchangeably, but in fact have completely different meanings to hospitals and insurers. A “charge” is the price listing internally for the hospital and the starting place for negotiations with insurance companies.

In public discussion of healthcare costs, these terms are used interchangeably, but in fact have completely different meanings to hospitals and insurers. A “charge” is the price listing internally for the hospital and the starting place for negotiations with insurance companies.

It is almost never the amount that an insured patient is billed—hospitals in the U.S. billed an average of 3-1/2 times what they received in payments for all of the services they provided in 2015, according to True Cost of Healthcare. The term “charge” is just the sticker price. While hospitals are getting better at reducing the actual cost of care-to-charge ratio, it isn’t reimbursed that way by insurance companies, which will be prohibitive in moves toward reducing the “charge” amount.

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With challenges such as the rising cost of healthcare, red tape that can create obstacles to providing quality patient care, or adjustments that come with increased transparency requirements, it can be easy to let discouragement color your outlook on the future of the healthcare industry. But I sincerely believe that this is the best time in history to be part of this field. We have the ability to impact people’s lives and futures like never before. There are countless technological innovations that are truly providing better care for patients at lower cost, creating better patient experiences and thriving communities.

I have had the privilege of working with several developers and inventors who are designing cutting-edge innovations that give me such hope and excitement for the future of healthcare. Here are just a few examples:

Improving patient experience

Wait times in a clinic or hospital ER have long been pain points for patients—and healthcare organizations are feeling the pain too in the form of low patient satisfaction scores that negatively impact reimbursement from insurance companies. Technology is being developed that gives updates on wait times and care directly to the phones of people in the waiting room via Bluetooth connections. Furthermore, hospitals can use this data to track and improve their process flow to reduce wait times, educate their staff, and lower the cost of care by increasing efficiency. Read full article.

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Remember the last time you were "in the zone" where you became so immersed in something you loved that time disappeared and the work just simply flowed without much effort.

Maybe it was at work, or at play or being immersed in a favorite hobby. Regardless, it's one of those infrequent conditions that can contribute to life satisfaction.

Mihaly Csikszentmihalyi, Hungarian-American psychologist formalized the condition with his 1990 book, "Flow", revealing his research on the nature and importance of finding something that can take you "into a zone" or what he called a "flow state".

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I am often asked today if I am a doctor or an administrator, my response is both, always! You might ask, can a physician really be both? The answer is yes, BUT not every physician. If you take the group of all physicians, the first cut is those that are interested, then it is narrowed by those that are prepared: either through formal education, life experience or both, and the final cut is those that have the demonstrated ability to lead by inspiring a diverse team and operationalizing a vision. Today this represents a rather narrow playing field.

It is important to remember that doctors are different; many have dreamed of being a physician since childhood, and rank among the best and brightest, with often only the top 0.5% of high school students eventually being accepted into medical school.

Physician Executives are wired differently; they are decisive, based on an unwavering priority hierarchy:

• Patients
• Mission of the Organization
• Personal Needs

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I’ve read a number of articles on the Iceberg of Ignorance, originally published in 1989 by Sidney Yoshida, reporting that top leaders only understand about 4% of what is going on in their companies. Does this sound right to you? If you are a CEO, you may not believe it, but do we really know? If you are a manager or supervisor, you may believe this about your bosses, but not yourselves. If you aren’t a manager or supervisor, but report to one, you may completely agree with this statistic!

While no leader in a large organization can truly know everything that happens on the front line, what are the best practices we can employ to ensure that we stay in touch with our staff? With our busy meeting schedules, how do we get in touch with what is really happening in our organizations?

I have used a few tactics over the years. Besides rounding on patients and staff, which I truly enjoy, I love to be present at as many recognition events as possible - quarterly leadership awards, patient experience milestones, annual tributes to Nurses, Doctors, Allied Health, etc. “Lunch with Lee Ann” is monthly event that I started years ago with both managers and staff.

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The deeper I get sucked into this vortex of dialog about aging – older vs elder, saging versus aging, retirement versus rewirement, etc., etc., ad nauseum – the more I sense that we are creeping to the edge of an age-agnostic era.

What does that mean? It means that instead of our identity being tied to a number it will be tied to how we choose to pursue our life.

Show of hands: how many of you mid-lifers and beyond would find that refreshing?

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Stan is a C-level executive in his late fifties. He’s done well, thriving and progressing in the volatile, high-pressure world of healthcare. Also, like many at his level in this chaotically-evolving industry, his career was recently disrupted when he was laid off, despite a stellar performance record, following the merger of two health systems.

Rather than withdraw and lick his wounds, Stan wisely invested in a career-transition program that equipped him to re-enter the industry at a level very close to what he was when laid-off. His successful re-entry happened in just under six months, about half the amount of time re-entry takes for most execs at his level.

I connected with Stan just as he was wrestling with which of two attractive offers to accept to continue to move his career forward – a situation I consider to be a “high-class problem”.

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"It’s not so much what we have in this life that matters. It’s what we do with what we have."
-Fred Rogers

In my years serving as CEO of healthcare systems, I always took special care around this time of year to express my thankfulness to our employees for their hard work and compassion, and for the amazing work we get to be part of every day in the healthcare industry. This year, I would like to share what I am grateful for with you—my friends and colleagues—in hopes that you will stop and reflect on the many blessings in your life and work, and find meaningful ways to share that gratitude with those around you.

1. Compassionate, dedicated healthcare professionals

It is the caring, brilliant, committed people we work alongside every day that make this such a special time to be part of the healthcare field. Together we have the privilege of healing and inspiring our patients and communities. It is an honor that I do not take for granted.

2. Innovation and advancements

In the span of my career, I have seen incredible advances in the medical field. 90% of what we do in hospitals today wasn’t available to patients 50 years ago. From digital technology to curing diseases, innovations in modern medicine are increasing people’s quality of life.

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HIGHLIGHTS SHARED AT THE TELEMED IQ SUMMIT 2019, NASHVILLE, TN

Attaining most any goal or dream requires us to do something different, which goes against the natural human tendency to stay in our comfort zone. Transformation has to start with change, but we resist change until the pain of staying the same exceeds the pain of change...yes, PAIN is the catalyst and friend of transformation.

Understanding the difference between change and transformation is important. Transformation requires a change of culture. A change of culture requires strong leadership, the kind of leadership comfortable with creative disruption. To simplify the difference between change and transformation remember that checking off items on a “To Do” list can bring change, but transformation requires completing items on a “To Be” list.

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A hospital’s charge description master (CDM), or chargemaster, is often referred to as the “heart” of the healthcare revenue cycle. It includes codes for every procedure, material used, medication, and service that a healthcare organization provides its patients. It is the structure that drives the hospital, and is the starting point for billing patients and insurers and complying with public reporting. A typical health care system chargemaster may contain 15,000 to 25,000 entries, according to Becker’s Hospital Review.

Neglecting your chargemaster can lead to inaccurate billing, regulatory risks, claim issues with payers, and low patient satisfaction scores, all of which affect your healthcare organization’s revenue. Your hospital can’t afford to overlook this essential piece of its operations. Ongoing evaluation of your chargemaster with an eye toward increased calls for pricing transparency in the healthcare industry is the key to maintaining a chargemaster that will serve your organization, as well as its payers and patients.

Ongoing maintenance

With so many diverse components in a chargemaster, it can be extremely difficult to set up correctly. Failing to update any of the components can result in negative outcomes for your healthcare organization. Often, when hospitals add new items to their chargemaster, they simply copy existing charges. However, this can be problematic because the new charges may not have the same requirements (e.g. CPT codes, modifiers, revenue code, or pricing) as the item being copied. Care should be taken to make sure the new charges are set up correctly.

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Whether coming from outside your organization or internally within your own hospital or health system, crisis situations have a lasting mark on the healthcare organizations they impact—and the CEOs who run them. Disasters—and how executives respond to them—can cost them their jobs and, more significantly, the public’s trust in their organization.

The fact is, you can have the best health system in the nation, and one crisis can eliminate years of goodwill and good work. Clear, decisive, prompt communication from a healthcare organization’s CEO is the key to navigating disasters while maintaining trust.

As a leader, you must bring calm urgency to communications with:

1. Your employees,
2. Other organizations and stakeholders in the community,
3. And the general public

Employees

When a crisis occurs, many executives focus primarily on their message to the general public, trying to provide accurate, up-to-date info, stay ahead of public opinion, and set the tone for communication about the incident. While this is certainly important, it is also essential to provide care and attention to your employees.

In times of crisis, a lack of stability impacts the workplace culture. Employees at every level of the organization will feel the effects of this. As an executive, it is your responsibility to ensure your hospital’s greatest asset—its people—receive accurate and timely communications regarding the crisis your organization is facing. Make your confidence in your staff clear, and actively seek out ways to be a source of stability.

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“Don’t go walking around like you just hit a triple – when you were born on third base.”

- unknown

“He wants to know why your skin is white and his is black,” clarified my translator. The Tanzanian boy, about 10 years old, was pointing to the skin on his hand and then to mine. His question in this remote kijiji (Swahili for village) was as arresting and profound as the inequities in global health.

My global interdisciplinary health team was in Africa as part of a feasibility assessment in partnership with a Tanzanian team to determine how to improve health in the region near Lake Tanganyika, which borders western Tanzania. While Tanzania is considered a low-resource, less developed country, the western region is considered the least developed area within this ‘third world’ country.

The local team was dedicated and committed to make a difference in the health of the people in the region. They believed that they needed a hospital and many clinics to do this since they knew that my colleagues and I had led hospitals and clinics in the U.S. and in eastern Tanzania. But my team was convinced that exporting the U.S. acute care model was not going to help them improve health, at least not nearly as much as investing the few available resources in other more impactful social determinants of their health. In addition, the local team did not have the resources, expertise or mission to expand the existing healthcare system.

First world population health is not an effective solution for Third world health challenges. First world population health efforts are often supported on the back of an acute care funding chassis: a hospital or healthcare system with access to a reimbursement system to sustain it. By design and nature, first world population health is typically incremental: icing on the core fee-for-service reimbursement cake.

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With an unprecedented number of healthcare provider mergers and acquisitions in recent years and new requirements being ushered in with the Affordable Care Act, healthcare professionals are in a constant state of technology systems transition. Though replacing a legacy system can be necessary and even beneficial to patient care or a hospital’s bottom line, times of transition deeply impact the people these organizations are relying on to provide quality care and keep the healthcare organization running efficiently.

To consider the implementation of a new system a success, you need to do more than make it to launch day on time and under budget. Your employees—the intended users of the new technology—need to understand the “why” behind the switch and actually use the system as intended with their sanity intact. In my experience, this can only be accomplished by engaging your people and giving them a voice at every step in the process.

Preparation

Before selecting a new system for your hospital or healthcare organization, it is essential to get the right people at the table to create a roadmap for the transition process. Be sure to involve and gather feedback from:

• Employees who can think critically about workflow efficiencies so you can ensure that you aren’t carrying bad practices forward with the new system.
• People who are highly knowledgeable about the current technology in place and its limitations. They will have invaluable insights into problems that any future systems need to solve.
• Anyone who has a vested interest in the new system. If the new technology is clinical in nature, you need to make sure physicians and nurses have a voice. If it’s a change in back-office technology, human resources professionals or accountants who will use this technology regularly will need to be invited into the conversation.
• Any department who will deal with a heavier-than-normal workload during the parallel running process or launch.

These groups have the expertise and high levels of investment to help your executive team document your current process, find the right technology to replace your legacy system, determine real costs, and set a reasonable timeline.

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When it comes to building a strong leadership team, choosing top talent isn’t the only priority; building a culture of trust is also essential to growth and success. According to a recent PwC survey of more than 1,400 CEOs worldwide, more than half of organizational leaders believe a lack of trust is a serious threat to the success of their teams and their business. However, if you are aware of the importance of trust, and actively working to make it part of your workplace culture, you can use it as an asset to your organizational function, rather than a liability.

Environments where trust is a key component encourage innovation, increase the pace of decision making, and often team members outpace their competition. The Workplace Therapist Brandon Smith insists, “Trust enables teams to not just take risks but also to move more quickly. There’s little second-guessing in high trust environments because team members assume there’s positive intent.”

It’s hard for teams to move forward effectively if they don’t trust each another. Instead of innovating, they are second-guessing each other, unnecessarily reworking tasks, or relying on one or two key team members to get the work done. I have found that when you have trust, things move much more efficiently. You have the ability to take the risk because your team feels comfortable and supported.

Trust is key, and risk, innovation, growth, and expansion can only happen when you have a solid foundation of trust to build upon.

To maximize your organizational potential and lead in your sector and community, you have to create a climate of trust and transparency.

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Cheryl, a patient of a large, multi-city health system, received a call from her insurance company. Looking at Cheryl’s medical history, you’ll find her Type 2 diabetes is well-managed with oral medications. She sees her endocrinologist every six months to monitor her blood glucose and lipid profiles.

One day she received a phone call from her health insurance provider indicating that she could save substantially on her insurance copay by switching one of her daily medications. In the same week, she received a phone call from the local pharmacist who said the insurance company had contacted him asking he suggest changing this same medication.

Cheryl was frustrated and confused by the conversations because she adheres to her doctor’s care plan, and her diabetes is well-maintained. At each appointment, the endocrinologist indicates there is no reason to change any of her medications.

So, at her next appointment with this doctor, she mentioned both phone calls. After discussing the suggestion, her doctor indicates he doesn’t see a need to change medications if the current medication is not creating a financial burden on Cheryl.

In the end, Cheryl is pleased with the care she receives from her doctor, trusting his judgment and knowledge of the care she needs. However, she’s frustrated by the insurance company’s persistence in wanting her to change medications (because this wasn’t the first time they called about it) and drawing her pharmacist into the conversation to attempt persuading her. She assumes the insurance company is motivated by the financial gains they can make with the pharmaceutical companies, which then trickles down to the local pharmacy.

And, her perception is her reality, correct or not: Her doctor cares about her health, and the insurance company cares about money.

Just like Cheryl’s reality, here are some perceptions that the general population may have that can be overcome through the intentional and conscientious approach to care.

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The question of why some communities and companies grow and prosper, while others shrink or even cease to exist, has intrigued me for decades. Theories exist with no single one applicable to every situation. Two variables stand out to me as “must-haves” to ensure community vitality.

1. Access to high-quality healthcare, and
2. Access to high-quality K-12 education

As a registered nurse I have focused on the delivery of and access to high quality healthcare for the last 28 years. Having cared for patients at critical times in their lives, I have consistently seen how reliable access to affordable, preventive and restorative healthcare services is critical to community health, especially for vulnerable or indigent populations.

My focus on quality and access in healthcare for all populations broadened during my tenure working with large geographies and populations as an experienced healthcare CEO and as a member of numerous boards of directors.

The ability to recruit, develop and retain human talent is essential to the success of any company, and healthcare is no exception. My experience suggests that since 2011, it has become harder to recruit and retain human talent based on each region’s overall access and quality of K-12 education.

In my rural area of Virginia, from a healthcare perspective, recruiting nationally and internationally was challenging for all types of careers, from entry-level professionals, through senior leadership positions. I attributed the recruiting issues to fierce competition over a finite talent pool, but exit interviews and feedback from existing employees and prospective employees indicated that a significant concern was the quality of K-12 education in my area.

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The business world seems to be moving in the direction of business process automation, yet in the healthcare industry only about 20% of provider organizations are widely engaging in hospital financial automation, according to a new Black Book CFO survey.

Automation can result in immediate cost savings, the elimination of duplicated tasks, and improved visibility. For the healthcare industry in particular, the automation of business processes can result in improved compliance, elimination of errors in workflow processes, enhanced vendor management, and better billing practices, to name a few.

So why are so few hospitals adopting automation for their back-office processes? I believe it’s because they have seen that automation technology doesn’t always save money as it claims. I have learned that when automation is employed without critical thinking around cost and workflow efficiency, the result is automation that will only produce unwanted outcomes—faster.

Consider the actual cost.

I don’t want to come across as overly negative toward technology—I love technology! My doctoral studies examined impact of computerization on business administration in healthcare industry. However, through the course of my research, I learned that despite promises to the contrary, technology doesn’t always save you money. In many cases, the difference in cost savings between companies that had completely automated their business functions and those that didn’t use automation at all was negligible.

As I have said before, all technology has a cost beyond the sticker price. Account for all the costs of automation to measure the impact to the bottom line. Things like training, data storage, equipment, and fees to make ongoing changes to the technology as your company’s needs evolve should be considered in addition to the named price of the technology.

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Leaders in the insurance arena gather to discuss innovation while remaining practical and compliant

I recently had the privilege of hosting the Think Tank at the Rise Association West Summit 2019 conference in San Diego, containing many of the top senior-level insurance executives from around the country. These impressive and inspiring individuals provided unique insights into practical and compliant innovation ideas impacting the future of healthcare.

Think Tank participants shared “What’s Working in Their Organization and the Overall World of Healthcare Innovation,” focusing on how to get the most comprehensive, accurate, and robust insights in taking accountability for the health of their members. In addition, we considered the latest innovation in telehealth, predictive analytics, AI, and machine learning. Furthermore, participants discussed the broader view in overcoming barriers to members’ health including social determinants and the keys to provider and payer collaboration in solving many of these issues together.

The final two hours allowed for a vigorous discussion centered on, “What does the Future of Healthcare Innovation Hold,” as we explored drivers of innovation and examined the role of health plans and providers in innovating the healthcare delivery system.

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