The Daily Briefing

News for Health Care Executives

How important is an effective manager?

August 31, 2011

The following is adapted from EEI Insights, the dedicated newsletter for the Employee Engagement Initiative.

While many factors of an organization impact engagement levels, the relationship between managers and employees is arguably one of the most critical. Well managed employees are able to overlook many other shortcomings of their organization, including lower pay, older equipment, and slimmer benefits. The general belief is that people leave managers, not organizations–but how true is this?

Recent research from the Employee Engagement Initiative national database shows that individuals who rate their manager as excellent are five times more engaged than those who rate their manager as poor. Put another way, 85% of employees with excellent managers are engaged versus only 17% of employees with poor managers–that’s quite a large discrepancy. On the flipside, less than 1% of employees with excellent managers are disengaged, versus nearly 25% of employees who rate their manager as problematic.

 

Clearly, managers and supervisors have a profound impact on the work life of the employees who report to them. This responsibility can be daunting--managers can make or break an organization’s ability to retain its top talent. How can we best support them in this critical role?

What really matters to staff?
In order to improve management, we must first understand what makes a manager effective. EEI has isolated ten drivers that measure the quality of an individual’s manager:

Manager Effectiveness Index

  • My organization helps me deal with stress and burnout 
  • My manager stands up for the interests of my unit/department 
  • My most recent performance review helped me to improve 
  • Conflicts are resolved fairly in my unit/department 
  • My manager is open and responsive to staff input 
  • My manager communicates messages that my coworkers need to hear, even when the information is unpleasant 
  • My manager helps me learn new skills 
  • I have helpful discussions with my manager about my career 
  • I receive regular feedback from my manager on my performance 
  • My manager helps me balance my job and personal life
  • My organization helps me deal with stress and burnout 

How should these drivers influence the way managers interact with their direct reports? Our researchers have identified four primary themes from the list above to help translate the data into action.

1. Care for people as individuals, not just employees
Only 36% of employees agree that their organization helps them deal with stress and burnout, despite the fact that it is the number one indicator of manager effectiveness. The good news is it doesn’t take much to make an employee feel valued as a person. Beginning each meeting by asking how their day is going, remembering important personal events, and acknowledging a job well done with a hand-written thank you note are all simple tactics that can go a long way.

2. Provide regular feedback on performance
Four of the ten drivers indicative of manager effectiveness reflect the importance of holding regular discussions with employees about professional development. Ongoing constructive feedback not only helps employees enhance their skills, but also builds trust and encourages open communication among managers and employees. Don’t reserve feedback for formal performance appraisals–give it early and often to promote continued growth.

3. Keep the lines of communication open
Two-way communication is critical to developing a healthy manager-employee working relationship. Employees want to feel as though they are a valued member of the team, and their feedback is appreciated. The good news is we are performing well in this area (nearly 65% of employees feel that their manager is open and responsive to staff input), but there is still room for improvement. Don’t simply gather feedback-–act on it. If a suggestion cannot be implemented, take the time to explain why.

4. Serve as an advocate for employees to both peers and leaders
As more and more demands are placed on frontline staff, it’s increasingly important that they feel supported by their manager. As such, it is not surprising that having a manager who is willing to stand up for the interests of the department is the number two driver of manager effectiveness. Employees want to trust their manager is not only willing to address conflicts among staff and communicate difficult messages, but they are also comfortable representing the department’s best interests to leaders or peers in other areas.

Access now
Employee Engagement Initiative members may access the Dynamic Resource Crosswalk for best practices on increasing manager effectiveness. Daily Briefing readers with questions about the Employee Engagement Initiative may email DBinquiries@advisory.com.

Management jobs take hit

Hospitals slice management roles to balance budgets

August 31, 2011

As hospitals grapple with major reimbursement cuts and uncertainty created by the implementation of the federal health reform law, officials increasingly are eliminating management positions to balance budgets.

  • One Virginia-based health system this month cut 117 senior and mid-level management positions, or 13% of its management team. Eighty-four positions were eliminated through attrition and 33 through layoffs. However, physicians and nurses directly involved in patient care were not affected.
  • A Kentucky-based hospital is cutting 155 jobs less than two years after cutting 500 positions, citing decreased health care utilization and market trends. The organization says its nurse-to-patient ratio will be unaffected by the cuts and one-third of the positions were already vacant.
  • A slew of New Hampshire hospitals have sliced staff in the wake of state Medicaid cuts.

Cuts about current challenges, fear of future pain

Noting that "[m]any hospitals are clearly feeling cost pressures," the director of public information at the Center for Studying Health System Change, says "[s]tates are already cutting Medicaid rates and reductions in the growth of Medicare payment rates are coming, so it's not surprising that hospitals are squirreling away nuts for the winter."

According to a spokesperson at the Virginia system that cut staff, the decision was a response to economic challenges but also "anticipated changes (as well as unknowns) within the health care reform environment." He notes that the cuts are intended to reduce bureaucracy between senior managers and patients. "By streamlining our management teams, we anticipate improved communication and more efficient decision making/implementation with respect to patient care," he says (Daly, Modern Healthcare, 8/26 [subscription required]; AP/Post, 8/26; Sun, "Breaking News Blog," Post, 8/25; Rau, "Capsules," Kaiser Health News, 8/25; Ungar/Howington, Louisville Courier-Journal, 8/26).

Paying for quality

AHIP: Hospital rewards, education help curb infections

August 31, 2011

Providing hospitals incentives to improve hygiene practices and boost safety education can lead to fewer infections, according to a new report by America's Health Insurance Plans (AHIP).

The report outlines several insurer reward programs that led to improved patient outcomes at hospitals. For example, one program—administered by BlueCross BlueShield (BCBS) of Tennessee—rewards health care providers for meeting certain quality goals.

Overall, the program thus far has reduced central-line associated bloodstream infections by 40%, preventing 296 infections at 60 hospitals between 2007 and 2008. According to a BCBS of Tennessee spokesperson, the program saved 35 lives, 4,973 hospital days, and $7.5 million in costs.

Another program outlined in the report involved Virginia-based Sentara Healthcare and Optima Health. Under the initiative, Optima pays bonuses to hospitals that successfully reduce facility-acquired urinary-tract infections, hospital-acquired pressure ulcers, patient falls, and myocardial infarctions. Hospitals that have no death or injury incidents are eligible to receive extra bonuses, National Journal reports.

According to Optima, the program reduced ventilator-associated pneumonia cases by 97% and central-line associated bloodstream infections by 91% between 2002 and 2011 (Fox, National Journal, 8/29 [subscription required]).

Temp staff can create lasting damage

Temporary hospital workers more prone to medical errors

August 31, 2011

Temporary personnel at U.S. hospitals are twice as likely as permanent workers to be associated with medical errors, according to a study in the Journal for Healthcare Quality.

For the study, Johns Hopkins University School of Medicine researchers and colleagues examined data from a voluntary medication error reporting system from 2000 to 2005. Overall, they analyzed almost 24,000 ED medication errors at 592 U.S. hospitals.

The study found that medication errors made by temporary workers were more likely to reach patients, cause temporary harm, or be life-threatening, compared with errors made by permanent workers. The study notes that temporary staff may not be as familiar with local employees and care management systems and protocols, which may hinder communication and teamwork. In addition, temporary workers may be less likely to vocalize problems when they see them and less likely to stay apprised of the latest medical knowledge.

However, the authors say temporary workers cannot be blamed entirely for the adverse events. "A place that uses a lot of temporary staff may have more quality of care issues in general," the study's lead author said, adding, "It may not be the temporary staff that causes those errors but a function of the whole system" (Johns Hopkins release, 8/25; UPI, 8/27).

Opening up the ICU

More hospitals welcome family into the ICU

August 31, 2011

Writing in the Washington Post this week, infectious-disease physician Manoj Jain explains how hospitals nationwide are adopting more open ICU policies in an effort to embrace patient-centered care.

The Institute of Medicine has made patient-centered care—where patients and their families are involved in medical decisions—one of its six goals in redesigning the U.S. health care system. In an effort to reach that goal and move "toward greater transparency," some hospitals are opening their ICUs to family members and finding ways to keep family members present during difficult situations.

For example, the ICU at Geisinger Medical Center in Danville, Pa., adopted an open ICU policy almost 10 years ago. Staff initially found the policy to be disruptive and altered it so family could only visit in 30 minute intervals, six times per day. Geisinger was able to fully reopen in the ICU in 2003 after developing an extensive communication program for family and staff.

At Jain's hospital, which recently implemented an open ICU policy, nurses have found ways to handle family members if a patient's condition rapidly deteriorates. During difficult situations in the ICU, family members can get in the way of necessary equipment and become distressed by the condition of their loved one. When an ICU patient requires urgent care at Jain's hospital, the family is asked to step out of the room. If they chose to stay in the room, a nurse stands with them to the side and explains the situation in real time.

In addition to comforting patients and families, Jain notes that a 1997 study found that open visitations had a positive effect on 67% of patients and 88% of families (Jain, Post, 8/29).

Government fraudbusters

U.S. on pace to prosecute more than 1,300 for health care fraud

August 31, 2011

Federal health care fraud prosecutions are on pace to rise 85% over last year, partly because of increased enforcement efforts by the Obama administration, according to data from the Transactional Records Access Clearinghouse (TRAC).

In 2010, government health fraud investigations yielded about $4 billion after the federal health reform law created one agency and expanded another. The Medicare actuary predicted the overhaul over the next decade will yield about $4.9 billion in fraud and abuse savings.

In the first eight months of 2011, 903 people have been prosecuted for health fraud through federal agencies, up 24% from 2010, when 731 people were prosecuted. According to TRAC, the number of prosecutions has increased by 71% across the past five years.

"The trend certainly looks accurate and on track with our data," a Department of Justice (DOJ) spokesperson said. She cited a large case in which the Medicare Fraud Task Force accused 111 physicians, nurses, and executives of falsely billing Medicare more than $225 million. The assistant attorney general of DOJ's criminal division said task force convictions have also increased (Kennedy, USA Today, 8/29).

Recession risks

Foreclosures prompt more health woes for U.S. residents

August 31, 2011

Princeton University and Georgia State University economists have identified a direct link between foreclosure rates and health problems in Arizona, California, Florida, and New Jersey.

According to their findings—which were published this month by the National Bureau of Economic Research—an increase of 100 foreclosures in a region correlated to a 7.2% rise in ED visits and hospitalizations related to hypertension for adults aged 20 to 49. They also saw an 8.1% increase in diabetes visits, a 12% jump in anxiety-related visits, and a 39% increase in visits for suicide attempts for that age group.

"You see foreclosures having a general effect on the neighborhood," one of the study's authors says, noting, "Everybody's stressed out. There is a connection between people's economic well being and their physical well being."

However, the Wall Street Journal notes that it is difficult to distinguish cause and effect, adding that a correlation does not necessarily mean foreclosures caused adverse health effects (Kalita, Journal, 8/31). 

Announcing the Advisory Board-Mercy Clinics Medical Home Health Coach Training Program

September 07, 2011

The Advisory Board and Mercy Clinics are pleased to announce our inaugural Health Coach Training course, launching this October at Mercy Clinics in Des Moines, Iowa, on October 4-5 and November 2-3.

Get inside Advisory.com

Members: Log in and see what you're missing

August 31, 2011

  • Members, please log in

    If you haven't already done so, please log in now to see the full range of tools, resources, and events available through your membership.

Searching for analytic tools and resources to support your next strategic decision? The list below represents the ten most popular analytic tools of 2011 categorized by focus area. For a full list of Advisory Board tools, visit the Data and Analytics Navigator.
 
Your focus area:  Evaluating your investment strategy

Medical Home Health Coach Practice Impact Calculator
 Health Care Advisory Board
Assess the return on investment from adding a dedicated diabetes health coach to primary care practices transitioning to a medical home model.

Clinical Integration Investment Calculator
 Health Care Advisory Board
Assess whether to pursue a CI strategy by calculating expected baseline investment costs in four key areas: information technology, program staffing, project development, and administrative expenses.
 
Your focus area:  Arming your nursing workforce with best practices
 
Nursing Executive Center Best Practice Crosswalk
Nursing Executive Center
Allows nurse leaders to search for targeted best practices that can be implemented at the individual unit-level or across the entire nursing organization.
 
 
Your focus area:  Forecasting and market sizing
 
Outpatient Market Estimator
Health Care Advisory Board
Generates current and forecasted outpatient volume estimates for any geography within the United States.

Outpatient Imaging Market Estimator
 Imaging Performance Partnership
Generates current and forecasted outpatient imaging volume estimates for any geography within the United States.

Cancer Incidence Estimator
 Oncology Roundtable
Generate current and projected cancer incidence estimates by tumor site for any geography within the United States.
 
Your focus area:  Assessing the impact of payment policy on your organization
 
Readmissions Penalty Estimator
Health Care Advisory Board, Clinical Advisory Board,Cardiovascular Roundtable
Estimate the potential revenue impact of the Hospital Readmissions Reduction Program established under the Patient Protection and Affordable Care Act of 2010.

Customized Medicare Value Based Purchasing Impact Assessment
 Health Care Advisory Board, Clinical Advisory Board, Financial Leadership Council
Estimate the potential revenue impact and identify specific metrics driving your institution’s quality performance under the methodology presented in CMS's hospital inpatient value-based purchasing program final rule.

Health Reform Crosswalk
 Health Care Advisory Board
Provides detailed information on provisions most relevant to the strategy, operations and financial health of provider organizations.

Accountable Care Readiness Diagnostic
 Health Care Advisory Board
Assess your organization’s ability to deliver on the core competencies of accountable care within the context of your market’s relative demand.
 
Learn more
The Data and Analytics Navigator places over 200 analytical tools and resources at your fingertips. Daily Briefing readers with questions about any of these tools may email  DBinquiries@advisory.com.

Daily roundup: August 31, 2011

Bite-sized hospital and health industry news

August 31, 2011

  • Arizona and North Carolina: Charlotte, N.C.-based MedCath plans to sell Kingman, Ariz.-based Hualapai Mountain Medical Center to Kingman Regional Medical Center, the Charlotte Business Journal reports. The sale, which includes an undeveloped 19-acre lot near the hospital, is expected to net MedCath roughly $42 million. The facility will close by Sept. 30 and be reopened in a limited capacity to reflect demand (Thomas, Charlotte Business Journal, 8/26).

 

  • North Carolina: Seventeen babies were born during an 18-hour lockdown at New Hanover Regional Medical Center as Hurricane Irene passed over the region, Reuters reports. According to a hospital spokesperson, the average number of births is 10 or 11 per day. None of the new mothers opted to name their newborns Irene (Johnston/Brumm, Reuters, 8/29).

 

  • Ohio: The Cleveland Plain Dealer this week examined the primary care physician (PCP) shortage in Ohio, highlighting efforts to educate new PCPs and encourage them to stay in the state after completing their residency. Nearly one-third of physicians nationwide are likely to retire in the next 10 years—about 21% of Ohio physicians are aged 60 or older. As a result, medical schools across the state are attempting to increase class sizes and hire additional faculty (Kleinerman, Plain Dealer, 8/29).

 

  • Texas: Rural hospitals statewide are preparing for cuts to programs and services in the coming months that will stretch already strained resources, the San Antonio Express-News reports. Under a new Texas Health and Human Services Commission rule that goes into effect on Thursday, hospitals will be reimbursed for only 60% of the cost of treating Medicaid patients if there is no immediate danger. "We're required by federal law to examine and assess every patient that comes in the ED," the CEO of Gonzales Healthcare Systems said, adding, "After hours in a small rural community it's hard to find primary care. You can send them home, but that creates a PR nightmare for the facility" (Cardona,Express-News, 8/28).

Fewer U.S. residents understand overhaul benefits than in 2010, poll finds

Just 58% of U.S. residents who are expected to gain health insurance coverage under the federal health reform law know that they will have access to financial aid to obtain coverage, compared with 72% who knew of the benefit at this time last year, according to the Kaiser Family Foundation’s (KFF) latest monthly tracking poll.

The poll also found that uninsured individuals now generally know less about the benefits of the health reform law than a similar poll found in 2010. For example:

  • 47% of respondents in the latest poll said they know that the law expands Medicaid to cover low-income people without children, down from 66% in 2010;
  • 57% know that the government now requires all insurance plans to offer a basic level of benefits, down from 64% in 2010; and
  • 49% believe that health reform will improve conditions for the uninsured, down from 67% in 2010.

Drew Altman, president and CEO of KFF, wrote in an accompanying column, "Experts who have advocated for expanded coverage for decades probably envision the uninsured sitting around the kitchen table anxiously awaiting the implementation of coverage expansions under the [health reform law]."

However, he explained that it does not appear so because most people likely will realize the benefits once the reform law becomes tangible for them, probably two years after the law's coverage expansion takes full effect in 2014. "When there is real insurance coverage available for people who don't have it, they will be more aware of it, and they will be able to render a judgment about whether coverage is affordable for them," Altman added.

The KFF poll also found that public opinion of health reform has dropped slightly over the past year, Politico reports. Thirty-nine percent of those surveyed expressed a favorable view of the law, the first time that the percentage has dipped below 40% since the law's enactment in March 2010. Meanwhile, 44% of respondents said they have an unfavorable view of health reform (Reeve, National Journal, 8/29 [subscription required]; Haberkorn, Politico, 8/29; Baker, "Healthwatch," The Hill, 8/29).