The healthcare industry has much to be thankful for

"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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Leadership Made Simple but NOT Easy – Achieving Cultural Transformation in Healthcare

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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Healthcare execs, do you know what’s in your chargemaster?

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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Identifying your next career move

I recently had the honor of co-presenting with Mike McBride, Regional President and COO of Ascension St. John, at the American College of Healthcare Executives - Southeast Texas Chapter’s conference in Houston. Our session, “Identify Your Next Career Move,” took the attendees through what makes up a successful career transition -- from self-branding to job interview preparation and all the steps in between.

Key takeaways from our presentation:

Access your mindset

Are you a glass-half-full type of person? Are you in a dark place in your current workplace? Building confidence is a key ingredient to success. To enter a transition without the highest level of confidence is a formula for failure. You must rebuild confidence before you start.

Unpack your baggage

At a certain point in our lives we all acquire baggage. That's a given. It's what you do with that baggage that matters most. Have you shoved it to the back of your closet to deal with later, or is it neatly unpacked and sorted and processed? If it is the former, then you have work to do. You will not make headway in a job search until you have dealt with your baggage.

Speak to your achievements

How are you at speaking to your abilities and achievements? If you cringe at the thought or don't know where to start, you have some work to do before you are ready to make your next career move. Never assume that the person interviewing you will read between the lines just because you have it as a bullet on your resume -- you must verbalize it.

Know your value

What is your superpower? Determine what differentiates you from other people who may be competing for the same job. If you are having trouble determining what makes you different, form an informal advisory board made up of close friends and colleagues. These are the people you can not only trust to tell you what your strengths are, but also areas where you can improve.

Develop your criteria

Create a list -- in priority order -- of factors that matter to you as you seek a new opportunity. Culture and mission should always rank somewhere on the list, but should also include personal factors that are specific to your work/life situation. Use this list as a guide when you determine if an opportunity is right for you.

Identify and research target organizations

Develop a list of companies and organizations that you have a strong interest in. Why are you interested in each of these companies? Be specific, and if they don’t align with your criteria list, then revise. If they do, research them thoroughly. Start connecting with individuals who work at this company on LinkedIn and developing genuine relationships within these organizations.

Build and work your network

Research shows that you will find your next opportunity through someone you know. A good, quality network takes work. You must be intentional and consistent in your outreach efforts to nurture and grow your network. Set aside time each week to focus on cultivating relationships within your industry.

Polish and build your professional brand

You are how others perceive you to be. Your brand includes everything from your resume to what shows up when your name is searched for online. While some perceptions can be outside the realm of your control, many are controllable. You can create the professional image you want to portray. Areas include your:

  • Resume
  • Verbal self-introduction (Answers “Tell me a little bit about yourself.”)
  • LinkedIn profile
  • Google search results (Are they positive/negative/neutral?)

Own the interview

Once you have an interview scheduled -- investigate, practice and prepare. Research those interviewing you. Reach out to network connections that may have inside knowledge of the culture of the organization or might provide you with a connecting point that could prove invaluable once in the interview. Practice your talking points out loud or with a trusted friend. Be prepared to explain an awkward exit from a previous position or extended career gaps on your resume.

While sometimes it takes seeing a certain job posting to spark your desire for a career change, it’s far more effective to begin working on the areas above well in advance of that moment. That way, when the right opportunity does come along, you are ready to start that journey.

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Leading with calm urgency in times of crisis

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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First and Third: One World Serious Health View

“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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Your People Are the Key to a Successful System Transition

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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Building Trust to Succeed

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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Bridging the Gap Between Providers and Payers

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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Community Vitality: The importance of access to high-quality healthcare and K-12 education

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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Want to get the most bang for your tech bucks? Stop automating bad practices.

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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Looking to the future of healthcare

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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Recognizing Emergency Nurses

Over 145 million patients come to US Emergency Departments every year; it takes over 167,000 emergency nurses to provide compassionate care to these patients: whether a child with a fever or a senior struggling to breathe, they are America’s frontline for care.

Many people outside of emergency medicine may not realize that our nation’s EDs provide an accurate and unfiltered view of society. This slice of reality shows humanity at its best and worst. In addition to the joy of saving a life, the occasional thank you and smile that an ED nurse will receive, they may be yelled at, unappreciated, subjected to unpleasant comments, and even assaulted…. by people they are just trying to help.

Yet, 24/7, 365 days per year - days, nights, weekends, holidays, sunny days, stormy days, natural disasters— these dedicated professionals put their personal needs and those of their families aside and dedicate themselves to caring for all types of strangers.

As an emergency physician, I can personally affirm that I could not do my job without them: they are my right hand (and my left), my eyes, my ears, my conscience, and sometimes even my kinder, gentler voice!

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Everything I learned in Girl Scouts

I was honored as a Girl Scouts of Western Ohio Woman of Distinction a few years ago, and I was asked to share some of the lessons or “words of wisdom” that I’ve learned through my own experiences and through others. As I reflect, the Five Key Ways that Girl Scouts help young adults thrive, are applicable and transferrable to every rising leader in general.

Girl Scouts is proven to help girls thrive in five key ways as they:

  1. Develop a strong sense of self.
  2. Seek challenges and learn from setbacks.
  3. Display positive values.
  4. Form and maintain healthy relationships.
  5. Identify and solve problems in the community.

Read the Girl Scout Difference here .

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The Benefits of Building a Diverse Team

“Strength lies in differences, not in similarities.” - Steven Covey

Diversity and inclusion are top priorities in many organizations today, and there are plenty of benefits that come with implementation. First of all, there’s an increase in profitability. A McKinsey & Company report found that companies with leadership in the top quartile for gender diversity were 15% more likely to have financial returns above their industry median, and those with leadership in the top quartile for racial and ethnic diversity were 35% more likely to do the same. On the other hand, McKinsey also found in a follow up that companies with executive teams in the bottom quartile for both gender diversity and racial and ethnic diversity were 29% less likely to achieve above-average profitability.

There’s more at stake than immediate profitability. Through my own experience, I’ve also seen improvements in:

Retention - Diverse leadership communicates that leaders cannot all look and sound the same, and a diverse leadership team helps create an environment where people of all races, genders, sexuality, religions, socio-economic backgrounds can thrive. It creates an environment where employees can see their path to advancement and leadership positions within the industry.

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Want to make the right permanent hire? Hire an interim first

When an executive leaves unexpectedly or a major personnel changes occur in your organization, the void is felt at all levels of the organization. Rather than rushing to return to a feeling of equilibrium, I believe one of the best ways to make the right permanent hire and position your organization for long-term success and stability is to first hire an interim manager.

Interim managers do more than just “hold down the fort” until a permanent hire can be made. Interims bring their expertise, perspectives, adaptability, leadership and motivation skills, and entrepreneurial mindset to the challenges your organization is facing. An interim executive comes in with an analytical mind and unbiased view to help your organization achieve sustainable results in a short amount of time, allowing you the time to iron out persistent organizational issues and assess your organization’s needs so you are better positioned to make hiring decisions with purpose and wisdom.

Gain fresh perspectives and re-focus on your mission.

Getting the objective outsider view that an interim can provide is important for the long-term health of your organization, especially if your organization tends to promote from within. Often, when a management position becomes vacant unexpectedly, organizations will rush to promote a promising lower-level manager, even if he or she still hasn’t fully developed the skills to be successful in the vacant position. Hiring an interim manager into this position for a short time before you hire internally allows your organization to work out process issues, for example, while bringing the potential internal hire up to speed. The interim can bridge that gap, setting up the internal hire and your organization for success.

Times of transition provide the opportunity to consider who you are as an organization and whether processes currently in place promote the organization’s mission and values. A lack of crisis doesn’t mean everything is running smoothly. When growth slows, mission creep sinks in, goals go unreached, or when urgent issues distract your organization’s leadership from mission-centered issues, an experienced interim’s perspective could be just the breath of fresh air your organization needs to refocus on its unique identity.

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It’s a Matter of Scale for Healthcare System CEOs

For healthcare CEOs, as the size of the healthcare system grows, so grows their need to balance priorities. By organizational structure, larger system CEOs, including those individuals who are Physician CEOs, often coordinate with multiple individuals reporting to a board of directors. The CEO perhaps has a specific specialty from past experience––finance, legal, medical––with next-level leaders who broaden the operational bandwidth through their specialties.

In contrast to the stand-alone hospital CEO who are more intimately involved in the daily operations of the rural or individual hospital, large system CEOs find themselves in larger cities with more public points of interactions and more team members among the healthcare staff to whom they must stay connected.

Time is always a factor

Hospitals are 24/7 operations, and large systems have hundreds or thousands of people relying on services at any given time. The large system CEO cannot reasonably be involved in these daily functions and resource needs. This CEO is consistently informed by the people they’ve entrusted with overseeing specific functional areas. The CEO must hire the correct people to provide operational knowledge and support who report back on the needs of the system.

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A CARE PLAN for Burnout Prevention

Too much of a good thing can sometimes be a problem; there is a risk that caring too much can result in burnout. Even a profession that is literally and figuratively built on it, as is healthcare, there is not immunity to an overdose of caring.

You might be thinking: “What healthcare leader would ever tell a member of their team to care less?” Self-reflect and visualize your peers and the people you are leading. Do any of these characteristics seem familiar?

  • Constantly worries about what people think
  • Always feels obligated to fix things
  • Has a hard time letting things go
  • Starts the day with a list of worries
  • Ends the day with a list of worries
  • Stresses about staff turnover
  • Stresses about staff happiness

I’m sure you can identify with some of these tendencies personally or amongst your team. The answer is not to stop caring about patients, staffing, getting through your “to do” list, or about being liked; the answer is to care just the right amount! Think of care as sugar; in the words of Mary Poppins it takes “Just a spoonful of sugar…!”

Care enough to progress toward your goals, being visible and open, maintaining control while knowing when to let go, and earning respect. Care about being liked, but do not rest your self-worth on it. Sound advice you might say, but easier said than done. Try this CARE PLAN:

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Leading from the front: The importance of community building for non-profit hospitals

Non-profit hospitals are beholden to stakeholders (i.e. the communities they serve), not shareholders, and are thus pivotal community assets. While for-profit hospitals report to shareholders and investors, non-profit hospitals have an obligation to use assets for the betterment of the communities they serve. Community benefits can include charity care, expansion of existing services such as trauma care and maternity services, clinical education, increasing access to care for Medicare and Medicaid patients, and promoting community health.

One of the best ways to promote community health and serve the community at large is to create community partnerships and develop relationships with those involved in existing healthcare services in the area. This way, non-profits are not duplicating existing resources and are working toward a common mission of improving the health of the people and communities they serve.

The move to value-based care is slowly migrating to capitated payments. This is an important progression, as the capitated payments model is more person- and outcomes-centered; the focus shifts to prevention and wellness; and hospitals are incentivized to improve health status. The notion suggests that the health of the population will continue to gain importance.

True population health requires addressing underlying social determinants of health, including socioeconomic status, level of education, neighborhood environment, nutrition, activity levels and access to healthcare. It is well documented in the literature that social determinants drive healthcare outcomes. As an example, those with wealth generally enjoy better health status than the poor.

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Podcast: Getting Your Hospital to Act Like a Startup

Recently I had the privilege to be a guest on the podcast, “Getting Your Hospital to Act Like a Startup.” My part begins in minute 28, but please enjoy the entire episode.

Summary:

The innovative path is the key to the future of successful healthcare. Innovation and technology are the indispensable components for tomorrow's care; unfortunately, health systems and hospitals often allow the here and now focus to take precedence over the future. The internal daily demands can force a loss of perspective and a diminished capacity for a cultural attitude of innovation. The future positioning of the healthcare organization is always where the CEO and leadership team must be viewing today's decisions for organizational viability and long-term success.

Designing and living a successful innovative culture is possible. The adoption of the "start-up" culture should be the drive of every CEO and leadership team. In this podcast I share my experience in working within health systems and discuss adopting the necessary characteristics to successfully acquire the adventure, joy, focus and discipline of a startup culture. In addition, the obstacles start-ups face when working with health systems is also explored.

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