Leading in an Era of Health Systems Change

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Slide 1

Leading in an Era of Health Systems Change Leading in an Era of Health Systems Change:
Dialogue with the Commission on the Accreditation of Healthcare Management Education and the National Center for Healthcare Leadership

Michael I. Harrison, AHRQ
John Lloyd, CAHME
Andrew N. Garman, Rush U. / NCHL

AHRQ Annual Meeting
Bethesda, MD
Sept 10, 2012

Slide 2

Session Objectives

Participants will learn about:

• The leadership learning implications of a value-driven healthcare system.
• Efforts to articulate these learning needs as a set of leadership competencies.
• How leadership competency models can be used to support learning and behavior change.

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Accreditation in Graduate Healthcare Management Education
An Introduction to CAHME

John S. Lloyd
CEO Emeritus, CAHME

Image: The logo of the Commission of Accreditation of Healthcare Management Education (CAHME) is shown.

Slide 4

CAHME Mission

• To serve the public interest by advancing the quality of healthcare management education by:
  • Setting measurable criteria for excellent healthcare management education.
  • Supporting, assisting and advising programs which seek to meet or exceed the criteria and continuously improve.
  • Accrediting graduate programs that meet or exceed the criteria.
  • Making this information easily available to interested constituencies.

Slide 5

ACEHSA and CAHME History

• 1968 ACEHSA established by AHA, ACHA, AUPHA and APHA.
• Early 1970's recognized by US Dept of Education and COPA.
• 1996 recognition by Council on Higher Education Accreditation.
• 2001 Orlando, FL Forum - RWJ Foundation sponsored.
• 2003 National Center for Healthcare Leadership founded.
• 2003 ACEHSA and NCHL Blue Ribbon Task Force recommended review of CAHME structure, financing and review of Criteria for Accreditation.
• 2005 CAHME name approved; corporate member structure ratified; new Board of Directors elected.

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Accredited Program Settings

¹—Includes 3 programs in Schools of Medicine.

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Degree Types Granted

Total is > number of programs since some programs grant multiple degree types.

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Total Enrollment in CAHME programs

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Post-graduate Positions

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Healthcare is changing: So are Accreditation Standards

Practitioners, Professional Societies and Academics:

• Wanted stronger leaders, and determined that CAHME criteria should focus more on leadership development.
• Wanted to challenge old techniques of teaching and learning.
• Wanted to push for continuous improvement in the programs.
• Wanted to assure all that leaders can produce a safer, more efficient health care system.

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Evolution of CAHME standards Over Time

Image: Three text boxes, "Evaluation and Improvement," "Program Mission," and "Goals-measurement and alignment" are connected by arrows to indicate an ongoing process. Below these text boxes are two more boxes, one captioned "Required Curriculum content" and the other "Coverage in required courses"; an arrow points from the first box to the second. At the bottom of the image, a large black arrow captioned "Pre-2007" points from left to right.

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Evolution of CAHME standards Over Time

Image: An arrow points from the box captioned "Evaluation and Improvement" to "Program Mission"; three arrows point from "Program Mission" to three text boxes: "Competencies," "Healthcare knowledge," and "Other goals." Arrows point from these three boxes to two boxes captioned "Teaching methods" and "Assessment methods"; a double-headed arrow also points between these two boxes and an arrow points from "Assessment methods" back to "Evaluation and Improvement." At the bottom of the image, a large black arrow captioned "2010-2013" points from left to right.

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Competency Models Selected in Accredited Programs

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Emerging Leadership Competencies:
Perspectives from the National Center for Healthcare Leadership (NCHL)

Andrew N. Garman
CEO, NCHL

Image: The NCHL logo is shown.

Slide 15

About NCHL

• Not-for-profit organization, founded in 2001, to be a catalyst in strengthening healthcare leadership to improve population health.
• Transitioned to a membership structure with Rush University and the University of Michigan in 2011.
• New structure designed to strengthen the dialog between academia and practice.

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About NCHL

• Board of Directors:
  • Peter Butler, Chair , President & COO, Rush University Medical Center.
  • Patrick E. Connolly, President, Sodexo Healthcare.
  • Janet M. Corrigan, PhD, President & CEO, National Quality Forum.
  • Susan D. DeVore , President & CEO, Premier.
  • Joanne M. Disch, PhD, RN , Clinical Professor, University of Minnesota School of Nursing.
  • Michael J. Dowling, President & CEO, North Shore-LIJ Health System.
  • Kyle Grazier, PhD, Chair, Health Management and Policy, University of Michigan.
  • Frederick Hessler, Managing Director, Citigroup.
  • David H. Klein, President & CEO, Excellus BlueCross BlueShield.
  • Christy Harris Lemak, PhD (ex-officio), Chief Research Officer, NCHL.
  • Kathryn J. McDonagh, PhD, RN, Vice President, Executive Relations, Hospira.
  • R. Timothy Rice , President & CEO, Cone Health.
  • Robert G. Riney, President & COO, Henry Ford Health System.
  • Amir Dan Rubin, President & CEO, Stanford Hospital and Clinics.
  • Jeffrey D. Selberg, Executive Vice President & COO, Institute for Healthcare Improvement.
  • Irene M. Thompson, President & CEO, UHC.
  • Gail L. Warden , President Emeritus, Henry Ford Health System.

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About NCHL

• Activities:
  • Research & Demonstration Projects:
    • Leadership Competency Model Development.
    • National benchmarking of leadership practices.
    • Analysis / assessment of future trends (in collaboration with Rush U's Center for the Advancement of Healthcare Value).
  • Leadership Development-focused Institutional Membership Group (the Leadership Excellence Networks / LENS Councils).
  • Professional Services.
  • Broad Dissemination of Evidence-based Approaches to Leadership.

Image: The cover of a report titled The Future of Healthcare: Global Trends Worth Watching is shown.

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Future Trends: Information Sources

• Primary data trend analyses:
  • Healthcare costs; Population trends; Higher education costs; Workforce.
• Third-party analyses:
  • Learning Healthcare Organization (Institute of Medicine); Value project (Healthcare Financial Management Association); Healthcare 2032 (Robert Wood Johnson Foundation); Primary Care 2025 (Kresge Foundation); Five Scenarios for the Future of Academic Medicine (ICRAM).
• Expert Opinion:
  • Senior leadership from LENS member organizations; NCHL board members; other key stakeholders from forward-looking organizations.
• Theoretical models / Approaches:
  • Creative Destruction; Diffusion of Innovation; Disruptive Innovation; Scenario Planning.

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Future Trends: Health Delivery

• Regardless of legislation, all bets are on the need to deliver care more efficiently (i.e., lower cost) in the coming years.
• Care will continue to move toward evidence-driven, outcome-based pricing, eliminating interventions that do not more than pay for themselves in the outcomes they yield and prioritizing those that deliver outcomes at lower cost (e.g., watchful waiting).
• Taken together, these trends may create a climate highly conducive to disruptive evolution.
• System change is likely to take precedence over system competition.

Image: A photograph of a car with the Google logo painted on the side is shown.

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Future Trends: Healthcare Leadership

• Many sector changes imply the need for new and different competencies, not simply strengthening / retuning old ones.
• Some key themes:
  • Patient-centered care.
  • Population health focus.
  • Continuous value improvement.
  • Learning healthcare organization / 'Big Data'.
  • Leadership (vs. Leader) Development.

Image: The "Evolution of Man" is shown, from ape to anthropoid to tool users to a guy crouching over his computer.

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Patient-Centered Care

• Development and effective management of patient councils.
• Meaningful but efficient incorporation of patients into care design.
• Balancing patient involvement with 'design thinking' approaches.

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Population health focus

• Collaborative competition.
• Community systems thinking.

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Continuous value improvement

• The pace of innovation will continue to outpace dissemination, but the consequences of late adoption will be greater.
• Pursuit of long-term goals will come at the expense of short-term organizational performance, creating problems of timing and 'leaps of faith'.
• Designing and leading innovation management functions:
  • Environmental scanning.
  • Technology piloting.
  • Internal diffusion.
  • Commercialization.

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Learning Healthcare Organization / 'Big Data'

• Systems implications:
  • Efficient data access.
  • Opportunity Identification and Prioritization.
• Advanced analytics:
  • Process simulation.
  • Social network analysis.
  • Multilevel modeling.
  • Data mining.
• Developing / mentoring on 'Evidence Literacy'.

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Technology evolution, adoption, spread

• The pace of innovation will continue to outpace dissemination, but the consequences of late adoption will be greater.
• Pursuit of long-term goals will come at the expense of short-term organizational performance, creating problems of timing and 'leaps of faith'.

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Leadership (vs. Leader) Development

• Focusing on individual development may have limited impact on organizational change.
• Core leadership competencies are changing, but not all leaders will need to master all new competencies.
• Leadership development is itself evolving:
  • Emphasis on context-based (vs. classroom-based) learning.
  • Leadership (vs. leader) focus.
• Greater need for leaders to mentor clinicians on 'value literacy'.

Slide 27

Discussion Questions:

• What leadership competencies are most critical for health care professionals to develop, in order to manage effectively in an era of reform in health care finance and delivery?
• What are the best approaches to spreading these competencies across the health system?