The Commission on Accreditation of Healthcare Management Education and Its Role in Advancing the Quality of Healthcare Management Education

A little background on my relationship with the Commission on Accreditation of Healthcare Management Education (CAHME).  www.cahme.org

In early September, 1972, just two weeks after finishing graduate school at the UNC School of Public Health, I was teaching my first class, at 6PM, as a junior Assistant Professor in the Baruch/ Mount Sinai Graduate Program in Health Care Administration, a program that had just been accredited by ACEHSA, the forerunner of CAHME
About ten minutes into the class a student fell asleep right in front of me (they all had fulltime jobs). We had seating charts back then and I asked Mr. Silverman to wake up Mr. Freedman, Mr. Silverman replied “Professor Metsch, you put him to sleep, you wake him up.” In 1975 I moved on to my first healthcare administration position.

Fast forward to 2012, 35+ years later.  After serving as President and CEO of Jersey City Medical Center/ LibertyHealth for seventeen years I was invited to return to the now Baruch Executive MBA in Healthcare Administration Program as an Adjunct Professor. Coincidentally I had just also started teaching in the MPA and MPH programs at Rutgers Newark.

Health Care Management education has evolved due in large part to CAHME accreditation, a peer-reviewed process which focuses, for example, on course content, competencies, and student feedback. CAHME accreditation gave us a template to make sure the program really added value for the students and prepared them to succeed in health care organizations. I invite you to learn more about CAHME at www.cahme.org

I decided to use the Case Study method in my course, “Project Management, The Hardest Part about Getting Started…..is Getting Started.” Cases from my time as a CEO, Harvard case studies, and cases presented by “Visiting” Professors were presented by my students from 1972-1975 who were now C-level executives.

We focused on Complex Problems. “Every major project (worth doing) is unique! So there is no “magic bullet” Project Management template. However, one way of starting any project is by reaching a consensus on ‘anchor concepts’ which can serve to keep the project on track.”

And I started to use Blackboard for course material. Using two different Blackboards at Baruch and Rutgers was cumbersome so I developed one web site instead. When I finished teaching for four years the web site evolved into Doctor, Did You Wash Your Hands?™  highlight and click on  http://doctordidyouwashyourhands.com/

I have opened up DOCTOR’s case study content as “quick cases” for classroom exercises, ongoing tracking of a policy issue like TrumpCare, and student project templates.

DOCTOR welcomes the participation of faculty from CAHME accredited programs by submitting case studies and commentaries to include in the open portfolio. Just send them to jonathametsch@gmail.com

I look forward to hearing from my CAHME faculty colleagues.

Jonathan

 

Jonathan M. Metsch, Dr.P.H.
http://www.mountsinai.org/profiles/jonathan-m-metsch
Adjunct Professor, Management, Zicklin School of Business, Baruch College, C.U.N.Y.
Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai
Adjunct Professor, Rutgers School of Public Affairs and Administration & Rutgers School of Public Health

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Is Chief Innovation Officer an oxymoron? Innovation is cultural not structural.

“Back in the day” Chief Medical officers were all men and you could tell when a new CMO had lost touch with his clinician peers when he started wearing suspenders and bow ties to look CEOish.
Almost by definition, the same is likely to happen with Chief Innovation Officers.

Here’s one description of a Chief Innovation Officer in a job posting:
The Chief Innovation Officer is responsible for managing the innovative processes within the organization that identifies strategies, business opportunities and new technologies. Develops new capabilities and architectures with partners, new business models….” (A)

As a doctoral student at the UNC School of Public in the early 1970s I was mentored by two of the thought leaders on the “diffusion of Innovation”, Drs. James E. Veney and Arnold Kaluzny. (B) There work is still a gold standard.

The innovation literature identifies a continuum of organizational innovation types, which can easily be applied to health care organizations. (C)
Innovators: When a product is put on the market the first individuals to buy the product are the ‘innovators’. This small group of people wants to be the first to try the product and they are willing to take risks. These exclusive users in this group are therefore trend setters. Subsequently, the product will become increasingly popular and sales will increase.
Early adapters: Just like the innovators, the early adapters like to try out new things and they are not afraid to invest in new products. This group is significantly larger than the ‘innovators’ group and often they already know much about the new product. Because of this knowledge they play an important role in word- of- mouth advertising with respect to the new product as a result of which sales will increase strongly.
Early majority: The early majority group loves trends, but prefers to wait and see before making a purchase. The product will be bought in droves by this group of people. The product will become extremely popular and this will cause a landslide in demand.
Late majority: The late majority group actually lags behind and will only buy the product after many other people have bought it and its popularity is already decreasing. The reason why this group does not buy the product from the start has to do with confidence in the product. This group has to be absolutely certain that they are not making a bad buy. The product is also sold frequently in this ‘late majority’ stage.
Laggards: The laggards group lags behind (consciously or unconsciously) in the trend and does not like innovation or change. It is not until the product is not much in demand anymore and is about to leave the market that this group decides to buy the product after all. The most obvious reason is that this group waits until the sales price is lowered.

Steve Jobs, perhaps the greatest innovator of his lifetime said:
“Great things in business are never done by one person. They’re done by a team of people.”
“You can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something – your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.”
“A lot of people in our industry haven’t had very diverse experiences. So they don’t have enough dots to connect, and they end up with very linear solutions without a broad perspective on the problem. The broader one’s understanding of the human experience, the better design we will have.”
“If you’re gonna make connections which are innovative… you have to not have the same bag of experiences as everyone else does.”

“Facebook was introduced in February 2004 by Mark Zuckerberg from his dorm room at Harvard University. Eight years later more than 900 million people have a Facebook account. This is a dramatic success story of the diffusion of an innovation. Normally when somebody develops a new product it can take years to get it out on the market.” (D)

Bottom line is if the CEO is not also the de facto Chief Innovation Officer, the organization will be “late majority” or “laggard“, not an “innovator” to be emulated.

INNOVATION CAN’T BE ASSIGNED OR DELEGATED! INNOVATORS EMERGE IF THE ORGANIZATIONAL CULTURE VALUES THEM.

“By definition, breakthrough innovation is the introduction of new ideas that drive a different way of doing things. This requires risk taking, of course, since no one can foresee the outcome or results of such initiatives. Breakthrough innovators are willing to make decisions and choices as much on the basis of intuition and insight as on data and forecasts – they bet on people rather than manage a process.” (E)

Did I just save the need for a doctoral dissertation?

(A) Chief Innovation Officer Jobs, http://www.careerbuilder.com/jobs-chief-innovation-officer
(B) Innovation of Health Services: A Comparative Study of Hospitals and Health Departments, by AD Kaluzny et al. https://www.ncbi.nlm.nih.gov/labs/articles/4496529/
(C) Diffusion of Innovations theory, by Patty Mulder, https://www.toolshero.com/marketing/diffusion-of-innovations-rogers/
(D) Diffusion of Innovation https://www.openabm.org/book/export/html/3525
(E) Innovation and Organizational Culture, by Ralph Ohr, http://innovationexcellence.com/blog/2016/09/05/innovation-and-organizational-culture/

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“Trust but Verify” (Ronald Reagan) – Four Lessons Learned as a junior CEO back in the day..

“It is fine to celebrate success, but it is more important to heed the lessons of failure.” – Bill Gates

Back in the day…
One summer Friday late afternoon I was in my car heading off for the weekend when the Commissioner of Health found me and told me he was closing the JCMC Trauma Center for failure to get renewed State approval.
Our new Trauma Service Director had told me that we were at risk for non-approval so we should have an American College of Surgeons consultation visit before the ACS certification, a prerequisite for State approval. But apparently he did not know that State approval had an absolute re-approval date of three years no matter what preparatory steps we chose to take.
The call was on the re-approval deadline date so the Commissioner shut the TC down but the radio stations said the ER was shut down, making the matter even worse.
To make a long story short, we got approval to reopen the TC on Monday after an early morning compliance visit by the State, and three months to get re-approval. Which we did with no contingencies, conditions or recommendations.

“Failure is only the opportunity to begin again, only this time more wisely.” – Henry Ford

Bariatric Surgery was the rage and our new Chairman of Surgery said we had to be in the game. So he recruited a team of bariatric surgeons to branch out to Jersey City Medical Center, and spent time at their home base training to be an Assistant Bariatric Surgeon (and thus able to bill for this role).
We staffed up, lots of prospective patients came to orientations, but no cases were ever done. Why? The prospective patients were mostly our own employees who “chose”, we were told, to have the surgery at the team’s home base for “privacy concerns.” So we not only paid for the programs fixed costs but also for the insurance impact when our employees had the surgery elsewhere.

“There are no secrets to success. It is the result of preparation, hard work and learning from failure.” – Colin Powell

Each of our three hospitals had different protocols to avoid “wrong site/ wrong side” surgery (e.g., wrong kidney removal). Some surgeons operated at 2 or 3 of our hospitals (as well as at other non-system hospitals) and thus had to navigate the different protocols. We called a meeting to establish one standard protocol for our system, to be approved by each hospital’s medical staff.
Only to find out months later that our two community hospital medical staffs amended the protocol rather than simply adopt it. So as CEO of all three hospitals I mandated the standard protocol, it rose to the level of the Boards of Trustees, but common sense prevailed.

“A person who never made a mistake never tried anything new.” – Albert Einstein

Three full time Chairmen told me they were in the final stages of building a free-standing surgi-center a half mile away from the hospital, and that the previous President had promised to buy it. Nothing in writing. I demurred. So they partnered with two competing hospitals. One Wednesday morning I went to a Chamber of Commerce showcase event only to find the three Chairman at their surgi-center booth. All three ran residency training programs and Wednesday was Grand Rounds for all three. They told me they were using vacation time. I said that was not appropriate. They said it was none of my business. I told each of them they had a choice, either sell their shares of the surgi-center or be fired. Two sold, one “left” and took his residents with him to one of the competing hospitals.

“You build on failure. You use it as a stepping stone. Close the door on the past. You don’t try to forget the mistakes, but you don’t dwell on it. You don’t let it have any of your energy, or any of your time, or any of your space.” Johnny Cash

 

 

 

 

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What Congress, President Trump and Former President Obama are saying about healthcare

“Politically, the collapse of the repeal effort is potentially devastating for Republicans. It leaves Trump without a significant policy achievement in the critical first six months of his presidency; it casts a pall over the party’s coming drives to pass a budget and overhaul the tax code; and it exposes GOP lawmakers to rising anger from their conservative base.
Substantively, it leaves much work undone. While the ACA has made health insurance accessible to millions of Americans, it has failed to contain rising costs, especially in the individual insurance market, where people without access to employer-provided coverage buy policies. Without federal action — and additional cash — those marketplaces could become unstable.”
“ “The vote last night presents the Senate with an opportunity to start fresh,” McCain said in a statement. Democrats, too, expressed interest in working across the aisle, especially on a plan to make federal cost-sharing subsidies permanent. The subsidies — which will total about $7 billion this year and $10 billion in 2018 — reimburse insurers for reducing co-payments and deductibles for certain low-income customers, reducing their out-of-pocket costs….” (A)

“House Republicans are fed up and openly blaming their Senate colleagues across the Capitol for torpedoing their party’s pledge to repeal and replace Obamacare.
They headed home for a five-week summer recess having failed on a key policy goal they vowed to get done once they controlled Congress and the White House. And things aren’t getting any easier as major fiscal fights are hanging over them this fall.
House Speaker Paul Ryan, who spent weeks urging his members to hold their fire and give Senate Republicans some space to get a health care deal, didn’t hide his frustration at a closed-door meeting in the Capitol basement on Friday. He effectively threw the Senate under the bus, telling his colleagues that the House of Representatives was the only arm of the government that was working.” Their overall message to voters: don’t blame us, it’s all the Senate’s fault.”(B)

““Trump, meanwhile, continued to express mainly hostility toward the ACA. On Friday, he unleashed a series of tweets blaming “3 Republicans and 48 Democrats” in the Senate who “let the American people down” by rejecting the latest overhaul proposal.
“As I said from the beginning, let ObamaCare implode, then deal. Watch!” Trump wrote. He also called for Senate Republicans to abolish the filibuster — a venerable Senate procedure designed to protect the minority party that requires contentious matters to receive the votes of at least 60 senators.”” (C)

“President Obama has always said we should build on this law, just as members of both parties worked together to improve Social Security, Medicare, and Medicaid over the years,” the statement continues. President Obama still believes that it is possible for Congress to demonstrate the necessary bipartisanship and political courage to keep delivering on the promise of quality, affordable health insurance for every American.” (D)

 

(A) Republican divided on whom to blame for health-care defeat, and what to do next, by Juliet Eilperin, Paul Kane and David Weigel, https://www.washingtonpost.com/powerpost/senate-rejects-measure-to-partly-repeal-affordable-care-act-dealing-trump-and-gop-leaders-a-major-setback/2017/07/28/f2865b10-7364-11e7-8f39-eeb7d3a2d304_story.html?utm_term=.b7a201c0398
(B) House Republicans rail on Senate GOP for torpedoing health care, by Deirdre Walsh, Phil Mattingly, MJ Lee, Kristin Wilson and Lauren Fox, http://www.cnn.com/2017/07/28/politics/house-republicans-blame-senate-health-care/index.html
(C) Trump lashes out over healthcare reform failure, by: Barney Jopson and Sam Fleming, https://www.ft.com/content/60659e20-73b0-11e7-aca6-c6bd07df1a3c(
(D) Obama speaks out after GOP health care bill failure, https://www.aol.com/article/news/2017/07/28/obama-speaks-out-after-gop-health-care-bill-failure/23054794/

 

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The House and Senate played “dodgeball” not wanting to be held accountable when twenty million people, their constituents, would lose access to affordable care.

“The Senate in the early hours of Friday morning rejected a new, scaled-down Republican plan to repeal parts of the Affordable Care Act, derailing the Republicans’ seven-year campaign to dismantle President Barack Obama’s signature health care law and dealing a huge political setback to President Trump.
Senator John McCain of Arizona, who just this week returned to the Senate after receiving a diagnosis of brain cancer, cast the decisive vote to defeat the proposal, joining two other Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, in opposing it.
The 49-to-51 vote was also a humiliating setback for the Senate majority leader, Mitch McConnell of Kentucky, who has nurtured his reputation as a master tactician and spent the last three months trying to devise a repeal bill that could win support from members of his caucus. (A)

Several Republicans, in fact, said they would vote for this bill only if guaranteed that it would never, ever, ever become law. And then they voted on the legislation that many considered terrible and were devastated by its defeat. Senate Majority Leader Mitch McConnell was visibly upset.” (B)

“Senate Republicans unveiled a “skinny repeal,” a narrow measure to roll back parts of the Affordable Care Act. It would leave 15 million more Americans without insurance next year, the Congressional Budget Office said.
Speaker Ryan tried to reassure senators balking at the narrow bill, but he left the door open for “skinny” passage.” (C)

““Speaker Paul Ryan’s statement saying he would conference with the Senate on a healthcare bill is not sufficient enough for Sen. John McCain (R-Ariz.)
“I would like to have the kind of assurances he did not provide,” McCain told reporters.” (D)

“As the highly unusual process of passing a bill to repeal the Affordable Care Act drew to a close Thursday, a number of Republican senators said they would like to see the upper chamber return to normal.
After a process that included skipping the usual public hearings, beginning debate without a final bill and sending a bill to the House hoping it won’t pass, senators said they want to return to the usual process of passing legislation….
(Senators) Shelby and Crapo were echoing Sen. John McCain of Arizona, who, earlier this week decried the process that Senate Majority Leader Mitch McConnell used on the health care bill. McCain had just returned to the Senate after being diagnosed with brain cancer and undergoing surgery to remove a tumor.” (E)

And!
6. You read that right: 1, 2, 3, 4, 5, 6 percent. Six. As the Senate prepares to vote on a “skinny repeal” version that its members haven’t seen – and don’t actually want to see enacted – a new statewide poll shows that half of Arizona voters would prefer to keep Obamacare but make revisions to the law. (F)

(A) Senate Rejects Slimmed-Down Obamacare Repeal as McCain Votes No, by Robe Pear and Thomas Kaplan, https://www.nytimes.com/2017/07/27/us/politics/obamacare-partial-repeal-senate-republicans-revolt.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(B) Senate Fails To Pass Latest GOP Health Care Bill by Tamara Keith, http://www.npr.org/2017/07/28/539945644/senate-fails-to-pass-latest-gop-health-care-bill
(C) Health Care Debate: Obamacare Repeal Fails as McCain Casts Decisive No Vote,By ROBERT PEAR, THOMAS KAPLAN and EMILY COCHRANE, https://www.nytimes.com/2017/07/27/us/politics/senate-health-care-vote.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(D) McCain says Ryan’s assurance on a healthcare bill is insufficient, by JESSIE HELLMANN, http://thehill.com/policy/healthcare/344254-two-gop-senators-say-ryans-assurance-on-a-healthcare-bill-is-insufficient
(E) Republicans Want the Senate to Return to Normal After Health Care by Jack Brewster, http://time.com/4877348/health-care-senate-norms-republicans/
(F) Only 6 percent of Arizona voters like Senate health care bill, by Laurie Roberts, http://www.azcentral.com/story/opinion/op-ed/laurieroberts/2017/07/27/only-6-percent-arizona-voters-support-senate-healthcare-bill-poll-says/518427001/

 

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Locally transmitted ZIKA case in Texas! Are we ready?

“Officials in Texas reported what they believe is a case of mosquito transmission of the virus within the state’s border, the first within the continental United States this year.
If correct, it would be the first known instance of local mosquito transmission within the continental United States this year.” (A)

This past April –
“The state now recommends that all pregnant women in six South Texas counties — currently in their first and second trimester — should be tested for the Zika virus.
The Texas Department of State Health Services is expanding their guidance for Zika prevention for the 2017 mosquito season, as they prepare for additional local transmission of the virus, meaning people who have not recently traveled getting bitten by a mosquito and then infected. Most Texas cases, however, are travel-related.
Cameron, Hidalgo, Starr, Webb, Willacy and Zapata counties are included in the new guidance. In addition to women in their first or second trimester, any pregnant woman who has a rash and at least one other Zika symptom — fever, joint pain, or eye redness — should be tested as well.
For pregnant women in Texas not in the six listed counties, they should be tested if they have traveled to areas with ongoing Zika transmission, including any part of Mexico.” (B)

….. organizing principles are urgently need to be established for tiered Zika hospital preparedness. Here are some thoughts. (C)
1. There should not be an automatic default to just designating Ebola Centers as ZRRCs, although there is likely to be significant overlap. There should not be an automatic default to just designating Ebola Centers as ZRRCs, although there is likely to be significant overlap.
2. Zika Centers should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and Zika-related “reading” expertise).
3. National leadership in clinical trials.
4. A track record of successful, large scale clinical Rapid Response.
5. Organizational wherewithal to address intensive resource absorption.
6. Start preliminary planning for Zika care out of the initial designated ZRRCs.
Zika protocols will be templates for are other mosquito borne diseases lurking on the horizon, such as Chikungunya, MERS, and Dengue.

(A) Case of Zika Virus, Likely Spread by Mosquito, Is Reported in Texas, by Donald McNeil Jr, https://www.nytimes.com/2017/07/26/health/zika-virus-mosquito-texas.html
(B) Texas prepares for more local transmission of the Zika virus, by Andy Jechow,http://kxan.com/2017/04/07/texas-prepares-for-more-local-transmission-of-the-zika-virus/
(C) Former hospital prez says: Designate local Zika centers now, http://doctordidyouwashyourhands.com/wp-admin/post.php?post=6528&action=edit

 

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Senator Graham said he could not support a “half-assed” plan that he called “politically” the “dumbest thing in history.”

“Senate leaders now hope they can convince a majority of senators to vote for a scaled-back bill that is being called a “skinny” repeal bill. This measure would reportedly rescind the ACA’s requirement that individuals have health insurance and that employers with 50 or more workers provide coverage for their employees. The bill also would eliminate a tax on medical devices that manufacturers have fought against since before the ACA was passed in 2010.
The Congressional Budget Office (CBO) has not published a score for this specific measure. But actuaries and the CBO in the past have said that if the individual mandate were eliminated, 15 million fewer people would have insurance, and premiums for older adults would escalate because many healthy people would drop their coverage and insurers would be left covering older and sicker Americans.” (A)

“With the economy stagnating and Congress bridling at President Richard Nixon’s heavy-handed spending controls, lawmakers in 1974 created a fast-track procedure to help make the tough decisions on rising budget deficits and swelling entitlement spending.
Since then, that process — called reconciliation — has been warped for many purposes, including large tax cuts, but never has it been used for the kind of complex policy making that Republicans are trying to do now with health care. And it is showing.”
One by one, key provisions and large blocks of text may be stripped from the Senate bill to repeal and replace the Affordable Care Act because the budget rules being used to pass the legislation are for budget matters — spending and taxation — not policy. (B)

“The Senate has entered the home stretch of the dramatic debate to overhaul Obamacare, with lawmakers bracing for what could be a long and grueling marathon series of votes that extends well into the night and morning. The Republican health care strategy: Pass bill first, fix it later
And the text of the GOP plan — a so-called “skinny bill” that rolls back Obamacare’s individual and employer mandates — remains unseen by senators or the public, although it was discussed during a closed-door lunch. The idea would be to get to a conference with the House, where GOP leaders would continue negotiations in hope of reaching a bill that can provide a long-awaited legislative victory to President Donald Trump.”
Multiple sources say Senate Republican leaders are circulating an outline, with a selling point that it amounts to “repealing the pillars of Obamacare — the mandates.”
The outline, according to two sources who have viewed it, proposes: Repealing the individual mandate, repealing the employer mandate for a minimum of six years, providing greater flexibility to the states through the 1332 waiver, and defunding Planned Parenthood, directing those funds to Community Health Centers.
The Republican Party’s ongoing efforts to pass legislation to weaken the Affordable Care Act is expected to culminate in the famous Senate process known as vote-a-rama, in which senators can introduce an unlimited number of amendments — often for the purpose of driving home a political point and forcing colleagues in the other party to cast uncomfortable votes.(C)

“Four Republican senators — enough to sink a majority vote — said that they will only support the GOP’s “skinny” Obamacare repeal bill if they get assurances that a better plan will get hashed out in a conference committee with the House.
In the latest twist in a bizarre legislative process, Sens. Lindsey Graham, R-S.C., John McCain, R-Ariz., Ron Johnson, R-Wisc., and Bill Cassidy, R-La., held a news conference to slam the proposal to roll back parts of Obamacare while leaving the door open to voting for it.
Graham said he could not support a “half-assed” plan that he called “politically” the “dumbest thing in history.” But he added that he could back the bill if he is promised that lawmakers could strike a better Obamacare replacement deal in conference.
Johnson said the plan was sold to senators as “a vehicle to get to conference.” McCain added that he is “voting no unless I see that there is a path to a conference” and said he would also listen to GOP Arizona Gov. Doug Ducey’s opinions on the plan.
Essentially, the senators said they would back the plan only with the assurance that the House will not pass the same bill.”(D)

 

(A) Senate Leaders Still Intent on Slashing Your Health Care, by Dena Bunis, http://www.aarp.org/politics-society/advocacy/info-2017/senate-rejects-health-care-repeal-no-replace-fd.html
(B) Republican Gamble on Fast-Track Rules for Health Care Hits Wall, by Robert Pear, https://www.nytimes.com/2017/07/26/us/politics/republican-fast-track-rules-obamacare-hits-wall.html
(C) Senate nearing end of health care debate period, preparing for a long night of votes, http://cw39.com/2017/07/27/senate-nearing-end-of-health-care-debate-period-preparing-for-a-long-night-of-votes/
(D) Four GOP senators shred ‘skinny’ Obamacare repeal — but leave the door open to voting for it, by Jacob Pramuk, http://www.cnbc.com/2017/07/27/mccain-graham-johnson-lay-out-terms-for-supporting-obamacare-repeal.html

 

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