In the past, care needed to happen in a doctor’s office or hospital, but how is that changing? What do patients and healthcare consumers expect today and what are we doing to keep up with this rapidly changing environment? Watch some of our top leaders from SCL Health discuss the future of healthcare and SCL Health in this quick, four-minute video:
Amy Anyangu, Director of Safety and High Reliability Organization (HRO) Development at SCL Health likes to use a funny example to teach people about resisting oversimplification and promoting critical thinking when problem-solving.
“If my child comes running up to me and says, ‘Mommy, mommy, where is the fire extinguisher?’ I don’t just answer that question and think that they just want to pretend to be a fireman. I ask the question of, ‘Why do we need the fire extinguisher? What’s going on?’ Maybe I need to look into this further.”
Most people would react to this by asking if there is a fire or why the child wants the fire extinguisher. To oversimplify the situation would be to assume the child has the situation under control or is just playing. It’s an extreme example, but Anyangu wants us to apply the same resistance to simplify when we’re confronted with a problem or situation with a degree of uncertainty and we feel the urge to default to our assumed solution.
A reluctance to simplify is one of the five principles of high reliability organizations, which are organizations that typically operate under trying conditions and still manage to keep mistakes from turning into catastrophic events.
“If we’re trying to solve a problem and we’re looking at a situation, sometimes we can take the first solution that comes to mind and run with it,” says Anyangu. “Had we taken some time to really dive into it and understand it better we would have gotten to the right solution.”
A reluctance to simplify when looking to solve a problem promotes critical thinking and situational awareness that you might not use when you think you know the answer. Taken to its extreme, oversimplification can have harrowing results.
Anyangu relays the story of a post-operative patient who was able to walk around and talk with her caregivers, but her pulse oximeter was going off and indicating that the oxygen levels in her blood were low. Her nurses had issues with the pulse oximeter cords before so they thought that must be the problem and changed the cords, and then changed them again.
“In reality this patient was having a post-op complication and it was an early warning sign to that complication,” says Anyangu. “We could have gone down the clinical path and said to our self, ‘It could be the cord, but it could be the patient. How do I rule that out because that is the more concerning thing?’”
Unfortunately, that patient passed away. Anyangu says our most common type of serious safety event is a delay in diagnosis and treatment like this.
“In our review of those events, it’s not uncommon to see this issue come up,” she says. “We oversimplify something and we end up down a different path than what the actual situation was and what was actually going on. We were lacking situational awareness for what the real problem was.
“If we keep going off the assumptions we have it puts us at really high risk for making mistakes,” says Anyangu. “We want to challenge our assumptions. We want to be an organization that doesn’t rely on assumptions and challenges those and really looks to see what it is we need to see.”
One of the tools we promote for error prevention is to “stop, reflect and resolve.” In the face of uncertainty, rather than going with our first assumption we should pause, think about what doesn’t make sense in that moment, and then consult with an independent, qualified expert for whatever the problem is.
Other tools that help us resist simplification are daily safety check-ins, cause analyses, shared learnings, promoting a questioning attitude and seeking diverse opinions and perspectives for problems. Anyangu has one overriding mantra for avoiding oversimplification: Don’t just answer questions, question answers.
“There is no technology that can think critically for us,” she says. “That’s the key piece where we really need the human side in everything we’re doing.”
Have you ever stumbled upon a great idea during your morning shower? Perhaps you’re one of those people who has a whiteboard full of scribbles? Or maybe you and your team have some well-developed plans, but just haven’t had the budget to execute on them?
Whatever the case may be, you now have a chance to turn your great ideas into cash, all while helping our patients and getting to sit in the driver seat of big change. SCL Health is launching its first ever Innovation Challenge. By bringing your best thinking to an important challenge, you could earn $1,000, as well as funding, resources, and senior leadership support. Submit your ideas between April 24 and May 11 for a chance to turn your idea into reality.
So, here it is, the 2017 Innovation Challenge theme:
How might we create the ideal patient journey both within and outside our hospitals and clinics?
Visit www.SCLHealthInnovation.org to submit your idea and learn more.
SCL Health believes the best solutions to solving today’s toughest healthcare challenges come from within. The contest is open to all associates. Team entries are encouraged, since it will be easier for the eventual winner implement an idea than a single individual. SCL Health will work with directors, managers and senior leaders to support winners with resources and funding – not to mention high-fives and pats-on-the-back.
So you may be thinking, what do I know about innovation? I’m not a hipster on his laptop in Starbucks. I’ve never invented a drone that delivers pizza. The truth is, innovation isn’t a tech thing. It’s about new ideas – or twists on old ones – that make things better.
You’ll see information on your computer desktop background and other places, and you can find questions and background materials on the website.
These questions and more were covered at the Spring Leadership Assembly on April 10-11, where more than 150 leaders from across SCL Health gathered to focus on solutions for the big issues in our ministry, gain knowledge and inspiration from industry experts, and network with each other. The theme of the event was: Our Mission to Serve: Expanding Accessible, Affordable, Exceptional Care Through Partnerships.
Throughout the event, the message was clear: SCL Health continues to be strong and successful; our mission comes through in our work; and we collectively provide a vast amount of community benefit. In the midst of healthcare change and vulnerability, SCL Health continues to thrive. Our quality scores are strong, we’ve expanded out outreach and services, and we’re working on innovative and digital solutions to provide healthcare when and where consumers need us. Yet we always have room to grow and improve.
Key takeaway messages from the Assembly:
- We must be better diversity and inclusion – in our workforce and in those we serve. Diversity is more than visible traits such as gender, skin color, age and physical ability. It’s also religion, culture, sexual orientation, beliefs, values, military experience and more. Participate in the national call to action to include diversity and inclusion in healthcare. Search online for #123forEquityPledge.
- According to a healthcare expert on mergers and acquisitions, SCL Health’s sustainability score is right in the middle. We’re doing great but we have room for growth, which we can accomplish by looking for opportunities to partner, fill gaps, consolidate and expand our presence in other communities. We must also lower costs, improve efficiencies and always focus on quality as the driver of success.
- In any relationship – such as a marriage, or the partnership between Saint Joseph Hospital and National Jewish Health – be willing to collaborate, establish strong connections from the start, realize that it takes more work than you expect, and show transparency in decisions. The result can be astounding success and a benefit to all involved.
Since Mike Slubowski took the helm of SCL Health 6 ½ years ago, we’ve come a long way, baby. He turned this organization around from an operating loss of $70+ million in 2010 to a strong balance sheet. Back then we had little clinical or system integration, a limited focus on community benefit, and care sites that were struggling. Today we have a commitment to great care, great people, an inspiring mission, a profound legacy and tremendous opportunity. He said we must always ask, “How is this improving the health of the people we serve, especially those who are poor and vulnerable?” We must continue our unrelenting quest for excellence.
- Rick Pollack, President of the American Hospital Association, pointed out the tremendous amount of mixed signals coming from Washington. Healthcare systems must focus on reforming systems for delivery, payment, insurance and IT. They must improve readmissions, accountable care organizations, medical homes and centers for innovation. They must provide wellness and good health, along with sick care. He encouraged SCL Health leaders to share their voices on healthcare reform through advocacy tools.
- Consumers are ready for us to come to them where they live and work. Consumerism requires that we get to know each person and what matters most to each one. For every patient, encounter and location, give them the chance to voice whether the experience was positive, negative or neutral. Perform service recovery when needed. Continue promoting telemedicine, virtual visits, an interactive patient portal, online scheduling, community hospitals and home health. Consumers today are asking for instantaneous and clear information online.
- According to a health economist and futurist, all healthcare systems in are for tough times, so we have to be creative and innovative to meet the challenges to provide the best care for those we serve. It’s up to us as daring spirits to think about what we can do to improve healthcare at SCL Health. Creativity is the common denominator of world-class health systems. Imagine all of the different ways that you can improve things. You can’t do it all on your own, but you can partner with others.
To access materials from the Assembly, SCL Health associates can visit The Landing > Dept & Team Sites > Marketing & Communications > Events and Conferences
As SCL Health prepares for the departure of our President and CEO Mike Slubowski in May, Lydia Jumonville, Executive Vice President and Chief Financial Officer, has been appointed to serve as the Interim President and Chief Executive Officer.
Lydia joined SCL Health as CFO in June 2010, and she has more than 30 years of experience as a finance executive, including providing tax compliance and consulting to real estate and healthcare clients of Arthur Andersen LLP. She holds a bachelor’s degree from Louisiana State University in Baton Rouge, Louisiana, and is a certified public accountant.
“The SCL Health Board of Directors and Sponsor Leaven Ministries are grateful to Lydia for accepting these expanded leadership duties,” says Kate Paul, SCL Health Board Chair. “We are fortunate that our ministry has highly qualified and engaged leaders who are willing to contribute their time and talent when the need arises.”
“My passion is faith-based, nonprofit healthcare, and I’ve been blessed to support SCL Health the past seven years. I am honored and humbled to have been selected to steward our health system during this transition period,” says Lydia.
The SCL Health Board has formed a committee that will pursue a national search for SCL Health’s new President & CEO.
Wow! Thank you to everyone who submitted good catches during Safety Week. During the week, we received a total of 353 Good Catch submissions. Because of your diligent work, SCL Health is a safer place for every one of our patients and associates.
The grand prize of a DJI Phantom 3 Standard Quadcopter Drone goes to Adriana Ramos Gonzalez at St. Mary’s Laboratory. While processing a specimen in the lab, Adriana noticed that a test had been left out of the handwritten order. She caught it and processed the specimen accordingly. Great catch and event reporting, Adriana!
- Christopher Allen, SCL Physicians Thornton Medical Center
- Cristen Conley, Saint Joseph Oncology
- Mary Dean, St. James 5 Main
- Nanette Graham, St. Mary’s Labor & Delivery
- Malia Maness, Good Samaritan OR
- Robert Nielsen, Lutheran OR/Surgery
- Samantha Perkins, Holy Rosary Long Term Care
- Christina Rozier, St. Vincent 4 Tower
- Ann Toelle, St. Francis Joint Replacement
- Ellen Wagner, Platte Valley Nursery
From removing trip hazards to catching medication interactions and incorrect dosages, these caregivers, along with every associate at SCL Health, is helping us achieve our High Reliability goal of zero harm. Please join us in thanking the associates who help us identify issues before they impact safety or become events of harm.
The SCL Health Mission Integration and Ministry Formation team is pleased to offer the 2017 Journey to Leavenworth immersion experience. This unique four-day renewal retreat provides an opportunity for participants to deeply connect to a personal sense of meaning and purpose in their lives and work. Applications are due on or before April 25, 2017.
Join others from across the SCL Health System at the Marillac Spirituality Center on the peaceful campus of the Sisters of Charity of Leavenworth in Leavenworth, Kansas.
This is the ground where the Sisters of Charity of Leavenworth first established their religious community in 1858. During the trip, you’ll have ample opportunity to explore our spiritual history and heritage as a health system, reflect on your own personal spiritual journey, and come away with a renewed sense of belonging and hope as a member of the SCL Health team. Even if you do not share a faith-based spirituality, you will come away from this trip having cultivated your mind, body, and spirit – an essential part of our mission and ministry at SCL Health.
Monday, May 22: Bus departs from Saint Joseph Hospital parking lot at 7:00 a.m.
- Tour of the SCL Motherhouse and archives
- Visit to the Landing site on the banks of the Missouri River
- A commissioning service
- Opportunities to form new friendships with other SCL Health associates, leaders, and volunteers
- Ample time for personal reflection and renewal
- Much more!
Thursday, May 25: Bus returns to Saint Joseph Hospital parking lot by 6:00 p.m.
Interested in attending? The Journey to Leavenworth is an optional formation opportunity sponsored by the SCL Health Mission Integration and Ministry Formation team and paid for by the care sites or department. Please note that transportation to and from Leavenworth is an important component of the immersion experience and selected applicants will be expected to travel with the group by bus from Denver. Due to space limitations, we will hold a drawing to determine the final participant roster. Applications are due on or before April 25, 2017. Please submit this application to Deb Roybal, Regional Vice President, Mission Integration and Ministry Formation at firstname.lastname@example.org. Applicants will be notified of their selection on or before May 1, 2017.
Questions? Please contact Deb Roybal at 303.812.4932 (Ext: 84932) or Sister Jennifer Gordon at 303.813.5202 (Ext: 25202).
Healthcare in general has an under-utilized resource that could improve processes, patient care and more. It’s not a new treatment or philosophy of care, but data. Data is abundant and readily available in healthcare, but often not connected to the caregivers and decision-makers who need it most.
“(Healthcare) has become data-rich due to the digitalization of healthcare but remains insight-poor because of a lack of solutions that can leverage that data,” says Julius Bogdan, Director of Data and Analytics Innovation (ADI) for SCL Health.
He sees this less as a deterrent and more as a welcome challenge.
“So it offers the opportunity to start building the solutions in this space that hadn’t existed before,” says Bogdan.
Bogdan came to SCL Health about a year-and-a-half ago from the software industry and uses his deep experience across other industries such as finance and manufacturing to help shape the data and analytics strategy for SCL Health. His department is focused on getting the right data to the right people at the right time and empowering them to make the right decision to improve the health of our communities through a focus on patient care in a sustainable way.
“The healthcare industry is very fragmented when it comes to data with each line of a business application having its own database, data warehouse and analytics tools,” says Bogdan. “Evolving technologies such as big data, advanced analytics and data visualization allow us to actually get insight from our data. We can then take that insight and operationalize it to really help propel the organization and healthcare forward. These technologies also help us pivot our focus from transactional systems (EHR, GL, Time and Attendance) to a patient-, outcomes-, or population-focus and all the data elements those entail regardless of where that data comes from.”
Physicians need access to insightful data while they work to incorporate clinical best practices at the point of care. In this new paradigm, a physician has all of the relevant analytics at his or her fingertips integrated into one application whether it’s an augmented patient history, calculated risk scores, predictive models for treatment modalities or population dashboards.
Bogdan is working on incorporating these types of data solutions into eSummit, where our caregivers frequently work, so they can have the best data available when they need it. Bogdan and his team have been recognized as thought-leaders in creating the modern healthcare platform and have been invited to speak at conferences across the world.
Bogdan wants to change the way we approach healthcare problems in general by using concepts such as design thinking and Agile methodologies coupled with new tools and modern architectures.
“We leverage concepts such as design thinking where we better understand the “why” for each project and build the right solution not the solution we’ve always built,” says Bogdan. “We also borrow principles from methodologies like Agile that lead to solution frameworks in a couple of weeks that normally would have taken us months or years to build.”
Some examples of the work ADI has undertaken include developing custom applications and dashboards that capture home health associates’ time, activities, mileage and intake processes. This fully automates a tedious paper and spreadsheet integration process while calculating variable pay, daily hours, mileage payments, productivity and other department-level metrics. ADI also built a real-time emergency department metric tracking feed for solutions like calculating ED average wait times, which can be consumed by any application. They also created an open and direct scheduling dashboard that provides insight into our scheduling patterns to identify trends and areas of improvement.
Bogdan wants to continue to drive this kind of innovation so caregivers and decision-makers have data at their fingertips.
“We want to provide insight into their day-to-day operations,” he says. “Everything from staffing to patient care to having a richer patient history that they can work with in the screens and environments they are already working in.”
When Mike Slubowski arrived at SCL Health in 2011 as its newest President and CEO, he inherited an intimidating to-do list by any stretch of the imagination. Comprehensive quality measures were hard to come by. The health system suffered a $79 million loss the previous year. The installation of Epic in legacy SCL Health sites – a monumental task in the best of situations – had not yet started. Our care sites were loosely affiliated, and there were a number of key leadership vacancies.
Today, six and a half years later, things look very different. SCL Health is a nationally recognized leader in quality. We have increased our commitment to charity care and community benefit every year, now at approximately 10 percent of our revenue. We are in the black financially and growing as an organization. Not only is Epic fully integrated across our system, we are a “Most Wired” health system. We’ve integrated functions and culture in a way that’s enabled us to reinvest into our mission. Our double-digit improvement in associate satisfaction was highlighted nationally by Press Ganey out of a pool of hundreds of hospitals and health systems nationwide.
As Mike prepares to start his next adventure as President and Chief Operating Officer of Trinity Health, the nation’s second-largest Catholic health system, we sat down with him to talk about his time at SCL Health and parting words of wisdom.
The key ingredient: people
For all the challenges Mike discovered when he first arrived, he realized he had everything he needed with people who are passionate about their work and the mission. From the sponsor and governing boards, composed of Sisters of Charity and lay business leaders who serve voluntarily, to the dedicated leaders and associates serving our patients at the bedside, SCL Health is led by individuals who are committed to doing the right thing.
“We have such committed associates and outstanding leaders who are inspired by our mission,” he says.
Many organizations spend time on the “what,” Mike says, referring to operations, strategic development and growth projections. But it’s just as important to focus on the “how.” How does the leadership team work together? Are associates engaged? A healthy organization with regard to its people generally becomes a smarter organization with regard to its performance.
Connectedness as a unified system, both culturally and operationally, is critical.
“As we approach challenging issues, such as improving quality and care outcomes while reducing costs, we can’t be binary (in our thinking),” he says. “We have to figure out a way to do both.”
Building on our legacy
For Mike, every important decision comes back to our mission. “We were handed a legacy of responding to the needs of the people we serve,” he says, of the founding Sisters of Charity of Leavenworth. The SCLs left communities better off than when they arrived, which is a goal that remains in effect today.
Mike is quick to dismiss a business mantra often recited by nonprofit organizations that states where there’s no margin, there’s no mission.
“I think it’s a cop out,” Mike says, noting that SCL Health’s founding sisters didn’t have margin, which refers to income after expenses. “Their mission drove how they acquired resources to make it happen.”
That’s not to say that healthcare doesn’t have intensive and sizeable capital and financial needs, he says, but this can’t be an excuse in how we approach the challenges facing our communities. We must be especially resourceful in how we meet people’s needs. “You can do good work for communities and do well as an organization at the same time,” he says.
Partnerships, stewardship and accountability
Indeed, this no-nonsense discipline has characterized Mike’s leadership at SCL Health. Year-over-year improvements in quality, safety, patient experience, stewardship, community benefit programs, growth, and other important strategic areas have come through a consistent commitment to action and measurement via scorecards that bring accountability aligned to our most important priorities.
Stewardship, defined as the wise use of the resources entrusted to us, is a theme in our decision-making. Leveraging skill, scale and learning, primarily by finding ways to integrate important functions and rapidly share and adopt best practices, has helped us improve outcomes, create better experiences, and strengthen our operations.
SCL Health has done this not just internally, but with partner organizations as well. In addition to SCL Health’s longstanding partnership with Kaiser Permanente, Mike considers SCL Health’s joint operating agreement with National Jewish Health to be one of his proudest achievements, along with the addition of Platte Valley Medical Center to the SCL Health family of care sites. These are both examples where SCL Health and its partners have accomplished so much more together than they could do on their own.
A champion for changing care models
Mike welcomes the shift to value-based models of care, in which providers are paid for keeping people healthy, not just treating illness. For him, these new care models are not about adapting to a government-led mandate. They drive better outcomes at lower costs and are clearly the right thing to do for patients. He takes special pride in Monument Health, the Clinically Integrated Network established in Grand Junction with St. Mary’s Medical Center; Northern Rockies Healthcare Alliance in Montana; and the creation of Accountable Care Organizations, or ACOs, in Montana and Kansas. SCL Health also participates in Medicare Shared Savings Programs and in bundled payment programs sponsored by Centers for Medicare & Medicaid Services (CMS). One of SCL Health’s greatest efforts to address the health of populations is with our own associates. Human Resource’s wellness programs, in which associates are rewarded for taking steps to healthier living and managing chronic conditions, show promise in leading this change in thinking.
Mike is no stranger to tough decisions and challenging situations. Early in his tenure with SCL Health, he was tasked with bringing together SCL Health and Exempla in a politically charged environment, along with the realignment of care sites in California and Kansas. In each case, a values-based discernment process guided these decisions. He’s also rejected the stereotype of a “holding company” or “operating company” model for SCL Health.
Instead, he’s worked to define SCL Health as a hybrid. By this, he means a unified ministry (“One SCL Health”), in which governance and leadership clarifies system-wide priorities and goals, provides value-added support services and acts a “servant leader” to leverage skill, scale and learning. This enables care sites to focus on care excellence, alignment with providers, stewardship, growth, and meeting the unique needs of each community served.
As healthcare transforms, there will no doubt be plenty of challenges in the future as well. But, Mike says, SCL Health will be well prepared for whatever lies ahead by sticking to a few helpful words of wisdom:
- Stay true to our mission and values – our mission is why we exist, and our values are how we carry out the mission.
- Remain person-centered. What we provide is the most personal of human services. We care for body, mind and spirit.
- Reflect on our successes. Consider what ingredients made us successful as we look to future goals and aspirations. “Success begets success,” he says.
- Don’t be afraid to try new things and learn from mistakes.
- Stay positive and act with courage, not fear.
- Embrace possibility thinking and inspire one another.
- Stay humble.
- Engage everyone in the change process.
- Remember the mantra that change includes people, process, technology and culture. If any of those four elements are left out, the desired change won’t last.
- Create a new destiny for the ministry. Clarify where we are headed, why we are going there, and how it requires the support of all associates to get there.
- Invest the time in getting out there to see each other and build relationships.
During a recent computer downtime, an associate in the St. Mary’s Medical Center lab received a specimen with handwritten orders on it. She asked to see the order form and found that a test had been left off. She added the test and processed the specimen.
It might seem like a small action, but it was a good catch and an example of a safety behavior that is very important to our organization — a preoccupation with failure. She was extra diligent since we were without our normal systems and was on the lookout for potential errors.
This mindset can seem counterintuitive at first. Why, exactly, should we be so focused on failure within our environment.
“We say our job is to find and fix problems,” says Amy Anyangu, Director of Safety and High Reliability Organization (HRo) Development at SCL Health. “We live in a complex system, and it’s a very error- and event-prone system. A high reliability organization is an organization that is able to function within that complexity and avoid the bad things from happening.”
Preoccupation with failure is one of five principles of high reliability organizations, which are organizations that typically operate under trying conditions and still manage to rarely make mistakes. Anyangu is one of our leaders on our journey to become a high reliability organization and she’s trying to promote a mindset and practices that help us see failures before they reach patients, and learn from them.
“In order to reach that level of reliability we have to have a sense where we’re not afraid of failure,” she says.
In practice, preoccupation with failure has led us to implement a number of efforts: daily safety check-ins at each care site; good catch reporting; rounding to influence and executive rounding; promoting a fair, safe and accountable culture; timely root cause analysis; and shared learnings.
Anyangu says that preoccupation with failure is better understood as a preoccupation with learning. We tend to learn a lot from our mistakes, but we have to change our mindset from just looking back on failures to also looking ahead for risks and potential failures.
“We do a good job of looking back — this happened, we can identify it, that was bad,” says Anyangu. “What we struggle with is the ability to look ahead and have that proactive sight.”
Anyangu uses a theoretical example of triplets born in the NICU named Jaden, Braden and Caden.
“So now these three babies, for pharmacy, radiology, lab or anyone interacting with them, we know that we’re at high risk to get these mixed up,” she says, because they look alike and have similar names.
She wants that kind of alertness to become second nature to our associates. A big part of that is feeling safe and comfortable to not only recognize failure, but bring it to attention so we can learn from it and prevent it in the future. Associates need to feel empowered to bring failure to light without fear of getting in trouble. That’s why good catch reporting is one of our ministry excellence goals this year.
“With good catches, yes, an error has happened,” says Anyangu. “But somebody caught that error before it turned into something. That’s why we use our online safety event reporting system; it’s our learning tool. It’s not a tattling tool.”
Becoming preoccupied with failure doesn’t mean that we should become paralyzed looking for issues. But Anyangu wants to develop mindfulness for detecting early signs or failure, seeing seemingly inconsequential errors as symptoms of a greater problem, and having a strong response to these potential issues.
“We can’t make the system work better for us, rather than against us, unless we learn what’s not working,” says Anyangu. “There are defects all around us. Let’s find them, identify them, and let’s learn from them.”