"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Monday, October 5, 2015

Amazing Accomplishments

I have had the opportunity over the last week to express my appreciation to the leadership of WMHS as to our accomplishments over the last year.  I also asked that they convey that same appreciation to our staff throughout the System.

Some of the more notable successes for fiscal year 2015 are as follows:

  • Created the Bridges to Opportunity program to address poverty throughout our region.
  • Established our first community garden, providing fresh fruit and vegetables to those who may not have the opportunity to get them.  We also  provided hundreds of pounds of fruits and vegetables directly to the Western Maryland Food Bank from the garden.
  • Strong recruitment year for physicians and advanced practice professionals helped to meet a number of previously unmet needs at WMHS.
  • Refinanced our hospital bonds and saved $43 million over the next 25 years.
  • Ended the year fiscally very strong with a total margin of 14.45%.
  • Grew days cash on hand to 208 days.
  • Ended the year as Maryland's top performing hospital for hand hygiene.
  • Received Premier's Platinum Performance Achievement Award for the treatment of myocardial infarction.
  • Selected as one of the nation's Most Wired Hospitals by the American Hospital Association.
  • Ranked as the 11th best hospital in Maryland by US News and World Report.
  • Received the Maryland Patient Safety Center's Distinguished Achievement in Patient Safety Award.
  • Saved over $8 million through the Center for Clinical Resources by caring for patients with heart disease, Diabetes, hypertension and COPD in a setting other than inpatient acute care.

FY 2015 was an exceptional year and only achievable through the hard work and dedication of some amazing people.

Tuesday, September 29, 2015

On Time and Under Budget

As November approaches, it will be six years since we moved into the "new" hospital. I was reminded of the success that we had when we were nearing completion of the building process during a meeting last week.  The audit partner from KPMG was rotating off of the WMHS account and, during the Audit and Compliance Committee, he took a walk down memory lane in his farewell remarks.  He commented on the "new" hospital project coming in on time and under budget.  He said that in all of his years in accounting and auditing, he never saw a project of this magnitude come in on time let alone under budget, especially a new hospital.  

My thought at the time was if you only knew how difficult that it was to accomplish.  Without strong, direct oversight neither would have happened.  Toward the end of the project in 2009, we were told that there was no way that the project would be completed on time.  We were told that instead of a November opening, it would be more in the February / March timeframe.  Our contractor was reminded that we were a hospital and that we planned our completion around our less than busy season.  Their revised completion date would put us the middle of our peak season with flu and pneumonia.  They were told that we would enforce our agreement and there would be penalties for every day that they missed our original completion date.  Fortunately, we prevailed but it wasn't easy.  

What also wasn't easy was keeping the project under budget.  The intense oversight that was involved by Kevin Turley, the VP in charge of the project, and Mike Smith, our Internal Auditor, were the reasons for our success.  The financial aspects of this project could have been equivalent to a runaway train if those building the hospital were given the opportunity.  They would submit receipts for the pay application without any detail, which we would not accept.  There was obviously a great deal of pushback and evasiveness, but we prevailed.  We would also have Mike Smith audit every pay application before any payment was awarded.  This process alone saved hundreds of thousands of dollars, if not more.  We applied a number of techniques to ensure that the project remained on budget and fortunately, we were successful.

There is a new book out called F.I.R.E. by Dan Ward, which focuses on Fast, Inexpensive, Restrained and Elegant methods for leaders when involved with projects. He copied the term F.I.R.E. from the military's approach to project work, Fast, Inexpensive, Simple and Tiny (F.I.S.T.).  Ward says Fast is for having a short schedule; speed is important, don't let the project be dragged out.  Amen!  The Inexpensive doesn't mean cheap; it means exactly what we did by effectively managing the construction and payment process.  Restrained means tight controls, a small group providing oversight and a well-defined schedule to which all are held. Very important as we found out first hand.  Ward's Elegant represents elegant simplicity.  Don't make the project more complicated than it has to be.  He says that you can have true sophistication as well as true design and process maturity through deep simplicity.  

I can certainly get on board with Fast, Inexpensive and Restrained; I am having a little difficulty with Elegant.  No matter how hard we tried, there was nothing simple about bringing this "new" hospital from the drafting table to reality.  Fortunately, we ended up with a wonderful outcome, but it took a great deal of time and oversight of the project for it to be known as such an exceptional outlier--being on time and under budget--in the eyes of our audit partner.

Tuesday, September 22, 2015

Sharing Forty Years of Learning (Continued)

Yesterday, I blogged about what I have learned after four decades in health care, with today being my 40th anniversary in health care.  Five of my top ten lessons were covered yesterday, with the remaining five to be covered today.  They are as follows:

Lesson 6: Treat People as You Would Like to be Treated
This lesson is easy to say but more challenging to put into practice for many.  I had the advantage of working in an entry-level position when I first started working in health care.  I saw how my co-workers were treated by supervisors, managers, nursing staff, physicians and other employees with more seniority; I even experienced much of it myself.  Some people were downright rude and disrespectful.  That was clearly not the way that I was going to treat people and I have pretty much tried to "walk the talk" if you will in this area.  I have found that it really isn't that difficult to be nice and respectful toward others.

Lesson 7: Be a Visionary
Yesterday, I blogged about accepting and embracing change, which is related, but as a leader you have to have a vision for what needs to be accomplished in your department, unit or organization.  If you don't have a vision for the future, you will be lost.  I have always loved being able to focus on what's next for me and for WMHS.  Fortunately, my visions for WMHS have been successes as they have become reality.  From the consolidation of the two hospitals to the building of a new hospital to creating a new care delivery model to the Trivergent Alliance; all have been successes (Thank God).  On the personal side, after realizing that health care is where I wanted to be, I had to create a vision for my career and, fortunately, that paid off as well.

Lesson 8: Listen, Listen, Listen
All forms of communication are critically important, but for me listening is the most important form of communication.  Believe it or not, I don't talk as much as I listen.  Case in point is when our Triple Aim Coordinating Council meets at the health system.  I sit there in awe of our folks in the trenches who are trying to ensure that our value-based care delivery model is as effective as it can be and that our patients are always at the center of everything that we do.  I have learned so much over a very short period of time from these caregivers and clinicians all through active listening.

Lesson 9: Use Common Sense
I have been blessed with good common sense and I use it.  People have a tendency to make things a lot more challenging than they should.   Quite frankly, the application of common sense can be an exceedingly powerful problem-solving technique.  I couldn't imagine functioning effectively without it.

Lesson 10: Career Should Not be at the Expense of Family
It can be very difficult to balance work and family.  At one point in my life, the hospital leadership for whom I worked, expected virtually 24/7 dedication to my job.  After three years of that, enough was enough.  I made the decision to come to Cumberland, which afforded me a better balance between my work life and personal life.  Over the years, I may have been the guy in the business suit coming into the school gym to see my daughters play in a basketball game, but I made sure that I was there.  Although, I must say having an understanding and supportive spouse over these many years certainly has helped with the work \ family balance.

I could go on but I think ten lessons are plenty.  It has been an unbelievable journey over the last 40 years and what's really cool is that it's not over by a long shot.

Thanks to all of you who have made these years as much memorable as rewarding.

Sharing Forty Years of Learning

A few weeks ago, I wrote about my milestone anniversary of 40 years in health care.  That anniversary is September 22.  It is hard to imagine that I have spent 40 years in a profession that I had never intended on pursuing.  Being in this profession for so many years, one has a tendency to learn a few things.  The following are the ten lessons that I learned over four decades working in the many levels of health care, from the entry-level position of equipment orderly to CEO and everything in between.

Lesson 1: Get a Mentor / Be a Mentor
I was fortunate enough to have a number of mentors over my many years in health care, especially the formative years.  As a result, I have been and continue to be a mentor to a number of individuals.  I learned how to speak correctly, write effectively, organize everything, manage my time, interact with just about everyone, develop trusting relationships, learn to depend on people, overcome my shyness and better prepare for what has become an amazing journey.

Lesson 2: Accept and Embrace Change
It's amazing when seasoned executives are asked to change and they just can't.  I have seen it all too often, an executive, including CEOs, being asked to consider a change and simply can't, or better yet, won't.  I have witnessed executives being terminated over their unwillingness to accept change.  From the time when I entered the first hospital in which I worked, change has been required.  Sometimes I didn't even have time to assess whether the change was good or bad for either the organization or me.  But, I had to eventually embrace it.  I loved the status quo early in my career.  Let me do my job and stay out of my way.  That was short lived.  As soon as I got into management, change became a critical component of what I had to do and it continues to this day.  Embracing change over the last 20 years, whether it was consolidating the two hospitals, planning for a new hospital, changing how we do business under value-based care delivery or forming the alliance with Meritus and Frederick, was critically important.   Change became necessary and under each of these major changes, we have become a better organization and I a better executive.

Lesson 3: Dress for the Next Level in the Organization
Set yourself apart and dress for the next level in the organization in the traditional sense.  Look professional while at work.  I wear a suit and tie almost every day and "dress down" to a sports jacket and tie; rarely, will I be dressed casually at work.  When WMHS relaxed our dress code to business casual a number of years ago, a department director said to me, "I hope that you don't deviate from your suit and tie everyday; we expect to see our CEO dressed as a CEO."  Fortunately, I like wearing a suit and tie each day, but I also think that the CEO should always look like a CEO, again in the traditional sense--not the Silicon Valley sense of a tee shirt and jeans.  There is plenty of time to dress down, just not at work. Again, my opinion.

Lesson 4: Surround Yourself with the Best
This is a lesson that I learned from Ronald Reagan, who as President of the United States, said that he could not be effective without his team of wonderful advisors.  He said that he always would surround himself with the very best. I recently heard a CEO describe himself as a mile wide and an inch deep.  That's me, a generalist.  I have wonderful people with whom I work; they are highly talented.  I depend on their expertise each and every day.  They, I guess, are the ones who are an inch wide and a mile deep.  Actually, that's not fair to them; they are so well versed in so many areas that an inch wouldn't cover it.   I have always surrounded myself with the best and I have been truly blessed over the last 30 years in health care administration.

Lesson 5: Make Yourself Indispensable / Reinvent Yourself
I don't want this lesson to sound like a contradiction of the preceding lesson; but early in my career, I always tried to know everything that I could about my job but also the jobs of those around me.  I tried to make myself indispensable.  I did so with great results as I had seven promotions in eleven years.  However, as the years went on, I found it to be exceedingly challenging to know everything about every aspect of health care, especially since I am not clinically trained.  So, there can be a limit to indispensability as you take on more responsibility, but constantly be reinventing yourself through continuing education.

The next five lessons will appear in tomorrow's blog.

Saturday, September 19, 2015

They Said What?

I can't for the life of me believe that two of the co-hosts on the View went on the attack earlier this week against Miss Colorado and her appearance during the talent part of the Miss America pageant.  Kelley Johnson, who is a nurse, gave a monologue about her patient Joe, who was suffering from Alzheimer's disease, and not being "just a nurse." The two co-hosts mocked her for having a "doctor's" stethoscope around her neck, being dressed in scrubs and lacking any talent.  I saw the clip of Kelley's monologue and I found it to be unique for the talent component of the pageant. I thought that she did a great job.  

For the women on the View to respond as they did just shows as to how out of touch and self-absorbed they really are on this show, which again is FOR WOMEN.  It is certainly not a show that I have ever watched--only read about.  Of late, it is making the news for hirings, firings, fights among the co-hosts, attacks on political affiliations and most recently, Whoopi Goldberg, another co-host defending Bill Cosby ,who is being accused as a serial rapist for over the last four decades.  And, now this.  

Taking on a nurse and her profession, which is one of the most trusted and respected all in the US for the last umpteen years, is crazy.  What are you smoking, ladies?  You must have a screw loose to attack this woman, who actually was a runner up in this year's Miss America pageant.  For so many of us, nurses have touched our lives in so many wonderful ways and for them to be attacked and mocked is mind boggling.  

Finally, the View is paying the ultimate price for their actions.  Two major sponsors, Johnson & Johnson and Eggland, have pulled their sponsorships.  Hopefully, more will follow suit.  These are out-of-touch women who are supposed to be discussing issues facing women; and if this is the best that they have, the show deserves to be cancelled.  Boy, do they miss Barbara Walters, the show's creator and host since the late nineties.  Once she retired and turned it over to this lot, the show continues to be an embarrassment.

Thursday, September 3, 2015

Milestone Anniversaries

This month marks two very significant anniversaries in my life--my wedding anniversary, Pamela and I will be married 39 years on September 10, and on September 22 I will mark forty years in health care.  Both of these milestones are inextricably linked.  You see, if it weren't for Pamela, I wouldn't be where I am today and most likely not in health care.  

I had some wonderful mentors in my early professional life, but no one has had more of an impact on my career decisions than Pamela.  (The amazing impact that she has had on my personal life is a given.)  These mentors would tell me that there was a promotion for me if I was interested.  I would come home and tell Pamela about the opportunity; she would say "and of course you are going to pursue this promotion."  

To this day, I am not sure if it was a lack of confidence at that time or if I hadn't really adjusted to a career in health care.  I had two degrees in Criminal Justice and my father was a police detective; I wanted to be in law enforcement.  I would tell her that I wasn't really interested and reminded her of my career goal at the time.  She would say, "that's ridiculous, a bird in hand is worth two in a bush."  

As I look back, it was clearly reverse psychology...she would say "continue in health care until that right law enforcement opportunity comes along."  In my early years in health care, I had seven promotions in eleven years.  Obviously, the more that I was exposed to the many aspects of health care through such promotional opportunities, the more I enjoyed what I was doing.  Fortunately, the mentors saw something in me, but it would have been for naught without Pamela.  

As they say, behind every great man is a great woman.  I am not sure as to how great I am so I will leave that for others to judge, but I can assure you that I have been married to a great woman for almost four decades.

Wednesday, August 19, 2015

Amy Gets It Right

I am not an avid reader of Dear Amy in the newspaper; however, I found today's column to be very appropriate for what we are trying to accomplish in health care today.  A woman wrote that her father, who is 91 and suffering from dementia, gave his son a living will a few years ago.  Under the circumstances, the son wants to fulfill his father's wishes by exercising the no heroic measures component of the Living Will.  The daughter wants to fulfill her mother's wishes, as she would like any measure necessary to resuscitate her father be exercised because the mother, who is of sound mind, will miss her husband terribly.  Amy's response was right on target; fulfill the wishes of the individual.  Why put someone through those heroic measures when they have no chance of any quality of life? 

Recently, my family experienced the same issue with a out-of-state distant relative who made his peace and said that he was ready to die. Unfortunately, the family hadn't conveyed his wishes to the staff.  Once he went into cardiac arrest and since he hadn't completed a do-not-resuscitate order, he was resuscitated.  Fortunately, his family finally got it and conveyed his wishes.  He died shortly thereafter.  

I just wish the family had that same "a ha" moment when their father was first hospitalized after a fall.  He was eventually transferred to a skilled nursing facility (SNF) from the hospital with two pretty significant pressure ulcers that only worsened at the SNF along with the addition of several other ulcers.  There was very little attention paid to the pressure ulcers with little care, treatment or wound therapy.   In addition, he was rarely ambulated by the staff.  The staff was pleased with themselves when they got him to sit in the chair.  When the family was asked about why they weren't more adamant about the care of their father, they said that the staff are working so hard as it is.  Yikes!  I can't imagine letting someone deteriorate right before your very eyes and not advocate for your loved one.  Between the pressure ulcers, the lack of ambulation and the meds that he was on, the entire scenario can be described in one word: iatrogenic.  His condition and subsequent deterioration were the direct result of an inadvertent lack of care brought on by medical professionals since his goal was to walk out of the hospital after that April fall.  It is so very sad in that there were so many who could have advocated for this man but didn't.