On Best Practices

Fulfilling life goals and bucket list dreams

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I don’t have a bucket list. But I did set four big broad life goals for myself about 10 years ago. They are doing work I like at a more manageable pace, travelling more, spending time with family, and having fun friends that I spend time with. Happy to say, I’m meeting these goals fairly well at this point.

My sister does have a bucket list. About 6 months after she lost her husband to cancer last year, she was still trying to figure out how much travel she was willing to do with family and friends. She mentioned to my husband and I that seeing the national parks was on her bucket list. My husband jumped on the idea and proposed a multi-week road trip itinerary to three parks – Yellowstone, Grand Tetons, and Glacier. My sister was in! Together they worked out the details and booked all the places we’ll stay – whether it’s one night while continuing to our park destinations or several nights near each of those parks.

That trip is happening now. My sister has been my best friend for as long as I can remember – she is only 16 months older than me. My husband and I have been best friends since the mid-1970s. I know the three of us will have a great time with lots of laughs and deep conversations as we traverse the miles together and take in the incredible scenery. She can check it off her bucket list and I’ll be meeting two of my big goals. Nothing wrong with that!

There is no “so what” to this post other than to encourage you to stay focused on your bucket list or life goals. I wish you all a happy end to the summer and hope you too have carved out some time for R&R with family and friends these past few months.

Related Posts:

Vacation season reminders for a more balanced life

4 tips when you must work on vacation

Take time to reboot

Do you know your big rocks?

The 6 R’s of summer

Nana Camp Chronicles: year 2 insights and adventures

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We held our second Nana Camp last week. Given how well it went (despite my husband and I being exhausted by Friday night), I think we’ll make it an annual event in the summer. Last year I wrote about our first one in my post “Leadership lessons from nana camp”. The rules we agreed on (pictured in that post) hung on our refrigerator until a few months ago when my husband went on a purging spree. Good thing I have a record here so we could revisit and decide on new/revised rules for this year.

Two (ages 10 and 8) of the four grandkids had their first away/overnight camps this year having attended Girl Scout camp. So, they came to Nana Camp with a new perspective. My daughter suggested that the 10-year-old could be a Counselor in Training (CIT) when we were last together as a family on Father’s Day. I wasn’t quite ready for that but I’m a fan of delegation! Not sure what a CIT would mean for us but as a start that day, she wrote down the list of ideas for this year and what they liked from last year. That list of course was put on the refrigerator door. We used it at our camp “orientation” session Monday morning to plan and vote on activities for the week.

The other two (ages 8 and 7) have been to day camps that are mornings only and gotten used to making their own lunches at home while their parents work in their home offices. Love hearing that! Means they all are capable of it and that I could expect them to do more for themselves at breakfast and lunch.

Together on Monday we agreed on activities for the week and what the rules would be. We also talked about their lessons from last year – mainly not to have stupid fights about everything – who sits by who at dinner, who sits by who in the car, who gets the first shower, who walks which dog – you get it! And of course, they are one year older and that much more mature!

Here is this year’s complete list of rules – a slight variation on last year with few additions: Continue reading →

Healthcare as a right in more progressive countries   

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I wasn’t going to write anything this week since my husband and I just returned from an 18-day trip with Road Scholar – The 4 Nordic Capitals. We spent 3-4 days in each – Copenhagen, Oslo, Stockholm, and Helsinki. It was everything I had hoped it would be! But no one hopes for jet lag and feeling like a zombie the first day or two back.

So, on day 2 of re-entry, I was up very early after too short a night’s sleep as my body adjusts to the 7-hour time difference. Why not start writing? I learned so much on the trip and have lots to share in due time. No question that we can learn a lot from these progressive Nordic countries – Denmark, Norway, Sweden, and Finland.

I visited three of these capital cities when we were on a cruise in the Baltic Sea in 2018. But having only 6-8 hours in a port is nothing like immersing yourself for a few days and really learning about the country – their history, political structure, culture, social services, technology, and more.

A day with a Road Scholar tour like this includes a 1-2 hour lecture from the local guide or an outside expert and then guided tours to a variety of sites with usually some free time late afternoon to explore on your own.

Let’s start with how progressive they are. I could start from various angles – a strong focus on sustainability, extensive public transportation infrastructure, free education through the university level, lengthy required maternity/paternity leaves, and of course their healthcare system.

From my lecture notes, here are a few data points I captured on healthcare:

In Finland, healthcare is not completely free but pretty close. Prescriptions are subsidized and you pay a maximum of 700 euro in a year ($769.37 using today’s conversion rate). Think about the people you know in the U.S. who are paying thousands a month for just one critical prescription. Hospitalization is 49 euro a day regardless of what it is for ($53.86 using today’s conversion rate). Think about people in the U.S. who have to declare medical bankruptcy due to hospital bills or deplete their life savings for nursing home care. (A 2015 study by the Kaiser Family Foundation found that medical bills caused 1 million U.S. adults to declare bankruptcy every year and that 26% of Americans aged 18 to 64 struggle to pay medical bills. Medical bankruptcy is almost unheard of outside the U.S.)

In Sweden medical care is free until you are 19 years old and dental care is free until you are 24. For medical care you pay $25 per visit or procedure. After a maximum of $720 per year you don’t pay. (Local guide spoke in dollars vs euros for us).

Yes, people in these countries have high tax rates but their dollars go to services for the entire population. Healthcare is just one example – they truly believe healthcare is a right with every citizen having equal access to services.

More to come on lessons from the Nordic countries in future weeks….

Leadership and crisis management lessons from Pennsylvania

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I love seeing stories of success with lessons to apply to our work in health IT. The recent I-95 collapse in Philadelphia and the re-opening in just 12 days is one of those stories. There was a great opinion piece in the Washington Post on July 16th by Pennsylvania Governor Josh Shapiro – “Opinion: We fixed I-95 in 12 days. Here are our lessons for U.S. infrastructure”. Initially experts told the Governor it would be months before they could reopen the highway and get traffic flowing. Instead, they reopened it in just 12 days. Indeed, there are many lessons for leaders in all industries.

Here are the four key takeaways he comments on:

  1. Empower strong leadership
  2. Speed up the bureaucracy
  3. Encourage creativity
  4. Work together

In the face of a crisis, empowering strong leadership is critical. We’ve seen it in healthcare during the pandemic and when responding to any kind of disaster. As Governor Shapiro describes it – “Managers of every component of the project were empowered to be decisive, take ownership and make a call when necessary — not defer and delay to the often-circular bureaucracy. Decisions were made quickly and in a synchronized manner.”

We have plenty of bureaucracy in healthcare including many processes in IT that seem burdensome. Governor Shapiro described how an executive order he signed shortly after taking office that catalogued each of the 2,400 permits, certificates and licenses the state issues and set timelines for each of them resulted in significantly reducing wait times – with one example cutting the time from eight weeks to two days. IT leaders take note – how many processes can be streamlined in your shop?

Innovation in healthcare is greatly needed and there are many bright spots we read about each day. But innovation is not just the new big flashy stuff, it can be a creative and new way to solve a problem that comes from someone on the team or an observer. Governor Shapiro wrote, “Encourage creativity and allow everyone to bring their ideas forward”. The backfill solution to rebuild the collapsed freeway using a recycled glass product was a result of that creativity from PennDOT engineers.

We all know there is no “I” in team. We accomplish great things by working together. In Pennsylvania, state and federal officials coordinated closely with each other and private contractors and organized labor collaborated working 24/7 to get the job done.

While we never want a crisis to manage through, there will be more. These lessons will be key then and every day.

Related Posts:

Leading through a crisis

Lessons from Succession: What not to do as a leader

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I recently wrote a blog post called “Ted Lasso leadership lessons”. If you were a fan of the Ted Lasso series, you can readily see there were many lessons to be learned. Another popular series, Succession, wrapped up around the same time. I wasn’t sure how I could comment on leadership lessons from that series as there didn’t seem to be any characters that you would want to model. But there were plenty of lessons on what not to do as a leader.

Others have figured out what to say about Succession leadership lessons, so I’ll share the insights from one of them. A Forbes article on June 26th by Robert Pearl, MD, titled “5 Fatal Flaws Of Healthcare Leaders: Inspired By HBO’s ‘Succession’” describes five dysfunctional leadership styles to avoid based on some of the lead characters. In his words:

  1. Delusional leaders overestimate their abilities. Their ideas are unrealistic and their vision for the future: pure fiction.
  2. Narcissistic leaders bask in praise and blind loyalty. They reject and punish those who provide honest feedback and fair criticism. Their obsession with status and self-importance blinds them to long-term threats and opportunities, alike.
  3. Immature leaders get promoted before they’re primed and polished. They often lack boundaries and excel at the sport of making others uncomfortable.
  4. Political leaders are better at advancing within an organization than advancing the organization itself. Like chameleons, these leaders change with the scenery, shifting alliances and values as organizational power waxes and wanes.
  5. Compromised leaders are skilled at making promises. They seek support by vowing to fulfill wants and palliate pains.

Dr. Pearl closes the article highlighting three attributes that excellent healthcare leaders must have:

  1. Clear mission and purpose
  2. Experience and expertise
  3. Personal integrity

The third, personal integrity, is particularly critical. As Dr. Pearl says, “Everything changes when an emerging leader becomes the head of an organization and faces a crisis. As risks and pressures intensify, people tend to fall back on approaches and habits they learned in the past, particularly problematic ones.” Without being a spoiler, anyone who watched Succession can see how easily the emerging leaders fell back to their own demise.

I encourage you to read the full article but must warn you with a spoiler alert – if you haven’t seen the show but plan to watch it given all the buzz, bookmark the article to read later.  What buzz you ask? The fourth and final season just received 27 Emmy nominations with a total of 75 nominations over all the seasons.

Related Post:

Ted Lasso leadership lessons

The transformative power of bold leadership in healthcare

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With reproductive rights and LGBTQ+ rights under attack in so many states, it was good to see the Summer 2023 Issue of the Brigham magazine in the mail this week. This issue is titled “Care for Every Body – Embracing Inclusive Medicine”. As a former VP and donor to Brigham and Women’s, I receive the paper copy to read. You can access it online here.

The main articles include:

  • Sex & Gender Glossary – essential terms and definitions for understanding sex, gender, and well-being.
  • Pro-Care. Pro-Patient. – describing how the Department of Obstetrics and Gynecology is working toward reproductive justice for all patients. An alarming data point: If all abortions in the U.S. were to stop, 24% more people would die from pregnancy complications and 39% more non-Hispanic Black people would die.
  • Soul Meets Body – describing how the Center for Transgender Health is breaking barriers and providing state-of-the-art, life changing care for trans and gender diverse people. An alarming data point: 46 states have proposed 491 anti-transgender laws in 2023, more than the previous four years combined.
  • Women ≠ Tiny Men – describing how physician-researchers are working to balance the scales for women’s health.

These articles and the programs described represent bold leadership in healthcare and what we should expect from healthcare providers.

Just as the Winter 2022 Issue titled “Standing Tall for Justice – Cultivating Equity and Inclusion in Medicine” was bold leadership as it covered racial equity in healthcare. And just as Michael Dowling, President and CEO at Northwell Health in New York, regularly shows us what bold leadership means. He doesn’t shy away from controversial issues as he addresses the issue of gun violence and calls for civility and decency in our public discourse.

Dr. Robert Higgins, President, Brigham and Women’s Hospital and EVP, Mass General Brigham comments in the introduction to the Summer 20223 Issue – “While forging the road toward a more inclusive healthcare systems is not an easy or immediately achievable goal, it is a vital commitment we must make. Our sense of humanity depends on it.”

Are you uncomfortable being a bold leader? Do you embrace or shy away from the DEI discussion? The DEI Committee of CHIME is hosting a webinar this Friday, June 30, at 12PM EDT that I highly recommend. It is titled “DE&I in Healthcare 2.0 – Getting Comfortable Being Uncomfortable in a Safe Space Zone”. Please follow this link to register if you want to learn how to stay DEI focused in an anti-DEI climate.

In a recent podcast interview, I was asked about some of the unique challenges and opportunities of being a CIO in the healthcare sector compared to other industries. I commented on how being in healthcare is mission driven and how we can make a difference in people’s lives. Leaders of our nation’s leading healthcare systems being willing to address the difficult issues and care for every person is one of the reasons I am passionate about working in healthcare.

What we do matters.

Related Posts:

Leadership means being bold and taking on the tough issues

Towards a more civil society

When is enough enough?

The healing power of humanity

 

Unlocking the power of time: insights from an inspiring leader

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Today is the longest day of the year and the official start of summer. This longest day leads me to reflect on how we spend our time.

I recently had the pleasure of interviewing Saad Chaudhry, Chief Digital and Information Officer at Luminis Health, for a Townhall episode on This Week Health. Saad is an inspiring leader on so many levels so preparing interview questions was easy. I had heard Saad talk in the past about what he calls his Manifesto of Time, so I wanted to make sure we discussed it in the interview. For Saad, looking at the number of hours the average person has in their lifetime means looking at how we choose to spend it and whether we give or take time from others.

As a health IT leader, he says we are in the business of time. He is committed to giving time back to staff and patients. He asks in his manifesto – “Does a process/technology/policy steal time from a fellow human? Is there a better alternative to simplify the experience?” He challenges us to make systems and processes easier for patients and staff, giving time back rather than taking more time from them.

I can’t say it nearly as well as Saad, so I encourage you to read The Manifesto of Time and listen to the short clip on time from our interview – Spending Time: Why It’s Important to Maximize Giving Back Our Most Valuable Commodity. We covered much more in the full interview if you are interested and willing to spend 30 minutes of your time listening – A Realigned Role, Generational Diversity, and Giving Back Time.

I know your time is precious – thanks for reading and listening!

Ted Lasso leadership lessons

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I was late to the “Ted Lasso” series so there were some seasons of binge watching. From its earliest days on Apple TV, I kept hearing about this show from my colleague at StarBridge Advisors, David Muntz. He loved it! My husband and I finally started watching some time last year and saw the season 3 finale last week along with all the other devoted fans.

There are so many lessons to share from this incredibly upbeat soccer coach who we came to know and love. Here are a couple pieces worth reading whether you are a fan or not – no spoilers:

If you haven’t already clicked through to the Becker’s article link above to read perspectives on the lessons from well-known healthcare leaders, please do. In the meantime, here are the lessons:

  1. Lead with empathy.
  2. Being vulnerable doesn’t make you weak.
  3. Optimism is infectious.
  4. Doing the right thing is never the wrong thing.
  5. Winning and losing aren’t everything.
  6. Optimists take more chances.
  7. Everyone differs from everyone else.
  8. Embrace change.
  9. Empowerment breeds confidence.
  10. Winning is an attitude.
  11. Humor cuts through tension.
  12. Courage is the willingness to attempt.
  13. Nobody is bigger than the team.
  14. Be self-aware and genuine. A truly authentic leader doesn’t have the time or the inclination to be anyone but themselves.
  15. Don’t dwell on mistakes or let them define you.
  16. Stay teachable.

I like all of them but 1, 4, and 13 are favorites. Continue reading →

Healthcare for all: ensuring inclusivity in LGBTQ+ patient care

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June is Pride Month. In recent years, LGBTQ+ rights have come under attack. All this after the landmark Supreme Court decision in 2015 supporting marriage equality. These attacks are taking many forms – “Don’t Say Gay” bills in state legislatures, bans on drag queen story hours, protests and intimidation at events, bomb threats at children’s hospitals providing gender affirming care, and more.

A March 7, 2023, piece in the Boston Globe by Renee Graham, “Understanding the intersectionality of hate”, begins by highlighting the number of bills pending in state legislatures. “The American Civil Liberties Union is tracking more than 380 anti-LGBTQ bills in nearly three dozen state legislatures, ranging from bans on gender-affirming care for trans youth to prohibiting classroom discussions about LGBTQ people or issues”.

In the face of these attacks and threats, and anti-LGBTQ+ legislation, allyship is more important than ever. Who doesn’t have a gay family member, friend, or colleague? Allyship is showing up and speaking up. There are many ways to do this as individuals and organizations, especially during Pride Month.

In 2015 I wrote a post titled “Marriage equality, it’s personal”.  I talked about the experience of my aunt when her longtime partner was hospitalized in her final days and how my aunt was treated. That was 1990. We’ve come a long way in healthcare but need to continue these efforts given the strong anti-LGBTQ+ sentiments.

I’m proud to have worked at Boston Children’s Hospital in recent years. Despite bomb threats due to their gender affirming care program, they are not deterred from their ongoing commitment to providing comprehensive and affirming treatment for LGBTQ+ patients and families. They have been awarded the Healthcare Equality Index’s (HEI) Leadership Status every year since 2015. They provide LGBTQ+ patient and family centered care in four key areas: patient non-discrimination, equal visitation, employment non-discrimination, and training in LGBTQ+ patient and family centered care.

The HEI is the national LGBTQ+ benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of their LGBTQ+ patients, visitors, and employees. Nearly 500 healthcare facilities achieved the top score of 100 in 2022 and earned the LGBTQ+ Healthcare Equality Leader designation.

My 2015 blog also referenced this HEI designation. I was working at Michigan Medicine then and they too were recognized with HEI Leadership Status. I closed that blog hoping that in the coming years, thousands more healthcare organizations would receive this same designation. There is progress, but more is needed.

Resources:

National LGBTQIA+ Health Education Center – Ten Strategies for Creating Inclusive Health Care Environments for LGBTQIA+ People

Human Rights Campaign Foundation – Transgender-Affirming Hospital Policies

Amplifying the voice of nurses

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May 6-12 is National Nurses Week. Nursing has been the most trusted profession for the past 20 years according to a Gallup Poll. That’s no surprise when you think about the nurses you have interacted with as a patient or as a colleague.

I’ve written a post about nurses almost every year since I started this blog. Do I have anything truly new to say this year? Yes, in that I want to highlight how the past three years has taken a toll on all our clinicians, in particular nurses. The public health emergency is expiring. Health care providers are adapting their policies as they continue to deliver care. We have entered a new phase for healthcare organizations, staff, patients, and families.

Staffing challenges are at the top of the list of concerns for many health executives – staff shortages and clinician burnout. There are no easy solutions. The toll of the past few years on our nurses was highlighted in a May 2nd NPR article by Jaclyn Diaz – “Nearly a third of nurses nationwide say they are likely to leave the profession“. The article starts with some sobering findings from the 2023 Survey of Registered Nurses conducted by AMN Healthcare. The survey examined the impact of COVID-19 on the career plans, job satisfaction, and mental health and wellness of more than 18,000 RNs. Key findings:

  • Close to 1/3 of nurses nationwide say they are likely to leave the profession for another career due to the pandemic. This level is up 7 points since 2021.
  • 89% of RNs said the nursing shortage is worse than five years ago, 80% expect that to get much worse in another five years.
  • Younger generations of nurses are also less satisfied with their jobs compared to their older counterparts.
  • 80% of nurses experience high levels of stress at work, an increase of 16 points from 2021.
  • 77% of nurses reported feeling emotionally drained, up from 62% in 2021.

Of all the blog posts I’ve written about nurses, this one from five years ago has the strongest message – “Celebrate nurses, but more importantly listen to them”.  This is true now more than ever. From the bedside to the boardroom we need to listen, amplify, and prioritize the voice of nurses.

IT leaders won’t solve the staffing challenges. But we have a role to play. The systems and solutions we provide and support as health IT leaders and vendors must help nurses do their job more easily and efficiently, not make it harder. We need to reduce the burden on nurses and ensure they are integrally involved in decision making, prioritization, and design processes.