leading in an era of health systems change: dialogue with the commission on the accreditation of...
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Leading in an Era of Health Systems Change:Dialogue with the Commission on the Accreditation of Healthcare Management Education and the National Center for Healthcare Leadership
Michael I. Harrison, AHRQJohn Lloyd, CAHME
Andrew N. Garman, Rush U. / NCHL
AHRQ Annual MeetingBethesda, MDSept 10, 2012
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Session Objectives
Participants will learn about:The leadership learning implications of a value-
driven healthcare systemEfforts to articulate these learning needs as a set
of leadership competencies How leadership competency models can be used
to support learning and behavior change
Accreditation in Graduate Healthcare Management Education
An Introduction to CAHME
John S. LloydCEO Emeritus, CAHME
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CAHME Mission
To serve the public interest by advancing the quality of healthcare management education by: ◦Setting measurable criteria for excellent healthcare
management education◦Supporting, assisting and advising programs which
seek to meet or exceed the criteria and continuously improve
◦Accrediting graduate programs that meet or exceed the criteria
◦Making this information easily available to interested constituencies
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ACEHSA and CAHME History
◦ 1968 ACEHSA established by AHA, ACHA, AUPHA and APHA
◦ Early 1970’s recognized by US Dept of Education and COPA
◦ 1996 recognition by Council on Higher Education Accreditation
◦ 2001 Orlando, FL Forum - RWJ Foundation sponsored
◦ 2003 National Center for Healthcare Leadership founded
◦ 2003 ACEHSA and NCHL Blue Ribbon Task Force recommended review of CAHME structure, financing and review of Criteria for Accreditation.
◦ 2005 CAHME name approved; corporate member structure ratified; new Board of Directors elected
Accredited Program Settings
2008200
92010
School or College Setting
# ## %
Public Health 25 28 29 35%
Business or Management 19 20 20 25%
Public Administration/Public Policy 8 7 6 7%
Other1 31 32 28 33%
Total 83 82 831 - Includes 3 programs in Schools of Medicine
Degree Types Granted
Degree Type 2008 2009 2010
MHA or similar 52 51 51
MBA 16 14 14
MPH 7 6 8
MPA 1 1 1
MS 8 10 9
Other 3 3 3
Total is > number of programs since some programs grant multiple degree types
Total Enrollment in CAHME programs
2008 2009 2010Full Time
Students 3231 63% 3431 63% 3703 62.3%
Part Time Students
1912 37% 1981 37% 2242 37.7%
Total 5143 5412 5945
Post-graduate PositionsHospital or Health System
50%Military or VA
12%Consulting
10%Pharmaceutical/Biotech/ Medical Devices
8%Physician Practice
6%Insurance/HMO
6%Long Term Care
3%Employed outside of healthcare/Overseas
3%Association
2%
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Healthcare is changing: So are Accreditation Standards
Practitioners, Professional Societies and Academics:
Wanted stronger leaders, and determined that CAHME criteria should focus more on leadership development
Wanted to challenge old techniques of teaching and learning
Wanted to push for continuous improvement in the programs
Wanted to assure all that leaders can produce a safer, more efficient health care system
Evolution of CAHME standards Over Time
Pre-2007
Program Mission
Required Curriculum
content
Goals – measurement and
alignment
Coverage in required courses
Pre-2007: • Emphasis on program goal alignment, coverage of required content areas• Little/no emphasis on teaching / evaluation methods
Evaluation and Improvement
2010-2013
2010-2013• Increasing emphasis on:
• Accountability to the mission & its stakeholders• Competency-based teaching & assessment• Continuous improvement to meet changing environmental needs• Competency model is not specified
Program Mission
Healthcare knowledge
Other goals
Competencies
Teaching methods
Assessment methods
Evaluation and Improvement
Evolution of CAHME standards Over Time
Competency Models Selected in Accredited Programs
Model
Number of Programs
using
8/2010
NCHL/ based on NCHL 28Locally developed / composite of two or more established models 21
Based on HLA 17SLU 9Based on the ACHE Competency Assessment Tool 3
Department of Defense Executive Skills 1
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Emerging Leadership Competencies:
Perspectives from the National Center for Healthcare Leadership (NCHL)
Andrew N. GarmanCEO, NCHL
About NCHL
Not-for-profit organization, founded in 2001, to be a catalyst in strengthening healthcare leadership to improve population health
Transitioned to a membership structure with Rush University and the University of Michigan in 2011
New structure designed to strengthen the dialog between academia and practice
About NCHL Board of Directors:
Peter Butler, Chair , President & COO, Rush University Medical Center Patrick E. Connolly, President, Sodexo Healthcare Janet M. Corrigan, PhD, President & CEO, National Quality Forum Susan D. DeVore , President & CEO, Premier Joanne M. Disch, PhD, RN , Clinical Professor, University of Minnesota School of Nursing Michael J. Dowling, President & CEO, North Shore-LIJ Health System Kyle Grazier, PhD, Chair, Health Management and Policy, University of Michigan Frederick Hessler, Managing Director, Citigroup David H. Klein, President & CEO, Excellus BlueCross BlueShield Christy Harris Lemak, PhD (ex-officio), Chief Research Officer, NCHL Kathryn J. McDonagh, PhD, RN, Vice President, Executive Relations, Hospira R. Timothy Rice , President & CEO, Cone Health Robert G. Riney, President & COO, Henry Ford Health System Amir Dan Rubin, President & CEO, Stanford Hospital and Clinics Jeffrey D. Selberg, Executive Vice President & COO, Institute for Healthcare Improvement Irene M. Thompson, President & CEO, UHC Gail L. Warden , President Emeritus, Henry Ford Health System
About NCHL
Activities Research & Demonstration Projects
Leadership Competency Model Development
National benchmarking of leadership practices
Analysis / assessment of future trends (in collaboration w.
Rush U’s Center for the Advancement of Healthcare Value)
Leadership Development-focused Institutional Membership Group (the Leadership Excellence Networks / LENS Councils)
Professional Services
Broad Dissemination of Evidence-based Approaches to Leadership
Primary data trend analyses Healthcare costs; Population trends; Higher education costs; Workforce
Third-party analyses Learning Healthcare Organization (Institute of Medicine); Value project
(Healthcare Financial Management Association); Healthcare 2032 (Robert Wood Johnson Foundation); Primary Care 2025 (Kresge Foundation); Five Scenarios for the Future of Academic Medicine (ICRAM)
Expert Opinion Senior leadership from LENS member organizations; NCHL board members;
other key stakeholders from forward-looking organizations
Theoretical models / Approaches Creative Destruction; Diffusion of Innovation; Disruptive Innovation;
Scenario Planning
Future Trends: Information Sources
Future Trends: Health Delivery
Regardless of legislation, all bets are on the need to deliver care more efficiently (i.e., lower cost) in the coming years
Care will continue to move toward evidence-driven, outcome-based pricing, eliminating interventions that do not more than pay for themselves in the outcomes they yield and prioritizing those that deliver outcomes at lower cost (e.g., watchful waiting)
Taken together, these trends may create a climate highly conducive to disruptive evolution
System change is likely to take precedence over system competition
Future Trends: Healthcare Leadership
Many sector changes imply the need for new and different competencies, not simply strengthening / retuning old ones.
Some key themes: Patient-centered care Population health focus Continuous value improvement Learning healthcare organization / ‘Big Data’ Leadership (vs. Leader) Development
Patient-Centered Care
• Development and effective management of patient councils
• Meaningful but efficient incorporation of patients into care design
• Balancing patient involvement with ‘design thinking’ approaches
Population health focus
Collaborative competition
Community systems thinking
Continuous value improvement
• The pace of innovation will continue to outpace dissemination, but the consequences of late adoption will be greater
• Pursuit of long-term goals will come at the expense of short-term organizational performance, creating problems of timing and ‘leaps of faith’
• Designing and leading innovation management functions• Environmental scanning• Technology piloting• Internal diffusion• Commercialization
Learning Healthcare Organization / ‘Big Data’
Systems implications◦ Efficient data access
◦ Opportunity Identification and Prioritization
Advanced analytics ◦ Process simulation
◦ Social network analysis
◦ Multilevel modeling
◦ Data mining
Developing / mentoring on ‘Evidence Literacy’
Technology evolution, adoption, spread
• The pace of innovation will continue to outpace dissemination, but the consequences of late adoption will be greater
• Pursuit of long-term goals will come at the expense of short-term organizational performance, creating problems of timing and ‘leaps of faith’
Leadership (vs. Leader) Development
• Focusing on individual development may have limited impact on organizational change
• Core leadership competencies are changing, but not all leaders will need to master all new competencies
• Leadership development is itself evolving
• Emphasis on context-based (vs. classroom-based) learning
• Leadership (vs. leader) focus
• Greater need for leaders to mentor clinicians on ‘value literacy’
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Discussion Questions:
What leadership competencies are most critical for health care professionals to develop, in order to manage effectively in an era of reform in health care finance and delivery?
What are the best approaches to spreading these competencies across the health system?