Welcome to a new year and new resolutions. At the top of my list of resolutions is to listen more carefully and allow for longer pauses in conversation. In Pulp Fiction, Mia Wallace (Uma Thurman) asks Vincent Vega (John Travolta), “When in conversation, do you listen, or do you just wait to talk?” After some thought, Vincent replies, “I wait to talk, but I’m trying to listen.” Like most people, I wait to talk. My hope is to become more engaged in the moment and be a better friend, colleague, teacher, and parent. Several of the pieces in this issue of the Journal of Healthcare Management (JHM) touch on the idea of improving communication.
We open with an interview with Laura S. Kaiser, FACHE, president and CEO of SSM Health. Ms. Kaiser’s story is worth listening to closely. She describes how history and mission inform her health system’s current initiatives. I was very interested in hearing her describe the Civica Rx project—her “passion,” as she refers to it—which is designed to help bring affordable prescription drugs to the marketplace. Without a doubt, bringing various stakeholders together to address this patient care issue is one of the hardest problems the U.S. health system faces today.
Also with this issue, we introduce two new column topics for 2019. For the first column in our series on diversity and inclusion, Eugene A. Woods, FACHE, president and CEO of Atrium Health, describes how he strives to “lead from the middle.” The goal is to help his team members reach a solution that they consider a win–win for themselves as well as the organization. I would say further that successfully managing from the middle is actually a win–win–win. Leaders also get a win because the people who must implement an initiative appreciate a sense of ownership over the project.
The second series of columns for the year will look at various aspects of managing risk to improve healthcare. To begin, Maxine dellaBadia Simon, FACHE, chief regulatory officer of NYU Langone Health, writes about the other side of the communication equation—that is, how to do a better job at getting your message out. In particular, she focuses on the relationship between culture and compliance in healthcare settings. Underlying the effective use of compliance is the belief among organization members that compliance is essential to safety and quality, not merely another task done to appease regulators. Linking the positive aspects of compliance to the health system’s vision and values is a task that requires consistent communication.
The first of our four original research articles is by Ann M. Nguyen, PhD, and Suzanne J. Wood, PhD, FACHE. They use qualitative methods to explore trends in health system–physician group integration. The authors’ thesis is that the migration toward integration is driven by a changing healthcare environment. The finding that younger physicians desire the employment model is consistent with what I have seen over the past few years. When I was on the admissions committee at Texas Tech’s medical school, I would routinely ask prospective students, “Why do you want to get an MD and an MBA?” The usual answer was, “My parent is a doctor and they tell me not to enter the profession unless I learn the business side, too. These days, you can’t just hang out a shingle and get paid.” The students, and their parents, already anticipated a medical profession that would become increasingly integrated.
Another key to good communication is a good relationship with the other party. A good relationship takes time to establish. The article by Larry R. Hearld, PhD; William Opoku-Agyeman, PhD; Dae Hyun Kim; and Amy Y. Landry, PhD, takes an empirical look at CEO tenure and makes some disturbing findings. For example, the CEO suite in U.S. hospitals appears to have a revolving door. Moreover, the facilities most at risk for financial challenges—rural and small hospitals—are also the most likely to face the disruption of shorter CEO tenures. This phenomenon begs the question: How will these hospitals improve without clear and consistent internal and external communication over extended periods of time?
The article by Julius Cuong Pham, MD, PhD; Tina Marie Truncellito Laupola, RN-BC; Anne Figueira, RNC-MNN, IBCLC; Jeannette Bala, RN; and Leslie Chun, MD, considers the importance of clear and consistent messaging through the use of daily safety briefings. Their findings show that staff may feel that a daily safety briefing is a good use of their time and helps to keep them focused on mission-critical features of the care process. Repetition and common narrative structures also help communication by giving the people receiving the information multiple opportunities to hear a message.
One of my favorite communication modes is the data-driven conversation. Authors Ajay Mahajan, PhD; Parag Madhani, MD; Sanjeevi Chitikeshi, PhD; Padmini Selvaganesan; Alex Russell; and Preeti Mahajan advance the SAIL (strategic analytics for improvement and learning) model at a Veterans Affairs medical center. I particularly like how they were able to quantify the possibility that reducing methicillin-resistant Staphylococcus aureus could have the unintended consequence of increasing catheter-associated urinary tract infections. Applying clear statistics on interrelated topics to make informed care decisions is one of the most challenging communication skills for healthcare leaders to master.
AUTHORS’ TIP: ADD QUANTITATIVE RIGOR TO QUALITATIVE STUDIES
To close, I would like to share another of my occasional tips on how to succeed in getting published in JHM (or elsewhere, for that matter). When conducting qualitative research, it is critical to apply the methodological rigor of quantitative studies. “Qualitative” does not mean there are no numbers to report. Rather, authors of qualitative study articles must provide a clear description of their sample and then report their findings with counts and percentages of respondents who expressed views. Doing so will serve to set up the great quotes and anecdotes that can bring a qualitative study to life. In this issue of JHM, Nguyen and Wood do a good job of quantitatively framing the qualitative work in their study of health system–physician group integration.