Winter 2011

International ACHE Profile:   

Krishnan K. Sankaranarayanan
Senior Officer, Patient Safety
Tawam Hospital
Al Ain, Abu Dhabi
United Arab Emirates

“ACHE membership adds a lot of credibility to your resume and was instrumental in getting me the patient safety officer job at Tawam Hospital, a Johns Hopkins-affiliated facility. This is my dream job.”

Q: Tell us briefly about your background in healthcare management.
A: I started off as a sales rep in 1988 for a pharmaceutical company in India and worked there for more than 16 years. I realized that I needed to look at opportunities in healthcare management, so I completed my MBA.

In 2004 I moved to Dubai to work for Deyafa Systems, a healthcare IT company, as a business development manager. Deyafa was my first international exposure, and I realized that I needed to be more specialized in healthcare management. This motivated me to complete the Continuous Quality Improvement for Health Services program from the Canadian Healthcare Association.

During this time, I read an article by Carson F. Dye, FACHE, and published by HealthLeaders OnLine called “20 steps to advance your career,” which prompted me to become a member of ACHE in 2005. This eventually landed me in my current job.

Q: How did you arrive at your current position?
A: I have used every dollar of ACHE membership, which was indeed worthwhile. I made full use of the Affiliate Directory and contacted members in different countries for jobs. ACHE membership adds a lot of credibility to your resume and was instrumental in getting me the patient safety officer job at Tawam Hospital, a Johns Hopkins-affiliated facility. This is my dream job.

Q: What are your primary job responsibilities?
A: My primary job responsibilites include the following:

• Implement international patient safety standards
• Help process improvements that support the reduction of medical errors
• Oversee the creation, review and refinement of the Patient Safety Program
• Identify risks and opportunities to improve patient safety
• Implement the Johns Hopkins Comprehensive Unit-Based Patient Safety Program (CUSP) to establish a “culture of safety”

Q: What is the biggest challenge you face in your current position?
A: In 1999, the Institute of Medicine’s (IOM) groundbreaking “To Err Is Human” report found that as many as 98,000 people died each year from medical errors in hospitals in the United States alone. Now, 10 years after the IOM report, medical errors are still a widespread problem in the United States. But reporting medical errors is not popular among healthcare providers in the Middle East, and the concept of patient safety is relatively new. As a result, Tawam Hospital reacted proactively to this cause and wanted to spearhead the patient safety movement within its facility and in the region.

But Tawam faced many barriers to patient safety, such as hierarchies between providers, a culture that isn’t accustomed to acknowledging medical errors, and the tendency for the poor communication and teamwork that leads to adverse events. Tawam also has a unique set of challenges; its employees hail from 60 nations, making cross-cultural communication a difficult task. Many of these caregivers have traditionally felt an added reluctance to admit mistakes because doing so might lead them to lose their jobs; Tawam had a history of terminating employees for making mistakes.

Tawam’s executive team realized that the best way to enhance patient safety was to build a culture of safety at the hospital, and launched the Johns Hopkins Comprehensive Unit-Based Safety Program (CUSP).

Q: What is the biggest reward?
A: Carson Dye’s article was a constant motivating factor. ACHE has chapters in the United States and groups outside the U.S., but there wasn’t one for the Middle East. I realized that my best bet to find my dream job would be to start a group for the Middle East. ACHE Healthcare Executives Group of the Middle East & North Africa (MENA) was born in 2006 and being its vice president is the biggest reward.

Q: Briefly describe the overall healthcare atmosphere in the UAE.
A: Centers of excellence like Johns Hopkins, Cleveland Clinic, Bumrungrad International Hospital, Medical University of Vienna, Methodist International and Harvard Medical are operating in the UAE. Healthcare is available to all nationals and expatriates through a robust insurance system.

Q: How do you see healthcare management changing in the next five years?
A: UAE is positioning itself as the regional hub for trade and business, which includes healthcare. There is growing interest for medical tourism, and healthcare facilities here are preparing themselves for this huge leap. The UAE government and the regulatory authorities are dedicated to getting the healthcare standards on par with the best in the world. They have been encouraging all facilities to go for international accreditation.

Q: What advice can you offer for other international affiliates?
A: ACHE provides unparalleled and incomparable networking opportunities for its members in comparison with other professional associations. In the last five years, I have observed that most healthcare executive search firms have been hiring Fellows for executive positions and I am now preparing for the Board of Governors Examination to advance to Fellow. My only advice to international affiliates would be to pursue the FACHE credential.

Feature Story:   

Integrating Ethics Into the Life of Your Organization

By Megan Downey

To meet the increasing challenges of delivering quality healthcare, a strong ethical foundation is critical to your organization’s success.

A clear, integrated set of ethical values will affect every aspect of your organization, from developing your strategic plan to the day-to-day, even minute-to-minute care of your patients. But developing these principles is not enough.

Healthcare leaders must employ and demonstrate ethical leadership, implement ethical principles at their organizations and effectively communicate these expectations to staff.

In this article, William A. Nelson, PhD, associate professor at The Dartmouth Institute for Health Policy and Clinical Practice and an advisor to the ACHE Ethics Committee, lays the groundwork for ethical leadership.

According to Nelson, an ethically-driven organization is reflected by many characteristics, such as a values-based culture, staff-accepted mission and vision, fully incorporated ethical practices and behavior, leadership, and an effective ethics committee. The driver of these characteristics is the executive staff. It’s imperative that the executive staff demonstrate that ethics is important.

According to Nelson, three initiatives must be in place in an organization for ethical practices to be employed:

1. The organization must develop and integrate its values statement.
2. Ethics practice guidelines must be established, implemented and monitored to ensure consistent, patient-centered care.
3. Staff must act in accordance with the organization’s values and have available resources to discuss ethics questions or concerns.

Develop and Integrate a Values Statement

Developing a values statement is the first step, but the critical next step is its dissemination and integration into the life of the organization. “A values statement is not just a list of nice words; its integration is the core ingredient for determining what the organization does and how it behaves,” Nelson says.

First, let’s start with some key definitions:

Mission: a specific description of an organization’s purpose

Vision: what the organization wants to become

Values Statement: how the organization will conduct its activities to achieve its mission and vision

According to “Organizational Values Statements,” a column by Nelson and Paul B. Gardent in the March/April 2011 issue of Healthcare Executive, values statements have a number of characteristics and purposes:

• Emphasize respect, integrity, trust, caring and excellence
• Represent the core principles to guide the organization’s culture
• Are disseminated to the staff to be integrated into their decisions and behaviors

While providing methodologies for all complex situations is impossible, Nelson says, the values statement should provide enough of a framework to guide an individual in making decisions that uphold the vision and mission of the organization.

The values statement should also be reviewed regularly by a group that represents all arms of the organization, from executive leadership to clinical leaders and community representatives. According to Nelson, the review process should be “an in-depth assessment of specific ethics-grounded values and the assimilation of those values into the organization’s day-to-day culture, practices and behaviors of the organization’s staff.”

Establish Practice Guidelines

The hospital then needs to establish clear practice guidelines so that staff members not only know the organization’s expectations when they’re faced with a challenging decision, but are empowered to make ethical decisions on their own, Nelson says. This fosters merging the values statement with best practices, so that the overall culture of the organization is grounded in ethics.

Reinforce Guidelines With Staff

The guidelines then need to be reinforced on a regular basis with both existing and new staff members.

“We’re sending a message to the community, staff, etc., that this is what is expected of you,” Nelson says. “Ethics is the foundation for healthcare organizations. It’s why we’re concerned about patient-centered quality care. It’s the framework for how you facilitate your mission.”

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For more information on the development, review and uses of value statements, read “Organizational Values Statements,” a column by William A. Nelson, PhD, and Paul B. Gardent in the March/April 2011 issue of Healthcare Executive. (Nelson contributes regularly to the Healthcare Executive Ethics column, which runs in each issue.)

In addition, ACHE has a number of ethics resources, including its Code of Ethics, which each ACHE affiliate agrees to abide by; an Ethics Self-Assessment; an Ethics Toolkit; and Ethical Policy Statements to serve as a guide for your organization. You can access these resources here.

ACHE Resources:   

Below are new ACHE resources such as books, study courses and websites to help you excel in your career.

Books:

Available Now Futurescan 2011: Healthcare Trends and Implications 2011-2016 The Society for Healthcare Strategy & Market Development Health Administration Press Anticipate, Respond, Recover: Healthcare Leadership and Catastrophic Events K. Joanne McGlown, PhD, RN, FACHE, and Phillip D. Robinson, FACHE Publishing Spring 2011! The Future of Healthcare: Global Trends Worth Watching Andrew N. Garman, PsyD, Tricia J. Johnson, PhD, and Thomas C. Royer, MD

Events:

Still Time to Register for Congress
There’s still time to register for the Congress on Healthcare Leadership, March 21–24 in Chicago! Don’t miss one of the largest gatherings of healthcare leaders in the world.

Internationally-focused seminars in this year’s program include:

• Hospital Status in Low-and Middle-Income Countries
• Medical Tourism: The State of the Art
• The Potential for International Hospital Partnerships

In addition to internationally-focused sessions, Congress also includes an International Affiliate Reception on Monday, March 21, giving you the opportunity to network with healthcare leaders from around the globe.

Visit ache.org/Congress for more information and to register.

Professional Pointers:   

Strategies to Resolve Conflict in the Workplace

Conflict in the workplace is unavoidable. But how conflict begins and evolves depends on three factors:

1. Workplace characteristics that might encourage conflict
2. The existence of official avenues for employees to ask for help
3. Whether or not your workplace has conflict-resolution training

You can determine the strategy that works best in your situation by understanding the nature of the conflict, the conflict styles of the involved parties and the importance of communication to the resolution process.

Function

Workplace conflict is an energy drain on all involved, and escalation of the conflict can lead to serious consequences. Unresolved conflict causes resentment, brings other employees into the conflict, sets the tone for office politics, lowers productivity and depresses workplace morale. By resolving workplace conflict, you maintain a workplace atmosphere conducive to work, healthy relationships and job satisfaction.

Conflict Styles

The effectiveness of your resolution strategy depends on understanding the conflict styles of the parties involved.

• Competitors use aggression, coercion and control.
• Accommodators give in to the needs of others, respond diplomatically and seek to preserve relationships.
• Avoiders view conflict as negative and seek to ignore what is happening.
• Compromisers seek a give-and-take approach.
• Collaborators want to work toward common goals or win-win solutions that require cooperation, consensus and integrating the needs of all parties involved.

Conflict Resolution Skills

Conflict resolution skills are based on effective communication and are helpful in de-escalating and resolving workplace conflict. The Conflict Resolution Network recommends that you choose from 12 skills that work best in your situation, such as creative responses, empathy, appropriate assertiveness, managing emotions, negotiation and mediation.

Interest-Based Relational Approach

This approach to conflict resolution respects personal differences and relies on cooperation and effective communication. Protect relationships by maintaining calm and courteous behavior and remembering that people are not problems. Respect the needs of all involved as valid and equally important. The approach calls for active listening, which requires paying close attention to what people say and restating what you heard.

Designing a Mixed Strategy

One strategy for resolving workplace conflict involves understanding the conflict response styles of all involved and designing a strategy based on that knowledge. Use the different conflict response styles of the employees to identify a strategy or a mixture of strategies for your specific workplace conflict situation. Understanding the different conflict response styles also helps you to identify what has not worked in the past and select a more effective strategy.

Adapted from “Workplace Conflict Resolution Strategies,” published Oct. 24, 2010, on Livestrong.com/blog. Click here for a full copy of this article.

Networking:   

Connect with your peers and expand your social network with ACHE.

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