Spring 2010

International ACHE Profile:   

Robert A. Kasworm
Operations Leader
Alegent Health – Tanzania
Machame Lutheran Hospital
Moshi, Tanzania

Q: Tell us briefly about your background in healthcare management.
A: I have a bachelor’s degree in medical technology and an MBA from the University of Utah. I worked for NCR Corporation in hospital computer sales and then took a position as laboratory manager at Immanuel Medical Center—now part of Alegent health, a nine-hospital, 8,000-employee health system based in Nebraska. Over the past 30 years, I have had administrative responsibility for clinical and ancillary services across multiple Alegent Health hospitals.

Q: How did you arrive at your current position?
A: Alegent Health is a faith-based ministry sponsored by Catholic and Lutheran partners. In 2001 I went to Tanzania to investigate our possible involvement with the health systems of the Northern Diocese of the Lutheran Church in Tanzania. I expected to be there three weeks, write a report and be done with it. But this visit deeply affected me. From then on, I could never get Africa out of my mind. Some would say it was a calling. Our work in Tanzania started small but increased in scope, which required me to relocate to Tanzania in 2004.

Q: What are your primary job responsibilities?
A: I serve as health adviser to the Northern Diocese of the Lutheran Church of Tanzania, as an appointed member of the senior leadership team at Machame Lutheran Hospital and also as operations leader of Alegent Health-Tanzania, which is largely involved in specific hospital and health projects.

Q: What is the biggest challenge you face in your current position?
A: The lack of resources. Tanzania is a desperately poor country and healthcare here reflects that. Some examples:

-We have a surprising number of people with high blood pressure, and they know they need to take medicine every day. But they stop because their choice is either to buy food and eat or buy medicine. The result is significant preventable disease from uncontrolled blood pressure.

-In this country, electricity comes and goes. This means we must have a generator for electrical backup. Our generator [at the hospital] is 20 years old and needs badly to be replaced, but where would we get the $30,000 needed to buy a new one?

-We have a school for clinical officers (low-level doctors) and for nurses. There are not enough books to go around, so each text is shared by five or more students. None has a computer. Each semester some students must drop out because they cannot come up with the school fees.

Q: What is the biggest reward?
A: Knowing that in many cases, if we were not here making things happen so that care can be delivered, it just would not happen. The person would do without care, and with all the implications: pain, suffering, deformity and even death. It’s as simple as that.

Q: Briefly describe the overall healthcare atmosphere in Tanzania.
A: Healthcare is provided primarily by a mix of government and faith-based facilities, which receive varying amounts of governmental support. A few individuals have insurance, but for most, it is self-pay. There are shortages in every facet, including educated staff, medicines and supplies, facilities and more. The technology employed is a mix of 1950, 1980 and a bit of 2010. We suffer a high rate of maternal deaths and deaths of individuals in early childhood, and are right in the middle of the sub-Saharan HIV-AIDS epidemic. There is a lack of infrastructure countrywide that results in routine electricity outages, water shortages and poor or nonexistent roads, leading to travel challenges. All of these factors affect healthcare. Poverty leads to poor health and poor health leads to more poverty. It can be a downward spiral.

Q: How do you see healthcare management changing in the next five years?
A: In the United States, we are moving to a period where the customers’ expectations will have to be reduced—not regarding actual care so much but regarding convenience and personal discretion. This will bring forth many management challenges. The rest of the world will have challenges that differ from locale to locale. Healthcare management in Tanzania will advance in the next five years as more administrators receive advanced education. Currently most top administrative posts are held by doctors, and I would predict that those without as much medical training might play a bigger role, freeing up the doctors for more clinical work.

Q: What advice can you offer for other international affiliates?
A: Many international affiliates are active in high-quality, high-resource facilities similar to those found in the United States. I would remind them and the U.S.-based affiliates that there are a great number of people in the world who receive minimal healthcare. I encourage all to look for ways to assist in caring for the people of the world.

Feature Story:   

Best Practices for JCI Accreditation
Lessons learned from accredited organizations
By Megan Downey

When ACHE surveyed International Affiliates in Fall 2009 on what topics should be included in upcoming newsletters, Joint Commission International Accreditation was a popular response. An article in the Winter 2010 edition of this newsletter touched on the need for national and global accreditation standards. This is a follow up to that article.

Gaining JCI Accreditation (JCIA) is an important milestone that will instill pride in your staff, foster respect and collaboration among all levels of your organization, and identify your organization as a provider of world-class care.

But the process is a challenging one.

Below, healthcare executives from three organizations share best practices for achieving and maintaining accreditation and the benefits they achieved.

The Initial Accreditation Process

The accreditation process, from start to finish, can take from one to two years, depending on the current state of the organization in relation to the standards. Getting the entire hospital on board is an important first step. Steve Sobak was the chief operating officer for KK Women’s and Children’s Hospital in Singapore when it went through its initial accreditation in 2005. Getting the project off the ground took more than three years.

“The medical staff was not prepared to take on the challenge,” says Sobak. “Also, when raised initially, it came from the administrative side, which failed to generate the necessary commitment and support from the clinical side.” On the second pass, the idea was successfully introduced and promoted by clinicians who observed other local hospitals that embraced JCIA. These so called clinical champions drove the process.

Once you have buy-in from the staff, the next step is to develop a process that includes the entire organization. Getting physicians integrated in the process is critical. “They can’t just be available on the day of the survey,” says Nish Patel, CEO of Women’s Hospital in Doha, Qatar, who led the organization’s recent recertification efforts. “Get physician champions on your team.” These doctors will motivate other doctors.

Also, unlike the accreditation process for some organizations in the United States, the executive team will likely be more hands-on, at least for the first few cycles. “The JCI surveyors are going to come up to you and ask you,” Patel says. “We all had to step up and get familiar with our processes—how things worked down to the nitty gritty, not just the overview.”

Rather than delegate responsibilities to a specific JCI committee, Patel suggests you develop task forces with members throughout all levels of the organization to address each chapter of the standards, and make sure the teams meet regularly.

Before the first team meeting, necessary financial resources for the entire process need to be set aside—such as securing JCI consultants, investing in infrastructure changes to meet the standards and staff training. Medical staff members also have to reallocate their time to attend meetings and participate in the process.

Once you have everything in place, it is time to bring in JCI consultants to perform a mock survey and assess the progress of your organization with each standard. John Wocher, FACHE, executive vice president of the Kameda Medical Center, Kamogawa City, Chiba Prefecture, Japan, was the leader of Kameda’s reaccreditation process. He also recommends attending a JCI Practicum, designed specifically for those seeking to obtain JCI Accreditation. The practicum includes a review of the current standards, the opportunity to address solutions to specific challenges and a walk-through of a mock survey at a local hospital.

For the Women’s Hospital staff, understanding the standards was a challenge. “Of course, it’s written in almost legalese, and some of our staff are working off of third or fourth languages,” Patel says. Patel brought in translators to help get the team up to speed. Picking the right translators to ensure smooth communication when surveyors are on site is also critical, adds Wocher.

The efforts don’t stop once an organization receives accreditation. “There was a constant need to remind, refresh and keep the interest up so as not to fall back into old habits and relax in the reporting and compliance requirements,” Sobak says. Also, to keep your accreditation, your organization will be reevaluated every three years.

The Triennial Reaccreditation Process

Preparing for the triennial reaccreditation can take roughly a year and can be particularly tricky with standards regularly changing. Women’s Hospital in Qatar received its initial accreditation in 2006. When the team started preparing for reaccreditation in 2009, it had to rewrite the book; JCI had developed new standards on facility management and safety and risk assessment, among other changes.

“It was such a foreign issue for us that we had to go chapter by chapter and standard by standard to see what was required,” Patel says. “For the risk assessment, we had to evaluate the risks of the hospital, the department and the emergency room. It was the first time anyone had asked us what risk assessment means in our institution. It became a very tough standard to meet, simply because it was one that was not previously thought of here.”

To start preparing, Women’s Hospital brought in consultants from Joint Commission Resources in June 2008, one year prior to its reaccreditation deadline, to perform a mock survey. The team used the survey results to determine what processes needed to be changed and how.

As reaccreditation is triennial, Women’s Hospital will be reviewed again in 2012. JCI is scheduled to set new standards in 2011 that focus on following a patient’s journey through the hospital and after initial care, rather than looking at policy and procedure. “That’s the acid test, rather than just reviewing a record,” Patel says.

Indoctrinating new staff that came on board after the initial accreditation is also a critical step.

Benefits of JCI Accreditation

The JCI Accreditation is a true testament to the teamwork and dedication of the entire organization, and the benefits extend beyond the JCIA certificate.

“We want to be known as the benchmark for international standards,” Patel says. “When we look at mortality rates, our rates are lower than other hospitals in the States.”

For Kameda Medical Center in Japan, the JCI Accreditation generated positive media and medical tourism industry interest, according to Wocher. The corporate culture at the Kameda Medical Center improved as a result.

Patel says the JCI process was a powerful team-building experience and a source of pride for staff. “It wasn’t just the front line who participated but nurses, admitting clerks and medical records clerks, among others. They saw the accreditation process as an important test, and they took it to heart and became the champion.”

For KK Women’s and Children’s Hospital, the process facilitated new friendships. “It broke down barriers,” Sobak says. “It allowed the medical staff to understand and appreciate the administrative support and duties, as well as gave staff the opportunity to work together and develop new networks and professional respect.”

ACHE Resources:   

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

• Leadership in Healthcare, Second Edition By Carson F. Dye, FACHE
• Healthcare Human Resource Series Self-Study Series
• World Hospitals and Health Services - The Official Journal of the International Hospital Federation

Professional Pointers:   

Five Keys to Increase Your Organization’s Resilience in the Downturn
by Susan J. Bethanis, CEO/Founder, Mariposa Leadership Inc.

Leaders in every organization need to look for ways to be more productive, which usually means slashing costs while increasing efficiency (i.e., doing more with less). But at the same time, you can’t stop moving forward. You must also look for ways to invest time, energy and resources in innovation initiatives (i.e., doing more for better returns).

(1) Recognize the importance of balancing productivity and innovation.
Let go of fear and take swift and decisive action to right the ship: comb through expenses line-by-line to see what can be eliminated; let go of nonessential staff and contractors; revamp outdated business processes and management systems; and coach executives and employees on working more efficiently and productively. At the same time, you need to encourage new ideas and ensure that you are turning the best of these ideas into process improvements that will save costs for your organization.

(2) Overcome fear through reflection and renewal.
Fear and risk play a big part in how we make decisions, and this dichotomy is especially amplified during the current economic climate because of the constant influx of bad news. Take the information you need and let the rest go. Reflection also comes in handy in process planning, especially if you can do it wearing several dual lenses: those of productivity vs. innovation, short- vs. long-term timeframes, and core values vs. survival strategies. Renewal is another way to combat stress. Rely on physical renewal to get us out of the “survival” zone and into the “high performance” zone.

(3) Strategize to increase productivity and efficiency.
Reset your thinking away from frantic day-to-day tasks and into a more introspective, thoughtful consideration of how the organization can position itself for greater returns. Here are some suggestions for increasing productivity and efficiency:

(4) Embed a formal innovation process into your organization.
Operate with a structured innovation process or system. Innovation encompasses not just one, but four distinct phases after an initial planning period:

Phase1: Expand thinking by collecting insights and generating ideas
Phase 2: Screen ideas
Phase 3: Convert ideas to innovations
Phase 4: Turn innovations into solutions

(5) Provide emotional and cultural support for productivity and innovation.
Processes and systems by themselves are not enough to increase and sustain productivity and innovation. For the processes and systems to work, you must also support the people behind them emotionally and culturally.

Adapted from “Five Keys to Increase Your Organization’s Resilience in the Downturn,” a special report by Susan J. Bethanis, CEO/founder, Mariposa Leadership Inc. To request a full copy of this report, visit mariposaleadership.com.

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