Spring 2012

International ACHE Profile:   

Audrey L. Ramiro, MD Hospital Administrator Ramiro Community Hospital Tagbilaran City, Bohol, Philippines

"It can be a wise and strategic move to focus on innovation to improve healthcare operations in the light of meager resources. It is practical to study the applicability of models in developed countries and their ability to change, adopt and seek opportunities for innovation."

Q: Tell us briefly about your background in healthcare management.
A: After I received my medical degree, I entered a graduate program as a full-time student and earned a master’s degree in public health. I then went to work at Ramiro Community Hospital, which my family owns, primarily as a rotating resident physician directly handling patient care. During my tour of duty as a physician, I saw the gaps in the hospital operations that needed to be addressed administratively. This was the impetus for me to embark on administrative functions beginning as its personnel officer, then as administrative assistant in ancillary services and to my current position as administrator. The majority of my task then was the revision of existing manuals and writing the rest of the whole gamut of hospital standard operating procedures, policies, rules and regulations.

Q: How did you arrive at your current position?
A: Twelve years ago I shifted my focus from practicing medicine and took the administrator position. The hospital was in an expansion phase at the time but also financially challenged. The governing board decided it was best to change management and tasked me to manage hospital operations. My admission to the other side of the hospital world was a leap of faith, and it was baptism by fire.

Q: What are your primary job responsibilities?
A: My primary responsibility is to direct, supervise and coordinate all hospital activities to ensure our policies and procedures are carried out, and to oversee our mission, vision and goals.

The position also encompasses the prospect of cultivating an organizational learning culture. Positioning and arranging opportunities in a dynamic hospital setting surely stimulates effective innovation and renovation. Lateral thinking and purposely engaging in innovation is a skill. This is what we have pursued for the past two years.

Management of hospital operations processes are not so different from other industries; the basic principles are the same. But how adept an administrator is, in terms of one’s observation skills, spells the difference in how the services are being rendered to be bravely distinct from the rest.

Q: What is the biggest challenge you face in your current position?
A: Physician relations pose a major challenge for the organization. Doctors generally have an autonomous mindset as they interact with staff, even though I, too, have a medical background. Our organizational culture is to provide the best services to our patients and doctors, and we support start-up doctors in specialized fields of medicine by investing in the diagnostic and therapeutic equipment that they need.

Q: What is the biggest reward?
A: Recognition by healthcare and especially nonhealthcare organizations locally and internationally, and by government agencies is the best accolade one can receive.

Q: Briefly describe the overall healthcare atmosphere in the country in which you work.
A: The Philippines is plagued with diseases that are mostly communicable in nature, and poverty is strongly related to health status. Filipinos seek medical care primarily when they become ill, as preventive care is still most wanting. Even with the brightest and the smartest in the government health sector, they cannot move leaps and bounds if health is not supported by a laudable budget and the political will of the implementers at the community level.

Q: How do you see the field of healthcare management changing in the next five years?
A: The future healthcare environment may require a good grasp of the short- and long-term factors that affect the healthcare industry. These elements include changes in the healthcare delivery system, resource availability, technological development toward communication, and information transfer and its evolving importance. In addition, societal expectations should be met in light of the regulatory requirements of the current Philippine government thrust toward universal healthcare.

Q: What advice can you offer for other international affiliates?
A: It can be a wise and strategic move to focus on innovation to improve healthcare operations in the light of meager resources. It is practical to study the applicability of models in developed countries and their ability to change, adopt and seek opportunities for innovation.

Feature Article:   

International Partnering

Quality of Care Can Improve

By John M. Buell

Andrew N. Garman, PsyD, professor, department of Health Systems Management, and Tricia J. Johnson, PhD, associate professor, both at Rush University Medical Center, Chicago, share their thoughts on how the international health community can partner with U.S. hospitals.

Each year thousands of patients worldwide travel to U.S. hospitals for care, which provides an opportunity for the international healthcare community to partner in care.

One organization that is working in this area is the U.S. Cooperative for International Patient Programs (USCIPP), created in 2010 by the Rush University Health Systems Management Department, Chicago, and the University HealthSystem Consortium (UHC), Chicago, with support from the U.S. Department of Commerce.

“Unlike many European countries, the United States is relatively new in thinking about its healthcare system in a global context, and the implications for relationships between U.S. and international healthcare organizations in providing patient care,” says Andrew N. Garman, PsyD, professor, department of Health Systems Management at Rush University.

USCIPP is comprised of U.S. hospitals that are primarily large medical centers that have historically served international patients or are strategically developing their international patient programs, according to Tricia J. Johnson, PhD, associate professor, department of Health Systems Management, Rush University. One of the organization’s goals is to build strategic relationships with public and private payors and international providers.

Johnson and Garman's research suggests that there are at least 30,000 international patients traveling to the United States each year for inpatient or outpatient hospital care, with most of them seeking treatment for complex issues that require expertise not available or not accessible in the patient’s home country. It is in this area that international health systems can benefit most from partnerships with U.S. hospitals.

Officials with USCIPP have been promoting its presence internationally at trade shows and conferences, most recently in November at Medica in Dusseldorf, Germany, and in January at Arab Health in Dubai, billed as the largest healthcare exhibitions in the world. A message presented to international health executives is that the U.S. health system can be a complement to international health systems.

Garman and Johnson say some countries and international health systems may be apprehensive about collaborating with U.S. health systems, as there has been a good deal of press recently about the costs of care in comparison to public health outcomes. But they say these statistics can be misleading. While U.S. healthcare costs are among the highest in the world, statistics show hospitalization rates in the U.S. are among the lowest when measured against other developed countries, according to The Commonwealth Fund.

“International countries, particularly those that have national health systems, do a better job than the U.S. on care quality as it relates to population health outcomes,” says Garman. “But in the U.S., we are in the lead in providing many types of high-complexity care.” Adds Johnson: “It makes sense from a quality perspective that international patients whose health issues aren't complex should receive care in their own country,” she says. “Any time you can receive care close to home, patient outcomes are better. You don't need to travel to the U.S. for bread and butter-type care that is available close to home. Patients who must have more complex care that requires more specialized training may benefit from a quality standpoint to travel to the U.S.”

One telling statistic that backs up Johnson’s and Garman's position is that U.S. hospitals perform well against other developed countries in coordinating hospital discharge. Based on a survey of adults with complex health issues in 11 developed countries, the U.S. had the highest proportions of patients who received instructions about symptoms and seeking additional care; received a written plan for care after discharge; and received clear instructions about what medications to take, according to The Commonwealth Fund.

Barriers continue to exist in getting international patients to the U.S., such as cultural differences, and in some cases the availability of air travel and visa arrangements. “Our hope is that USCIPP can help U.S. and international organizations address barriers to accessing the high-quality care U.S. hospitals can provide, particularly for those patients who will benefit most from this access,” says Garman.

ACHE Resources:   

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

• List Your Hospital in ACHE's Directory of U.S. Hospital Partnerships With Foreign Hospitals

Books:

The Future of Healthcare: Global Trends Worth Watching (Health Administration Press, 2011). This book draws on reliable, agenda-free sources to predict the impact of emerging global trends on the US healthcare system.

ONLINE MEMBER DIRECTORY

The Online Member Directory can help you identify other healthcare leaders in your country and beyond with similar backgrounds or areas of interest. The directory allows you to search by geographic location, area of expertise, job level and other criteria.

Professional Pointers:   

Being a Servant Leader

by Jon Gordon, president, The Jon Gordon Companies

Smiling is important. Eye contact matters. Patience is essential. Being warm and friendly is a must. And providing a positive emotional experience for your customers is a priority.

But these are not the greatest of customer service strategies. Ironically the greatest of all strategies has nothing to do with customers and everything to do with employees.

The greatest strategy is this: Great customer service begins with being employee focused first and customer focused second. If you treat your employees well, they will treat their customers well.

Too often organizations focus all their energy on the customer while ignoring the very employees that serve their customers. This may work in the short run, but eventually employees become tired, burned out, negative and resentful.

Just the other day I was speaking at a hospital and was told it was conducting patient satisfaction surveys as a way to improve nurse performance. “What about nurse satisfaction surveys,” I asked. “No we're not doing that,” I was told. The problem was clear. Only measuring patient satisfaction will not make nurses more energized, positive and attentive. Patient satisfaction will go up when nurse satisfaction goes up.

I have found that organizations that deliver the best service also have the best culture—where employees are valued, listened to and cared for, and in turn these employees value, care for and serve their customers.

This article is an excerpt from an original article published by Jon Gordon, an author and speaker. Visit www.jongordon.com. View the full article.

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