Summer 2011

International ACHE Profile:   

Maria de la Viesca Medical Director, Quality and Safety Clinica Universitaria De Navarra Pamplona Spain

"As we are facing difficult times, finding different ways to get resources is necessary. If you want to be competitive, you need to differentiate through research, technology, patient-centered care, quality and safety."

Q: Tell us briefly about your background in healthcare management.
A: I started working in healthcare management in 1984 as deputy CEO at a university hospital. At that time, the team included a CEO, medical director, CFO, COO and myself. Besides working with the hospital management team, I was in charge of general services and nursing areas such as inpatient and outpatient units and admissions.

That year was a difficult one for our hospital, but we managed to fix the issues, and I learned a lot from the situation. The organization divided its risks by working with more insurance companies and creating its own insurance company. The hospital also reduced costs, although we did not stop investing in technology and research.

For me it was an opportunity to learn how to work with a team, sharing the vision and the strategic goals of the organization.

Q: How did you arrive at your current position?
A: I had been working as deputy director for 20 years, gaining expertise in quality and safety management issues such as patient-centered care, standardizing, measuring using indicators, etc. In 2004, the hospital management board decided to start a quality and safety area as a strategic goal, and I was appointed the director. I was truly delighted! It was a real challenge for me.

Q: What are your primary job responsibilities?
A: Leading the quality and safety service, chairing the hospital quality committee, leading the Joint Commission International Accreditation process (we have been reaccredited three times), and designing the triennial programs for quality and patient safety.

Q: What is the biggest challenge you face in your current position?
A: Successfully involving everybody in quality is always a challenge. All leaders and staff need to know how to work with quality. All of us need to be transparent, rigorous, creative and collaborative and use evidence-based knowledge. Another challenge is to maintain and improve our successes to get better outcomes.

Q: What is the biggest reward?
A: It is great to see that there are increasingly more doctors and nurses who are champions of quality. We frequently receive calls from staff asking for help when they have a problem, such as wanting to standardize a process or solve a safety incident. Another big reward is to be reaccredited by the Joint Commission International this year without any requirements for strategic improvement. That meant that our organization achieved full compliance with the standards and measurable elements.

Q: Briefly describe the overall healthcare atmosphere in the country in which you work.
A: Pessimism is the general feeling among healthcare professionals in Spain, but there is also hope. We expect that from the next general elections, which will be held in November, management could be improved. In the last few months, we have experienced many budget cuts, with no replacement of vacancies, default pharmaceutical expenditure by government, etc. After the elections we will know what the new programs will be and the budget for healthcare. Perhaps there will be an opportunity to improve.

Q: How do you see the field of healthcare management changing in the next five years?
As we are facing difficult times, finding different ways to get resources is necessary. If you want to be competitive, you need to differentiate through research, technology, patient-centered care, quality and safety.

Q: What advice can you offer for other international affiliates?
I think we need to improve the international network and not be afraid or selfish about sharing our outcomes and management best practices. Another key point is not allowing our hospitals to decrease in essential investments. There are always ways to be more efficient, and we need to learn from other industries. We need to be creative and simplify our organizations in order to dedicate more money to the core product—medical care—and, at the same time, decrease other expenses.

Feature Article:   

The Top Six Global Patient Safety Challenges

By Megan Downey

Paula Wilson, recently appointed as president and CEO of Joint Commission Resources (JRC) and Joint Commission International (JCI), is tasked with furthering JCI’s mission of improving the safety and quality of care worldwide.

As part of its international hospital accreditation program, JCI requires accredited organizations around the globe to comply with six International Patient Safety Goals, which promote specific improvements in patient safety:

• Identify patients correctly
• Improve effective communication
• Improve the safety of high-alert medications
• Eliminate wrong-site, wrong-patient, wrong-procedure surgery
• Reduce the risk of healthcare-acquired infections (HAIs)
• Reduce the risk of patient harm resulting from falls

These are areas in which evidence has shown that there is a high degree of error, and that have serious patient outcome implications. Wilson notes that these goals don’t differ significantly from The Joint Commission’s National Patient Safety Goals. The strategies for addressing these goals are also similar. She points out, though, that, "there is no one solution to any of these goals. Organizations need to understand the issues, measure the events and take steps to figure out solutions that are appropriate for their own organization," she says.

In many cases, organizations need to drill down even further to the department level to determine whether the same solution is appropriate across all departments at the same location. Wilson also says that, above all, organizations need to accurately measure their rates of incidents like HAIs and falls. "What you think the rates are might not be what they actually are," she says. "The data have to be manageable, otherwise you get overwhelmed."

Tools such as an electronic health record system or Lean Six Sigma and change management can be effective to use to ensure data is accurate, but organizations need to start by identifying what to measure first. "Ask, ‘What’s our experience with this, and what does this tell us about why it’s happening?’" Wilson says.

In addition to establishing the patient safety goals, Joint Commission International and The Joint Commission work with the World Health Organization as the Collaborating Centre for Patient Safety to develop proactive solutions for patient safety, as well as standard operating protocols (SOPs) for hospitals in Asia and Europe.

"Standard operating protocols are good, but organizations also have to look at their own experiences and processes and evaluate them," Wilson says. "This could involve using the Lean Six Sigma and change management tools that are part of The Joint Commission’s Center for Transforming Healthcare. When organizations find what’s wrong in their particular site, the payoff is enormous."

JCI also has consultants that can help individual organizations identify and implement appropriate strategies for infection prevention, medication safety and more.

"Standard operating procedures are good, but you really do have to look at your individual organization’s experience," she says. "Each has to take a moment and examine its own experiences and processes and evaluate them. If you do find what’s wrong with your particular site, the payoff is enormous."

JCI also has consultants that can help individual organizations determine and implement appropriate strategies for infection prevention, medication safety and more.

"These issues are complicated and challenging, and we’re dealing with them under high stress," Wilson says. "The issues are not different internationally. And that’s one of the most interesting things about this whole process: The steps are the same, but the solutions are different."

Learn more about the JCI International Patient Safety Goals.

ACHE Resources:   

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

Books:

Getting It Done: Experienced Healthcare Leaders Reveal Field-Tested Strategies for Clinical and Financial Success Kenneth H. Cohn, MD, MBA, FACS, and Steven A. Fellows, FACHE Applying Quality Management in Healthcare: A Systems Approach, Third Edition Diane L. Kelly, DrPH, RN

Self-Study Course:

Accelerating Leadership Development in Yourself and Your Organization

Professional Pointers:   

Building CEO-Board Relationships That Last

The adverse effects of CEO turnover on a healthcare organization include threats to pursuing the organization's mission, negative effects on hospital-physician relationships and additional drains on the organization's staff and financial resources. To avoid such negative outcomes, hospitals should pursue strategies to attract and retain the right CEOs and to build strong and enduring relationships between CEOs and their board.

To help identify proven approaches that can benefit hospitals and their boards, The Synergy Organization, Bensalem, Pa., conducted an in-depth research study to identify strategies CEOs and board chairs use to increase CEO longevity and success.

The data uncovered six building blocks that highlight the key actions taken by the most successful CEOs and their boards to build solid, lasting leadership partnerships.

1. Leadership

The most effective leaders create a clear and compelling vision that everyone can understand. They anticipate and respond to others' fears, goals and dreams so that everyone can direct their actions together toward achieving common goals.

2. Relationships
The willingness and ability to proactively interact with one another to share information and promote mutual gains is critical to organizational success. The best leaders know that the way to ensure their own success is to ensure that of others around them.

3. Communication
Effective communication calls for clear, open and transparent conversations with people at all levels of the organization. CEOs must be approachable, and their words and actions must consistently support the hospital's mission.

4. Selection
Good leaders understand that when the right people work together to accomplish the right tasks at the right time, performance will often exceed expectations.

5. Measurement
The CEOs of the most successful organizations use a variety of objective metrics to evaluate their team processes and progress to maximize their efficiency and productivity.

6. Flexibility
Effective leaders keep one eye on the future and are relentless in their quest to propel their organizations forward. But, along the way, they find ways to compromise and work cooperatively with people at all levels both inside and outside of their organizations.

Adapted from “Building CEO-Board Relationships That Last,” written by Kenneth R. Cohen, PhD, president and founder of The Synergy Organization, and published by The American Hospital Association's Center for Healthcare Governance in the October 2008 issue of Trustee. Click here for a full copy of this article.

Networking:   

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