Summer 2012

International ACHE Profile:   

Ilian Grigorov Managing Director City Hospitals and Clinics Sofia, Bulgaria

"Our target is to become Bulgaria’s premier private healthcare provider and have the first hospital in the country with Joint Commission International accreditation. Toward that end, as managing director, I work to instill a culture of high-quality care that will enable City Hospitals and Clinics to achieve that accreditation."

Q: Tell us briefly about your background in healthcare management.
A: I moved operationally to healthcare in 2009 after spending 15 years in private equity and investment banking. Although both my parents are physicians, prior to pursuing my current role, I never thought that I would work in healthcare.

Q: How did you arrive at your current position?
A: While in my previous job I made a number of investments in healthcare, including acute-care hospitals and freestanding imaging centers. Through that exposure I was slowly drawn into the field. I found healthcare to be a fascinating sector, and I became enamored of it. In late 2009 I founded my own healthcare services provider company with a number of like-minded colleagues. Now, we are one of the largest ambulatory and imaging practices in Bulgaria and are about to launch our first hospital in November 2012.

Q: What are your primary job responsibilities?
A: I am the managing director of City Hospitals and Clinics in Sofia, Bulgaria. I am responsible for the overall strategy of the company and several of its operational aspects. Our target is to become Bulgaria’s premier private healthcare provider and have the first hospital in the country with Joint Commission International accreditation. Toward that end, as managing director, I work to instill a culture of high-quality care that will enable City Hospitals and Clinics to achieve that accreditation.

Q: What is the biggest challenge you face in your current position?
A: The uncertainty surrounding the future of healthcare in Bulgaria is our biggest challenge. We constantly make strategy changes and tactical modifications to address issues such as the rapidly changing healthcare environment, a reimbursement structure that is in flux and emerging technologies in both medicine and operations management.

Q: What is the biggest reward?
A: The biggest reward I anticipate in my current position will come from our efforts to increase the level of awareness among Bulgarian healthcare stakeholders regarding measures of quality and safety. Access is not an issue in my country, but Bulgaria does have one of the lowest rankings for quality indicators in Europe. Achieving international accreditation for our hospital will validate our quality and safety efforts and serve as a manifestation of that reward.

Q: Briefly describe the overall healthcare atmosphere in the country in which you work.
A: Bulgaria has one of most liberal healthcare systems in Europe in terms of equality of private and public providers and their access to public reimbursement. The system was designed in the early 2000s and was modeled after the Australian reimbursement system. In Bulgaria, healthcare is provided according to clinical pathways, whereby the provider is reimbursed on a clinical episode basis. The reimbursement is a single payment for both the technical fees and the physicians’ fees and also covers pre-hospital admission, post-discharge procedures and, of course, the hospital stay.

Q: How do you see the field of healthcare management changing in the next five years?
A: I think that the most significant change will be in moving toward the provision of high-quality care. Increasingly, we will see the reimbursement bodies pay for outcomes rather than for procedures.

Q: What advice can you offer for other international members?
A: My advice is to stay tuned in to what is happening in the field. The healthcare market is becoming global. Providers in areas throughout Asia, the Middle East, Latin America and Eastern Europe may eventually challenge the big world markets, such as the United States and Western Europe, by offering high-quality healthcare services at a relatively low cost.

Feature Article:   

International Partnerships a Two-Way Street

By John M. Buell

Many healthcare providers in developing countries are becoming receptive to the idea of partnering with U.S. hospitals to strengthen their healthcare management skills and ultimately improve the performance of their health system.

These countries are also seeing opportunities for private hospitals and private practice to become involved in the healthcare process as a way to be more responsive to the needs of the population. As such, more countries and their health providers also see the value of a disciplined approach to leadership and governance in which many U.S. hospitals are proficient in.

James A. Rice, PhD, project director, Leadership Management & Governance, Arlington, Va., has worked with several countries in many areas of healthcare, including governance. In Kenya, for example, Rice says healthcare providers there 20 years ago, using best practices from the United States, found that physicians and nurses could be enabled if staff members possessed basic management skills, and management could then be supported if senior leaders had a broader view and vision when looking at system design. Leaders in turn realized they needed a different approach to better governing the system itself, and better governance helps executive leaders.

“All that experience suggested the need to pay attention to a structured formal approach to developing leaders,” says Rice. He says there are three primary motivations when partnering with U.S. healthcare providers:

1. An opportunity to enhance local reputation. “By indicating that they have an affiliation with a respected U.S. organization, it becomes like a Good Housekeeping Seal of Approval,” says Rice. “It makes it easier to attract patients and the best doctors.”
2. The ability to gain access to best practices in disciplined approaches to continuous process improvement, continuous quality outcomes and patient safety outcomes. “That disciplined approach is important and should be seen as a value added to these relationships,” says Rice.
3. Managerial value. Forming relationships with U.S. hospitals provides opportunities to learn about modern change management and process improvement techniques in financial management, marketing and development of patient experience, according to Rice.

Just as there are partnership advantages for the host country, there are also benefits to U.S. hospitals, says Charles R. Evans, FACHE, CEO, International Health Services Group, Alpharetta, Ga.

As the CEO of a hospital in Florida in the early 1990s, Evans led an organization that was part of an international partnership with a Russian hospital. “I was taken with what an incredibly positive experience it was not only for our partner in Russian but our own organization,” says Evans. “And I have thoughts of that today in my work with the International Hospital Federation as I encourage other U.S. hospitals to get involved in partnering.”

While U.S. hospitals have much to focus on internally, “there is a place for us to think more broadly than just our own community,” says Evans. He says partnering with underserved international hospitals has three major advantages for U.S. hospitals.

1. Impact on organizational culture. “Partnering is a high profile and low cost way to demonstrate in real terms the stated values of the hospital,” says Evans. “We talk in the U.S. about commitment to the community and the needs of the underserved. This defines community globally and acknowledges that we are global citizens.”
2. High impact with employees and physicians. “The bonding with caregivers in my hospital as a result of this project (in Russia) was way more than I expected, particularly with doctors. They were so committed to the partnership and appreciative that the hospital was involved. People have created lifelong relationships with colleagues in other settings. It was a life changer for many.”
3. Opportunity to enhance cross-culture competencies. “This involves how we train staff members to be more effective in caring for patients of all ethnicities,” says Evans. “There is a cultural awareness and sensitivity that results from being part of an international hospital partnership. Partnerships are a major plus to promote the importance of culturalal competency and patient care. Many of our communities are diverse culturally, and the opportunity that goes with international partnerships is remarkable and unique.”

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:

Healthcare Leadership Excellence Creating a Career of Impact (Health Administration Press, 2012). This book will motivate you to think beyond the pressing day-to-day challenges of healthcare management and plan a career with purpose.

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:   

Eliminate Credibility Blind Spots

By Cara Hale Alter, author, The Credibility Code: How to Project Confidence and Competence When It Matters Most (Meritus, 2012)

In face-to-face interactions, certain behaviors may be irritating and distracting to some, which can damage your image. Steps, however, can be taken to identify and eliminate these behaviors, also called credibility blind spots. The surest way to uncover credibility blind spots is to capture presentations on video in a typical business setting. While there are numerous behaviors to look for, here are some of the most common: Speech fillers. These are superfluous sounds or words, like “um” and “you know.” A smart, young CEO recently said to his team, “So, I actually sort of passionately believe that we have an opportunity to, uh, you know, sort of really take this platform to a new level. So we just kind of, uh, need to jump in, you know, with full force.” He wanted to fire up his people, but his fillers extinguished his passion. Embrace the tactical pause. Instead of interjecting fillers, simply pause while your mind searches for the next word.

Extraneous movements. Extraneous movements—such as jiggling your knee, bobbing your head or shifting your weight—weaken your personal power. You might say, “I can’t help myself. I just can’t be still.” The truth is, excessive fidgeting is a self-comforting behavior. Stillness sends a message that you’re calm and confident.

Self-commenting. When you feel self-conscious, it’s easy to overreact to your every mistake. If you trip over a word, you might apologize (“Sorry!”), make a joke (“No more coffee for me!”) or resort to nonverbal reflexes like shaking your head or shrugging your shoulders. The problem with this self-commenting is your external preoccupation with your internal criticism. Mistakes happen; simply correct them and move on.

Misplaced upward vocal inflections. You probably work with someone who speaks in “up talk”: using upward inflections that sound like question marks at the end of sentences. This vocal pattern is widespread—and contagious. Be vigilant in not picking it up.

Shrinking tendency. If you’re like most people, when you feel intimidated you make yourself smaller to avoid being an easy target. You might place your feet closer together, tuck your arms to your sides, dip your chin or pull back on your volume. Any or all of these behaviors say “I feel threatened.” Practice optimal standing posture throughout the day—not just in important situations—to help make it habitual.

This article is adapted from one by Cara Hale Alter, author, The Credibility Code: How to Project Confidence and Competence When It Matters Most (Meritus, 2012). Visit thecredibilitycode.com.

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