Speaker Panel Answers My Accreditation Questions

By Claire Thayer, July 15, 2019

In June, Iris J. Lundy of Sentara Healthcare, Lorie Gillette and Dr. Robert C. Pendleton of the University of Utah Health, Lori Flies of Houston Methodist, and Patrick Horine, Chief Executive Officer at DNV GL Healthcare participated in a Healthcare Web Summit webinar discussion on how accreditation can be a catalyst for improvement in care quality, patient outcomes and overall operational efficiency. If you missed this lively presentation, you'll want to be sure to watch the Webinar Video. After the webinar, we interviewed our speakers on four key takeaways: 

1. Can you describe some of the quality improvement benefits within your system that have been implemented since contracting with DNV GL Healthcare? 

Lori Flies: At Houston Methodist, a few of the many quality improvement benefits included:

Implementation of ISO 9001 internal survey/internal audit using a process-based approach has improved identification of variations in quality and safety so that we can take corrective actions and evaluate improvement. Another benefit that we implemented was structured management review to quality and safety variations has resulted in leader decisions that drive improvements, such as ED throughput. Lastly, since contracting with DNV GL Healthcare, we’ve experienced stronger integration of clinical and non-clinical aspects of patient care; for example, last year working with both clinical and facility aspects of assessing ligature risk. 

2. You've talked about process owners within each of your hospitals, can you tell us more here? 

Iris Lundy: Each NIAHO standard or an identified process has an owner within the hospital (process owner) and a system lead who serves as the subject matter expert.  These individuals assist with developing educational material and other tools to assist their hospital with successfully implementing.  The system person assists to ensure we are standardizing as much as appropriate across our system.  There is also a VP sponsor for each of these groups to assist with removing barriers when they are identified. 

3. As an academic health system, you've mentioned historic silos within organization structure and clinical specialties. How did implementing management to support ISO 9001 force you to break down these silos? 

Bob Pendleton and Lorie Gillette: At the University of Utah Health, when we implemented a management system as per the ISO 9001 standards, silos were broken down due to the new reporting structure for management review which included adding key directors as well as executive leaders. The goal was to spread system information requiring process improvement and in turn, agree upon shared system goals collaboratively. Providing training and aligning goals on a system level provided the impetus to break down silos.  

4. Can you tell us how DNV GL approaches accreditation and give us a few examples of how you work more collaboratively with hospitals and why this approach is advantageous for the hospital? 

Patrick Horine: We think of our hospitals as partners. This process should be meaningful to the hospital leadership and staff. It is not just about noting a finding, but you want to understand how an organization applies a standard and their process. Doing so enables us to share insight, share ideas on how other organizations meet the requirements, and what they may consider for making improvements. We learn from the hospitals as well that we can improve our process and use to help others. We still hold the hospitals accountable for compliance, we just take a different approach in doing so. This is advantageous because the hospital staff get more from the survey experience. They see the practical application and understanding of the requirements and appreciate this being more than just passing the survey for the certification and about improving for their patients.   


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

‘Cadillac Tax’ on High-Cost Health Plans Could Affect 1 in 5 Employers in 2022

A new KFF analysis estimates that the Affordable Care Act’s tax on high-cost health plans would affect one in five (21%) employers offering health benefits when it takes effect in 2022 unless employers change their health plans.

Kaiser Health News

Friday, July 12, 2019 

Reckitt Benckiser Agrees to Pay $1.4 Billion In Opioid Settlement

British company Reckitt Benckiser has agreed to pay $1.4 billion to resolve all U.S. government investigations and claims in what is the biggest drug industry settlement to date stemming from the nation's deadly opioid epidemic.


Thursday, July 11, 2019 

As Its Drug Pricing Plans Fall Through, Trump Administration Turns To Congress To Act

The Trump administration has dropped one of the meatiest portions of its plan to reduce drug prices.


Friday, July 12, 2019 

California Effort to Stop Surprise Hospital Bills Stalls

A California proposal aimed at limiting high medical bills from emergency room visits has stalled for the year.

Associated Press

Thursday, July 11, 2019 

Congress has ambitious agenda tackling health care costs

Lawmakers are trying to set aside their irreconcilable differences over the Obama-era Affordable Care Act and work to reach bipartisan agreement on a more immediate health care issue, lowering costs for people who already have coverage.

Associated Press

Monday, July 8, 2019 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Our Dunning-Kruger Healthcare System

By Kim Bellard, July 11, 2019

Psychologist David Dunning, originator of the eponymous Dunning-Kruger effect, recently gave an interview to Vox’s Brian Resnick. For those of you not familiar with the Dunning-Kruger effect, it refers to the cognitive bias that leads people to overestimate their knowledge or expertise. More importantly, those with low knowledge/ability are mostlikely to overestimate it.

Dr. Dunning believes that we tend to think that this effect only applies to others, or only to “stupid people,” when, in fact, it is something that impacts each of us As Dr. Dunning told Mr. Resnick, “The first rule of the Dunning-Kruger club is you don’t know you’re a member of the Dunning-Kruger club. People miss that.”

So, how does this relate to our healthcare system?

We brag about our excellent care, our great hospitals and doctors, and all those healthcare jobs powering local economies. Yet we have by far the most expensive healthcare system in the world, which is expensive not because it delivers better care or to more of its population than health systems in other countries, but because it feels it is justified in charging much higher prices. Our actual outcomes, quality of care, and equity are all woefully mediocre on a number of measures.

How many of you live in an area that has at least one hospital system claiming to be one of the “best” hospitals in the country? Similarly, how many of us like to believe that our doctors are “the best”? Perhaps they even have “best doctors” plaques in their offices to support this claim.

Statistically speaking, most of us receive average care, and some of us receive sub-standard care. We don’t live in Lake Wobegon. We can’t all be getting the best care, or even above-average care. Just look at how few hospitals earn high ratings from The Leapfrog Group.

In The Atlantic, Olga Khazan reported on a new study that suggests that, despite all their supposed superior knowledge, doctors don’t really make better patients than the rest of us. They get C-sections about as often, and about as unnecessarily as we do, they get about the same amount of unnecessary/low value tests, they’re not better at taking needed prescriptions.

As Michael Frakes, one of the authors told Ms. Khazan, the doctors “went through internships, residencies, fellowships. They’re super informed. And even then, they’re not doing that much better.” Professor Frakes speculated that even physicians tended to be “super deferential” to their own physicians, despite their own training and experience.

It is widely accepted that as much as a third of our healthcare services are unnecessary or inappropriate — even physicians admit that — but, of course, it is other physicians doing all that. No one likes to believe it is their doctor, and few doctors will admit that they are the problem.

Dunning-Kruger, indeed.

Much as they’d like us to, it is not enough for us to always assume that our healthcare professionals and institutions are qualified, much less “the best.” It is not enough for us to trust that their opinions are enough to base our care recommendations on. It is not enough to believe that local practice patterns are right for our care, even when they are at variance with national norms or best practices.

“Trust” is seen as essential to the patient-physician relationship, the supposed cornerstone of our healthcare system, but trust needs to be earned. We need facts. We need data. We need empirically-validated care. We need accountability.

Otherwise, we just fall victim to healthcare’s Dunning-Kruger effect.


This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting.


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Scott Gottlieb walks through the revolving door to the Pfizer board

After a two-year stint running the Food and Drug Administration, Scott Gottlieb has joined the board of directors at Pfizer, giving the world’s largest drug maker crucial insights into the inner workings of the Trump administration as it attempts to contain national angst over the rising cost of medicines.

Stat News

Friday, June 28, 2019

Five Things We Found In The FDA’s Hidden Device Database

After two decades of keeping the public in the dark about millions of medical device malfunctions and injuries, the Food and Drug Administration has published the once hidden database online, revealing 5.7 million incidents publicly for the first time.

Kaiser Health News

Thursday, June 27, 2019

Senate health committee may change surprise billing proposals ahead of floor vote

The Senate health committee approved its major healthcare package on Wednesday, but with one change to the proposed ban on surprise medical billing and potentially more to come ahead of a full Senate vote expected later this month.

Modern Healthcare

Thursday, June 27, 2019

In first 2020 debate, Democrats escalate their attacks on pharma and its high prices

Democrats demonized the pharmaceutical industry throughout the first primary debate of the 2020 presidential election, racing to prove their status as the candidate most willing to “take on pharma.”

Stat News

Thursday, June 27, 2019

At AHIP19, a call to 'break glass' to survive fast-changing industry

A panel of top executives, including a major provider, payer and former CMS chief opened America's Health Insurance Plan's annual meeting with some soul searching and a call for the industry to disrupt itself.

Healthcare Dive

Monday, June 24, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Growing where you are already planted

Kristin Rodriguez, Health Plan Alliance, June 24, 2019


Dan Michelson, CEO of Strata Decision believes integrated delivery systems need to shift their focus from buying and building hospitals to leveraging their existing platforms to generate growth and often more profitable streams of revenue.  This creates the ability for delivery systems to become a hub for health and healthcare in the future.

What needs to occur for this transformation to take place? 

In an article published in Becker's Hospital Review recapping the 2019 JP Morgan Healthcare Conference, Michelson outlines six ideas for integrated delivery systems to get started on leveraging their existing platform.  Each represents a formidable challenge, but if we work together and take advantage of resources available to us, we can start moving in the right direction.

  1. Embrace the digital front door: Healthcare providers have long excelled at building relationships and trust once consumers walk into our hospitals and clinics.  We need to harness the ability to create that same meaningful relationship, without limiting ourselves to a physical location.  

    Benjamin Isgur, Health Research Institute Leader at PwC Health Research Institute, echoes this advice.  At the recent Alliance Spring Leadership Forum, he underscored that Private Equity investors are particularly interested in anything that gets closer to the consumer.  And consumers themselves are eager for a new era of care delivery, with new venues and new menu options.  If we don't offer consumers a more convenient alternative, someone else will
  2. Get serious about affordability: This isn’t just about transparency or about reallocating resources more thoughtfully.  It is bigger than combining clinical and financial data.  The healthcare cost problem is huge and policymakers, drug manufacturers, insurers, delivery providers and consumers all play a role.

    It's important we avoid the danger that is “everyone’s problem” becoming “no one’s problem.”  As part of integrated systems, Alliance members are particularly well positioned to get a strong line of sight on this challenge.
  3. Don't just provide, prevent: Michelson points to the “strong strategic rationale associated with taking on a broader role of driving health versus only providing healthcare” in the communities we serve.  Policymakers understand this too; Medicaid and Medicare Advantage plans are encouraged more and more toward payment models and benefit design approaches that take on more than just clinical care.

    Just a few themes in the government-sponsored care space include VBIDtelehealthbenefit flexibility, and behavioral health integration, all of which present unique opportunities to leverage the network, venues of care, community partnerships, and more to reimagine the system’s role in the local healthcare landscape.
  4. Partner to innovate, or miss out: Becoming a hub isn’t just about the digital front door or food farmacies. It also means creating a space for innovators to gather, where research and education can occur so that ongoing evolution becomes a core competency of the system.
  5. Target chronic conditions and specific services: This builds on the center of excellence model in profound ways.  Systems that craft a powerful experience for specific chronic conditions or targeted services stand a better chance of maintaining a relationship with those consumers.  Michelson notes that this is both an opportunity and a threat for integrated systems, as we compete more and more with new platforms gaining competency in serving chronic conditions, like those of CVS Health and Walgreens
  6. Don’t just aggregate data – use it:  An Alliance member and informatics leader said that he envisions the day when his informatics teams can stop being data archeologists and can instead be data analysts.  The truth is that integrated systems are still solidifying their competency as data aggregators.  But it’s not enough.  It’s time to turn our attention to applied analytics: practical data sets that provide decision support so that we can gain better insights and pivot our platforms even faster.

With payers big and small across the country, the Alliance member network is a veritable think tank for executives wrestling these questions and challenges.  Join us and work elbow to elbow with your peers at our upcoming events designed exclusively for Alliance organization leaders. You can also meet and hear from Dan Michelson at the Fall Leadership Forum 2019.