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Boot Camp for Trustees Handout Flipbook PDF
Boot Camp for Trustees Handout
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Dear MHA members and trustees, Thank you for joining us for the virtual MHA Winter Trustee Conference. The virtual format allows us to provide important education programming and networking opportunities to trustees during a time when we must maintain physical distance to protect our own health and that of our communities. Thursday, Jan. 14, will feature the popular boot camp for new trustees, which includes four sessions on board governance, health system finance, advocacy and quality improvement. This day of learning is intended to provide foundational information for trustees. On Friday, Jan. 15, join community leaders and experts for general conference sessions to learn about the social factors that have a strong impact on overall health. Racism, housing, transportation, educational attainment, food security and access to economic resources are just some of the social influencers of health affecting the health of individuals and families. Hear about how hospitals and health systems are working toward solutions to improve the health and lives of all Minnesotans. Please join us for a virtual happy hour on Thursday evening. We look forward to seeing you all!
Rahul Koranne, M.D., MBA, FACP President and CEO, MHA
Mary Theurer, MHA board member, chair, MHA Trustee Council
2021 Boot Camp for Trustees Agenda Thursday, Jan. 14 9 – 9:10 a.m.
9:10 – 10:10 a.m.
Welcome Dr. Rahul Koranne, president and CEO, Minnesota Hospital Association and Mary Theurer, MHA board member, chair, MHA Trustee Council The Board Member’s Governance Role Ben Peltier, vice president, legal and federal affairs, Minnesota Hospital Association
10:10 – 10:20 a.m.
Break
10:20 – 11:20 a.m.
Financial Basics for Hospital Trustees Joe Schindler, vice president, finance policy and analytics, Minnesota Hospital Association, and Jan Brosnahan, chief financial officer, Winona Health Services
11:20 a.m. – 12:30 p.m. 12:30 – 1:30 p.m.
Lunch Break How to Advocate for the Hospital and Health System Community Mary Krinkie, vice president, government relations, and Bob Hume, vice president, policy, Minnesota Hospital Association
1:30 – 1:40 p.m.
Break
1:40 – 2:40 p.m.
Trustee Role in Quality and Safety Tania Daniels, vice president, quality and safety, and Jennifer Schoenecker, senior director, quality and safety, Minnesota Hospital Association
2:40 – 2:45 p.m.
Closing Comments Dr. Rahul Koranne, president and CEO, Minnesota Hospital Association
5 – 6 p.m.
Virtual Happy Hour Hosted by Dr. Rahul Koranne, president and CEO, Minnesota Hospital Association Special guest: former U.S. Senator Dave Durenberger speaking on governance and hope
The Board Member’s Governance Role Ben Peltier, vice president, legal and federal affairs, Minnesota Hospital Association Ben Peltier is the vice president of legal and federal affairs for the Minnesota Hospital Association. Ben is an experienced hospital attorney who has served as an in-house attorney for a large Minnesota health system and legal counsel to hospitals and physicians while in private practice at a Washington, DC law firm. Early in his career, Ben managed health care policy issues for U.S. Representative John Boehner of Ohio. During his time on Boehner’s staff, Ben worked on a variety of health reform topics including Medicare reform, HIPAA and health insurance regulation.
2021 Winter Trustee Conference Boot Camp for Trustees The Board Member’s Governance Role Ben Peltier, Vice President, Federal and Legal Affairs, MHA Thursday, Jan. 14, 2021 I.
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Board Member Fiduciary responsibilities a. Duty of Care i. Legal standard: “The duty of care requires that directors inform themselves ‘prior to making a business decision, of all material information reasonably available to them.’ Smith v. Van Gorkem, 488 A.2d 858 (1985).” ii. Practical steps for board members: 1. Take the same care and concern as any prudent layperson 2. Be an active participant in board business 3. Review and understand relevant materials b. Duty of Loyalty i. Legal standard: “The duty of loyalty means that all directors and officers of a corporation working in their capacities as corporate fiduciaries must act without personal economic conflict. As the Delaware Supreme Court explained in Guth v. Loft, 5 A.2d 503, 510 (Del. 1939), ‘Corporate officers and directors are not permitted to use their position of trust and confidence to further their private interest.’” ii. Practical steps for board members: 1. Place the interests of the organization ahead of personal interests at all times 2. Avoid and/or disclose conflicts c. Duty of Obedience i. Legal standard: “Under the duty of [obedience], a corporation's directors and officers must advance interests of the corporation and fulfill their duties without violating the law. In re The Walt Disney Co. Derivative Litig., 906 A.2d 27 (Del. 2006).” ii. Practical steps for board members: 1. Ensure the organization is abiding by applicable laws 2. Maintain organization’s mission and purpose Board Member Risk a. Corporate liability. Failure of the board to exercise its appropriate oversight may result in the corporation facing legal challenges i. Litigation for damages ii. Regulatory penalties iii. Bad public relations b. Risks related to tax-exempt status of organization
1 The Board Member’s Governance Role Thursday, Jan. 14, 2021
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i. Failure to operate in compliance with law and regulations may result in the organization losing its tax-exempt status 1. Potential harm to fundraising 2. Loss of chance to participate in programs reserved for non-profit entities 3. Loss of tax deductions for donors ii. Each board member may be personally liable for damages if the organization enters into certain excessive compensation arrangements c. General liability. Under the common law, a Board member may be personally liable in certain circumstances: i. Personal or direct injury to others ii. Co-mingling of personal and organizational funds iii. Otherwise accepts personal liability Board Member Protections a. Take steps to protect yourself: i. Education, knowledge, effort, documentation b. Avoid appearance of conflicts and self-enrichment i. This includes the proverbial “win-win” where both the organization and the board member benefit from the arrangement c. Organizational liability insurance i. Directors and Officers Liability Insurance (D&O) 1. Insurance coverage to protect individuals from personal losses if they are sued as a result of serving as a director or an officer 2. It can also cover the legal fees and other costs the organization may incur as a result of such a suit. 3. Policies will always include “exceptions” to coverage ii. Employment Practices Liability Insurance (EPLI) 1. Provides coverage to employers against claims made by employees alleging discrimination, wrongful termination, harassment d. Minnesota Law Minn. St. § 317A.257. A board member is “not civilly liable” unless they are: i. Compensated (which includes in-kind) ii. Actions were not good faith, were willful, or were reckless iii. Claim based on federal law or contractual obligation iv. Physical injury or wrongful death v. MN Attorney General claims a breach e. “Business Judgment Rule” i. Courts acknowledge that it is not their function to manage a corporation ii. So long as the board members operate within the limits of the law, business judgment will not be subject to judicial review iii. Grobow v. Perot test: 1. Act in good faith 2 The Board Member’s Governance Role Thursday, Jan. 14, 2021
2. 3. 4. 5.
Act in the best interests of the corporation Act on an informed basis Don’t be wasteful Do not involve self-interest
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Sample Cases a. Background b. What went wrong c. How to avoid similar issues
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Conclusion. The Board Member’s “Fiduciary Checklist” a. Prepare for board/committee meetings b. Attend board/committee meetings c. Actively participate in board/committee meetings i. Discuss fully, express opinions, ask questions ii. Openly ask for information and clarification d. Understand and follow applicable laws, regulations, and governing documents (articles, bylaws, corporate and board policies) e. Adopt long-term strategic plan, revisit it often f. Regularly review and improve the organization’s compliance programs i. In re Caremark International Inc. Derivative Litigation, 698 A.2d 959 (Del. Ch. 1996) 1. More in-depth and routine review of compliance risks 2. Regularly updating the compliance program to account for emerging risks 3. Don’t be overly deferential to management when it comes to risk and compliance concerns 4. Establish and expand alternative reporting mechanisms 5. Fully document Board review of risks and compliance programs (this is done through better minutes) g. Avoid actual, perceived, or potential conflicts and help others do the same h. Use your individual, independent, best judgment
3 The Board Member’s Governance Role Thursday, Jan. 14, 2021
Financial Basics for Hospital Trustees Joe Schindler, vice president, finance policy and analytics, Minnesota Hospital Association Joe Schindler is vice president of finance policy & analytics at the Minnesota Hospital Association (MHA). He has over 30 years of experience providing Minnesota’s hospitals and health systems with financial and market analysis plus support in the areas of reimbursement, financial policy and legislative issues. His expertise includes policy analysis, hospital financial analysis, wage index and cost comparison projects. He also oversees MHA’s critical data programs and is developing MHA’s new business partnership program to provide best-in-class solutions to its members. Jan Brosnahan, chief financial officer, Winona Health Services Jan Brosnahan spent the beginning of her career as a CPA with KPMG Peat Marwick, then spent over 20 years in the electronics industry as a division controller during which time she also served as finance and audit committee and board member for Winona Health Services. She joined Winona Health as their CFO in 2013, to leverage her financial and lean leadership skills to help increase health care value and efficiency. At Winona Health, she is responsible for financial operations, patient accounting and billing services, supply chain, organizational compliance, business development, health information management, contracting, grants management and insurance. She also provides leadership for innovation and strategic planning. Jan holds CPA, CMA and CHFP certifications.
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MHA Trustee Boot Camp
Health Care Finance Basics for Hospital Trustees 1
Presenters Jan Brosnahan, CFO, Winona Health Joe Schindler, Vice President of Finance Policy & Analytics, MHA
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Agenda Fiduciary Duty Hospital Structure Hospital Economics Financial Statement Basics Hospital Financial Focus and Leadership
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Fiduciary Duty Financial Oversight • Protecting the limited hospital resources to ensure optimum services and benefit to the community served • Long-range and short-range financial plans • Regularly review financial reports • Budget & Capital planning • Philanthropic participation • Protecting the 501(c)3 “non-profit” status • Annual external financial audit • Reviewing and approving annual 990 tax return Source: Zismer Daniel K, Ph.D, Werner Mark J, MD
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Hospital Ownership Structures Not-For-Profit Corporation [103 hospitals] • 501(c)3 tax-exempt designation • Controlled by voluntary boards or trustees • Independent, partner or affiliate
Public Hospitals [36 hospitals] • • • •
Federal, State, County, City, District controls Tax-exempt designation Controlled by trustees Receive funding from local, state, and/or federal governments
For-Profit Hospitals [2 hospitals]
Source: Zismer & Gapenski
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The Economics of Hospitals
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Where do revenues for hospitals come from? • • • • •
Reimbursement for services Grants Charitable donations Tax levies Other sources, as hospitals diversify • Example: joint ventures
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Scheduling/ Pre-Registration
Registration
Patient Exam Documentation & Coding
Collections
The Revenue Cycle A/R Follow-up
Charge Entry Validation
2 Secondary Claims
Denials & Appeals
Payment Processing
Claims & Statements
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Reimbursement - Payers • Medicare • Medical Assistance or Medicaid • Commercial Insurance Statewide payer mix based on charges • Self-Pay • Charity Care • Bad Debt 2.6% Workers Comp / Auto / P&C
1.8% Self Pay
34.9%Medicare FFS
34.7% Commercial/HMO
8.8% Medicare Advantage 17.2% Medicaid FFS & PMAP
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Reimbursement - Methods • Fee-for-Service • Cost-based • Charge-based • Prospective payment • • • •
Per Procedure Per Diagnosis Per Day Bundled Pricing
• Value-based contracts • Capitation • A fixed payment made to providers for each covered life, or enrollee, that is independent of the amount of reimbursement. Source: Gapenski, Healthcare Finance 10
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Reimbursement – Charges vs. Payments • Hospital Charges • The established single price charged for each product or service. • • • •
Hospital room rate (includes nursing care) Line-item medications Supplies Operating and emergency room incremental charges
• Hospital Revenue • The net payments actually received from insurers and patients. 11
What Are The Operating Costs? 2018 Minnesota Hospitals Costs
0.3% Malpractice 9.9% Other Costs Misc Costs 2.3% Provider & Other Taxes 5.4% Interest & Depreciation
52.2% Salaries & wages
17.3% Supplies
12.6% Purchased Services Source: Minnesota Hospital Assocation
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Reimbursement Imbalance
Payments relative to cost levels: Medicare: 86% of cost Medicaid: 80% of cost
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Financial Statement Basics
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Three Main Financial Statements Balance Sheet Statement of Operations (Income Statement) Statement of Cash Flows
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Balance Sheet Current Assets (in thousounds '000) Cash and Cash Equivalents Gross Patient Receivables Allowance for Contractual Adjustments & Bad Debt Net Patient Receivables
Current Liabilities $12,200
Accounts Payable
$8,000
$44,000
Accrued Expenses
$6,000
Currenet Portion of Long-term Debt
$1,500
($20,000) $24,000
Inventory
$2,200
Prepaids and Other Current Assets
$1,600
Total Current Assets
$40,000
Non-Current Assets Marketable Securities Gross Fixed Assets Accumulated Depreciation Net Fixed Assets Other Assets Total Non-Current Assets TOTAL ASSETS
$12,000 $56,000 ($10,000) $46,000 $2,000 $60,000 $100,000
Other Current Liabilities Total Current Liabilities Non-Current Liabilities Long-term Debt (less current portion) Other Liabilities Total Long-term Liabilities Net Assets Unrestricted Restricted Total Net Assets TOTAL LIABILITIES & NET ASSETS
$1,000 $16,500
$28,000 $5,500 $33,500
$35,000 $15,000 $50,000 $100,000
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Balance Sheet: Assets (what is owned, of value) Current Assets (in thousounds '000) Cash and Cash Equivalents
$12,200
Gross Patient Receivables Allowance for Contractual Adjustments & Bad Debt Net Patient Receivables
$44,000 ($20,000) $24,000
Inventory
$2,200
Prepaids and Other Current Assets
$1,600
Total Current Assets
$40,000
Non-Current Assets Marketable Securities Gross Fixed Assets Accumulated Depreciation Net Fixed Assets Other Assets
TOTAL ASSETS
$56,000 ($10,000) $46,000 $2,000
Total Non-Current Assets
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$12,000
$60,000 $100,000
Balance Sheet: Liabilities (What is Owed) & Net Assets Current Liabilities Accounts Payable
$8,000
Accrued Expenses
$6,000
Currenet Portion of Long-term Debt
$1,500
Other Current Liabilities Total Current Liabilities
$1,000 $16,500
Non-Current Liabilities Long-term Debt (less current portion) Other Liabilities Total Long-term Liabilities Net Assets Unrestricted Restricted Total Net Assets TOTAL LIABILITIES & NET ASSETS
$28,000 $5,500 $33,500
$35,000 $15,000 $50,000 $100,000
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Statement of Operations Operating Revenues (in thousands '000s): Gross Patient Revenues Contractual Allowances & Discounts Provision for Bad Debts Net Patient Revenue Other Revenues
202X $400,000 ($204,000) ($8,000) $188,000 $12,000
Total Operating Revenues
$200,000
Salaries & employee benefits Professional Fees Contracted Services Medical Supplies & Drugs Depreciation & Ammortization Interest Other Expenses Total Operating Expense
$128,000 $14,000 $15,000 $16,000 $8,000 $1,000 $14,000 $196,000
Gain/(Loss) from Operations Non-Operating Gain/(Losses)
$4,000 $2,000
Total Excess Margin
$6,000
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Statement of Cash Flows Cash Flows from Operating Activities Change in Net Assets Adjustments to reconcile changes in Net Assets Depreciation & Ammortization Unrealized Gains & Losses on Investments Changes in Operating Assets and Liabilities
202X
Net Cash Provided by Operating Activities
$x,xxx
Cash Flows from Investing Activities Net acquisitions of property, plant & equipment Changes in marketable securities Net Cash Provided by Investing Activities
$x,xxx $x,xxx $x,xxx $x,xxx $x,xxx
$x,xxx
$x,xxx $x,xxx $x,xxx
Cash Flows from Financing Activities Principal payments on Long-Term Debt Short-term borrowing
$x,xxx
Net Cash Provided by Financing Activities Increase / (Decrease) in Cash Cash at the beginning of the year Cash at the end of the year
$x,xxx
$x,xxx $x,xxx
$x,xxx $x,xxx $x,xxx
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Financial Key Performance Indicators (“KPI’s”) • Ratios are used by organizational management, boards, and lenders to analyze and assess a business’s financial condition. • • • • •
Profitability Ratios Liquidity Ratios Debt Ratios Efficiency Indicators Activity Indicators
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Examples of Common KPIs
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Ratio calculation examples
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Operating Margin Trend (example)
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MHA Data Services • Finance • Quality & Patient Safety • Workforce • Market Share • Salary Survey of CEOs/CFOs/CNOs • Community Benefits
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Financial Focus and Leadership
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10 Signs of Deteriorating Financial Performance 1.) Shrinking or Negative Operating Margin 2.) Declining Cash Position 3.) Large Negative Variances From Budget 4.) Increase of Days in Accounts Receivable 5.) Bond Rating Downgrade 6.) Debt Covenant Default 7.) Decreasing Market Share 8.) Key Physician Loss 9.) Lack of Monthly Financial Reporting 10.) Deteriorating Performance Indicators
Source: Zismer, D.K & Minnesota Hospital Association
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New Industry – New Challenges • What are our health system’s core services and how are they performing financially? • Is the organization financially positioned to serve its mission for the short-term and long-term? • What financial forecasting is occurring, especially with regard to cash position? • If not, what will it take to get to that financial position? • Understand relationships with capital resources and recent bond ratings.
• What is the market or competitive landscape? • What are the relationships in the market? • Should we consider merging with a larger hospital system? 30
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Actions Boards of Trustees Can Take • Develop an understandable reporting style • Ensure annual operating and capital budgets are developed and approved • Review and approve financial performance indicator targets • Ensure the cost-effective utilization of resources • Participate in the development of long-range and short-range financial plans • Understand the operations and developments in the health care landscape • Monitor and ensure adequate capital is available for the organization’s investment strategies • Actively encourage philanthropic support • Determine policy on the provision of needed community services • Don’t lose sight of the Mission • Congratulate management when a job is well done! Source: Minnesota Hospital Assocation
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Questions?
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How to Advocate for the Hospital and Health System Community Mary Krinkie, vice president, government relations, Minnesota Hospital Association Mary Krinkie is the vice president of government relations at the Minnesota Hospital Association, directing MHA’s policy and advocacy efforts. Since joining MHA in 2001, Mary has navigated numerous pieces of complex legislation through the state legislative process. Her ability to work with both Democrat and Republican majorities has been a key component of MHA’s advocacy success. Mary is recognized as a persuasive voice for the hospital community. Bob Hume, vice president, policy, Minnesota Hospital Association Bob Hume is the vice president of policy at the Minnesota Hospital Association. Prior to joining MHA in late 2020, Bob served as Deputy Chief of Staff and Senior Advisor to Minnesota Governor Mark Dayton and then-Lt. Governor Tina Smith. Prior to his state service, Bob was Deputy Chief of Staff and Communications Director to Saint Paul Mayor Chris Coleman. Hume has also served as staff and advisor to several U.S. Senate campaigns, including those of Senator Amy Klobuchar of Minnesota, Senator Chris Coons of Delaware, and former United States Senate Majority Leader Tom Daschle of South Dakota.
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How to Advocate for the Hospital and Health System Community Mary Krinkie Vice President, Government Relations Minnesota Hospital Association
Bob Hume Vice President, Policy Minnesota Hospital Association
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Overview • Who we are • Overview of election and legislative environment • Advocacy 101 • Short meeting demonstration • Q&A
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Election results/political environment • Senate: 34 Rs and 33 DFL, narrowest margin • 10 new senators • Two DFL incumbents lost their primaries, seats stayed DFL • DFL flipped three Republican seats & Rs flipped two DFL seats • House: 70 DFL and 64 Rs • 23 new House members (12 new DFL, 11 new Republicans) • Republicans picked up 5 seats. No incumbent Rs lost. • 18 retirements. All open seats stayed with the same party. • 37 members of the 2018 class re-elected. • 45% in first or second term
• Last election under the current district lines. 3
2021 Session process • With COVID not under control, 2021 session will start/stay remote. Access to legislators will be more challenging. • Will necessitate scheduling of calls, texting and zoom meetings. • Senate committee structure remains mostly the same. • Tax Chair and Education Finance & Policy chairs flip • House committee structure has changed: • Health Finance & Policy – Rep. Tina Liebling • Preventative Health Policy Division – Rep. Mike Freiberg • Human Services Finance & Policy – Rep. Jennifer Schultz • Behavioral Health Policy Division – Rep. Peter Fischer • Six second term members have gavels
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The state budget forecast (Dec. 1, 2020) • $641 million surplus for the current biennium, FY 2021 which ends on June 30, 2021. • $1.273 billion shortfall for the FY 22-23 biennium, which begins on July 1, 2021. • This is a dramatic swing since May when a $4.7 billion shortfall was projected for the upcoming biennium. • MN currently has $2.377 billion in the budget reserve. • Governor’s budget based on this forecast. Legislative budget based on Feb. forecast. • Lots of spending demands and wishes.
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Budget perspectives • Health care system fragile. Not a good time for any HHS cuts. • The Medical Assistance program is a state-federal partnership. If the state cuts $1 dollar, there is a loss of $1 dollar in federal matching funds. • MHA strategy of maximizing payment shifts and payment delays. • MHA’s top budget issue is to preserve inpatient fee for service rebasing process with new revenues – not to be done with budget neutrality.
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Previous & on-going MHA legislative priorities • Avoid new mandates that add administrative burden, costs, and little patient benefit: • Continue to oppose mandated nurse staffing ratios • Continue to oppose mandated reporting of incidences of violence to MDH • Continue to oppose physician non-compete legislation • Continue to support the Nurse Licensure Compact • Continue to support updating the MN Health Records Act, to more closely align with HIPAA. Advance exception for Treatment, Payment and Operations.
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Initial legislative priorities -new • Advance telemedicine proposals – several initiatives: • Allow the home to be an originating site • Allow telephone modality • State waivers expire 6/30/21. Efforts to make permanent. • Keep parity of service and parity of payment in statute • Allowing more time for “catch up” fingerprinting as part of the background check process, 60 days to 180 days. • More funding for mental health programs – growing need • Addressing health disparities – any bi-partisan proposals? • Appetite for Medical Assistance payment reform? 8
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Poll: What is the most important issue this session? • Continuing COVID support • Potential for state budget cuts that impact my hospital • Burdensome regulations • New funding for mental health
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Advocacy 101 • Advocacy is about being there – politics is a personal business; driven by relationships • Options include: • In person lobbying – use your personal story to have a conversation with your elected official or someone on their staff • Attending town halls and other events – make your voice heard in the community, asking questions and increase your visibility • By phone, email and traditional mail – simple action to let them know you’re paying attention. • Via social media or legacy media – spread our message on a wider scale, using any platform available to you.
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Meeting Basics: Elected/Government Official(s) • During your meeting: • Introduce yourself – mention that you’re a constituent, emphasize any connections to start relationship building. • Introduce your issues – lawmakers are there to learn, don’t assume they know everything you know. • Use personal stories – remember you are the face of this issue to the person you’re talking to; make an emotive connection when you can. • Have an ask – you both know you are there for a reason – don’t forget to ask what you came there to ask for. • Offer to be a resource – and then be one • End on a positive note
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Sharing your story Choose something personal – something rooted in our commitment to care for Minnesotans. • Put yourself in their shoes – you live in their community, choose community based issues to discuss • Don’t be a robot – allow your story to evolve as the conversation does • Keep it short, focus on impact • Don’t feel the need to be an expert where you aren’t. • Engage in the conversation – gestures and eye contact • Avoid using jargon, acronyms and ‘insider language’.
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After the Meeting • Offer thanks – these meetings are rooted in human interaction; a little bit of gratitude will go along way in building a relationship. • Follow through – the goal is to be a ‘first call’ resource for our leaders; if you offer information, don’t forget to provide it. • Let us know! MHA is here to support your efforts and ensure that we’re all using a unified voice in advocating for our priorities. We can’t do that if we aren’t in dialogue with each other.
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Do you know where they stand? If they support our issues
If they are ‘conflicted’
• Thank them • Reiterate how critical their support is • Ask them to co-sponsor or vocally support our position • Find out how you can support THEM - show them they are not alone
• Emphasize the real impact of our issues • Talk about how their support would help us provide better care to Minnesotans • Ask what their specific objection is, and address it, or commit to getting back to them • Offer MHA as a resource to address their concerns, and let us know
If they have expressed opposition • Remember to be respectful; even if they aren’t. • Emphasize the real impact of our issues • Challenge their assumptions; respectfully. • Offer more information on our issues. • Commit to keep lines of communication open.
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Lobbying by email and mail • Format the address and salutation properly • See www.leg.mn.us for mailing address and members • Identify yourself as a constituent and include your full address, including your zip code and phone number • State why you are writing and your position on the issue • Discuss the impact the issue will have on your facility and ability to provide care • Ask that the official support or oppose what you want them to • Commit to following up • Conclude with how best to reach you • Keep it to a page if possible, and NO JARGON!
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Lobbying by phone • Identify yourself as a constituent at the start of the call • State why you are calling and your position on the issue • Refrain from using talking points or personal stories unless the person engages you • Ask for support or opposition • Commit to following up if necessary • Take notes! – Be polite! the person who answers to the phone is simply doing their job
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Sample Meeting
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Successful advocacy takes all of us – bring your colleagues • Efficacy is essential – your peers need to believe these things: • • • •
They are capable of helping Their voice will be heard Acting together is always more effective The problem can be solved
Instead of this: “join me to meet with Senator Krinkie next week so we can keep these cuts from happening. Say this: ”Our voice matters a lot more than you may think, please join me to meet with Senator Krinkie next week so we can explain why these cuts are a bad idea.”
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Use empowering language when asking for help We often try to emphasize how ‘easy’ an action will be to encourage action – but the science tells us otherwise. • It is not in everyone’s nature to meet with strangers. • Unfamiliar situations or potentially unpleasant situations are difficult • Reinforcing people’s anxieties while reinforcing your need for help is the best way to be successful. Instead of this: “Please call Senator Krinkie and weigh in on this budget.” Say this: “I know this is a big request and it can be challenging, but we need you to call Senator Krinkie and weigh in on this budget. Each call gets us closer to where we need to be.”
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We are not logical; we are psychological People are not perfectly rational, even if they think they are. • Powerful emotions stoke powerful actions. • Research shows paring emotional appeals with clear, understandable and appropriate actions is the best way forward. Instead of this: “We should sign this letter to let Senator Krinkie know we cannot bear cuts to the human services budget.” Say this: “Cuts to the human services budget would put an unacceptable strain on our hospitals and health systems who are doing their best to provide badly needed healthcare to Minnesotans. We need to sign this letter to let Senator Krinkie know what these cuts will mean for patients.
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Thank you! And Helpful Links • Minnesota Legislature - https://www.leg.mn.gov • Find legislation • Find who represents you • Find contact information • Minnesota Governor Tim Walz - https://mn.gov/governor • Contact information • News releases and other position papers • State of Minnesota – www.state.mn.us • List of agencies • Contact information
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Trustee Role in Quality and Safety Tania Daniels, vice president, quality and safety, Minnesota Hospital Association Tania Daniels has led MHA’s nationally recognized quality and patient safety division for 20 years. As MHA’s vice president of quality and patient safety Tania has provided leadership for a broad array of quality and safety improvement work resulting in improved outcomes in each of the triple aims – improved health of the population, better patient experience and lower health care costs. She has led several large-scale collaboratives across Minnesota and the nation resulting in 1,387 fewer patients from being harmed and $11 million in cost savings. Jennifer Schoenecker, senior director, quality and safety, Minnesota Hospital Association Jenny Schoenecker is a senior director of quality and patient safety who works with the Minnesota Hospital Association to develop, implement, and facilitate hospital and health system clinical activities and collaboratives to improve the triple aim. Jenny provides MHA members with technical and implementation support, including consults, training/education, and assistance with prioritization of quality, safety and mental/behavioral health action plans.
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Trustee Role in Quality and Safety
Tania Daniels vice president, quality and safety
January 14, 2021 1
Today’s discussion MHA’s improvement model Priorities and results The board’s role with quality and safety oversight
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Minnesota provides high-quality, low-cost health care • Minnesota’s hospitals provide some of the best quality care in the nation, and we are committed to keeping it that way • According to the Agency for Healthcare Research & Quality (AHRQ) MN is routinely one of the states with the highest quality and lowest health care costs in the nation. 3
Quality and safety quadruple aim
Caring for Experience Healthcare of Care Staff Population Health
Per Capita Cost
Polling time: What is the most important aim?
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Quality and safety topics Falls/
Readmissions
Pressure ulcers
Safe surgery – procedural safety across the board
Severe sepsis and sepsis shock
Catheter-associated urinary tract infection (CAUTI)
Culture
Falls with injury
Delirium
Central lineassociated blood stream infection (CLABSI)
Adverse Drug Events (ADE)
Venous Thromboembolism (VTE)
Clostridium difficile (C.Diff)
Antimicrobial stewardship
Surgical site infection (SSI)
Patient and family engagement (PFE)
VentilatorAssociated Event (VAE)
Disparities
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Break out groups • What aim did you identify as most important and why? • • • •
Health Care Cost Staff
• What does quality/safety look like to you?
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1/12/2021
MHA’s QS committee structure MHA Board Quality & Patient Safety Committee
Mental & Behavioral Health Committee
Registry Advisory Committee
Delirium Committee
Falls Committee
HAI Committee
Medication Safety Committee
Perinatal Committee
Pressure Ulcer Committee
Sepsis Committee
Surgical Committee
Pediatric Committee
Community of Patient Partners
Additional topics: Law Enforcement and Healthcare Emergency Preparedness Medical Cannabis Oral health and many more
7
MHA committees leading quality and safety Over 500 engaged members
Over 150 engaged physicians Committees create, publish and update Road maps
8
4
1/12/2021
MHA’s continuous quality improvement model -PDCAC PLAN
DO
CELEBRATE
ADJUST
CHECK
9
PLAN DO CHECK ADJUST 10
5
1/12/2021
Identify Issue Site Visits
DATA
Local/ National News
Member Input
11
PLAN Data
Review Literature
Expert input
Learn From Others
EXPERT COMMITTEE
12
6
1/12/2021
‘Plan’ Develop and publish road map One stop tool Web portal Gap assessment Customize actions Linked resources Track actions Track progress 13
P’D’CAC (Do)
14
7
1/12/2021
‘Do’ MHA and health systems Educate Communicate
Gap Analysis
Site Visits
15
CHECK Outcome Measures
Process Measures
Site Visits
Member Input TRACK PROGRESS
16
8
1/12/2021
‘Adjust’ Road map adjusted based on pilot Road Map
Track Road map updated by Surgery Committee Data Best practice elements Prior 98 to 53 now Baseline participation
33 hospitals
Current participation
73 hospitals
In participating hospitals
84% of road map best practices in place
Educate
Communicate
17
‘Celebrate’
18
9
1/12/2021
‘Celebrate’
19
‘Celebrate’
20
10
1/12/2021
‘Celebrate’ Good Catch for Patient Safety Award • Presented to Minnesota hospital staff who demonstrate their commitment to keeping patients safe by "speaking up" to prevent potential harm to a patient.
21
Example 1: Falls with Injury
Falls with Injury Rate
MN 0.45
Your Hospital 0.75
22
11
1/12/2021
MHA’s continuous quality improvement model -PDCAC PLAN
DO
CELEBRATE
ADJUST
CHECK
Polling time: What action will be most effective to prevent falls?
23
Results 390 falls with injury prevented. Costs savings of $2,613,672
24
12
1/12/2021
Example 2: Readmissions
25
MHA’s continuous quality improvement model -PDCAC PLAN
DO
CELEBRATE
ADJUST
CHECK
Polling time: What action will be most effective to prevent readmissions?
26
13
1/12/2021
Results 520 readmissions prevented Costs savings of $8,044,945
27
Example 3: Adverse Health Events; Pressure Injuries 160 141 140
130 122
120
118 107 95
100 80 60 40 20 0 Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
28
14
1/12/2021
MHA’s continuous quality improvement model -PDCAC PLAN
DO
CELEBRATE
ADJUST
CHECK
Polling time: What action will be most effective to prevent Pressure Injury events?
29
Trustee role • What quality /safety topics are better than state average? • What quality /safety topics are worse than state average? • What is the plan to address the issue? • Who is accountable? • What resources are needed? • How will progress be monitored?
30
15
1/12/2021
COVID-19 Response • • • • • • • • • • • • • • • • •
Statewide HealthCare Coordination Center Critical Care Coordination Center (C4) C4 policy group Critical Care Workgroup Minnesota COVID Ethics Consortium Critical Care Ethics and Scarcity Subgroup Pharmaceutical Shortages Workgroup Statewide Healthcare Coordination Center Tactics Group Patient Movement Group RHPC/LPH/MDH Vaccine Planning Group MDH Vaccine Advisory Long Term Care Coordination Behavioral Health Workgroup Testing Workgroup Time Sensitive Procedures Workgroup Obstetric Care Science Advisory Team
31
16
MHA Board Certification The Minnesota Hospital Association (MHA) board certification program is designed to make a good board member great and a committed board member an exceptional asset. Board certification helps promote consistent standards, meaningful accountability, effective leadership and broad knowledge of critical health care issues. It helps trustees move beyond the basics of governance to develop a strategic understanding of the health care environment and move their hospital’s mission and vision to a new level. Certified trustees are knowledgeable, accountable ambassadors and champions for their facilities and communities.
Advantages of board certification
• • • •
Increase knowledge of health care issues, financial accountability and performance, public policy and effective governance best practices Understand board and CEO roles and responsibilities Approach strategic planning proactively Understand the importance of trustee involvement in contacting legislators and conducting grassroots community advocacy
How do I become certified? MHA board certification continuing education focuses on topics beyond the individual hospital, including effective governance, strategic planning, quality and patient safety, fiduciary duties and board development. Attend an MHA educational program or conference on governance topics and submit a continuing education approval form to start earning credit. Certification takes approximately two years; 35 credits are needed to complete the certification process. Each credit is equivalent to one hour of education.
A maximum of 20% of a trustee’s total education credit hours – or seven credits – can be earned through outside organizations such as the Governance Institute, AHA Annual Meeting or AHA Center for Healthcare Governance. All courses taken outside of MHA need approval; submit a course approval form to MHA to obtain credit. MHA tracks each trustee’s progress toward certification. Check your progress by visiting the board certification status page on the MHA website and selecting your name from the drop-down list.
Components of board certification
Principles of effective governance: 12 credits Mission, vision and bylaws Conflicts of interest, confidentiality and ethics Selecting and supporting the CEO and lines of authority Legislative policy priorities, grassroots advocacy and governmental regulations Legal issues and the commitment to compliance Communicating with the CEO, other board members, doctors, staff and the community
• • • • • •
Strategic planning and positioning: 8 credits Setting goals Leadership principles Trends Developing operational policies Physician relations Community relations
• • • • • •
Board role in quality and patient safety: 4 credits Improving the quality of care Ensuring adherence to quality and patient safety standards and expectations
• •
over Minnesota Hospital Association | www.mnhospitals.org | 2550 University Ave. W., Ste. 350-S, St. Paul, MN 55114-1900 | (651) 641-1121
Fiduciary duties: 4 credits Health care finance fundamentals Budgeting process Access to capital Facility design and construction/growth
• • • •
Board development and self-assessment: 4 credits Assessing governing accountability Board performance Board self-assessment
• • •
General: 3 credits All other types of educational programs
•
Basic standards of board involvement By completing this program, trustees are committing to follow basic standards of board involvement: Demonstrate basic knowledge of the hospital mission, vision and bylaws Participate in committee meetings as required by the hospital bylaws Participate in board education Participate in board self-assessment Participate in annual CEO evaluation Serve as a point of contact with the hospital’s state representative and senator, reaching out as requested by the hospital CEO or MHA Comply with conflict of interest policies and abstain from voting when appropriate
• • • • • • •
Advanced certification Board members who have completed the MHA board certification program are eligible for enrolling in the advanced certification program. Eight credits are needed for advanced certification, two in each of the following areas: Effective governance Strategic planning Quality and patient safety Board development
• • • •
These eight credits can only be received by attending MHA education programs. Advanced education programs are provided at MHA trustee conferences.
Questions? With questions, contact Christy Hammer, manager, education programs, MHA, 651-659-1412.
Boot Camp for Trustees Participant List Jan. 14, 2021 Name
Title
Organization
Crystal Adams Ara Anderson Lori Andreas
Trustee Trustee CEO/Administrator
Patti Banks Karen Baxter
CEO Trustee Chief Operating Officer, East Market Hospital Board Trustee/District Board Member Chief Executive Officer Trustee Trustee Director, Program and Network Development, Mergers and Acquisitions Trustee Trustee Trustee - Vice Chair Trustee
Lake Region Healthcare Essentia Health-Deer River Appleton Area Health Ely-Bloomenson Community Hospital Cook Hospital & Care Center
Bradley Beard Andrea Bedard Joel Beiswenger Jessica Bitz Judith Bjerga
Ryan Bjerke Doug Bjorklund Amy Brichacek Christine Bright Carrie Brimhall Trudy Canine Sarah Carlsen Steve Condon Santo Cruz Liz Dahl Ryan Daniel Steve Davis Teresa Debevec Jennifer DuPuis Aaron Enge Michael Enzmann
Trustee Trustee Trustee Senior Vice President and General Counsel Trustee Chair Trustee Trustee CEO/Administrator Trustee Trustee Trustee
Kent Feltz Stefanie Gefroh Sally Grove
Hospital Board Trustee Board Member Trustee
Essentia Health Cuyuna Regional Medical Center Tri-County Health Care Cambridge Medical Center Lakewood Health System
CentraCare Tri-County Health Care Lakewood Health System Riverwood Healthcare Center Lake Region Healthcare St. Croix Regional Medical Center Northfield Hospital & Clinics CCM Health CentraCare - St. Cloud Hospital Cook Hospital & Care Center CentraCare - St. Cloud Hospital Tri-County Health Care Cook Hospital & Care Center Community Memorial Hospital Cook Hospital & Care Center Cuyuna Regional Medical Center Essentia Health Lakewood Health System
Linda Hall Cassie Harrington Patty Henderson Arrick Jackson
Trustee Public Trustee President and CEO Board Member
Susan Johnson Teresa Kittridge Nicole Klimek Dan Koster John Lammert
Trustee Trustee Trustee Trustee Chair Trustee Chairperson
Jo Langan Laurie Lewandowski Brian Lovdahl Ann Madden Rice Willie Morales Laurel Nelson Joanie Olson Susan Peet Don Potter Arti Prasad Jack Priggen Warren Rau Les Riess
Trustee West Region Chair Chief Executive Officer President Trustee Trustee Trustee Trustee Trustee Trustee Public Trustee Board Vice Chair Trustee
Timothy Riley Darla Roache Kathleen Ryan Mary Sanders Nathan Schmidt Dean Sedgwick Anthony Sertich Kevin Skjei Wade Swenson Robert Thueringer Dan Tosel
Board Vice President Trustee Trustee Chair Trustee Trustee Trustee Board Member Board Member Trustee Trustee Chair Board Member
Jackie Trooien Renee Wachter Mark Wagner
Trustee Board Member Director
Children's Minnesota Olmsted Medical Center Glencoe Regional Health Essentia Health Johnson Memorial Health Services Bigfork Valley Hospital Alomere Health Carris Health - Redwood River's Edge Hospital & Clinic Ely-Bloomenson Community Hospital Essentia Health CCM Health Abbott Northwestern Hospital Appleton Area Health Lake Region Healthcare Bigfork Valley Hospital Lakewood Health System Cook Hospital & Care Center Hennepin Healthcare Olmsted Medical Center Appleton Area Health Community Memorial Hospital Ely-Bloomenson Community Hospital Mille Lacs Health System Riverwood Healthcare Center North Shore Health CCM Health Bigfork Valley Hospital Essentia Health East Region Appleton Area Health Lake Region Healthcare CentraCare - St. Cloud Hospital Appleton Area Health Hendricks Community Hospital Association Essentia Health East Region Winona Health Services
Craig Warren Timothy Weir
Trustee Chief Executive Officer
Gene Wenstrom Patty Winchell-Dahl
Trustee Chair
Hennepin Healthcare Olmsted Medical Center Prairie Ridge Hospital and Health Services North Shore Health