Navigating Change in Health Care Reform: Who s Role the CNO or CMO? Presentation ID: W4 Mary Jo Snyder, RN, MS, MBA. Presentation ID: W4

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1 Navigating Change in Health Care Reform: Who s Role the CNO or CMO? Presentation ID: W4 Mary Jo Snyder, RN, MS, MBA Presentation ID: W4

2 Today s presenters do not have any relevant financial interests presenting a conflict of interest to disclose. Participants must attend the entire session(s) in order to earn contact hour credit. Continuing Nursing Education credit can be earned by completing the online session evaluation. The American Organization of Nurse Executives is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. AONE is authorized to award one hour of pre-approved ACHE Qualified Education credit (non-ache) for this program toward advancement, or recertification in the American College of Healthcare Executives. Proprietary Information of Echo Consulting Group, LLC

3 Presenter Disclosures Mary Jo Snyder, MS, MBA, RN Financial Disclosures Echo Consulting Group, LLC Owner and Partner Unlabeled/Unapproved Uses Disclosure: None

4 Learning Objectives Synthesize information from current Chief Medical Officers and Chief Nursing Officers on their changing roles related to health care reform Recognize the emerging roles of nursing and physician leaders and given tips on how to build a successful working relationship Identify strategies to build successful working relationships between nurse leaders and physicians

5 Presentation Outline Review traditional roles of the CNO and CMO Affordable Care Act Survey Responses Debate Clips Throughout Challenges for the Nurse Executive Role in the Future

6 The Executive suite is challenged Who is best positioned to lead these changes? Pay for Performance ACO Reduce Readmissions CMO or CNO? Rapid Sustainable Change Population Health Medical Homes

7 Let s Ask Survey C Suite Executives Community settings Urban settings Systems Query Colleagues Informal Questionnaire NOT RESEARCH Sent to 78 mix of CNO and CMO Responses 42%

8 Questionnaire 1. What type of setting do you work? Community Hospital 64% Rural Hospital 0% Academic Hospital 6% System Level 24% Other 6% Pediatric Free Standing Hospital Accreditor 2. Do you have a CMO in your C-Suite? Yes 91% No 3% At system level only 6%

9 Questionnaire 3. Who should be responsible for leading healthcare reform initiatives in the C-Suite? CNO - 10% CMO 18% CEO 33% Other 39% Dyad CNO/CMO Dyad COO/CMO Chief ACA Officer Entire C suite as collaborative team 4. Has your organization established any positions (Executive Director and above) focused on Population Health and/or Healthcare Transformation? Yes RN 0% MD 24% Other 27% Senior VP VP Chief ACA Officer No 49%

10 Questionnaire 5. What initiatives have you started regarding the impact of the Affordable Care Act? (check all that apply) Population Health Strategies 64% Medical Home 64% Change in care delivery at the hospital 91% Purchasing Physician Practices 64% Additional Advance Practice Nurses 71% Care Delivery Changes to meet QM for incentive payments 64% Creation of or joining an ACO 93% Technology investments to support healthcare change 100% Alignment/shared savings - non-employed/independent physicians 30% Joint ventures with physicians -29% New approaches to handle anticipated ED overcrowding 64% Cutting Staff to deal with change in reimbursement -36% Other (included in above)

11 Welcome the Interviewees Lynn Sund Senior Vice President and Chief Nursing Executive Dr. Robert Kiskaddon, MD, FACEP Chief Medical Officer and Vice President of Medical Affairs Chairman, UNC Health Care System Chief Medical Officer Committee

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14 Chief Nursing Officer Current State Ensure that patient-care, clinical and staffing standards are met Advise senior management on best practices in nursing and patient care Assist with establishing compensation and benefit programs for nurses Develop patient-care programs Manage nursing budgets Establish nursing policies and procedures Participate in cross-departmental decision making Conduct performance improvement activities Maintain regulatory and compliance approvals and accreditations Work with senior management and medical staff to develop strategic plans Represent nursing services at board of director meetings

15 Proprietary Information of Echo Consulting Group, LLC

16 Chief Medical Officer Current State Assures medical staff compliance with bylaws, rules and regulations, policies, procedures, and behavior standards Assures strong medical staff relations Assist in reviewing physician contracts, compensation, and stipends for physicians Supports the Medical Staff in its self governance and accountability to the Hospital Board for quality and safety of patient care Assists in strategic development of initiatives and programs Participates in the development of clinical information systems and electronic medical records Develops, implements, and evaluates clinical practice protocols, facilitating the transition to evidenced based practices. Drives the development of a culture of patient safety. Integrates, monitors, and evaluates quality assurance, disease management, and utilization review activities

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18 Affordable Care Act Questions: 1. Will hospitals get paid for charity care they now provide for free to uninsured patients? 2. Will this flood hospitals with new, high-use patients? 3. Will Emergency Departments be overcrowded because of pressure on two midnight rule or inability to manage re-admissions?

19 Affordable Care Act Guarantees: 1. Hospitals will receive less money 2. It will be expensive to monitor and accurately report quality 3. Medical Staff Relations will be stressed 4. Critical delivery system changes must be created while meeting all quality parameters

20 Affordable Care Act Migrating from volume to value How does the puzzle come together?

21 Affordable Care Act Three Common Themes Accountability Efficiency Quality

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26 Love or War in the C-Suite

27 All disciplines look to nursing when throughput and related quality and safety are concerns Yet Physicians remain the final authority of what care is actually provided

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30 Delivery or Finance Reform Current CNO Ensure that patient-care, clinical and staffing standards are met Advise senior management on best practices in nursing and patient care Assist with establishing compensation and benefit programs for nurses Develop patient-care programs Manage nursing budgets Establish nursing policies and procedures Participate in cross-departmental decision making Conduct performance improvement activities Maintain regulatory and compliance approvals and accreditations Work with senior management and medical staff to develop strategic plans Represent nursing services at board of director meetings Current CMO Assures medical staff compliance with bylaws, rules and regulations, policies, procedures, and behavior standards Assures strong medical staff relations Assist in reviewing physician contracts, compensation, and stipends for physicians Supports the Medical Staff in its self governance and accountability to the Hospital Board for quality and safety of patient care Assists in strategic development of initiatives and programs Participates in the development of clinical information systems and electronic medical records Develops, implements, and evaluates clinical practice protocols, facilitating the transition to evidenced based practices. Drives the development of a culture of patient safety. Integrates, monitors, and evaluates quality assurance, disease management, and utilization review activities

31 CNO or CMO as key change agent- do we see that differently?

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34 Dyad Relationship Dyad s risk When a two person relationship breaks down, there is nothing to help stabilize the relationship Roles and responsibilities are not clearly defined

35 A Real Life Example January 31, 2014 I thought you would find it of interest that at an HSHS Executive meeting in Chicago this week, the CMOs and CNOs from our 13 hospitals had a pre- meeting which was a joint meeting of the two groups. They talked about topics of interest to both groups i.e. Quality, etc. Both groups agreed it was a great meeting and they plan to do it again. I think it is a great example of appropriate collaboration. Jean Jensen, VP, Hospital Sisters Health System Redesign/Operational Excellence

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38 Triad Relationships Triad is intentional and there are three types Relational Structural Power Let s see what type we need

39 Types of Triads Relational Shared values bind the relationship Not necessarily through a specific project Everyone is responsible for preserving a healthy relationship between all members Structural Shared project bind the relationship Need to meet regularly Break communication silos Power Both shared values and project bind the relationship There is a strong resonant value and a common need

40 Breaking Through Turf Wars Working together versus power trips Both need a strong grounding in clinical and business skills Constant interaction Keeping patient centered perspective

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42 Chief Nursing Officer Future State Care delivery based on evidence based practice both inside and outside the walls of the hospital Cross continuum responsibility Enterprise wide EMR Integration of nursing in multiple settings Expanding nursing roles in outpatient areas and advanced practice ROI reporting and justification versus traditional budgets

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44 Chief Medical Officer Future State Focus on Finance Managing the magnitude of transformation from volume to value No outcome no income Must move from monitor to enforcer Evidence Based Practice Entire population versus service line quality

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46 Challenges for Nurse Executives Move from the CNO as purveyor of clinical operations Expertise in reducing variability in care delivery processes Resources and attention are primarily focused on acute care, not preventative or health maintenance Nurses are not seen as revenue generators Cannot be a blind advocate for your cause

47 Contemplate the Following The speed in which change must occur is alarming Physicians pay related to quality will drive change but there is little discussion about nursing s pay related to quality Dyad and Triad relationships can be difficult to manage Future success is not just dependent on the arbiter of care decisions but the efficient delivery of that care

48 Are Nurses doing what they do as essential to patient care and population health. or.. are nurses assisting that which is going on?

49 Mary Jo Snyder, RN, MS, MBA

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