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Finance Monthly hears from José R. Sánchez, the President and CEO of Chicago-based Norwegian American Hospital, who discusses what it takes to be a CEO of a hospital and the initiatives that the hospital has been up to since we last spoke a year ago.

 

I have been President and CEO of Norwegian American Hospital since 2010 and have had a long career in healthcare, going back 30 years, mostly in New York. I spent almost 16 years with the New York City Health and Hospitals Corporation where I held a number of positions during my tenure in various leadership roles. I was the most senior leader within the system, responsible for the largest healthcare network that included 3 hospitals, 23 clinics and over 9 000 employees. Healthcare is a very competitive field in just about every part of the country. The rules I follow are excelling in any responsibility given to me and managing an efficient operation. I focus on quality improvement, best practices, growing business, expanding services, addressing community needs and having a viable bottom line.

A successful hospital CEO knows how to cultivate leadership within the organisation. I believe that inherent leadership skills that engender the support and confidence of the providers, patients, and the surrounding community are most important. Good leaders will not only engage with their executive team but the best leaders are those who engage at all levels of the organisation. Additional skills that have been helpful to me are those I have been able to gain through roles in management and understanding operations, while staying updated on current changes in the market. I focus on identifying and bringing in the best talent for the success of the organisation. It is also important to understand the politics of healthcare. I believe there is a very close relationship between understanding the fundamental principle of operations in the healthcare setting and understanding how policies are shaped. You need to be able to balance both equally and be able to identify critical priorities and act on those priorities, on behalf of, or for, the benefit of the organisation.

As we understand today, healthcare is an evolving system. The direction of healthcare is very unclear and this is probably the most disruptive time ever in healthcare. Therefore, there is greater demand for training the workforce to respond to those changes. In order to make every attempt to have high moral in the organization, it is important to value the roles and responsibilities that the workforce has. Communication is also key for high morale, taking time to explain trends in healthcare, and working in collaboration as a team. Celebrate the successes openly and openly address the challenges we have every single day. Staff development is key to improving and maintaining high moral. Standardisation of policies across the board is critical and transparency is key as well. Trust is a major driver to maintain and improve morale.

The successes of Norwegian are many but we have been able to keep the doors open by being a proactive organisation, representing the needs of the community by creating specific programs that address the health disparities in the community. We also have been able to have a very lean, efficient organisation and have been a financially viable institution, posting a profit for the last 6 years. We made significant improvement in quality across the organisation and have received numerous recognitions and awards, both nationally and locally. In 2015, NAH received the Healthgrades® Patient Safety Excellence Award. This distinction put Norwegian American Hospital within the top 10% of all hospitals evaluated for their excellent performance in safeguarding patients from serious, potentially preventable complications during their hospital stays. We were recognized for having the lowest hospital inquired infection rate among 67 hospitals in Greater Chicago area. In 2017, our Pediatric Care-A-Van received the prestigious American Hospital Association NOVA Award. Only five NOVA Awards are given nationwide each year. We have engaged the community to be active participants in the hospital and to provide input to improve quality and community engagement. We also are very proud of our relationship with all the stakeholders in the community: community based agencies, schools and the business community. Some of our successes of pride include the financial investment for the renovation of the first floor of the hospital and the creation of our own family residency training program.

NAH has really addressed the healthcare needs of the community and taken responsibility to develop and grow the next generation of healthcare providers through our active participation with medical students and our resident program. We also are the largest employer in the Humboldt Park community, so approximately 65% of our workforce comes from residents of the community. We serve as the economic anchor to the surrounding communities. Norwegian American Hospital reinvests back into the community through programs to care for the underserved and uninsured, manage chronic conditions like diabetes, health education and promotion initiatives and outreach for the elderly. Our Comprehensive Diabetes Centre addresses the diabetes rates in our community that have risen exponentially. We also started a new Family Medicine Residency program to help attract new doctors to the area because physicians tend to remain in the communities where they complete their residency. Our partnerships with local faith-based organisations have opened doors to raise awareness of specific health needs in our community. Recently, Norwegian American Hospital donated land where a veterans’ home was constructed, a move that symbolizes a long-term commitment to Chicago’s homeless veterans and their quality of life. Our hope is that dependency on hospital services will be reduced. People living on the streets tend to cycle in and out of emergency rooms and in-patient stays. NAH is proud to be among the first hospitals in the City of Chicago to address homelessness and housing for veterans.

We have fully embraced the Affordable Care Act with participation during open enrollment periods to expand Medicaid for those individuals who are eligible for the program. We also support programs in the community and are active participants in health fairs. Community health fairs are go-to events for our local residents who want to learn more about a variety of health topics and wish to receive free or low-cost screenings. In addition, throughout the year, NAH offers numerous opportunities for the public to learn more about key health topics and how to incorporate healthy lifestyle changes. This year, we have a Care-A-Van that brings services to schools and children and families throughout the year. The state-of-the-art mobile clinic brings healthcare to 3 000 underserved children who otherwise would not receive care for asthma, obesity, diabetes, high blood pressure, lead poisoning and other preventable health disparities.

At the forefront of our agenda is our quality journey that has direct impact in patient outcomes. Each quality service line has a dashboard that reports clinical metrics. We have an external affairs committee that was developed several years ago with members who are residents of the community. They have become the ears of the community to provide input to hospital leadership as it relates to improving care and communicating community concerns and needs. We do a community assessment regularly to evaluate and understand the need for services required in the community. Our commitment to improve healthcare outcomes and patient safety is manifested in the performance results of several national clinical measures within the Centers for Medicare and Medicaid Impatient Quality Reporting Program. NAH exceeds the national scores or benchmarks in many categories which include mortality, patient safety indicators and Hospital Acquired Infections. We exceed the national benchmarks in five out five mortality categories and six out of seven patient safety indicators, with a slightly better overall patient safety score than the national benchmark. NAH is accredited by The Joint Commission for hospital and behavioral health programs; College of American Pathology for laboratory services; Healthcare Facilities Accreditation Program (HFAP) as a Certified Primary Stroke Center; and Illinois Department of Public Health’s (IDPH) Level II Perinatal Care Certification.

The goal of the hospital is to change and evolve every day. We need to be adaptable to a very disruptive healthcare environment. We have to focus on trends in healthcare which includes the triple aim of quality, population health and financial viability. The policies of the state continue to change and we need to adapt and respond quickly to those changes. It is clear that our goal needs to be on quality improvement, best practices, expansion of services, efficiency and using technology as a tool to help us accomplish our objectives. NAH recognizes that health is more than simply treating patients who come through our doors. We want to build not only a healthier, but a more prosperous community.

2018 has been a trying year for healthcare. We are beginning to see acceleration of mergers and acquisitions throughout the country and beginning to see merging models of care. In 2018 we are beginning to see other providers emerging in the market, such as CVS, Walgreens and others.

We are beginning to look at challenges and changes in healthcare and at opportunities to improve the current system. Certainly, in this very difficult time there are great opportunities to improve care, address the need of consumerism, growth and efficiency and develop new models to address the population needs. Healthcare today is about collaboration, we can no longer exist in silos. The solution to many problems will require a collective effort of sharing information, sharing responsibilities and focusing on innovation. I suggest that new leaders need to pay attention to demographic changes in the country as well as the elderly population that continues to grow. We need to not only focus on health, but the social determinate of health: food, housing and transportation. Prevention and education will continue to play a significant role to the outcome of interventions we will make.

2018 will be a year to focus on positioning ourselves strategically on many different fronts. Growth, efficiency, financial viability and adapting to the new healthcare order. We will focus on sustainability and leverage the gains we’ve made. We will create more growth opportunities for the hospital outside of our four walls. Our focus will be on shaping policies that address the needs of the people who comprise this community. We will continue to find funding solutions for the programs that have been subsidizing NAH. We will do all of this so that we can continue to provide the highest quality of care for the most vulnerable members in our community.

Positioning the hospital for 2018 is in the hands of the leadership of the hospital to create the vision and future to keep the tradition of Norwegian American Hospital alive, which has served the Humboldt Park Community for over 120 years.

 

Website: https://www.nahospital.org/

As part of our Thought Leader features, this month Finance Monthly had the privilege to interview José R. Sánchez, the President and CEO of Chicago-based Norwegian American Hospital (“NAH”), a 200-bed safety net hospital. Here he sheds some light on his role to create and meet the vision of Norwegian American Hospital, recent changes in the American healthcare system and how he balances between the need for profitability and the needs of the hospital’s patients.

 

Tell us a bit about your career path prior to joining Norwegian American Hospital? What brought you to your current position?

I began my career in the healthcare field in the city of New York back in 1979, working in various hospitals until 2010. I joined the New York City Health and Hospitals Corporation in 1996 as head of one of the public healthcare hospitals. I was promoted to Senior Vice President of the largest healthcare network in the public healthcare system and was also CEO of Lincoln Hospital. My responsibility was to lead the business operations and integration of the network, which was comprised of three acute care hospitals (two of them were level-one trauma centers), and 24 clinics in East Harlem, Central Harlem, and the South Bronx in New York City. In 2010 NAH was in search of an executive CEO to turn around the failing hospital that was just about to close, as a result of poor financial performance, low quality, a poor reputation, declining volumes and a lack of an infrastructure to support the hospital’s growth.

 

How has your role impacted the hospital in the past 6 years?

In 2010 I outlined a vision for the recovery of the hospital and restored financial stability, quality improvement, physician engagement, community engagement and investment in technology to improve electronic medical records. Since that time, the hospital has been able to close in the black for the last 5 years. Our quality has improved significantly and we have been awarded and recognized nationally for our quality journey and accomplishments. We have grown every business line and we have improved and aligned with the vision of the organization and the integrity of the overall community, as well as full implementation of electronic medical records. Currently every service we offer is online.

 

What were the goals that you arrived with back in 2010? 6 years later, would you say that you have managed to achieve them?

We have been able to achieve the original outlined vision of 2010 and surpassed and excelled in each one of those areas. Today, Norwegian American Hospital is considered at the top of the safety net hospitals across the state in financial status, quality metrics and operational efficiency.

 

What are Norwegian American’s ethics towards its patients?

NAH is fully dedicated to improving the health status of every resident in the Humboldt Park Community on the West side of the city of Chicago. Patients are put at the centre of our universe and we always aim at providing the best care possible through identifying evidence-based best practices.  Decisions are made on what is best for our patients and resources allocation is focused on community needs.

 

How have you managed to balance between the need for profitability and the needs of your patients?

As a not-for-profit organization, it is a pretty difficult balance between profitability and patient needs. It is clear that our mission to provide care to every patient, regardless of ability to pay, needs to be balanced within the existing hospital resources. Safety net hospitals in the State of Illinois depend primarily on Medicaid patients and State subsidies. To balance the budget that will be required to provide the care that is needed for patients in poor communities. To frame the question, there are 40 safety net hospitals in the State and they comprise 19% of all hospitals. Those hospitals collectively provide $375 million in community benefit and also provide approximately 40% of services to individuals with substance abuse and mental illness. Part of our effort to balance profitability and patient need is to take a very strong advocacy role to ensure services are delivered to those patients in our community. We at NAH treat patients with the worst health conditions in the State, requiring significant resources. Our objective is to ensure the greatest operational efficiency to meet patient needs.

 

Could you tell us a bit about any recent changes in the American healthcare system, both in terms of regulation and funding? How have they impacted NAH?

Back in 2010, the Affordable Care Act was passed as legislature in this country, as a landmark legislation to reform the traditional healthcare delivery system in the United States. The objective was to expand coverage to all Americans and to reduce cost and improve quality. During the last 7 years of implementation of the Affordable Care Act, we have seen a significant positive trend in coverage, where more than 20 million Americans have been able to secure health care coverage. In addition, the objective of reducing cost has never been obtained as a result of many individuals who entered the market with insurance coverage, who presented conditions worse than predicted. Therefore, the cost of healthcare in our country has increased. For example, premiums of health coverage have continued to escalate. As a result, the high utilizer of services has increased and insurance plans have passed on the cost to consumers through higher premiums and higher deductibles for services. The impact of the Affordable Care Act has created a positive impact for NAH since its implementation. Before the legislation, our self-pay, no pay percentage of patients was about 15%. Today we are somewhere between 5 and 7%. Therefore, it has improved our bottom line.

 

What would you say differentiates Norwegian American from other healthcare providers?

NAH has been able to transform to the expectations of market trends in operational efficiency, technology implementation, cost reduction and quality improvement.

 

What lies ahead of you and NAH?

It is totally unpredictable what lies ahead for safety net hospitals and any other healthcare system in the United States at this time. We know that the current President outlined a health plan called the American Healthcare Act to repeal and replace the Affordable Care Act. Although that proposed legislation was rejected by the House of Representatives, the future of healthcare is still unpredictable. The Secretary of Health of the United States has tremendous authority and influence to change and modify policies that will have an impact on healthcare for the rest of the country. Any changes at the federal level would have impact in our State and therefore, at NAH we know that our on-going goal is to continue to reduce cost across the board. It is difficult to reduce cost when a significant number of hospitals in the country are operating in a deficit and in very small margins. Norwegian is one of these institutions operating in very small margins and any negative impact will have devastating results in the operations of the hospital.

 

 

Sage, a market leader in cloud accounting software, announced at Sage Summit 2016 its strong commitment to future technologies, with a focus on new and existing partnerships that power business growth. Revealed during CEO Stephen Kelly’s keynote address, which opened the world’s largest gathering of entrepreneurs and business builders, Kelly spoke about how, through the use of the latest technologies and tools, Sage is levelling the playing field for entrepreneurs – and it’s just the start of the technology revolution all entrepreneurs and business builders of all sizes need to be a part of to compete and grow.

Investing in the future with the introduction of Sage Cloud

The dedication to helping businesses grow is a personal crusade of Kelly’s. Following the investment of £139m on research and development during FY15, the Sage CEO used the keynote as a platform to set out how all Sage products will now be connected to the cloud, with new mobile, social, chatbot and IoT offerings in the pipeline for the entire portfolio.

Sage Cloud will allow businesses to integrate all activity across Sage products quickly and easily. It will also make it possible for Sage customers to activate integrations with partner products within a few clicks and will eliminate the need for maintenance or change due to product upgrades. Sage further pledged its dedication to the developer community with the launch of Sage Marketplace, a new open, API-driven platform for Independent Software Vendors to showcase their Sage developer add-ons and apps.

Industry firsts – leapfrogging the competition

Another highlight was the official launch of Sage’s new admin bot, Pegg, a smart assistant that allows users to track expenses via their chosen messaging app. Pegg removes the complexities and enables entrepreneurs to manage finances through conversation. By digitising information at the point of capture, it takes away the pain from receipts and expenses, eradicating the need for paper and data entry.

Powerful new partnerships

This coincides with the news that Sage has partnered with Slack, which will act as one of the core messaging channels connected to Pegg. Having recently joined as ‎Global Director for Mobile Product Management, Sage’s Kriti Sharma said: “With the rise of freelancing and the sharing economy, the number of small businesses is growing exponentially. Most of these business owners use messaging apps, and with Pegg we aim to bridge the gap between these apps and work, rendering accounting invisible to the end user and making running a business as simple as sending a text. We’re incredibly excited to partner with Slack, the fastest growing enterprise messaging app; together we share the vision that the future of the workplace is conversational, easy and fun.” Announced with a demonstration live on stage, the accounting industry’s first bot, Pegg is available now in Beta. New users can register to sign up here for Slack or here for Facebook messenger.

In an interactive live demo, Sage’s new EVP of Product Marketing, Jennifer Warawa, showed how the combined solution of Sage Live and TomTom Telematics works. The new software integration allows businesses with fleets of vehicles - small or big - to seamlessly record mileage and automate expense reports. Because Sage Live is running on the Salesforce platform it can easily use existing integrations with third parties such as TomTom WEBFLEET. Via the fleet management, service journey data is automatically available in Sage Live.

There were several new partnership announcements, as well as details on how existing ones have strengthened. In front of an audience of 15,000 and over 35,000 on LIVE stream, Stephen Kelly announced that Sage’s award-winning real-time accounting solution, Sage Live, will harness the power of Salesforce Lightning. Via the integration, Sage customers will benefit from Salesforce’s new Lightning Experience – a reimagined consumer-like experience that’s modern, efficient and smart – which will be accessible via Sage Live across every device.

Microsoft CEO Satya Nadella joined via video to announce the coming together of Microsoft Office 365 and Sage 50 – making Sage the first ever software company to partner with the platform. The Sage CEO also welcomed Sir Richard Branson to the stage, where they participated in a conversation on their shared vision of the future of business and giving back.

Champion of Business Builders

Sage’s commitment to supporting entrepreneurs at every stage of their growth was underlined with Kelly revealing new stats on entrepreneurs’ dissatisfaction with the support they get from the US Government. He also reiterated his criticism of ‘out of touch’ events like the World Economic Forum in Davos and announced a series of policy events around the world

The Giving Economy

Broadening out to touch on Sage as a participant in its communities, the keynote highlighted how Sage will expand its corporate philanthropy initiative, Sage Foundation, through work with three distinct communities; military veterans, young people and women. Sage’s Chief People Officer Sandra Campopiano launched a new open grant process with a donation to an inspiring Chicago charity that seeks to inspire more women to work in the technology sector.

She awarded a $50,000 donation from Sage to Brave Initiatives, a program encouraging high school girls to see themselves as capable coders and tune them into community issues.

Sage CEO Stephen Kelly said: “It was almost impossible to tell the story of the technology revolution at Sage in one keynote. With a more connected world comes new demands on our hero business builders, and we are fired up by doing everything we can to support entrepreneurs in following their passion. We are working on making concepts like the Internet of Things, machine learning, blockchain and data sciences into a reality for businesses, accountants and partners. This is way more than cloud and mobile-first. It’s designing and building technologies that truly power businesses, freeing entrepreneurs to grow and win.”

For those not attending Sage Summit 2016, all of the keynotes and more can be viewed at the virtual event http://bit.ly/29N0zbE

More Information on Sage Live can be found here

(Source: Sage) 

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