Center of Excellence

by James Forkan

The National League for Nursing (NLN) officially recognized Adelphi University and the College of Nursing and Public Health as a Center of Excellence for 2014–2018 at a September 19 banquet during the NLN’s Education Summit in Phoenix, Arizona.

Although none of the honorees made remarks at the event, statements were read for each of the newest Centers of Excellence. The College’s statement cited “a focus on advancing the science of nursing education. The outcomes of the research undertaken by the faculty have influenced maintaining excellence in our three levels of education programs. The faculty engage students in their research and projects and have widely disseminated their findings in their peer-reviewed journals and conference presentations. Adelphi’s [College of Nursing and Public Health] plans to continue a focus on advancing nursing education science through more collaborative research with their clinical partners and interprofessional colleagues.”

Dean Patrick Coonan, Ed.D., R.N., NEA-BC, FACHE, called the designation “exciting news” in late August, when Beverly Malone, Ph.D., R.N., FAAN, chief executive officer of the Washington, D.C.-based NLN, announced that the league had singled out Adelphi “for creating environments that advance the science of nursing education.”

The NLN also considers Adelphi and five other Centers of Excellence institutions to be “role models whose faculty, deans and researchers are available to share expertise, insight, knowledge and experience to lift the entire nursing community to a higher level of achievement,” Dr. Malone said.

Dr. Coonan praised “our faculty, who have continued to contribute to advancing the science of nursing education through publications, presentations and supporting our students in their research and projects.” 

In addition, he cited Jane White, Ph.D., the College’s associate dean for research, for sprearheading the Center of Excellence application process over the last year. “Her committee members helped compile documents necessary for the application, which were many….We are indebted to them,” he said.

Dr. White’s committee members were Patricia Donohue-Porter, Ph.D., Maryann Forbes, Ph.D., Andrea McCrink, Ed.D., Deborah Murphy, M.S., and Janet Raman, Ed.D.

The COE honor is the latest news in an eventful period for the College that began in Spring 2013. The 70th anniversary of the former School of Nursing segued into Adelphi changing the name and mission of its nursing school. Renamed the College of Nursing and Public Health, it has expanded into such programs as the Master of Public Health and the M.S. in Nutrition. In addition, Adelphi began construction of the 100,000-square-foot Nexus Building and Welcome Center, which will serve, as of Fall 2015, in part as the College’s new home, with ultramodern simulation labs and more.

During the years in which these institutions carry the Center of Excellence designation, their faculty and administrators serve as advisers and sounding boards to others who intend to seek its status, Dr. Malone said.

The six newest additions bring to 35 the number of Center of Excellence designees chosen by the NLN Board of Governors since 2004—31 higher education institutions and the rest healthcare organizations.

All told, the NLN has 40,000 individual and 1,200 institutional members.

Maintaining Leaders: Adelphi Completes First High-Performance Leadership Program

by Jordan Chapman

Catholic Health Services of Long Island employees participate in Adelphi’s High-Performance Leadership program.

Adelphi University’s newly launched intensive High-Performance Leadership (HPL) program, aimed to benefit middle- and senior-level managers throughout the entire system of Catholic Health Services of Long Island (CHS), certified 300 CHS leaders on December 10, 2014.

The course maintains and offers new techniques to sustain and enhance employee engagement and high-quality patient satisfaction and to devise solutions for myriad challenges facing the healthcare industry to positively impact business outcomes.

“One of the big issues in healthcare right now is patient satisfaction—that it’s no longer just enough to cure them,” said David Prottas, Ph.D., associate professor in the Robert B. Willumstad School of Business Department of Management, American Association of University Professors (AAUP) vice president for grievance and one of four Adelphi faculty members leading the HPL program.

“You get satisfied customers if your employees are fully engaged in their jobs,” Prottas said. The HPL program was brought in to sustain effective leadership in a health system of some 70,000 employees.

He explained that an employee’s engagement with his or her work comes down from their direct managers and leaders. When 25 percent of the healthcare leaders taking the course have 50 more people reporting directly to them, the impact is big.

“Most people are promoted to management because they’re really good at what they do,” Prottas said. “But very often they’re not given any training on how to be a manager.”

Course work didn’t involve lectures. Prottas described a setting consisting entirely of role-play and exercises, leadership assessments and feedback on management style. “It’s not telling them what to do, but helping them practice how to do it,” he said.

Instructors of the High-Performance Leadership program include (from left): David Prottas, Ph.D, Carol Ann Cacciopoli, Mary Nummelin and Neil Halloran 

“It was enlightening, and I think it was self-fulfilling in that you get some time to reflect on things you’ve done for many years,” said Kathleen Engber, director for nursing education and clinical informatics at St. Francis Hospital. “It’s keeping them motivated and keeping the staff [motivated] so the patients get the best possible care. It’s all about the patients,” she said.

“We’ve been wanting to do management training for a while now,” said Tony Pellicano, senior vice president of human resources and chief HR officer for CHS. “We’ve had a very good experience with [Adelphi]. We thought it a good opportunity to take the relationship to the next level,” he continued, noting the special M.B.A. physician cohorts Adelphi currently offers to CHS doctors and managers.

“We know we can’t just do this once. We need to have an ongoing presence. We want to have follow-up educational sessions and see if we can grow this into something larger,” he said, noting aspirations to have the program merged into the special physician cohort M.B.A. program. “[That way] employees can go for an M.B.A. and, at the same time, get a leadership certificate from Catholic Health Services. …This is the first stage to getting that off the ground.”

The financial relationship and impact on providing better and more affordable care to patients is poised to change as Adelphi University continues to build its partnerships with hospitals to develop leaders and strengthen healthcare delivery overall. The HPL program is an extension of Adelphi’s growing commitment to improving the healthcare industry.

What Do You Know About Healthcare?

*Data taken from the Bureau of Labor Statistics, Occupational Outlook Handbook. The date can be found online.

by Jordan Chapman

Students may not expect to see Basics of the U.S. Healthcare System (BUS 390) as an offered undergraduate course in the Robert B. Willumstad School of Business, but based off the numbers above, it’s safe to assume there is more to healthcare than just the healing. “The U.S. Bureau of Labor Statistics states that jobs in healthcare management will grow faster,” Ulrich Rosa,College of Nursing and Public Health lecturer, who’ll be teaching the course, said, “due to the enactment of the Affordable Care Act and the aging baby boomer population.”

The Spring 2015 coursework will include a broad overview of what the U.S. healthcare system is made up of and how it works, how it’s financed, how it’s integrating with technology, different professional options, the origins of the hospital, long-term care and mental health.

“Someone will be able to walk out of the class and say, ‘I have an understanding of how big this is,’” Rosa said. “They’ll get to know why it’s so difficult to understand. So many people are involved in it. It’s more than just hospitals. It’s the pharmaceutical industry…medical supplies, the insurance business.”

The bottom line is that, whether Adelphi students are working in the field or not, the country’s “healthcare [system] will have a direct impact on your professional, personal and family life,” said Brian Rothschild, assistant dean for the Willumstad School of Business. “Accountants, marketing specialists, financial analysis experts, human resources, lawyers, PR professionals and more. Any discipline, any profession can be found within the health system.”

The Future of Healthcare Requires a Value Transformation

by Jordan Chapman

“Our job is to demand and expect (excellent healthcare).”—Michael E. Porter, Ph.D.

In the last 50 years, science has accelerated the art of healing in astounding ways, but when it comes to the delivery of healthcare services, the United States and many countries around the world have a serious problem.

This was the topic of discussion when Michael E. Porter, Ph.D., visited campus in late October to speak to Adelphi faculty and students as part of the Hagedorn Lecture Series, in conjunction with the Robert B. Willumstad School of Business 50th anniversary.

Porter, a leading authority on healthcare strategy, is widely recognized in government, corporate, nonprofit and academic circles across the globe for his insights on company strategy, the competitiveness of nations and regions, and strategic approaches to societal problems.

He has developed a new idea for healthcare delivery—based on working and existing models in other countries. It’s centered on value for the patient.

The Problem

The best way to understand value is to first understand how the current system doesn’t focus on patient need. Porter used a migraine patient as an example to illustrate the current U.S. healthcare structure:

If a patient experiencing chronic migraines makes an appointment to see his or her primary physician, they might wait a week to get in, they take a day off work to attend the appointment, fill out the paperwork upon arrival and hand over the co-payment to see a doctor. The doctor, though genuinely concerned, may not be able to solve the problem, so he or she recommends any number of outpatient neurologists. If the neurologist can’t figure out the problem, they might recommend psychological counseling, physical therapy or an imaging center to receive a head scan. Each step is a different appointment, another day taken off from work, more co-payments, more travel and more paperwork.

“Traditional organization of healthcare delivery is organized around specialties and discreet services,” Porter said, and the patient is the Ping-Pong ball bouncing around to the different services. “The patient goes through this odyssey. …Each [specialty] is a separate visit that needs an appointment. …Each visit is a separate administrative action. Organization is at the core of the problem,” but so is the system’s current fee-for-service payment structure.

“The current system, as you know, has been dominated by [this] approach,” he said, noting a clear mismatch between fee-for-service and value for the patient. “Fee-for-service is a horrible way to get paid if what you really care about is value. …You get paid more if you do a lousy job and the patient has to come back, because you can charge again. There’s no way to create value doing it this way—it’s impossible.”

What’s worse, Porter explained, because doctors are working for volume, it’s often the case that physicians aren’t experts in any one area, because they focus so heavily on treating everything.

“Primary care physicians see all kinds of different patients,” Porter said. “A typical primary care doctor might have 2,000 different patients with every single problem on the face of the earth. That physician just can’t know everything, and just can’t be evenly interested in every possible disease. …We put our clinicians and our patients through this process where who they see is often a function of their specialty, who’s on the schedule and who has got a slot, as opposed to expertise in the patient’s particular problem.”

The result is a lot of educated guessing, physicians doing their best, referrals to different doctors and minimal answers. Here enters the Ping-Pong ball: you.

The Solution 

When moving to a high-value healthcare delivery system, Porter described six fundamental strategic transformations that have to happen in the following areas: organization, measured outcomes, bundled payments, integrated care, expansion of geographic reach and enabling IT platforms.

“Healthcare is unique,” Porter said. “Healthcare has been a fact-free zone. Nobody knows the outcomes. We know what the cost of the hospital is, we know what the cost of the system is, we know the cost of an office visit, but none of those are the relevant costs we need to understand in order to understand value.”

The relevant costs are the expenditures it takes to care for a patient with a given problem over the course of their disease.

“If we can look at the outcomes we achieve for that patient, and the total cost that we expended to achieve those outcomes, then we have the magic information that we need to know about value,” Porter said, careful to explain that cost of healthcare is different from the amount billed to the patient.

What does understanding the total cost of a condition mean in terms of value? “Bundled reimbursement is a single reimbursement for the whole process of care for a condition,” Porter said. An example of this was illustrated with the current structure for hip and knee replacement surgery. Porter said the bundled cost would fall under hip and knee pain, where joint replacement would just be one of the options for care under that condition. “Not a fee for each thing that happens to you, not a fee for each doctor that talks to you, but one fee for the whole process,” he said.

Integrated health centers would specialize in one condition—for example, migraines—and would bring doctors, clinicians, psychiatrists, physical therapists and surgeons who specialize in that condition under one roof. “Let’s get the talent we need to deal with [the problem] in a single unit,” Porter said, explaining that only then can doctors and clinicians truly communicate and collaborate to better serve the most important person—the patient.

The Results 

“Outcomes [in Germany, after switching to this model] improved dramatically, literally overnight,” Porter said. “Patients who visited this [migraine] center, their comments were things like, ‘Finally, someone understands my problem.’” Even better, visits and answers all come within the first visit, because every doctor is available on-site.

Cost for the patients, in the short run, went up because patients were paying for the total bundled payments up front for a one-day diagnosis, instead of over a six-month time frame with multiple doctors and visits. “It took only eight months for [the German] model to start becoming—not only much better in terms of outcome—but much more efficient. Today, the run rate is 20- to 25-percent cost reduction,” Porter said. How? One-day visits equal less administrative work and fewer repeat visits and days off from work—less wasted time.

“There is growing and overwhelming evidence that these things work and the impact is big,” Porter said, noting that an equivalent reduction in healthcare costs in the United States, today, would result in a national budget surplus.