Example of My Work

Health System Analysis Paper

 Richard Sabulsky_Immersion 3_Health System Analysis Paper.pdf

Immersion 3 Daily Reflections

            The Immersion three experience is an activity that I have looked forward to with great anticipation. As an MHA student, I valued this opportunity to participate in the exchange of ideas with current leaders of health systems endeavoring to serve the populations of patients throughout their communities. This Immersion has accomplished this by including a diverse group of health systems such as the following: Academic Medical Center, Federally Qualified Health Center, VA Medical Center, Public Safety net Hospital, Children’s Hospital, and Post-Acute Care Rehabilitation Center.

Day 1

Lennar Foundation Medical Center University of Miami

            Throughout day one of the Immersion, my classmates and I were able to have extensive discussions with leaders at the Lennar Foundation Medical Center. Three topics from today that captured my attention were the university’s collaboration with Walgreens to provide health services within the clinic retail space and the perioperative leadership’s team approach to leverage data to improve OR case capacity, and the patient care experience focus the includes the patient’s needs are “Top of Mind”.

            The University realized the need to extend primary care services out into the surrounding communities. In contrast to the strategy of other health systems which have adopted a “build it and they will come” approach to construct medical office space in the community, the UHealth leadership accepted a collaboration proposed by Walgreens that utilizes Nurse Practitioners and Physician Assistants to provide healthcare services within the clinic retail space at various Walgreens locations. The tag line for these services provided by the UHealth Advanced Practice Providers (APPs) is, “Convenient Care from Experts You Trust”.

            The perioperative team set a strategy to improve OR throughput by leveraging data from the electronic health record (EHR) and realigning team priorities. The team developed the infrastructure to harvest key data from the EHR that is displayed in dashboard to provide leaders with improved insights into metrics such as the following: on time first case start time, case cancellations, room turn-around time etc. In addition, the perioperative leadership team successfully realigned OR team priorities with a “safety first strategy.” Specifically, the perioperative team garnered support to improve OR throughput by breaking down staff resistance to proceeding with add-on cases or late-start cases by pointing out that the only reason to stop proceeding with surgical cases is when a safety concern is agreed to be present. If no patient safety concern is confirmed, then the case proceeds as the costs of underutilized OR capacity is expensive; and the margin of revenue associated with the case is positive even if over-time pay for the staff is necessary.

            Lastly, the focus and commitment of the leadership team at Lennar Foundation Medical Center to create a positive patient care experience within the organization by keeping the patient’s needs at “Top of Mind” was very evident. I believe that this simple reminder can serve staff well to remain vigilant in meeting and exceeding the expectations and needs of patients.

Day 2

Jessie Trice Community Health Center

            The day spent with the leaders and providers at the Jessie Trice Community Health Center (JTCHC) was very inspiring! This 501(C) (3) is a safety net for the community within Dade County Miami, Florida providing primary care, dental care, and behavioral health services to the members of their community.

            Health information technology (HIT) is integrated throughout the services that are provided to patients. In 2004, Jessie Trice selected Greenway Intergy as its electronic healthcare record (EHR). This product has proved to be strategically important to coordinate care, develop patient related outcome measures, and improve revenue cycle management for their organization. JTCHC has also integrated additional HIT to enhance the patient care experience by performing digital retinal imaging assessments for diabetic patients to detect for diabetic related retinopathy. These digital images are reviewed by ophthalmologists. Additional telehealth technologies are being utilized to support school-based nursing services and in-home visits.

             The center is also confronting the opioid abuse crisis throughout the neighborhoods that they serve with the evidence-based interventions offered at the Jefferson Reaves House which was established in 1987. The treatment programs focus on the following populations: women, pregnant women, and women with children up to the age of five.

             JTCHC also strives develop excellence throughout its staff with its ongoing work with The Studer Group. Adopted best practices includes specific techniques to retain and re-recruit high-performing employees; support and develop middle, solid performing employees; and improve or de-select underperforming employees.

            The incredible work being done in all areas of the organization has been recognized by the National Committee for Quality Assurance (NCQA), and many other federally qualified health centers benchmark their practices to the standards modeled at the Jessie Trice Community Health Center.

Day 3

Miami VA Healthcare System

            The Miami VA Healthcare System is serving the population of service men and women with many innovations that enhance the value and quality of care. The innovations that really impressed me included the telehealth technology, operating room technology, and the VA Nursing Academic Partnership (VANAP).

            The Miami VA Healthcare System utilizes telehealth through the following mechanisms: Home Telehealth, Clinical Video Telehealth, and VA Video Connect. The Home Telehealth is used in the care and management of chronic diseases such as diabetes and COPD. This technology is also incorporated into behavioral health counseling for Post Traumatic Stress Disorder (PTSD). Clinical Video Telehealth (CVT) is used to conduct video medical evaluations to make a diagnosis, manage care, perform check-ups, and actually provide patient care such are post-surgical follow-up evaluations. In July 2018 the VA also launched VA Video Connect to extend primary care access to veterans. Within the first five months, a total of 8,067 Veterans attended 24,752 VA Video Connect appointments with more than 2,100 VA care team members across the country.

            Operating room (OR) technology is being used to increase the efficiency of process throughput. Specifically, The OR staff members are able to use wireless remote technology to complete surgical safety checks such as the surgical time out and other process measures associated with the Surgical Care Improvement Project (SCIP).

            The VA Nursing Academic Partnership (VANAP) provides a nurse internship experience that is VA centric to achieve practice readiness for a career in nursing. The program initiated at the Miami VA Healthcare System has been recognized with a full five-year accreditation with the Commission Collegiate Nursing Education (CCNE).  The VANAP has experienced 100% retention of participants to select a nursing career in the VA health system, and the partnership is associated with $2.8 million cost-avoidance in recruitment and retention.

            At the conclusion of our time with the leaders at the Miami VA Healthcare System, I had a more comprehensive understanding of the expertise and breadth of health services that are provided to the population of patients who are the men and women who have served our nation.  

Day 4

Day four of the Immersion experience as split between the following two health systems: Jackson Memorial Health System and Nicklaus Children’s Hospital.

Jackson Memorial Health System



            Aside from the renowned trauma care services and neonatal intensive care unit services, I was particularly struck by this organization’s intentionality to strategically engage its workforce - which is diversely represented by union leadership - to begin their journey of changing the culture to support the organization’s strategy to improve its financial shortcomings. The Chief Operating Officer described the importance of starting that conversation with stakeholders from a position of trust and transparency that clearly laid out that the organization was not going to be solvent, and there was a serious real threat that no workers would have jobs if action was not taken to improve the financial situation of the health system. The vision campaign that emerged to garner the support of employees across all aspects of the organization included the following:

1. Navigating an Environment of Change

            -The Patient Experience: retail consumer model shifting to the healthcare                space

            -Execution of change management strategy is often thwarted by culture

            -Being an Academic Medical Center with high level clinical skills and

             outcomes is no longer the only criteria for success: Patient Experience!

2. Jackson Health: Focused on “The First Care Experience”

            -Voices of Care: patients describing their stories. These video stories were               shown to employees

            -Hands of care: Employees placed their hand prints on the initiatives that                  they valued

            -Collaboration with IT: “Care Badge” electronic recognition messaging                    for employees to send positive encouragement to a colleague. In first six                months, 17,000 Care Badge messages were sent.           

             This engagement with the culture if the organization has been created with creating the environment of support that was needed for the organization to make the necessary changes that returned the health system to stable financial footing.

Nicklaus Children’s Hospital

            At Nicklaus Children’s Hospital, I was particularly impressed with being able to tour their system’s telehealth delivery platform. The floor plan is laid out in small enclosed office spaces or pods. The provider’s (MD, NP, PA) desk contains three computer screens to display the patient’s EHR, live video, diagnostic imaging, lab results, and vital signs. Of particular interest to me was the hospital’s partnership with the area schools to be able to use telehealth in the schools to enhance school-based healthcare service in those schools that are without a school nurse. The GlobalMed Transportable Exam Station (TES) is the technology used to accomplish this type of video health assessment. The technology is portable enough to be enclosed within a hard-rolling suitcase as shown on the GlobalMed website:

            As simulated on the GlobalMed website, in-school telehealth evaluations can support a successful decision for the child to remain in class, or for treatment of the child’s illness to be initiated.

Day 5

Memorial Healthcare System

            On the final day of Immersion Three we visited the following two facilities that are part of the Memorial Healthcare System: Memorial Regional Hospital and Memorial Rehabilitation Institute.

            The leaders at Memorial Regional Hospital facilitated discussions around the following service lines within their organization: Cardiac and Vascular Center Institute, Emergency Medical Services, and Behavioral Health. While many topics were reviewed two strategies that target populations struggling with behavioral health and the opioid crisis were memorable for me.

            First, the Rebels Drop in Center provides mentoring to reduce emergency department utilization and hospitalization. The center has demonstrated outcomes such as 92% of its participants are not hospitalized within the first 90 days of starting to work with the center’s programs as surveyed with the Life Skills and Emotional Stability instrument. Program leaders attribute this to the social engagement that participants experience while active in the programs offered by the center.

            Second, the Mothers in Recovery Program was initiated by Memorial Regional Health System after it was noted in 2015 that 600 babies were born in Broward County with Neonatal Abstinence Syndrome (NAS) secondary to the opioid crisis. The program was undertaken to address the physical and psychological impacts related to addiction. This program is a collaboration that provides a continuum of care in cooperation with the following community partners: Susan B. Anthony Recovery Center and Memorial Outpatient Behavioral Health Center. The Mothers in Recovery Program has treated 119 women and demonstrated a cost avoidance over $1 million dollars to treat NAS.

            The final facility visited during the Immersion was Memorial Rehabilitation Institute. This institute has developed a comprehensive rehabilitation network that consists of personalized post-hospital care:

            -Post Acute Care Network

                        -Inpatient rehab

                        -Skilled Nursing and Rehab

                        -Home Health Skilled Nursing and Rehabilitation

                        -Outpatient Rehabilitation

            One of the successful innovations of the rehabilitation institute was to create a family training program which provides family members with the skills to safely perform lifts and transfers when attempting to assist a family member who is recovering from a traumatic brain injury or stroke. This Family in Training Program has demonstrated improved patient safety by decreasing the incidence of patient falls.

            In closing, this Immersion experience has provided an in depth view of the strategies that differing health systems have adopted to serve the populations of patients within their communities.