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Spring 2009

In this issue:

THIS SPRING IN MHA EDUCATION

Slowly but surely, spring seems to be arriving here in Massachusetts, and this spring and summer, MHA has many upcoming programs designed to help you and your hospital perform at peak levels, despite the economic downturn. Our programs are affordably priced and also offer great opportunities to network with statewide hospital personnel.

In this issue we have a couple of featured articles relating to HR and construction that we hope you'll find interesting. As always, we value your feedback and love to hear your ideas about programming that would meet your needs!

Sincerely,
Kirsten L. Singleton, Director
Eileen Velásquez, Events and Marketing Specialist
Mass. Hospital Association Center for Education & Professional Development

MHA'S ANNUAL MEETING JUNE 9-11, 2009 - CHATHAM, MA A CRITICAL TIME FOR MEMBERS TO GATHER

On June 9-11, 2009, MHA will hold its 73rd Annual Meeting in Chatham, Mass. This year's theme is "Navigating Stormy Seas." In the midst of the economic crisis, this is a critical time for members to come together and share news from the trenches. This year's program features sessions taught by national leaders, including Richard Umbdenstock, President and CEO of the American Hospital Association, who will hold a Town Hall meeting. We also have noted futurist, Jeff Goldsmith, coming to share the latest on healthcare's continuing transformation with a focus on health information technology and the financial support available to hospitals. To lighten up the mood, we will hear from the cartoon editor of the New Yorker, Bob Mankoff, who will talk about the role of humor in our society. We'll conclude with a special address by Major General David Rubenstein, FACHE, president of the American College of Healthcare Executives. He will talk about the growing needs of military veterans and how hospitals can be prepared to meet them. Aside from the great learning opportunities, the annual meeting provides a casual atmosphere to get away from the normal stresses and relax for a few days. We have an interesting urban a capella group, Ball in the House, to entertain you. We hope that you'll make room in your schedule for this event, and remember the cost is very low - just $229 ($199 for teams of three or more from a hospital). We can keep the costs down for members because of our generous sponsors: MHA Insurance Agency, Aramark, Barr & Barr, Inc., HBE, MorrisSwitzer Environments for Health, Ropes & Gray, Russell Reynolds Associates, Sodexo, TeamHealth, Witt/Kieffer

43rd ANNUAL HR/LABOR FORUM TO LOOK AT 4 GENERATIONS: HOW CAN HOSPITAL MANAGERS ENGAGE AND RETAIN THEIR DIVERSE STAFFS? MAY 8, 2009 - SHERATON HOTEL, FRAMINGHAM, MA

On May 8, MHA will hold our annual Human Resources/Labor Forum in Framingham. This year we're looking at retention and management issues through the generational lens. Our first keynoter, David Rowlee noted speaker with Morehead Associates, will take a sometimes humorous look at how generational issues can create unique but surmountable challenges. We'll then feature a panel made up of hospital executives and industry leaders looking at how management can manage the diverse workforce in the most effective ways. Our final keynote will feature Stacy Nelson, a master trainer with the Vitalsmarts organization (most noted for their "Crucial Conversations" series). Vitalsmarts has developed a new series on influence in the workplace and Stacy will show ways that managers can find the most effective techniques to motivate and engage their staff. We're grateful to our program sponsors: MHA Insurance Agency, Leaders for Today, MetLife and Ropes & Gray.

FEATURED HR ARTICLE:
WRITTEN BY JOSEPH GRENNY OF VITALSMARTS

Dear Crucial Skills,

What do you do about folks who absolutely refuse to take responsibility for their own behavior?

One of my colleagues frequently behaves disrespectfully and even aggressively toward others-including myself. A number of us have spoken with him about his behavior. At times he's defensive and denies the problem-but at other times he'll apologize then ask me or others to monitor his behavior for him. At the end of the conversation I have somehow become responsible for his future behavior.

How can I change this so that he is responsible for his own behavior and starts to make real changes?

Signed,
Not my job

Dear Not my job,

First, let me offer a note of encouragement.

In researching our latest book, Influencer: The Power to Change Anything, one of the most inspiring places we visited was an organization called Delancey Street. Delancey was founded thirty years ago by Mimi Silbert, a remarkable woman who has changed the lives of more than 15,000 graduates of her program. Mimi works exclusively with hardened felons and drug addicts and has a 91 percent success rate at helping them turn their lives around-forever. She gets no government funding and has no staff, no guards, and no locks. All she has is a remarkable influence strategy.

Now, here's why I bring up Mimi. She would tell you that the most powerful source of influence she taps is social influence-the peer pressure applied by the combined group of Delancey residents. She believes that people who behave badly typically do so because those around them allow and enable their bad behavior. And the reason people at Delancey change, is because everyone around them demands that they change.

When I hear questions like yours, it's hard for me not to remember Delancey. Mimi's philosophy makes me stop and wonder, "If someone is behaving so badly, in what way are those around them part of the problem?"

So-thank you for your question. Your question demonstrates your willingness to examine your own role in perpetuating your colleague's bad behavior. And since you asked, I'll offer two suggestions about how you can ensure you are part of the solution rather than part of the problem.

1) Hold the right conversation. It sounds like you have raised concerns about his bad behavior. What you haven't done is raised concerns about his failure to take responsibility. Whenever you walk away from a crucial confrontation feeling unresolved or suspecting things won't really change, you should take those feelings as a sign you didn't hold the right conversation. Your real issue is not his bad behavior; it's that you believe he isn't owning up to his commitment to change. That's a different conversation. It's a trust problem, not a behavior problem.

2) Move to Action. The goal of a crucial confrontation is not mere understanding, it is real change. That's what you were hoping for and didn't get. And part of the reason is that you failed to agree on consequences and boundaries. Whenever you're concerned about recidivism, you should deal with that question in your crucial confrontation. Let's say, for example, that your colleague shows acceptance of your concerns about his behavior. And even agrees to change. If, based on your past experience, you believe he may not change, it is your job at this point in the confrontation to raise this issue and agree on what will happen if he doesn't change.

For example, you may say, "I am hopeful about the commitment you're making. And yet I hope you'll understand that since we've discussed this before and it continued to happen I am nervous about your follow through. I would like to have an agreement with you about what I will do if the problem occurs again. Does that sound reasonable to you?"

If he consents, then you should propose something like, "I believe my next step should be to hand this over to HR or your supervisor. If it happens again I don't want to feel responsible to continue to have to deal with it. And I think you are in a position to make this stop forever, immediately. Do you agree? I'm trying to be clear that this is not my problem to own, and that since this is now a 'relationship' issue, I must discuss how the boundaries of our relationship will need to change if the problem isn't resolved."

Finally, I suggest you figuratively link arms with others. In the spirit of Delancey, if everyone demonstrates a resolve to not tolerate his behavior, he will either change or leave. That is how people work. No one can stand being in an environment where others neither allow nor enable his or her bad behavior. So once again I congratulate you for your willingness to examine your own role, and encourage you to spread the word to others. You have enormous power to influence change. Use it!

Joseph Grenny is an acclaimed keynote speaker and consultant who has designed and implemented major corporate change initiatives for the past 20 years. He is also a cofounder of Unitus, a nonprofit organization that helps the world's poor achieve economic self-reliance.

3RD ANNUAL HEALTHCARE CONSTRUCTION CONFERENCE: WHAT'S POSSIBLE IN THIS ECONOMIC CLIMATE? MAY 15, 2009 - WALTHAM, MA

Despite the economic crisis, most hospitals have projects in the pipeline that cannot be halted indefinitely. At this year's 3rd Annual Healthcare Construction Conference, we'll take a proactive look at how hospitals can get projects moving during these tough times. What are the best ways to tap into the opportunities opened by the new stimulus package? What new strategies will allow hospitals to advance the ball on construction plans? We'll hear from Dana Swenson, director of facilities, UMASS Memorial Health Care about what they are accomplishing, and also get the latest from facilities expert Paul Breslin of Noblis, and architect Kurk Rockstroh from Steffian Bradley on specific strategies for re-design in the downturn. We'll also share the latest from a recent MHA survey of our hospitals' pending projects. It's a full program with useful information for hospital facilities and financial folks. We're grateful to our program sponsors: Barr & Barr, Inc., The Construction Institute, MA Health & Educational Facilities Authority, VHB/Vanasse Hangen Brustlin, Inc., MorrisSwitzer~Environements for Health

FEATURED CONSTRUCTION ARTICLE:
Samaritan Medical Center Shares Lessons Learned During Expansion Project

Written by: Thomas Carman, President & CEO, Samaritan Medical Center, Watertown, New York
Submitted by MHA Signature Sponsor, HBE

Samaritan Medical Center, located in the city of Watertown, NY, is a 294 bed, full-service community hospital serving the needs of its local communities since 1881. In 2006, our future projections and strategic planning confirmed the hospital's need to expand its current facilities to meet the demand of our growing communities.

Like many hospitals embarking on an expansion, we engaged an architectural firm to prepare a Master Facilities Plan that would meet our program requirements while staying within our budgetary limits.

Lesson # 1. The current, most frequently utilized hospital design method forces the hospital to make key project assumptions about project cost. The decision to move forward with a hospital construction project many times is made without reliable cost information. In our case, cost estimates developed as part of our master plan led to assumptions which did not prove out after we had submitted a certificate of need application.

As we moved forward in the planning process, we became aware that our project was quickly growing in cost, and had expanded beyond our budgetary objectives. Our initial cost estimate for the parking garage portion of our project was $5.9 million. Yet, the final, low bid for the project was $7.6 million. When the bids for the parking structure came in over our initial projections we were alarmed by what we should expect for the other aspects of the project. We took some extra time to examine the projected costs of the 130,000 square foot patient pavilion portion of our plan. An estimated cost, provided by an estimating firm, indicated our Patient Pavilion project was $10 million over budget.

Lesson # 2. We learned the hard way that the cost of a hospital design is not necessarily the first priority of the firm doing our design work. In fact, our original design firm did not fulfill their responsibility to meet our project budget even though they were well aware of it. We, the hospital, were at risk in this process. Not our designer or our consultants. As we looked at the balance of our planned project we spent many long and hard hours attempting to identify how to meet the objective program we had identified. We could no longer move further down the design road without attention to the eventual project costs.

As it became clear that our efforts to "value engineer" our project were not going to deliver the programmatic outcomes we needed nor meet our budget, we considered our alternatives. One alternative would have been to engage a firm that would manage the process by stacking contingency upon contingency. This approach would have an end result of delivering the project "within budget." It was conveyed to me by an industry source that one hospital in our area chose this option and actually told a group of Construction Management Firms not to send in preliminary numbers that might be too low. They wanted to set their budgetary bar high enough to ensure they would stay within budget. While this approach may help to guarantee that a maximum price is not exceeded, it hardly assures a cost effective outcome. We eliminated this option as it would not deliver the best outcome for Samaritan Medical Center. It was at this point that we opened discussions with a hospital design-build organization that provided the hospital with a guaranteed cost that met our budget and included all of our programmatic requirements.

Lesson # 3. The architect's pen is as essential to controlling project cost as is the ordering pen of our medical staff. Several firms are noted for their ability to provide cost discipline in the hospital design and construction process. We asked firms specializing in hospital design and construction to evaluate our planned program and offer design solutions. Our Board Chairman John Wheeler put it this way, "As Trustees, we have a responsibility to our community to ensure completion of every phase of this much-needed project and to achieve all of the objectives in our Facility Master Plan." Some design firms have learned how to harness budgetary realities while producing cost efficient yet functional and attractive hospital buildings. Some design firms have not.

One firm, using a completely integrated approach, proposed a guaranteed cost of $51 million dollars for the parking garage and Patient Pavilion, which would then be constructed at the same time and within the hospital CON budget. Firms that will take this risk before working drawings are 85% complete do exist. When we reviewed the design-build solution for our master plan, a completely new and innovative design was prepared for us. This design incorporated all of the functional and programmatic elements that were included within the original hospital CON.

Some of the firms offering a design-build approach offer the benefit of a guaranteed cost for a project before the expense of Construction Drawings is incurred by the client. In our circumstance, working with a firm that provided this flexibility to us resulted in a successful financial and operational outcome for our expansion project.

Lesson # 4. While your architect may produce an impressive master plan, the ability to convert that master plan into a cost effective design utilizing best practice design should be considered. Measuring your original design solution against an alternative design with a guaranteed lump sum simply makes sense.

In the end, our decision to move away from the traditional Architect/Engineer/ Construction Manager approach and to engage a hospital design-build organization gave Samaritan Medical Center the benefit of a guaranteed cost within our original budget. Most importantly, all programmatic elements are addressed including the parking structure, a new Emergency Department, new Surgical Suites, new ICU/PCU, and private patient rooms on the Medical/Surgical unit. I am convinced that by challenging our original Master Plan design assumptions at Samaritan Medical Center, we were able to complete our Master Plan objectives within the available budget. In the Healthcare arena, there is a time and a place for a second opinion. We certainly benefited from one on our expansion project.

If you have any questions or suggestions for articles, please email Eileen Velásquez or call (781) 262-6059.

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