As far as healthcare's leading professional organizations are concerned, there's a giant fly in the alphabet soup of healthcare associations.
Six healthcare associations well known by their acronyms are lining up against a newcomer, the National Center for Healthcare Leadership, which is backed by some leading healthcare system executives, including Gail Warden, president and chief executive officer of Henry Ford Health System, Detroit, and Gary Mecklenburg, president and CEO of Northwestern Memorial HealthCare, Chicago, and immediate past chairman of the American Hospital Association.
The NCHL aims to transform the way healthcare executives are trained-from graduate school programs to midcareer development classes to advanced-level courses designed to turn out healthcare CEOs ready to do battle with health plans, fight for quality improvements and lead hospitals and healthcare systems to financial stability.
The NCHL's critics, which include the American College of Healthcare Executives, the Healthcare Financial Management Association, the Healthcare Information and Management Systems Society and the Medical Group Management Association and some prominent healthcare management educators, say the new organization's goal-to better align healthcare management education with the needs of the field-is a good one. But, they say, they can do that just fine, and another group would duplicate their efforts and shatter the chance of reaching a consensus on the best way to train future healthcare leaders.
Some also are questioning who the NCHL's real beneficiaries are: future healthcare leaders, or high-level executives in the fall of their careers who need a place to land as staff members, board members or instructors after retirement.
Warden is the NCHL's chairman and CEO. He recently announced his retirement from Henry Ford, tentatively set for 2003 or 2004. The five-hospital system lost $110 million on operations and $88 million net in 2001, according to unaudited financial results released earlier this month. The losses, on total revenue of $2.45 billion, drew a downgrade from Standard & Poor's, which dropped its rating on Henry Ford's debt by two notches to A- from A+.
Warden and Mecklenburg are two of eight members of the NCHL's board (See box, p. 7)
In an interview with Modern Healthcare last week, Warden said, "Nobody said that I'm going to go run (the center) when I retire, and we don't have a date for when I'm going to retire. People are just trying to make up a story."
Mecklenburg said the controversy is overshadowing the leadership problem.
"I think what is important is that a number of organizations have come together around the issue of leadership in healthcare," Mecklenburg told Modern Healthcare last week. "There have been foundations that have agreed with the approach to that issue and have been willing to fund it."
A shotgun wedding
The NCHL was founded last November and is based in Chicago (Feb. 4, p. 20). The Internal Revenue Service has given a preliminary approval to the group to be a tax-exempt public charity under Section 501(c)(3) of the Internal Revenue Code.
The NCHL is the product of a 2-year-old marriage of convenience between select industry executives and academia. In 2000, the Healthcare Research and Development Institute, a private, for-profit organization whose members are executives of some of the largest healthcare systems in the country, submitted a proposal on management training to the Robert Wood Johnson Foundation, the $8.8 billion healthcare philanthropic organization based in Princeton, N.J. Modern Healthcare is one of 48 clients of Pensacola, Fla.-based HRDI.
The HRDI wanted to start an advanced institute to turn today's senior-level executives into tomorrow's big-system CEOs-a healthcare "war college" of sorts, said William Jessee, M.D., the MGMA's president and CEO.
Separately, the Association of University Programs in Health Administration and the Accrediting Commission for Education in Health Services Administration had submitted a joint proposal to Robert Wood Johnson to better link management education to the provider community and ensure that training is based on measurable performance outcomes, Jessee said.
Robert Wood Johnson officials suggested that the two groups work together, and it eventually approved a $200,000 grant that led to the National Summit on the Future of Education and Practice in Health Management and Policy, which was held in Orlando, Fla., in February 2001, said Jessee, who served on the grant's steering committee.
"The opinion at the summit was, `No, we don't need a new organization, we need to focus existing organizations on the problem,' " Jessee said.
Coincidentally, the furor over the NCHL comes at a time when hospital CEO turnover is at a seven-year low (See story, this page).
Stephen Loebs, who was chairman of the summit and is a strong supporter of the NCHL, agreed that there was no discussion about starting a new organization at the time. But, "there was a consensus that there needed to be a transformation of the field, and a stronger partnership between academia and the field," said Loebs, who for 20 years has been chairman of the health management graduate program at Ohio State University, Columbus.
Warden said a follow-up meeting in March 2001 with a smaller group of summit participants cemented the work done at the summit and led to the idea to create a new organization. Marie Sinioris, the NCHL's chief operating officer, said that all through summer and fall of 2001, there were at least 20 conference calls with the March group to discuss the issue before the grant proposal to fund the NCHL was made to Robert Wood Johnson in November 2001.
The proposal was sponsored by the HRDI and the two academic associations, and in March, Robert Wood Johnson awarded the center a $479,600 grant for one year to go along with a seven-month, $113,000 grant from the W.K. Kellogg Foundation for a total of nearly $600,000.
Jessee contended that the summit was just a way to put a veneer of collaboration on the plans the three sponsors-the HRDI, the AUPHA and the ACEHSA-already had made.
"One of my colleagues characterized it as like a union meeting, where the union leadership tells you from the platform what they've already decided, and whether the membership wants to vote on it doesn't matter," Jessee said. "It's sort of emerged as a fairly heavy-handed effort to set itself up as an entity to determine what healthcare management education will look like at every level ... without having much of a constituency base supporting it."
Jessee wrote at least two letters criticizing the proposal to form the NCHL in the name of the Healthcare Leadership Alliance. The alliance includes the six professional associations-the ACHE, the HFMA, HIMSS, the MGMA, the American College of Physician Executives and the American Organization of Nurse Executives. The AONE is a subsidiary of the AHA. One letter was sent to Rosemary Gibson, senior program officer for the Robert Wood Johnson Foundation, in November 2001, and the other was sent to Warden after a meeting in Chicago in January that included representatives of the alliance and the NCHL.
In the letter to Gibson, Jessee said a new organization with a broad mandate would be counterproductive.
"There is no need to `reinvent the wheel,' as (the) NCHL proposes," Jessee wrote, saying that the established professional organizations could best handle the issue. Jessee told Warden in the other letter that the NCHL's workplan caused the chiefs of the six main professional organizations "grave concerns" about duplication and could lead to less cooperation among all the interested associations and providers, rather than more.
Thomas Dolan, the ACHE's president and CEO, said he has concerns but on the whole he supports the center.
"I want to do what we can to improve the field, but again, it's important that we get all of the players together and get a consensus about how to do that," he said. "We're not threatened by it. We'd like to find a way to work with them, and we'll go from there."
Gary Filerman called the NCHL's creation "presumptuous" and "extremely divisive."
Filerman was the president of the AUPHA for 28 years and he served on the Pew Commission on the Future of the Health Professions. He is a professor and director of the health systems program in the School of Nursing and Health Studies at Georgetown University.
"They just believe that they know how to do it better," Filerman said of the NCHL's organizers. "Their basic attitude is, `If we don't do it, it's not good.' "
Jeptha Dalston, president and CEO of the AUPHA, is a member of the NCHL's board. David Fine, also an NCHL board member, is chairman of the AUPHA. Fine, CEO of the University of Alabama at Birmingham Health System, said the closer relationship and improved dialogue between educators and providers was long overdue.
Sinioris: NCHL no threat
Sinioris said she can't see how critics can maintain the NCHL's executive backers are arrogant and heavy-handed with all the time that was spent discussing the problem of healthcare leadership and developing the proposal, not to mention the support of the two academic groups.
"Our bylaws are very clear, and they were modified to make it clear that we are not going to supplant any other organizations. We are not going to be duplicating the work of these organizations," Sinioris said. "For them to get on board, (the professional associations will have) to believe what they read and get involved. We've offered them board seats, we've offered them seats on our councils. I don't know what more we could do. Walk the talk."
Critics noted, too, that Warden also is a member of the Robert Wood Johnson board. He is also chairman of the HRDI.
Paul Tarini, a foundation spokesman, said the NCHL's grant request was handled by staff members, not the board. The grant amount was not sufficient to require a board vote, Tarini said.
Warden added, "I did nothing to influence the decision of the staff. I'm on other boards that get grants from the (foundation). I don't see it as a conflict, and I don't think the (foundation) sees it as a conflict. If they did, they would ask me to recuse myself."
Duplication of diversity
Filerman, the former AUPHA president, also cited the NCHL's stated goal of increasing racial, ethnic and gender diversity in healthcare management.
"Nobody bothered to ask the Institute for Diversity in Health Management about that," he said. "If the same resources were made available to the (institute) as are going to be tapped off by the center, one might argue that the (institute) would do a much better job than the center, which has absolutely no competency to do what it purports to undertake in diversity."
In an April 16 interview, Rupert Evans, president and CEO of the institute, said he had been trying to arrange a meeting with Sinioris, the center's COO, but the parties hadn't been able to schedule one yet. The institute is sponsored by the AHA; the ACHE; the Catholic Health Association; the National Association of Health Services Executives, which is a group for African-American executives; and the Association of Hispanic Healthcare Executives.
Evans said he spoke with Warden at the recent AHA conference in Washington, and, according to Evans, Warden said he wanted to bring the institute into the discussions at some point.
"That's kind of putting the cart in front of the horse, but that's OK," said Evans, who added that he's concerned that the center's efforts will duplicate his organization's and will compete for foundation funding with it.
Evans and Sinioris met on April 26. Of the NCHL's plans, Evans said after the meeting, "It sounds reasonable, but the proof is in the pudding. We'll have to see what the next step will be."
Sinioris said she doesn't believe the center will crowd out the diversity institute. "We hope that they will be actively engaged with our council (a standing committee) on diversity," Sinioris said, adding that there will also be a council for women and that the effort will extend to increasing diversity on the education side, too. "Again, we're looking more broadly than any one of these organizations," she said.
Replacing talk with action
In their letters, Jessee and Filerman both asked Warden to slow the progress of the NCHL so that a better consensus could be reached on what needed to be done.
But the sponsoring groups had to act, Fine said.
"I think that the established entities in the field, (with) their established governance and membership circumstances, and their own domestic politics, probably could have still been talking about the need to get started five years from now," Fine said.