Health systems revamp vetting process during COVID-19
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • metro_pavilion_i.jpg
      MetroHealth to launch new surgical residency program this summer
      HCA launches joint venture to boost domestic PPE production
      Medicare ACO participants fell in 2021
      Lilly: Drug can prevent COVID-19 illness in nursing homes
    • HCA launches joint venture to boost domestic PPE production
      Lilly: Drug can prevent COVID-19 illness in nursing homes
      Mobile labs take vaccine studies to diverse neighborhoods
      Biden to sign virus measures, requires mask use to travel
    • Medicare ACO participants fell in 2021
      Louisiana gets reports vaccine providers are discriminating
      'We know this is real': New clinics aid virus 'long-haulers'
      The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
    • UnitedHealthcare operating earnings fall by $2 billion in Q4
      CMS approves rule forcing insurers to ease prior authorization
      COVID-19 still a big uncertainty for insurers in 2021
      Health insurers' outlook boosted after Dems' Georgia win
    • Biden signs executive orders to reverse, pause Trump-era rules
      CMS finalizes blood-based colon cancer screening coverage
      As virus surges, states reporting shortages of vaccine
      New CDC director takes over beleaguered agency amid crisis
    • Providers await new HHS coronavirus grant reporting deadline
      Operation Warp Speed Dr. Moncef Slaoui, Pfizer Group President Angela Hwang, Moderna CEO Stephane Bancel, CVS Health Executive Vice President Karen Lynch and McKesson CEO Brian Tyler participate in a panel discussion on the COVID-19 vaccine.
      Hospitals, drug companies strive to stand out virtually at JPM
      Intermountain, Trinity, Memorial Hermann behind $300M private equity fund
      Operation Warp Speed to bump up McKesson's stock price
    • A man in a room with servers.
      Momentum grows to outsource hospital tech functions in 2021
      5 things to know about Google's $2.1B Fitbit acquisition
      Providence bets on machine-learning, consolidating data centers
      Mental health treatment was most common telehealth service during COVID
    • Mobile labs take vaccine studies to diverse neighborhoods
      As virus surges, states reporting shortages of vaccine
      Sticking to Mediterranean diet is good for the brain
      Chance of COVID-19 triage care looms over Arizona hospitals
    • Elizabeth Richter will serve as acting CMS administrator
      Providence names new chief financial officer
      Wisconsin's top health official departing for federal job
      Cone Health CEO, CFO to depart amid pending Sentara merger
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
      Yale New Haven's COVID-19 nurse-staffing model has long-term benefits
    • Dr. James Hildreth
      How medical education can help fight racism
      Modern Healthcare InDepth: Breaking the bias that impedes better healthcare
      Videos: Healthcare industry executives describe their encounters with racism
      Michellene Davis
      Healthcare leadership lacks the racial diversity needed to reduce health disparities
      Hospital divided into multiple pieces
      Health systems may be warming to offshoring, a mainstay practice for insurers
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      self service station
      COVID-19 pushes patient expectations toward self-service
      Targeting high-risk cancer patients with genetics
      A nurse holds up a phone with a message to a family member saying surgery has started.
      Texting, tablets help hospitals keep family updated on patient care
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Highmark Health inks six-year cloud, tech deal with Google
      Study: 1 in 5 patients report discrimination when getting healthcare
      HHS proposes changing HIPAA privacy rules
      Android health records app launches at 230 health systems
    • California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
      Healthcare was the hardest hit by supply shortages across all U.S. industries
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      New care model helps primary-care practices treat obesity
      How hospitals are building on COVID-19 telehealth momentum
      Researchers: Hospital price variation exacerbates health inequities
    • MedPAC votes to boost hospital payments, freeze or cut other providers
      Most Next Gen ACOs achieved bonuses in 2019
      Congress recalibrates Medicare Physician Fee Schedule after lobbying
      CMS approves rule to encourage value-based drug pricing
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
      Dr. Bruce Siegel
      Why taking a hospital not-for-profit was Dr. Bruce Siegel’s boldest move
    • Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
      Mark C. Clement and David Cook
      We all need to 'do something' to fight inequities and get healthcare right, for every patient, every time
    • Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
      Healing healthcare: some ideas for triage by the new Congress, administration
      Dr. Sachin H. Jain
      Medicare for All? The better route to universal coverage would be Medicare Advantage for All
      Connectivity: a social determinant of health that can exacerbate all the others
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - Health Care Hall of Fame
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Social Determinants of Health Symposium
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala (2022)
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
      Next Up Podcast: COVID-19, social determinants highlight health inequities — what next?
      Ceci Connolly
      Next Up Podcast: How to navigate the murky post-election waters
      Next Up Podcast: Saving Rural Health
    • An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
      doctor burnout
      Beyond the Byline: How healthcare supply chain struggles contribute to employee burnout
      Beyond the Byline: Covering race and diversity in the healthcare industry
      Beyond the Byline: How telehealth utilization has impacted investor-owned company earnings
    • Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Chip Kahn
      The Check Up: Chip Kahn of the Federation of American Hospitals
      The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      The Check Up: Dr. Kenneth Davis
      The Check Up: Dr. Kenneth Davis of Mount Sinai Health System
      The Check Up: Dr. Thomas McGinn
      The Check Up: Dr. Thomas McGinn of CommonSpirit Health
    • Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Governance
January 09, 2021 01:00 AM

Health systems revamp vetting process during COVID-19

Pandemic adds speed, focus to decision-making

Alex Kacik
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    Modern Healthcare Illustration / Getty Images

    Ideas that used to take up to eight months for Mayo Clinic to vet are now ready to execute in less than two weeks.

    The COVID-19 pandemic has accelerated a push to streamline decision-making at Mayo, a move that will permanently shape its governance model. Healthcare organizations across the country are making similar adjustments as they aim to improve long-standing and potentially obsolete oversight policies.

    “Are we going to consistently get to the execution stage in 12 days? Maybe not, but now we have the mechanisms to track how long the process is taking and identify the barriers to moving more quickly,” said Roshanak Didehban, Mayo’s chair of practice administration. “I don’t think we can under-recognize the gravitational pull back to the way we used to be. But now we have a systemic approach to get work done quicker.”

    Some hospital systems have restructured to be more responsive and flexible, mirroring other U.S. industries. Yet, that change has been slower or nonexistent in certain healthcare institutions given the concern that the heavily regulated industry requires a more deliberate and methodical approach. 

    Typically, ideas need to go through a myriad of finance, legal, quality and information technology committees that only meet monthly, dragging out the process. But the pandemic has shown many systems that efficient decision-making doesn’t always mean sacrificing quality and safety. 

    “If you have an organizational structure that likes to vet and evaluate practically every position even when it’s not needed, that’s often what took place. People didn’t have that luxury during the pandemic,” said Greg Eli, shareholder at consultancy LBMC.

    “There’s been a realization among not-for-profit, for-profit and investor-owned systems that you don’t need the same level of formality or as much involvement to make decisions effectively. I think we’ll see the pendulum swinging back somewhat, but it won’t swing back to where it was pre-pandemic.”

    Mayo Clinic

    "As an industry, we have to take a step back and realize how quickly we can pivot and meet the needs of our patients more effectively and efficiently. It is incumbent upon all of us as healthcare leaders to stay true to the lessons we have learned."

    Roshanak Didehban, Mayo Clinic’s chair of practice administration

    Time is of the essence

    Prior to the pandemic, Mayo would have to get the green light from up to 12 separate committees and departments to implement an idea.

    While the Rochester, Minn.-based system set out to change that dynamic before disaster struck in March, the pandemic kick-started that effort.

    COVID-19 revealed how clarity of focus expedited decisions, said Didehban, who serves alongside Dr. Amy Williams, executive dean of practice, in Mayo’s dyad leadership model. Keeping staff, patients and the community safe was of utmost importance, she said.

    Mayo consolidated its separate committees into a single multidisciplinary team that operated on an hourly rather than monthly basis. It also delegated decision-making authority to lower levels of the corporate hierarchy and did away with the approval-to-initiate step, Didehban said, describing it as “approval to think about an idea.”

    “We noticed this transformation in April and how powerful it was,” she said.

    There are two types of governance, one that involves systemic changes in the bylaws and require the board’s guidance, and smaller, day-to-day operational changes, explained Victor Giovanetti, executive vice president of hospital operations at LifePoint Health.

    For the former, the Brentwood, Tenn.-based system learned that they could still act quickly and maintain compliance, he said. “At times we got some relief from state and federal waivers, but overall the big governance decisions were easier to manage,” Giovanetti said. “We learned we could do the day-to-day governance and decision-making faster and with more decentralization, while still operating within the guardrails of our bylaws.”

    Giovanetti headed up a COVID-19 task force comprising the various departments of the system. Under normal circumstances, it could take a month to secure more ventilators. In March and April, it only took a matter of hours, he said.

    But, Giovanetti cautioned, there are certain matters they would not want to move quickly through after the national emergency subsides.

    “Drug utilization and purchasing are things that need to have the level of filtration to meet our national quality program,” he said. “While we moved quicker around remdesivir and other therapies with the support of the government, under normal operations they would go through more of a filtering process.”

    Still, not all healthcare organizations have streamlined their deliberation process, said Paul Keckley, an industry consultant.

    “The existing committee structures have actually continued. If anything, outside of compensation, they’ve defaulted more to management on key issues around COVID,” he said, adding that is the case for larger health systems but things could be different at stand-alone hospitals.

    How COVID-19 has shaped governance

    Before:

    • Multiple committees vet idea
    • Monthly committee meetings
    • Steps like “approval to initiate”
    • Executives hold ultimate decision-making authority
    • A lack of focus 

    After:

    • Consolidated committees
    • Committees meet more frequently 
    • Fewer steps to approval
    • Decision-making authority delegated to managers/staff
    • Patient care/staff safety are the primary concerns

    Source: Modern Healthcare reporting

    Outlook

    Some healthcare organizations are bound to emerge from the pandemic with a revamped decision-making process. Industry observers are hopeful that the momentum will produce more efficient and effective systems.

    Many providers have put together executive committees or task forces that essentially act as a board between regularly scheduled meetings. But those have already lost some luster, said Bill Horton, a partner at Jones Walker. And some organizations are reverting to their traditional structures.

    “They have started to fall out of favor to some degree because they are not inclusive of the entire board,” he said. “Still, there is recognition that there are means where boards can assemble quickly to handle discreet matters and still preserve a genuine opportunity to deliberate.”

    The makeup of those boards has been questioned due to COVID-19, Horton and other experts said. Smaller not-for-profit hospital boards are typically community leaders who may not have much healthcare experience.

    “The composition of these boards doesn’t fit the current needs of healthcare, particularly during a pandemic,” said Lyndean Brick, CEO of the consultancy Advis. “When there is an opening for a new board member, we need to ask ourselves what we need and what is the role of a community board member.”

    Those smaller organizations were often slower to react, LBMC’s Eli said.

    “In healthcare you have the ‘haves’ and the ‘have-nots’—the pandemic has only widened the gap between the two,” he said.

    Some of the waivers implemented during the national emergency will be unwound, and leaders will need an informed and knowledgeable board to guide them, Horton said.

    “That could be troublesome from a reimbursement and fraud and abuse standpoint,” he said. “The more enlightened boards will see what has worked and what hasn’t and try to be more proactive. If nothing else, boards will be in a position to think about contingency governance plans.”

    As for Mayo, there is always the risk of reverting to the mindset of, “this is how we have always done it,” Didehban said. But it’s promising that Didehban and her peers are constantly asking, “why?”

    “As an industry, we have to take a step back and realize how quickly we can pivot and meet the needs of our patients more effectively and efficiently,” she said. “It is incumbent upon all of us as healthcare leaders to stay true to the lessons we have learned.”

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Top Beaumont Health cardiologist makes case to oust CEO, other leaders
    Top Beaumont Health cardiologist makes case to oust CEO, other leaders
    Nurses share in pandemic decisionmaking process through professional governance
    Nurses share in pandemic decisionmaking process through professional governance
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
        • Social Determinants of Health Symposium
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala (2022)
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing