The landscape of healthcare continues to rapidly change and in many cases there is no clear-cut direction of what changes to expect or the best way for those in the industry to prepare. Improving the delivery of healthcare is Nueterra’s core mission, and during times of great change the company understands the importance of solidifying the company’s vision so that it’s easier to determine necessary changes moving forward.

The ultimate goal in any company’s analysis is to determine how a company wants to be viewed by its customers internally and externally. This becomes even more important when a company is on a path of transition. The process often begins with evaluating the company’s mission and the purpose of why the company exists. This helps decide behaviorally how the company will accomplish goals such as providing higher-quality care, better patient outcomes, lower healthcare costs and more access for patients.

Companies who strive to make these changes must also consider the needs and expectations of the staff at both the senior leadership level and with front-line employees. Unity between these two groups is especially important because it’s necessary to define the company in a way that meets the needs of both groups. There is often a difference in perception so it’s important to provide everyone in the organization with a clear concept of where the company is heading and each individual’s role in the projected outcome.

To make the transition successful, create a road map that clearly defines where the company stands today and where it desires to go in the future. This process should also include an assessment of the company’s culture. Ask staff members to define the company currently and inquire how to best achieve the forward momentum desired by the company.

One way to structure this transition is through the acronym SERVE, as profiled in the book “The Secret: What Great Leaders Know — and Do” by Ken Miller and Mark Blanchard.

S – Seeing and shaping the future

E – Engaging and developing others

R – Reinventing continuously

V – Valuing results and relationships

E – Embodying the values

Through listening and placing the SERVE acronym into action it becomes easier to establish a vision among the senior leadership, middle managers and all of those who lead within the organization. With the establishment of clear goals and processes it’s easier to create an ultimate vision for the organization that will benefit staff and internal and external customers today and in the future.

Nikki Johnson
Vice President, Human Resources
Nueterra

Much like a broken down car, a breakdown in communication will get you no farther down the road of business or life. I love the words of Lee Iacocca who said, “You can have brilliant ideas, but if you can’t get them across, your ideas won’t get you anywhere.” So, with communication being such an important topic, why is effective communication in the corporate environment so challenging to sustain when moving forward?

One reason is that we often assume that our messages are fully understood by those on the receiving end of our communication. I resonate with George Bernard Shaw who said “The single biggest problem in communication is the illusion that it has taken place.” This can happen when communication is delivered in a style or manner that isn’t easy to understand (i.e. too complex). This little assumption is often at the root of many breakdowns in communication, which illustrate just how difficult effective communication can really be.

Because communication is a two-way street and multi-directional in nature, we must continually verify if what others are seeing and hearing is really the message we intended for them to hear. From the listener’s perspective, it can be helpful to paraphrase during the course of the conversation and ask questions such as, “I heard you say ____, am I hearing you correctly?”

While there are benefits and drawbacks to every form of communication, as leaders in our organizations we need to understand that there are a variety of mediums at our disposal, and each medium is effective when used appropriately given the context and the message being communicated. Let’s not forget that the medium chosen for the communication will directly influence how the message is perceived.

A communication medium like email allows the sender and receiver to correspond at different times, which works well if team members are not in the same geographic location. Face-to-face conversations can be so much richer because the communication is happening in real time, feedback is immediate and there is potential for a true dialogue and exchange of ideas. In situations that are highly sensitive, personal or controversial, messages are best delivered face-to-face. This allows for the inclusion of nonverbal feedback that shows up as body language and facial expressions.

Using the right communication medium and not blindly assuming that we’re understood when we communicate can help ensure that we communicate effectively. If you want to practice communicating effectively with others, remember the simple advice from music theorist and composer John Cage who said “Begin anywhere.” My experience with “Fierce Conversations” has taught me to begin anywhere by taking it “one conversation at a time.”

Travis Tasset

Vice President, Organizational Development

Nueterra

The Boston Marathon is one of the oldest marathons in the United States. It dates back more than 100 years and is set in one of our most historic cities. Marathons are intense events that require months of training and preparation. Running 26.2 miles requires mental and physical preparation and reflects human triumph and determination.

Unfortunately, the 2013 Boston Marathon did not end how anyone envisioned. As the number of injured and hospitalized continues to rise, the many individuals and families affected by the tragedy are in my thoughts and prayers. What should have been a celebration and a culmination of training and preparation is a devastating reality for those with family and friends whose lives are altered because of the attack.

Truly this event was horrible and despicable, one which I do not discount the severity. We all want justice for the responsible party or parties to be caught and put on trial for the actions. But I also want recovery for the injured, healing for the hurting and safety for our country.

Now more than ever the 2013 Boston Marathon represents the human triumph and determination —demonstrated in the selfless acts of the many individuals who aided strangers and the determination of first responders to advance through such uncertainty.

I believe people enter into professions to make a difference, and we have witnessed  many professionals rise to the challenge this week.  Thank you to all those who provided care to the injured and hurting, and thank you to the first responders for your selfless acts. Thank you to the countless people who assisted in these events.

Dan Tasset

Chairman

Nueterra

Two years after the passing of the Patient Protection and Affordable Care Act (PPACA), questions about accountable care associations (ACO) remain. Many administrators of ambulatory surgery centers (ASC) question where their facility lies in the current ACO model, especially since implementation of an ACO is not mandatory at this time.

The ACO concept, created to improve patient outcomes, increase the quality of healthcare services and reduce healthcare costs, is something most ASC administrators already strive to do on an everyday basis. This includes improving clinical outcomes within the facility and bettering the patient experience through efficiencies and lower costs. I believe that most administrators would argue that physician-owned ASCs are some of the most efficient at doing these things and that the efficiency and quality of care then translates into happier patients.

At this time there’s unfortunately no clear-cut answer for administrators regarding the next ACO mandate, but I think it’s advantageous for ASCs to begin moving toward the ACO model through the implementation of things such as electronic medical records and alignment with a “pay for value” system.  Begin by understanding and lowering your costs where possible, and also collecting outcomes/quality data where possible. These two pieces alone could highlight a clear advantage for you over your competitor.

David Ayers

CEO, U.S. Operations

Nueterra

Creating a Forecast

Changes in the healthcare industry including accountable care organizations and decreasing reimbursements make it a good idea to continually look for ways to make your ambulatory surgery center or hospital more agile. One way to add flexibility is through the addition of a new specialty at your facility.

Begin the process with information that’s readily available. Verify those doctors who consistently bring well-paying cases to the facility; then determine if there are any complementary procedures that could enhance your facility’s current offerings. If a specialty is new to the facility, be sure to assess current contracts.  If the procedure is not covered or wasn’t negotiated to the benefit of the facility, then the contract(s) might require renegotiation.

Once a service line offering is identified, involve the right people in order to make the process beneficial. Talk to the facility administrator or business office manager about staffing and current contracts and reimbursements, and ask an administrator or sales director to confirm case volumes. The director of nursing can verify the facilities clinical staffing needs, and the materials manager can determine the costs for equipment and procurement of supplies.

A thorough forecast can be a great way to determine if a new service line extension is the right choice for the facility, its staff, physicians and patients.

Kalin Mieras

Director, Financial Planning & Analysis

Nueterra

One of my roles within Nueterra is as a facilitator for our Leadership Development Institutes (LDIs). In this position I am constantly on the lookout for content and curriculum that meets our training needs. Last summer a series of serendipitous events led me to discover the work of Susan Scott at Fierce, Inc., and their two-day Fierce Conversations workshops.

Fierce Conversations are based on the idea that each of us is engaged in many conversations throughout the day, at home and at work. Some of these are “good” conversations while others are interactions we would probably rather forget. In retrospect we might discover that many of the conversations we look back on as “good” conversations are actually the ones where we consciously or unconsciously pushed the boundary of what we would consider to be a “comfortable” conversation.

If we choose to avoid the discomfort in a conversation there is a distinct possibility the things that need to be said will be buried for the time, which can result in misunderstandings and tension between individuals. Continued tension can affect how we see ourselves and also how we work and deal with others. I believe that the Fierce Conversation method is so effective because of its simple elegance to challenge the traditional way of doing things.

The Fierce Conversations models are built on a foundation of three transformational ideas, four objectives and seven principles — all designed to help their users create actions to live “Fierce” in the world. The four Fierce Conversation models are the Team model, Coaching model, Delegation model and the Confrontation model.

I think implementing Fierce Conversations in the workplace can be beneficial because of the prescriptive nature of the models. They explain exactly what do to and how to do it. I found the Fierce Conversations training helped me create an intellectual and emotional context around conversations as a leverage point to achieving success at work and in my personal life. Every day each of us are engaged in conversations on a regular basis and with each conversation we each have the opportunity and ability to create more effective communication both at home and at work “one conversation at a time.”

Travis Tasset

Vice President, Organizational Development

Nueterra

In 1997 Nueterra was founded with a focus on physician partnerships to build ambulatory surgery centers (ASCs). At this time the company was known as the ASC Group. After many years spent perfecting the ASC/physician management model, the company (now named Nueterra) turned its focus to include hospitals. Whether working with ASCs or hospitals, Nueterra’s primary goal is to be the best partner by providing minority ownership and management services.

In order be an influencer and provide great experience to our partners, it’s critical that Nueterra’s staff employ active listening and problem solving skills, and in age of immense technological advancement the best communication remains face-to-face. This communication forum allows our partners an opportunity to voice their wants and needs, and by facilitating this process all of Nueterra’s partners and staff can institute methods to improve and grow.

Once needs and wants are established, then strategic planning can begin. Strategic planning is often defined as an organization’s process for defining the company’s strategy or direction. This process can also include making decisions on how to best allocate resources in order to pursue the strategy.

Key Strategic Planning Questions:

• What do we do?
• Who is the target for our work?
• How do we excel?

Unfortunately there is never just one answer to these strategic planning questions and as a company grows and evolves so does its focus. Therefore it’s critical to check back often with both employees and partners to see how the company’s focus has changed and then align those current initiatives with the overall strategic planning.

Gordon Docking
Senior Vice President of Operations
Nueterra

In 2010 Nueterra embarked on a mission to propel healthcare forward on a global basis by employing its successful domestic healthcare management model internationally. Today the company works with physicians, healthcare systems and patients throughout the world to offer beneficial healthcare opportunities. As a global company, Nueterra’s diverse portfolio allows the company and its healthcare partners numerous opportunities to work in areas of the world where individuals are enjoying economic growth, more disposable income and an increasing desire for U.S.-influenced healthcare.

The regions of Latin American and the Caribbean are significant examples of a population with a growing desire for quality, U.S.-influenced healthcare. Forecasts in these areas of the world predict growth, especially among those individuals age 60 and older. These changes demonstrate a significant need for more healthcare facilities and hospital beds in the region. In fact, the United Nations predicts growth in this 60+ age group in the Latin America and Caribbean region to increase from 40.7 million to 70.6 million in the next 15 years, a change of nearly 75%.

• Caribbean – Up 52%, from 5.1 million and 12% of the population in 2010 to 7.8 million and 16.7% in 2025
• Central America – Up 77%, from 13.5 million and 9% of the population to 24 million and 13.5%
• South America – Up 72%, from 40.4 million and 10.3% of the population to 69.4 million and 15.6%

To accomplish this endeavor by positively influencing millions of patient lives throughout the world it is important to create partnerships dependent on proper due diligence including, but not limited to, financial stability of the country, its laws, foreign investments, securities and exchange regulations. It’s also critical to understand and meet the cultural needs and expectations of all of our international partners in order to effectively communicate the alignment of goals and discuss difficult issues directly with a spirit of transparency.

Tammy Duckworth-Ham
President, Latin American Caribbean region
Nueterra

As the holiday season winds down, it’s important to take time to reflect on the past year and make time to look forward to the New Year in order to determine how to create the next 12 months. This past December, during the swing of holiday season, Nueterra’s home office employees spent the month focusing on one of our core values – generosity.

Typically when we think of generosity or when we think of someone being generous, we usually do so in terms of financial generosity. For example, we recognize people as generous when they pick up the lunch tab or they donate money to a local charity. Certainly people are being generous when they do such things out of kindness and not out of a feeling of obligation.  At the same time it is worth noting that our finances are just one of many resources where generosity can be applied.

At Nueterra, we strive to live and embody the value of generosity by being generous with our resources and time, which means being liberal in our giving and sharing. In fact, generosity can be an incredible vehicle for propelling our best intentions into existence in the world. We are proud to support philanthropic activities at the local, national and even global level. In addition to financial generosity or financial giving, the associates at our home office and external facilities are generous with their time through volunteering for these philanthropic activities.

Thankfully, generosity is not limited solely to financial giving and sharing. There are many other ways we can be generous such as by sharing our knowledge with others and by giving of ourselves. I believe one of the greatest gifts we can share with another person is the gift of providing our attention and presence. In our attention-deficit and attention-starved world this is no easy task. Attention is truly a scarce commodity in times like these. Whether we are at work or at home, in a meeting or at the dinner table, with friends or family or even coworkers, there are multiple opportunities to give our full attention and presence to those we are with at that moment.

I think Ralph Waldo Emerson said it best, “The only true gift is a portion of yourself.” As 2013 unfolds, please don’t deny others the gift that only you can give them— you.

The question I would like to leave you with is: At work and at home, who is in most need of and would benefit the most from your full attention and presence and how can you make that a reality? And by when will you give it?

A significant amount of leadership information focuses on coaching employees who are low-performing with an overall goal to improve employee performance and attitude. But with all of this energy devoted to low-performing employees, what happens to the consistently high-performing employees, those who look for opportunities to excel personally and professionally? Oftentimes, these high-performing employees are left to their own devices to figure out how to create their own opportunities for education and advancement. While many leaders would greatly welcome the chance to focus on what’s right as opposed to what’s wrong, this change in the mindset of many leaders can require time and re-education.

An engaged employee is a leader’s dream. Employee engagement can be defined as a staff member’s emotional attachment to their job, colleagues and/or the organization as a whole. When engaged, employees create a natural connection with their co-workers and truly care about the outcomes provided by the organization. You can identify an engaged employee as someone who consistently goes above and beyond their job description and works to create a better work environment for themselves and their co-workers. These staff members view their employment as more than a job; it’s a career. They can be identified as someone who stays late to complete a project, volunteers for an internal committee and those who look for solutions.  Take a moment and think of your most engaged employee on your team. Wouldn’t you love to have an entire team of those engaged employees?

An effective way to engage an employee is to make time to explain the “why.” Define how the employee’s actions directly affect the organization’s goals and how the department ties to a bigger purpose, providing your team with an emotional connection to what they do. Author Lee J. Colan provides an excellent example in his book “Passionate Performance: Engaging the Hearts and Minds of All Your Employees.”  An individual was employed as a dishwasher at a hospital, but she never thought of her job as simply that of a dishwasher.  From her first day on the job, her supervisor made it clear that their collective purpose was to help maintain a clean, safe environment so their patients could go home as soon as possible.  By making this strong connection to the patients, the employee could fully commit to her job because she understood how her work directly affected the overall purpose.

Help your employees see the big picture by sharing examples of positive results in your department and tie that performance to the overall goals.  Leaders are often involved in meetings and receive communication that does not always make its way back to the employees. It’s the job of a leader to cascade information so that each team stays connected to the cause. Don’t assume engaged employees will make this connection. Reinforce the action to the cause because it provides an opportunity to recognize the engaged employee and thank them for the work they do and their contribution to the organization. For many leaders, the biggest challenge of providing this type of communication is one of time.  However, the use of monthly one-on-one meetings is a great way to communicate directly to each individual employee. Schedule these meetings at the same time, same day each month and commit to that time. Cascading the information will help ensure employee engagement is focused on the common cause.

Jana Baker
Director of Training, U.S. Operations
Nueterra