April 4, 2016 | (19) Comments

It’s difficult to get through a day without seeing or hearing a headline that reminds you of today’s uncertain financial landscape. People are worried about saving for retirement and paying for their kids’ education. We hear about layoffs. And when we see the low gas prices, we’re reminded there’s a shortfall at the company where your neighbor, your church member or your spouse works.

Many of us can’t help but carry the burden of financial concerns these days. We all remember the recession of 2008, but even then, Houston was comparatively unscathed and among the quickest-to-rebound cities. But this time feels different, because it is different.

Now, because the oil and gas industry is primarily impacted, Houston is feeling the brunt of it. And subsequently your friends and family in the oil industry have been or may be impacted. And to some degree, we feel residual effects at Texas Children’s because the families of our patients are impacted.

I understand that many of you carry these concerns with you into work, and then you hear that we, too, are “managing to the margin” – or more pointedly, tightening our belts. You worry about that, and I understand. But I’ve got three things I want you to think about. Three things that are shaping a really promising future for all of us here at Texas Children’s.

First, we are proactively managing our margin right now in response to positive growth. That’s a really good thing. Have you been out to The Woodlands lately? Texas Children’s Hospital The Woodlands is looking amazing, and it is months from opening its outpatient services. We will spend $360 million to build this 550,000-square-foot facility, which will ultimately house 32 acute care beds, 28 ICU/NICU beds, 25 Emergency Center patient rooms and offer services in 29 medical and surgical pediatric subspecialties.

And if you’ve been to the medical center campus recently, you’ve seen the cranes and the work we’ve begun on our 19-floor, 640,000-square-foot pediatric inpatient care tower. We will spend $575 million on this new tower, opening in 2018, and the renovation of our Emergency Center, to be completed in 2020.

The fact that we can invest in state-of-the-art facilities like these is a testament to our organization’s financial strength and is in response to ever increasing demand for our services. The more exceptional our care, the higher the demand for our services. We are responding to that demand by expanding our clinical programs, facilities and, most importantly, our workforce.

That’s the second thing I want you to think about – our people. To ensure we can fulfill our mission, deliver on the promise of providing the best possible care, we’ve got to have the right people in place. Our team has to be the right size, have the right skills and talents and be the right fit for the culture of our one amazing team here at Texas Children’s. So that means right now our recruitment efforts are very aggressive. Over the next three years, we will hire about 5,000 new people. Currently, we are hiring about 17 new people every single day. But we’re balancing our “growth spurt” with the challenges of an ever-changing health care market.

Which brings me to the third thing – our experience with managing growth spurts. You know, it’s not the first time we’ve grown rapidly. Since 1989, we’ve had four major expansions totaling more than $3 billion. And we’ve grown from about 1,400 employees to about 13,000 in that time. So growth is not unfamiliar to us – or as people like to say: “This is not our first rodeo.”

The leadership team we have in place has been here during volatile bear markets and favorable bull markets. We’ve experienced fluctuations in acuity and demanding patient volumes when we’re short staffed. We’ve endured weather events that closed the doors of other hospitals, and we’ve built expansive new facilities a time or two, or three, and we’ve had to recruit aggressively many times.

This has evolved and matured us as a leadership team and as an organization. Our experience has made us smarter and more agile. It’s why we proactively tweak our budget mid-fiscal-year, if necessary, and it’s why we can confidently continue large-scale capital projects.

Most importantly, it’s why I can assure you that we’re in a good place here at Texas Children’s. We make decisions with all of you in mind, and we are constantly balancing the needs of our patients with those of our people, because we know we cannot take care of one without ensuring the support of the other. So, I know the news you hear all around us isn’t always good, but know that we are moving boldly because we’ve been blessed such that we can, and we’ve prepared such that we know how.

 

January 17, 2016 | (6) Comments

“Everybody can be great, because anybody can serve. You don’t have to have a college degree to serve. You don’t have to make your subject and verb agree to serve. You only need a heart full of grace.”

These are the words of Dr. Martin Luther King, Jr., and of all of the quotes for which he is best known, I am most inspired by this one because of my personal beliefs about service. Dr. King was an extraordinary example of servant leadership. His work was steeped in his desire for unity, he was inclusive and was a careful listener of those he led and of those who opposed him as well. And he took thoughtful, transformational actions that changed hearts and people.

Most importantly, Dr. King was driven by his desire to improve the lives of others. He was without a doubt one of our nation’s most gifted leaders, and he spent most of his life serving a mission to create a better quality of life, a better world for others. He led with that vision, and he served with a heart full of grace.

I draw inspiration and guidance from the servant leader Dr. King was. I have always approached my responsibilities as Texas Children’s President and CEO with a focus on service. I am here to serve a mission. I am here to serve the children and women we care for and their families. I am here to serve all of the employees and all of the medical staff, our volunteers and our Board of Trustees. I am here to serve the entire constituency of Texas Children’s.

Every day that I walk through the doors of Texas Children’s Hospital, I am thinking about what I can do to support everyone in our organization to make sure that we’re moving ever closer towards becoming an even better, greater Texas Children’s.

By the same token, I appreciate that same spirit of service in all of you. Much like Dr. King believed anyone can serve, you know one of my maxims is that everyone is a leader. Beyond that, I believe that everyone can be a servant leader. And to me, possessing a spirit of servant leadership means having a sense of ownership and responsibility for our organization, the families we care for and the people we work with. When you feel that sense of ownership, you think differently, your work is elevated, and you are more deeply vested in serving our mission.

Dr. King’s vision was propelled by people who not only shared it, but invested themselves in it wholly. They took personal ownership of it. They walked with him, prayed with him, and they channeled his inspiration into personal actions that served a common aspiration for unity and equality, and subsequently, together they advanced a nationwide movement.

As you reflect today, take a moment to think about that. Our service to Texas Children’s is our most valuable asset. Indeed, leadership can inspire hope, but service is ultimately what fulfills it.

December 23, 2015 | (2) Comments

Last week, as I was thinking about my Christmas message to you, I of course thought about all the things the season typically means – family, beloved traditions, lots of good food and opening that perfect gift. But over the last few weeks, I’ve been thinking a lot about gifts much greater than anything that fits beneath a tree. In particular, I thought about what a gift it is for us to be able to be here for children when they need us. This time last year, we couldn’t always do that.

Like most years around this time, our patient volume was high, but last year we reached historic highs – at or beyond our 650-bed capacity throughout November and December. On many days we reached a point when we simply had to deny children the opportunity to receive care at Texas Children’s. In fact, in November 2014 we denied 101 hospital transfers.

Denying a patient who is being transferred from another hospital is heartbreaking. These are not low-acuity patients who walk into our Emergency Center with mom. When another hospital attempts to transfer a child to Texas Children’s, that facility has assessed that the patient is so critically ill that he or she needs the comprehensive care that only Texas Children’s can provide. Having to say no to children who needed us last year is not something any of us want to see happen again.

That is why we launched the Promise Campaign to build a new community hospital in The Woodlands and a new tower here in the Texas Medical Center. But the children who need us now cannot wait until that new space is available. We need to be prepared for the high-volume season that is now upon us. And that’s where all of you play such an important role. Our leaders, physicians, nurses and staff have been working intently and strategically for months. We assessed our previous approach to patient flow decision-making, and we created a new structure.

We now have rotating teams of operational leaders and physicians focused on patient volume every day. We created a “real-time demand and capacity” process to manage patient census, so that we assess patient flow at three pivotal points daily and can more accurately forecast bed capacity. We’ve increased acute care capacity at the Main Campus and at the West Campus, and perhaps most impactful is that we’ve shifted the way we think. For example, we no longer approach the PICUs at the Main Campus and the West Campus as separate units – we think systematically about these units and consider the total capacity between them when we make decisions about the best place to send a child for care.

We’ve created interdisciplinary roles dedicated to patient flow, and our executives, physicians and unit leaders are rounding and asking front-line staff, “How are things? What do you need?” And we’re making sure the support is where it’s needed, when it’s needed. This focus and teamwork is what allowed us to continue receiving patients last week when we peaked at a census of 691. We were still able to say yes to families and children who needed us when others shut their doors due to lack of capacity.

This is huge, and it’s important. And in many cases, it’s crucial. What you are doing, what you are dedicated to accomplishing, is working – and because of the effort everyone is making together, we can care for these children at Texas Children’s. For many of these families, there is no greater gift than the moment they learn we have a bed available for their child.

I truly wish that no child ever has to be in the hospital during the holidays, but my greater hope is that if they do, Texas Children’s can be there to care for them and ensure the best possible outcome so that they can see a better Christmas next year. That is our gift – during the holidays and every day. Thank you for all you’re doing to ensure we can continue to offer that gift.

I wish you all happy holidays and a merry Christmas.

October 1, 2015 | (28) Comments

As we move about the day, working alongside our colleagues, we might be surprised at the journeys some of them have traveled.

Take Kathy Green and her husband, Kurt. Both are Texas Children’s employees. In fact, Kathy has been at Texas Children’s about as long as I have. She met her husband here, and they have two children, ages 6 and 8. Kathy and Kurt are not only employees, they are also one of our patient families. Their children have used the services in about 60 percent of the departments at Texas Children’s.

Most of the family’s visits are for the Greens’ son who has major medical complexities, including immunodeficiency. For six years, Kathy has been his advocate and care manager, and she’s endured the challenges of coordinating care for a child who requires multiple specialists.

Because she’s a nurse and she’s immersed in the Texas Children’s system, Kathy’s an experienced, informed advocate for her son. But she has said that she often wonders how others do it. How do families who can’t afford the critical care and treatments needed for children with major medical complexities get the support they need? How do they even begin to understand the medical issues or navigate the complex, patchwork health care system for their children? Who’s looking out for them to make sure they receive the right care when and where they need it?

We are, Kathy. Yesterday, the Health and Human Services Commission of Texas announced a new contract with Texas Children’s Health Plan that will help close the gap for children who have major medical complexities.

This is a milestone several years in the making. Five years ago, I received a letter from Texas State Representative John Zerwas with a call to action. In response to the Affordable Care Act, Rep Zerwas asked for Texas Children’s help in developing an innovative approach to the way we serve children. He is a physician as well as a legislative leader, so he knows that the basic and most fundamental tenet of the Affordable Care Act is being able to provide access to the right care, at the right time and the right place — a fundamental tenet of Texas Children’s model of care.

Right away, I met with Texas Children’s Health Plan President Chris Born to discuss how we could create a better model for care, decreasing costs for the state while increasing efficiency for our patient families. Since then, Chris has worked diligently to re-configure the way we support families of medically complex children.

Currently, the system lacks proper coordination of care for children with medical complexities. Often, their physicians don’t communicate, which leads to a gap in what happens to these children once they leave the hospital or clinic setting. And their parents are left in charge of navigating the extraordinarily complicated health care system.

For the past few years, Chris worked intensely with the state to advocate for and develop a different approach to care for this population, which means moving these kids out of a fee-for-service model into a managed care model, where case managers can help take the burden off parents. Ultimately, the state supported the idea of a more comprehensive, coordinated approach to care for medically complex children and created the STAR Kids Program. And yesterday, almost five years to the day after that call-to-action letter from Rep Zerwas, Texas Children’s Health Plan was awarded STAR Kids designation to provide Medicaid Managed Care for children with medical complexities.

Through Texas Children’s Health Plan and a handful of other designated plans throughout the state, the STAR Kids Program will provide health coverage to children and teens with special health care needs, including benefits such as prescription drugs, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment and supplies.

The STAR Kids contract will allow the Health Plan to increase its reach to about 40,000 new children and teens in 54 counties. These children see multiple specialists and therapists, and many receive home care services. They typically see at least one physician every week. We will hire nearly 400 new case managers to help these patients coordinate care between their multiple providers and assist them in navigating the complicated facets of health care. Coordination and management of care helps prevent children with significant intellectual development disabilities or complex medical problems from falling through the gaps and provides a structure where their progress can be followed throughout the system.

This new care model is a huge step in supporting the unique needs of these patients and their families, and improving their access to health care services, while also reducing preventable events or unnecessary visits to the hospital or care provider.

This milestone and Texas Children’s involvement is the result of Chris’ passion and hard work over the years. He has spent countless hours pursuing better options for these children and encouraging the state to adopt a more robust, coordinated model of care. Now, it is a reality with Texas Children’s Health Plan leading the way.

We’ve responded boldly to Kathy’s question of “who?” From Day One, Texas Children’s has always answered the call, and because of the passion and vision of so many here, we will continue to do so for decades to come. It’s our mission.