Administrative Issues Journal: Connecting Education, Practice, and Research (Winter
2015), Vol. 5, No. 2: 3-16, DOI: 10.5929.2015.5.2.1

LOVE & AYADI / DOI: 10.5929.2015.5.2.1 Page 3

Redefining the Core Competencies of Future Healthcare
Executives under Healthcare Reform

Dianne B. Love, Ph.D
M. Femi Ayadi, Ph.D.
Healthcare Administration Program School of Business University of Houston – Clear Lake

ABSTRACT

As the healthcare industry has evolved over the years, so too has the administration of
healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act
(ACA) has brought additional changes to the healthcare industry that will require changes to the
healthcare administration curriculum. The movement toward a vertically integrated delivery
system for healthcare has demanded that healthcare executives have a new set of skills and
competencies. These competencies include management skills across hospitals, ancillary
providers, physician practices, ambulatory settings, as well as skills in risk management and
quality. Healthcare organizations can transform healthcare delivery through the power of
technology and systems oriented care. This will require a new type of healthcare executive with
new skill sets. This paper examines the skill sets of leaders of some of the leading integrated
delivery systems in the United States through key interviews with twelve top executives. Based
upon those interviews, c-suite executives in large healthcare systems were surveyed to identify
the core competencies of the successful healthcare executive of the future and the graduate
education requirement needed to achieve those competencies. The results of the study are used
to provide suggestions on how the curricula of healthcare administration programs can be
revamped.

Keywords: core competencies; healthcare executives; healthcare reform; Affordable Care Act;
healthcare administration curriculum

s the healthcare industry has evolved over the years, so too has hospital/healthcare
administration and the Master of Healthcare Administration (MHA) and Master of Healthcare
Administration/Master of Business Administration (MHA/MBA) curriculum. In the first half of the

20
th

century, most hospitals were not for-profit, primarily religious or government owned. People with
money could afford healthcare, while the elderly and poor were dependent upon charity care. Most
hospital administrators had a public health, nursing, or social work background. The passage of
Medicare and Medicaid legislation in 1965 (Social Security Act Amendment, 1965) provided funding for
the poor and elderly to pay for healthcare. This also began the development of for-profit hospitals,

A

LOVE & AYADI / DOI: 10.5929/2015.5.2.1 Page 4

which gave rise to professional hospital administration, and the number of healthcare administration
programs grew significantly.

The era of the 1980s gave rise to prospective payment for Medicare and Medicaid and managed care for
commercial payors. With these changes from cost-based reimbursement to a fixed prospective payment
system, healthcare became a business, and healthcare administration programs began to offer more
business courses. This led to MHA/MBA degrees and MBAs with healthcare concentrations. In the
1980s, as well, hospitals began purchasing physician practices. There was an increase in ancillary
services and providers, and integrated delivery systems proliferated. The Masters in Hospital
Administration became the Masters in Healthcare Administration. This shift toward healthcare as a
business saw the introduction of new courses into the MHA and MHA/MBA curriculum such as managed
care, physician practice management, quality, and an increased emphasis on quantitative skills. Thus,
the 21

st
century saw an increase in the number of physicians in executive positions and increased

requirements that C-Suite leaders have for-profit experience even for not-for-profit hospitals.

The signing into law of the Patient Protection and Affordable Care Act (ACA) (ARRA, 2009) has brought
additional changes to the healthcare industry and, as a result, will require changes to the healthcare
administration curriculum. ACA has brought a move toward value-based purchasing from fee-for-
service, an increase in risk sharing—such as bundled pricing, shared risk contracting and capitation—as
well as a movement towards clinical integration and healthcare systems such as Accountable Care
Organizations (ACOs), Physician-Hospital Organizations (PHOs), and Independent Physician Associations
(IPAs). This movement toward a vertically integrated delivery system for healthcare has demanded that
healthcare executives have a new set of skills and competencies. These competencies include
management skills across hospitals, ancillary providers, physician practices, ambulatory settings, risk
management skills, and skills in quality. The healthcare industry is also moving away from procedure-
based fee-for-service medicine toward prevention and wellness and population management. This
requires a new set of skills for healthcare executives such as predictive analytics, population
management, change management, physician relations, quality and safety. The healthcare executive of
the future will need both educational training and hands on experience in all of these areas in order to
be able to navigate this complex environment and provide optimal performance at every facet of their
organization.

An essential determinant of healthcare organizational performance is management competence (Fine,
2002). Ross, Wenzel, and Mitlyng (2002) suggest that “there is not another industry where the
understanding of core competence is as crucial as it is in healthcare today.” Several organizations have
developed competency models, including the American College of Healthcare Executives (ACHE),
National Center for Healthcare Leadership (NCHL), Medical Group Management Association, (MGMA),
Healthcare Financial Management Association (HFMA), Healthcare Information and Management
Systems Society (HIMSS), American Medical Informatics Association (AMIA), and the Association to
Advance Collegiate Schools of Business (AACSB). Healthcare administration programs use a combination
of these competency models in their programs, in addition to receiving input from healthcare executives
in the field. The purpose of this research project was to identify the core competencies of the healthcare

LOVE & AYADI / DOI: 10.5929/2015.5.2.1 Page 5

executive of the future in the era of healthcare reform and to use these competencies to provide input
into the development of the graduate curriculums of healthcare administration programs so that the
program graduates are ready to assume leadership in the new healthcare system. The study uses input
provided from leaders of some of the leading integrated delivery systems in the United States.

METHOD

Key interviews were conducted with a focus group of leaders of some of the leading integrated delivery
systems in the United States. The interviews assessed the leaders’ views of the future. Twelve interviews
were conducted with healthcare executives from both for-profit (25%) and not-for-profit (75%)
organizations (Table 1). These in-person interviews consisted of open-ended questions in areas such as
skills necessary for the future healthcare executives, what skills should no longer be taught in a
healthcare administration program, and what future healthcare executives need in addition to
coursework to prepare them as healthcare executives.

Table 1
Focus Group Interviews by Executive type

Type Number

CEO 6

Chief Integration Officer 1

Chief Medical Officer (CMO) 4

Healthcare Executive Recruiter 1

The results of these interviews were used to develop a survey document. The preliminary survey
document was tested on additional healthcare executives. The results of the test group were used to
develop a final survey document. Survey questions were developed based on those interviews to
identify the core competencies of the successful healthcare executive of the future and the graduate
education requirements needed to achieve those competencies. The survey is provided in Appendix 1.
The survey was sent to a random sample of chief executives officers (CEOs) of large hospitals and
healthcare systems. Survey sample was from the American Hospitals Association (AHA) membership in
the 2013 Guide Book and CD, compiled from the AHA annual survey of hospitals and other sources to
provide a comprehensive directory of healthcare in America. Survey Monkey was used to send out and
collect the surveys. The survey was conducted between April 2013 and March 2014. The online survey
was sent to 210 CEOs from large multihospital systems in different regions of the country. A total of 39
executives responded to the survey, a 19% response rate. The survey results were analyzed using SAS
software 9.2. The executives were asked to rank skills in order of importance from a list of core
competencies in training healthcare executives. The ranking order was from 1 to 5, with 5 being the
highest rank.

LOVE & AYADI / DOI: 10.5929/2015.5.2.1 Page 6

RESULTS

The list of skills is shown in Table 2 and grouped in order of importance to the survey respondents. The
top ranked skills for future healthcare executives (see Chart 1) include: Leadership (4.87), How to Work
with Physicians (4.55), Physician Practice Management and Physician Relations (4.47), Change
Management (4.39), Healthcare Finance (4.39), Quality (4.36), Hospital Operations (4.32), Strategy
(4.28), Ethics (4.13), and Teamwork (4.10).

Table 2
The Healthcare Executive of the Future should be educated in the following areas. Rank 1-5 with 5 being
the highest.

Skill Rank (n=39)

Top Ranked Skills

Leadership 4.87

How to Work with Physicians 4.55
Physician Practice Management and Physician Relations 4.47
Change Management 4.39
Healthcare Finance 4.39
Quality 4.36
Hospital Operations 4.32
Strategy 4.28
Ethics 4.13
Teamwork 4.10
Middle Ranked Skills
How to Manage Effective Meetings 3.97
Integrated Delivery Systems 3.84
Patient Safety 3.84
How to Collaborate to Drive Future Successful Systems 3.84
Risk Management/Population Management 3.74
Healthcare Planning 3.65
Healthcare Information Technology 3.58
Healthcare Policy 3.55
Ambulatory Care Development 3.53
Least Ranked Skills
Healthcare Law 3.47
Project Management 3.45
Community Professional Relations 3.42
Value-Based Purchasing 3.37
Healthy Work Environment 3.37
Healthcare Continuum of Care 3.34
Post-Acute System Development 3.19
Mergers and Acquisitions 3.14

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Skills ranked in the middle range (see Chart 2) include How to Manage Effective Meetings (3.97),
Integrated Delivery Systems such as ACO, CI (3.84), Patient Safety (3.84), How to Collaborate to Drive
Future Successful Systems (3.84), Risk Management/Population Management (3.74), Healthcare
Planning (3.65), Healthcare Information Technology (3.58), Healthcare Policy (3.55), and Ambulatory
Care Development (3.53).

The skills that were ranked the lowest in terms of importance for the future healthcare executives (see
Chart 3) included Healthcare Law (3.47), Project Management (3.45), Community Professional Relations
(3.42), Value-Based Purchasing (3.37), Healthy Work Environment (3.37), Healthcare Continuum of Care
(3.34), Post-Acute System Development (3.19), and Mergers and Acquisitions (3.14).

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Executives were further asked what skills they felt should no longer be included in healthcare
administration training (Chart 4). Their suggestions included Mergers and Acquisitions (33%), Project
Management (22%), and Healthy Work Environment (22%). Seventeen percent of the respondents felt
that Post-Acute System Development, Community Professional Relations, How to Collaborate to Drive
Future Successful Systems, and Healthcare Continuum of Care should no longer be included in health
administration education curriculum.

Not surprisingly, in addition to classroom education, the healthcare executives in the survey felt very
strongly that future healthcare executives should be trained via fellowships/residencies, internships, and
class projects to provide hands-on experience. In a recent report, Capelli, (2013) argued that work
experience, specifically internships, tops the attributes companies look at when evaluating recent
college graduates for a job, based on results from a survey of employers (The Chronicle of Higher
Education, 2012). When asked what other suggestions the executives had for educating the healthcare
executive of the future, they included the following topics: executive coaching, training the future
healthcare executive in understanding the difference between leading and management; using practical,
real world applications; and exposing students to people who have generated change. When asked what
courses/training the executives could benefit from today, they included finance and insurance, latest in
healthcare strategy and reform, change management, and analytics.

DISCUSSION AND CONCLUSIONS

The top ranked skill for the healthcare executive of the future was leadership. Leadership of the facility,
leadership of ancillary providers, and physician side leadership is essential to the new payment models
under the Accountable Care Act. The healthcare industry is going through the most significant change

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since the passage of Title XVIII and XIX, which created Medicare and Medicaid in 1965. Physicians will
have to change how they practice medicine. Hospitals will have to change how they utilize ancillary
services and how they work with physicians. Physicians will have to be incentivized to keep patients out
of the hospital, reduce the number of readmissions, reduce never events, and reduce the number of
days the patients are in the hospital. The focus will be on prevention and wellness. Physicians will be
rewarded financially for keeping patients well and managing the chronically ill patient. Specialists will no
longer be rewarded for the number of patients they admit to the hospital or by how many procedures
they do. The healthcare executive of the future will need to develop the leadership skills to be able to
navigate these new complex environments, while providing optimal performance at every facet of the
vertically integrated organizations.

Healthcare executives will have to work with physicians to get them to focus on quality, prevention,
wellness, managing chronically ill patients, and following clinical guidelines established by the physicians
themselves. The success of healthcare systems will now be based upon the physicians’ willingness and
ability to partner with the hospital to improve quality and reduce costs. This will require clinical
expertise and understanding of the clinical process by the healthcare executive, and how to work as
partners and not in a vacuum.

The importance placed on skills in physician practice management is not surprising given the importance
of hospitals and physicians working together in the clinically integrated environment, whether within an
ACO or PHO/IPA or some other type of risk sharing arrangement. Hospitals are purchasing physician
practices and managing them as part of their integrated network. It is important for the healthcare
executive to know how to manage those practices in an efficient manner in order to increase physician
salaries. Physicians are generally being paid on production and Relative Value Units, (RVUs), and
contracts with the hospital are for three years. If the physicians do not see an improvement in their
salary during that three-year period, they may move to another hospital or to another physician
ownership model.

The passage of ACA has brought a significant need for change, which is reflected in the importance
placed on change management skills by the healthcare executives in the survey. The healthcare system
is changing from the traditional fee-for-service, procedure-based system to a prevention and wellness,
risk-taking system. Hospitals are no longer paid based upon how many procedures they do or how many
patients are in their hospital. The performance of the hospital is based upon how well they manage the
population they are responsible for, and how well they manage patients with chronic conditions. They
are rewarded for keeping patients out of the hospital, not putting them in and keeping them in the
hospital. The healthcare executive of the future will need to be able to help their employees adapt to
these changes.

The financial success of a hospital, even a not for-profit hospital, is a function of bringing in more cash
from patient services than they pay for the services necessary to provide those services. The old adage
of no margin, no mission is more important than ever. In the new payment systems, all hospitals will be
compensated based upon population management and quality, and, as such, resources will have to be
allocated in a different manner. Hospitals will have to understand these new payments systems and

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partner with employers and insurance companies to contract in a manner that incentivizes their
employees and physicians to maximize revenue under these new payments systems. Risk sharing
arrangements, capitation, and bundled pricing will be dependent upon understanding and modeling
these financial arrangements.

Quality is also a top ranked skill, and physicians and hospitals are now being compensated based upon
value-based purchasing and quality incentive payments such as Bridges to Excellence and Physician
Quality Reporting Systems (PQRS). Both government and employers are demanding that they receive
value for the dollars that they spend on healthcare and that those expenditures result in a more efficient
and higher quality system. A significant portion of physician compensation is based upon how well they
perform based upon a number of clinical indicators that improve the health and quality of life of the
patients and lower the long term cost of care. Programs such as Bridges to Excellence provide bonuses
to physicians for their clinical quality. For hospitals, Medicare reduces payment for readmissions to the
hospital and for never events. Commercial payors base the annual increase to hospitals upon
readmissions and contracting of hospital-based physicians. More governmental payors and employer
groups are basing a significant portion of the providers’ compensation on clinical quality indicators.

The ACA requires hospitals and physicians to share risk related to care outcomes and savings. These risk-
sharing relationships will require significant investments in technology, workflow, and care management
systems. The same factors of clinical integration driving shared risk arrangement and value-based
purchasing will require collaboration, population management, and clinical and financial data analysis,
as well as an understanding of the entire healthcare system. It is evident that the leading priorities in the
era of healthcare reform include improving quality, sharing risks, and population management. In a
survey of hospital and care system leaders about their priorities, improving efficiency through
productivity and financial management was cited as the top priority (HRET, 2014).

In order for clinical integration and coordination of care to occur, there needs to be a movement
towards population health management models. One of such models is the ACO model. Recently, the
Centers for Medicare and Medicaid Services (CMS) issued quality and performance results showing that
Medicare ACOs in the Pioneer ACO Model and Medicare Shared Savings Program have improved patient
care and generated over $372 million in total savings for the program (HHS, 2014). In an ACO, providers
who join the ACO become eligible to share savings with Medicare when they deliver care more
efficiently. One such example is the Memorial Hermann Accountable Care Organization in Houston,
Texas, which has a very large, high performance physician network. This ACO produced $52 million in
savings from 2010-2014 (Fernandez, 2014).

The emphasis on population management models also demands a renewed need for analytic skill sets.
Predictive analytics is used in healthcare to analyze data across the continuum of care to manage
patient populations and improve patient care while avoiding financial and reimbursement penalties for
hospital. For example, predictive analytics can be used to predict hospital readmissions.

The curriculum of existing healthcare administration courses can be redesigned to incorporate the new
skills identified from the results of the survey. The focus on value-based purchasing requires physician

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engagement. Courses on quality and safety should include value-based purchasing. Population based
management should be covered extensively in epidemiology courses. It can also be emphasized and
covered in introduction to public health and managed care courses. Change management can be
covered in the leadership class as well as in the organization management classes. The topic of physician
relations should be addressed in hospital operations and strategy classes. Predictive analytics need to be
taught in statistics or decision science classes, while healthcare accounting and finance courses should
introduce and emphasize concepts such as activity-based costing, physician compensation models,
RVUs, bundled payments, and shared savings contracts. Clinical integration in integrated delivery
systems such as ACOs, IPAs, and PHOs, should be incorporated into the managed care class. Shared
savings contracts and some population management discussion can also be covered in managed care
classes. Healthcare administration programs need to maintain relevance in their curriculum in the era of
healthcare reform. It is critical that the healthcare administration graduates from these programs are
equipped with the necessary skill to lead and transform the healthcare organizations of the future.

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APPENDIX

SURVEY INSTRUMENT: Questions on Future Healthcare Executives

1. The healthcare executive of the future should be educated in the following areas. Rank 1 – 5
with 5 being the highest.

Hospital Operations
Leadership
Physician Practice Management/Physician Relations
Risk Management/Population Management
Quality
Health Information Technology
Healthcare Finance
Healthcare Law
Healthcare Planning
Healthcare Policy
Integrated Delivery Systems (ACOs, CI, etc.)
Statistics/Spreadsheets/Understanding Data
Healthcare Continuum of Care (ASCs ,LTAC, HHA, DME ,Infusion Therapy, Pharmacy)
How to Run Effective Teams/Meetings
How to Work with Physicians
Integrated Delivery Systems (ACOs, CI, etc.)
Ambulatory Care Development
Statistics
Spreadsheets
Understanding Data
Post-Acute System Development
How to Collaborate to Drive Future Successful Systems
Community Professional Relations
Teamwork
Managing Change
Value-Based Purchasing
Strategy
Ethics
Merger and Acquisitions
Safety Issues (Patient Safety)
Project Management
Healthy Work environment

2. Which of the above should not be included?

3. What other topics should be included?

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4. In addition to classroom education, how else should the healthcare executive of the future be
trained?

Internship
Residency/Fellowship
Class projects
Other

5. What topics in your MHA/MBA education do you think no longer should be included?

6. What other suggestions do you have for educating the healthcare executive of the future?

LOVE & AYADI / DOI: 10.5929/2015.5.2.1 Page 15

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Capelli, P. (2013). Why focusing too narrowly in college could backfire. The Wall Street Journal.
Retrieved from http://online.wsj.com/news/articles/

Caron, R. M., Hooker, E. E., & Ulrich-Schad, M. A. (2013, Summer). Body of knowledge for health
administration education: Teaching epidemiology in the age of health care reform. Journal of
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Fernandez, D. K. (2014) Accountable Care Organization: Managing success. Presentation at American
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Fine, D. J. (2002). Establishing competencies for healthcare managers. Healthcare Executive, 17(2), 66-7.

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Health Research and Educational Trust (HRET) (2014, April). Building a leadership team for the
healthcare organization of the future. Chicago, IL: health Research and Educational Trust.
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Herzlinger, R. (2013). Benchmarks for confronting the challenges for innovation in healthcare with a
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HHS Press Release (2014). New Affordable Care Act tools and payment models deliver $372 million in
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/Libraries/Assets/Education%20and%20Certification/Certification/Body%20of%20Knowledge/B
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Ross, A., Wenzel, R. J., & Mitlyng, J. W. (2002). Leadership for the future: Core competencies in
healthcare. Chicago: Health Administration Press.

The Chronicle of Higher Education. (2012). The role of higher education in career development:
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%20Survey.pdf

Wagner, K. (2014, August 1). Web special: Core competencies for a changing healthcare environment.
HFM Magazine Retrieved from www.hfma.org /corecompetencies/

ABOUT THE AUTHORS

Dianne B. Love, Ph.D. ([email protected]) is an Associate Professor of Healthcare Administration in the
School of Business, at the University of Houston- Clear Lake. Dr. Love holds a Ph.D. in in accounting from
the University of Arkansas. She is a past president of the Texas Gulf Coast Chapter of HFMA and an
adjunct faculty member at the University of Texas Health Science Center in Houston and the Physician
Exccutive MBA program at Auburn University.

M. Femi Ayadi, Ph.D. ([email protected]), is an Associate Professor of Healthcare Administration in the
School of Business, at the University of Houston-Clear Lake. Dr. Ayadi holds a Ph.D. in economics as well
as an M.A. in economics from the Andrew Young School of Policy Studies, Georgia State University. Prior
to coming to the university, Dr. Ayadi was a health economist at the Centers for Disease Control and
Prevention. Dr. Ayadi teaches health economics and Public health. Her research is published in journals
such as American Journal of Preventive Medicine, Pediatrics, Medical Care, and Journal of Health Care
Finance.

All correspondence to this article should be directed to M. Femi Ayadi. 2151 W. Holcombe Blvd.
Houston, Texas 77030 Tel: 281-212-1712 Email: [email protected]

Copyright of Administrative Issues Journal: Education, Practice & Research is the property of
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Academy of Health Care Management Journal, Volume 7, Number 2, 2011

CHANGE AND INNOVATION IN HEALTH SERVICES
DELIVERY

Bernard J. Healey, King’s College

Kermit W. Kuehn, University of Arkansas

ABSTRACT

The Health Care and Education Affordability Reconciliation Act was signed into law by
the President on March 30, 2010. This legislation will have a significant impact on the U.S.
health care delivery system. Specifically, the legislation will challenge the current operating
models of health care organizations that have relied on fee-for-service revenue structures to
prosper.

This changing environment will produce tremendous opportunities for those health care
institutions that are prepared to positively respond to the demands of the health care consumer.
Two factors will gain additional traction going forward: 1) The focus will continue to shift
toward prevention and wellness and away from health restoration. 2) The focus will move
toward performance outcomes in health care delivery and away from the number and type of
activities being performed. Consumer education is critical to this transition. Using concepts
from disruptive innovation research, this paper explores ways to develop and deliver effective
health education programs to the public, particularly in the area of chronic diseases and their
complications.

INTRODUCTION

The medical costs for individuals with chronic diseases account for seventy-five percent
of the total health care costs in the country. In order to contain the cost of health care going
forward, as well as address the access problems of many Americans, dealing with chronic
diseases is critical. Health education programs designed to prevent high-risk health behaviors in
individuals and communities is one way to address this daunting challenge. The answer to
preventing these high-risk health behaviors lies in behavioral interventions, the focus of
behavioral medicine. This type of medicine involves preventing or changing high-risk health
behaviors so that chronic diseases do not develop.

Why don’t these programs exist already? The current health care business model is built
around restoring people to health and not preventing illness. Health care providers are paid well
for restorative activities and little for preventative ones. In order to drive change in the U.S.
health care system, potent forces must be used to disrupt current behavior. Research in

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Academy of Health Care Management Journal, Volume 7, Number 2, 2011

‘disruptive innovation’ conducted in other industries suggests that these concepts can be used in
developing and expanding health education programs.

DISRUPTIVE INNOVATION IN HEALTH CARE DELIVERY

Clayton M. Christensen, author of the Innovator’s Dilemma, has studied innovation and
management for decades. Christensen (2009) argues that the disruptive innovation theory can
work in the exploitation of change in health services delivery. The three key elements of this
innovation include: a technology enabler, a business model innovation and the development of a
value network. Health education programs must consider each of these elements in order to have
the greatest likelihood of impacting medical care.

Technology as an enabler is central to innovation in the field already, but has not resulted
in the cost declines needed for a healthy and sustainable health care system. However, in
education, considerable variation as to offerings is more evident and gaining wider acceptance.
Adapting this delivery capability into the health care system seems plausible and necessary.
Digitizing health records and telemedicine provide evidence of technology’s role in extending
access and potential cost containment.

The second element of the innovation ‘triad’ relates to the business model of the health
care system of the future. The emphasis on wellness and prevention, and performance outcomes,
will call for new ways of thinking as to how organizations are paid. The current fee-for-service
model rewards the wrong behaviors, both from the health care provider and the consumer. When
it is broke, then you fix it. While the argument for prevention has been in the health care
conversation a long time, the money has yet to follow.

Increasing patient knowledge of disease, especially chronic diseases, can go a long way
in changing behaviors. In order to prevent the long term complications from these diseases, the
patient must understand the serious complications resulting from their practice of high-risk
behaviors. They must assume a more active role in the long-term prevention and treatment
process, and then they will begin to influence the value networks used to meet those needs.

This third innovation element, developing a value network that is sustainable, will likely
require a catalyst from outside the current networks. One source that seems intriguing is the
engaging of the public health apparatus to lead the way in the reform of our current health
delivery system.

Public health departments are well-experienced in population-based community
education and intervention efforts. They also have a culture that is more consistent with a
wellness-prevention value proposition. Finally, there is an existing organizational structure that
generally has a positive standing within the communities they operate. This investment in health
education and testing will likely need to be mandatory for any reform of our health care system
to be successful and could be made part of the participation requirement of a program.

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Academy of Health Care Management Journal, Volume 7, Number 2, 2011

Unleashing these transformational forces has worked well at lowering cost and increasing
the availability of a product or service in the business world (Christensen, Grossman & Hwang,
2009). The catalyst for this type of disruption in health care could very well be public health and
the preventive strategies they have developed. In order to respond to the opportunities presented
by the disruption, leadership and empowered workers in public health departments are needed, as
well as resources. The underlying logic is rather simple: If disease does not occur there is no
need to allocate large sums of money to treatment.

Disruptive innovation allows the combining of resources in the production process in new
and innovative ways that usually allows greater value to be produced by the process. This is
exactly what is required for our health care system to survive and deliver better quality services
at a lower price. The health care system and public health are both faced with limited resources
and increasing demands from everyone for improved value of health care services. Public health
departments and our medical care system have had tremendous successes in improving the health
and life expectancy of most Americans. The country faces its greatest health challenge in the
expanding epidemic of chronic diseases.

THE USE OF TECHNOLOGY TO PREVENT DISEASE

As introduced earlier, technology can help in the battle against the growing epidemic of
chronic diseases. Technology is available to improve the communication of the prevention of
risky behaviors to large portions of our population. Public health departments have the
information that can help individuals prevent chronic diseases from developing. The challenge
has been that the money received for public health departments has never been sufficient to
develop, implement and evaluate the massive dissemination of chronic disease information to the
entire population. This is not to say that there have not been chronic disease education efforts by
health departments. There have been many successful programs developed and implemented in
schools, workplaces and the community designed to prevent chronic diseases and their
complications. These educational efforts need to be expanded to larger and more diverse
population segments.

According to Turnock (2009) computers and electronic communications have improved
the ability to gather, analyze and disseminate health information. This technology has to be
expanded to deal with the chronic disease epidemic through the provision of a continuous stream
of information about these diseases to the entire population. There are already examples of
success stories concerning the innovative use of technology by public health departments and the
Centers for Disease Control and Prevention (CDC) that includes Epi-X and ECards. On a local
level, low cost activities such as voice-narrated power point slides to educate large numbers of
people about colorectal cancer and H1N1 influenza have been used successfully.

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One of the best examples of a public health surveillance and information systems is Epi-
X. This system offers web-based communications for public health professionals. State and
local health departments and poison control centers to access and share preliminary health
surveillance information with large numbers of health care professionals. This system supports
postings of up-to-date medical information and discussions about disease outbreaks and other
public health events that involve many parts of the nation and the world.

The CDC currently has available over 100 free Health-e-Cards (electronic greeting
cards). These cards contain a colorful greeting that encourages healthy living, promotes safety
and can even celebrate a health and safety-related event. This concept could also be expanded to
include chronic diseases along with ways of preventing the complications that can develop later
in life as a result of practicing the unhealthy behaviors that lead to chronic diseases.

EXAMPLE OF AN INNOVATIVE PREVENTION PROGRAM

Last year, a colorectal cancer task force in Luzerne County, Pennsylvania developed a
colorectal education program. The program utilized a marketing approach to increase the
awareness of the need for screening for colorectal cancer in the county. Two businesses were
chosen to participate in this program which began in May 2009. The program was made
available to all employees of these businesses.

This educational program was developed on a SharePoint software site at a local College.
It consisted of a pre-test, a colorectal cancer educational program and a post-test of knowledge
gained from the education program. The educational program consisted of a series of voice-
narrated power point slides about the risk factors for developing colorectal cancer, the various
tests available for this disease and recommendations for those at high-risk for developing this
disease.

The results from this program offer support for this approach. A significantly higher
percentage of participants stated they were more likely to ask their doctor to be screened for
colorectal cancer on the post-test than on the pre-test. All participants indicated that they were
likely to share what they learned from the program with friends and family members. And as a
side note, this program resulted in the discovery of colorectal cancer at an early stage in two
participants resulting in life saving surgery for both individuals.

This colorectal education program is an excellent example of the use of disruptive
innovation in order to develop a health education effort designed to reduce the incidence of
colorectal cancer in a large population. This program was very inexpensive to develop and
implement on a community basis. It is now being duplicated in other counties in Pennsylvania.
The health care delivery system in the United States is consumed with the cure of illness and
disease as the only way to deliver medical services to patients.

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DISCUSSION

The concept of preventing medical problems before they occur has never been an
accepted practice of modern medicine. Since the benefits of prevention and public health
departments are found in the future, there has never been any real interest in providing adequate
funding to public health departments. This is no little challenge.

Therefore, health education programs need to be looked at as a long-term investment that
is capable of producing large payoffs in terms of improved health for the population over time.
Although these educational innovations will require resources and costs in the present, they offer
the best solution for containing health care costs tomorrow.

The need for creativity and innovation in the delivery of health care services has never
been greater. Consumers are expecting more emphasis on prevention of illness and disease.
These changes offer opportunities for the medical care system and public health agencies to form
partnerships in the prevention and treatment of chronic diseases. Public health departments must
find ways to share the science of prevention with larger segments of the population in order to
reduce the chronic diseases epidemic impacting the health care system. The concept of
disruptive innovation outlines the ingredients for a successful transformation.

REFERENCES

Christensen, C. M., J. H. Grossman & J. Hwang. (2009). The innovator’s prescription: A disruptive solution for

health care. New York, New York: McGraw Hill Publishers.

Turnock, B. J. (2009). Public health: What it is and how it works (Fourth Edition ed.). Sudbury, Massachusetts:

Jones Bartlett Publishers.

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