• Achieving Results Through Diversity

    Apr 18, 2014

    Nicholas Tejeda encourages his clinical staff and leadership to consider the unique characteristics and needs of every patient, community member, and partner organization they encounter. The result is improvements in clinical quality, reduced costs, and improved patient satisfaction.


    Nicholas Tejeda Photo 2Nicholas Tejeda has achieved three major accomplishments in his career as the CEO of Doctors Hospital of Manteca, Manteca, Calif., and all of those achievements came before his 35th birthday. First, he led his 73-bed hospital to implement a capitated agreement in the highly competitive California provider market. Second, in the span of one year, his hospital reduced readmission rates by more than 20 percent. Third, the hospital raised its Leapfrog Group quality rating from a “C” to an “A” within a one-year timeframe.

    Many factors play into these accomplishments, but Tejeda’s unique perspective on diversity has had a major impact on his ability to make significant strides in clinical quality and positive business results. Recognized by the Federation of American Hospitals with the 2013 Corris Boyd Leadership and Diversity Award, Tejeda incorporates all types of diversity awareness (e.g., age, gender, race) into a broader term he calls “cultural humility.”

    “I encourage staff to enter a scenario, be humble, and understand that each person is unique. If you pause and respect that perspective, you have an opportunity to consider peoples’ needs, how they are different than you, and how you share a culture and vision with them. If you ask yourself those questions, you suddenly start to consider the person and then this diversity thing makes sense from a clinical and business perspective,” says Tejeda.

    Focusing Diversity Efforts

    Tejeda segments his diversity efforts into three areas: patients, management and clinical staff, and governance.

    Patients. Doctors Hospital of Manteca collects data on its patients to identify what demographics within the community use the hospital. “Some hospital leaders equate the demographic of their hospital patients with the demographic of their community. But those numbers aren’t always the same. For example, in my community, 40 percent of the population is Hispanic, but only 22 percent of those community members use our hospital. Where is that other 18 percent going for care and why? That’s the business imperative that we need to address,” says Tejeda.

    Management and clinical staff. Doctors Hospital of Manteca looks to hire the best person for the job. “It’s wonderful that we have a very diverse community that brings a strong pipeline of talented candidates. In any industry, having staff that can understand and relate to your customers just makes sense—and it has never been more important in hospitals given the number of newly insured individuals due to healthcare reform,” says Tejeda.

    Governance. A hospital’s board of directors should match the demographic of the patient population, says Tejeda. “If I have 40 percent Hispanic population in the general community, it makes sense that board members would reflect that mix and represent those voices during board discussions and decisions.

    “That principle also applies to age, gender, socioeconomic status, and diversity of thought. For example, well-established business leaders on your governing board are a great asset, but hospital boards can benefit from the different perspectives of young entrepreneurs in the community who are hungry to make their mark,” says Tejeda.

    Using Diversity Strategies with New Patient Populations

    Tejeda’s commitment to diversity and cultural humility are advantages for his hospital as it welcomes new patients under its recently negotiated Medicare Advantage narrow-network capitated agreement. Some patients in the plan may be switching from a caregiver not covered in the narrow network, or they may be newly insured and seeking hospital care for the first time. By practicing cultural humility, the hospital staff can help new patients navigate unfamiliar practice patterns, facilities, and physician options.

    “We must be cognizant of the needs of our growing senior patient population who are covered by this new Medicare Advantage agreement. To gain a better insight into senior patients’ needs, we are enlisting some of our senior staff to speak to their peers and share insights into what they expect from a hospital,” says Tejeda.

    Partnering with Other Providers

    To ensure that patients in the Medicare Advantage narrow network have access to needed care, Doctors Hospital of Manteca has agreements with various providers, including other hospitals, home care services, hospice care, skilled nursing facilities, and assisted living facilities.

    “We are in constant discussions with those other providers on how we can partner, whether in person or virtually, to manage populations. Our partner hospitals also have populations that they are managing, and we can augment their need to care for patients in our community,” says Tejeda.

    Leading by Recognizing the Needs of Others

    Tejeda has improved clinical quality and implemented ambitious business strategies at Doctors Hospital of Manteca at a time when healthcare leaders are facing the challenges posed by healthcare reform, value-based payment, and other factors affecting the healthcare industry. His ability to lead by recognizing the needs of patients, community members, and partner organizations—and encouraging his staff to do the same—is a major factor in his ability to seize opportunities amid widespread change.

    Nicholas Tejeda, FACHE, is CEO of Doctors Hospital of Manteca, Manteca, Calif.