Stephanie Mercado is CEO of the National Association for Healthcare Quality (NAHQ), whose mission is to prepare a coordinated, competent workforce to lead and advance healthcare quality across the continuum of healthcare. They believe that workforce readiness and healthcare quality competencies are key to achieving quality, safety, equity, and value in healthcare.
In this episode of the Leading Learning Podcast, co-host Celisa Steele talks with Stephanie about NAHQ certifications, competency frameworks, and their solutions-based approach to building their learning portfolio. They also discuss workforce development, partnerships with employers in academia, and the value in asking, “If your organization ceased to exist tomorrow, would anyone start the organization again and why?”
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[00:00] – Intro
The Role Associations Play in Society
[01:33] – What’s your perspective on the role that associations play in society?
Associations play a critical role in society and are a foundational underpinning element to the success that we have in all of the industries we represent. The role of the association is grounded in the word itself, which is to associate. When people either start associations or become a member of associations, they’re coming to them in a “help me help you help me” situation. They’re coming together as a community to educate, (sometimes) certify, and advocate for the work that the individuals within those associations are responsible for.
When I think about industries across all disciplines, I really think about the fact that it’s people helping people, and that I don’t know of an industry in business that doesn’t have a corresponding association to go with it because that’s how people support each other to do their best work.Stephanie Mercado
The Certified Professional in Healthcare Quality (CPHQ) Certification
[03:14] – NAHQ offers the Certified Professional in Healthcare Quality certification CPHQ). Would you share a little bit about the backstory on that certification, how it came to be, and why it came to be?
Providing a little backstory on the beginnings of the profession of healthcare is also helpful. After Medicare was signed into law in 1965, the federal government became the single largest payer of healthcare expenditures. About 10 years later, there was discussion about how expensive it turned out to be. As a result, the federal government realized there needed to be some type of quality and understanding utilization review.
That was when the profession of healthcare quality was born (1976). Following the pattern of every association that has ever come into existence, there was no training on what to do. Around 1983, they had learned how to get into the quality assurance space and really understand it. They decided to create a certification so other people could carry that badge of honor with the CPHQ, and it has absolutely stood the test of time. Since then, it has evolved far beyond the notion of quality assurance and is focused on quality and safety broadly.
[07:14] – How does NAHQ go about figuring out the needs and wants of the market and then determining what offerings to build and offer?
We actually come from a position of what problem are we trying to solve. We actually don’t set as a goal at NAHQ to create learning or to create certifications, although we do have learning and certifications. What we aim to do is to support the workforce and help people advance their careers.Stephanie Mercado
Its mission is more about preparing the profession to do its best work and unleashing human potential to make healthcare better. It’s about trying to figure out what the need is in the market and what problem they are trying to solve.
They go through many techniques to assess the market, but not to figure out what they need to learn, more to figure out what problems they need to solve, which may be supported through learning. They spend a lot of time looking at healthcare trade publications and figuring out the macro trends in healthcare, what people struggle with, and how they can help them.
They also engage their Strategic Advisory Councils (part of NAHQ’s governance structure), which is a built-in focus group that helps them identify what the market needs are. They also do traditional market research.
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[10:18] – NAHQ has put in a lot of work and invested in heavily developing the Healthcare Quality Competency Framework. How did you approach creating that framework? And how do you go about that work of maintaining it?
When they developed the framework, it was in response to solving a problem. With the government trying to understand the quality and value coming from Medicare, healthcare quality competencies and skills had been developed on the fly at a local level without the benefit of a standard.
Most people came into healthcare quality because they were really good at something else, and then they were assigned to the quality role. But they didn’t have the skills to actually deliver on quality, safety, and value—those underpinning non-clinical competencies.
They started by defining what those competencies were and the landscape. In doing that, they came up with the eight dimensions (and 29 total competencies within those) that are in the Healthcare Quality Competency Framework. Then they identified what people needed to know in each of those areas with foundational, proficient, and advanced level skills (486 in total) so that it was clear what the work was.
The framework does two things: (1) It solves the problem of having healthcare quality being built and defined on the fly without the benefit of a standard by outlining everything that should be present in a high-functioning quality organization; and (2) it gives individuals an opportunity to understand what a career path might be.
NAHQ’s Involvement in Workforce Development
[14:39] – Would you talk a little bit about NAHQ’s involvement in workforce development? How do you engage with employers, whether that’s to buy your products or potentially to help shape your products during development?
NAHQ’s roots are in being an individual membership and certification organization. They were hearing that organizational leaders needed help training their teams, so they started to explore if they could do it at scale. But often the healthcare leaders wouldn’t even know where to start with the training.
In trying to understand the problems in the market, they created an assessment around the Healthcare Quality Competency Framework. It wasn’t to assess the skills or competencies that an individual had, but rather to understand their work in relation to the competency framework. They could then put their work into the categories of foundational, proficient, or advanced levels (or N/A).
They were able to produce a very robust reporting package to help organizations understand, from a big-picture quality perspective, whether their bases were covered. It allows you to drill all the way down into departments, regions, and individuals to identify who is doing what work and what the delta is between that and the work that the employer wants them to be doing. Then it’s about how you close that gap (skilling, mentoring, coaching, etc.).
In addition to the assessment, they also offer support through what they call a NAHQ Navigator. They assign one to their organizations to walk with them step by step through the journey to assess the team’s plan for career pathing/progressing through their careers and also make sure they get the proper upskilling they need (that solution is called the Workforce Accelerator).
The NAHQ Navigator
[18:06] – How long have you had the NAHQ Navigator out there, which is part of the Workforce Accelerator? Is that a relatively new edition, or has that been out there for a while?
They piloted the concept of Workforce Accelerator in 2020, right before the pandemic hit the U.S. It was very successful, and they got a lot of interest from the stakeholder groups that participated. In 2021, they did a beta launch of Workforce Accelerator. It went so well that they needed to hire more navigators. They are in a full commercial launch of the initiative now, and Stephanie is excited about the impact that it’s having on leaders’ ability to support their teams and unleash human potential.
NAHQ’s Partnership with Academic Institutions
[20:33] – NAHQ forefronts opportunities for universities right on its Web site. Can you share with us some of your experience partnering with academic institutions, what that looks like, and how it’s gone?
At NAHQ, they really believe that the key to reducing variability in healthcare delivery is to reduce variability in healthcare quality competencies. They wanted to figure out how to get upstream on this so they wouldn’t have an entire healthcare workforce, not only in the United States but around the world, that hasn’t been built on these standards and competencies in the first place. So, they started working with higher ed.
A lot of higher-ed organizations in healthcare quality, health business administration, nursing, etc. have begun to incorporate quality and safety competencies into their curriculum. This is great but it perpetuates the problem, which is a high degree of variability in healthcare quality competencies. NAHQ tries to standardize some of that competency training. They plug their standards right into the curriculum.
Personal Approach to Lifelong Learning
[23:02] – How do you approach your own lifelong learning? When you are thinking about how to continue to grow as a CEO, as an individual, what are some of your practices, habits, or sources that you go to help you learn?
There are three categories that Stephanie pursues professional development in: healthcare; learning, skilling, and competency development; and leadership and management topics. Seven days a week, she starts her day by opening up e-mail, which includes news feeds from some of the best sources for all of that type of content.
She also has a great network of people that have become good professional friends and trusted advisors. They are kind of like her board of directors (she calls them her “tiger team”) that she can draw on outside of the NAHQ board of directors for support. She also keeps up with reading or listening to books.
The Future of Learning
[27:23] – When you are thinking about the future, particularly the future for learning, what excites you? Are there trends or developments that you have your eye on?
One of the key things is the notion of skills-based hiring and performance management. There’s a lot of work being done around really being able to identify who has what skills for the work. Employers don’t have the time or the money to hire people who don’t know how to do what they say they can do. Stephanie thinks this validation of skills for the purpose of hiring and performance management is really interesting, as well as the related technology.
Advice for Learning Business Leaders
[28:20] – What advice—or maybe it could be a question to consider—would you offer to other association CEOs or learning business leaders as they’re trying to think about, “What do I need to do to be successful?”
Stephanie is a big fan of the notion that Simon Sinek brought forward, which was to start with why, and that people don’t buy what you do, they buy why you do it. The secret to her success has been searching for those answers. Why are we here? What can we do that nobody else can do as good as us? How can we add value to the market and solve those challenges?
When she first joined NAHQ as the executive director, she went in search of finding out what they could do that would really add value to the market and be their differentiating value proposition. The question she asked everybody was, “If NAHQ was wiped off the face of the earth tomorrow, would anyone start this organization again and why?” This stopped everybody in their tracks because they didn’t know.
I think that when you take a breath and say, “Okay, what are we really trying to do here, and let’s get consensus on what that is,” it doesn’t start with tactics. It really starts with the problem that you’re trying to solve for. Luckily for us, what became very clear to me as I asked that question, “If NAHQ was wiped off of the face of the earth tomorrow, would anybody start it up again and why?” the answer was because we’re the only organization focused on workforce competencies for quality and safety.Stephanie Mercado
Being intentionally curious and persistent in this way is one of the secrets to their success at NAHQ.
[31:35] – Wrap-Up
Stephanie Mercado is CEO of the National Association for Healthcare Quality.
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