January 31, 2014

Amid all the theories of what makes a successful leader, one thing I’ve learned over the course of my career is that leadership always influences and determines outcomes – not some of the time, but all of the time.

This is one of the lessons I’ve devised to help grow myself as a leader and develop future leaders as well. I began exploring the idea in earnest in my mid-20s when a colleague asked what I believed defined a great leader. I drew a blank.

That moment compelled me to develop a formal definition of leadership for myself. It took more than a year of reading, writing and contemplation before I crafted a satisfactory definition.

Leadership, to me, is Vision + Structure + People.


First, a successful leader must be a true innovator. Having vision and being motivated by an instinctual drive is not a learned skill but is honed over time.


The second component – structure – keeps a leader grounded while also providing the space and time needed to remain a creative visionary.


Last, people are unequivocally the most important ingredient in the definition of a successful leader. The team you’ve built to achieve your common vision will define your tenure as a leader. The colleagues you have committed to leading will ultimately be the most important factor in the entire equation.

While these three components have laid the foundation for my work at Texas Children’s Hospital, there is not a universal definition of leadership. In fact, to become successful, you must create your own definition based on who you aspire to be, how you want to lead, your personality and your core values.

At Texas Children’s, I ask every leader, from managers to executives, to submit their own definition of leadership, and we keep these on file. This helps new leaders hone in on what is important by providing a guide that ensures everything they do comes back to that definition. What’s more, in a large organization like Texas Children’s, it also helps me and my executive team learn more about each leader on our team.

Ultimately, harnessing your own definition of what makes a leader is the way to become a great leader yourself. When I meet someone who aspires to be a great leader, my first question to them is, “What is your definition of leadership?” It is a question I encourage everyone to thoughtfully consider.

Create your own definition, then start living it.

This editorial was authored by Texas Children’s President and CEO Mark A. Wallace and was originally published in the Houston Business Journal on January 17, 2014.

January 30, 2014

In just a few short months, the codes that health care organizations use to describe patient care will become standard across the globe. It’s the first time in more than 30 years that all health care organizations will use the same system for reporting patients’ diagnoses and procedures. The change that will make this sweeping impact is the mandated transition to the ICD-10 coding system on October 1.

Last year, Texas Children’s launched its efforts to be ready for the mandatory implementation of ICD-10. On October 1, the current ICD-9 code sets that have been used to report medical diagnoses for the last 30 years, as well as inpatient procedures, will be replaced by ICD-10 code sets.

“We believe that communicating this change clearly and consistently will help all of us make the transition,” said Texas Children’s Chief Safety Officer Dr. Joan Shook. “Some of the tools we’ve developed – like a fact sheet that answers frequently asked questions – are specific to this change, while other times we use existing hospital and provider publications to keep everyone informed.”

The transition to ICD-10 is required for organizations covered by the Health Insurance Portability Accountability Act (HIPAA). This includes hospitals, clinics, laboratories and other providers of ancillary services (i.e., radiology, rehabilitation, psychiatry, home health, etc.).

What is ICD-10?

ICD-10 is the abbreviated term for the 10th revision of the International Classification of Diseases. It’s a coding system used to report and code diagnoses, injuries, impairments and other health problems and their manifestations. ICD-10 was implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, the current coding system used at Texas Children’s. ICD-10 is the standard coding system used in almost every country in the world, except the United States.

So why the change to a system that seemingly worked in the U.S. for 30 years? The current ICD-9 system has simply run out of space to accommodate new diseases and procedures. The data fields are limited, are not sufficient for accurate medical research, and the system doesn’t support the exchange of health data with other countries. Because the system is 30 years old, it has many outdated or even obsolete terms and is not consistent with current medical practices.

Finally, it lacks sufficient detail to be able to understand exactly what care was given. Many discoveries have been made in the past few decades, and the structure of the current coding system is not designed to expand for the inclusion of specific details and new advances in medicine.

Why it matters

The specificity that the ICD-10 codes will allow is perhaps the most important change that will be realized with the conversion. The ICD-10 codes allow greater specificity and exactness in describing a patient’s diagnosis and in classifying inpatient procedures. For example, after the conversion to ICD-10, an accidental fall can be classified as a fall from a specific type of playground equipment (i.e., fall from playground slide), or asthma can be coded by degree of severity.

“This information will provide a better record for everyone, from providers to billing staff, on what care a patient receives,” said Texas Children’s Chief Nursing Officer Lori Armstrong. “And we all know that the more specific and comprehensive that data is, the more useful it becomes.”

The increased level of detail within ICD-10 more accurately reflects the care provided. Better quality data can reveal patterns of care and other insights that help caregivers make better decisions and achieve better outcomes.

From a financial perspective, conversion to ICD-10 allows performance-based payment systems, more accurate data and more accurate billing. The billing process is more streamlined, efficient and more robust, which helps prevent fraud and abuse.

“ICD-10 provides an opportunity for Texas Children’s to elevate the specificity and scope of our collective clinical documentation efforts,” said Robert Mattix, vice president of Revenue Cycle Administration. “Our organization-wide ICD-10 preparedness is critical to capturing information for quality measurements, such as AHRQ Pediatric Quality Indicators, CHCA complications and mortality, and appropriate third-party reimbursements.“

Getting ICD-10 ready

Texas Children’s ICD-10 preparedness teams already have been working diligently for months to ensure we are ready for the mandatory October 1 conversion. The most important action everyone else can take is to get educated and be ready for the transition, as it will impact physicians, coders, billing staff, nurses, lab, front desk and many other areas.

The two roles most affected by the ICD-10 conversion are physicians and coders. For the medical staff, Texas Children’s is partnering with Baylor College of Medicine (BCM) to provide e-learning videos. Physicians’ education will be specific to their respective specialties and will fulfill the education requirements for both Texas Children’s and BCM. The coder staff will attend an on-site ICD-10 coding boot-camp for training and education.

For the other impacted roles, the ICD-10 education team has prepared a role-specific curriculum offered online.

“If we all focus on educating ourselves over the coming months, the result will be a smooth transition come October 1,” said Myra Davis, senior vice president of Information Services. “In the end, the goal is worth it: to improve the quality of our operations and ensure even better outcomes for our patients.”

For more information

ICD-10 Fact Sheet

ICD-10 Industry Updates

ICD-10 Myths and Facts

“West Campus was a blank canvas,” said Child Life Specialist Rachael Walker.
Imagine stark white rooms with lots of medical equipment. Not a very inviting place for young patients who are already timid and nervous. Walker said the white walls provided a great opportunity for Child Life Intervention with the help of a talented artist named Larry Crawford.
Places like radiology, pathology and the emergency center got a facelift as beautiful murals transformed the rooms making them inviting and familiar for kids.
Getting kids to step into the CT room used to be a challenge, now Walker uses the  underwater mural to invite kids in. Kids and parents are intrigued and calmed by the murals.
“When the CT Mural was installed  we started to see a reduction in the number of kids who were sedated for CT scans,” said Walker, “Kids started to come in more willingly to search and find Nemo. Before, Child Life Specialists might have spent a lot of time convincing them to come in but now kids step in more willingly as they gaze at the beautiful underwater scene.”
The art is planned with children’s interests in mind. The goal is to use the murals for distraction or guided imagery and story telling. Crawford incorporated familiar images, characters, things for counting to create a more calming atmosphere. The mural project was implemented to put kids at ease in the hospital and make the setting more child-friendly.
The entire project was funded by the community. Different organizations came together to raise money for West Campus and the donations were used to brighten these rooms and create this kid-friendly atmosphere.
“You decorate your home and office to create a certain mood. This is the same thing in a different setting,” said Walker.
Walker and the other child life specialists have seen the positive effects of the murals and were able to share the incredible project with those who contributed to it. Community donors were invited to the hospital for a special tour of the special rooms.
“The murals create a less threatening environment for our patients and families,” said Walker, “The child life department plans to continue enhancing West Campus one wall at a time.”
January 15, 2014

Today, Texas Children’s President and CEO Mark A. Wallace announced a new organization-wide mission statement. The new mission statement was approved by Texas Children’s Board of Trustees just before the holidays.

The mission statement: Texas Children’s mission is to create a healthier future for children and women throughout our global community by leading in patient care, education and research.

“This organization-wide statement gives all Texas Children’s entities a single focus: we are one Texas Children’s with one mission,” Wallace said. “Our mission statement is important. It tells the world who we are. It guides our growth and clarifies our vision. Since 1954, the core of our mission has not changed – to provide the best possible care. What has evolved is the way we do that.”

There has been a lot of change in the last several decades. Over the last 60 years, Texas Children’s has built recognized Centers of Excellence in pediatric subspecialties; created the nation’s first HMO for children; formed the largest pediatric primary care network in the country; and developed a global health program that’s channeling care to children and women all over the world. Our physical footprint includes three hospitals, three research facilities, more than 50 local primary care and subspecialty care practices, and we’re still growing.

“Today, Texas Children’s is a diverse and comprehensive global organization, intensely focused on a single mission that’s full of endless possibility,” Wallace said. “There’s still much to be done, but we already have so much to celebrate.”