Sandy Orsulak, RN, BSN, is Vice President of Clinical Operations at Versant Health. Here, she discusses her career journey, tackling large projects successfully, and her advice for the next generation of female healthcare professionals.
On Recent NCQA Accreditation Success
The National Committee for Quality Assurance (NCQA) sets a rigorous standard for organizations with Utilization Management programs. NCQA accreditation means that the UM program making decisions about member care has shown that they are following objective, evidence-based best practices.
Sandy Orsulak knows the ins and outs of meeting high standards. Her experience began at the hospital level with The Joint Commission, the nation’s oldest and largest health care accreditor, ensuring that hospitals met the requirements of direct patient care. “As a nurse working in these hospitals, you’re responsible to ensure that you’re adhering to all of the Joint Commission requirements,” Orsulak explains. “[They] evaluate what’s happening at every level in the hospital…That was really the doorway for me in understanding what happens when a body [like The Joint Commission] comes in.”
After the hospital setting, Orsulak moved into the world of the policies and processes behind managed care. Were health care organizations meeting state requirements? Federal guidelines? Now, Orsulak has nearly two decades of experience working with the National Committee for Quality Assurance (NCQA) at the health plan level. She brought this extensive knowledge to the table to help secure NCQA accreditation for Versant Health’s Utilization Management program.
“You can write a perfect policy,” Orsulak says, “but if you can’t implement it, you will fail.” After being charged with getting NCQA accreditation for Versant Health’s Utilization Management program, Orsulak knew she would need to get full buy-in from the entire organization.
She got to work—putting together a formal project plan, keeping people engaged and excited, and constantly providing updates to every department. Orsulak notes that everyone throughout the company was very receptive to the NCQA effort because the project had buy-in from the top; the Executive Leadership Team was on phone calls, asking questions, supporting efforts, and participating in conferences. “That really sent a positive message throughout the organization, that leadership believed in it and was showing up for it,” Orsulak says.
Of course, the true test of principles comes when a company goes for NCQA recertification. Policies and processes need to be implemented “…day-in, day-out—there are no breaks!” Even now that accreditation has been secured, it’s important to stay engaged. “Every single day, you learn something new,” Orsulak says. “Healthcare is constantly changing.”
Advice for Taking on Your Next Big Project
Orsulak highlights two keys to successful projects. First, make sure there is buy-in from top-level leadership. She notes that if leadership support is there from the beginning, your success rate will be much higher. Second, be sure to approach any big project systematically so no details get lost. If possible, she advises, reach out and get additional expert advice. This could mean advice from coworkers or even outside consultants. These additional insights can help ensure that you hit all the angles and truly knock a project out of the park. “Never lose sight of your network,” Orsulak says. “That’s part of the beauty of being in the industry for a long time. You can tap into these relationships, these friendships.”
Staying Driven in the Healthcare Field
Orsulak’s passions and personal story keep her focused on being the best healthcare leader she can be. “What has influenced me the most – and what drives me the most – is working for the underserved population,” Orsulak says. Her career decisions have all been centered on a fundamental question: Am I going to be able to impact a population that has not necessarily been paid attention to?
Having grown up in a poor family, Orsulak knows what it is like to be without reliable access to good health care. “We never had health insurance [growing up],” Orsulak says. “Health care was a privilege.” On her own since the age of 16, Orsulak worked to become a registered nurse (RN) with a Bachelor of Science in Nursing, followed by a master’s degree in healthcare administration. She has since done it all: nursing, working with inner-city hospitals, working as a community health nurse, coordinating volunteer efforts, working with groups like the National Alliance on Mental Illness (NAMI) and with Health Care for the Homeless—always with the goal of helping people and being there for them. “If I can’t [help people] through direct nursing,” Orsulak says, “I want to do it through policies that have an overarching impact.”
This approach spills over into Orsulak’s leadership approach. She wants to make sure that Versant Health’s Utilization Management team isn’t driven by dollar signs and cost-cutting, but by truly addressing member needs. She encourages her teammates to look at their jobs as being advocates for the member on the other end, making sure they receive the right level of care. “As a leader, that’s the message I have [for my team],” Orsulak says. “You are the advocate for the patient.”
Advice for the Next Generation
What advice is there for the next generation of female health professionals? “Don’t be intimidated, don’t back down,” Orsulak says. “Sometimes it’s very challenging to be in a room of male leaders…Find your voice and know how to use it in different settings.” She notes that it is also important to know when to listen, as well, in order to step in and make a statement in an impactful way. Her final takeaway for women in the professional world? “If you want [something], don’t let someone tell you you can’t have it.”
Orsulak reflects on her own journey: “I came from a very poor family; there were times when I myself was homeless. There were times when I couldn’t figure out how the heck I was going to get my next meal or how I was going to get through school.” Anyone looking at her situation from the outside would have told her to focus on taking any job available, try to survive, and don’t try for too much more, Orsulak says.
Luckily, she never let that kind of thinking get in the way. “[There were] lots of tiny baby steps,” Orsulak says, “but I never lost sight of my ultimate goal.” Of course, always remember your network, and don’t feel like you have to go it alone, either. “Find your mentors,” Orsulak advises. “They’re out there! I mentor four people right now.”
The Future is Bright
So where do we go from here? For Versant Health, the future is a new level of industry leadership in the managed vision care space. And while Orsulak supports the company and her team in their next big projects, we can apply her advice and experience for ourselves, too. What’s on your goal list? Be sure to get buy-in from leadership, and reach out to people in your network (past or present) who could help mentor you or give you advice. Take things one at a time, don’t be intimidated by challenging situations and never lose sight of your goals. We’ll see you at the next milestone!