Visiting Nurse Association of Ohio: Claire M. Zangerle, President and CEO

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The future of medicine could be as close as home, no matter where home may be. At least that’s what Claire M. Zangerle, MSN, MBA, RN, President and CEO of VNA of Ohio believes. She sees home healthcare as an unrecognized growing part of what lies ahead for the medical profession.

“If caregivers on the acute care side were more in tune with how home care is a benefit to their  patients, they would see less re-hospitalizations, greater patient self-management and a reduction in overall healthcare costs,” she said.

Formerly the Chief Nursing Officer at the Cleveland Clinic, Zangerle has been at VNA since July, 2008.  In making the switch from acute to post-acute care, she saw this as an opportunity to take a relevant business to the next level and be a part of the future of the healthcare industry across regions.

“When people think of us the VNA, they think all we provide is care to the inner-city residents,” she said. “However, we are not unilaterally focused – we care for the insured, the under insured and the uninsured, whether they live in the inner city or the suburbs.  We don’t turn anybody away.”

The more than 100-year-old VNA of Ohio, the largest home healthcare agency in the greater Cleveland area, is based in the city but serves 19 surrounding counties. The VNA offers services including home healthcare, rehab, mental health care, in-home hospice and a 14-bed hospice unit. The organization also operates a private duty entity called Home Assist as well as a visiting physician program – HouseCalls.

One of the VNA’s biggest secrets its staff of 32 mental health nurses. Zangerle said VNA of Ohio is the only home healthcare company that has a mental health staff that large.

Overall, the VNA handles about 14,000 admissions per year with close to 800 employees, recording an estimated $1.5 million in uncompensated care on a $55 million budget.

Referral Network

Networking with local healthcare facilities has gone a long way toward helping the VNA provide services as well as receive patient referrals.

“It has only been in the last five years that we have actually had competition for our business,” Zangerle said. “So, we’re working on building relationships with our referral sources.”

Part of that effort to create better relationships with referring parties includes enhancing the VNA’s information technology. Staying current with the latest technology will help the VNA work more closely with neighboring healthcare providers.


According to Zangerle, competition for patients in the Cleveland healthcare arena is significant, particularly from corporate-based for-profit entities with deep pockets that are headquartered outside the state but operate branch offices in the area. Other competition comes from organizations that provide only one service, such as home healthcare or hospice.

“You would think that being a full-service provider would differentiate us but it seems like consumers are picking and choosing the services they want from different companies,” she said. “That means you need to coordinate your care.”

An emerging area of competition for home healthcare providers comes from traditional acute care facilities. In an effort to ensure that their patients don’t make return trips to emergency rooms and doctors’ offices, hospitals are establishing their own home healthcare entities. However, Zangerle doesn’t think that’s necessarily the most effective use of hospital resources.

“Hospitals are not in the business of post-acute care,” she said. “So, having them stay in the business of acute care and partnering with somebody who is well versed in and has a process established already for post-acute care is what’s going to help us in the future in both saving healthcare dollars and delivering better care to the patient.”

Still more competition comes from small healthcare companies that simply hang out a shingle and begin offering services, without accreditation and certified nursing. Zangerle works to differentiate the VNA from these types of organizations by stressing the importance of using healthcare providers that do things like meet regulatory requirements and perform security checks on employees.

Management Strategies

Based on her experience at the Cleveland Clinic, Zangerle’s management goal is to lead the VNA of Ohio in the journey toward the American Nurses Credentialing Center’s MAGNET designation.  This designation will not only attract excellent employees, but increase patient referrals as well.

“I believe that every organization that has nurses should be MAGNET designated because it is certainly a demonstration of nursing excellence, not just clinically but as a process and collaboration,” she said.

In the VNA’s move toward a MAGNET journey, one of things the CEO needs to accomplish is to teach the workforce about shared governance. It’s not just about complying with the guidelines, but it’s a choice the organization makes to demonstrate excellent nursing practices.

“We don’t just have nurses here, so we have to have everyone buy in,” she said. “It’s not just nursing practices but it’s a whole collaboration.”

Part of the transition to a MAGNET program involves changing the company’s organizational structure. Zangerle describes the now evolving structure at the VNA as “old-school” with the CEO calling all the shots from the top.

“I’m trying to turn that upside down,” she said. “I don’t know what’s going on in the field all the time, so I want the people who are doing the work in the field and the people who are supporting them to be the decision makers.”

Human Resource Challenges

The biggest challenge Zangerle faces is learning the logistics of working with a unionized registered nurse workforce.

“It takes an incredible amount of energy and time to make sure that I’m meeting the expectations of their contract,” she said.

To ensure progressive staff development, human resources hired an individual to execute a program.  Clinical staff development has been enhanced as well within the quality department. Training is another area of focus, with a goal to have all home health aides become state-tested nursing assistants and for certification for med-surg nurses.  There is already a requirement for the behavioral health and hospice nurses to be certified.

“Currently, anyone can come off the street to any home health agency and go straight from a fst food restaurant to caring for somebody in their home,” Zangerle said. “To me, that just doesn’t work.”

Capital Expenditures

The VNA has taken its community service to the streets, participating in the revitalization of the neighborhood in which the organization’s corporate headquarters is located. Funds have been designated for street improvements and other exterior renovations in the VNA’s inner-city neighborhood.

“We’re part of the revitalization efforts in collaboration with others in our neighborhood – a hospital, a community college, a university and other local businesses to see how we can all work together to make this a destination where people want to work,” she said.

-by Kathy Knaub-Hardy

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