Vivian Lee, MD, PhD, MBA, describes the healthcare industry as a "puzzle," but the dean of the University of Utah School of Medicine, senior vice president of University Health Sciences and CEO of University of Utah Health Care is working to put the far-flung pieces together.
A physician trained in radiology with additional degrees in medical engineering and business, Dr. Lee is well-suited to tie healthcare's loose ends together to move forward, whether they relate to payers, physicians, administrators or patients.
Here, Dr. Lee opens up about what excites her about academic medicine, what needs to change in healthcare and how University of Utah is driving and measuring value throughout its healthcare system.
Question: What drew you to lead an academic medical system and University of Utah in particular?
Dr. Vivian Lee: When the search firm called me up in 2010, University of Utah was ranked number one in quality by the University HealthSystem Consortium. And since then, the University of Utah has been in the top 10 for the past four years in a row. There's also a graph that I love, built with data published by United Health Foundation and Kaiser Family Foundation that plots all the 50 states. The Y-axis shows the cost of healthcare and the X-axis shows the healthiness of the people. The "sweet spot" is in the upper right corner where the cost is the lowest but the people are the healthiest [see right]. There's only one state in that sweet spot corner: Utah. In healthcare 
reform, a lot of changes need to happen, and I was attracted to do what I can in a place that is already so focused on quality. That position gives us a good head start to lead the transformation of healthcare.
Every system has its role to play in healthcare, but in academic medicine our role is unique. We're the training grounds for all the future healthcare professionals. At the University of Utah we have five colleges with students in medicine, nursing, physical therapy, nutrition, pharmacy and even a new dental school. Changing an entrenched system like healthcare is already challenging, but evolving a system to shape the future of healthcare is that much harder for those trained in the old siloed system. The kind of organization that can really define the future of healthcare is the organization that is training all the future professionals. When tomorrow's providers start to deliver care they will need to work in teams, put patients first and be able to manage outcomes and cost. Our students will have that ingrained from their training here, and they will be able to deliver quality care in a new system built on value.
On a personal level, I am, like my colleagues, an academic. We don't just do things because everyone else does them; we challenge ourselves to do things better. We measure and prove in a scientific way and make evidence-based decisions. Those characteristics of academic medical centers make them a stimulating place to work.
Q: You've been described as having "a big vision of the future" by former colleagues. Where do you see healthcare heading in the future?
VL: The business model of healthcare needs to change so that our primary focus is on keeping people healthy. Currently healthcare is structured as a fee-for-service model, where we are reimbursed for procedures delivered on an episodic basis. We don't inherently think about healthcare as "taking care of people" throughout the course of their lives, nor are we funded in a way that incentivizes us to do so. That should be our purpose. It's why we went to medical or nursing school in the first place. But the business of healthcare hasn't been built around that premise.
The future of healthcare is accountability, on the system level and on the patient level. This means we need more engagement with patients. At University of Utah Health Care, we are piloting a major initiative in orthopedics around patient-reported outcomes. Instead of relying on X-rays or lab reports to measure patient satisfaction, we are actually talking to patients about how they're feeling and what their outcomes goals are. If their goal is to be out on the golf course that should be a measurement for what we need to do to get them to where they want to be. It’s remarkable that the system doesn't already function in this way. But it needs to.
Q: What are the biggest challenges University of Utah Health Care faces today?
VL: I think our biggest challenge is how to transform our existing healthcare system in a way that will ensure a successful future. Healthcare is such a complex web of entities. We take care of patients and train physicians, but we don't work in isolation. There are a lot of partners who need to change with us. We need payers to embrace the changes we want to make, patients to take on new responsibilities — like going on the exchanges and making good decisions about which plans are right for them — and providers and administrators who aren’t afraid to deliver a new kind of care and create new structures. We all have to do it together. That's a huge challenge in our healthcare system, a large, complicated puzzle of pieces spread across a broad landscape. We have to coordinate its assembly.
Q: What is your main priority for University of Utah Health Care in 2014?
VL: To become a value-driven organization. That refers to providing high-quality care and services at reasonable costs. I'm a big believer in data and in measuring things. As Peter Drucker once said, "You can't manage what you can't measure." The problem is that, in healthcare, we haven't had a good way to measure outcomes and costs.
To do that, we are continuing to improve our Value-Driven Outcomes initiative. It's an incredibly transformative tool that allows us to measure outcomes against our cost. Not the charges everyone is excited about — but what economists say is the real problem — that the healthcare system doesn't know the true cost of providing care. VDO allows us to look at quality and cost of care for every patient and procedure in the system. Then we can visualize both our outcomes and costs and improve our care. We've started down that road by developing these tools with our frontline providers, physicians, nurses and operating room teams. We can look at a procedure together, and everyone in the room can see where the outliers are in terms of both quality and costs. Then we can confront how to standardize the procedure across multiple providers to truly deliver value.
One of our first applications of our VDO tool is in orthopedics looking at total joint replacements. One thing we noticed is that some patients were staying in the hospital longer than others—typically patients who got out of the OR in the late afternoon. We discovered they were staying longer because when they went to get physical therapy after surgery, the PT staff had already gone home for the day. So with a simple adjustment of PT staff shift scheduling, patients can get their first PT on the same day of surgery, which is shown to be helpful for recovery.
By having the data available, we've become an even stronger learning organization. When you give people the tools to learn from experiences, every day they can do things better than day before. People find fulfillment in that and it’s a very engaging and motivational path to be on.
Another major priority is putting the health back into healthcare and really focusing on health and wellness. It has been well-received so far. We recognize that what we do with patients in hospitals and clinics is a small part of overall wellness of the individual, and we need to contribute more in that area.
We are also very much focused on helping patients attain better health by thinking about them in their socioeconomic situations. We have a collaboration with our main campus, for example, called Connect 2 Health. The program provides a social services navigator for patients in our clinics and hospital. We can give them the treatment they need in the hospital, but social circumstances prevent them from keeping healthy — a patient may be cared for and discharged only to return home where one of their utilities may have been shut off. They may not have money for their prescriptions, and we can help them sign up for Medicaid. Our volunteers and students have created a network of navigators that help our patients with many of these social issues, because care doesn’t end outside our hospital doors.
Q: Even with your busy schedule, you blog regularly and are also active on Twitter. What value do you find in those mediums as a healthcare leader?
VL: Many people have said, you can never over-communicate. Especially in times of change, people need to hear what leadership is thinking about, and also need to express their own views and ideas. Blogging is just a piece of my communication strategy. I can't expect people to read my mind. Blogging gives me a great outlet for celebrating great work and recognizing talented innovation.
There are other communication outlets, like our Innovation Station. It's an online site where employees from the front lines can give ideas of how to make us better. It keeps them in the loop and they can track how their recommendation is helping.
Tweeting is just fun. I went to a meeting of medical school deans and administrators two years ago, and there was a big push to get the deans to do social media. There, I was introduced to Twitter. I think it's really fun but I don't think I'm the best tweeter, because I don't think in 140 character units. I'm getting better. I get a lot of information from it and I always find something interesting to share with others.
I'm looking forward to the day when I have more fellow deans to tweet with...#hereshoping.