At the Becker's Hospital Review Annual Meeting in Chicago on May 10, four C-level health system executives shared their expectations for the industry over the next four years and beyond.
The keynote panel discussion included Ruth Brinkley, president and CEO of Louisville-based KentuckyOne Health; Stephen Mansfield, PhD, president and CEO of Dallas-based Methodist Health System; JP Gallagher, COO of NorthShore University Health System in Evanston, Ill.; and Paul Summerside, MD, CMO of BayCare Clinic. Bret Baier, Fox News anchor and former White House correspondent, moderated the panel.
Here is an edited transcript of these leaders' responses:
Bret Baier: Tell us about your plans for your organization over the next few years. Where are your leadership teams spending your time?
Ruth Brinkley: We're a $2.5 billion organization that's come together [from three health systems in the state]. I like to talk about the fact that we're integrating the system intentionally, trying to develop culture so the culture doesn't develop by default. We're trying to figure out how to locate and best serve the population. Kentucky has a lot of health needs. We're first on a list of things we don't need, like heart disease, cancer, diabetes and obesity. We're spending our time bringing people together to confront those challenges. We're focused on our purpose and staying solvent. And we're trying to have the state be a part of our system, to influence state and local officials.
JP Gallagher: A lot of what we've been doing in the last 10 years is where we're going. We have one provisional staff, 20,000 physicians across all our sites. There's not a lot of straddling as to where they're going or what they're trying to do, but all that is changing. We need to be nimble enough to change. We're exploring new relationships, and adapting from there.
Stephen Mansfield: We have a four-year plan, and this is sort of our lap year. It's probably the hardest planning horizon I've seen in the four decades of my career. We need to produce a better product at a lower price point. That's the known in a lot of unknowns. We've got to get access to care for more people outside of our network and system now. That will require a lot of trial and error, being focused and having a sense of urgency.
Paul Summerside: Times are always uncertain. If you don't think things are uncertain, then you're fooling yourself. I've been reading a book on people who have kept their composure to navigate out of very troubling circumstances. Leadership has one mind on chaos, the other has to get up each day and put a foot exactly in the right place. And you have to not be distracted from that. That's the key to leadership in this environment. Don't miss a step because of it.
Bret Baier: What opportunities do you see for hospitals in the near future, given the wave of change that is about to take hold of the healthcare industry?
Stephen Mansfield: According to the National Research Council's Recent Report, there are plenty of things that the American healthcare system is very poor in, but their list does not focus on the delivery system. In America we have so many public health issues ranging from obesity and diabetes epidemics, poor prenatal statistics, high rates of HIV and teen pregnancy. The concern that I have and the opportunity is to reverse a generation of bad health decisions. That's what's driving up healthcare costs. It's a substantial issue. We started with our own employees, because you can't hope to treat a population if you can't manage your own population. We drove a stake in the ground in 2008 to push our staff to live healthier. It's hard work, but we've shown it can be done. If you don't manage outside the hospital and measure quantitatively, you'll never make much headway.
JP Gallagher: In conversations we've had within the NorthShore community, we talk about what we can control. It's easy to be depressed by the magnitude of change that we face, but leadership has done our homework on what's going on in our market and elsewhere. And then we got really intentional about communicating that message to our employees. We want to make sure our people have an understanding of what's happening, what we're doing and how it all fits into this big picture. We're very data driven, with a fully functional electronic medical record system and an enterprise data warehouse that gives tremendous insight on how population health is managed or not. Data geeks have identified tremendous sources of clinical variation among our physicians, and we've harnessed them to better standardize some service line rationalizations. We're always looking at what services do we need to provide and how do we ensure we're best allocating what resources we have.
Paul Summerside: Our system has been putting in an EMR system, and let me be honest, I'm a complete skeptic. We've waited 10 years to do it, and I'm happy we waited. I think it's a big sham quite frankly. There are so many other uses to that money; what else could we do with this? We could put a nurse at every bedside, hire more physicians. I'm a data geek. You don't need EMR to get there. I can tell you the wound infection, mortality and average length of patient hospital stay for each of my physicians. I'm absolutely about quality and throughput. I'm not anti-Excel. I don't deny there's some benefit to integrated computerized data, but with that much money and training, there have to be better uses.
JP Gallagher: We realized we have to walk before we can run. EMR is expensive, but it has given us a way to understand where to use our money, too. Data has imperfections, it's not gospel, but we've been able to use it to help keep our clinical variability costs under control. In the last eight months, we've shown scatter diagrams to our orthopedic surgeons to show the less costly care plans for spinal replacement surgeries have nearly the same outcomes as more expensive treatment sequences. The data helped convince doctors to adopt less expensive, medically appropriate practices that have lowered their average procedure by $18,000. They order fewer Doppler tests, patients have shorter hospital stays and care along the continuum is down. Congestive heart failure and diabetes are different challenges. But the EMR system gives us tools we can leverage to swing at different pitches and keep guessing.
Ruth Brinkley: What I believe is that we haven't come across the best EMR solution yet. I think we have to go through this generation in order to get to the next one, which may have worked out the kinks. There's a lot of potential, but I think we're going to have to spend a lot of money to get there. It's an issue of survival. You have to put one foot in front of the other every day. No one really knows where things are going to land, so the opportunity is to focus on the fundamentals: improve the quality and reduce the cost of healthcare while keeping error-free, safe patient care. If you have those fundamentals in place, that makes you an attractive partner for our position. But you must focus on the fundamentals — you can't build on a shaky foundation.
Bret Baier: Are there opportunities that you have pursued with your organizations, but later abandoned?
Stephen Mansfield: The hard part for everybody who works in this profession is that it's hard to find things to take off your to-do list, but easy to think of dozens of things that have been added. You must prioritize. Our system still has an appetite for growth, but not the same appetite we had in the past. We're trying to see what we can learn from experiments we're doing. We are less inclined to spend time on the health insurance exchanges [for individuals and small business launching next year]. I think they're a great concept, but we're not putting our personal resources into them before we see what they look like.
Ruth Brinkley: We haven't taken a lot off the plate, but we have changed our approach and understanding to some things. We need to stay solvent and get paid in ways the system is still figuring out in the new reimbursement environment. I like to say we keep a foot in both the value and volume canoes. Keeping patients healthier is gaining more of our attention, and we're exploring the value of what health organizations are to the community. If we're the most expensive, error-prone system in the communities, we're not helping.
JP Gallagher: There aren't many bets we've made that we regret. Pivoting a bit on the question, we're engaging in some trial and error with new steps to adapt to big changes that are coming. We're focusing on the quality of our continuum of care and managing more tightly. We're looking at the role of mid-level providers and how we can relieve physicians' burden of unnecessary tasks to get a greater sense of making the most of what we have.
Paul Summerside: One thing we've pretty much given up on is getting independent physicians. We think that strategy has gone the way of the dodo for us. No more potpourris of medical staff admissions. We used to think all business was good business, but I don't think that's true anymore. We're not technically a closed medical staff, but we make no concessions to other physicians, so we're pretty much there.
Bret Baier: What advice do you have for other healthcare leaders facing the same issues you all are?
Stephen Mansfield: The complexity of today can be all consuming. It's important that all of us become cognizant of the need to care for self, family and those outside of our work circle. Because work can consume you, and it will. And it has. All of us know folks who've been on that journey. There's a lot more to it than what we do. Keep focused on the horizon.
Ruth Brinkley: Take care of your people, and that includes yourself, too. You must take care of them and enjoy the journey. You have a great opportunity to shape the future of your hospital. It'll be a couple generations before we get there. Take care of the folks now who are building the future and develop and nurture the executives of tomorrow.
JP Gallagher: Kurt Vonnegut told a college graduating class that the only advice he had based on what he knew for sure was "Wear sunscreen." There's a lot we don't know, too. Accept it, but also keep in mind that somebody's got to figure this out. If you come out with a very strong workforce, 10 years from now we'll have figured some things out and it will have worked out well.
Paul Summerside: Keep a positive mental attitude. Ask yourself in the mirror each morning, "What can I do today to make the world a better place?" And surround yourself with those people. There's no room for Eeyores. That goes for your personal life, too. Be ruthless; the bad stuff has got to go.
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The keynote panel discussion included Ruth Brinkley, president and CEO of Louisville-based KentuckyOne Health; Stephen Mansfield, PhD, president and CEO of Dallas-based Methodist Health System; JP Gallagher, COO of NorthShore University Health System in Evanston, Ill.; and Paul Summerside, MD, CMO of BayCare Clinic. Bret Baier, Fox News anchor and former White House correspondent, moderated the panel.
Here is an edited transcript of these leaders' responses:
Bret Baier: Tell us about your plans for your organization over the next few years. Where are your leadership teams spending your time?
Ruth Brinkley: We're a $2.5 billion organization that's come together [from three health systems in the state]. I like to talk about the fact that we're integrating the system intentionally, trying to develop culture so the culture doesn't develop by default. We're trying to figure out how to locate and best serve the population. Kentucky has a lot of health needs. We're first on a list of things we don't need, like heart disease, cancer, diabetes and obesity. We're spending our time bringing people together to confront those challenges. We're focused on our purpose and staying solvent. And we're trying to have the state be a part of our system, to influence state and local officials.
JP Gallagher: A lot of what we've been doing in the last 10 years is where we're going. We have one provisional staff, 20,000 physicians across all our sites. There's not a lot of straddling as to where they're going or what they're trying to do, but all that is changing. We need to be nimble enough to change. We're exploring new relationships, and adapting from there.
Stephen Mansfield: We have a four-year plan, and this is sort of our lap year. It's probably the hardest planning horizon I've seen in the four decades of my career. We need to produce a better product at a lower price point. That's the known in a lot of unknowns. We've got to get access to care for more people outside of our network and system now. That will require a lot of trial and error, being focused and having a sense of urgency.
Paul Summerside: Times are always uncertain. If you don't think things are uncertain, then you're fooling yourself. I've been reading a book on people who have kept their composure to navigate out of very troubling circumstances. Leadership has one mind on chaos, the other has to get up each day and put a foot exactly in the right place. And you have to not be distracted from that. That's the key to leadership in this environment. Don't miss a step because of it.
Bret Baier: What opportunities do you see for hospitals in the near future, given the wave of change that is about to take hold of the healthcare industry?
Stephen Mansfield: According to the National Research Council's Recent Report, there are plenty of things that the American healthcare system is very poor in, but their list does not focus on the delivery system. In America we have so many public health issues ranging from obesity and diabetes epidemics, poor prenatal statistics, high rates of HIV and teen pregnancy. The concern that I have and the opportunity is to reverse a generation of bad health decisions. That's what's driving up healthcare costs. It's a substantial issue. We started with our own employees, because you can't hope to treat a population if you can't manage your own population. We drove a stake in the ground in 2008 to push our staff to live healthier. It's hard work, but we've shown it can be done. If you don't manage outside the hospital and measure quantitatively, you'll never make much headway.
JP Gallagher: In conversations we've had within the NorthShore community, we talk about what we can control. It's easy to be depressed by the magnitude of change that we face, but leadership has done our homework on what's going on in our market and elsewhere. And then we got really intentional about communicating that message to our employees. We want to make sure our people have an understanding of what's happening, what we're doing and how it all fits into this big picture. We're very data driven, with a fully functional electronic medical record system and an enterprise data warehouse that gives tremendous insight on how population health is managed or not. Data geeks have identified tremendous sources of clinical variation among our physicians, and we've harnessed them to better standardize some service line rationalizations. We're always looking at what services do we need to provide and how do we ensure we're best allocating what resources we have.
Paul Summerside: Our system has been putting in an EMR system, and let me be honest, I'm a complete skeptic. We've waited 10 years to do it, and I'm happy we waited. I think it's a big sham quite frankly. There are so many other uses to that money; what else could we do with this? We could put a nurse at every bedside, hire more physicians. I'm a data geek. You don't need EMR to get there. I can tell you the wound infection, mortality and average length of patient hospital stay for each of my physicians. I'm absolutely about quality and throughput. I'm not anti-Excel. I don't deny there's some benefit to integrated computerized data, but with that much money and training, there have to be better uses.
JP Gallagher: We realized we have to walk before we can run. EMR is expensive, but it has given us a way to understand where to use our money, too. Data has imperfections, it's not gospel, but we've been able to use it to help keep our clinical variability costs under control. In the last eight months, we've shown scatter diagrams to our orthopedic surgeons to show the less costly care plans for spinal replacement surgeries have nearly the same outcomes as more expensive treatment sequences. The data helped convince doctors to adopt less expensive, medically appropriate practices that have lowered their average procedure by $18,000. They order fewer Doppler tests, patients have shorter hospital stays and care along the continuum is down. Congestive heart failure and diabetes are different challenges. But the EMR system gives us tools we can leverage to swing at different pitches and keep guessing.
Ruth Brinkley: What I believe is that we haven't come across the best EMR solution yet. I think we have to go through this generation in order to get to the next one, which may have worked out the kinks. There's a lot of potential, but I think we're going to have to spend a lot of money to get there. It's an issue of survival. You have to put one foot in front of the other every day. No one really knows where things are going to land, so the opportunity is to focus on the fundamentals: improve the quality and reduce the cost of healthcare while keeping error-free, safe patient care. If you have those fundamentals in place, that makes you an attractive partner for our position. But you must focus on the fundamentals — you can't build on a shaky foundation.
Bret Baier: Are there opportunities that you have pursued with your organizations, but later abandoned?
Stephen Mansfield: The hard part for everybody who works in this profession is that it's hard to find things to take off your to-do list, but easy to think of dozens of things that have been added. You must prioritize. Our system still has an appetite for growth, but not the same appetite we had in the past. We're trying to see what we can learn from experiments we're doing. We are less inclined to spend time on the health insurance exchanges [for individuals and small business launching next year]. I think they're a great concept, but we're not putting our personal resources into them before we see what they look like.
Ruth Brinkley: We haven't taken a lot off the plate, but we have changed our approach and understanding to some things. We need to stay solvent and get paid in ways the system is still figuring out in the new reimbursement environment. I like to say we keep a foot in both the value and volume canoes. Keeping patients healthier is gaining more of our attention, and we're exploring the value of what health organizations are to the community. If we're the most expensive, error-prone system in the communities, we're not helping.
JP Gallagher: There aren't many bets we've made that we regret. Pivoting a bit on the question, we're engaging in some trial and error with new steps to adapt to big changes that are coming. We're focusing on the quality of our continuum of care and managing more tightly. We're looking at the role of mid-level providers and how we can relieve physicians' burden of unnecessary tasks to get a greater sense of making the most of what we have.
Paul Summerside: One thing we've pretty much given up on is getting independent physicians. We think that strategy has gone the way of the dodo for us. No more potpourris of medical staff admissions. We used to think all business was good business, but I don't think that's true anymore. We're not technically a closed medical staff, but we make no concessions to other physicians, so we're pretty much there.
Bret Baier: What advice do you have for other healthcare leaders facing the same issues you all are?
Stephen Mansfield: The complexity of today can be all consuming. It's important that all of us become cognizant of the need to care for self, family and those outside of our work circle. Because work can consume you, and it will. And it has. All of us know folks who've been on that journey. There's a lot more to it than what we do. Keep focused on the horizon.
Ruth Brinkley: Take care of your people, and that includes yourself, too. You must take care of them and enjoy the journey. You have a great opportunity to shape the future of your hospital. It'll be a couple generations before we get there. Take care of the folks now who are building the future and develop and nurture the executives of tomorrow.
JP Gallagher: Kurt Vonnegut told a college graduating class that the only advice he had based on what he knew for sure was "Wear sunscreen." There's a lot we don't know, too. Accept it, but also keep in mind that somebody's got to figure this out. If you come out with a very strong workforce, 10 years from now we'll have figured some things out and it will have worked out well.
Paul Summerside: Keep a positive mental attitude. Ask yourself in the mirror each morning, "What can I do today to make the world a better place?" And surround yourself with those people. There's no room for Eeyores. That goes for your personal life, too. Be ruthless; the bad stuff has got to go.
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