Strong leadership is essential for any successful organization. In healthcare, this principle is perhaps amplified because of the challenging environment hospitals and health systems now operate in. Hospital and health system leaders often run into similar barriers, but rarely do they get an opportunity to share their strategies for overcoming these challenges and discuss ideas for moving forward.
To provide an opportunity for health system CEOs to share successes and frustrations, Becker's Hospital Review facilitated a conversation between Sandra Bruce, president and CEO of Chicago-based Presence Health, and Deborah Proctor, president and CEO of Orange, Calif.-based St. Joseph Health. Below are Ms. Proctor's questions, Ms. Bruce's responses and Ms. Proctor's follow-up responses.
Deborah Proctor: How do we partner with other healthcare providers in this new environment? What skills do you draw on?
Sandra Bruce: Establishing solid partnerships with other providers in this new environment is critical and we are doing so in a variety of ways. For example, we may partner with other hospitals in our supply chain efforts to help reduce supply costs further or we may seek other partners to become part of our clinical integration model.
Partnering and aligning with physicians has always been important, but in the new era ofhospital-physician alignment, it is essential. The emergence of new care models such as clinical integration and accountable care organizations depends on strong partnerships as payment moves to a lump fee that is allocated across the ACO. As managed care payments move from fee-for-service to value-based care, there are also payment incentives that are tied to clinical outcomes such as preventable hospital readmissions.
We also continue to look for participants to become part of our clinical integration entity — Presence Health Partners. Clinical integration is a meaningful provider alignment vehicle to retain high-caliber physicians while attracting new independent physicians, especially primary care. The model provides an alternative to employment and offers physician participants a robust resource of technology, care management, reporting and analytics capabilities that will be necessary for physicians to meet the new demands of accountable care and population health management.
And, finally, there is a need for us to partner with our community. Population health management is focused on improving the health of our communities by focusing on better chronic disease management and preventive care. This new environment requires hospitals and health systems to reach beyond the brick and mortar of our facilities and work to empower patients with the tools to help them stay well.
The skills essential to the success of these partnerships are collaboration and negotiation. Healthcare has lived in silos for many years, but this new emerging healthcare environment requires us to develop and strengthen relationships among healthcare providers, payors and physician partners.
DP: I couldn't agree more that partnerships are going to shape our future. Similar to Presence, we are seeking stronger partnerships with our physicians. Our efforts in clinical integration have intensified over the past several years not just out of the necessity to align with reform, but because we understand that patients are most interested in seamless, less fragmented healthcare. They want systems that talk to one another and care that flows easily from the hospital to doctors' offices to other healthcare resources within their communities.
Over the next several years, our intent is to develop a true network of healthcare that includes acute-care hospitals, physicians, home health, skilled nursing and other healthcare providers. This will be a network based on partnerships, not always ownerships. We're going to have to learn to be better members of highly coordinated healthcare teams.
Additionally, we have already realized the potential of developing never-before imagined partnerships. Our planned affiliation with Hoag Hospital in Southern California is a good example of such an opportunity. After several decades, we began to recognize the benefits of the two health systems becoming potential affiliates. When we announced our plans last August, people in our communities were extremely positive. Many have told me they are excited about the prospects of two outstanding providers finally coming together for the good of the community. That's a much different way of operating, but it bodes well for the new environment.
DP: Where would you like to take your organization beyond the hospital setting? What business leaders outside healthcare fascinate you?
SB: Healthcare must move quickly and aggressively into the ambulatory space. The healthcare delivery model of today was developed primarily for treating patients with infectious disease, trauma and serious illness. To be effective today, the model needs to become more focused on prevention/wellness and chronic disease management. It also needs to move beyond the physical, more traditional healthcare settings that have been established and begin to utilize more telehealth functions that allow for more remote health monitoring capabilities to ensure the most consistent and effective disease management for patients.
Some business leaders outside of the healthcare setting that I find most intriguing are the 20-to-30-something tech industry entrepreneurs. I'm amazed at the tremendous success of entrepreneurs like Mark Zuckerberg. The innovative thinking and persistent approach paid off for the 19-year-old start-up entrepreneur who co-founded what is now the largest social-networking site in the world. Along the same lines, I have always been impressed with the vision that Steve Jobs possessed as he created products that clearly met the needs of consumers before they even realized they had the need. He truly met the customer expectation like no one ever has been able to achieve.
DP: I agree that being a leader in the wellness category is going to be essential for us as healthcare providers. We must have a presence where people live and work. That means establishing ourselves in retail settings as well as at the workplace. To prepare for this shift, we've concentrated on developing wellness programs for our own staff over the past few years, with the intention that if we can get it right with our own teams, we can help others. So far, we've done very well. Our wellness program has about 80 percent participation. We've learned that it takes a solid program, committed leadership and significant communication to make these types of efforts really work.
As for leaders that fascinate me, I will always hold among my greatest role models the women religious — the Sisters who provide great business and spiritual guidance. They are the mission; they are servant leaders first and foremost and they have always served those with the greatest need while managing successful endeavors.
DP: What three qualities must a healthcare system leader have?
SB: First, a healthcare system leader must have the ability to manage in a fast-paced, ambiguous environment. At times, the end point may not be clear and the path to get there may be undefined as well. This ever-evolving environment requires leaders to be flexible and collaborative.
Second, a health system leader must have the ability to create a management structure that is both top-down and bottom-up. By this I mean it must be both hierarchical and collaborative in order to maximize cross-functionality to work efficiently and effectively.
Third, a healthcare system leader must have the ability to embrace evidence-based decision making from both a clinical standpoint and a business perspective. This requires a culture shift from basing decisions on what we think to basing decisions more on data and what we know.
DP: Personally, I've been inspired by contemporary theologian Gerald Arbuckle who writes about the need for "prophetic leaders" who understand mission and can imaginatively and collaboratively ensure it endures in these transformative times. That's not an easy task, and I remind myself daily of the qualities that Arbuckle outlines for a "prophetic leader:" memory of the great traditions, creativity, orientation toward the community, steadfastness in commitment, patience in adversity, humility, a sense of humor and the ability to recognize what people lose during a time of rapid change. Okay, that's more than three qualities. However, these are awesome characteristics for a leader, especially in a faith-based organization like ours. These qualities encapsulate that great balance we must achieve between honoring our traditions and working with others to shape a positive future.
DP: Realistically, how do we transform when faced with such drastic cuts in reimbursement?
SB: There are no other options for healthcare systems except to transform the care delivery model. We need to establish greater innovation around patient, resident and family-centered care. We must operate with greater efficiency with even higher standards for quality and safety. Physician alignment and accountability for the health and wellness of our communities are essential. U.S. healthcare must reduce the cost to growth rate to no more than the nation's Gross Domestic Product. Estimates now show that healthcare spending could reach 20 percent of the U.S. economy by 2021.
DP: Sandra is absolutely right. We don't have other options except change. As healthcare providers, our focus must be on quality and value. Two years ago, our organization developed an initiative called The Value Imperative which calls upon our key functional areas to identify those activities that can be performed more efficiently and, in doing so, provide greater value to those we serve. When we started, there were those who said pursuing efficiency, quality and value would require trade-offs. Yet, our teams have proven just the opposite. Working together, they have found innovative ways to transform healthcare so that we spend less and increase the value of services we provide.
DP: How much time do you spend driving cultural change?
SB: A significant portion of my time is focused on driving cultural change and that will continue for the next several years, particularly as we continue to create this new organization in an industry that is essentially being turned upside down. To succeed in this new environment, attributes of the new culture will need to be focused on continual performance improvement, data driven decision-making and moving to a model of care that is more patient centric rather than business centric.
DP: I spend the majority of my time focused on nurturing our culture, as well as nurturing the next leaders of our organization who will be part of the great changes underway. We are fortunate to have a strong culture at St. Joseph Health which is steeped in the values and traditions of the Sisters of St. Joseph of Orange. However, even a strong culture must evolve with the times, and that's where leadership becomes extremely important. My challenge is to transform this rich and values-based culture so that we can maintain our basic principles and still address the needs of the new environment. Similar to Sandra, we are focused on performance improvement, physician engagement and a model that puts the patient — and the communities where they live — at the core of our efforts. To drive such change, I am well aware that we must be intentional, respectful and foresighted — not always an easy combination, but a way of moving forward that I expect from myself and my leadership team.
In closing, I want to thank Sandra for not only having this conversation, but for being a great colleague and remarkable leader in healthcare. Thanks, too, to Becker's for facilitating this dialogue. How wonderful that we can learn from one another in these types of discussions.
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To provide an opportunity for health system CEOs to share successes and frustrations, Becker's Hospital Review facilitated a conversation between Sandra Bruce, president and CEO of Chicago-based Presence Health, and Deborah Proctor, president and CEO of Orange, Calif.-based St. Joseph Health. Below are Ms. Proctor's questions, Ms. Bruce's responses and Ms. Proctor's follow-up responses.
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| Sandra Bruce |
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| Deborah Proctor |
Sandra Bruce: Establishing solid partnerships with other providers in this new environment is critical and we are doing so in a variety of ways. For example, we may partner with other hospitals in our supply chain efforts to help reduce supply costs further or we may seek other partners to become part of our clinical integration model.
Partnering and aligning with physicians has always been important, but in the new era ofhospital-physician alignment, it is essential. The emergence of new care models such as clinical integration and accountable care organizations depends on strong partnerships as payment moves to a lump fee that is allocated across the ACO. As managed care payments move from fee-for-service to value-based care, there are also payment incentives that are tied to clinical outcomes such as preventable hospital readmissions.
We also continue to look for participants to become part of our clinical integration entity — Presence Health Partners. Clinical integration is a meaningful provider alignment vehicle to retain high-caliber physicians while attracting new independent physicians, especially primary care. The model provides an alternative to employment and offers physician participants a robust resource of technology, care management, reporting and analytics capabilities that will be necessary for physicians to meet the new demands of accountable care and population health management.
And, finally, there is a need for us to partner with our community. Population health management is focused on improving the health of our communities by focusing on better chronic disease management and preventive care. This new environment requires hospitals and health systems to reach beyond the brick and mortar of our facilities and work to empower patients with the tools to help them stay well.
The skills essential to the success of these partnerships are collaboration and negotiation. Healthcare has lived in silos for many years, but this new emerging healthcare environment requires us to develop and strengthen relationships among healthcare providers, payors and physician partners.
DP: I couldn't agree more that partnerships are going to shape our future. Similar to Presence, we are seeking stronger partnerships with our physicians. Our efforts in clinical integration have intensified over the past several years not just out of the necessity to align with reform, but because we understand that patients are most interested in seamless, less fragmented healthcare. They want systems that talk to one another and care that flows easily from the hospital to doctors' offices to other healthcare resources within their communities.
Over the next several years, our intent is to develop a true network of healthcare that includes acute-care hospitals, physicians, home health, skilled nursing and other healthcare providers. This will be a network based on partnerships, not always ownerships. We're going to have to learn to be better members of highly coordinated healthcare teams.
Additionally, we have already realized the potential of developing never-before imagined partnerships. Our planned affiliation with Hoag Hospital in Southern California is a good example of such an opportunity. After several decades, we began to recognize the benefits of the two health systems becoming potential affiliates. When we announced our plans last August, people in our communities were extremely positive. Many have told me they are excited about the prospects of two outstanding providers finally coming together for the good of the community. That's a much different way of operating, but it bodes well for the new environment.
DP: Where would you like to take your organization beyond the hospital setting? What business leaders outside healthcare fascinate you?
SB: Healthcare must move quickly and aggressively into the ambulatory space. The healthcare delivery model of today was developed primarily for treating patients with infectious disease, trauma and serious illness. To be effective today, the model needs to become more focused on prevention/wellness and chronic disease management. It also needs to move beyond the physical, more traditional healthcare settings that have been established and begin to utilize more telehealth functions that allow for more remote health monitoring capabilities to ensure the most consistent and effective disease management for patients.
Some business leaders outside of the healthcare setting that I find most intriguing are the 20-to-30-something tech industry entrepreneurs. I'm amazed at the tremendous success of entrepreneurs like Mark Zuckerberg. The innovative thinking and persistent approach paid off for the 19-year-old start-up entrepreneur who co-founded what is now the largest social-networking site in the world. Along the same lines, I have always been impressed with the vision that Steve Jobs possessed as he created products that clearly met the needs of consumers before they even realized they had the need. He truly met the customer expectation like no one ever has been able to achieve.
DP: I agree that being a leader in the wellness category is going to be essential for us as healthcare providers. We must have a presence where people live and work. That means establishing ourselves in retail settings as well as at the workplace. To prepare for this shift, we've concentrated on developing wellness programs for our own staff over the past few years, with the intention that if we can get it right with our own teams, we can help others. So far, we've done very well. Our wellness program has about 80 percent participation. We've learned that it takes a solid program, committed leadership and significant communication to make these types of efforts really work.
As for leaders that fascinate me, I will always hold among my greatest role models the women religious — the Sisters who provide great business and spiritual guidance. They are the mission; they are servant leaders first and foremost and they have always served those with the greatest need while managing successful endeavors.
DP: What three qualities must a healthcare system leader have?
SB: First, a healthcare system leader must have the ability to manage in a fast-paced, ambiguous environment. At times, the end point may not be clear and the path to get there may be undefined as well. This ever-evolving environment requires leaders to be flexible and collaborative.
Second, a health system leader must have the ability to create a management structure that is both top-down and bottom-up. By this I mean it must be both hierarchical and collaborative in order to maximize cross-functionality to work efficiently and effectively.
Third, a healthcare system leader must have the ability to embrace evidence-based decision making from both a clinical standpoint and a business perspective. This requires a culture shift from basing decisions on what we think to basing decisions more on data and what we know.
DP: Personally, I've been inspired by contemporary theologian Gerald Arbuckle who writes about the need for "prophetic leaders" who understand mission and can imaginatively and collaboratively ensure it endures in these transformative times. That's not an easy task, and I remind myself daily of the qualities that Arbuckle outlines for a "prophetic leader:" memory of the great traditions, creativity, orientation toward the community, steadfastness in commitment, patience in adversity, humility, a sense of humor and the ability to recognize what people lose during a time of rapid change. Okay, that's more than three qualities. However, these are awesome characteristics for a leader, especially in a faith-based organization like ours. These qualities encapsulate that great balance we must achieve between honoring our traditions and working with others to shape a positive future.
DP: Realistically, how do we transform when faced with such drastic cuts in reimbursement?
SB: There are no other options for healthcare systems except to transform the care delivery model. We need to establish greater innovation around patient, resident and family-centered care. We must operate with greater efficiency with even higher standards for quality and safety. Physician alignment and accountability for the health and wellness of our communities are essential. U.S. healthcare must reduce the cost to growth rate to no more than the nation's Gross Domestic Product. Estimates now show that healthcare spending could reach 20 percent of the U.S. economy by 2021.
DP: Sandra is absolutely right. We don't have other options except change. As healthcare providers, our focus must be on quality and value. Two years ago, our organization developed an initiative called The Value Imperative which calls upon our key functional areas to identify those activities that can be performed more efficiently and, in doing so, provide greater value to those we serve. When we started, there were those who said pursuing efficiency, quality and value would require trade-offs. Yet, our teams have proven just the opposite. Working together, they have found innovative ways to transform healthcare so that we spend less and increase the value of services we provide.
DP: How much time do you spend driving cultural change?
SB: A significant portion of my time is focused on driving cultural change and that will continue for the next several years, particularly as we continue to create this new organization in an industry that is essentially being turned upside down. To succeed in this new environment, attributes of the new culture will need to be focused on continual performance improvement, data driven decision-making and moving to a model of care that is more patient centric rather than business centric.
DP: I spend the majority of my time focused on nurturing our culture, as well as nurturing the next leaders of our organization who will be part of the great changes underway. We are fortunate to have a strong culture at St. Joseph Health which is steeped in the values and traditions of the Sisters of St. Joseph of Orange. However, even a strong culture must evolve with the times, and that's where leadership becomes extremely important. My challenge is to transform this rich and values-based culture so that we can maintain our basic principles and still address the needs of the new environment. Similar to Sandra, we are focused on performance improvement, physician engagement and a model that puts the patient — and the communities where they live — at the core of our efforts. To drive such change, I am well aware that we must be intentional, respectful and foresighted — not always an easy combination, but a way of moving forward that I expect from myself and my leadership team.
In closing, I want to thank Sandra for not only having this conversation, but for being a great colleague and remarkable leader in healthcare. Thanks, too, to Becker's for facilitating this dialogue. How wonderful that we can learn from one another in these types of discussions.
More Articles on Transforming Healthcare:
AHA Report Calls on Hospital Boards to Help Transform HealthcareHow Healthcare Can Achieve A Fundamentally Different Future: Q&A With the Authors of "Healthcare at a Turning Point"
5 Ways Population Health is Transforming Hospital Strategy