6 questions with ProHealth Care CEO Susan Edwards

The experienced health system leader shares her thoughts about top-notch communication habits, how she keeps focus on the most pressing priorities, and why she believes credible subject matter expertise is a must-have for any organization undergoing change.

Susan Edwards became president and CEO of Waukesha, Wis.-based ProHealth Care in 2010, replacing a CEO whose tenure at the organization had spanned more than four decades. At the time of her appointment, change didn't come easily for ProHealth Care and its 4,700 employees. Ms. Edwards joined the system within months of the Affordable Care Act's passage. She quickly found herself needing to drive ProHealth Care's change-averse culture toward being more nimble and aligned.

Here, Ms. Edwards shares lessons she's learned during her time at ProHealth Care, the most pressing items on her strategic agenda for 2017, and how she works effectively with ProHealth Care's board and its employed and affiliated physicians.

Question: What success have you had in the past to implement large-scale change that other leaders can learn from?

Susan Edwards: Our organization has gone through many changes. I came on 6 years ago and replaced a CEO who had been here for 42 years. Change wasn't something that was front and center for our employees, leaders and physicians.

When dealing with large-scale change, the most important thing is being up front and open with everyone, from the board to physicians to employees. Help them understand why you're changing and what it is you're driving toward or away from. It's important to provide constant feedback to employees and physicians on where you are in the process and the successes you've had. Make it clear that you've listened to them.

We've done a lot of work around communication. When going through massive change, a lot of leaders just focus on the work at hand, getting so engaged with the change that they forget to help employees understand we're all in this together as an organization. Change is often hard for employees, and we need to thank them for their participation in the process. We also try to help employees understand how the changes we're making will impact them so they understand what the future looks like.

We do a lot of communication in person. Having our leaders highly visible is key. Also, we celebrate milestones. When we have work going on in any division — clinics, home care, hospitals, post-acute — we celebrate outcomes and engage employees so they know we recognize they've gone through something and we have a better outcome now to show for it.

The credibility of leadership and subject matter experts is also critical in engaging employees in change. I think as you start to change processes, it's important to have subject matter experts front and center because that builds credibility.

Overall, if there's one thing we've learned, it's this: The importance of ongoing, never-ending communication.

Q: What are the three most pressing priorities on your strategic agenda for 2017?

SE: I wish there were only three things.

One priority is making sure we have the right leadership for the future, the right talent to help us move from volume to value. We need individuals who understand what we have to do as an organization to make sure we're truly managing the health of populations. For example, what does that look like for healthy people or people with chronic conditions?

We need to line up talent that understands care management not only for patients but also across settings and transitions of care.

An understanding of the risk-based environment from a contractual standpoint is also a talent set we're seeking as we move to risk-based agreements. Another skill set is managing populations, in much broader terms, versus individual patients.

Secondly, we continue to focus on the economics of healthcare — dealing with rising costs and astronomical drug prices that are impacting our cost structure a great deal, and recognizing that we have to build a lot of new infrastructure to succeed in the transition from volume to value. That's been a huge issue from our perspective. We have good technology, but we need to right-size our investment and bring in different technology that will support ProHealth Care as the healthcare industry changes. Our cost structure is impacted by the need to make those investments.

The third thing is the evolution of consumerism and what that means for ProHealth Care as a provider in this marketplace. Consumerism involves retail medicine and added costs to capture patients. The whole element of virtual health is different from the way we've always done it here. "The way we've always done it" is something you used to hear quite often in this organization, but things are shifting to be much more convenient for the consumer.

Q: What, if anything, will carry over from 2016?

SE: We have a lot of things that do carry over. We're working with Prism Healthcare Partners on several initiatives over many months, including system efficiency, patient throughput and supply chain cost reduction. At ProHealth Care, we identify department leaders who are accountable for specific elements of ongoing performance improvement work. Those leaders are very engaged and collaborate with teams in the organization to build enthusiasm. Prism's subject matter experts engage ProHealth Care's department leaders as well as individual employees who are enthusiastic about discussing their work and how it can be improved. That employee expertise builds further credibility and helps achieve buy-in and better outcomes.

Furthermore, we will continue to engage physicians and people in the clinical environment to work with subject matter experts when making changes. The work we are doing is not being done to them but rather with them. They own the outcomes.

Specifically, our work on MACRA with physician reimbursement will carry over. We're making sure we understand the impact on the organization as a whole and can address any challenges that come with that. Reimbursement methodologies are changing constantly. We are doing what we can to effect positive change.

We have 450 physicians in our accountable care organization, about 190 of whom are employed. The remainder are independent. In this world, you can't really differentiate between the two with the work being done. We have a Physician Advisory Council made up of 32 employed and independent physicians, which meets monthly. It's fair to say we function as a team, working together on issues, and MACRA is a good example of that. We've done an incredible amount of communication about it.

Q: How do you maintain momentum or energy behind the priorities carried over from year to year?

SE: We're continuing to look at our priorities to make sure they're still relevant. Things change rapidly. Part of our process is to go back and really validate whether things that carry over are still the right work at the right time.

Q: Do you have any advice for leaders on how to maintain clear priorities throughout the year? How can leaders maintain uncompromised focus weeks and months from now?

SE: We try to keep things front of mind by constantly reviewing progress to understand if there is something we need to do differently. We hold each other accountable.

The senior leadership team meets weekly, and we have strategic priorities front and center on every agenda. We meet with VPs and directors every other week, then we meet with every titled leader every other month. It's really getting back to communication. We share the same agenda so everybody knows the same information.

I would say transparency really does help drive a lot of support for the work being done. You have to engage all the stakeholders in a very open, transparent way. Obviously, communication has been key to that. We don't sugarcoat things.

Q: Does your executive team and board hold any special gatherings at the end of the year to discuss the year ahead? How are priorities communicated so the entire senior leadership team and governing body is working from the same information?

SE: We have a multi-year strategic plan that is developed under the direction of the board, and within that plan we prioritize what we believe is critical for the future. We consistently go back to the board with key metrics to show what we've done to achieve those imperatives. Our board holds us accountable, but it's also a mutually open process.

In every meeting I have with the board, I have 45 minutes to talk about strategic issues that will impact ProHealth Care's future and long-term viability as an organization. I find that time so incredibly valuable. The board represents our community, and they give me a better understanding of what our community needs and wants. We talk about what's going on in the industry but more specifically about our market and how we're responding to changes. This has enabled ProHealth Care to be proactive and get ahead of the curve. It's very interactive, and we build a better mousetrap that way.

At one time, change was not very welcome in this organization. Now it's a part of who we are. We are continually evolving, and as we do so we learn more and continue to refine our focus on what we must change to thrive in the new environment.

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