ACA repeal, change management and leading through uncertainty: 5 questions with Dr. Richard Afable, president & CEO of St. Joseph Hoag Health

The only consistent thing about the healthcare industry today is that change is constant. As health systems navigate evolving reimbursement models, workforce training and the uncertain fate of healthcare reform, leaders must maintain the ability to engage and inspire their workforces.

Richard Afable, MD, executive vice president of Providence St. Joseph Health Southern California Region Orange County/High Desert and president and CEO, of St. Joseph Hoag Health, is well practiced in change management. With more than 15 years of medical practice as a board-certified internist and geriatrician, five years as a medical school educator and 15 years as a health system executive, Dr. Afable has helped shepherd numerous individuals and organizations through various transformations.

St. Joseph Hoag Health, based in Irvine, Calif., is an integrated delivery system created by the 2013 affiliation of St. Joseph Health and Hoag Memorial Hospital Presbyterian. Prior to the creation of St. Joseph Hoag Health, Dr. Afable was president and CEO of Hoag Memorial Hospital Presbyterian in Newport Beach, Calif.

Here Dr. Afable took the time to answer Becker's five questions.

Question: What is currently your most pressing strategic imperative at St. Joseph Hoag Health? 

Dr. Richard Afable: For us, the most important goal we're pursuing is making an effective transition from a volume-based care model to embracing all elements of a value-based system. California has been home to value-based care systems for many decades, much of it led by the presence of [Oakland, Calif.-based] Kaiser Permanente for the last seven or eight decades. Managed care is alive and well on the West Coast.

At St. Joseph Hoag Health, we are well beyond the tipping point — the most significant portion of the care we deliver is value-based in some way. Some of these models have been a part of our system for more than two decades, but when you get past that tipping point where the core of your business is in value-based systems, it changes how you operate and really your entire identity as an organization.

Q: What keeps you up at night?

RA: As someone who has been in healthcare for more than 30 years and is very experienced in the way healthcare is delivered and received, I have to say I sleep pretty well. That being said, I do have concerns, and they are primarily about our caregivers. Healthcare is an industry undergoing transformation and change, and this means we are asking new things of people, which affects how they work, live and recreate.

We have almost 15,000 caregivers here in southern California, and they make up just a portion of our more than 100,000 caregivers within our larger health system, Providence St. Joseph Health. We are asking for a transformation from every individual with whom we work. What worries me is how well each caregiver can make that transition. My hope is that the effect will be positive, creative and beneficial, not only to patients but to [the caregivers]. It's my job as a leader to try to facilitate that process in the most positive and constructive way possible.

Q: House Republicans recently unveiled changes to its proposed American Health Care Act, with more changes likely to come. When it comes to an ACA replacement plan, what do you hope to see?

RA: When it comes to replacement the focus seems to be on what are perceived as the problems with Obamacare — it's inefficient and overly costly, and maybe ineffective in certain ways. I won't debate whether those issues are true or not. What I'm most concerned about with repeal and replace is the ACA has increased access and provided services to individuals who have heretofore lacked those healthcare services. It's also done another thing: It's helped people who previously had no insurance whatsoever and were living in fear as it relates to their health. We don't want anyone to be in a place where they are afraid they are sick or have a health problem but don't have access to care. The ACA at least helped people gain access and become more engaged in their health and also take more responsibility, whether we like the law or not.

If repeal and replace occurs, we need to be sure whatever is put in its place continues to or even enhances the engagement of Americans in their health and well-being so they can continue to play in active role. If [a replacement plan] does that, then I almost don't have as much concern about the efficiency, effectiveness and cost elements. I just want to make sure the gains we made in personal health and well-being will be continued.

Q: Amid all of the uncertainty around the future of healthcare reform, how do you maintain confidence and engagement among staff?

RA: One of the things we do to build confidence and engage with our caregivers is tell stories. Telling stories of the past, such as stories of our founders, and from current days help us reflect on how people care for others or illuminate how we could have done things better.

Our senior management team meetings always begin with a "safety story." This might be a story of when one of our caregivers went above and beyond to take exceptional care of a patient — an individual who maybe was having one of the worst days of their life. Or it could be a story of a time there was an error or a safety concern that resulted in a difficult situation or patient harm. We ask, what could we have done better? What could we do to further enhance our commitment and promise to take care of people?

Q: What do you think is most integral to effective change management?

RA: We live in an era of constant change. Healthcare is no different. For me, as a leader within our healthcare organization, it's about building a "coalition of the willing" — people who can gather together to commit to a common vision. We must also create an environment in which there are aligned incentives. Incentives always exist in people's lives and work, but by aligning incentives and rewards you can align actions and commitment to the mission.  

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Word from the C-suite: 'Show employees how they contribute to the bigger picture'

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