Arguably, all health systems strive for greatness, be it in their community, region, nation or even worldwide. At the Becker's Hospital Review 6th Annual Meeting in Chicago May 7, four health system executives discussed how to continue down the road of excellence and some mistakes and surprises they have encountered along the way.
The panelists included June Komar, corporate executive vice president of strategy and administration for San Diego-based Scripps Health, Randy Oostra, president and CEO of Toledo, Ohio-based ProMedica, J.P. Gallagher, COO of NorthShore University HealthSystem in Evanston, Ill., and Kate Walsh, president and CEO of Boston Medical Center.
Questions were posed by Chuck Lauer, the former publisher of Modern Healthcare and an author, public speaker and career coach.
The following is an excerpt from the panel discussion, with responses lightly edited for length and clarity.
Question: Once your system has gained success, how do you continue on the road to excellence?
J.P. Gallagher: We are a very measurement-driven organization. We tend to look at things in three buckets. The first one is loyalty. We are trying to move away from focusing on patient satisfaction to forming deeper relationships with patients that transcend single interactions. Also in this bucket is employee loyalty, which is a strong indicator of long-term success. The second indicator is quality. We started by tracking outcomes against CMS core measures, and now we have expanded to somewhere north of 70 measures. The third bucket is financial stability. We continuously look to see how we are managing the entire enterprise, including looking at productivity, how well we use resources, and now we are trying to use predictive analytics to apply resources more effectively.
June Komar: We have a long history of success but 15 years ago we were in a meltdown. Our move back to a successful position was all about our physician relationships. We work hard every day to engage physicians fully as partners. They literally can bring your system down, but when they're with you, there's nothing you can't do together. We also really take care of our employees and give them some sense of stability in a changing world. We help them understand their own contribution to patient care and try to engage deeply with them. We also build up an accountability culture. At Scripps, you will be here to miss your targets once, but not twice.
Randy Oostra: We're a community-based system, and we have 500 board members — we keep boards in every hospital. Our approach to quality is to look at the total performance score for Medicare. We have taken that approach as a system — since that's how we're getting paid and rated, that's what we should focus on. We have a focus on engagement scores and looking at physician and patient engagement. And something we've been passionate about recently is addressing social determinants of health.
Kate Walsh: We operate under a framework that is a quest for quality. Employee satisfaction and engagement, as well as patient satisfaction, have been struggles and a challenge for us. We have made a significant investment in team training to create a safer environment for our patients. Healthcare is an industry where you are rewarded for the more time you spend practicing.
Q: As your system has grown, what are some mistakes that were made that you feel could have been avoided?
JPG: Certainly, no organization is perfect. Where I feel like I've tripped has been in communication. All of us have to navigate change and work with imperfect information and still lead as effectively as we can. I have underestimated the need to communicate and make people understand how we are approaching a situation, and also be able to pivot and be open to feedback and change paths. I don't regret many mistakes because you learn the most and recognize you can recover after mistakes, and this is a key determinant of success. In our market, we are going through a lot of change and transition toward risk-based reimbursement on broader platform.
JK: It would be that we missed the opportunity to fully engage everyone we could. So many people want to do the right thing in healthcare. Just really figuring out what your employees need to be able to make you successful. Give tools to employees to continuously improve to get the costs down. We have learned, should have done it faster, get everyone rowing and then in the same way. Spend our time working at that. HC systems are very diverse. Not everyone reports to the CEO. Make sure that folks share a mission and give them the tools to engage,
RO: A lot of it comes down to communication. The other thing is every community is different. When you think about the people you serve, it's wrong to sometimes think that one thing works for one community or a cut of community, it will work everywhere. If you're not relating to all groups, you don't get the opportunity to communicate your message and do things in the right level. When we failed, it fell to lack of communication and not respecting the community, no matter how big or small.
KW: First, Massachusetts is about seven years ahead of the country in terms of reform. But then suddenly there was competition for our patients. As utilization drops, people are happy to have Medicaid patients over empty beds. We have had to earn our patients back when we thought they would always just come.
The Medicaid population is the fastest growing. In our business, we must figure out how to provide care within that payment envelope and figure out how to reach people before they get sick. Many low income people have moved out to small cities and towns. We need new strategies for each them instead of expecting them to come to us.
Q: What are some surprises that have occurred as you grew and became successful?
JPG: I didn't see the ACA coming. However, looking at the pace of changes of systems being put in place are still very slow in their evolution, but trying to move and be prepared for something new is a reality that we need to embrace and is critical.
JK: I think the rate of change in the industry is pretty breathtaking. We're being challenged tremendously by people who are in completely different industries than us, like retail pharmacy. They are very aggressive. A lot of people in the private sector know about convenience and access and they build systems to deliver healthcare based on those principles. It's been a change for us, in that we don't control healthcare, we are competing. People want to come in and compete with us and that is surprising.
RO: I'm shocked about the cost of health IT. I can't get over that. Also it would be that we got interested in obesity and in hunger. We screen all patients for hunger, provide short term food needs. And we're building housing, and we're in a joint venture for mental health. We're looking at things we never looked at before.
KW: The biggest is just how hard it is to move our patient satisfaction scores. Our other one is just how slow the rate of change actually is despite how breathless we all feel. We talk a lot about how pay is reforming, but I don't know a system that is not still on fee-for-service.