6 questions with Dr. Mike Schatzlein of Ascension Health

Michael Schatzlein, MD, is a man of many hats. So many, it's a wonder he has time to wear them all.

Dr. Schatzlein has more than 40 years of healthcare experience, both as a physician and an administrator. Currently, he serves as senior vice president and group operating executive for St. Louis-based Ascension Health, as well as president and CEO of St. Vincent's HealthCare in Jacksonville, Fla. At Ascension, he oversees operational and financial performance, quality outcomes and strategic growth in the Indiana, Jacksonville and Tennessee markets, and is a leader and advocate of population health management.

At home, he is a husband, father, grandfather, music producer, remix engineer, keyboardist and trumpet player. In fact, Dr. Schatzlein joked he almost tried to become a professional trumpet player, but after hearing Wynton Marsalis play, he decided he had no hope.

He went to medical school instead.

After earning his medical degree from Indiana University, Dr. Schatzlein practiced cardiothoracic and vascular surgery from 1980 to 1994, performing the first heart transplant in northern Indiana in 1985. He has worked in the administrative side of healthcare since 1994.

Dr. Schatzlein took the time to answer some of our questions.

Note: Responses have been edited for length and clarity.

Question: How does your clinical background and experience inform your methods and strategies in your current role?

Dr. Mike Schatzlein: I have been concerned about the discontinuity in healthcare — the lack of overall coordination — since I was in practice. My desire to develop clinically integrated systems of care goes back to the 1980s and 1990s, and that is why I'm focused today on population health. I am also a student of Edward Deming, who went to Japan after World War II to help rebuild their economy. He is the father of the Toyota Way of process improvement. His principles are to reduce variation, waste and rework, though he applied these principles to manufacturing. When you do these three things in healthcare, you can lower cost and raise quality. The idea is to streamline processes to improve the consistency and quality of the outcomes, and cost goes down as a byproduct.

My second passion after population health is improving processes and safety in hospitals. If you go into an American hospital — with 300,000 preventable deaths occurring across all hospitals — and you look at all of the thousands of processes with the eye of an automotive process engineer, as well as the eye of a physician who believes in evidence-based medicine, you will be astonished. I'm overwhelmed by the opportunities to improve those processes and improve safety. My experience as a physician led me to population health as the best solution for delivery, and process improvement as the best solution for cost and quality.

Q: In your opinion, where do the greatest obstacles in healthcare lie?

MS: The obstacles in the population health arena are things most people don't talk about. It's the fact that society expects and demands more and different healthcare services than they need. If we were to magically switch to 100 percent evidence-based medicine in this country, doing only things that are shown to make people better, we would save one-third of the nearly $3 billion we spend on healthcare. Quality would go up — and the public would be in full revolt.

A symbiotic relationship between physicians and the population has developed over the last five decades. Fee-for-service reimbursement models have something to do with it, but I don't know a doctor who intentionally does unnecessary operations. But there is this push-pull going on.

For example, I'm a big fan of [rookie quarterback] Marcus Mariota of the Tennessee Titans. If he gets his knee banged up getting tackled on a Sunday afternoon, he'll get an MRI right then. That has led to every pickup basketball player who bangs his knee thinking he needs an MRI right now, too. I was told by a physician that the evidence-based treatment for that injury is six weeks of physical therapy, applied heat and an ACE™ wrap. If the patient hasn't totally recovered at the end of six weeks, then you get the MRI. And at that point, most of those people won’t need the MRI. But the demand is so high that we cave in and we do it right away. This is America — we want everything now.

Here's another example. My wife Liz and I were watching a Law & Order rerun marathon one day. It seemed like all of the commercials were for prescription drugs. One drug was for opioid-related constipation. First of all, there are far too many people consuming opioids in this country. There are people who have pain, but our opioid consumption is too high. You can only get narcotics from a doctor. If they have constipation, their doctor should figure out what to do about it. There are multiple over-the-counter solutions. Maybe the person doesn't even really need to be on the narcotic. Instead, because of these commercials, we have all of these patients demanding prescriptions for the constipation medicine. We are one of two countries to advertise prescription drugs, spending billions of dollars promoting them. We are pumping demand for unnecessary utilization.

Q: What do you believe is the single most important element of an effective population health management program?

MS: If you ask the public this one, they might not use this term, but what they indicate in surveys is navigation. They are confused by the complexity of the system. Another advantage of navigation is we can help support primary care physicians in maintaining a continuum of care that doesn't involve specialty pinball. This means the patient who doesn't just go to a heart doctor for chest pain, then to a neurologist for headaches. Those could both be appropriate, but I think it should all be organized through the primary care physician who knows the whole story about the patient. Navigators help facilitate that.

Within Ascension, we call them health partners. They do home visits, talk to folks on the phone, visit everyone when they are discharged from the hospital, make sure they understand how to take their prescriptions and get them filled and schedule a follow-up visit with the doctor. Transitions in care are where people fall through the cracks — they don't understand their discharge instructions, or they are confused about their new prescriptions from the hospital vs. all the orange bottles already in their medicine cabinet.

Q: What is your No. 1 tip for helping a team work better?

MS: Listening is important. Leaders often have strong personalities. The world moves ahead behind people who conquer territory rather than hold territory, but you can never be the smartest guy in the room about everything.

I think mentoring is very important in developing people. That is one of my passions in healthcare — identifying people with talent and helping them discover their strengths and develop them in areas of developmental need.

Q: What book has most influenced your professional journey?

MS: The Kindle is a great thing for me because I can get three or four books going at a time. Nonfiction can be tough. I'm rereading Winston Churchill's account of World War II. It's very interesting, but I need to take breaks from it with novels because it's so detailed. It's fascinating, but sometimes you just want to read Gone Girl.

A relatively obscure book that's influenced me is What it Takes by Richard Ben Cramer, about multiple candidates from the 1988 presidential campaign. It follows Republicans and Democrats starting from their decision to get into the primaries and through the general election. It's interesting because you get several biographies plus some history in one book. I learn a tremendous amount from biographies.

Q: As a music lover, what is your favorite music-related memory?

MS: I've become friends with Ben Folds and I was able to be there when he recorded his most recent CD. He wrote a concerto for piano and orchestra, which premiered with the Nashville Symphony. My younger son, who is a grad student at Purdue, came down for it, and Liz and I went with him to the concert. Later, I got to be in the control room when it was recorded. On the other half of the CD, Ben is searching for the next genre of music. He is tremendously creative. He found an eclectic group of classical musicians who play a unique combination of instruments and recorded with them. That's what I'm into now. 

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