Rachelle Schultz, EdD, serves as Chief Executive Officer for Winona Health.
On April 8th, Rachelle will serve on the panel "Health System Leadership in 2020: Tools for Success" at Becker's Hospital Review 11th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place on April 6-9, 2020 in Chicago.
To learn more about the conference and Rachelle's session, click here.
Question: What, from your perspective, is the biggest challenge about the future of work for hospitals, and what can they do about it? (i.e. automation, desire for more flexibility, clinician shortages, etc.)
Rachelle Schultz: The challenges hospitals face today include long-standing issues, such as provider shortages, reimbursement pressures, and regulatory burden. Today, we can add to that shifting demographics, workforce needs, consumerism, cost of healthcare, and the impact of technological advancement – both in medical care and treatment as well as work support. Any one of these issues presents problems for a hospital to solve, however, today ALL of these are hitting simultaneously. The luxury of being able to focus on one problem and go after it seems a memory of the past. The underlying call to action in my mind is a new vision for the future that contemplates all of these factors in a new paradigm of improving health and how we deliver healthcare services. None of these challenges has a short-term solution, thus we must navigate our times with new thinking, new approaches, and a willingness to take some risk. And, in some cases, the emerging problems may actually be the solutions we need. For example, automation may provide relief for workforce shortages and release more of the human potential toward more meaningful work that is valued by our patients. Automation may also enable more flexibility and support for our physicians, clinicians and support staff. I believe there are exciting (if daunting) changes underway and we can either shape them by thinking differently and finding both/and solutions or we can be shaped by them in a “done to you” approach. Our willingness to be open and flexible with regard to the role of the hospital will matter as we go forward with an intention to create a new paradigm for improving health and delivering healthcare.
Q: How can hospitals reconcile the need to maintain inpatient volumes with the mission to keep people healthier and out of the hospital?
RS: The shift of healthcare delivery to outpatient services is past the tipping point and hospitals have experienced this shift with concern and trepidation. The reasons for this shift are many. For example, there have been significant advancements in medical and surgical care, for which we should all be grateful. Additionally, early intervention or care coordination to proactively support people in managing chronic conditions has served patients well from a health status perspective. If we step back to consider these changes, the benefits to patients are substantial. However, the impact on the hospital model, as it exists today, has resulted in financial strain. The question that hospitals must face is what does the hospital of the future look like – and it will look different than it does today. This is a fundamental question of what is the role of a hospital in the future. Inpatient needs still exist but this need occupies a different space in the healthcare ecosystem. All that said, in rural communities’ hospitals hold a unique and valued role, which can continue, but what and how that role is defined needs to be re-created. The mission of my organization has not changed during its 125 years of service to the community – but that service to the community has been transformed many times over the past century and a quarter. The current transformation is simply the work for our current physicians, leadership and staff to do. A hospital’s mission and vision are the critical touchstones during this process – not the how.
Q: Where do you go for inspiration and fresh ideas?
RS: The healthcare industry hosts any number of complicated, inflexible and byzantine processes that patients, physicians, clinicians and staff must navigate every day. It is easy to say “healthcare is different” and yet, there is a lot to be learned by other industries that have faced transformational redesign. I am fortunate to be able to connect with many organizations outside of healthcare to get a sense of possibilities – manufacturing is great for “seeing” processes real-time, banking is great for customer service as is retail, online retail is great for virtual experiences, and the list goes on. I imagine possibilities by asking questions such as, “what if Amazon sold health insurance”? Simply imagining the complete disruption of something like this provides a vision for how we need to think in a future state. The customer experience, ease of use, removing the friction of the multitude of process from the customer, etc. already exist in other service areas. To think that the healthcare industry is somehow protected from such a transformation is putting our heads in the sand. The horse is already out of the barn. Even so, I still believe that healthcare is a local experience and relationships matter. People matter. So, these other industries provide inspiration and ideas – but it is the people inside of healthcare that are going to have to respond to the burning platform. The movement must be away from thinking transformation will simply go away toward excitement about what is possible and most importantly, what will serve our patients best. It took us decades to build the system we have today and it will take time to unravel and rebuild it, and the forces of change are ensuring we do so.
Q: Healthcare has had calls for disruption, innovation and transformation for years now. Do you feel we are seeing that change? Why or why not?
RS: We have seen disruption, innovation and transformation over the years and we have all benefited from it. Think about surgical procedures that used to require a week's stay in the hospital and today those procedures are done the same day. Or advancements in cardiac care or cancer care that saves lives every day. The evolution of healthcare is full of examples of change and transformation. The difference now is that we are experiencing change that is broader-based and more systemic across the entire healthcare ecosystem. Given the wide array of change underway today, it is easy to get caught up in the immediate issues and try to address them in an old context. The result is a brief respite at best. The disruption, innovation and transformation of today, I believe, requires that we do some serious thinking about what our future state might look like and chart our paths accordingly. One of my favorite quotes is by Bill Gates where he notes, “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten.” Change is and has been a constant. Getting better at predicting, managing, or shaping that change and its impact on our organizations is something we all need to embrace.