Becker's CEO + CFO Roundtable 2019: 3 Questions with Jeffrey Balser, President and Chief Executive Officer at Vanderbilt University Medical Center; Dean of Vanderbilt University School of Medicine

Jeffrey Balser, MD, PhD, serves as President and Chief Executive Officer at Vanderbilt University Medical Center and Dean of Vanderbilt University School of Medicine. 

On November 11th, Dr. Balser will give a presentation on "The Future of Academic Medicine: How to Monetize Expertise, Diversify Revenue and Advance Clinical Innovation" at Becker's 8th Annual CEO + CFO Roundtable. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place November 11-13, 2019 in Chicago.

To learn more about the conference and Dr. Balser's session, click here.

Question: What is the single most important thing you need to do in your role? (Ie: What do you have to be great at?)

Jeffrey Balser: The most important thing by far is communication. I like to think of my role as tending a garden with 25,000 brilliant, creative, driven people who are always trying to excel and grow and really want to understand where we’re headed. I find the biggest challenge in such a large and diverse organization is helping everyone to understand not only “what” we are doing, but the all-important “why.”

My three favorite words for clear communication are “always check-in.” Because what I find is whenever I think I’m doing a great job of communicating, even when people show facial expressions that suggest understanding, when I take the time to check in later, so often the message hasn’t really come through in the way I intended. Regardless of your role at VUMC, whether we are communicating with patients, our colleagues at work, or both, it’s critical to always check-in. Doing so builds relationships and understanding. And people always appreciate it.

Q: There is a lot to improve upon in healthcare. Of the many issues that hold your attention, what is the one you consider exceptionally imperative and urgent?

JB: It’s undoubtedly the waste in the system. The rising cost of healthcare can be attributed to many things, but nearly all analyses show that the most significant driver of healthcare cost is waste. Whether it’s duplicate or unnecessary tests, drugs or procedures, systems that are not interoperable or don’t provide information in a manner that lets us share information across geography and over time, or overly-burdensome administrative overhead we impose on ourselves, the costs likely exceed $1 trillion each year in our country alone.

It’s important that as a nation we make progress on the lightning rod issues such as health insurance reform — but in my view, we’re also missing the forest for the trees. Waste is all around, often residing in decades-old systems and processes that haven’t really changed in 50 years, and aren’t optimized for what we now understand could be standardized to conform to the latest evidence-based and accepted standards. The goal is never to eliminate true conscious variability – decisions clinicians are making to tailor care to the needs of the individual patient. Rather, we need to eliminate unconscious variability – the more-or-less automatic and reflexive ways we make choices in healthcare that are inefficient and add cost.

At VUMC, we have begun tackling the issue in at least two ways: by implementing patient-centered care models, supported by information systems that help us streamline and standardize many of the complex features of care for some our most complicated and expensive adult and pediatric patients; and by using a combination of health IT and process optimization to reduce the unconscious variability in drug and diagnostic test ordering. Using these processes for inpatient drug ordering alone, we’ve been able to save at least $35 million each year relative to the industry median.

There is almost unlimited opportunity when it comes to reducing waste. Everyone engaged in the healthcare system – providers, payers, pharmaceuticals companies, supply vendors, and patients – must commit to working together to address and cut out this “low-hanging fruit” that is within our control, as we continue to tackle the thornier and politically-charged issues affecting our patients.

Q: Healthcare leaders today need skills and talents that span beyond those emphasized during formal training and higher education. What is one specific competency that you learned or sharpened in real life?

JB: As leaders in healthcare, we manage rapidly evolving trends, from new reimbursement policies to massive technology shifts – and the rate of change promises to only accelerate. Leadership in this whirlwind requires a mind conditioned to constant learning. What I know today is simply not enough for success tomorrow. Even though the leadership of these large organizations at times feels like a battle-stations kind of experience, to succeed over the long run we need to hold onto our child-like wonder and eagerness to know more and more every day.

At VUMC, we’ve begun to evolve our training programs to not only focus on the disciplinary content, but also on building the skills and attitudes that will support lifetime learning. This ethos spurred a redesign seven years ago in our School of Medicine curriculum, one we call Curriculum 2.0, aimed at preparing healthcare leaders to not only keep up but lead the rapid changes in our industry. It is vital that the next generation of healthcare leaders not only embrace innovation but condition themselves to constantly look over the horizon with a sense of wonder.

When trainees ask me what advice I have after 10 years as VUMC’s leader, I tell them it’s all about humility and being aware every day that you are learning and growing – and if you ever forget that, you’re done!

Executive Officer, Executive
Director, The Permanente
Medical Group (TPMG);
President and Chief Executive
Officer, Mid-Atlantic Permanente
Medical Group (MAPMG);
Co-CEO, The Permanente
Federation LLC

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