Becker's Speaker Series: 4 questions with Banner-University Medical Center Phoenix CEO Dr. Steve Narang

Steve Narang, MD, has served as CEO of Banner-University Medical Center Phoenix since 2013.

Previously, Dr. Narang served as CMO at Banner Children's at Cardon Children's Medical Center in Mesa, Ariz. Before that he held several medical director and teaching positions in Narang Steve headshotLouisiana, including medical director of graduate medical education and medical director of pediatric emergency services at Our Lady of the Lake Regional Medical Center in Baton Rouge.

In addition to his current role, Dr. Narang is founder and medical director of the American Academy of Pediatrics-Value in Pediatrics National Quality Improvement Collaborative Network. He is also a member of the executive board of the quality committee at the Arizona American Academy of Pediatrics Committee. Dr. Narang earned his medical degree from Northwestern University Medical School in Chicago and completed a residency in pediatrics at Johns Hopkins Hospital in Baltimore. He received a master's in healthcare management from Harvard University in Boston.

On Wednesday April 19 at 3:05 p.m., Dr. Narang will deliver a presentation called "Using Clinical Process Redesign and Quality Improvement to Improve Financial Performance of an Academic Medical Center" at Becker's 8th Annual Meeting in Chicago.

To learn more about the conference and Dr. Narang's presentation, click here.

Here, Dr. Narang took the time to answer Becker's four questions. Responses have been lightly edited for length and clarity.

Question: Before becoming CEO of Banner-University Medical Center in 2013, you served as CMO at Banner Children's at Cardon Children's Medical Center. What types of advantages does your experience as a CMO and as a clinician lend you in your current role?

Dr. Steven Narang: Having spent 15 years as [a] busy clinical provider and then five years with progressive leadership responsibilities in the areas of patient safety and clinical quality, there is no doubt in my mind that the only way we can successfully redesign healthcare to be more affordable and accessible is to have frontline 'clinical provider-led teams' redesign clinical delivery to ensure that we reduce overuse, misuse and underuse of resources.  

It is estimated that 70 percent of all healthcare costs are driven by decisions made by the provider. Thus, healthcare transformation can only be successful if led by experienced clinical leaders. My own experience as a medical director of quality and then as a CMO reinforced to me that we can never truly deliver 'value-based healthcare' if [we] don't lead at the 'intersection' where financial, operational and clinical quality goals all meet together to support consumers' needs. I ask our providers every day to lead courageously at these intersections, supported by experts from finance, operations, process engineering, etc., to align structures, systems and strategies to ensure every patient receives the right care for the right reason at the right time, place and cost. 

I do believe that as a practicing clinician, a physician executive, and now as a CEO, it has become easier for me to translate what 'better care' looks like from a financial and operational perspective.

Q: How do you maintain optimism and engagement among staff despite the tumultuous and uncertain future of healthcare reform?

SN: There is no doubt, with the uncertainty of healthcare reform, declining reimbursement, increasing expenses and declining hospital admissions, that all healthcare organizations are beginning to re-invent their businesses and learn how to 'do more with less.' At the same time, we all know that the delivery of healthcare is clearly more than a business, as there is truly no way one can quantify economically the care of a human being's health. 

Thus, with this context, every day in my leadership journey, I am reminded by Simon Sinek's quote, 'People don't buy what you do; they buy WHY you do it.' It is the message that drives me to connect with each and every one of our 3,600 staff employees and over 1,000 active medical staff. Through every day conversations, daily blogs, quotes of the week and attending staff huddles and meetings, my personal focus in simple: connect authentically with each and every single person who has joined us in this journey.   

My conversations always focus on understanding who each individual truly is and why he or she is here, versus what he or she does in the organization. I see my personal role in this organization to simply reinforce a culture focused first on understanding one another's passions and [fostering] relationships. Then we can focus on improving how we care for each other so we can deliver compassionate and better care to our patients every day. The only way I know how to help lead this culture is to be myself, be visible, be vulnerable and be curious. I also always remind myself every day that there is no such thing as the 'right answer,' as there is always another 'right answer.' Healthcare delivery is too complex and too personal to do it any other way.

Q: What is the first key step hospital leaders must take when they identify the need to launch clinical process redesign and improve quality?

SN: Start with why. It's that simple. Too often, healthcare administrators launch quality improvement programs in a top-down, highly directive approach focused on a regulatory report on the institution's performance in terms of clinical quality, cost or patient safety. Too often, these initiatives are led by the C-suite and are focused on short-term success. Too often, these programs are narrowly focused on the 'what' instead of the 'who' and the 'why.' 

Improving quality is clearly not the job one of one department or one person. Clinical quality improvement has to be embedded as part of an organization's genuine culture.  Cultural change only happens with alignment of structures and strategies and must be led at the front line, driven genuinely by a belief that better is possible. Simply put, the first step in any successful program to lead clinical quality is to establish a structure of thought leaders led by providers whose 'why' around improvement resonates so clearly and so passionately, it will impossible not to follow. As soon as those individuals are identified and organized in a governing structure, the magic can begin.

Q: How could embarking on process redesign better position a hospital for success under value-based reimbursement?

SN: Regardless of the ambiguity associated with the future of the ACA, most healthcare industry experts have no doubt that we simply cannot afford to deliver healthcare in the current cost structure. Payment for value versus volume is here to stay, and coupled with the impact of consumerism on our healthcare economy, there is no doubt that the industry has to be re-invented. I often joke with my colleagues that in this rapidly transforming healthcare system, as a hospital CEO I am in danger of being the CEO of the next Blockbuster Video or Staples, versus the CEO of Amazon or Apple. Clearly, the most expensive aspect of healthcare delivery occurs in the four walls of a hospital, and as hospital leaders, we must proactively lead the redesigning of our own care delivery models or risk being left out in a highly disruptive marketplace. 

Hence, as we look at our own clinical process redesign initiatives at Banner-University Medical Center Phoenix, we rarely use the word 'hospital' as that is too limiting. Our vision, structures and strategies are focused on the care of patients across the continuum and on a set of patient-centered conditions, such as cardiovascular, neuroscience and digestive health, and redesigning the care delivery model so that patients can easily access and navigate care seamlessly across different settings to optimize their personal health. If our design successfully puts patients in the center of this model, we will reduce waste in our processes and align structures and systems, so that patients easily find themselves in the right care setting at the right time. Moreover, because the 'focused factory' has been redesigning itself to deliver care more effectively and efficiently, patients will receive safer and more affordable care, as the continual redesigning of care processes in a high volume 'focused factory' can only lead to a decrease in per-unit cost of care. This journey is critical to position the medical center to thrive, even in a population healthcare model, where hospitals may eventually evolve into cost-centers. 

Ultimately, the re-invention of the complex, high-cost academic medical center to ensure that its value proposition is well aligned with improving the health of a population must happen. There is no more time to wait. Our industry cannot afford to.

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