'Culture really does start at the top': St. Luke Health's CEO Dr. David Pate reflects on his decadelong tenure

David Pate, MD, president and CEO of Boise, Idaho-based St. Luke's Health System, is stepping down in January after leading the health system 10 years. Here, he discusses key lessons learned as leader of the nonprofit, how St. Luke's has positioned itself for success and why efforts must turn to disease prevention in the next decade.

Question: What do you consider your biggest accomplishment as president and CEO of St. Luke's Health System?

Dr. David Pate: As I reflect back, there are really three things that I feel have been critical accomplishments that have positioned St. Luke's Health System for success well into the future. First, we have evolved from a confederation of hospitals to a truly integrated health delivery system in which our patients are benefiting from the efficiency, quality and safety gains that are achieved through the functions of a true system. Second, we have achieved a national leadership position in quality and safety that has resulted in saved lives and avoided complications. Third, we have successfully navigated a business model transformation to the point that one-third of our revenues are in global risk arrangements. Of these, I am most proud of our quality and safety achievements.

Q: What is one leadership lesson that has stuck with you over the course of your tenure?

DP: Probably the most important is that culture really does start at the top, with me and the board, but I have to make sure that every leader is driving the kind of culture we want in their departments and areas.

Q: What is one thing you wish you had known when you became leader of the health system?

DP: I wish I had known more about the social determinants of health and ways to make a meaningful improvement in those determinants for the communities we serve.

Q: What have been the biggest changes in healthcare since you stepped into the top post at St. Luke's, and how did you ensure the health system weathered those changes successfully?

DP: The biggest changes have been the enactment and implementation of the Affordable Care Act; the adoption of EHRs; the increase in the number and scope of practice of advanced practice providers; the emergence of telehealth and digital health; the development of augmented reality, machine learning and artificial intelligence; the use of gene therapy and the increasing transition of services that previously required inpatient treatment to outpatient settings, including, in some cases, patients' homes; the development of automation in healthcare, from the use of robotics in surgery and pharmacies to the use of chatbots for the treatment of depression; and the emergence of many would-be disruptive innovators, especially from private equity and venture capital firms.

Our success in navigating all these changes has been multifactorial — hiring the best and brightest leaders, not necessarily with the most experience, but with the best attitude, aptitude and innovative thinking; empowering and developing physician leaders; a strong focus on effective strategic planning that is reviewed and updated annually, with broad engagement and an office of strategic results to oversee implementation of our strategic initiatives; education and engagement of our boards; development of change management and project management as essential competencies in the organization; organizational redesign to streamline our decision-making and clarify decision-making processes and roles; the creation of a virtual care digital hospital; and the creation of a separate entity with separate leadership to focus on the transformation of our business model.

Q: What do you hope to see in the healthcare arena in the next five to 10 years?

DP: I hope that organizations across the country will advance the transformation from fee-for-service to value to achieve better outcomes and lower total healthcare spending. I fear many will not be able to do so, and their futures will be precarious.

Further, if our industry does not fix what is wrong with healthcare, I am quite sure Washington, D.C., will try to do so, and I don't believe that will be the best answer. We have to tackle the issues of affordability of and access to healthcare services. The issue of drug costs also has to be tackled. The current business model is inappropriate and leading to life-saving drugs being launched with prices in the millions of dollars for one course of treatment.

Lastly, I would hope that the federal and state governments would realize that we really can't afford to treat all the advanced and chronic disease with increasingly costly treatments, as we do now. We must address the prevention of disease in earnest if we hope to lower healthcare spending.

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