Strong Culture Can Lead to Lasting Change: Q&A With Randy Oostra, CEO of ProMedica

Randy Oostra has served as president and CEO of Toledo, Ohio-based ProMedica since 2009 and has been with the system since 1997. After 15 years in the system, one might think that Mr. Oostra would already know how staff and physicians feel about ProMedica's culture.

But he's not afraid to admit that he doesn't always. In fact, he welcomes input on everything from the system's mission statement to its strategic plan to ensure everyone in ProMedica is on the same cultural page.

Here, Mr. Oostra discusses how cultural awareness and flow of communication has led the system to be successful with changes made under healthcare reform and what advancements have him excited about the industry.

Question: To start off, can you look back and attempt to sum up 2012? What were some highlights of the year for you, both at ProMedica and across the national healthcare landscape?

Randy Oostra: 2012 felt like a long year because of the massive amount of change happening in healthcare. Nationally, there is a lot of uncertainty and acknowledgement that the current model is not sustainable. It's exciting, and I think some things we put in motion will provide success in coming years.

From a ProMedica perspective, it was an exhausting year but one of the best, if not the best, years we've had based on our metrics. We did multiple things to prepare our staff for healthcare reform. We did culture workshops where we used interactive sessions to prepare the staff on where we were in healthcare and how we needed to change. About 12,000 people went through those facilitated sessions. We also had our whole staff focus on patient satisfaction.

We did a lot of work in IT last year. As a system, we had 30 major go-live events including physician order entry. It's astonishing to do that many go-lives in one year.RandyOostra

ProMedica was also selected by Medicare for the Shared Savings Program and our health plan was selected to be a state-wide provider of Medicaid. We also had some growth; we added physicians and added a hospital last year.

Q: As someone who has been with ProMedica since 1997, how do you think that longevity affects your leadership style?

RO: Longevity can be good and bad. The good part is that it allows for perspective. As you have longevity in careers and institutions, you gain a perspective and a balance. Our team has been together for a long time. Everyone understands their roles and responsibilities and knows what everyone is doing. In times like now, it's very effective because you know people will do their job and take on their responsibilities.

It's challenging to think about leading and facilitating change in an institution because you have to work with the board and community to explain changes. Having familiarity helps in that area. It all gives you perspective. My 15 years here are helpful as we think about the next decade.

Q: You're a huge advocate for culture improvement. How has culture at ProMedica changed under your watch?

RO: Culture is incredibly important, especially in times of change. We looked at incredible changes from financial pressures, electronic medical records, the [Patient Protection and] Affordable Care Act, ACOs and population health management expenses and workforce and recruitment issues. These are the times to step back and go to the basics of what we believe and [form] a sense of unity.

When you look at culture, there are different cultures in the workforce, and they deal with life differently and different things motivate them. For example, cultural differences affect marketing strategy. There are board members that like to look at the newspaper and want to be advertised there, and the young medical group wants social media marketing. If you have the same message for everyone, it doesn't work. We need to communicate and work with each group differently. If we don't do that, we won't be successful in healthcare. When you think about driving teamwork, working with physicians and sharing and navigating decision-making, we want to make sure everyone is together and going about it similarly.

Culture has a huge impact, and we focus on participation and making sure everyone gets an opportunity to voice their thoughts. We do that routinely through webcasts, and we also go on the road to different facilities where we talk with our staff. We make it a point to ask for input on everything we do, like evaluating our mission statement, values and strategic plan. We did that through an online survey, and we got great thoughts on what the staff would like to improve.

We also do executive sessions during all of our board meetings and try to make sure people feel comfortable sharing their thoughts. During those, we focus on dialogue and communication.

Those are the biggest things we've done over the last few years, having free-flowing communication.

We coupled all of that with a huge push in employee wellness. We want to show that healthcare organizations should be different from other organizations in employee wellness. We sponsor programs for people to lose weight, and we offer fitness club membership for employees. We have signs that show nutrition for what we serve in our cafeteria and vending machines, and we got rid of sugary beverages. We also don't hire tobacco users.

Some facilities now have stand-up desks. Instead of people sitting all day, we put in hundreds of these desks in the system's facilities so people can stand. The desks work well for people with back problems, and we've had a strong response.

From a wellness perspective, we believe we have to have a role in doing things differently. We should be different and a model for health and well-being. All of these things are the right things to do for healthcare organizations.

There has also been an emphasis on leadership development. We've been getting input from physicians and putting them on boards and in senior leadership positions. All that changes culture from top-down to being based in participation and teamwork.

Q: "Culture" can really be an ambiguous term, encompassing a range of workplace issues. Where should a health system CEO start if he/she wants to drive serious, lasting improvement?

RO: The first thing to think about is the direct impact culture has on change in healthcare. When culture wasn't aligned with changes in the past, those changes failed. Culture is not a soft, fuzzy thing, but it's important when you think about what type of environment you want to create to work in.

If you're interested in culture, start with conversations. Get others' perspectives on employee, patient, physician satisfaction. If the results are not where they should be, ask why, culturally, we're not doing the things we aspire to do. Start small, with a series of conversations, and see if your perceptions align with everyone else's. Talk to people, deal with misconceptions, and use that to address cultural issues in the organization.

Q: What is it about healthcare that excites you most right now?

RO: It is a very interesting time to be in healthcare. It is — in some ways — it's very challenging, but it is still very, very exciting. When you begin to look at the need to change — the fact that healthcare is not sustainable, a lot of people are getting added to Medicare and Medicaid and dealing with cost issues while providing high-quality care — the challenge alone is very exciting.

One interesting thing is the advances we've seen, like the adoption of EMR and physician and nurse order entry and the fact that we're talking about ACOs and global issues of health. Addressing community need and access is not dull by any means — it's very exciting. Who is better to solve the issue in the community than mission-based, community focused non-profits? It's a great opportunity for healthcare institutions to address community needs.

At ProMedica, we became interested in personal determinants of health, and specifically hunger as a health issue. When you look at the mission statement, [editor's note: ProMedica's mission statement is "Our Mission is to improve your health and well-being"] it doesn't mean we only take care of people in our four walls, we need to go outside our four walls to deal with health and well-being in the community. For example, we're working with Share our Strength's No Kid Hungry campaign to help end childhood hunger in communities across the country. We're excited about it because it's a little non-traditional. It is something we feel excited about.

Q: Any New Year's resolutions you can share?

RO: I think any time you go through a lot of change and challenge, it's good to come back to focusing on what's important on a work and personal basis. Personally, mine is to have more balance in life over the next year. Professionally, it is to keep balance and take time to step back and think globally and strategically about the things we do.

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