The Chief of Change: Q&A With Dr. Ralph de la Torre, CEO of Steward Health Care

Ralph de la Torre, MD, gets things done, but he starts by forgetting everything he knows.

In an industry entangled with commentary, red tape and fear of change, Dr. de la Torre has ambitiously forged to the forefront as CEO of Steward Health Care System with the attitude that little is impossible. The young, Boston-based system itself is the result of unlikelihood: The 2010 sale of Massachusetts' second-largest hospital chain, the Catholic Caritas Christi Health Care, to Steward, an affiliate of the New York-based private equity firm Cerberus Capital Management. As CEO of Caritas, Dr. de la Torre orchestrated the deal — involving the Catholic Archdiocese of Boston, unions, local communities and a private giant — when it could have easily ended in cacophony.

Steward has moved swiftly. The 10-hospital system has drawn physicians like a magnet, as providers from Massachusetts-based Tufts Medical Center, Partners HealthCare and Beth Israel Deaconess join Steward's ranks. The system was named a participant in the Medicare Pioneer Accountable Care Organization Program in late 2011, one of the first such 32 in the country, and it recently established a health insurance plan called Steward Community Choice. All this activity may leave some people forgetting an important fact: Steward's not even two-years old.

Behind the progress is Dr. de la Torre, a man who gets little sleep and devotes even less time to naysayers. The MD in his name reflects the time he spent in the operating rooms before the C-suite. He was the youngest chief of cardiac surgery not only at Beth Israel Deaconess Medical Center in Boston, but in the history of any Harvard teaching hospital. In 2007, Dr. de la Torre established the hospital's CardioVascular Institue, which integrated the program's medical and surgical specialties and coordinated patient services. Again, he knows how to get things done.

Here, Dr. de la Torre discusses his management style, physician engagement, problems in American healthcare and how he executes big ideas.

Question: You've been a champion of healthcare innovation — everything from the CardioVascular Institute at Beth Israel Deaconess Medical Center, the Caritas-Steward sale, to redefining America's community hospitals. What fuels your drive to break the mold in healthcare?

Dr. de la Torre: I must admit, I am a generally inquisitive person who loves to tinker, explore and think about innovative, out-of-the box approaches. On a professional level, I take a different approach than many. I begin by forgetting everything that exists and constructing what I believe to be an ideal structure with an ideal process. Once the ideal is constructed, you simply connect the dots from the present to the future adding layers of details and contingencies.

Q: How do you choose to deal with naysayers?

RT: If the criticism is credible, I listen and incorporate changes if needed. If it is not, I forge ahead and prove them wrong.

Q: Over the years, what one attitude, belief or notion have you found to be most destructive in the healthcare industry?

RT: The inability to cope with or embrace change. Healthcare is an industry that despises change, but everything changes. Technology changes, culture changes, attitudes change, and we as an industry and as a profession need to learn how to change with the times.

Q: Soon after you were named CEO of Caritas Christi in 2008, you invited the Service Employees International Union to organize employees — something Dennis Rivera, the then-head of the union, said he experienced only twice before. Why did you choose to take a proactive approach?

RT: It seemed very logical. When I met with Dennis many years ago and he explained to me his vision of healthcare, his vision of how employees would interact with employers and how caregivers would all unite to provide the optimum care — it seemed completely analogous to my beliefs and the beliefs of Steward as a company. Out of that came the realization that we agree on what needs to be done. We may disagree on some nuances of how to get there, but the end state is one that both parties completely embrace. From there, further discussion followed, and it just happened naturally.

Q: As a fairly new system, how is Steward building rapport and forming ties with physicians in the area? Have you heard feedback from physicians on why they find the system appealing?

RT: Steward is a healthcare company. It's not a hospital company, and it's not an insurance company. In many ways, it's mostly a physician company that happens to operate hospitals and some insurance components. Hence, it is naturally aligned with the way physicians view the healthcare world.

If you look within our structure, many constructs exist for physician empowerment and caregiver empowerment. So why do physicians gravitate towards us? Because in many ways we have designed ourselves to accommodate them and think like they do. Bricks and asphalt don't take care of patients; a team of people take care of patients.

Q: Many healthcare CEOs have publicly said the Supreme Court ruling on the Patient Protection and Affordable Care Act isn't significant to them because the law's values will be instilled regardless. What is your opinion on the matter?

RT: I agree. The main caveat that drives America is the moral imperative not to deny care. Once we as society get to that moral imperative, whether it's PPACA or state-by-state laws, we're there. Healthcare reform has occurred.

Q: Industry experts say Steward is redefining the traditional community hospital. How do you break such a "big picture" initiative down into manageable work?

RT: I think you just hit upon the largest obstacle facing healthcare executives. The challenge can seem daunting. What you have to do is break it up into smaller business plans and smaller tasks. In other words, you create a seven-year plan that is complex and far-reaching, and then you break it down into several components, and you break those components down into further components, and then you break those down into deliverables for a given year, and so on. Then you concentrate on the task immediately ahead of you. If everyone concentrates on their task, you eventually get to the designed end-point.

Q: A Boston Globe report from February 2011 mentioned you average four hours of sleep a night. How do you avoid burnout, or is that not so much an issue?

RT: As a kid, I never slept much. You then superimpose surgical residency training at Mass General Hospital when it was basically every other night, [and I] was trained to sleep even less. You couple that with a healthy dose of paranoia, and you end up at four hours. For awhile, it really bothered me. I thought there was something wrong because I didn't sleep. Now, except for the occasional 2 a.m. purchase of a Ronco Veg-O-Matic, it doesn't really bother me.

Q: How might people who work with you describe you as a boss?

RT: I hope people would describe me as demanding but fair. In many ways, it's a self-fulfilling prophecy. Having been lucky enough to pick the management team now in place at Steward, we are all very similar. We're all success-driven, hard-charging individuals who in many ways view ourselves to be in a constant start-up mode. The expectations are demanding but fair, [tolerant] of errors of commission, but not omission.   

Q: What's the hardest lesson you've had to learn so far?

RT: When you're a physician and you're taking care of an individual patient, you can count on everybody trying to do the right thing. They are all honest, hard-working, and want the patient to have a successful outcome. What surprised me is that when you take healthcare from the patient and make it about a million patients or a hundred million patients, a lot of other agendas and objectives come into play, and you lose some of these ideals.

I've found that to be a hard lesson because you can't predict what people are going to do. As a corollary to that, I have been surprised that it is very easy for people to distort the truth and prey on fear in order to achieve an outcome. Those concepts have been very hard lessons for a physician.

More Articles on Hospital and Health System CEOs:

A "Lean" Vision Drives Stanford Hospital & Clinics Performance: Q&A With CEO Amir Dan Rubin
CEO David Feinberg: Prescription for Excellence
CEO Delos "Toby" Cosgrove: Leader & Advocate

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