The corner office: Dr. Richard Afable of St. Joseph Hoag Health on knocking down barriers, one by one

"I'm more excited about healthcare today than I was 10 years ago, primarily because of the change and the fact that the script is not written — you get to participate."

Richard Afable, MD, MPH, is president and CEO of the integrated delivery system St. Joseph Hoag Health in Newport Beach, Calif. Dr. Afable brings clinical and business sensibilities to his work each day, and he has made a point to reduce healthcare's troublesome silos.

St. Joseph Hoag Health is the product of a February 2013 affiliation between St. Joseph Health and Hoag Memorial Hospital Presbyterian. The combination of the nonprofit, faith-based institutions created a seven-hospital system with a physician network and several ambulatory care sites throughout Orange County.

Before the affiliation, Dr. Afable served as president and CEO of Hoag Memorial Hospital Presbyterian, a two-hospital and 5,000-employee organization. Prior to taking on this role in 2005, he was executive vice president and CMO of Newtown Square, Pa.-based Catholic Health East, which included 31 hospitals and 47 long-term care facilities.  

Dr. Afable, an internist and geriatrician, earned his medical degree from Loyola University Chicago's Stritch School of Medicine and his master's of public health degree from the University of Illinois. He practiced medicine for more than 15 years in private practice, as clinical assistant professor of medicine at Northwestern University in Chicago and as associate professor of medicine at Wake Forest University in Winston-Salem, N.C.

Here, Dr. Afable took the time to answer Becker's Hospital Review's seven questions.

What's one thing that really piqued your interest in healthcare?

The start of my career was in clinical care and medicine. Upon finishing my medical education and training in Chicago, I practiced medicine in Chicago for 10 years. As a geriatrician and internist, that's when I learned the field of healthcare. Geriatrics had been of interest to me since medical school, mostly due to mentors I'd worked with who turned the field of care for the elderly into a life experience for me. I was taking care of patients and learning the field of healthcare as a clinician, but then it became increasingly more related to the structures and requirements of healthcare management. Those were different than, but advantageous to, the medical care I was providing.

What do you enjoy most about Orange County?

Well, the most remarkable element is the very obvious Pacific Ocean. This is a coastal community, so the centerpiece — besides the people — is the easy access to all of the recreational elements the Pacific Ocean provides in a very nice climate. (Sorry about that, Chicago friends.) The culture of this community is outdoors — the sea, coast, water and mountains. I've been quick to accommodate to that lifestyle and all the outdoor recreations available to us who are fortunate enough to live in this very nice place.

If you could eliminate one of the healthcare industry's problems overnight, which would it be?

I would do everything possible to take down the silos and barriers that prevent [collaboration between the] multitude of participants in healthcare delivery. I would take those barriers down and build alignment. We need to do a better job with the elements of efficiency, reduction in variation, ensuring the best possible outcomes and getting to a cost that is affordable for people, payers, employers and the government. We'll never get there in a divided healthcare environment.

Everyone is afraid that their piece of providing healthcare will somehow be compromised, and that's what prevents alignment. We have to somehow trust that mutual benefit can occur and that everyone can and should not only survive but thrive in a more aligned world. Although many barriers and silos are slowly eroding, it's still slow.

In California, and specifically southern California, barriers are coming down faster than in other areas of the country. Alignment is happening between hospitals, health plans and physician groups. It's out of necessity, and I think ultimately a lot of what we're doing will [serve as a] model for the future of the rest of the country.

What do you consider your greatest talent or skill outside of the C-suite?

I have a lot of interests. I was a musician in a prior life, so I like to dabble in my hobby of musical endeavors. I also enjoy the outdoors, and that includes a good round of golf as often as I can get it.

How do you revitalize yourself?

I happen to enjoy change, and I'm very comfortable with ambiguity. I'm more excited about healthcare today than I was 10 years ago, primarily because of the change and the fact that the script is not written — you get to participate. From a work perspective, I'm very energized. From the personal side, you have to take time to assess your health, not only physically but also mentally and spiritually. I try to recharge those batteries and take enough time for myself as I can, although I'm not doing that to get away from the healthcare environment. It's preparing me for healthcare.

What's one piece of advice you remember most clearly?

"The business follows the care and not the other way around." That was said to me by a physician CEO after he made the transition from medical provider to healthcare manager. He was near the end of his career and was pointing out the fact that [this idea] allowed him to maintain a level of balance in his life, and ultimately success. He wanted to be sure I could keep that perspective. As a clinician, it's appropriate and easy for me to believe that concept deeply. That's been my guidepost for my entire career.

What do you consider your greatest achievement at St. Joseph's Hoag Health so far?

As I said, the biggest barrier to what I'd like to see happen in healthcare is the lack of alignment. I was able to participate in and be a major driver of an alignment project that has produced the kinds of exceptional results I've always envisioned. The Hoag Orthopedic Institute, our orthopedic enterprise, is a pilot of creating value through alignment. It has exceeded my expectations and the expectations of those involved. The reason it's had great success is because it focuses on care, then lets business follow. It's represented many of the fundamental elements of what I believe will create great success in healthcare; it's a tiny version of what needs to happen in much grander scale.

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