Unafraid to Change Her Mind: Q&A With Dr. Melinda Estes, CEO of Saint Luke's Health System

Melinda Estes, MD, is a board-certified neurologist and neuropathologist, but her resume is well-seasoned with leadership roles at some of the country's most prominent healthcare institutions.

She became president and CEO of the 11-hospital Saint Luke's Health System in Kansas City, Mo., last September. Before then, she served as president and CEO of Burlington, Vt.-based Fletcher Allen Health Care for about eight years, spent nearly 20 years in a range of leadership roles with Cleveland Clinic — including two years as CEO of Cleveland Clinic Florida in Ft. Lauderdale — and also served as senior vice president of medical affairs at MetroHealth System in Cleveland.

It's easy to assume an individual with a healthcare background as sophisticated and vast as Dr. Estes' must have set out for this industry from the very beginning, but that's not so — she began her undergraduate education as a music major with dreams of becoming a professional bassoonist. Years later, now armed with a medical degree and master's degree in business administration, Dr. Estes is hailed as a leader who knows the delicate balance between the clinical and financial tenets of healthcare. She has proven time and time again that she is not daunted to turn around and make a change — a valuable attribute in times of reform.

Here, Dr. Estes discusses some of the most important lessons she's learned throughout her career, Saint Luke's plans to deliver value-based care and how her time spent as a physician has influenced her perspective as a health system CEO.

Question: Who is the toughest boss you ever had? How did he or she challenge you and what did you learn?

Dr. Melinda Estes: It's really difficult for me to point out a single person. In the course of my career, I've had a number of people I've reported to who were demanding individuals and strove for excellence. You ask what I learned over that period of time, and certainly first and foremost was that you always need to be prepared.

Looking at all sides of an issue is very valuable, including looking not only at the intended consequences but the unintended consequences. Every action has a reaction, but unintended consequences and thinking those through before you make a decision — that's certainly something I learned. I had a series of bosses who challenged me to make data-driven decisions. Today we have plenty of data, but healthcare hasn't always been that way. I was challenged early on to make sure we had reasonable data sources.

Q: Do you feel there are aspects of your leadership and perspective that may not be as developed if you had not spent time as a physician?

ME: What makes a good physician, as well as a good leader, is good listening. Listening to what patients are telling you or rhythms of an organization and what employees are telling you — those are two sides of the same skill. Healthcare is a team-driven effort. We put a tremendous number of people around the patient. Physicians are very data-driven. What you do when you treat a patient is examine them, make a diagnosis, get tests and make a treatment plan. That same approach, in many respects, works pretty well in a hospital or health system: Listening, figuring out the problem, getting data and making a plan to move forward.

Sometimes you see a patient and you think you know what's going on, and then you change your mind. As a healthcare CEO, I think it's useful to change your mind. Multiple heads make better decisions. That's a skill I learned early on — don't be afraid to ask for help. I try to hire the absolute best people I can and let them do their jobs. If you do that, you have a group of people with tremendously varied skill sets bringing different approaches to problems.

Q: Back in April, Saint Luke's was the first participant in Blue Cross Blue Shield of Kansas City's Collaborative Value Program. Are there any developments on that front since? In what other ways is the system embracing collaborative and value-based care?

ME: We're still in the first year of the Blue Cross Blue Shield arrangement, so it's really too early to tell what the results will be. But central to this model is the development of a medical home. Our group is in the process of getting Level 3 medical home accreditation [from the National Committee for Quality Assurance].That will put us in a good position to be a medical home and provide value-based care.

We're also in a similar arrangement with Humana for their Medicare product [that was finalized in 2010], and we're talking to many other payors about similar arrangements. We've put a lot of emphasis on the government's value-based purchasing projects, and we're an active participant in the VBP arena. We're actively working on it and trying to monitor all the shifts in our market and nationally toward VBP.

Q: You're a champion for a range of issues in the healthcare industry. Are there any issues you'd find yourself advocating even if you weren't a health system CEO?

ME: There are a number of issues I'm personally invested in as a healthcare CEO, and one is quality of care and the safety of our patients. Second is access, and finally, I am a firm believer in the idea that health starts with what you put in your mouth. I'm a real believer in nutrition. We, as healthcare providers, have an obligation not only to provide nutrition education but to practice what we preach. Is there something I'd advocate even if I weren't CEO? One is access. I feel very strongly that everyone should have ready access to healthcare. And I'm a real proponent of nutrition and a healthy lifestyle.

Q: Your career path is an interesting one — it suggests it's never too late to make a change. How do you keep yourself going in midst of a nationwide reform, when healthcare is trying to tackle such large, unprecedented changes?

ME: Most careers I liken to sailboat racing. Conditions may change, whether wind, seas or tide, and you have to be unafraid. In terms of all the change, I think you can either view it as truly daunting or as an opportunity. I view it as an opportunity to figure out better ways to provide quality, safe care for patients and continue to achieve the excellence in healthcare that Saint Luke's is known for.

I'm a firm believer in paying attention to what you can control. We work really hard in trying to work on those things we can control and we keep an eye on other things going on, but don't get too caught up in it. None of us knows what will happen in the next six months, as I expect the election will have an impact on healthcare.

Q: Finally, what are some things occurring at Saint Luke's right now that have you the most excited?

ME: There's a lot going on at Saint Luke's, just like everywhere in healthcare. We'll be moving to a new electronic medical record over the next two to five years. We'll also be building a data warehouse, which should give us an opportunity to have real-time data from patient records, financial records and utilization records to make better decisions and ask better questions.

The second thing is our Focus 2015 project. [Editor's note: This system-wide initiative launched in January to achieve a $100 million improvement through revenue enhancements and the elimination of ineffiencies.] Everybody in healthcare is really working on the value equation. The numerator of the value equation is quality, safety and access, but the denominator is cost-effectiveness. I think that's in perfect concert with the national movement. Regardless of what happens with the Affordable Care Act or the election, the fundamental problem is that healthcare costs won't go away.

Saint Luke's is a big and complex health system. We're trying to leverage the power of that system and view ourselves more as a system rather than a collection of entities. We're looking at integration at multiple levels, whether operational or strategic, and how that will let us leverage the power of our system.

More Articles on Saint Luke's Health System:

Saint Luke's Inks Value-Based Contract With BCBS Kansas City
300 Hospital and Health System Leaders to Know
Saint Luke's Hospital in Missouri to Break Ground on $26.7M Neuroscience Tower

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