Vanderbilt CEO: What the telehealth boom makes inexcusable

Jeffrey Balser, MD, PhD, is president and CEO of Nashville, Tenn.-based Vanderbilt University Medical Center, a position he's held since 2009. Over the course of his 12-year tenure, he has expanded the health system from two to five regional campuses, which include seven hospitals, 1,700 beds and 3,000 physicians.

Dr. Balser shared with Becker's the most important lessons he's learned from the COVID-19 pandemic and the biggest challenge facing Vanderbilt and healthcare. 

Editor's note: This interview has been edited lightly for clarity.

Question: What are some of the biggest lessons you learned during the pandemic?

Dr. Jeffrey Balser: I would say the big lesson is around the role trust plays in how health systems function. And there are two kinds of trust I think we've learned about; one is trust between healthcare provider systems and the public. And I think if you look at healthcare back in 2017, 2018, and you looked at how consumers talked about healthcare, I think healthcare ranked somewhere below toilet paper brands, and that pretty remarkably changed during the pandemic as people, I think, became less justifiably irritated with a lot of the snafus around insurance approval and all the things that drive people crazy about healthcare, and became focused on the thing that really mattered, and that was how can healthcare help them stay alive. And then as healthcare played such a huge role in helping people get vaccinated, I think it changed the way the public feels about healthcare for a period of time. And I hope we can sustain that.

I think we also learned that, especially in underrepresented communities, communities that are underserved, the preexisting relationship we have with those communities has a big impact on how successful we are in helping them in a crisis. So we found in Nashville, in areas and communities where we actually had people on the ground already working before the pandemic who were known to that community, we were much more successful then in managing through the challenges they had in a crisis because they already trusted our people. 

So the other kind of trust we learned about was trust inside the health system. And just like any industry, healthcare systems have silos, professional silos. So physicians, nurses, pharmacists, all those white-coat professions … we all have professional roots that cause us to have different orientations toward problems, and sometimes cause us not to interact and communicate as well as we like. 

And then it's even more different between what we call the white coats and the blue suits. So the people in the health system that are managing finance and HR and all those other areas, and how they think versus how clinicians think, and what I think we found during the crisis was people forgot about all those differences in orientation and training and history, and just focused on figuring out the problem and got to know one another. And we built bridges of trust between groups of folks that never had even met. And I think that was really valuable for us as well. One of the things we're doing at Vanderbilt is working on ways to sustain that growth in cross-disciplinary trust, cross-silo trust, beyond the pandemic.

Q: What are some of the biggest challenges Vanderbilt is facing at this time?

JB: I would say what we are all now facing in healthcare, especially in large tertiary systems, large quaternary systems like ours, is workforce challenges. Nursing is probably the most acute workforce challenge in U.S. healthcare — inpatient nursing, particularly critical care nursing, because I think we were already in a shortage situation before the pandemic. And I think what we've seen during the pandemic is people's plans to retire were somewhat accelerated. And so now we have — what I read actually in Becker's a few weeks ago — is we have 55 job postings for every nurse and inpatient nurse. And so that's going to be a huge challenge for regional quaternary centers like Vanderbilt, and we're already feeling that.

Q: What are your goals and priorities for Vanderbilt for the rest of this year and going into 2022?

JB: I would say for the rest of this year, we're heavily focused on the well-being of our people coming out of the pandemic. I don't think people in healthcare have seen anything like this in terms of the level of stress that they've experienced not just at work, but also at home since the two World Wars. It was like fighting a battle on home territory. It was pretty remarkable. And I think we're all proud of how that's gone, but at the same time, people are physically and emotionally exhausted. And I think being attentive to how folks are doing and recovering over the next six to 12 months is going to be very important. 

I would also then say beyond that, going into the next year, I think that the digital health care economy and our move into digital health has been dramatically accelerated by the pandemic. I think many of the qualms we had about patients embracing it, and whether the technologies would work … all that went out the window very quickly when we did get it to work, and patients loved it. So now the patients expect it, as they should. And healthcare needs to be about providing digital healthcare services where appropriate as patients desire them, not as we wish to deliver them. And I think that the opportunity there to do more and to serve patients who live in remote communities or are disabled and can't get to the quaternary healthcare center easily, there is just no excuse anymore for not being able to provide services to folks. And I think the quality of digital care will grow exponentially as we apply machine learning to help us understand what patients really need and what trends are really developing in patients that we might not even be aware of. So I just think that the horizon for what digital healthcare can look like in this country is remarkable, and we need to embrace that fully and find ways to make it happen.

Q: What do you think is your biggest accomplishment professionally, especially in this last year?

JB: I would say, hopefully, the degree to which the leadership team at Vanderbilt has hung together and been able to support one another during some very difficult and challenging times. And by management team, I mean a broad range of people, from department chairs to managers all over our system. As CEO in a crisis like this, the most useful thing I can do is help us keep our dots connected and help us support one another and communicate, communicate, communicate. And so that's what I've been focused on throughout the pandemic, as have many other leaders at Vanderbilt. I think we've all done a really, really good job of staying focused on the needs of our leadership team for psychological support, and for being there when others needed us. And I think we came out of this feeling like an even stronger leadership team because we did that really well.

Q: What advice do you have for other healthcare CEOs?

JB: Early in my tenure, when people would ask me about these kinds of jobs, I would talk about finances, and I don't do that anymore. What I talk about now is communication, and I would say COVID for a CEO was the ultimate communication challenge. Suddenly, it wasn't just optional that I was trying to communicate with 30,000 employees. It was essential. And it had to be frequent. And so what I would say to CEOs coming into these kinds of roles is whatever you do, focus hard on communication, because not only will you be building the community you're leading, but you will also be laying a framework down for something that works when crises that you cannot anticipate occur. And so I think emphasis on communication by the CEO would be my strongest recommendation to a new CEO.

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