In an era of rapid CEO turnover, Virginia's Sentara Healthcare, an integrated delivery system with a 450,000-lives health plan, 12 hospitals, 3,800 physicians and 28,000 employees, has been a model for long-term stability. But this month, longtime Chief Operating Officer Howard Kern took the reins from David Bernd, who served 43 years at Sentara, including 21 as CEO. Modern Healthcare editor Merrill Goozner spoke with Kern about the transition. The following is an edited transcript.
Modern Healthcare: In taking on this new job, what are the biggest challenges you face?
Howard Kern: The transition has been very smooth. My old boss did a great job preparing me. A great board has been very supportive and the leadership team has been really solid and consistent. Probably the biggest challenge I have, the imperative that the board has set for me, is clinical quality. They want to see Sentara continue on the journey it's been on to drive improved clinical-quality performance.
MH: You began that journey in 2012. But Sentara has always considered itself a high-quality system. What has compelled you to re-emphasize the issue of quality?
Kern: First and foremost, while we had good quality, there was a lot of variation, and anybody who studies quality will tell you that variation is the absolute enemy of quality. We wanted to reduce variation and focus on standardizing best practices.
Second, we have grown as a healthcare system. One of the major promises and value propositions that an integrated delivery system ought to be able to provide is better clinical quality and better learning internally for the organization. So we are on a journey to create that value proposition.
Lastly, I think the pace of improvement in the industry is really starting to accelerate, which is good. We need to make sure Sentara is at that pace or better.
MH: What needed immediate addressing?
Kern: Organizationally, we had cultures in our different hospitals and provider divisions that had evolved from years of being independent. Now they are part of an integrated system. The notion of being part of an integrated system doesn't happen naturally. It's got to be driven through a level of understanding, education and alignment, a shared common purpose. And so, we spent a lot of time culturally building that understanding.
(Now) I think everybody gets it and (has) become more supportive. Absent that, you get everybody stuck in their silos and they're resistant to being told how to do things. The other key imperative is engaging them in the process. Everybody has to have a seat at the table and they have to feel like they're having an opportunity for input and participation.
MH: How did you pull a dozen hospitals together and create that common purpose?
Kern: We implemented a model two years ago called High Performance Design. A couple of key components of that relate to building a horizontal capability across the organization. We have 12 hospitals, four medical groups and an array of ambulatory services. This high-performance design model created a horizontal focus that goes across all those silos to build a core resource of clinical leaders, and administrative and nursing leaders, that focuses on better practices and best practices.
They say this is the best way to do it, and then educate and facilitate the vertical leadership in each of the organizations to execute that well. That's been a key part of what's allowed us to drive better performance and reduce unwanted variation across the system.
MH: How did you get buy-in from physicians?
Kern: Physicians are key. We've engaged physicians in important leadership roles. We've brought in physician leaders from the community. We gave them a seat at the table and they've helped set the goals. The physician leaders are at the table with management, with nursing, helping to define the priorities that we're going to focus on.
In addition to those horizontal teams, in each of our clinical disciplines, our service lines, there's a physician leader and either an administrative or nurse manager partnering together. They bring distinct competencies. Both are leading the vertical team. So physicians feel they have significant levels of input in multiple dimensions.
MH: Do you get pushback on standardization from physicians who say “My patient is different?”
Kern: I had that question posed to me by a physician on our board. First and foremost, we recognize that while you want to reduce variation, some variation is good. You can accept that as long as it's constructed toward learning and improving practice overall. Variation needs to be more intentional versus just random variation, which is where the quality weakness comes in.
Second, this notion of data equality is very important. You've got to invest in good data systems and they've got to be reliable, and there's got to be transparency so that the clinicians see the data and understand how they were developed. You've got to be willing and able to put that data on the table and let them kick the tires and make sure that it's accurate.