Up & Comers all-stars: Thoughts about then and now

Modern Healthcare recently asked four past honorees to share their perspective about where healthcare was when they were chosen as an Up & Comer and where they see it going.

Dr. Donald Berwick, class of 1987

Then: Vice president of quality-of-care measurement, Harvard Community Health Plan, BostonNow: President emeritus, Institute for Healthcare Improvement

Marna Borgstrom, class of 1992

Then: Senior vice president of administration, Yale-New Haven (Conn.) Hospital Now: CEO, Yale-New Haven Health System

David Entwistle, class of 2008

Then: CEO, University of Utah Hospitals and Clinics, Salt Lake CityNow: CEO, Stanford Health Care, Palo Alto, Calif.

Warner Thomas, class of 2006

Then: Chief operating officer, Ochsner Health System, New OrleansNow: CEO, Ochsner Health System

David Entwistle: I had aunts who were nurses, grandmothers who were nurses. I have an aunt who was a CEO of a hospital in rural Mississippi. I had the opportunity to visit her at work and see what they were able to do in really impacting patients' lives.It allowed me an opportunity to think about where I wanted to be.

Marna Borgstrom: I grew up in and around healthcare. My dad (a community physician) was a volunteer in so many ways that I got pulled into working in the health department, working at Planned Parenthood, things like that. … Getting into executive leadership for me came when I had opportunities to do some work for people (at Stanford and Yale-New Haven) who were important mentors, who were very strategic and very committed to evolving with healthcare.

Warner Thomas: I never aspired to be a top leader or aspired to be a CEO. I started off, actually, at Ernst & Young in auditing and consulting and then went to work for one of my clients in healthcare. I thought it was very interesting; I thought it was a very complex industry and most importantly, it had a higher purpose of helping people. … At the end of the day, you were there to serve people and there to help people, and that's really what was interesting to me.

Dr. Donald Berwick: (At) Harvard Unity Health Plan, which was my first real job in leadership, I was put in charge of quality of care. And the HMO had a program that they worked out with Harvard Business School in which we got training one day a month for several years. It was eye-opening. So, I was just lucky. I got into a couple of positions where people took me under their wing and taught me some stuff I didn't know.

Marna Borgstrom: When I started in healthcare in the late 1970s, there was a very traditional model. It was really driven around the needs, schedules and experiences of some very talented caregivers. They were orchestrating the entire experience that people had. A huge change in healthcare is the focus on being patient- and family-centered, on teamwork, and on recognizing that we have to do a better job of achieving value in healthcare, value that is defined as having consistent quality, safety, a strong experience for patients and families at a cost or price point that reflects the value they are getting.

Dr. Donald Berwick: If you look back over the past couple decades, we've made care better in very important ways. We can cure diseases today that when I was in training were uniformly fatal. We can transplant organs. We can do amazing stuff. But we are still shy of where we should be on patient safety, despite the efforts of many places. We're going to get that one nailed. I know we can do that.

David Entwistle: Consumers today have access to more information than they did before, both about their diagnosis and about the choices they have. They are starting to use that to drive decisions in terms of where they go, who they choose as their healthcare providers. At the same time, the Affordable Care Act is impacting the payer market by driving consumers toward having more of that onus on them in terms of the cost.

Warner Thomas: The Affordable Care Act is driving change that has been necessary for many years in healthcare, and I think it has now engaged the providers to really step up and take a much more proactive role in redesigning care, improving quality, reducing readmissions and waste in the system.

Warner Thomas: The idea of constantly learning, working to make others around you better, being a good communicator, being able to lead through adversity and change. To me, those are as applicable today as they would have been five years ago, 10 years ago, 20 years ago.

David Entwistle: As I meet with students, as I take the opportunity to meet with my own team, and even as I look at my own skill set, the constant seems to be adapting as we try to respond to things that are changing.

David Entwistle: We've got to be able to use the information that we're getting. Our EHRs, our technology, our data sets are just providing a rich source of opportunity for us to be able to learn. The question is: Are we leveraging that data into knowledge? Are we using that to limit variation? Are we using that to make improvements? There's a tremendous amount of opportunity in healthcare that's now being driven by the data and the question is: Are we using our technology to do that?

Dr. Donald Berwick: On the population health front, we are way, way away from where we need to be. That is because we've underinvested in prevention and also because we remain inequitable in our society. I no longer think we can separate the pursuit of health from the pursuit of justice and equity. Healthcare systems are going to have to become activists in solving the problems of poverty and racism that are still with us and building community infrastructures that matter.

Marna Borgstrom: Healthcare has grown as a function of lack of investment in social infrastructure like safe housing, education and access to healthy food. Those social determinants are probably more important to invest in than investing more in the healthcare system. We, as a healthcare system, need to be part of helping to fuel a broader societal transformation. The challenge we have, though, is we have to keep a viable business model going while we're investing in the transformation. Right now, it doesn't pay us in any way, shape or form to make the kinds of investments in so-called population health that I think can really make a difference.

Warner Thomas: It certainly was great to have the exposure. But it's not about an individual effort. It's about an organization, a team that I was able to work with and accomplish many things.

Dr. Donald Berwick: I was a maverick.I knew it. There were many other friends who were on this track in great places … but we were still pretty much outsiders and pretty much bringing a message that was a little dissident. To have the kind of encouragement that your award gave me, that was meaningful. It said, “OK, keep at it. Keep going. You're on a track here that's valuable.”

Marna Borgstrom: I still am in touch with some of the people (in my class) who are all doing wonderful and really important things in healthcare. Every time you can build a group of colleagues who can be resources and you can reach out to—I don't think I've ever solved a single problem alone. The way that we solve them is by pulling in the best thinking of people that we've been exposed to. This recognition gave me a broader network of very important and accomplished colleagues.