Dr. Thomas Shanley gets excited talking about the potential impact research and discovery can have on health outcomes. The new president and CEO of the Ann and Robert H. Lurie Children’s Hospital of Chicago ran the organization’s research institute for the past four years, as well as serving as chair of pediatrics at Northwestern University’s Feinberg School of Medicine. He’s also eager to grow the hospital’s presence and reputation both in Chicago and nationally. Shanley succeeded Patrick Magoon, who retired late last year after 42 years with Lurie Children’s, the last 22 as president and CEO. Shanley recently spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: You’ve only been in the CEO job for a couple of months, but what are some of your goals? Do you anticipate major shifts in strategy?
Shanley: I’ve been here for four years and participated in the development of our strategic plan, which we call our Vision 2025. It defines the aspirational goals that we want to attain by that year. I’ve recrafted the articulation of those goals, but not substantively; they are built around five pillars.
The central theme is that we aim to become a national leader in achieving healthier futures for every child. The tip of the spear as the first of the five key goals is providing the best care and experience for our children and families, and that’s what Lurie Children’s has always been about.
The second part of that is advancing pediatric medicine and science.
Our third pillar is being the employer of choice, both from a faculty standpoint and all the staff that are necessary to do what we do on a daily basis.
If we continue to do that well, more kids want to be taken care of by a Lurie provider, and the growth strategy—a specific aim of reaching 300,000 individual patients by 2025—gets to our opportunities in terms of how we think about partnerships and our own facility opportunities.
If we do all that well, I think we will be able to maintain our fiscal strength, which has a lot to do with making sure we have good relationships with our partners and advocating for the challenges that we have with the Medicaid system. We’re very grateful for strong philanthropic support that allows us to do many of these missions that we don’t have revenue streams to be able to support.
MH: Where or how did you recraft those strategies?
Shanley: Mostly in terms of where the emphasis was in terms of what we want to achieve, and that’s making sure that our quality outcomes, which are exceptional in many areas but not all, reach all areas, and continue to make sure that we’re able to support the research that’s necessary to move things from basic science all the way out into the impact on the health of the kids. As a clinician and a scientist, that obviously is an area of strength for me to make sure that we’re pushing on.
MH: Where are some areas in quality that Lurie can improve?
Shanley: If we use U.S. News & World Report as one of the benchmarks—issues (with that ranking) aside—they currently measure 10 areas. In six of those, when you look at outcomes only, we are at least as good if not better than the top four institutions by ranking in that category. So we know we have some exceptional outcomes; for example, our cardiovascular program is truly exceptional. We know that there are some specific areas where we need to do better, and I will use one example, pulmonary medicine. So how do we get better in terms of the outcomes that are measured in that component?
We went out and found an exceptional leader whose program in cystic fibrosis, for example, was one of the top three in the country, and recruited her to lead our pulmonary division and program, and scale her approach in cystic fibrosis in improving outcomes across all the platforms that pulmonary medicine covers. We’ve seen a leap in terms of those outcome measures in that particular division.
We use our metrics to identify areas of improvement. We recruit strong leadership, and then invest in those operational changes that need to be done to improve the outcomes.
MH: You’re in a market with two other children’s hospitals. Cincinnati Children’s Hospital Medical Center isn’t that far away either. How does that shape your Vision 2025?
Shanley: As we think about the local market, it’s very difficult for a variety of reasons. It’s difficult for personnel that lead specialty programs, allied health professionals that contribute to that overall complex, multi-disciplinary care programs, and additional allied services that are key to an optimal experience in terms of a complex patient. That’s because there’s going to be an increasingly smaller number of regional centers that can put that team together and I think we have an exceptional foundation at Lurie in terms of those programs and that type of leadership. There’s a lot of momentum that was built—no pun intended—with the transition of the hospital (to the downtown campus) where we have a very strong academic partner in the Northwestern University Feinberg School of Medicine. That’s a differentiating environment that we have here.
And we just moved the research enterprise—the Simpson Querrey Biomedical Research Center—into a state-of-the-art biomedical building. That environment is attracting true international leaders in pediatrics to Lurie.
MH: How would you like to see the research agenda advance?
Shanley: When I came in, I restructured the research institute away from programs and structured it more in what we call translational pillars. Those pillars are basic science research; translational research; clinical trials; health effectiveness and outcomes; and health service and policy research. When I looked at our strengths and what some of our gaps were … we had a lot of opportunities and room to grow within the basic science component, and we had some real strengths in terms of health service and research to be able to build upon and expand overall.
Probably our biggest gap as an institution was in genomics research. We made a very targeted recruitment and a very targeted investment in leadership in our genomics research program. That led us to recruit Nicholas Katsanis, a Ph.D. investigator who moved a lab of about 25 people from the Duke School of Medicine to take over our advancing translational genomics medicine research program. That’s an important emphasis as we think about the contribution of genetics to so many pediatric diseases and trying to better understand how they contribute to disease process, how they contribute to curative processes, etc.
We currently have two areas of focus in that: one in the cancer domain—understanding how changes in the DNA of a tumor compared to the child’s original DNA may contribute to a mass becaming a tumor, which affords us targeted opportunities as we understand that aspect of it. The other area is in epilepsy. We have had a number of kids referred to our precision medicine program in epilepsy where they undergo a series of DNA testings.
MH: Late last year, Lurie was picked to be part of a CMS grant to test a new integrated-care model. You will be looking at two specific ZIP codes in Chicago, impacting about 43,000 kids. Part of it, I imagine, will look at social determinants, right?
Shanley: They’re social influencers of health; they influence your health outcomes. They aren’t deterministic. I would say one of our fundamental principles here is, we believe we can change the influences of these factors on kids’ health. We’re trying to control the narrative a little bit on that.
We selected (two) ZIP codes (for the Integrated Care for Kids grant) because, as we looked at the utilization of our emergency department, many kids were coming from these two neighborhoods essentially for primary care, which is a very ineffective and cost-ineffective way of providing the type of primary care that should be provided in those communities.
We had already started to put in some foundational work to identify the communities’ needs in managing primary care and in understanding what some of the key social influencers were in these neighborhoods. So then we could try to work with community-based organizations, along with the Illinois Department of Health, to add components that we describe as health-plus—things like food assurance; good, solid primary care, particularly with some of the federally qualified health centers that are part of these communities; opportunities for engaged activities and physical activities and safe spaces. We were building this platform and then this grant came along to figure out if there was a way to encapsulate this all in a transformative model of care.
MH: What will you be measured on under that grant?
Shanley: The lowest hanging fruit is to reduce unnecessary ED utilization, as well as certain disease targets. Asthma is a good example. If we do a much better job of supporting the management of that chronic pediatric disease in the community, we should have a reduction in inpatient admissions, as well.