Traditional talking points have become strategic imperatives

Healthcare organizations will look at the COVID-19 pandemic as a tipping point.

It will permanently shape how healthcare companies operate, spurring a new sense of urgency and resilience, executives said at Modern Healthcare’s Leadership Symposium last month.

Health systems have pursued alternative revenue sources as they focus on stabilizing not only their organization but the broader community. Healthcare leaders have adopted a new communication strategy as traditional business models and working environments have been tested. The social determinants of health have become a strategic imperative as organizations address healthcare’s systemic inequities.

“The things we need to talk about have evolved,” said Kate Gallego, mayor of Phoenix. “In many ways what seemed like policy opportunities six months ago have become policy imperatives today.”

The role of a CEO has fundamentally changed, leaders said. COVID-19 has ushered in a new era that will require a different skill set and approach. Here are five areas of expertise needed as the role evolves.

Supply chain management
“The days of cheap PPE and commodities are over. We can always work on cost and savings, but there has been a restructuring. The whole idea of prioritization of value for healthcare systems and suppliers is important because we are spending a lot of money on things that don’t necessarily involve care at the bedside.”
Daniel DeLay, senior vice president of supply and services resource management, CommonSpirit Health

Flexing up and down
“Shutting down a $12 billion business for three months and trying to reopen it wasn’t fun. With COVID-19, we need to have a product-line mentality and flex up and down with what is going on in our community.”
Terry Shaw, CEO, AdventHealth

Economic stabilization 
“It’s amazing (how) you take for granted that the economics (can) change quickly in your backyard.”
Terry Shaw, CEO, AdventHealth

Dealing with expanded social determinants of health
“We often talk about preexisting medical conditions that can put individuals at risk, but the root causes are really preexisting social conditions that conspire to reduce resilience, opportunity and health.”
Dr. Jerome Adams, U.S. surgeon general

Overcoming institutional racism
“Some of our policies are well-meaning, but our appearance policy—what does professional hair mean, what do those things mean and are they reinforcing structural racism?” 
Dr. Sherita Hill Golden, chief diversity officer, Johns Hopkins Medicine

• To keep employees engaged and informed while working remotely, Allegheny Health Network has scheduled more team-centered and all-employee meetings, said Cynthia Hundorfean, CEO of Allegheny. “This is new for all of us,” she said, adding that she was surprised that productivity has been high. “I am hoping that it is sustainable.”
• “I was relearning a lesson we all know as leaders—you can’t overcommunicate,” said Jim Hinton, CEO of Baylor Scott & White Health. Leaders tend to undercommunicate by a factor of eight during crises since they are tied up in meetings, he said.
• Ascension moved about 30,000 employees home in March. While productivity has been high and employees are happy, managers will continue to focus on maintaining a positive experience, CEO Joseph Impicciche said. “Can you maintain and continue to build the culture you want to build in a remote working environment? That is something I have tasked my team to focus on,” he said.
• Still, remote work hasn’t fit all systems. After a dialogue with employees, Atlantic Health System limited working from home after caregivers and support staff criticized the bifurcated system, CEO Brian Gragnolati said. “I was taken aback by the reaction we got,” he said, noting that some disapproved of the double standard. “We have to be careful navigating this … it is something culturally that we have to be very cognizant of.”
• While disagreements will arise, transparency and honesty go a long way, said Dr. Jaewon Ryu, CEO of Geisinger Health. “We have to get comfortable with information not being perfect and not having the answers to everything,” he said. “We are going to try to be transparent and honest with what we do know.”

Amid the cultural change taking place in 2020, many hospital leaders have also had to mitigate financial distress.

As health systems saw volumes decline and revenue plummet, it underscored the need to expand their investment portfolio. Atlantic Health System, like some other large health systems, has invested in venture capital funds as well as made direct contributions to healthcare startups.

How many times have health systems provided the intellectual property that propelled startups, and then paid dearly to use that product, said Brian Gragnolati, Atlantic Health’s CEO. While healthcare organizations have historically shied away from nontraditional investment opportunities, that dynamic is changing, he said.

“We view these investments as an essential component of our overall financial strategy, especially since the impact of COVID has been so dramatic,” Gragnolati added. “We are leaning into this more rather than running away from it because as our traditional sources of revenue continue to be under pressure and we recover from what has been an unbelievable financial impact, we need the ability to transform our business models.”

In addition to establishing new revenue sources, Atlantic benefits from early access to products that improve its operations, Gragnolati said. It can also participate in the development process, he said, noting that the population health arena is a priority.

“One of the things we are figuring out is how to invest or stand up companies in areas where we want to transfer wealth to areas where there isn’t capital or jobs,” he said.

Dr. Sherita Hill Golden, chief diversity officer of Johns Hopkins Medicine, learned early in her career what a “minority tax” was. One of her first mentors told her that she would be asked to serve on many committees because she was a Black woman. “ ‘For the next two years you have my permission to say no,’ ” her mentor, who happened to be a white man, told her. “ ‘If someone gives you a hard time, tell them to come to me.’ ”

There are “derailers” early in life, Golden said. She learned to analyze whether the offers would advance her career, and if it was something Golden would be asked to do if she was not Black.

“Part of me felt guilty that I wasn’t doing enough, but now I get to be a chief diversity officer,” Golden said. “If that committee is not going to give them visibility with executive leadership, help them with promotions, that is actually a minority tax. … If you don’t have that protection from someone senior to you, it is very easy to get pulled in.”