Trinity Health's Gilfillan talks about transforming his system

Last week, Dr. Rick Gilfillan stepped down as CEO of Trinity Health, a Catholic not-for-profit system with 93 hospitals in 22 states that reports $18 billion in annual revenue. Gilfillan took over in 2013 and led the system through a $250 million transformation that he counts as his boldest move.

WHAT WAS YOUR RISKIEST DECISION? Implementing our 2020 strategy. We created a strategy to build a people-centered health system and deliver acute-care population-health management, community health and well-being. It also included an initiative to build a common Trinity Health operating platform that would make us a much more integrated system rather than a collection of hospitals.

WHY WAS THAT MOVE RISKY? One, the potential distraction for an organization that is just focused on delivering great clinical care. Doing that well is more than a full-time job. Two, the obvious threat of destroying demand for acute-care services. Our goal was to have 75% of our revenue flow through alternative payment models. Three, we needed new people with new skills. They were in short supply. And again, we had to do all that while we still providing great care. So there was a lot of execution risk. Fourth, we did it across the entire system. We felt, because each system has its own special dynamics, that rather than piloting in one market at a time, we made a commitment to have an ACO and bundled-payment programs in every one of our ministries in the space of one year from 2014 to 2015.

WHAT WAS THE RESPONSE FROM THOSE INVOLVED? There was excitement, surprise, concern, disagreement, and passive and active resistance. It varied across our different ministries because we had to sign 19 regional health ministries and what we call three national health ministries that were accountable for delivering the results for each of their businesses. Today our CEOs and our clinical leaders are committed to this transformation. We’ve had significant leadership turnover, of course. But we have been certain that new CEOs understand and are committed to the strategy because transformation at this level can only be driven by the most senior leaders engaged in making the change.

ADVICE TO EXECS IN SIMILAR POSITIONS: I’m hesitant to offer advice, but I will say this … Americans are delaying care because they can’t afford it. Our board believes that access to healthcare is a right, not a privilege, and as healthcare leaders, we’re the ones best-positioned to create a system that’s affordable and accessible and high quality to all. To other CEOs considering transformation, I would say, and hope, that they would be bold. Look for alternate payment models that support and reward you for managing total quality and costs. You could adapt the rest of your business over time. There’s ambient growth in the marketplace because of the aging baby boomers. Healthcare spending will double over the next 10 years or so. So begin. Get on the path. Invest, not just marginally, but with a commitment to move as much of your revenue as possible into alternate payment models. It’ll take longer than you think.

DESCRIBE YOUR LEADERSHIP STYLE: I aspire to be a humble servant leader who’s open, accessible, curious, team-based and inclusive in decisionmaking with high expectations that our team members are close to their business, accountable for results, aligned with our strategy, guided by our values, and supportive of our team. I’m not there yet, certainly, but that’s my model.

HOW WOULD OTHERS DESCRIBE IT? Initially they would say, “Why does he have so many questions? He seems not to trust us. He may be a micromanager.” That was early on. Frankly, I got that feedback from a coach who surveyed our team. But I think they’ve come to understand that I’m not micromanaging. I want to make sure that we are all aligned and that we’re operating effectively as a team. I think a lot of our team members have become similarly curious, questioning and probably closer to the business over time.