As healthcare leaders look to the year ahead, a variety of major challenges are top of mind including complex staffing issues, financial constraints, new technology and evolving patient demands. At Modern Healthcare’s 2023 Leadership Symposium, Sue MacInnes, chief market solutions officer at Medline, led a wide-ranging discussion with health system leaders about their most urgent priorities, long-term goals and strategies for sustainable growth.
Sue MacInnes: What will be the most pressing issues for you and your health system in 2024 and beyond?
Welela Tereffe: Workforce sustainability is the foundation for everything, but there are two things beyond that that concern me for 2024 and beyond. The first is the right use of technology, in terms of appropriate application and de-application of technologies. We tend to think more about layering on implementation and not about de-implementation. The other component is protecting our systems from cyber attack. Health systems are one of the top targets for cyber attacks, and our industry is the least prepared to protect its data, its people, and its functions in the case of a cyber attack. Many health systems keep it a secret when it happens, but the number of systems, including national systems, that have been compromised to the point of having to shut down activities for weeks at a time is growing every single year. The impacts of that can be devastating. Then, one more pressing issue is the persistent discrepancy between how much we spend and what we get out of what we spend. Part of sustaining our workforce is ensuring people see the manifestation of their own desire for altruism and equity in the healthcare we deliver. If you look at the Organisation for Economic Co-operation and Development countries, we spend more per capita on healthcare than any of them, but we have among the worst health outcomes in the OECD. We’re also the only G21 nation where bankruptcy for medical debt is a major issue. Other countries do not allow that to happen to their people.
Bruce Meyer: I’ll piggyback on the technology but a different aspect: it’s artificial intelligence. We have no governance mechanisms on AI. We’ve had AI for quite a long time, but what is available today is something entirely different. That evolution of the technology means we are extraordinarily vulnerable to bad stuff happening because AI is making a decision somewhere in the ecosystem of healthcare. It could be a great decision, but it’s on us to figure out how to make that a great decision. It could also be a terrible decision, and we have no governance structure at all. The financial incentives in our country for entrepreneurs, Silicon Valley and venture capital suggest that the folks who own it are probably more interested in making money than doing something that’s really contributing to the health of human beings in our country.
WT: (AI) is the Wild West. One of the things that’s particularly concerning about it is that it amplifies disparities. When you apply it in healthcare, without the right governance and controls, you can fully expect that it will widen the gap between the haves and the havenots and further solidify the implicit bias throughout our system.
Kathleen Sanford: The pressing issue for us is making sure we have a pipeline of clinical staff and we’re giving people what they want so they want to work for us. At CommonSpirit Health, staff are asking for a place where they can grow and where we’re going to care about them. They’re asking for us to look after their well-being and to make sure that their mental health is good. They’re asking for a safe place to work. And they’re asking us to look at our productivity models a little differently than in the past. The satisfaction of your employees has a direct correlation to how your patients feel. You cannot run an organization if you don’t have people who are dedicated, educated, wanting to fulfill your mission, and wanting to be with you for a while. Turnover is very high for new graduates in this country. They’re coming into these jobs not knowing what they’re getting into, so part of the pressing issue is working with the schools to make sure they’re getting the right education. Then, when they come to us, they can continue to grow.
Marisa Farabaugh: At AdventHealth, we’re focused on ensuring we have the right people around the table, investing in our people and leaders, and how we engage our diverse membership to work towards our mission. Our staff, team and people are a huge focus for the leaders at AdventHealth. We are also thinking about how we differentiate ourselves from competitors.
SM: Marisa, as a chief supply chain officer, what do you need from other leaders in the C-suite and how can you help them in turn?
MF: COVID shined a spotlight on the supply chain and the importance of a solid foundation. Healthcare leadership recognized that without our critical resources, we are unable to provide clinical care to our communities, so we have to be working together. A clinically integrated supply chain is the ideal option because it ensures the clinical voice in all that hospitals procure and purchase. It is incredibly important to ensure this ability for clinicians to partner with their supply chains teams, which will ultimately drive what products are contracted.
At AdventHealth, the chief clinical officer and I are highly connected. Our teams meet every other week to discuss supply chain strategies and impacts to our clinical teams. We also have a monthly meeting where all those strategies and decisions are approved by a governing body comprised of administrative and clinical leaders across our system and throughout our regions. AdventHealth is in nine states, with more than 50 acute care facilities. We make decisions with heavy market input and collaboration. AdventHealth has a strong operating model, and to be effective in this space, the decisions you are making must be deeply intertwined with clinical practice.
SM: Is there value in optimizing the supply chain by bundling specific processes?
WT: I am a huge fan of integrated supply chain oversight because it’s one of the most effective, least disruptive ways to reduce unnecessary variation, increase safety and optimize costs. And when you do it well, people don’t even notice it. Physicians are very data driven. There will be (challenges), but if you can present data that shows physicians the variations between them and say, ‘OR kits only make a difference in terms of cost or perhaps are even worse in safety,’ they’ll shift.
SM: Has productivity improved or declined over the last three to five years?
BM: We don’t have a good measure of work satisfaction relative to productivity, and that is the biggest problem. We’re really moving to patient-facing time for that reason, because the RVU (relative value units) system is very perverse. The problem with productivity as we currently measure it is it doesn’t capture the burden we have placed on almost all our staff, and predominantly the direct provider staff. What we have done over the last 20 years is pile on more and more administrative burden, yet say, ‘Do more with that patient and family than you were doing 20 years ago.’ Then, we’ve said, ‘And your throughput must actually get better, despite the administrative burden.’ We have essentially made the quality of work-life substantively worse, and we haven’t solved that problem.
KS: CommonSpirit Health has focus groups of nurses who tell us what they want us to work on in our longterm strategy, and one of the things is looking at our productivity, as our models and administrative burden have changed. They tell us that’s one thing that’s going to make them want to work for us.
SM: Each of your systems have very specific goals for 2024. What are some of them?
KS: I’ll talk specifically about the nursing strategy for our system. When people set up strategy, they often just think about their financial strategy or their growth strategy. But I think that COVID finally taught people that you also must have clinical strategies. We have a five-year nursing strategy, and we let the frontline nurses help us set the strategy, either in focus groups or in voting. First, they want us to come up with very concrete growth programs for them and their individual careers. They want us to look at their well-being and how to keep them safe. They want us to look at productivity because of the things that we were just talking about. And the fourth was our relationship with academia. They said, ‘We need you to look at that because there needs to be a smoother move from the colleges into work.’ So, those are going to be incorporated into our strategy.
BM: When I think of what our goals are, it’s really our 2030 strategy, meaning, what do we want to be like in 2030? For us, it’s incorporating technology in a responsible way. It is improving the quality of work-life for all our staff. It is creating a financially sustainable model between payer and provider. And it is improving the lives of our people, our members on the insurance side and our patients and families on our provider side. So, what are we doing every year to move toward those goals?
WT: This is part of the challenge for large systems— it’s hard to limit the number of goals. Everybody’s working on everything all at once. And that, I would say, is the overarching goal of our system for this year: to really get our arms around change management capabilities and systems. To some degree, that means making hard decisions about where we will not play this year, but we think it’s critically important. In employee engagement surveys, over 90% say, ‘I know what the mission is, and I know how my job connects to it and I am passionate about what I do,’ but they’re also telling us, ‘We’re overwhelmed. We don’t feel like we understand change, or that we’re resourced to embrace it.’ We believe taking a disciplined attitude toward managing that will allow us to continue accelerating toward continuous improvement. We are in an environment where if you are not continuously improving and becoming more efficient, you’re falling behind. Of all the priorities described, harnessing technology to improve efficiency and reduce stress is probably our first one because we can’t keep asking more of people without making it easier for them to do more.
SM: Is hospital at home hot or not?
BM: Skilled nursing at home is very, very hot. Hospital at home is warm. Because here’s the difficulty—unless as a provider you are in a full-risk structure with your payer, moving your revenue stream out of the hospital is career suicide. That’s why having a sustainable financial structure between payers and providers becomes critical. At the end of the day, if we can provide the same care at home that is a safer environment for the patient where there’s less risk of mental status changes, behavioral changes, falls, infection, etc., it’s the right thing to do for patients and families. But right now, it’s unaffordable as a healthcare provider.
SM: What is the appetite to be in a shared-risk model with a vendor or a supplier?
MF: We’ve seen supply chain and purchased services risk-based programs evolve over time. A few years ago, there was appetite to shift risk towards our suppliers and vendor partners. When this occurs, the factors that are usually tied to the negotiated risk factor—such as length of stay or reducing CAUTI (catheter-associated urinary tract infections), for example—are not only dependent on what the vendor partner is bringing to the table, but there can be many other contributing factors that will increase or decrease the negotiated factor being monitored. The key to a successful partnership is a trusting relationship, built over time, with very clear definitions of goals and drivers for the risk-based assumptions. If these are not clear, it will create friction between the parties. These agreements should be treated the same as other agreements where two parties are working together to achieve a common goal. Culture is important. The ability to have difficult conversations upfront is also important. A trusting relationship is key to build off the foundation and risk together.
KS: It (depends on) the relationship. I want partners who care about healthcare in this country and care enough to put some skin in the game.
