Becker's Hospital Review

16 Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 Transforming Healthcare: A Conversation With Presence Health CEO Sandra Bruce & St. Joseph Health CEO Deborah Proctor By Sabrina Rodak  S trong leadership is essential for any successful organization. In healthcare, this principle is perhaps amplified because of the challenging environment that currently surrounds hospitals and health systems. Hospital and health system leaders often run into similar barriers, but rarely do they get an opportunity to share their strategies for overcoming these challenges and discuss ideas for moving forward. To provide an opportunity for health system CEOs to share successes and frustrations, Becker's Hospital Review facilitated a conversation between Sandra Bruce, president and CEO of Chicago-based Presence Health, and Deborah Proctor, president and CEO of Orange, Calif.-based St. Joseph Health. Below are Ms. Proctor's questions, Ms. Bruce's responses and Ms. Proctor's follow-up responses. Deborah Proctor: How do we partner with other healthcare providers in this new environment? What skills do you draw on? Sandra Bruce: Establishing solid partnerships with other providers in this new environment is critical, and we are doing so in a variety of ways. For example, we may partner with other hospitals in our supply chain efforts to help reduce supply costs further, or we may seek other partners to become part of our clinical integration model. Partnering and aligning with physicians has always been important, but in the new era of hospital-physician alignment, it is essential. The emergence of new care models such as clinical integration and accountable care organizations depends on strong partnerships as payment moves to a lump fee that is allocated across the ACO. As managed care payments move from fee-for-service to value-based care, there are also payment incentives that are tied to clinical outcomes such as preventable hospital readmissions. We also continue to look for participants to become part of our clinical integration entity — Presence Health Partners. Clinical integration is a meaningful provider alignment vehicle to retain high-caliber physicians while attracting new independent physicians, especially primary care. The model provides an alternative to employment and offers physician participants a robust resource of technology, care management, reporting and analytics capabilities that will be necessary for physicians to meet the new demands of accountable care and population health management. And, finally, there is a need for us to partner with our community. Population health management is focused on improving the health of our communities by focusing on better chronic disease management and preventive care. This new environment requires hospitals and health systems to reach beyond the brick and mortar of our facilities and work to empower patients with the tools to help them stay well.  The skills essential to the success of these partnerships are collaboration and negotiation.  Healthcare has lived in silos for many years, but this new emerging healthcare environment requires us to develop and strengthen relationships among healthcare providers, payors and physician partners. DP: I couldn't agree more that partnerships are going to shape our future. Similar to Presence, we are seeking stronger partnerships with our physicians. Our efforts in clinical integration have intensified over the past several years not just out of the necessity to align with reform, but because we understand that patients are most interested in seamless, less fragmented health- care. They want systems that talk to one another and care that flows easily from the hospital to doctors' offices to other healthcare resources within their communities.  Sandra Bruce Over the next several years, our intent is to develop a true network of healthcare that includes acute-care hospitals, physicians, home health, skilled nursing and other healthcare providers. This will be a network based on partnerships, not always ownerships. We're going to have to learn to be better members of highly coordinated healthcare teams. Additionally, we have already realized the potential of developing never-before imagined partnerships. Our planned affiliation with Hoag Hospital in Southern California is a good example of such an opportunity. After several decades, we began to recognize the benefits of the two health systems becoming potential affiliates. When we announced our plans last August, people in our communities were extremely positive. Many have told me they are excited about the prospects of two outstanding providers finally coming together for the good of the community. That's a much different way of operating, but it bodes well for the new environment. Deborah Proctor DP: What three qualities must a healthcare system leader have? SB: First, a healthcare system leader must have the ability to manage in a fast-paced, ambiguous environment. At times, the end point may not be clear, and the path to get there may be undefined as well. This ever-evolving environment requires leaders to be flexible and collaborative. Second, a health system leader must have the ability to create a management structure that is both top-down and bottom-up. By this I mean it must be both hierarchical and collaborative in order to maximize crossfunctionality to work efficiently and effectively. Third, a healthcare system leader must have the ability to embrace evidence-based decision making from both a clinical standpoint and a business perspective. This requires a culture shift from basing decisions on what we think to basing decisions more on data and what we know.   DP: Personally, I've been inspired by contemporary theologian Gerald Arbuckle who writes about the need for "prophetic leaders" who understand mission and can imaginatively and collaboratively ensure it endures in these transformative times. That's not an easy task, and I remind myself daily of the qualities that Arbuckle outlines for a "prophetic leader:" memory of the great traditions, creativity, orientation toward the community, steadfastness in commitment, patience in adversity, humility, a sense of humor and

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