Latest / Becker’s Healthcare Podcast / Michael Wiggins, Assistant Professor of Healthcare Management and Leadership at Texas Tech University Health Sciences Cente

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Michael Wiggins, Assistant Professor of Healthcare Management and Leadership at Texas Tech University Health Sciences Cente · Becker’s Healthcare Podcast

0:02
The most important health care decisions don't happen
0:05
in isolation.
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They happen when leaders come together.
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Becker's sixteenth annual meeting brings together more than
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3,500
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hospital and health system executives this April in
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Chicago.
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With 800 speakers from Ascension,
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Cleveland Clinic, CommonSpirit and more, the conversations get
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real. Leaders will share how their scenario planning
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for policy shifts, breaking through value based care
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barriers, and building clinical teams that translate
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event
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details,
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visit beckershospitalreview.com
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and click on the events tab in the
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upper right.
0:46
This is Laura Diredell with the Becker's Healthcare
0:48
Podcast. I'm thrilled today to be joined by
0:51
Michael Wiggins, assistant professor of Healthcare Management and
0:53
Leadership at Texas Tech University Health Sciences Center.
0:57
Michael, it's a pleasure to have you on
0:58
the podcast today. Well, thank you, Laura. Thank
1:00
you for the invitation. It's a pleasure to
1:02
spend a few minutes with you and your
1:03
listeners.
1:05
Absolutely. And, you know, I'm excited for the
1:07
time we have today because I know health
1:09
care is such a dynamic field. And so
1:11
to get your perspective and especially on the
1:13
academic side, will help, you know, make sure
1:15
we're,
1:16
sharing with our broader audience some of the
1:19
the cool things that you've been working on
1:21
as well as how, you know, you're seeing
1:23
the future continue to evolve. But before we
1:25
dive into that, can you introduce yourself and
1:27
just tell us a little bit more about
1:28
Texas Tech?
1:29
Oh, absolutely. Well, and and I as you
1:32
mentioned, I have the privilege of serving as
1:33
an assistant professor at Texas Tech University Health
1:36
Sciences Center. And, at the center, we have
1:38
schools of medicine, nursing, pharmacy, biomedical sciences. We
1:43
also have the Julia Jones Matthews School of
1:45
Population and Public Health. And then the school
1:47
where I teach,
1:49
which is the School of Health Professions. And
1:51
I teach
1:52
in the health care management leadership department. And
1:54
we we have both an undergraduate program as
1:56
well as a master's degree program.
1:59
And I've been with the health sciences center
2:00
for almost two years now, after spending,
2:04
well, a little over thirty years,
2:06
serving in various health care leadership positions, including
2:09
as chief executive of a couple of academic
2:12
medical centers. So
2:13
I'm I'm thrilled now to take some of
2:15
that experience that I was able to pick
2:16
up over those thirty years and and try
2:19
to apply that into preparing students to be
2:21
future health care leaders.
2:26
Fantastic. Well, and, you know, I'm curious,
2:28
to just your point in looking at, you
2:31
know, the impact you're able to make on
2:33
the academic side. What really prompted your move
2:35
from being a health care executive into academics?
2:39
Yeah. Well, Laura, that's a question that that
2:42
a lot of colleagues ask me. I'll tell
2:43
you, it's it's something that I started preparing
2:45
for a long time ago. I just,
2:48
I love to teach. I always have. And
2:50
I I love to be around learners too.
2:52
It's it's part of why I enjoyed leading
2:55
academic medical centers so much. Just the the
2:58
energy and enthusiasm that learners bring to the
3:00
environment. The fact that that students sort of
3:02
keep us on our toes too. We we
3:05
have to stay up to date and informed
3:06
and current or else they're gonna call us
3:08
on it. And and so there's some accountability
3:11
there. But, knowing that I love that environment,
3:13
I've gone back years ago and completed my
3:16
doctorate.
3:17
And then I've begun just doing guest lectures
3:19
at local universities. I I eventually took on
3:22
a couple of faculty teaching opportunities,
3:25
as an adjunct.
3:26
And and so I knew that at some
3:28
point, this is what I wanted to do.
3:30
This is where I wanted to be. And
3:32
and so I'd I'd sort of developed a
3:33
plan to do that.
3:35
And then this opportunity with Texas Tech University
3:37
Health Science Center came along, and and I
3:39
was just so impressed with the organization.
3:43
And I'd really start with my my faculty
3:45
colleagues. They they've just got this impressive mix
3:48
of backgrounds. There are some who have spent
3:50
careers in academia.
3:52
They've been teaching and conducting research. And then
3:54
there's some like me,
3:55
who have the academic prep, but but we
3:57
spent most of our careers leading health care
4:00
organizations. And so really brings together the academics
4:04
and practice in
4:05
a way that I think offers something really
4:07
special to our students. And and and the
4:10
leadership team we have there is just extraordinary.
4:12
Our program directors, doctors Merritt Brockman, Carrie Shaver,
4:15
Morgan House, our department chair, doctor Ryan Schmidt,
4:18
our dean, doctor Lander Seacrest.
4:20
Just tremendous leaders really help us keep our
4:23
focus on learners and and those we serve.
4:25
So so it's been a wonderful transition for
4:28
me. Again, something that I planned for, and
4:31
and I'm just thrilled to be in this
4:32
role now, Lauren.
4:35
That's amazing to hear. You know, to have
4:37
that kind of, opportunity to really lean into
4:39
your strengths and do what you enjoy most
4:42
and influence the future at the same time,
4:44
is just fantastic.
4:46
Now when you're thinking about, especially the last
4:48
year or so, can you tell us about
4:49
an initiative that you led? What did you
4:51
do, and what were the results?
4:53
Yeah. I I'll tell you much of my
4:55
focus in the last year, Laura, has been
4:56
on academic medical centers and and systems
5:01
of care. And and I have a particular
5:02
interest in economic models that support integrated
5:05
systems of care. And, the reality is right
5:07
now, we we don't have very many true
5:09
systems of care in The US. We have
5:12
a lot of what what I refer to
5:14
as nodes of care. We have hospitals and
5:16
physician practices, ambulatory surgery centers, you name it.
5:19
And and sometimes they're connected, sometimes they're affiliated,
5:22
but but oftentimes not. But even the ones
5:26
that are, they're they're really rarely
5:28
coordinated very effectively. And so this fragmentation,
5:32
as we know, it's it's inefficient.
5:34
It adds cost,
5:35
and and that's not a new concept. No
5:37
no one's listening right now saying, oh, wow.
5:39
You know, I I never thought about that.
5:42
You know, we see this, for example, in
5:43
patient flow. I mean, hospital operators are very
5:46
familiar with this. The the fact that we
5:48
literally put humans into inventory
5:51
in our health care system.
5:53
We we have patients holding in the emergency
5:55
department for days because they can't get a
5:57
bed to be admitted.
5:59
And so they just become human inventory
6:01
in our system. And, you know, meanwhile, the
6:04
inpatient units, patients are taking up beds because
6:06
of a disposition issue. They,
6:08
maybe they need a a skilled nursing facility,
6:10
but there's no capacity.
6:12
Or maybe they need home health, but they
6:14
can't get on the schedule till next week.
6:15
Again, it just creates this inventory issue. And
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I,
6:19
I I like the way a colleague of
6:21
mine, doctor Pat Lee, he's the CEO of
6:23
Central Health in Austin, Texas. He he refers
6:26
to this as a system with edges,
6:28
where patients get to an edge in the
6:31
system,
6:32
and and they're just stuck. They just can't
6:34
go any further.
6:35
And and we see that example playing out
6:37
all over the country. And hospital operators, you
6:39
know,
6:40
working very hard to deal with those situations,
6:43
and they understand
6:44
the cost that it's creating, whether opportunity cost,
6:47
resource cost, what have you.
6:50
But the work that they're doing is primarily
6:52
in their own organizations or in their own
6:55
nodes.
6:56
And so to me,
6:58
this is where I've been trying to spend
7:00
my energy and my time is getting to
7:02
this new mindset. It's a real shift
7:05
that we have to take. We have to
7:07
begin thinking about these costs in our system
7:10
as opportunities for investment.
7:13
So when, you know, when we see these
7:15
patients piling up in our EDs,
7:17
we we have to see that not just
7:19
as a cost, but as an opportunity for
7:21
investment. Why are those patients there? Are there
7:24
are there other forms of care that would
7:27
be better to meet their needs? Should we
7:28
invest in those forms of care?
7:30
And so part of my focus is bringing
7:33
just economic clarity to those decisions.
7:37
You know, if a hospital knows that a
7:39
lack of skilled nursing capacity is costing them,
7:41
let's let's say, a million dollars a year,
7:44
well, should they be willing to invest a
7:46
portion of that million dollars into developing a
7:48
solution? Well, I I would expect most health
7:50
care leaders would say, yes. I I'd I'd
7:52
be glad to invest something less than a
7:55
million dollars to solve a million dollar cost
7:57
issue.
7:58
And so I'm working to try to help
8:00
organization,
8:01
help them think in those terms
8:03
to begin thinking about cost as investment
8:06
opportunities.
8:08
And while I use patient flow as an
8:10
example, that's that's an obvious one. Most leaders
8:13
are in health care dealing with that. But
8:15
but that sort of thinking can really apply
8:17
to any area where an organization has significant
8:20
cost. So so, Laura, that's that's been my
8:22
primary area of focus is just helping organizations
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tend to think about cost as opportunity.
8:31
I love that. And I think that's such
8:33
a important mindset shift because there's so much
8:36
change happening within the health care space and
8:39
really having the opportunity to step back and
8:41
understand, you know, where those investments can, really
8:45
make the biggest difference and then looking, you
8:47
know, further ahead
8:48
in the impact and value that they're going
8:50
to bring into the organization.
8:52
You know, it seems like such a, an
8:54
important and beneficial way to look at strategy
8:57
overall.
8:58
And, you know, from,
8:59
your seat
9:01
in thinking about the next year or so,
9:02
what are some of the big priorities and
9:04
headwinds that you and and health care leaders
9:06
should be focused on?
9:08
Well, sure. And there there are several that
9:10
that come to mind. As I mentioned, most
9:12
of my attention being focused on academic medical
9:14
centers.
9:15
You know, I think about tremendous headwinds. Of
9:18
course, you know, this mindset
9:19
shift I was thinking about in terms of,
9:22
thinking of cost as investment opportunities, and those
9:25
investment opportunities don't necessarily mean
9:28
direct ownership. It might mean partnership. It might
9:31
mean
9:32
other types of relationships that solve those issues.
9:35
But but when I do think specifically about
9:37
academic medical centers, you know, I think about
9:40
the headwinds as they relate to their tripartite
9:43
academic mission,
9:45
the the research, the education, the clinical enterprises
9:48
that make up the academic mission.
9:51
And and the reality is that we we're
9:53
seeing a squeeze on research funding. We're seeing
9:56
a squeeze on the educational mission, which we,
9:59
yeah, can think about as the the workforce
10:01
pipeline, and then we see the squeeze on
10:03
clinical revenues. But but but I think
10:07
academic medical centers, they're they're not just, you
10:10
know, caught between a a rock and a
10:11
hard place. It's sort of three-dimensional for them.
10:14
They they sort of have not only the
10:15
rock and the hard place, they've got this
10:17
heavy thing pressing down on them, which is
10:20
the most proximate issue, the loss of research
10:23
funding.
10:24
And, you know, Laura, if you if you
10:25
hosted a political podcast, I'm sure we could
10:28
really stir things up right now, but around,
10:30
you know, the emotion around some of this
10:32
research funding. But, you know, we'll stay away
10:34
from that.
10:35
But but
10:37
universities,
10:38
they
10:38
they've built these resource intensive research infrastructures, and
10:42
they've done that with the assumptions about funding.
10:45
And those assumptions were reasonable at the time
10:48
based on their expectations. But now the cost
10:52
of that research infrastructure is just unsustainable.
10:56
And and so they're understandably
10:58
beginning to turn to
11:00
a source of funding that's always supported them,
11:02
and that's the clinical component of their system
11:05
or the or their clinical partners.
11:07
And they're asking these partners to fill that
11:09
gap.
11:10
And, unfortunately, this is coming at a time
11:13
when the clinical enterprise
11:15
is being squeezed by higher cost, being squeezed
11:18
by stagnant or declining reimbursement.
11:21
And so they have less to give
11:23
while they're being asked to give more. And
11:26
and so there have already been some very
11:28
difficult choices.
11:30
Some have had to
11:31
trim research programs, cut programs.
11:35
And so I think there's going to continue
11:37
to be that sort of rationalization
11:39
that's occurring,
11:40
and I think it's gonna require even more
11:42
alignment and collaboration
11:44
between
11:45
the academic enterprise and the clinical components of
11:48
the systems.
11:49
They they have to align their investments
11:52
to meet not only their strategic focus, but
11:55
also the focus of their community needs.
11:57
And so the programs that have value across
12:00
all three components of the tripartite mission,
12:03
across research, across education, across clinical,
12:07
those are gonna be the ones that survive
12:09
and thrive,
12:10
and those that don't just simply won't. So
12:12
I you know, Laura, I really think that's
12:14
that's one of the most difficult things organizations
12:17
are gonna have to deal with in in
12:19
the coming months and and potentially years.
12:22
That's such a great point. And especially, you
12:25
know, looking at how some of those funding
12:27
shifts, you know, in research and,
12:30
you know, need the research still needs to
12:32
be done and innovation still needs to be
12:33
done. And so trying to
12:35
understand, you know, where that's gonna come from
12:37
and then how the clinical as well as
12:39
the, research and academic enterprise work together.
12:43
You know, I I think
12:44
across the board, we're seeing
12:46
different kinds of collaborations and alignments,
12:49
to to figure that out.
12:51
And and one of the things you mentioned
12:53
was looking at partnerships or or trying to
12:56
find different ways
12:59
that AMCs can, you know, leverage their reputation
13:03
as well as,
13:04
be a bit more creative with how they're
13:06
getting things done. And so are there any,
13:09
creative partnerships that you've seen either at Texas
13:11
Tech or, from other institutions that kind of
13:15
embody this shift you're talking about?
13:17
Well, the the ones that I have seen,
13:19
Laura, are the ones where
13:21
they really begin to recognize
13:24
what is the strength and the core business
13:26
that that each partner brings. I mean, you
13:29
you see some of the
13:30
consolidation that's happening in the industry, whether it's
13:33
hospital operators, purchasing surgery centers, or whether it's
13:38
hospital operators getting more involved in the post
13:40
acute setting or what have you.
13:43
I I think we're beginning to see a
13:45
bit more of that vertical integration that truly
13:48
is
13:49
beginning the the to create more of these
13:51
systems of care. You know, as I mentioned
13:53
earlier, there just aren't that many systems. Even
13:57
even the organizations that call themselves systems usually
14:00
are just a a collection
14:02
of providers within a particular part of the
14:05
system. So, you know, for instance, a hospital
14:07
company that may own a number of hospitals,
14:10
but that's really just one component of the
14:12
system. So when I see organizations that are
14:15
beginning to integrate to create the full circle
14:18
system where you have
14:20
provider, payer, acute, post acute, ambulatory.
14:24
When all of those things begin to come
14:26
together,
14:27
that's when you can really benefit from the
14:30
efficiencies
14:31
across all of those networks, whether it's patient
14:34
flow, whether it's patient interaction,
14:36
leveraging technology, leveraging databases.
14:40
Really, you only get to maximize that reality
14:43
when all of those pieces of the system
14:45
are connected.
14:50
That makes a lot of sense. And thank
14:52
you for digging a little bit deeper there.
14:53
Now what do you think the hardest thing
14:55
you'll have to do in the coming year
14:57
will be?
14:58
Well,
14:59
you know, it's I I would imagine the
15:01
answer I give you now and the answer
15:03
I would give you in twelve months about
15:05
what was the hardest thing, those might be
15:07
different. I mean, what you know, part of
15:08
what's exciting about working in this field is
15:11
is you sort of never know what's coming
15:13
the next day. So,
15:15
you know, I'll reserve the right to say
15:16
there may be something out there on the
15:17
horizon that we don't quite see yet.
15:20
But, you know, I will say in general,
15:22
I think the hardest thing
15:24
is helping organizations make very difficult choices. And
15:27
and to me, the ultimate
15:30
challenge of leadership and the ultimate choice is
15:32
where organizations are gonna invest their limited resources.
15:36
Where are they going to make those investments?
15:39
And I think oftentimes, the most challenging part
15:42
of that decision
15:43
is simply deciding what not to do.
15:47
I I advise organizations when they're doing their
15:49
strategic planning,
15:51
often they're making these big lists about things
15:54
they want to do, new service lines. I
15:56
mean, here I am even, you know, advising
15:58
organizations they need to make investments. Right? They
16:01
need to make investments to reduce their cost.
16:03
So I'm I'm also one of those saying
16:05
there's something new out there they need to
16:07
invest in.
16:08
But
16:09
and and even though that's appropriate,
16:12
rarely do I see organizations
16:14
create an associated list of things that they're
16:16
going to stop
16:18
doing in order to free up resources for
16:20
these new initiatives.
16:22
And that's a hard decision. That that's a
16:24
lot harder, in my opinion, than deciding what
16:26
you're going to do.
16:28
So organizations, what what tends to happen is
16:30
we just add and we add and we
16:32
add until we reach some sort of a
16:34
of a breaking point or a crisis point.
16:37
And, usually, the first breaking point we see
16:39
is is a financial breaking point of some
16:41
sort, and then we end up having to
16:43
make urgent, unplanned, maybe even short term type
16:47
decisions to react
16:49
to that breaking point. And so, obviously, it
16:51
would be much better to take a more
16:53
routine systematic approach to to calling the initiatives
16:57
that are not the highest priority.
17:00
But, again, that's hard work, and it's especially
17:02
hard
17:03
for academic medical centers, for safety net providers
17:06
because they have obligations. They have obligations
17:09
that are placed on them. They don't get
17:11
to walk away,
17:13
from those obligations.
17:14
You know, community hospitals,
17:16
they might decide to shut down a program
17:18
because it's not producing operating margin. But those
17:21
patients who are displaced,
17:22
they're gonna end up at the doorstep of
17:24
the academic medical centers and the safety net
17:27
providers. So so
17:29
in addition to making those hard decisions about
17:31
what initiatives we're gonna walk away from,
17:34
some organizations who don't have those choices,
17:37
they have to figure out how are they
17:38
going to create create the right mix of
17:41
services
17:42
to stay a viable. And I'd also say
17:44
from a policy standpoint,
17:47
we have to make sure we're maintaining funding
17:49
mechanisms.
17:51
Often these are through supplemental payment structures so
17:53
that those organizations, the academic medical centers, the
17:56
safety net providers,
17:58
that they can maintain those services to provide
18:00
access for all. That just continues to create
18:04
a safety,
18:05
safety web, if you will, not only for
18:08
our community, but for the other providers in
18:09
the community as well. So, you know, I
18:11
I, you know, kinda gave a little bit
18:13
of a list of the things that I
18:14
think will be very difficult in the coming
18:17
year. But as I said, Laura, I I
18:19
may reserve the right that that there's something
18:20
out there we don't see just yet.
18:24
Absolutely. There's always, you know, those uncertainties
18:27
or or new things. I mean, things change
18:29
so quickly in the health care space, whether
18:31
it's, you know, economic or policy, regulatory
18:34
shifts, and technology as well has played such
18:37
a big role in how health care has
18:39
transformed so quickly in the last couple of
18:41
years, especially. So,
18:43
I I think your point is very well
18:44
taken. But, you know,
18:46
in in
18:47
thinking about the the next year as well,
18:50
how are you thinking about growth? What are
18:51
some of the best opportunities that health systems
18:53
can take advantage of?
18:55
Yeah. You know, I'll I'll go back to
18:56
our discussion when when we were talking about
18:58
thinking of cost as investment opportunities.
19:01
You you know, I would say to any
19:02
organization,
19:04
if you are experiencing
19:05
cost,
19:06
significant cost, especially cost associated with,
19:10
your core business, whether it's patient flow or
19:13
something,
19:14
of that nature,
19:15
it fundamentally means there is a supply and
19:18
demand imbalance in the system. And so I'd
19:21
say study those issues, understand them, evaluate
19:24
whether there truly is a growth opportunity that
19:27
might be an investment for you. Because I
19:30
I can almost guarantee an organization that wherever
19:33
you find those costs, wherever you find those
19:36
imbalances,
19:37
I would suspect other organizations are struggling with
19:40
the same issue. So if you can solve
19:42
that or that issue for your organization,
19:45
not only do you get the direct benefit
19:47
of it, but maybe you can scale that
19:49
in such a way as to solve that
19:51
issue for other organizations as well.
19:54
And that potentially is a significant growth opportunity
19:57
just just for those who are more entrepreneurial
20:00
health care providers.
20:01
And then, of course, as I mentioned, some
20:03
of these,
20:04
more vertical integration strategies that really close the
20:08
loop on the system
20:10
so that the organizations begin to benefit from
20:13
all of those,
20:15
sort of efficiencies
20:16
of bringing the system together, whether it is,
20:18
as you mentioned, Laura, technology
20:20
or it's other ways of really capitalizing
20:23
on that flow.
20:25
I I think organizations are gonna have some
20:27
great growth opportunities in that space. And it
20:30
it gets us closer to the kind of
20:31
system thinking investment mindset
20:34
that that I think will be necessary for
20:36
successful health care leaders. So,
20:39
you know, that sort of thinking, I think,
20:40
is gonna benefit not only health care organizations,
20:42
but I think, more importantly, I I think
20:45
it's gonna benefit the communities we serve.
20:50
Absolutely. I couldn't agree more. Michael, thank you
20:53
so much for joining us on our podcast
20:55
today. This has been such an informative conversation,
20:57
especially thinking about where health care is at,
21:00
some of the big challenges, and then, you
21:01
know, what type of investments and alignments,
21:04
organizations will need to seek growth in the
21:07
future.
21:08
And and I'm looking forward to seeing you
21:09
in person as well at the annual meeting.
21:11
I know that you'll be on a panel
21:13
and speaking and and connecting with health care
21:15
executives from across the country to share more
21:17
deeply some of these insights and, findings that
21:19
you've had. And so we're excited to have
21:21
you there and continue on the conversation.
21:23
I'm looking forward to that, Laura. And, and
21:25
thank you for,
21:27
having me as a as a guest on
21:28
your podcast today. It's been a pleasure.