Latest / Becker’s Healthcare Podcast / Leading Through Uncertainty, Redesigning Healthcare, and Making Meaning for Teams with James Hereford

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Leading Through Uncertainty, Redesigning Healthcare, and Making Meaning for Teams with James Hereford · Becker’s Healthcare Podcast

• 0:00
  - At Insight Global Health, we are dedicated to
• 0:02
  - helping you and improving health care for everyone.
• 0:05
  - That means building stronger teams and delivering sustainable
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  - solutions that truly make a difference.
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  - We offer a full spectrum of talent and
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  - technical services and deliver cross industry expertise
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  - to bring you innovative best practices to solve
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  - the problems that we face in health care.
• 0:20
  - We're not just promising you results. We are
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  - delivering them. Visit us at insightglobal.com.
• 0:26
  - Thank you for listening to the Becker's Healthcare
• 0:27
  - podcast. I am Molly Gamble with Becker's Healthcare
• 0:30
  - and joined by James Hereford, president and CEO
• 0:33
  - of Fairview Health Services. James, welcome. Thanks for
• 0:36
  - joining me today. Well, thank you, Molly. It's
• 0:38
  - a pleasure to be here. Good to be
• 0:39
  - with you. We're at the live of the
• 0:40
  - sixteenth annual meeting. How has your week been
• 0:43
  - so far?
• 0:44
  - Well, my week here started last night fairly
• 0:47
  - late. I got in, and then I'm leaving
• 0:48
  - today, so it's been very brief. It'll be
• 0:50
  - a quick one. But it's always good to
• 0:52
  - be here. Good to, you know, run into
• 0:54
  - a whole bunch of people. Health care is
• 0:56
  - such a small world that it's nice to
• 0:58
  - reacquaint.
• 0:59
  - Let's make the most of your time. We're
• 1:00
  - we're gonna
• 1:02
  - go beyond introductions, learn a little bit more
• 1:04
  - right now about the the scope of your
• 1:06
  - work, the your organization,
• 1:08
  - and also your role. Can you briefly touch
• 1:11
  - on each just to orient our listeners?
• 1:13
  - So Fairview Health Services is headquartered in Minneapolis.
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  - We serve,
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  - the broader,
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  - Minnesota market,
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  - about 1,200,000
• 1:24
  - unique individuals in the state of 6,000,000.
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  - We're the third largest employer in the state.
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  - Total revenues are about 9,000,000,000.
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  - We are a truly,
• 1:34
  - kind of birth to grave integrated system. Right?
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  - So,
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  - large base of primary care.
• 1:40
  - We have academic
• 1:42
  - relationship with the University of Minnesota, so the
• 1:44
  - tertiary quaternary level.
• 1:46
  - Significant specialty,
• 1:47
  - present,
• 1:48
  - presence in our organization, both
• 1:51
  - employed,
• 1:52
  - academic, as well as, community.
• 1:54
  - And then we have we're really good at
• 1:56
  - specialty pharmacy. It's one of the things that
• 1:58
  - we're very proud about in terms of not
• 2:00
  - just can we maximize three forty b, but
• 2:02
  - can we manage the care of individuals
• 2:05
  - very well? And that's what we do. I've
• 2:07
  - got a great graph that to show that
• 2:08
  - we manage a specialty
• 2:10
  - pharmacy patient.
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  - The PMPM spend is 10 to 15%
• 2:15
  - less because we're management. And so we're really
• 2:17
  - good at those those sorts of things, and
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  - including having a a senior,
• 2:21
  - subsidiary, Ebenezer, that is, independent living all through
• 2:25
  - all the way through skilled nursing facilities.
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  - So truly a, you know, full featured integrated
• 2:29
  - system. Very much so. So fair review. $9,000,000,000
• 2:31
  - system, so so 1,200,000
• 2:33
  - patients in a state of 6,000,000, you said.
• 2:35
  - Yep. I think one of the things, James,
• 2:37
  - just to zero out or zoom out a
• 2:40
  - little bit, is I'm appreciating more and more
• 2:42
  - in events like this, the decisiveness of leaders
• 2:45
  - in these conversations. There's a lot that you're
• 2:47
  - managing, a lot of competing priorities,
• 2:50
  - compounding effects of legislation, and
• 2:53
  - reimbursement changes that we're seeing. I guess, if
• 2:56
  - you had a take a look at your
• 2:57
  - past year, one truly defined by rapid change,
• 3:00
  - is there a recent decision or pivot
• 3:02
  - that really took the most conviction from you
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  - as a leader, particularly when it comes to
• 3:07
  - to people?
• 3:09
  - Well
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  - People resources or or capabilities.
• 3:12
  - I think the,
• 3:14
  - operation Metro surge in Minneapolis
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  - was a fairly
• 3:19
  - significant event at a whole bunch of levels.
• 3:22
  - It certainly impacted,
• 3:24
  - our workforce in a significant way. And when
• 3:27
  - Alex Creddy was murdered, you know, as a
• 3:30
  - nurse, it affected our nurses significantly. And we
• 3:33
  - always talk about leadership in a couple of
• 3:35
  - different ways in at Fairview. One is leadership
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  - is not a noun.
• 3:40
  - It's a verb. It's what you do, and
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  - you anybody can be a leader. It's how
• 3:44
  - you, you know, react to situations. You go
• 3:47
  - towards the problem. Do you bring people with
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  - you?
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  - Are you actively involved in making the organization
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  - better? And that could be at any level
• 3:53
  - of the organization.
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  - Likewise, just because you have a leadership title
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  - doesn't mean you're a leader.
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  - The title doesn't make you affected. It's what
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  - you do. And that was a great example
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  - of
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  - impacting our organization and our people in a
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  - pretty significant way, in a very kind of
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  - visceral
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  - and emotional way, and the importance of being
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  - able to continue to focus on who we
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  - are and what we do. And we're there
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  - to care for patients.
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  - Period. End of story.
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  - Doesn't matter what your immigration status is, who
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  - you work for, doesn't matter. We care for
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  - patients. And so being able to continue to
• 4:27
  - focus back on that was absolutely crucial to
• 4:30
  - be able to stabilize our organization,
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  - make sure that we could be there to
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  - deliver care that was necessary to the entirety
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  - of the population of the Twin Cities and
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  - state of Minnesota.
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  - So it's less a a big pivotal moment
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  - Right. More as how do we continue to
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  - stay connected with who we are and what
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  - we're about. At the same
• 4:49
  - time, building on where we have to go
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  - because we can't stand still, not in our
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  - marketplace and not in health care delivery in
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  - The United States these days. So how do
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  - you do that, maintain stability, at the same
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  - time be disrupted? Mhmm. And so there's a
• 5:02
  - million decisions you make every day about how
• 5:04
  - do we continue to challenge the status quo?
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  - How do we challenge and get better? How
• 5:08
  - do we iterate to, you know, learn from
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  - our what we've done and get better at
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  - what we need to do to deliver on
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  - patient data? Right. And I think it's another
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  - great reminder too. Health systems don't operate in
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  - vacuums. What happens externally is it's shaping
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  - the patient experience, the pro the care team
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  - experience, how they're showing up to work, how
• 5:28
  - they're showing up and relating to patients. I
• 5:30
  - guess, did did that stretch of time challenge
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  - any assumptions
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  - that people might have commonly have about health
• 5:37
  - system leadership? And the way you showed up,
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  - were you more visible?
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  - Did it make you rethink
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  - your decision making or
• 5:45
  - how you relate to talent? Any any any
• 5:48
  - of those effects that you can relate to?
• 5:51
  - It is interesting. It's an interesting balance point
• 5:53
  - because, you know, there was a lot of
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  - pressure on CEOs and health care CEOs specifically
• 5:59
  - to come out and be very aggressive
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  - about, you know, the what was happening in
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  - in many hours. Right? And and one of
• 6:06
  - the great things that came of that was
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  - really unifying the Twin Cities, you know, against,
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  - at that point, a common enemy.
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  - We didn't have that luxury. Right? We couldn't
• 6:14
  - say, oh, ICE, bad.
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  - Federal government, bad.
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  - Got it. We're a big vendor for the
• 6:21
  - federal government in terms of delivering care. And
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  - ICE, you know, law enforcement is a part
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  - of the ecosystem of who we deal with
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  - every day, and it's a very important relationship,
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  - especially with local law enforcement.
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  - So, you know, we reached out and really
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  - kind of struck a deal with ICE about,
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  - okay. It's important that we're able to be
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  - in a position to deliver care. We get
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  - you have a job to do. Whether we
• 6:45
  - agree or disagree with how you're doing, it
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  - doesn't matter. But we need you to be
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  - able to minimize your presence in our
• 6:52
  - hospitals.
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  - And so we struck an accommodation
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  - that was based on, we need to be
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  - able to do what we do need to
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  - do, and we need your cooperation because you're
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  - also dependent on us. But it's an example
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  - of that kind of tension of there's a
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  - pragmatic
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  - thing that we have to continue to stay
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  - kinda focused on, which is delivering care. At
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  - the same time, there's inordinate pressure about, you
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  - know, CEOs gotta take a stand. We gotta
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  - be, you know, this, at the forefront of
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  - the ability to,
• 7:20
  - make judgments about what is happening. Is it
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  - good or bad? Absolutely. And to a certain
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  - degree, you can do that. To a certain
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  - degree, you've gotta maintain a balance Yes. In
• 7:29
  - how you approach that. What no matter how
• 7:31
  - you feel individually,
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  - that organizational
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  - accountability
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  - overrides that.
• 7:36
  - What I'm hearing is there's no easy answers
• 7:38
  - in that position.
• 7:40
  - A ton of relationship management,
• 7:42
  - a ton of trying to make things work
• 7:44
  - for the greater good, which is access to
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  - health care
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  - regardless of of role, immigration status, title.
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  - So I I really appreciate you walking us
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  - and expanding on that, James. What I always
• 7:55
  - describe to, you know, anybody who asks what
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  - my job's like, I say, look. You have
• 7:58
  - to understand. And I have a brilliant team.
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  - Yeah. And so the only problems that get
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  - to me are really hard problems in which
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  - there are always 51, 49 calls.
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  - Everything else gets solved. Right? So it is
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  - that you're always in this position of trying
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  - to weigh against these very difficult judgments.
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  - I wouldn't trade it for anything in the
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  - world. It's a, you know, great job, and
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  - the impact you have is amazing, but it's
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  - not easy. Yeah. I
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  - I believe you. If you have a zoom
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  - out of your organization and and look to
• 8:26
  - the industry as a whole, are there any
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  - areas where
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  - you
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  - are seeing the need for leaders to be
• 8:32
  - more decisive?
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  - This is about all the forces that are
• 8:35
  - reshaping health care right now, which are many.
• 8:38
  - Yeah. Where would you crave more conviction from
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  - your your peers and your colleagues?
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  - I think leaders of care delivery organizations
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  - have to have
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  - a, affirmative answer
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  - to what's next. You know, this current financing
• 8:54
  - of health care system is breaking down. We
• 8:56
  - can see that everywhere. I always describe it
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  - as this big Jenga tower that people keep
• 9:01
  - taking pieces out of in terms of health
• 9:02
  - care financing. In some point, the thing is
• 9:04
  - gonna fall over. We have had this long
• 9:07
  - run of this cross subsidization
• 9:09
  - between commercial,
• 9:11
  - entities and the government. And the commercial entities
• 9:14
  - having to make up the difference for you
• 9:16
  - know, we don't get even get paid what
• 9:17
  - it costs us to deliver Medicare and Medicaid
• 9:19
  - commercial entities. If we had to make that
• 9:21
  - up,
• 9:23
  - that's not gonna sustain itself. Mhmm.
• 9:26
  - What we need to do as a health
• 9:28
  - care delivery, which let's keep in mind, that's
• 9:30
  - where the value is created. It's nowhere else
• 9:32
  - and all the middlemen and all the other
• 9:34
  - things that are happening. We're the ones who
• 9:36
  - are delivering value to our patients, but we've
• 9:38
  - also been very protected.
• 9:40
  - Very well, we gotta defend this, and we
• 9:42
  - have to defend that. But we can't continue
• 9:44
  - just to defend the system that is breaking
• 9:46
  - down. We have to have some answers around
• 9:49
  - what's the next system have to look like
• 9:51
  - to be effective, to continue to care for
• 9:53
  - patients and to be able to afford? I
• 9:54
  - mean, I have these, you know, very big,
• 9:57
  - very expensive capital assets called hospitals
• 10:00
  - that, you know, demand continued capital infusion
• 10:05
  - as the,
• 10:06
  - Sisters of Providence are famed for saying,
• 10:09
  - no profit, no margin, no mission. Right? Right.
• 10:11
  - And so we also have to be able
• 10:13
  - to make a enough margin to be able
• 10:15
  - to reinvest.
• 10:16
  - The other balancing point, I think, for,
• 10:18
  - us as health care leaders, especially nonprofit health
• 10:21
  - care leaders, I think it's it's very different
• 10:23
  - in that you also have this
• 10:26
  - mission to the community and a relationship to
• 10:28
  - how you're improving the health of the community.
• 10:30
  - You know, if I'm in a for profit
• 10:32
  - yeah. I got quarterly analyst calls, and I've
• 10:34
  - gotta answer to the street. I don't have
• 10:36
  - to do that. Mhmm. But I have a
• 10:38
  - different set of stakeholders
• 10:40
  - that in many ways are as demanding, if
• 10:42
  - not more so, in terms of how we
• 10:43
  - relate to our communities that we serve Mhmm.
• 10:46
  - And that kind of public health mission. So
• 10:48
  - that's another balancing point that we have got
• 10:50
  - to get clear about how we do that.
• 10:52
  - May I ask a follow-up there? I mean,
• 10:54
  - at events like this, we hear leaders describe
• 10:56
  - how the math does not work. They paint
• 10:58
  - a rich picture of some of the dysfunction
• 11:00
  - in the the status quo systems, and and
• 11:03
  - not just one organization, but the health care
• 11:05
  - system as a whole. And then
• 11:07
  - do we kind of retreat back to our
• 11:09
  - organizations? And when these discussions come up, protect
• 11:12
  - her,
• 11:13
  - have have some resistance to ways to redesign?
• 11:15
  - Redesign is tough. But I I think your
• 11:17
  - point Yeah. The conviction needed easier not to
• 11:19
  - in the short term. Term. And and to
• 11:20
  - describe what's not working. But to your point,
• 11:23
  - the conviction around redesign is where we might
• 11:25
  - be needing to up up the ante a
• 11:27
  - bit. I think that's certainly a part of
• 11:29
  - it. Right? And a big part of it
• 11:30
  - is and we're also in you know, facing
• 11:33
  - down
• 11:34
  - two kind of transformational
• 11:36
  - technologies.
• 11:37
  - One is around precision medicine.
• 11:39
  - It is gonna change the way that we
• 11:41
  - think about the delivery of care. And,
• 11:43
  - you can see it in the what the
• 11:45
  - you look at what's in the pipeline.
• 11:47
  - If we don't look at how we deliver
• 11:49
  - care and how we orient our care delivery
• 11:51
  - systems to that,
• 11:53
  - we'll have missed a significant opportunity.
• 11:55
  - The other is AI.
• 11:57
  - And I'm old enough to remember, you know,
• 11:59
  - late nineteen nineties, early aughts, the web. It's
• 12:02
  - gonna change everything. Problem is nobody knew exactly
• 12:04
  - how. Right. Right? AI is the same thing.
• 12:07
  - It is gonna be transformative.
• 12:09
  - The problem is we don't know exactly how.
• 12:11
  - And so it is critical for organizations like
• 12:14
  - ours to be able to lean into those
• 12:17
  - and really challenge ourselves on the status quo
• 12:19
  - and say, yeah. We've always done it that
• 12:21
  - way. It doesn't mean we always get to
• 12:22
  - do it. We have to consider how do
• 12:25
  - we continue to press forward and think about
• 12:27
  - the transformational effects.
• 12:29
  - The concern is
• 12:31
  - even doing that's gonna be insufficient.
• 12:33
  - So we don't really have control of our
• 12:34
  - input costs.
• 12:36
  - So
• 12:37
  - pharma, medtech, high-tech, labor, I have very little
• 12:40
  - control over those. But those industries, those segments
• 12:43
  - make all their money largely off of health
• 12:45
  - care delivery. Care delivery. Yeah. And so if
• 12:47
  - you don't have control of your input costs,
• 12:49
  - it's really hard to have control of your
• 12:50
  - output. Right. There's a certain amount that we
• 12:52
  - can do, but it's limited. And so we're
• 12:54
  - also gonna have to think about what those
• 12:56
  - fundamental relationships look like.
• 12:59
  - As uncertainty just becomes more and more the
• 13:01
  - norm,
• 13:03
  - you you can't afford to take your your
• 13:04
  - foot off the gas. Right. And you have
• 13:06
  - to keep things moving. You have to keep
• 13:07
  - your people motivated, focused,
• 13:10
  - taken care of. Is there a mindset or
• 13:12
  - a a leadership habit that you think has
• 13:14
  - become even more critical,
• 13:15
  - to keeping people moving forward in your organization
• 13:18
  - or more broadly?
• 13:19
  - Well, couple of things. We talk about leadership
• 13:22
  - as a verb. Yeah. It's not a noun.
• 13:24
  - And so, yeah, don't care what your title
• 13:26
  - is. I don't care where you work in
• 13:27
  - the organization. We all have the opportunity to
• 13:29
  - be leaders, and we all make choices about,
• 13:31
  - are we gonna lead in this situation or
• 13:33
  - not? Are we gonna go towards the problem
• 13:34
  - or not? But the other thing we talk
• 13:36
  - about is there's at least three fundamental things
• 13:38
  - that you have to do as a leader.
• 13:40
  - You have to set and hold standards. If
• 13:42
  - you're not setting and holding standards, you're really
• 13:44
  - not leading.
• 13:45
  - You have to have a system of accountability.
• 13:48
  - So you have to have a way of
• 13:49
  - relating to the people who are accountable for
• 13:52
  - the work, how you hold them accountable in
• 13:54
  - a way that's constructive, not de struck. Right?
• 13:56
  - So how do you learn not to not
• 13:59
  - do things, but to do things, and if
• 14:01
  - they're not completely successful, learn from that? And
• 14:03
  - then I think almost the most important at
• 14:05
  - this point is you have to make meaning
• 14:08
  - for people.
• 14:09
  - There's so much information and disinformation
• 14:12
  - and opinions and people who claim to be
• 14:15
  - health care experts who don't know really all
• 14:17
  - that much about what they're talking about. Right.
• 14:20
  - Filling the airspace, filling the, you know, the
• 14:22
  - waves with stuff, podcast included. Right?
• 14:25
  - Part of the job of leaders to take
• 14:27
  - all that information and help make meaning for
• 14:29
  - the people that you're leading. And, again, it
• 14:31
  - doesn't matter if you could be the CEO
• 14:33
  - or you can be the environmental service work.
• 14:35
  - It doesn't matter.
• 14:36
  - It's how do you take in that information
• 14:38
  - and make meaning about what's important to the
• 14:41
  - organization. That's why I really feel like the
• 14:43
  - it's the first time that mission, vision, and
• 14:45
  - values really have become
• 14:48
  - a a cornerstone
• 14:49
  - to really stand upon as you're talking about
• 14:51
  - how do you what does this mean for
• 14:53
  - us? And I refer back to the example
• 14:55
  - of Operation Metro Search. We relied on who
• 14:58
  - we are as a cornerstone
• 15:00
  - for how we approach that particular challenge.
• 15:03
  - If I can, James, just as we wind
• 15:05
  - down here, I'm gonna take something you had
• 15:07
  - raised
• 15:07
  - later in our conversation, the AI piece.
• 15:11
  - Technology is a through line of this entire
• 15:12
  - week. As you talk about those three things,
• 15:16
  - setting and holding standards, system of systems of
• 15:19
  - accountability, and also making meaning, how are you
• 15:22
  - treating
• 15:23
  - technology decisions with those values in mind? Because
• 15:25
  - you need to make sure that these digital
• 15:27
  - investments are supporting rather than straining your workforce.
• 15:30
  - Right. What's the framework of decision making you
• 15:32
  - hold around that? Can you point to that
• 15:33
  - or illustrate that highly?
• 15:35
  - Well, I I I don't know that the
• 15:37
  - framework of decision making is all that different.
• 15:39
  - I think what guides our decisions are, you
• 15:40
  - know, always the same in terms of it's
• 15:43
  - this
• 15:44
  - you know, I always look at this as
• 15:46
  - while we have these competing dimensions of performance.
• 15:48
  - Right? It's your,
• 15:50
  - economic performance, your quality performance, your service
• 15:54
  - performance, your engagement of your employees.
• 15:56
  - All that has to be held in balance.
• 15:58
  - Right? Or held you can't you don't get
• 16:00
  - to choose a couple of notes. You gotta
• 16:02
  - do the move. But the common denominator with
• 16:04
  - that is process. So how do we do
• 16:06
  - our work? And to me, that's what grounds
• 16:08
  - us in the conversations about how do we
• 16:10
  - think about AI. So,
• 16:12
  - you know, like many organizations, we've implemented ambient
• 16:15
  - listening for our physicians.
• 16:17
  - And it was critical in terms of improving
• 16:20
  - their workflow because one of the downsides of
• 16:22
  - EMR is what it's done is chain our
• 16:25
  - clinicians
• 16:26
  - to a a damn terminal.
• 16:28
  - And, you know, patients one of the number
• 16:30
  - one complaint compliant patients is, my doctor doesn't
• 16:33
  - look me in the eyes anymore because he's
• 16:35
  - too busy typing on a a computer. And
• 16:37
  - Right. Frankly, they're not very good typos.
• 16:39
  - Right? So being able to untether that Yeah.
• 16:41
  - Changes that workflow fundamentally.
• 16:44
  - Now that's a easy example. That's one of
• 16:46
  - the more mature technologies that are available. But
• 16:48
  - I think as we see more development of
• 16:51
  - a Genentech AI and some of the other
• 16:53
  - capabilities,
• 16:54
  - that how does it impact the process and,
• 16:56
  - therefore, the people in the process
• 16:58
  - has to guide the decision making. And, ultimately,
• 17:00
  - how does it serve our patients? How are
• 17:02
  - we creating value with us?
• 17:03
  - So, obviously,
• 17:04
  - if my providers are spending more time looking
• 17:07
  - at patients in the eye, engaging with them,
• 17:09
  - that's gonna help us in a whole bunch
• 17:11
  - of different fronts, including the satisfaction of our
• 17:13
  - providers, which is an important aspect. Absolutely. The
• 17:16
  - process in getting people your people closer to
• 17:18
  - the meaning of the work is what, ideally,
• 17:21
  - technology will be doing.
• 17:23
  - Ideally. Yeah. Yeah. And the the meaning of
• 17:25
  - the organization, who you are, what you're about,
• 17:28
  - everything should be in service of that. 100%.
• 17:31
  - James, this was such a great conversation. We
• 17:34
  - really you hit on a lot, a lot
• 17:35
  - of great leadership advice, a lot of timely
• 17:38
  - leadership experiences to touch on. So I wanna
• 17:40
  - thank you so much. James Hereford, president and
• 17:43
  - CEO of Fairview Health Services. Thank you so
• 17:45
  - much for being my guest on the Becker's
• 17:46
  - Healthcare podcast. Pleasure. Thank you.