Latest / Becker’s Healthcare Podcast / Preparing Rural Health Systems for Performance and Transformation with Tessa Misiaszek

Transcript

Preparing Rural Health Systems for Performance and Transformation with Tessa Misiaszek · Becker’s Healthcare Podcast

• 0:00
  Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  Healthcare. Thanks so much for tuning in to
• 0:04
  the Becker's Healthcare podcast series. It's great to
• 0:06
  have you. And I'm very excited to be
• 0:09
  joined by Tessa Myszczak, president of leadership solutions
• 0:12
  at AMN Healthcare, where she oversees the sales
• 0:14
  recruitment and financial performance across interim executive
• 0:18
  leadership and academic
• 0:20
  solutions. She brings
• 0:22
  a ton of experience to our conversation today
• 0:24
  and beyond, obviously, from serving as a CEO
• 0:27
  of a health care organization to holding a
• 0:29
  professorship at the HALT International Business School and
• 0:32
  co authoring Branding That Means Business. With fifteen
• 0:35
  years in the academic sector and deep roots
• 0:38
  in both health care and staffing, she's a
• 0:40
  recognized thought leader and keynote speaker who leads
• 0:42
  with empathy and a mission to connect ideas,
• 0:44
  expertise, and people
• 0:46
  to unlock potential at every level. And I'm
• 0:50
  hoping
• 0:51
  that we're unlocking some potential today. Tessa, welcome.
• 0:54
  So great to have you. Thank you so
• 0:56
  much, Lucas. It's wonderful to be here.
• 0:58
  Yes. Before we get into some of the
• 1:00
  details of our conversation, I I do wanna
• 1:03
  sort of start us off with the broader
• 1:05
  picture of our episode today. And we know
• 1:08
  that CMS is investing significantly in rural health
• 1:12
  transformation today. It's it's a big topic around
• 1:15
  the health care space.
• 1:17
  What do you think the agency is signaling
• 1:20
  about how
• 1:21
  rural health care organizations
• 1:23
  will be expected to operate and be measured
• 1:27
  in the coming years?
• 1:30
  Yeah, Lucas. So this is such,
• 1:32
  an important moment that we're facing right now,
• 1:35
  and it it's a great question. So,
• 1:38
  when we think about what
• 1:40
  CMS is signaling, it's really a fundamental
• 1:43
  pivot from
• 1:45
  in the context of rural health care, kind
• 1:47
  of moving from access to care as the
• 1:49
  primary metric to performance
• 1:52
  as a governing
• 1:54
  standard. So, you know, for decades, rural health
• 1:57
  policy was oriented around
• 2:00
  really getting
• 2:01
  care and access to care to unserved populations.
• 2:05
  But now what CMS is saying is that
• 2:07
  presence and that access to care is not
• 2:10
  enough. We need to know that the outcomes
• 2:12
  that you're producing,
• 2:14
  that whether or not you're financially sustainable
• 2:17
  and whether or not you can demonstrate transformation
• 2:20
  is actually happening at the delivery level
• 2:22
  are all important factors. And so the new
• 2:25
  rural health transformation program
• 2:27
  makes this explicit. And so
• 2:30
  for those of you who are listening, you
• 2:31
  may not be aware. CMS
• 2:34
  has
• 2:35
  released and is releasing
• 2:37
  approximately $10,000,000,000
• 2:38
  into the market to be focused about 200,000,000
• 2:41
  per state
• 2:42
  on rural health care transformation.
• 2:44
  And
• 2:45
  this is an enormous opportunity
• 2:47
  as we look at rural health care systems
• 2:50
  and hospitals
• 2:52
  to really think of this as an opportunity
• 3:04
  community
• 3:06
  context that for a community
• 3:08
  context,
• 3:09
  but again, not to be less rigorous in
• 3:11
  the expectation.
• 3:12
  And so this is an incredibly important moment
• 3:15
  for rural health care organizations, but
• 3:18
  with this new funding comes a lot of
• 3:21
  accountability
• 3:22
  and a lot of infrastructure
• 3:25
  that has to be put into place in
• 3:26
  order to ensure success.
• 3:29
  Yeah. I think two really crucial things there.
• 3:31
  Right? The dimensions are changing. There's a lot
• 3:34
  more to consider as you mentioned. But I
• 3:35
  think what you just mentioned now too is
• 3:38
  really, really crucial, which is the accountability piece.
• 3:40
  Right? Okay. How is this being measured? You
• 3:42
  need to be able to produce that accountability
• 3:44
  of, okay, here's how we're measuring performance. And
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  again, that emphasis on sustainability
• 3:50
  on these performance
• 3:52
  based accountability metrics that we're seeing is really,
• 3:54
  really crucial.
• 3:56
  When we're thinking about these operating models that
• 3:58
  you've just mentioned and the change, right, that
• 3:59
  needs to happen for organizations,
• 4:02
  How should rural health leaders
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  think about their operating models they're currently in,
• 4:08
  their infrastructure, and, again, also decision making today
• 4:12
  to be ready for that accountability
• 4:14
  and that environment that's changing?
• 4:17
  Yeah. That's a great question. And, again, when
• 4:20
  we look at the leaders who are going
• 4:22
  to be ready are the ones who treat
• 4:25
  transformation
• 4:27
  as not a project, but as a permanent
• 4:29
  operating condition. So, you know, this kind of
• 4:32
  sounds abstract.
• 4:34
  And so when we think about
• 4:36
  how do we make this more concrete, it's
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  really, first of all, thinking about
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  the infrastructure that's required for financial visibility.
• 4:43
  So, so many rural health organizations
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  are
• 4:47
  running on incomplete financial intelligence and they don't
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  have real time
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  margin data by service line. They may not
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  fully understand cost
• 4:56
  structures of their workforce decisions,
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  and it's difficult to be able to measure
• 5:01
  the financial impact of these types of transformation
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  initiatives
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  before committing to them. And so this is
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  something that CMS
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  is driving with having the funds be tied
• 5:14
  to performance, which means that you really have
• 5:16
  to understand your baseline as a hospital system
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  or an organization
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  before you can measure progress.
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  The second piece is really looking at operational
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  infrastructure. So, you know, the rural health initiatives
• 5:28
  determined by each state
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  require
• 5:31
  operational capacity that a rural hospital may not
• 5:34
  currently have. So how do you bolt on
• 5:36
  these new programs
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  onto an already fragile administrative structure? So it's
• 5:42
  important to look for partnerships
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  in order to build the systems, the staffing
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  models, and the governance to be able to
• 5:49
  execute on this opportunity.
• 5:52
  Then to your point, the third piece being
• 5:53
  the decision making, the rural health leaders
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  often operate in resource constrained environments where decisions
• 6:00
  might take longer because you're trying to figure
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  out if the margin for error is too
• 6:06
  great or
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  too slim. And so,
• 6:09
  you know, operating with caution is understandable. But
• 6:12
  in the context of this type of transformation
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  where you really have
• 6:17
  the first year to demonstrate
• 6:19
  a level of efficacy in your efforts and
• 6:22
  to have measurable results in order to get
• 6:25
  the funding the second year, it's very important
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  that the rural hospitals
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  move with attention and move with the velocity
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  so that they are able to have the
• 6:34
  success and continue to receive this funding.
• 6:38
  And you've mentioned
• 6:39
  understanding the baseline
• 6:41
  for the organization, which is so crucial. I
• 6:43
  would argue that's, again, like you said, the
• 6:45
  most important piece is understanding that baseline of
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  where they're at. But what's that one change
• 6:50
  that you would prioritize
• 6:52
  right now if it's not, again, understanding that
• 6:55
  baseline?
• 6:56
  Yeah. You You need to build data infrastructure
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  because everything else is gonna depend on it.
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  So
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  if you don't really have financial transparency
• 7:05
  and outcome measurement in place, then it's really
• 7:07
  difficult to demonstrate
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  performance.
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  And so,
• 7:11
  again, you can't convince
• 7:14
  your board to make the transformation investments if
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  you can't lead your team through the change
• 7:19
  credibly because you don't have the access to
• 7:22
  data. So that's really the foundational move
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  before you launch programs or expand service lines
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  is to really understanding how do I build
• 7:32
  a level of infrastructure
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  around the type of data I need to
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  be collecting and then
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  helping to help drive the the decisions I
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  make with regards to the projects and the
• 7:43
  transformation I wanna put into place moving forward.
• 7:47
  In the case of rural health care, we
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  talk so much about
• 7:52
  specifically leadership and and and the workforce in
• 7:54
  and of itself because, again, in rural environments,
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  it's often more resource constraint. There's less folks
• 8:00
  available, quite frankly, to do the jobs necessary
• 8:03
  for health systems.
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  And again, we see workforce and leadership stability
• 8:07
  really often treated as operational issues. Right? Okay.
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  These roles need to be filled. We need
• 8:11
  to make sure
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  that we have the providers in place to
• 8:14
  be able to care for our communities. But
• 8:16
  again, as we're looking back to what we
• 8:17
  just talked about, this all elevates this to
• 8:21
  a strategic
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  level. And I'd love to talk a little
• 8:24
  bit about that in terms of how do
• 8:26
  recruitment
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  retention and leadership continuity then
• 8:30
  directly
• 8:31
  impact
• 8:32
  a rule system's ability
• 8:34
  to execute some of these goals and some
• 8:36
  of these things that we've just touched on?
• 8:38
  Yeah.
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  I love, Lucas, that you've answered this question
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  because this is what I'm so passionate about,
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  because I think this is a field,
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  you know, when you think about workforce and
• 8:49
  leadership stability that's
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  continuously
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  underestimated.
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  And
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  when we think about the relationship between leadership
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  continuity
• 8:58
  and execution capacity, they are completely interrelated. So
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  when you look at these
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  transformation
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  programs,
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  what they actually require, whether it's
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  new care delivery models, community So
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  a
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  So a CFO vacancy in a rural system
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  doesn't just create a financial management gap. It
• 9:31
  stalls every strategic decision that requires
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  financial modeling. And a CNO vacancy doesn't just
• 9:38
  create a clinical oversight gap. It really undermines
• 9:41
  your ability to design and implement
• 9:44
  new care delivery protocols. And so
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  I've really spent a long time, many years
• 9:50
  researching this, and the research is unambiguous when
• 9:53
  it comes to the continuity of leadership.
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  And organizations
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  that invest in leadership continuity,
• 10:00
  they just don't have reactive hiring when a
• 10:03
  vacancy opens, but they're actually proactive in their
• 10:06
  pipeline development, their succession planning,
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  and they're the ones that are able to
• 10:11
  sustain
• 10:13
  transformation momentum.
• 10:15
  And so when we think about the recruitment
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  challenge in rural health systems, this is quite
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  real.
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  You know, they're competing for the same leadership
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  talent that bigger organizations
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  and other,
• 10:27
  in urban areas are also competing with. They're
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  often competing with larger compensation
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  packages
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  and bigger administrative
• 10:35
  infrastructure. But there are things that rural health
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  organizations can do as it relates to
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  the leadership hierarchy,
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  the
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  culture that it
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  perpetuates
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  when they think about the work redesign that
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  can happen at every level of the organization
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  to offer people
• 10:55
  more balance and more flexibility.
• 10:58
  There are ways in which rural health organizations
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  can offer an employee value proposition that's very
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  attractive to top talent
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  and, again, gives oftentimes that top talent an
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  opportunity to
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  achieve more in their career at at a
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  larger leadership level and and to be able
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  to accomplish more as well.
• 11:19
  Now,
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  like, you've just outlined, this can be incredibly
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  complex. Right? There's a lot of things that
• 11:26
  leaders have to think about. There's a lot
• 11:28
  of things that are coming up. Right? And
• 11:30
  and we know, again, these leaders and especially
• 11:32
  when we're thinking about a a CFO, etcetera,
• 11:34
  they're they're incredibly busy. They have to have
• 11:36
  a lot of capacity to deal with all
• 11:38
  of these things.
• 11:39
  What kind of leadership capacity does all of
• 11:42
  this require, again, beyond that day to day
• 11:45
  management that they're already taking care of?
• 11:49
  Yeah. That's a great question.
• 11:51
  It it really requires
• 11:53
  transformational
• 11:54
  leadership,
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  and this is meaningfully
• 11:57
  different,
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  skill sets and capability than what we see
• 12:01
  in traditional operational management.
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  So you really need leaders who can hold
• 12:06
  a long term vision while also
• 12:09
  managing and adapting to short term disruption.
• 12:13
  So you want that leader who can engage
• 12:15
  community stakeholders authentically while navigating
• 12:18
  really complex regulatory environments.
• 12:21
  And you also need that type of leader
• 12:22
  who understands data and can use it to
• 12:26
  drive decisions
• 12:27
  rather than just report on the outcomes.
• 12:30
  You also want to have leaders who are
• 12:33
  comfortable with ambiguity because with transformation,
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  by definition,
• 12:40
  you are, operating in territory that really isn't
• 12:43
  fully mapped. And so that kind of leadership,
• 12:45
  again, it it needs to be assessed for.
• 12:48
  It has to be developed intentionally and really
• 12:50
  needs to be retained with purpose.
• 12:54
  Change is hard for human beings,
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  but it it it becomes a little bit
• 12:59
  easier if your leader is more comfortable with
• 13:01
  change, I would argue.
• 13:04
  Absolutely.
• 13:05
  You've touched on the fact that, again, this
• 13:08
  can be very a very competitive landscape. You
• 13:10
  know, we talk about leaders obviously being maybe
• 13:13
  drawn to,
• 13:14
  to larger areas where or more urban areas
• 13:17
  where there is better compensation, etcetera.
• 13:20
  When you're looking at organizations
• 13:23
  that are bet better positioned for all of
• 13:25
  these shifts and all of these transformations that
• 13:27
  we've just outlined right,
• 13:29
  what are those organizations
• 13:32
  doing differently in practice that are getting this
• 13:35
  right?
• 13:36
  Yeah. There's that's a great question. There's a
• 13:38
  few things that stand out pretty consistently.
• 13:42
  First,
• 13:43
  these types of organizations have made the strategic
• 13:46
  decision to treat the workforce and their talent
• 13:49
  as infrastructure and not overhead.
• 13:56
  Pipelines before the vacancy hits.
• 13:59
  They're using interim
• 14:01
  leadership,
• 14:02
  strategically and not just as a gap filler,
• 14:04
  but as a way to build
• 14:06
  and maintain momentum and execute
• 14:08
  on transformation work streams
• 14:11
  while they're also at the same time probably
• 14:13
  looking for a more permanent hire.
• 14:16
  The second piece is that they're building partnership
• 14:18
  ecosystems. So rather than trying to solve every
• 14:21
  problem internally, the
• 14:29
  make
• 14:38
  we can't do this alone and we're not
• 14:39
  going to try. We really need to partner
• 14:42
  with those of you so that we can
• 14:44
  better serve our entire
• 14:47
  patient community.
• 14:49
  And the third piece I would say is
• 14:50
  that they're integrating their strategic
• 14:52
  and operational
• 14:54
  planning cycles. So transformation goals aren't living in
• 14:57
  a separate document or as a separate project
• 15:00
  that gets reviewed quarterly. They're embedded in the
• 15:03
  operating cadence of the organization.
• 15:05
  So leaders
• 15:06
  are accountable to the transformation metrics the same
• 15:09
  way that they would be accountable to their
• 15:12
  everyday financial metrics.
• 15:14
  Tessa, it's so great to have you on.
• 15:16
  I think we covered so much ground in
• 15:17
  our conversation here today. As we leave our
• 15:21
  listeners,
• 15:22
  what's the biggest takeaway
• 15:24
  you want rural health leaders to walk away
• 15:27
  with? And then this is probably my favorite
• 15:29
  question of the day.
• 15:31
  What's the one thing? Right? What's the one
• 15:33
  thing they should start
• 15:35
  right now to move again
• 15:37
  from that awareness, okay, this is happening, to
• 15:39
  actually making a difference?
• 15:42
  Yeah. Gosh. It's and it's so hard, Lucas,
• 15:44
  to focus on just one. But
• 15:47
  I I do think the biggest takeaway
• 15:49
  is that the window is open right now,
• 15:52
  and it, you know, may not stay open
• 15:54
  indefinitely.
• 15:55
  And this is a moment where CMS is
• 15:57
  making a significant investment in rural health transformation
• 16:02
  and
• 16:02
  in building an implementation
• 16:04
  infrastructure
• 16:06
  that there is genuine political and regulatory
• 16:09
  will behind this shift that we have seen.
• 16:13
  But that will is tied to demonstrated performance
• 16:17
  and organizations that are slow to engage will
• 16:20
  find themselves structurally behind
• 16:22
  when the accountability
• 16:24
  timeline arrives and they have to demonstrate efficacy.
• 16:27
  So
• 16:28
  I guess the biggest takeaway is that you
• 16:30
  as an organization, you have to start with
• 16:32
  an honest assessment, not a strategic planning
• 16:37
  meeting or retreat,
• 16:39
  but an honest look at your current leadership
• 16:42
  capacity,
• 16:43
  your financial
• 16:44
  transparency, your operational infrastructure
• 16:47
  and your workforce pipeline. You know, really understand
• 16:51
  what do you currently have, what's missing.
• 16:54
  And then, of course, what's genuinely fragile that
• 16:56
  we need to be careful about. And so
• 16:59
  from that assessment,
• 17:01
  you're able to build a sequence plan and
• 17:03
  you don't have to do everything at once,
• 17:05
  but
• 17:06
  you do have to know what you're working
• 17:08
  with before you can make credible commitments for
• 17:11
  transformation.
• 17:12
  So the organizations, I think, that will
• 17:15
  thrive in this moment and in this environment
• 17:18
  are the ones who are very clear eyed
• 17:20
  about their starting point and then
• 17:23
  again, are bold enough to build from that
• 17:25
  place and move forward. So I I would
• 17:28
  say that's the biggest takeaway.
• 17:30
  We come back to the baseline. Right? You
• 17:33
  have to have that baseline in place to
• 17:34
  be able to be successful. Tessa, thank you
• 17:37
  so much for your time and certainly your
• 17:39
  insights. It's fantastic to have you. Thanks for
• 17:41
  being here. Thank you so much for having
• 17:43
  me.
• 17:43
  And we also want to thank our podcast
• 17:45
  sponsor, AMN Healthcare. You can tune in to
• 17:47
  more podcasts from Becker's Healthcare by visiting our
• 17:49
  podcast page at beckershospitalreview.com.