New challenges, new skills
In 2010, these challenges weighed heavily on Schandler’s mind. With health reform looming and the revenue base rapidly shifting to outpatient services, he knew the independent hospital/voluntary medical staff model wouldn’t remain financially viable much longer. “We needed to do strategic planning differently to get to where we wanted the hospital to be.”
So, White Plains set out to develop more-specialized services, along with a network of physicians to provide and feed them. The goal was to keep more patients and revenue at home while doing a better job of serving community health needs.
At the same time, Schandler looked to retire in five years. “I quietly talked to the board about how we could create a transition that made sense.” That meant recruiting an executive with the capacity to be CEO, and the skills and experience to help transform the White Plains operations and culture into a clinically integrated health system before taking the helm. “In a time of rapid change, we felt everyone would be better served if we could make a seamless transition,” Schandler says.
The leadership gaps White Plains identified closely parallel those identified in a survey of hospital senior executives, conducted by Spencer Stuart for the American Hospital Association. These include developing nontraditional health partnerships, population health management, transformational/change management and advanced financial expertise to manage new payment and risk models.
In Fox, then senior vice president for physician and ambulatory network services at North Shore-LIJ Health System, Schandler and his board found their woman. In addition to 14 years’ experience building networks and managing large-scale integrated physician operations, Fox had broad experience in strategic planning and rationalizing health care operations from a stint as senior manager at consultants Ernst and Young — not to mention clinical street cred from her days as a pediatric intensive care nurse and nurse manager. She brought the deep clinical development and operating experience needed to truly integrate White Plains’ historically committed voluntary medical staff into a coordinated care delivery system.
After joining White Plains in 2010 as senior vice president of administration, Fox had five years to demonstrate and develop her abilities. She first focused on clinical program development, including bolstering the hospital’s quality management and clinical support services. Nursing was a special focus, and multidisciplinary rounds were introduced to help ensure closer collaboration and coordination of care including therapists and case coordinators.
These improvements, in turn, helped to attract selected specialists who were invited to work for the hospital full time as employees or contract partners through a hospital-physician organization. At the same time, Fox engaged community physicians in White Plains’ vision of better coordinated care.
In 2014, White Plains joined Montefiore Health System as a tertiary care hub for the system’s regional network in the lower Hudson Valley. While White Plains retains substantial local control and has its own board, Fox also will report to the CEO and board at the Montefiore system, which is now considered the hospital’s parent.
In addition to making substantial capital investments, Montefiore offers expertise in population health management and at-risk reimbursement from bundled payments to capitation.
As many hospitals across the state struggle, White Plains’ revenues are up and its length of stay is down 14 percent despite a substantially higher case mix. Quality has been recognized with a Joint Commission Top Performer on Key Quality Measures award in 2013. Payers are noticing, too. The hospital already has pay-for-performance contracts with all major payers, and is positioned to take on bundled payment and capitated risk.
But as necessary as experience and skills are, hospital leaders also must embody enthusiasm for change and the possibilities of a transformed health system for improving patients’ lives and health. Here are some of the characteristics and qualities a new CEO may need to succeed in an ever-changing health care world.
SKILL 1: Change champion
More than 80 percent of hospital executives see transformational change/change management among the most critical leadership skills in the next few years, along with innovative thinking/creativity, and critical thinking/strategic planning, the AHA survey found. Yet, 41 percent see change management skills lacking in their C-suite. Indeed, developing change management as a core executive competency is among the key recommendations of the AHA’s 2014 report “Building a Leadership Team for the Health Care Organization of the Future.”
Leading change requires imagination and flexible thinking first of all, says Carol Geffner, president of Newpoint Healthcare Advisors, Newport Beach, Calif. Executives with experience implementing new care models or incorporating new technology have an advantage. Even developing a small program provides insight into how to envision change, and create a constituency that will benefit and demonstrate incremental results that build confidence in the new model.
Incremental change is what most systems can expect for the time being, if for no other reason than that reimbursement doesn’t completely support value-based care in most places, Geffner says. “We are in the first stages of [moving from] volume to value. We have to figure out how to keep our revenue base strong while we create value-based systems.”