Why is alignment across health care such a key concern for you?

AFABLE: I talk about alignment happening in at least three areas: clinical, operational and financial. When I think about alignment, I think about bringing those three elements together, so that the stakeholders who are providing care are all winning together, meaning gaining what they’re trying to achieve; or losing together, meaning that if things don’t go as well as they wanted, they experience that together. I think you can see the power in that. If the stakeholders in health care are in alignment, the effect of how health care is delivered and received will be optimized, and there will be fewer barriers to accomplishing the goal because you can then focus on the care itself. We’ve been working hard at building alignment on a regional basis. A region is not so much geography, but how communities receive and experience care — how people commune together, and how they receive education, recreation, coordination of services, and health care and health services. We’ve been moving toward a regional approach, specifically in Orange County with St. Joseph Hoag Health, and we actually have subsegmented our county into four or five, depending on how we look at it, communities of care. We tailor the care and design it so that it meets the needs of local individuals, as well as aligns the rewards and challenges.

What are the biggest barriers to reaching such regional alignment?

AFABLE: The legacy of health care is win-lose, which is if I win as a hospital or doctor, then somebody in the community has to lose. The classic story is the relationship of the health plan to the provider: If the provider makes more money, then the insurer must make less money; or if the insurer makes more money, then the patient must have some financial challenges. That is an assumption of legacy health care, which has to come down. The biggest barrier to change is the ability for all stakeholders to believe that everyone would gain more and lose less if they did it together, and that’s’ a huge mind shift. That’s the challenge.

How does a CEO of one hospital begin to make such a huge shift in mindset?

AFABLE: It is a strategic mind shift and you have to believe in the option of partnering with others. You don’t have to become part of a big system; you don’t have to sell yourself to do this; you can partner with others. To make this happen, you have to believe that the benefits of doing this outweigh the challenges. What’s the alternative? The alternative is to try to stay in your silo, battle it out to the best of your ability and hope that you can win more than lose in a competitive environment. However, this is becoming increasingly difficult and is, in my opinion, riskier than the attempt to partner with others. Many health care leaders, especially the single-hospital CEO, are in a quandary as to the direction and opportunities, risks and challenges. Waiting for the right answer to come forward so that you can choose is probably not the most effective way to make those decisions, because the right answer and the apparent decision will be more about a host of choices than about finding the right answer. A lot of people are sitting on the sidelines waiting to see what the right choice is. People need to make a decision that’s based on belief and then go for it.