Developing the Next Generation of Health Care Leaders

00:28:10:00 - 00:28:48:22
Tom Haederle
America's health care leaders don't have a crystal ball yet is that would be. But based on current data, as well as emerging demographic and economic trends, they do have a pretty good sense of where health care is headed in the next 5 to 10 years. It's safe to say that change is on the way and making sure that change is productive and serves patients interests will require new thinking from tomorrow's health care leaders.

00:28:50:11 - 00:29:16:17
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Today's podcast is about what we can expect from the hospital or health system of the not too distant future in the next 5 to 10 years. Here to explore that topic, one that will impact nearly everyone at some point is Lindsey Dunn Burgstahler, vice president of programing and intelligence at the American Hospital Association.

00:29:16:28 - 00:29:40:21
Tom Haederle
In conversation with Dr. Scott Cullen, a managing director and chief clinical innovation officer at Accenture. Accenture is the corporate sponsor of the AHA Next Generation Leaders Fellowship, a yearlong program focused on mentoring promising leaders for the future, and training the kind of rising young stars who can help to bring about real and lasting change in the hospitals and health systems in which they serve.

00:29:41:03 - 00:29:44:09
Tom Haederle
So let's join Lindsey and Scott for this very important discussion.

00:29:45:09 - 00:29:49:27
Lindsey Dunn Burgstahler
Welcome, Scott. Thank you so much for joining us on the Advancing Health Podcast.

00:29:50:05 - 00:29:52:01
Scott Cullen
Thank you. It's great to be here. Appreciate it.

00:29:52:15 - 00:30:27:09
Lindsey Dunn Burgstahler
I'm so looking forward to talking with you today because we're going to explore the care delivery models of the future, the hospital of the future. And I think more importantly, the type of leadership that we need for success as we think about those future models. And that's something we at the AHA think a lot about. And I know you and Accenture do a lot of thought leadership on this topic and are really on the forefront of thinking about what that looks like and look forward to getting in to it with you today.

00:30:28:03 - 00:30:50:19
Lindsey Dunn Burgstahler
So as we think about the future and I, I think about the future of health care, there's a lot of different models that we could go towards in the future. A lot of ways we talk about using people differently, using technology in new ways, but at the heart of it, it's really a more decentralized model than we have today, and that creates challenges.

00:30:50:19 - 00:31:13:15
Lindsey Dunn Burgstahler
It can sometimes be more difficult. I think we hope in the end it it leads to better care and better experience for our patients and communities. But the word decentralized is never one that sounds uncomplicated. So I want to start by just getting your view of the future of health care delivery. Let's say let's look ten years out from now.

00:31:14:03 - 00:31:22:09
Lindsey Dunn Burgstahler
Do you what sort of models do you see and what types of ways will health care be delivered? That's markedly different than what we're doing today.

00:31:22:27 - 00:31:46:00
Scott Cullen
Okay. Well, thank you. That's the great framework setting. And I agree with you. I think that there are going to be different models. I think there are going to continue to be different models because though people's needs for medical care are going to continue to exist, there are so many different market factors and situational factors that are going to have an impact.

00:31:46:00 - 00:32:19:06
Scott Cullen
And if our health care system in the U.S. continues long current track that it's been on, in some ways we're going to continue to have a lot of experimentation in different places. Folks are often looking to each other for answers about how what works or how things occur, but the leaders moving forward are going to need to be comfortable with a model around how they test and learn as opposed to what's been tried and true.

00:32:19:12 - 00:32:39:01
Scott Cullen
If we're going to be successful moving forward. And there are a few different reasons for that and the implications for what those systems are going to look like are are interesting. So, you know, one of the reasons is, of course, that there are going to be 45% more, 60 to 90 year olds ten years from now than there are right now.

00:32:39:18 - 00:33:02:13
Scott Cullen
So think about the implications of that. Just a starting point. In addition to chronic disease burden, what we have thought of as the middle of the pyramid traditionally is going to just about double by that time as well. So not only are there going to be many more people using the services from a traditional demand perspective, they're going to be sicker.

00:33:03:07 - 00:33:28:05
Scott Cullen
And so our challenge fundamentally around that is that we don't have enough people to take care of all of those people right now under the current models. In fact, its part of that shift to a larger population to 60 to 90 year olds, we're going to see a drop by almost 30% in the number of folks in the 40 to 60 year of age range.

00:33:28:17 - 00:33:51:10
Scott Cullen
Right. So this is just straight up demographics. So when you think about that, what's the solution? It means that there's no hiring solution to the workforce deficit that's going to be occurring. Really, it's already occurred, right? We're seeing substantial attrition. But as we move forward, that's only going to be exacerbated by the rising demand and the drop in supply.

00:33:52:00 - 00:34:16:26
Scott Cullen
So what's the solution? What's going to have to fill that gap? A: we're going to need to broaden the labor pool, which means that we're going to need to bring more folks into providing health care than we traditionally have in the past. And there's a variety of pathways for that. But fundamentally, we're going to need to find ways to distribute the need for care and the burden of how that gets delivered more broadly.

00:34:17:06 - 00:34:42:06
Scott Cullen
The second implication is that we're going to need a lot more technology. So health care has been behind in general in the past on adoption of technology. I mean, we all think that the high tech act and the adoption of EMR is a watershed moment in technology. And to some degree it is, right? But that's only a very small piece of the solution here.

00:34:42:06 - 00:35:09:01
Scott Cullen
And to broaden the impact of how we can deliver care across a very, very extensive and heterogeneous workforce. We're going to be working in different environments at different times with different skill sets. We're going to need ways to tie those folks together into coherent teams so that we're not providing more fragmented care or providing less fragmented care.

00:35:09:17 - 00:35:33:01
Scott Cullen
Fundamentally, and frankly, the only way to do that is by changing some fundamentals about how care is delivered. So that's a lot of prequel to the fact that I think that the health system of the future is going to look more distributed, as you pointed out, right? So it's going to be less about piles of bricks and mortar on the hill and it's going to be more about what's happening in people's homes.

00:35:34:00 - 00:36:01:10
Scott Cullen
It's going to be more about what's happening in communities, right? So if you look at the model for the adult caretaking environments that that have grown in in successfully in some other areas around dementia care and around elderly care, finding ways to re-aggregate folks in communities of care is probably going to be one of the paramount elements.

00:36:01:10 - 00:36:24:07
Scott Cullen
We've seen some big systems actually make investments in getting into the assisted living world and getting into independent living world. You know, I can think of one in particular whose revenue is now larger in that space than it is in their traditional acute care. So that's a major piece of it  - is, we're going to be rich communities and people.

00:36:24:15 - 00:37:02:22
Scott Cullen
Another piece of it is as we bring that technology forward, we're going to be better able to leverage skill sets that are more rare to support folks with skill sets that are more common. And so if you think about highly educated physicians and nurses and technicians who currently work in the acute setting or in the ambulatory setting, those skill sets are going to need to be broadened. We need to find ways to get those same kinds of judgment skills into places where traditionally we're not bringing medical thinking or nursing thinking.

00:37:02:28 - 00:37:24:27
Scott Cullen
Right. And so that's in the home, that's in those new communities, that's in other places. And who's going to provide that? Well, it may not be the traditional health care organizations that are providing all of that, right? We see lots of disruptors getting into this space now. We see lots of artificial intel agents bringing these kinds of capabilities to the fore.

00:37:25:12 - 00:37:56:12
Scott Cullen
And so as these disruptive innovators become more mainstream, I think we're going to see the nature of how care is delivered and how the partnerships between traditional health care provider organizations and these innovators change. Because for us in the traditional fields, and I consider myself having been a primary care provider here in Boston for a good 15 years before I went into consulting, I still identify with that segment.

00:37:56:12 - 00:38:17:27
Scott Cullen
But the challenge for us in that segment is going to be that we're going to need to invite and involve other players, right, that we don't often think of. We're already starting to see folks that we call convergence providers, like the big pharmacy chains, the big pharmacy grocery chains, others are getting in the game and we're going to have to work with them.

00:38:18:03 - 00:38:29:11
Scott Cullen
Right? We have no choice because they're not only going to provide essential services, but they're going to also control referrals to the traditional parts of the system as well.

00:38:30:11 - 00:38:57:18
Lindsey Dunn Burgstahler
So I recently heard the the term "waiting room to living room," and I've heard a lot of different monikers around this idea of distributed care. But that's my new favorite. And I think you do a nice job of pointing out that those models I like that you use the term community because it really will be a community of caregivers, some professionals and some just siblings, children and parents of individuals receiving care.

00:38:57:27 - 00:39:33:24
Lindsey Dunn Burgstahler
I wanted to go back to one of your first points, though, about the demographics, and I don't think we touch on those enough. So 2020 census, I think are the population over 65 is about 11%. That will jump to in several decades, about a quarter of our population or a little shy of that. So really, really significant shifts. And so I think some of the things that we as a field think we're doing to improve patient experience, reduce costs are really just going to be necessities in the future.

00:39:33:25 - 00:39:45:22
Lindsey Dunn Burgstahler
What are your thoughts on just those demographic trends? And, are customers you work with coming to you with concerns about that yet or as you look into the future, is that just something on your mind?

00:39:46:06 - 00:40:14:22
Scott Cullen
Actually, surprisingly, a few have raised that. I mean, everyone's aware that it's going to be an issue, but I don't think that they really have absorbed the the concept of that tsunami of demand quite yet fully. I have spoken to a couple of large conferences recently, and there have been some folks who've really raised questions after the session that they were aware of some of that issue.

00:40:14:22 - 00:40:44:13
Scott Cullen
And so that's that's a little concerning strategically. You know, the the emphasis and focus on patient experience, and I tend to think of it as patient centricity is going to go well beyond how that's currently measured now or how that's currently rewarded or thought of now. And you're right, it's going to become essential not just competitively or from a reimbursement perspective, but also for better or worse.

00:40:44:13 - 00:41:13:07
Scott Cullen
Fortunately or not, we're going to see that the same kinds of things that folks identify as being more patient centric are also going to align with what the need is going to be. So when you think about increasing the digital footprint of the provider organization and increasing the digital access for folks to care, that's going to align well with the fact that we are going to have capacity issues, right?

00:41:13:16 - 00:41:40:20
Scott Cullen
Also, when you think about the fact that that's going to need, we're going to need to find new ways of delivering, you know, from the waiting room to the living room, as you talked about, that also aligns well with all the studies that have been done of hospitalized and at home and or other services being delivered at home demonstrate less cost, right, less need in the capacity space intensivity and also a much higher patient satisfaction.

00:41:41:02 - 00:42:01:29
Scott Cullen
So those things tend to align pretty well. They're going to be other elements that are going to be more challenging for traditional systems the in the concept of patient centricity, because it's really about bringing care to the patient as opposed to bring the patient to the care. And fundamentally, it's going to be less expensive for the system overall and for individuals.

00:42:02:13 - 00:42:32:13
Scott Cullen
If we can find ways to bring that care to the patient and maybe at a lower level of intensity before that level of intensity that's required to correct the problem gets higher right? So that's a piece of it, too, being anticipatory as opposed to reactive. We have a largely reactive health care system now, and if it doesn't become more anticipatory, we're not going to be able to manage that demand as effectively because the level of intensity of needed services is going to be so much higher.

00:42:33:00 - 00:42:54:26
Lindsey Dunn Burgstahler
I also want to go back to some of the comments you made about disruptors. So these nontraditional organizations that are getting into now direct delivery of care, and it made me think that not only the location of where care is delivered will be more distributed, but the who or the organization that may be providing that care could be more distributed.

00:42:55:14 - 00:43:19:13
Lindsey Dunn Burgstahler
One of the things that I, I know when I think about these organizations is that not all of them, but many of them have pretty targeted models of who they're caring for. Be it a one medical that is trying to get the people with nice insurance and will pay out of pocket just for access on top of that to those that are tired of getting Medicaid, Medicare.

00:43:19:21 - 00:43:46:15
Lindsey Dunn Burgstahler
So what will the if they're successful and we don't know that yet for all of those. But if they are, what does that start to look like for, you know, the hospitals and health systems? Is it become a concern or do you see opportunities there? Because I think I heard you used the word opportunity. So I'd love to hear kind of how you see that potentially being something that hospitals could partner on versus being overly concerned about.

00:43:46:28 - 00:44:13:20
Scott Cullen
Yeah, that's a great question. When you talk about a more distributed system, you're talking about a system that's also going to have to be managed differently and thought about differently in terms of control structures and some of the rest of that. I think what we have to think about in our traditional models and in our hospitals is that there are always going to be people who need physical care.

00:44:13:23 - 00:44:37:29
Scott Cullen
Right. And there are always going to be patients with higher intensity levels of care. And based on the demographics we've talked about, that number is just going to continue to increase. Right. So I think we over utilized beds in hospitals. Now, to some degree, we have incentives to do so in spite of the many decades of pressure that we've had.

00:44:38:07 - 00:45:06:29
Scott Cullen
Right. Utilization to date. But I think a large part of the reason for that is that we're not we don't have alternatives in many cases for patients. And so we're going to need to collaborate with others to find alternatives when it's appropriate, but also to have those channels open for when the higher level of intensity of care that is appropriate for the acute care hospital physician or what have you is available and increasingly predictable.

00:45:07:20 - 00:45:39:21
Scott Cullen
And predictability is a big part of the challenge for our health system. One of the reasons why we're so reactive is because we've long been challenged by the data requirements that we needed to be more anticipatory. And so if we are better at aggregating and sharing the data, we can then feed the technology that allows us to get visibility into anticipating demand, we're going to be more successful in meeting that demand.

00:45:39:28 - 00:46:13:24
Scott Cullen
And that's even in partnership with the One Medicals of the world and, you know, Oak Street and City Block. I'm not going brands here just to sell things, but, you know, you talked about the different segments. And you're right, they all have different segments that they're focused on. And that's that's their business strategy. And in some ways, they're highly advantaged relative to the hospital systems that have to take all comers, that have to build a large amount of fixed infrastructure and are bearing a greater regulatory burden.

00:46:14:19 - 00:46:28:06
Scott Cullen
It's not a level playing field at all. So figuring out how you level that playing field between the innovators and the traditional systems is going to be one of the big strategic challenges for leaders going forward.

00:46:29:02 - 00:47:06:21
Lindsey Dunn Burgstahler
So I want to turn our conversation to leadership, because you ended on the comment about leaders. So we think a lot about leadership and we have a fellowship that's aimed at leaders who are 5 to 10 years from the C-suite. And we know that the nature of care and how they may have been trained in their health management programs, running large tertiary centers with many service lines to, you know, distributed organizations that probably, if not in ten years, certainly not too far beyond that, will be significantly incented for keeping people healthy.

00:47:07:01 - 00:47:36:07
Lindsey Dunn Burgstahler
What are the leadership attributes that you believe are important? And then kind of a second part of the question, how should leaders think about getting experience in those? Because one of the things that, you know, I think about is one of the first things we look to in our career development is mentorship. And mentors are excellent for many things, but the top leaders of today's organizations aren't confronting the challenges that future leaders are going to be asked to confront.

00:47:36:15 - 00:47:38:23
Lindsey Dunn Burgstahler
So how can they start to prepare themselves?

00:47:39:03 - 00:47:58:12
Scott Cullen
That's a great question. But let me speak first to the first part of your question, which is the nature of those skills, right? Where they're going to get them is is a more complicated question. But I think that I touched on this a bit at the beginning. The folks who embarked on the Oregon Trail back in the 1830s.

00:47:58:12 - 00:48:22:04
Scott Cullen
Right. They didn't know exactly what they were going to be finding. Rather than putting a lot of furniture and a lot of linens and a lot of things from back home, right, into those Conestogas, they put a lot of tools into those wagons. Because when the future is uncertain, you have to tool up is the bottom line.

00:48:22:27 - 00:48:53:25
Scott Cullen
So we're really beginning to embark on that journey over the next ten years. And they're going to be some leaders. They're going to be some leaders, I mean, organizations that are leaders and are willing to be on the cutting edge of these things. And they're going to need wagons full of tools. And the thing about that is that they're going to need to have a bunch of different tools in their tool sets and be unafraid to use the first thing and then let it fail if necessary, and then pick up the next tool and see what works better.

00:48:54:10 - 00:49:27:23
Scott Cullen
And in health care, culturally, we have built our concept of high reliability on the idea that a process that is done the same way over and over, right, is a guarantee of a particular outcome. But that's not actually the underpinning of the manufacturing ideas behind high reliability. Those ideas are based on outcomes. And so any different processes that lead to a better outcome are acceptable and are then adopted and improved.

00:49:27:24 - 00:50:00:16
Scott Cullen
Right? But we've been long challenged to measure outcomes effectively. And so what's been easiest is to fall back on the process, right? So it's easier to say we're going to follow the same process and hope for the best outcome as opposed to measuring the outcome and figuring out what's the best process that gets us there. So it's that agile mindset, it's that Lean Six Sigma mindset, right, that we need to have as we go into a test and learn world for the next ten years.

00:50:00:28 - 00:50:33:12
Scott Cullen
And that that approach and that mindset is not as comfortable for some folks who've been around for 30 years. So where are folks going to get those kinds of skills? I think that more and more, we're seeing that penetrate other businesses, other areas. If you look at Amazon, you touched on One Medical, so I'll go there, right? We've been saying for five years, why can't health care be more like Amazon?

00:50:33:17 - 00:51:06:12
Scott Cullen
Well, guess what? So it's going to be very interesting to see what comes out of that area. And so, for example, Amazon Care is a good example of an attempt at innovation that didn't go where they wanted it to go. And so they've rolled it up and they've said, all right, now we're going to do something different. So they've acquired One Medical. And they see One Medical as innovative enough to potentially provide that next experiment, that next hopefully successful model for moving forward.

00:51:06:12 - 00:51:28:22
Scott Cullen
So I think that we're going to need to look out, and we already do in some organizations, look outside of health care for examples of how innovation has been effective and successful. And for folks who've got backgrounds other than health care. And it required those skills around the agile mindset and the ability to flex and test and learn and then pivot.

00:51:29:08 - 00:52:03:07
Scott Cullen
And that's a challenge for health care, because not just that culture of what was then measured as most effective, but also because people's lives are on the line, right? Let's face it, a bad outcome doesn't just mean that there's a defect in a widget that popped out of the machine. So it's going to require a combination of clinical leadership who understands the need for innovation and sees that pathway forward to some to some degree.

00:52:03:10 - 00:52:34:22
Scott Cullen
Right. But they're not they're not going to see all the way to Oregon. They're going to see maybe to the front range. Okay. Then they're going to need trusted partners who can help them get on the other end of the rope as they go over those mountains so that they get to the other side. I think out of industry is one place to look, but I think we're also seeing evolving thinkers within health care who've begun to define some reasonable, agile frameworks for innovation that others are going to have to emulate.

00:52:34:22 - 00:53:09:00
Lindsey Dunn Burgstahler
So I've got three comments to close this out. The first is I'm a child of the eighties, so I so appreciate the Oregon Trail analogy for those who don't know, very popular computer game in the eighties. So love that one. Second the Amazon example. For listeners who don't know, Amazon is set to acquire One Medical. But I more appreciated your comment about them closing down Amazon care which was going to be their direct to employer business, virtual care, virtual primary care - closed it down and pretty quickly.

00:53:09:00 - 00:53:34:10
Lindsey Dunn Burgstahler
And I think that ability to know things aren't going well and stop is incredibly difficult in traditional health care organizations and such a key part of probably the future leadership that you're mentioning. And then third, you know, I think we'll just end on your comments about Agile, which is I think you answered the question by not answering it by saying we don't know.

00:53:34:10 - 00:53:51:04
Lindsey Dunn Burgstahler
We don't know what they need to know. So what they need to know is the frameworks and the methods that help us answer questions that we don't know the answers to. So Scott, I so appreciate your time today talking about future of health care, talking about leadership. And again, thanks for joining us.

00:53:51:18 - 00:54:04:28
Scott Cullen
Well, thanks, Lindsey. It's been fun. Appreciate it.

00:54:04:28 - 00:54:08:07
Lindsey Dunn Burgstahler