The journey to a new tomorrow: A conversation with Janice E. Nevin, MD, MPH, President and CEO, Christiana Care Health System
Janice E. Nevin, MD, MPH, President and CEO, Christiana Care Health System, shares her perspective on embracing challenges and disruptions in healthcare, improving patients’ experience, and preparing for the future, with David Nuzum, Senior Partner, McKinsey & Company in a June 2018 conversation.
DISCLAIMER: The views and opinions expressed are those of the interviewee(s) and are not necessarily those of McKinsey & Company.
As we look ahead to the next five to seven years, what do you see as the biggest changes or disruptions in healthcare, that you expect to see?
The disruptions that I see coming that will be real opportunities for us are in big data. The potential for big data, particularly data that is real-time clinical data, aggregated with claims data, consumer data, will allow us to personalize care, reach out and potentially impact care—impact outcomes before they have happened.
So I'm excited about the possibility of using data, predictive analytics, artificial intelligence, machine learning, to really help us understand what people need to drive that value before they, or we, may even know that it's coming.
The other area where I believe there's some real opportunity for disruption is certainly around some of the new technology that's being developed. We've taught Alexa “Christiana Care skills.” And I think the opportunity for Alexa to really function, for example, in the home to help prepare people, perhaps for surgery or manage their post-op course, or perhaps even interact with them on a regular basis to help manage a chronic illness, has a huge potential to really drive care in a different way.
The other piece that I get excited about is the potential of gene editing, and particularly the CRISPR technique. In many ways, I think this is an evolution in how we will think about treating illness of the kind that occurred when we discovered antibiotics.
And at Christiana Care, we have the only gene editing institute in the country that's embedded in an NCI-designated community cancer center. So why would the head scientist of the gene editing institute want to be in an organization like Christiana Care? A lot of it's around our mission, and our values, and behaviors. He wants to be able to interact regularly with the physicians that care for patients with cancer, and with the patients themselves.
So, the underlying theme in all of this is, we talk about disruptions that will enable us to solve real problems, innovation that has intent behind it, and ultimately the opportunity to really make a difference in the lives of the people we serve.
Improving the way patients experience care
You talked about how some of these disruptions would improve outcomes. How do you see these changes impacting patient experience in the way that care is delivered?
Well, I certainly hope that they will improve the way that patients experience care, and the way they experience health.
What's happening is the technologies that we talked about are highly used in just about every other aspect of a person's life. My daughter, who is 23, gave me a really hard time because she couldn't yet schedule an online appointment with her primary care physician, who happens to be a member of our staff.
My 84-year-old mother is adept at using her smart phone. I firmly believe that [we have] an opportunity to create access and really create an experience that delights people with the emergence of the technology that is so comfortable to people really of all ages.
At Christiana Care, we have talked about our journey from hospital system to health system. Success as a hospital was how many people could we get in the front door. Success as a health system has been how many lives can we manage using data, using care coordination.
We will be a system that has the ability to impact the health of all of the people who live in the communities that we serve. And it's creating that experience that will truly deliver health, based on these new technologies. It will be a disruption in a very positive way, and I'm excited about that.
Embracing partnership opportunities
Thinking about partnerships and the important role they can play, what are some innovative partnerships that are changing the landscape of healthcare?
We're used to seeing announcements about horizontal integration and consolidation. I think what's remarkable in that space is [that] some of the mergers have now become mega mergers.
And it'll be very interesting to see how, for example, a 191-bed hospital system creates value. [I am] looking forward to the learning from that. But, of course, it's the vertical integration that's getting the most attention—CVS, Aetna, the potential for Walmart, Humana, and certainly the JP Morgan–Berkshire Hathaway–Amazon announcement. Those are going to be disruptions. And as a health system provider, it would be perhaps easy to sit back, dig heels in and say, "Well, we're just going to hunker down and see what comes of all of that." But we're not doing that. We are really embracing the opportunity.
What's causing all of this activity? I think, to some extent, there's a level of frustration about how people experience care.
There's a level of frustration on the part of payers—whether it's a government payer, or an employer, or a person who's concerned about their out-of-pocket expenses. There's clearly a concern about cost. So, we've got an opportunity to either resist what's coming, or really jump in and celebrate the opportunity that we have to partner with various entities and make a difference. What does that look like for us? Well, we're certainly seeking partners in the payer community.
I haven't yet talked about the importance of aligning the payment structure, and really the disruption that needs to happen there, moving from fee-for-service to value-based payment. We're actively seeking payer partners so that we can, together, come up with solutions that will create health and take cost out of the system, and ultimately make it more affordable for whoever's looking for that affordability.
I think there are also some great opportunities for us to deepen our partnership with community organizations. So, one of the partnerships that we're investing in is a partnership with the New Castle County Paramedics, our local county paramedic system. And it's about working with them to help get patients—who are brought to the emergency department repeatedly for substance use overdose—identifying them, partnering with New Castle County, bringing services to the home, and ultimately getting those people into treatment.
I'm very excited about that partnership. I think that there are also ways that we can partner with tech companies. We have a partnership with Augmedix. We're using Google Glass to really help our providers manage the issues that impact their day-to-day existence, and really address the whole issue of burnout, which is an enormous problem in healthcare.
The Google Glass essentially allows them to have direct eye contact with their patient. It gets them away from the keyboard. There's a remote scribe that does the notes for them so that at the end of the day, they've got a minimal amount of electronic health record work to do. And they can go home and be with their families. So, lots of different ways that we can partner with community, with payer, and with a variety of tech companies.
Redefining our values
What are your other aspirations for Christiana Care Health System? And how do you believe these will set up the organization for success given some of the industry shifts we discussed earlier?
So, when I talk about our evolution to being a system that impacts the health of all of the communities we serve, that is our aspiration. And we're uniquely privileged because of our position in the state and in the region to really be able to have a measurable impact on health.
It will require partnership from every corner of the state, and certainly, also the region. We have extraordinary people at Christiana Care. We're the largest private employer in the state, and I am an absolute believer in the power of our people to not only manage the change that is coming, but to really lead that change.
So, we've been doing work, really, over the last year and a half that ultimately has been about engaging our people. There's a lot of evidence that organizations that not only survive but thrive in times of uncertainty and change are organizations that deeply connect to their values.
A year and a half ago, I said, it’s time for us to relook at our values. And I want to do this work in a way that engages every single person in the organization. We have almost 12,000 employees. And not only our employees, but our medical dental staff, our Junior Board, our board and the governance committees, everything. And we did that. It was remarkable. We deployed 400 ambassadors, almost all of them frontline caregivers. People who were selected by their peers.
And they helped us manage this process. And at the end of the year, we had not only defined our values statement, but we had, in fact, engaged everyone. The most poignant example of that was I had someone who works in one of our more remote outpatient facilities came up to me and say, "Thank you for letting me be part of this. It's been the most rewarding thing I have done since I've been at Christiana Care. Frankly, I didn't even think you knew we existed. And now I feel part of something."
And that was ultimately what this was all about. It's been amazing in the last year, since we described our values, how those words are now driving the work that we do. “We serve together” is really our version of teamwork. We are an organization where we had lots of teams, and people were thrilled to be on their team, loved their team but we were challenged to work across the organization as one team, and we've been able to do that.
And I believe it will be through the engagement of all of our people—frontline, leaders, community—that we get where we want to be, which is we will be living in a much healthier state and community.
The business of taking care of people
Do you have any advice for other CEOs who are leading in this environment? In your experience, what has worked well? And what would you do differently?
I think it's important to understand that in healthcare, we're in the business of taking care of people. And that's true whether you're a provider, or if you’re a payer, if you're creating a device. Ultimately, it's going to impact someone's life.
I also think it's really important to engage, [develop] leaders, [bring] in new ways of thinking, [allow] people to be innovators, as well as going deeper into the organization and engaging frontline. That's where we have been successful.