The Future of Healthcare: “When everyone in healthcare acts in their perceived self-interest, then collectively we create a healthcare system that is not sustainable” with Rick Sheff, MD of The Greeley Company
…The second root cause is that all the stakeholders in healthcare are acting in their perceived self-interest. When I say stakeholders, these include physicians, hospitals, insurers, pharma, EMR providers, device manufacturers, other tech companies, attorneys, and yes, patients, too. Of course, there is nothing wrong with acting in one’s self interest. The problem is that when everyone in healthcare acts in their perceived self-interest, then collectively we create a healthcare system that is not sustainable. We all need to temper our self-interest with acting in the interest of the whole. If we don’t, then the whole healthcare system suffers, as do all the parts that make it up.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Rick Sheff, MD, Chief Medical Officer, The Greeley Company. Dr. Sheff brings over 30 years of healthcare management and leadership experience to his work with physicians, hospitals and healthcare systems and has co-authored 15 books on the subject. Prior to joining Greeley, Dr. Sheff served as a VPMA, president of an independent practice association, and held multiple medical director positions. He taught at Tufts University School of Medicine and served as chair of the Massachusetts Academy of Family Practice Research Committee.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
After beginning my career in family medicine, which I loved, I found myself being pulled into more leadership opportunities. Eventually, I reached a fork in the road: to pursue a family medicine residency director position with a local hospital, or to stay on at my current hospital and advance into a VPMA/CMO position. I called on the wisdom of my mentors and received excellent advice in the form of a hard truth. One mentor told me that power, influence and resources in healthcare were shifting away from academic medicine and into the areas I had been working, namely leading the management and financing of healthcare, he said, “If you want to make a difference, go shine your light there.” This ultimately led me to pursue a career as a physician executive, which is how I eventually came to serve as a consultant and then a leader for The Greeley Company.
Can you share the most interesting story that happened to you since you began leading your company?
We got called into a setting in which a hospital was in a pitched battle with the largest multispecialty physician group in its market. The group was considering selling itself to a competitor of the hospital, and the hospital was considering hiring physicians to compete with the largest group in its community. Working with Greeley was considered the last gasp before they went to war. We listened to individuals on all sides. We facilitated the two sides in a gradual, phased process that began with holding up the mirror to their current situation. In the process, each side, even each individual, felt their “truth” was finally acknowledged. We were able to help them develop a shared vision for their collaboration, and then to conduct a series of specific projects to help make that vision a reality. Three years and five phases later, the group and hospital were in a deep and mutually beneficial collaboration that nobody had remotely considered possible. Helping achieve this kind of result is what keeps me at Greeley and working with our clients for more than 20 years.
Can you tell our readers a bit about why you are an authority in the healthcare field?
I have had the opportunity to practice medicine, train as a physician executive, and now travel the country consulting for more than 20 years in a company that has worked with more than 1,000 hospitals. Hospitals, health system leaders and physicians call The Greeley Company when they have a problem they can’t fix themselves. As a result, I’ve had the great fortune over the years to work with some of the best and brightest healthcare thought leaders in America in developing Greeley’s practical, effective solutions to solve the types of problems that keep healthcare leaders up at night. We help our clients implement these solutions for some of the biggest challenges in healthcare.
What makes your company stand out? Can you share a story?
We pursue excellence in everything we do, and we partner with hospitals and healthcare leaders to help them succeed in ways they couldn’t on their own. Our commitment to excellence in helping leaders implement Greeley’s practical solutions is what makes us unparalleled in the industry. One CEO shared with me that their medical staff was the weakest part of the hospital, but 5 years after partnering with Greeley it is now the single strongest driver of the hospital’s success. Another hospital was in major CMS trouble. After working with Greeley, they not only got flying colors on their final CMS survey, they reduced nursing documentation by 70% at the same time! This got nurses back to the bedside, improved critical thinking, and HCHAPS scores and physician satisfaction improved.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
The Greeley Company has been an industry leader for more than 30 years and consistently delivers innovative solutions to healthcare’s greatest challenges. Specifically, we see pain points in the areas of improving quality of care while reducing cost, which can be achieved by:
- Achieving regulatory compliance by reducing the burden on clinicians
- Addressing the critical need for physician leadership training, effectiveness and accountability
- Helping medical staffs achieve real value through peer review that changes physician culture
- Finding new approaches to physician-hospital alignment
Greeley’s method is to always seek a Win/Win/Win for physician success, hospital success, and good patient care.
Are you working on any exciting new projects now? How do you think that will help people?
I’m particularly excited that we will be rolling out a brand-new diagnosis and treatment for physician burnout that will provide unique outside the box solutions starting in second quarter 2019.
Some of the other exciting projects we are working on now include:
- Helping hospitals respond to immediate threats from CMS in a way that leaves them a better hospital with sustainable compliance and improved processes with less burden on clinicians
- Interim staffing solutions when important roles become vacant and the right candidate isn’t readily available, especially for senior leadership roles such as CMO and CNO
- External peer review when getting physician performance measurement has to be right, including to document medical necessity or determine if corrective action is warranted
- Standardizing medical staff bylaws and peer review across healthcare systems to get more value from being a system
- Optimizing physician leadership performance and accountability across all physician leadership roles, including both medical staff and medical director positions
- Service line co-management solutions that create breakthrough partnering between physicians and the hospital or health system
- Rebuilding trust and reducing conflict between a medical staff and hospital
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
- Never lose site of the “Why”: As Simon Sinek has said so beautifully, “Start with “Why?” and anything is possible.” This will be part of Greeley’s solution to physician burnout, including helping physicians rediscover the joy of medicine.
- The Greeley Performance Pyramid: I would have saved myself so many dumb mistakes in physician leadership if had known about the Greeley Performance Pyramid, which provides such a common sense, practical approach to optimizing practitioner performance through steps to:
- Select excellent practitioners
- Set, communicate and achieve buy in to performance expectations
- Measure performance
- Provide periodic feedback
- Manage poor performance
- Take corrective action
3. Understand how to exercise power and influence without authority, something we teach in our Greeley leadership training programs.
4. Leading with integrity and with heart: No one necessarily taught me this, but it is something I’ve grown into along the way. Life is short, and the world is small — if you treat everyone well, and you act with integrity, you rest your head more easily and find greater success.
5. The task is not yours to complete, neither may you refrain from beginning it: This quote, attributed to Rabbi Tarfon, emphasizes that we must do what we can to be part of the solution, but understand that the job is not done and likely won’t be done by us alone.
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
There are two root causes for why the U.S. is ranked poorly, as well as several additional key challenges that play a role in our healthcare system’s poor performance. The first root cause is that healthcare is a scarce resource. We have a duty to develop a fair and just way to allocate this scarce resource across our population, but Americans believe healthcare is and should be unlimited. We won’t elect a politician who tells us otherwise. We need healthcare leaders and political leaders to directly address this reality, including educating the American people about it. Until we do, we will fail to turnaround the performance of the American healthcare system.
The second root cause is that all the stakeholders in healthcare are acting in their perceived self-interest. When I say stakeholders, these include physicians, hospitals, insurers, pharma, EMR providers, device manufacturers, other tech companies, attorneys, and yes, patients, too. Of course, there is nothing wrong with acting in one’s self interest. The problem is that when everyone in healthcare acts in their perceived self-interest, then collectively we create a healthcare system that is not sustainable. We all need to temper our self-interest with acting in the interest of the whole. If we don’t, then the whole healthcare system suffers, as do all the parts that make it up.
Additionally, we struggle to strike the right balance between valuing technology/procedures and other ways of achieving health. These include placing greater value on the cognitive services provided by physicians in assessing and managing complex medical conditions, including communicating and coordinating with other providers. We also need to focus more on the psychological and social determinants of health, such as poor access, poverty, and lack of housing. We teach this approach in Greeley’s training for physicians to lead what we call “clinical transformation,” which is how to achieve breakthrough improvements in quality and reductions in cost at the same time.
Finally, I cannot stress enough the importance of effective leadership training. This is something that many health systems fail to invest in, when really it is a key factor in driving change and improvement in healthcare. If you can train the right leaders who are in touch with their “Why” and equip them with the knowledge and tools of effective leadership, they can implement new ways to make healthcare work for all of us.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
My answer echoes my previous statements on addressing healthcare’s pain points. Five improvements that need to be made are:
- Reduce the burden on clinicians by simplifying everything, not over interpreting standards, and only doing things that make clinical sense.
- Invest in developing and holding accountable physician leaders both for the organized medical staff, and for the growing army of medical directors and physician executives.
- Drive cultural change through thoughtful peer review and peer-to-peer accountability for medical staffs and employed physician groups.
- Use service line co-management to create greater physician-hospital alignment and address areas of conflict and low trust.
- Encourage physicians to find their “Why?”.
Thank you! It’s great to suggest changes, but what steps would need to be taken? What can the individuals, corporations, communities and leaders do to help?
To further elaborate on what I’ve said earlier, there are several key steps we can take to help improve the healthcare system:
- First, make clinical transformation, which is the achievement of breakthrough improvements in quality and reductions in cost at the same time, job one for everyone in healthcare. If your organization isn’t making clinical transformation job one, you will not succeed in the world we are heading into in healthcare. We emphasize this point in Greeley’s training for physician leaders.
- We must work together. All too often we find healthcare organizations and communities experiencing high levels of conflict and low levels of trust, especially between physicians and hospitals/healthcare systems. If this describes your organization, take active steps to heal the past and create the foundation for collaboration going forward. Getting called into and turning around settings of high conflict and low trust is some of the most gratifying work we at Greeley get to do.
- Don’t try to do it all yourself. There are others who can help. Things our clients see every five years we see every two weeks. At Greeley, we find we can enter an organization, do a significant project with them, and leave them a better organization, achieving better results faster and more cost effectively than they could achieve on their own.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I am a lifelong learner. I love reading books by thought leaders such as Simon Sinek, Patrick Lensioni, and others. I am addicted to the Great Courses from The Teaching Company. By listening to some of the greatest college professors in the country in far ranging fields I often gain insights that can be applied in new and exciting ways in our work in healthcare. And perhaps most importantly, I find it ever more central to focus on the “Why?” for my life, why am I on this earth, and how I can I be of greatest service to others.
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