← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Chris Nicholas, Chief Executive Officer at Renown Regional Medical Center
00:22:12
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- [00:00]
A
This is Laura Dearda with the Beckers Healthcare podcast. I'm thrilled today to be joined by Chris Nicholas, chief executive officer at renowned Regional Medical Center. Chris, it's a pleasure to have you on the podcast today.
- [00:11]
B
Yeah, Laura, thanks for having me.
- [00:12]
A
Now I'm excited for our conversation because I know there's so much happening right now at Renown and certainly we'll be excited to learn more about some of the cool things you're doing as well as your perspective on the future. But before we dive in, can you introduce yourself and tell us a little bit more about Renown Regional Medical center in particular, what's your biggest winner success story from the last year?
- [00:32]
B
Yeah, absolutely. I'll go a little broader and share a little bit about Renown because I think it's important in the context, but. So Renown Health is a integrated healthcare delivery network, not for profit healthcare system located in Reno, Nevada and kind of critical, important part of the community just given our scope and scale and the region that we cover. So we cover about 100,000 square mile catchment area from the Utah border to the eastern side of the Sierras and then all the way up to Idaho and Oregon and then down south to about the half halfway point between Las Vegas and Reno, Nevada. And so we have a big catchment to serve and also within that catchment is quite a bit of what we would call rural or frontier medicine. And so we deal with a lot of patients coming into the urban centers to get their care and even into the clinics get that specialty care. So as the only local not for profit academic health system in our region, we carry a tremendous amount of responsibility and it's a privilege to do that. Renowned Regional Medical center plays a pretty prominent role within that system. So we're made up of a health plan that's roughly about 600 to 650 providers. We have also a not for profit health insurance arm, Hometown Health. We have a couple of other hospitals, an inpatient rehab hospital, smaller, what we would call a community hospital. And then we also have the main campus which is Renowned Regional Medical Center. We're a level two trauma center as well as the academic teaching hospital and medical center and comprehensive stroke center as well as the tertiary hospital for that, that catchment that I just described.
- [02:09]
A
That's fantastic to hear. And you know, currently as you mentioned, just such a unique hospital and organization that you work with and would love to just hear again more of some of the cool things that you're doing.
- [02:22]
B
Yeah. So I think you asked about the success over the last year. So Maybe just hit on a couple of those really quick. It's hard to narrow it to one. We've been on just a tremendous kind of incline of both growth and success. And I think it starts with, you know, we just, just completed what will be our 10 year strategic plan last year. So we're in I guess month seven at this point or month eight of that 10 year strategic plan. And a lot of credit to Dr. Erling, the chief executive officer of Renowned Health, for coming in and really being able to pull that together and get the community and the organization focused on that. And it was just an incredibly transparent process that was very inclusive. It involved community members, board members, obviously leadership, but also front lines. And I think it was a unique way. And then also, also you heard me say 10 years. I think it's hard these days to project out, you know, even two or three years in advance to look at a 10 year strategy and really think about the commitments that we're making within that I think is pretty significant and important. So a lot of credit to our leader, Dr. Brian Earling, for the work that he's done and the way that we've been able to go about that work. I think that a couple other just quick successes is what I would call the ecosystem or the operational infrastructure that we've created and really embedded at renowned Regional center. And I'd start with how it's driven, engagement and clarity. So our leaders and our people really know now what the strategy of the organization is and what the strategy of the hospital is. And they feel informed, they feel that we're speaking to them and that's validated through engagement, survey results with specific questions that target that to really understand are we doing a good job talking about what we're focused on and providing continuous updates on how we're doing towards those goals. I think Dr. Ehrling, again, to give him, you know, a tremendous amount of credit, he does town halls at least every month and really is, you know, I would say incredibly transparent in those and open for questions to just make sure that people really understand where we're going, where we're focused at the hospital level. Something that I think has been really vital to our success is we've been able to talk to about 3,000 of our employees pretty much face to face three times a year through what we call employee forums. So about two weeks a year, 28 or so forums are done within that two week period. And about 3,000 of our frontline team members and leaders show up to those to understand and hear about how we're performing where we might need to focus, where we're going and really what's needed from them to continue to advance that mission. We also do things through weekly emails to provide timely updates on things that are happening. And then the last two pieces here would be really focused on a high performing leadership team, starting with the executive leadership team of the hospital. As I came into my role, we've really constructed that over the last three years so we've got new people to renown and to that team on the, on the team, but we've also got just people that have been here that are just new to that team. So creating that cohesiveness and bringing that team together has been important. But then taking that down, you know, one, two and even three levels to really how are we investing in our middle leaders, our directors, our managers, our supervisors, and starting things like leadership development institutes and really focusing in on development plans that are based on a comprehensive assessment of performance of our leaders. And then obviously a enterprise expansion that really culminates with internal advancement. So really taking what we've done at the hospital level and expanding that to the enterprise to focus on advancing our leaders, but also creating succession planning, which is, as you probably know, many times an afterthought. And then lastly is what we call leader alignment, is how do we take the strategic goals of the organization and cascade those down to US operational leaders and you know, really connect their work to the organization's focuses and priorities, set those clear expectations and ultimately establish that accountability. And when you do that, you have to protect their time and their bandwidth to actually ensure the right work gets done and that it gets prioritized and accomplished. And then lastly is making sure that they actually have the resources, training and support to do the work that we're asking them to do. So sorry, that was a lot, but that was the narrowed down version.
- [06:40]
A
Absolutely. No, I love that. And I think, you know, as you mentioned, being able to have the ability to look at the leadership team, figure out where, you know, they are building upon their strengths, where they fit within the broader organization, how they can provide the most value, I think is an exciting prospect in healthcare today, especially given all the transformation and the real true need that hospitals and systems have for leadership in building them into the future. So I'm excited about that. It seems to keep got a great process there with the leadership development institutions and certainly the opportunity to participate in those I can imagine are a strong retention tool for those who are excited about growing and developing leadership within healthcare.
- [07:26]
B
Yeah, I would agree. I Think we've seen a tremendous amount of success and advancement of our leaders over the last couple of years, that we really put that intentional focus there.
- [07:35]
A
Absolutely. So, you know, I'm curious, when you think about everything that's happening in the healthcare landscape, what are the top two to three issues focused on right now? What's top of mind for you as you're thinking about the future?
- [07:46]
B
Yeah, you know, I think we're in a little bit of a unique space, although I know this is a national problem or challenge that healthcare leaders are focused on today. But workforce is real. We're a little bit what we would call geographically isolated. We're surrounded by mountains on pretty much all sides of us. And the next urban city is really about an hour and a half to two hours away over a large mountain range, the Sierra Nevadas. And so we're not only trying to catch up to the growth that's happened, but also to make sure that we're prepared for the growth that's going to continue to happen in our region. And so we've, we've really taken a couple of approaches that this one is We've got a 50 year academic affiliation with the University of Nevada Reno School of Medicine, really focused on how do we train more doctors and keep more doctors in Nevada. I think it's a huge opportunity for us in the state that that ranks pretty low in doctors per capita. And we're in year four of that affiliation. And obviously the 50 year nature of it means that it's long term and it's gonna take some time to expand some of the residencies and fellowships as well as expanding academic teaching and clinical research. So that's one way from the physician standpoint that we're focused on that workforce component. The other is a huge amount of credit to our chief people officer, our people team, as well as our chief nurse executive. They've really focused in on how we develop partnerships and grow existing training programs or develop new ones either with partners or just completely independently in the organization to make sure we have the right health care workers and the right pipelines feeding those, those jobs. So physicians are important, but you have to have all the people that surround the physicians to make the magic happen, if you will. So we've, we've got academic practice partnerships with the University of Nevada Reno School of Nursing, the Orbis School of Nursing. We've also partnered with Great Basin College to do a respiratory therapist training program, a critical shortage of respiratory therapists across the country, and then some internal things that we've done Kind of independently we've developed our own Echo tech training programs, our surgical university training programs for both surgical nurses and surgical techs, neurodiagnostic tech training programs as well. And so a tremendous amount of creativity through partnership and just de novo build of how do we make sure we have the right pipelines of the different clinical resources and people that we need to take care of our community? I think the other major one, not a surprise, is really navigating the uncertainty of kind of state federal changes. We have a unique environment here in Nevada at the state level. And then obviously I think we're all aware of what's going on from a federal standpoint with the big beautiful bill. Others may call it something different, but I think that our focus on these changes and I guess to build that muscle started three years ago when Renown was in a challenging financial situation. And we created what we called roit, which is a rapid operations improvement team proc process really focused on how do we recover the organization financially and get to a more sustainable place. And that was built from the standpoint of a healthy, balanced recovery. So how do we make thoughtful investments? First, sometimes organizations tend to gravitate more towards an austerity mindset, but also how do we make sure we have the right process and structure to really identify, scope, approve, execute and track the improvements that we commit to. And that's a process where we actually took 12 leaders out of their day jobs for about three months and brought them into a room and they became really the workforce that helped do that recovery work and help identify those projects. And that's since become really a training ground for our high performing leaders so they can get a little bit broader perspective to kind of the health system as well as how do you take a concept that has potential and really pull that all the way through to execution and then advance to today? You know, we've created a, what I call a sustainable structure to make sure that we're looking forward into the future and kind of managing the now. We call that rev. So renowned Economic Viability committee and that's an enterprise wide committee that's really overseeing the execution of what we call financially sustainable initiatives that not only evaluates new opportunities, but make sure that what we've committed to is, is really tracking the big decisions are made at an executive leadership level. But it's good to have everybody in the boat as we're really looking at, you know, how do we want to navigate some of these big federal changes that are coming and really understand that from an integrated health Care delivery system perspective, you know, that the health plan can have an entirely different perspective and focus than a hospital might. And same thing with a medical group. And so it's nice to have really that enterprise level focus and commitment to whatever those things are that we look to kind of navigate some of the, I'd say challenges, but also opportunities that exist within what's happening today and then also just forcing ourselves to continually look forward to making thoughtful investments today that will position us favorably in the future.
- [13:06]
A
That's fascinating to hear about. And you know, I love how you outlined that process that you have been using, especially even from three years ago of creating the roit, the committees that are, you know, focused on change, focused on identifying the right projects that you can really then elevate and make sure you've got that potential for the broader organization. I'm curious, over the last year, three years especially, what did you learn about that process? Is there anything that would be beneficial to share with other leaders of organizations as they're, you know, trying to do the same things that you're talking about now today with you know, thinking about economic viability, thinking about what their need to do from an organizational perspective with some of those high performing leaders and then making sure it trickles down to the rest of the organization?
- [13:55]
B
Yeah, you know, I think enterprise buy in and commitment is really important. We tend to sometimes as a organizations, especially integrated delivery systems, go into what I would call foxholes and we begin to focus on, you know, how do we make our business, our component of the organization viable and sustainable. And I think much of the work exists in those foxholes and should, but there's a component of that, a percentage of that that really requires an enterprise look at what do we want to do and how do we want to do it and how will it impact the organization, the community, the people that work within the organization and that are served the organization. And so you know, my, my advice, I guess if, if I would give it is kind of where we've navigated ourselves to now, which is really taking an enterprise wide approach to looking at some of these financial sustainable operational decisions that we make and even strategic decisions and making sure that we've got all the perspectives in so that as we stack hands on top of it, there's full commitment to it and there's, and there's frankly full clarity because sometimes what we do on a hospital side can have a negative impact elsewhere in the organization and vice versa.
- [15:08]
A
Got it. That's helpful to know. Thank you for digging a little bit Deeper there now, what do you see as being the big opportunities for growth in the next few years or so?
- [15:17]
B
Yeah, I think specific to our community, you heard me say 10 year strategic plan. So you have to imagine there's a lot underneath that I'd say really in our community, we're maybe uniquely positioned and you could pick the service line and specialty and there's probably demand and growth in almost all of them. A particular area that we're focused on early in this strategic plan is in our oncology. So today we see tremendous opportunity to approach oncology and cancer care differently in our community. One prominent focus of that would be keeping care local. If patients are having to leave our community for not just oncology services, but really any other service, we're taking a pretty hard look at that as an organization and deciding does it make sense for us to provide that care here and attempt to provide that care here for oncology specifically? It comes down to, in my mind, three things. It's about access, it's about integration, and it's about advanced treatments. So how do we make sure that when a diagnosis happens that the care to especially medical oncology is accessible and then once that diagnosis has happened and you're in the process of receiving that cancer care, how do you navigate it? It's a complex environment and so making sure that the care is well integrated and that it's, you know, seamless for a patient to navigate through it and experience it because they're obviously dealing with a lot. And then lastly, and this goes back to our academic affiliation with UNR Med is how do we make sure that we're bringing all of the treatments, the cutting edge and advanced treatments and therapies to our community and to our patients. CAR T and BMT therapies are things not offered today in our community that if you require those, you have to go outside of our community a lot of times over the mountain range to California. And so we believe that we probably need to provide those services at some point now or in the future, as well as just expanding the clinical trials and research so that there's access especially to those clinical trials for members. Another couple of areas would be women's and children's services. I think there's significant demand for these services today and it is going to continue to grow and expand in the coming years throughout this 10 year plan. So we need to be able to not only accommodate the demand today, but grow and be able to meet that. Over the last 10 years of being here at Renown. I think we've seen tremendous growth in our pediatric subspecialties. In our children's hospital, we've added probably roughly about 25 to 27 of those. We used to transfer out a large portion of our children that needed that specialty care and today that transfer percentage is less than 3%. So we're really happy about that and feel good about it. But we know that there's still growth that we need to experience to make sure that we're taking care of our mothers and babies and kids in our community. I think the other piece of this transitioning away maybe from specific service lines is around our ambulatory footprint and our approach to value based care and continuing to make sure that we're not only investing in the delivery system, but that we're really looking at how are we going to transform care. And from a value based perspective, that academic affiliation is I think, critical and important to a multitude of different areas that we're focused in from a growth perspective over the next 10 years. And the last one I'd say is we've seen tremendous growth in what we call Renowned Medical Group or our employed medical Group. I think we're probably going to encroach 650 to 700 providers sometime by the end of the year, early next year. And I think that there's a lot of momentum there. They've done some incredible work and that's allowing us to bring physicians and providers into our community to continue to help accommodate all that demand that I talked about.
- [19:12]
A
That makes a lot of sense. It's really great to see you taking a look at the services you want to expand and keep people in the community. I know that is a huge undertaking, but certainly necessary to continue. As you've been talking through that mission of serving the community well, and really fascinating to get an inside glimpse at some of those conversations and the things you're thinking about, especially in the years to come. And speaking of the future, leadership takes a variety of different forms. And so when you think about all of this transformation, all of the things that you're aiming to do over the next couple of years, as well as just the real headwinds that are facing healthcare leaders today, what will it take in order for leaders to develop a thriving organization in the next five years or so, what do you see as being essential for leaders across the board?
- [20:03]
B
Yeah, you know, I think the usual answers are all correct, like resiliency and creativity and flexibility that we often hear about. But I think those also often live at some of the top parts of the organization and the organization's leadership structure. When you think about how you need to translate that down to the hundreds and hundreds of leaders that, you know, really get the job done each day and support the frontline team members to care for our patients, I gravitate back to things like integrity, doing what we say going to do when we say we're going to do it, or being clear about why we didn't. I think authenticity and vulnerability are continuing to kind of elevate themselves as just critical leadership skills so that people can connect with the leadership and the organization's mission. And that becomes a driving force for really speed, execution and success. When people have that level of trust and commitment in not only the leadership, but obviously the organization and its mission. And the last two, I'd say, is the purpose or mission driven focus. So everything should be anchored back to that mission. The decisions we make and how we operate and what we do is really based on what the mission of the organization is. And then lastly, and I would have to give Dr. Erling a tremendous amount of credit, that clarity and transparency. And transparency. Most importantly, just being committed to who we are and who we serve and why we do that, and just being transparent about what we're doing in order to be able to fulfill that mission and our purpose.
- [21:36]
A
Absolutely. That is such amazing insight and great advice, especially for those who are trying to figure out how to lead through all the change and then rising leaders as well. Thank you so much for joining the podcast with us today, Chris. I really appreciate your conversation. I think it's been inspiring to hear the things that you're doing at Renown and I look forward to seeing you as well at OCEO CFO Roundtable. I know you'll be a speaker for us and just we'll keep the conversation going.
- [22:03]
B
Yeah. Thanks, Laura. Excited, excited to join you all in Chicago and appreciate the time today.