← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Michael Wiggins, Assistant Professor of Healthcare Management and Leadership at Texas Tech University Health Sciences Cente
00:21:48
Loading summary
Transcript19 lines
- [00:02]
A
The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit, and more, the conversations get real. Leaders will share how their scenario planning for policy shifts brief, breaking through value based care barriers and building clinical teams that translate new ideas into real world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
- [00:47]
B
This is Laura Deardeau with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Michael Wiggins, Assistant professor of Healthcare Management and Leadership at Texas Tech University Health Sciences Center. Michael, it's a pleasure to have you on the podcast today.
- [01:00]
C
Well, thank you, Laura. Thank you for the invitation. It's a pleasure to spend a few minutes with you and your listeners.
- [01:06]
B
Absolutely. And you know, I'm excited for the time we have today because I know healthcare is such a dynamic field. And so to get your perspective and especially on the academic side, we'll help, you know, make sure we're sharing with our broader audience some of the cool things that you've been working on as well as how, you know, you're seeing the future continue to evolve. But before we dive into that, can you introduce yourself and just tell us a little bit more about Texas Tech?
- [01:30]
C
Oh, absolutely. Well, and as you mentioned, I have the privilege of serving as an assistant professor at Texas Tech University Health Sciences Center. And at the center we have schools of medicine, nursing, pharmacy, biomedical sciences. We also have the Julia Jones Matthews School of Population and Public Health. And then the school where I teach, which is the School of Health Professions, and I teach in the Healthcare Management and Leadership department. And we have both an undergraduate program as well as a master's degree program. And I've been with the Health Sciences center for almost two years now after spending a little over 30 years serving in various healthcare leadership positions, including as chief executive of a couple of academic medical centers. So I'm thrilled now to take some of that experience that I was able to pick up over those 30 years and try to apply that into preparing students to be future healthcare leaders.
- [02:26]
B
Fantastic. Well, you know, I'm curious to just your point in looking at, you know, the impact you're able to make on the academic side, what really prompted your move from being a healthcare executive into academics?
- [02:40]
C
Yeah, well, Laura, that's a question that a lot of colleagues ask me. I'll tell you, it's something that I started preparing for a long time ago. I just. I love to teach. I always have. And I love to be around learners, too. It's part of why I enjoyed leading academic medical centers so much. Just the energy and enthusiasm that learners bring to the environment. The fact that students sort of keep us on our toes, too. We have to stay up to date and informed and current or else they're going to call us on it. There's some accountability there. But knowing that I love that environment, I'd gone back years ago and completed my doctorate. Then I'd begun just doing guest lectures at local universities. I eventually took on a couple of faculty teaching opportunities as an adjunct. And so I knew that at some point this is what I wanted to do, this is where I wanted to be. And so I sort of developed a plan to do that. And then this opportunity with Texas Tech University Health Science center came along, and I was just so impressed with the organization. And I'd really start with my faculty colleagues. They've just got this impressive mix of backgrounds. There are some who have spent careers in academia, they've been teaching and conducting research, and then there's some like me, who have the academic prep. But we've spent most of our careers leading healthcare organizations, and so really brings together the academics and practice in a way that I think offers something really special to our students. And the leadership team we have there is just extraordinary. Our program directors, Drs. Merritt Brockman, Kerry Shaver, Morgan House, our department chair, Dr. Ryan Schmidt, our dean, Dr. Andre Secrest, just tremendous leaders, really help us keep our focus on learners and those we serve. So it's been a wonderful transition for me, again, something that I planned for, and I'm just thrilled to be in this role now.
- [04:33]
B
Lauren, that's amazing to hear. You know, to have that kind of opportunity to really lean into your strengths and do what you enjoy most and influence the future at the same time is just fantastic. Now, when you're thinking about, especially the last year or so, can you tell us about an initiative that you led? What did you do and what were the results?
- [04:53]
C
Yeah, I'll tell you. Much of my focus in the last year, Laura, has been on academic medical centers and systems of care. And I have a particular interest in economic models that support integrated systems of care. And the reality is right now, we don't have very many true systems of care in the US we have a lot of what I refer to as nodes of care. We have hospitals and physician practices, ambulatory surgery centers, you name it. And sometimes they're connected, sometimes they're affiliated, but oftentimes not. But even the ones that are, they're rarely coordinated very effectively. And so this fragmentation, as we know, it's inefficient, it adds cost. And that's not a new concept. No one's listening right now saying, oh, wow, I never thought about that. We see this, for example, in patient flow. Hospital operators are very familiar with this. The fact that we literally put humans into inventory in our healthcare system. We have patients holding in the emergency department for days because they can't get a bed to be admitted. And so they just become human inventory in our system. Meanwhile, in the inpatient units, patients are taking up beds because of a disposition issue. Maybe they need a skilled nursing facility, but there's no capacity. Or maybe they need home health, but they can't get on the schedule till next week. Again, it just creates this inventory issue. And I like the way a colleague of mine, Dr. Pat Lee, he's the CEO of Central Health in Austin, Texas, he refers to this as a system with edges, where patients get to an edge in the system and, and they're just stuck. They just can't go any further. And we see that example playing out all over the country, and hospital operators, again, working very hard to deal with those situations, and they understand the cost that it's creating, whether opportunity cost, resource costs, what have you. But the work that they're doing is primarily in their own organizations or in their own nodes. And so to me, this is where I've been trying to spend my energy and my time is getting to this new mindset. It's a real shift that we have to take. We have to begin thinking about these costs in our system as opportunities for investment. So when we see these patients piling up in our eds, we have to see that not just as a cost, but as an opportunity for investment. Why are those patients there? Are there other forms of care that would be better to meet their needs? Should we invest in those forms of care? And so part of my focus is bringing just economic clarity to those decisions. You know, if a hospital knows that a lack of skilled nursing capacity is costing them, let's say, a million dollars a year, well, should they be willing to invest a portion of that million dollars into developing a solution? Well, I, I would expect most healthcare leaders would say yes, I'd be glad to invest something less than a million dollars to solve a million dollar cost issue. And so I'm working to try to help organization, help them think in those terms, to begin thinking about cost as investment opportunities. And while I use patient flow as an example, that's an obvious one. Most leaders in healthcare are dealing with that. But that sort of thinking can really apply to any area where an organization has significant costs. So Laura, that's been my primary area of focus, is just helping organizations tend to think about cost as opportunity.
- [08:32]
B
I love that. And I think that's such an important mindset shift because there is so much change happening within the healthcare space and really having the opportunity to step back and understand, you know, where those investments can really make the biggest difference and then looking, you know, further ahead in the impact and value that they're going to bring into the organization. You know, it seems like such a, an important and beneficial way to look at strategy overall. And, you know, from your seat in thinking about the next year or so, what are some of the big priorities and headwinds that you and healthcare leaders should be focused on?
- [09:09]
C
Well, sure, and there are several that come to mind. As I mentioned, most of my attention being focused on academic medical centers. You know, I think about tremendous headwinds. Of course, you know, this mindset shift I was thinking about in terms of thinking of cost as investment opportunities, and those investment opportunities don't necessarily mean direct ownership. It might mean partnership, it might mean other types of relationships that solve those issues. But when I do think specifically about academic medical centers, I think about the headwinds as they relate to their tripartite academic mission, the research, the education, the clinical enterprises that make up the academic mission. And the reality is that we're seeing a squeeze on research funding, we're seeing a squeeze on the educational mission, which we, you can think about is the workforce pipeline. And then we see the squeeze on clinical revenues. But I think academic medical centers, they're not just caught between a rock and a hard place. It's sort of three dimensional for them. They sort of have not only the rock and the hard place, they've got this heavy thing pressing down on them, which is the most proximate issue, the loss of research funding. And Laura, if you hosted a political podcast, I'm sure we could really stir things up right now, but around the emotion, around some of this research funding. But you know, we'll stay away from that. But, but universities, they've built these resource intensive research infrastructures and they've done that with the assumptions about funding. And those assumptions were reasonable at the time based on their expectations. But now the cost of that research infrastructure is just unsustainable. And, and so they're understandably beginning to turn to a source of funding that's always supported them and that's the CL clinical component of their system or their clinical partners. And they're asking these partners to fill that gap. And unfortunately, this is coming at a time when the clinical enterprise is being squeezed by higher cost, being squeezed by stagnant or declining reimbursement. And so they have less to give while they're being asked to give more. And so there have already been some very difficult choices. Some have had to trim research programs, cut programs. And so I think there's going to continue to be that sort of rationalization that's occurring and I think it's going to require even more alignment and collaboration between the academic enterprise and the clinical components of the systems. They have to align their investments to meet not only their strategic focus, but also the focus of their community needs. And so the programs that have value across all three components of the tripartite mission, across research, across education, across clinical, those are going to be the ones that survive and thrive and those that don't just simply won't. So I, you know, Laura, I really think that's, that's one of the most difficult things organizations are going to have to deal with in the coming months and potentially years.
- [12:23]
B
That's such a great point. And especially, you know, looking at how some of those funding shifts, you know, in research and you know, need. The research still needs to be done, innovation still needs to be done. And so trying to understand, you know, where that's going to come from and then how the clinical as well as the research and academic enterprise work together. You know, I think across the board we're seeing different kinds of collaborations and alignments to figure that out. And one of the things you mentioned was looking at partnerships or trying to find different ways that AMCs can leverage their reputation as well as be a bit more creative with how they're getting things done. And so are there any creative partnerships that you've seen either at Texas Tech or from other institutions that kind of embody this shift you're talking about?
- [13:18]
C
Well, the ones that I have seen, Laura, are the ones where they really begin to recognize what is the strength and the core business that each partner brings. I mean, you see some of the consolidation that's happening in the industry, whether it's hospital operators purchasing surgery centers or whether it's hospital operators getting more involved in the post acute setting or what have you. I think we're Beginning to see a bit more of that vertical integration that truly is beginning to create more of these systems of care. You know, as I mentioned earlier, there just aren't that many systems. Even the organizations that call themselves systems usually are just a collection of providers within a particular part of the system. So, you know, for instance, a hospital company that may own a number of hospitals, but that's really just one component of the system. So when I see organizations that are beginning to integrate to create the full circle system where you have provider payer, acute post acute, ambulatory, when all of those things begin to come together, that's when you can really benefit from the efficiencies across all of those networks. Whether it's patient flow, whether it's patient interaction, leveraging technology, leveraging databases. Really, you only get to maximize that reality when all of those pieces of the system are connected.
- [14:51]
B
That makes a lot of sense. And thank you for digging a little bit deeper there. Now, what do you think the hardest thing you'll have to do in the coming year will be?
- [14:59]
C
Well, you know, it's, I would imagine the answer I give you now and the answer I would give you in 12 months about what was the hardest thing, those might be different. I mean, you know, part of what's exciting about working in this field is you sort of never know what's coming the next day. So I'll reserve the right to say there may be something out there on the horizon that we don't quite see yet. But I will say in general, I think the hardest thing is helping organizations make very difficult choices. To me, the ultimate challenge of leadership and the ultimate choice is where organizations are going to invest their limited resources. Resources, where are they going to make those investments. And I think oftentimes the most challenging part of that decision is simply deciding what not to do. I advise organizations when they're doing their strategic planning, often they're making these big lists about things they want to do, new service lines. I mean, here I am even advising organizations they need to make investments. They need to make investments to reduce, reduce their costs. So I'm, I'm also one of those saying there's something new out there they need to invest in. But, and, and even though that's appropriate, rarely do I see organizations create an associated list of things that they're going to stop doing in order to free up resources for these new initiatives. And that's a hard decision. That, that's a lot harder, in my opinion, than deciding what you're going to do. So organizations, what tends to happen is we just add and we add and we add until we reach some, some sort of a breaking point or a crisis point. And usually the first breaking point we see is a financial breaking point of some sort. And then we end up having to make urgent, unplanned, maybe even short term type decisions to react to that breaking point. And so obviously it would be much better to take a more routine, systematic approach to culling the initiatives that are not the highest priority. But again, that's hard work. And it's especially hard for academic medical centers for safety net providers, because they have obligations. They have obligations that are placed on them. They don't get to walk away from those obligations. Community hospitals, they might decide to shut down a program because it's not producing operating margin. But those patients who are displaced, they're going to end up at the doorstep of the academic medical centers and the safety net providers. So in addition to making those hard decisions about what initiatives we're going to walk away from, some organizations who don't have those choices, they have to figure out how are they going to create the right mix of services to stay viable. And I'd also say from a policy standpoint, we have to make sure we're maintaining funding mechanisms. Often these are through supplemental payment structures so that those organizations, the academic medical centers, the safety net providers, that they can maintain those services to provide access for all. That just continues to create a safety safety web, if you will, not only for our community, but for the other providers in the community as well. So, you know, I, you know, kind of gave a little bit of a list of the things that I think will be very difficult in the coming year. But as I said, Laura, I may reserve the right that there's something out there we don't see just yet.
- [18:25]
B
Absolutely. There's always, you know, those uncertainties or new things. I mean, things change so quickly in the healthcare space, whether it's, you know, economic or policy, regulatory shifts, and technology as well has played such a big role in how health care has transformed so quickly in the last couple of years especially. So I think your point is very well taken. But you know, in thinking about the next year as well, how are you thinking about growth? What are some of the best opportunities that health systems can take advantage of?
- [18:56]
C
Yeah, you know, I'll go back to our discussion when we were talking about thinking of cost as investment opportunities. You know, I would say to any organization, if you are experiencing cost, significant cost, especially cost associated with your core business, whether it's patient flow or something of that nature, it fundamentally means there is a supply and demand imbalance in the system. And so. So I'd say study those issues, understand them, evaluate whether there truly is a growth opportunity that might be an investment for you. Because I can almost guarantee an organization that wherever you find those costs, wherever you find those imbalances, I would suspect other organizations are struggling with the same issue. So if you can solve that issue for your organization, not only do you get the direct benefit of it, but maybe you can scale that in such a way as to solve that issue for other organizations as well. And that potentially is a significant growth opportunity just for those who are more entrepreneurial healthcare providers. And then, of course, as I mentioned, some of these more vertical integration strategies that really close the loop on the system so that the organizations begin to benefit from all of those sort of efficiencies of bringing the system together, whether it is, as you mentioned, Laura, technically technology or its other ways of really capitalizing on that flow. I think organizations are going to have some great growth opportunities in that space, and it gets us closer to the kind of system thinking, investment mindset that I think will be necessary for successful healthcare leaders. So that sort of thinking, I think, is going to benefit not only healthcare organizations, but I think more importantly, I think it's going to benefit the communities we serve.
- [20:51]
B
Absolutely. I couldn't agree more. Michael, thank you so much for joining us on the podcast today. This has been such an informative conversation, especially thinking about where healthcare is at some of the big challenges, and then, you know, what type of investments and alignments organizations will need to seek growth in the future. And I'm looking forward to seeing you in person as well at the annual meeting. I know that you'll be on a panel and speaking and connecting with healthcare executives from across the country to share more deeply some of these insights and findings that you've had. And so we're excited to have you there and continue on the conversation.
- [21:24]
C
I'm looking forward to that, Laura, and thank you for having me as a guest on your podcast today. It's been a pleasure.