What does it really mean to transform care across a huge system?
Two years ago, Ascension Health—the nation’s largest Catholic health system—created Ascension, a parent company that would develop "systems, services, and models to enable us to succeed in the new world" while allowing Ascension Health to "remain focused on making the incremental, operational changes along the way." That’s what Ascension CEO Anthony Tersigni told me and my colleagues Dan Diamond and Tom Cassels in early 2013 in our very first "Lessons from the C-Suite" profile, and I’ve been eager to follow up with him.
At the time of our original conversation with Tony, he was just a year into his tenure as head of the newly formed parent company. He shared his goals for Ascension, calling them "themes you can put on a bumper sticker": develop a vibrant Catholic health ministry; become an entrusted steward; and re-imagine health and co-create healthier communities.
I was struck by Tony’s vision and wanted to understand more about how he’s making systemic change at an organization that has 1,900 sites of care in 23 states and the District of Columbia. He and I spoke recently, and he shared his areas of strategic focus, which include a particular emphasis on developing leaders who are prepared for the new health care environment.
Q: Tony, you talk a lot about becoming 'One Ascension.' What does that mean, especially in terms of transforming care delivery?
Tersigni: This is a journey we’ve been on since our founding in 1999. Traditionally we’ve been a collection of hospitals, so that Ascension in essence was a system of systems. We grew within our specific markets and leveraged our size and resources to provide care in our separate locations.
With health care changing and evolving—to taking care of lives instead of just focusing on delivering care—we needed to integrate. Rather than being a system of systems, we needed to become one integrated ministry. For the benefit of those we serve everywhere, we need to become more centralized in how we do certain things across Ascension.
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This idea is not new. We’ve been about person-centered care for hundreds of years, and specifically about holistic care that focuses on the body, mind, and spirit. We provide care even if we can’t cure because we know it’s about more than just the specific medical intervention. We have been focused on population health for years. Our goal has always been to care for people holistically and across the continuum of care. Changes in health care have simply galvanized our philosophy—effectively, moving from this fee-for-service model to the value-based care system we believe in is what One Ascension is all about.
Q: How are you putting this into practice?
Tersigni: We’re focusing on a few specific areas:
Physician alignment and network development: We need to develop a national network that is in essence a national ACO model. Working across caregivers, and developing a national strategy to do so effectively, is essential.
Clinical management: I think we already do a great job in clinical quality and safety, but I’m not so naïve as to think we can’t do better. It’s critical we answer questions such as “how do we nationalize eliminating variance and waste in our system?” Looking at this from a centralized perspective will enable us to ensure consistent, high-quality clinical management across the entire organization.
Financial acumen and risk management: This comes down to answering the question “how do we take on risk?” We need to take on risk collectively, as an organization, so we can properly evaluate it. It can’t just be about risk mitigation for a particular health ministry—it has to be organizational risk mitigation.
Leveraging and communicating information: We spend hundreds of billions of dollars on this in health care interoperability, and no one is getting it right. Many people say we’ll never get patients to agree to share their information and therefore we’ll never be able to do anything here, but I completely disagree.
Take TSA pre-check for example—when I first used it a few years ago I was the only person in line, now I’m better off not even using it because there are so many people. People realized how effective it was, and so were willing to share their information to become part of the program. The same can happen in health care. We just need a group of willing users who see the value and this will take off.
We held a focus group during our strategic planning process. (This is something in health care we traditionally haven’t done; instead, we’ve just told people what they need.) Through these groups we learned people want four primary things from us:
- Respect me: Treat me with respect, understand what is important to me, care for me as a whole person, and communicate in a way I can understand
- Include me: Listen to me, care for me in a personal way, and include my loved ones in my care
- Connect me: Connect me with the right health information that is relevant to me
- Engage me: Engage in a collaborative decision making process with me
If we’re able to deliver those four things, we think people will opt-in and we will be able to communicate and leverage information much more effectively.
Product design and development: Plans and insurance companies have this, but we don’t. We need to be able to create the things that our populations need currently and will need in the future to be healthier.
Culture and leadership: We can’t think the good old days of health care will come back…ever. We need leaders who are all in with us on our One Ascension vision. In fact, we’ve had conversations with our longer-tenured executives saying, "if you’re going to be here we need you all in, or if not we want to support and care for you by helping you to recognize other alternatives where you might fit."
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We’re developing our next generation of leaders through our Leadership Academy; to join this program, you have to be open to going where the organization needs you. We give you one pass, but after that we would question if you’re the right fit because we want people who are totally bought into One Ascension and the transformational impact it can have.
Q: Developing leaders is clearly a major focus for you. What’s your leadership philosophy?
Tersigni: It all begins with our mission, vision, and values. We focus on forming the whole person; we think it’s important for you to get to know yourself before you can lead. Spiritual formation and leadership principles must be combined into one. That’s the journey we’re on in developing our leaders, and will continue to be on.
I believe that 99% of people who come into work every day at Ascension want to fulfill our mission, vision, and values. It’s our obligation as an employer to allow them to do it—organizations like ours survive over time because of a focus on community. The community wouldn’t let any individual fail, and therefore wouldn’t let the collective fail.
That’s the spirit we want to create, and the ultimate example of this is our Leadership Academy. I became Dean of the Academy because I wanted to make sure we created this type of community of leaders within our organization, not just give some degree or certification. Without that community fabric, we’re always one generation away from extinction. You need the next generation picking up the mantle and continuing to live these values. That’s why we don’t have "graduations" in our Leadership Academy—it’s an ongoing journey.
Q: Did you always have this leadership-development focus? Or has that emerged as part of your own journey?
Tersigni: I was on a panel many years ago with the then-CEO of a Fortune 100 company. I was a relatively new chief executive in comparison to him, so I asked him how he spent his time. He rattled off 30% on leadership development, 20% on something else, 10% somewhere else, but I remember being amazed at the 30% on leadership development.
I realized I spent barely any time there. I’d always thought of that as an HR or manager issue, that I needed to focus on the operational and other aspects of the organization. I realized I needed to spend a lot more time there. That’s where the Ascension Leadership Academy came from, and why, as you can see, I’m so passionate about it.
My ultimate goal is to deliver this type of training to everyone throughout our organization, modified of course, and do the same with our two-year spiritual formation training. Providing this type of support to our staff in enabling them to live our mission, vision, and values is what I see as my legacy. It’s providing the ingredients to take care of millions of lives via longitudinal care with caring employees that respect the dignity of the individual.
Q: What’s your hope for the future of Ascension?
Tersigni: Within 18 months, I want us to realize our goal of becoming One Ascension. I want to provide a system of support from birth through death in a much more relationship-driven way than ever before.
Lastly, we currently have a U.S. health care system designed for middle class America. I hope we can be part of redesigning that system to support everyone, including the most poor and vulnerable.