Renee DeSilva 0:07

Welcome back to The Academy Table. I’m Renee DeSilva, CEO of The Academy and your host, and this episode I welcome Roxanna Gapstur to the table. Roxanna is President and CEO of WellSpan Health, located in south central Pennsylvania. It was great to hear from Roxana on so many of the important topics impacting healthcare today and our time together, we covered reimagining care delivery, improving the patient experience, establishing successful partnerships, and building a pipeline of women leaders. Roxanne has insights across the conversation are worth your attention. But here are my key takeaways.

First, I appreciated Roxanna’s thoughts on all things patient experience. Our core part of WellSpan’s brand promise is the relentless pursuit of consumers and patients and that commitment really comes through as Roxanna explains how providers and consumers perceive true access to care quite differently.

Next, Roxanna shared great thoughts on successful partnerships beyond aligning on values and the problems to be solved. She believes that customers in this case providers should be a good partner by proactively helping to improve the product and sharing the value with others. I know that these types of relationships are something we’d look to foster in the academies community. And it was great to hear how that’s come to life for her.

And lastly, Roxanna is one of the few health system or even healthcare CEOs with a nursing background. She believes that that will change in the future, as the pipeline of clinical leaders serving in non-clinical roles continues to grow. In that spirit, she shared some of WellSpan internal development frameworks really designed to help on that issue. So with that, let’s head to the table.

Roxanna, welcome to the table. So happy to have you here this afternoon.

Roxanna Gapstur 2:07
Thank you, Rene, I’m delighted to be here with you.

Renee DeSilva 2:10
I want to start with a question that was asked of me recently, so I’m stealing the question from a colleague. When you think about the leadership role that you’re in today, would you consider yourself an intentional or accidental leader?

Roxanna Gapstur 2:27
Great question. I would consider myself an accidental leader. And my journey began as a patient care nurse and a hospital many years ago. And I had never imagined at that point that I would move beyond taking care of patients. So the fact that I am today a CEO of the health system seems unusual to me right now that I look back at that very first year that I was a nurse that certainly wasn’t something that I was thinking of doing.

Renee DeSilva 2:56
Yeah, and when I just think when I just do a quick mental check, I think there are so few nurses who are in CEO positions, so I want to explore that at the tail end of our conversation. Maybe before we go there, talk a little bit around how you ascended. What were some of the steps from that frontline nurse to where you sit down and talk to us a little bit about the twists and turns along that career path journey?

Roxanna Gapstur 3:19
Yeah, so multiple twists and turns, as you can imagine. I think one of the key pieces of this whole thing, my career at least was my own willingness to take risks or to try something new. And I am certainly one of those people who really enjoys learning, I consider myself a continuous learner. And I was always interested in learning more and doing more and getting deeper into certain topics. And so as I went through my clinical career, and then moved into a leadership role as a nurse manager, I think I was probably seen as one of those people who likes to learn who likes to try new things. And so that willingness to try things to take risks, I think, was really pivotal in my journey as a leader. A couple of other things I mentioned around early forces shaping my own career, were just, I really took, I think, a risk moving from an area that I knew, which was oncology to a different kind of leadership role, which was hospital and ambulatory settings, emergency department. So willing to make that jump. And then the second thing was really mentors and sponsors who pushed me forward who gave me stretch opportunities, who saw something in me that maybe I didn’t see in myself. So those were really pivotal persons in my career.

Renee DeSilva 4:34
So let’s pause on that mentorship and sponsorship concept, and I think there’s a distinction between the two. Can you elaborate on that? How have sponsors in particular shown up for you or across your career?

Roxanna Gapstur 4:45
Yeah, I’ve been very lucky in my career to have a number of especially strong women leaders who were willing to sponsor me in a couple of different organizations that I was in and I see the difference there as being a sponsor being someone who will rule We put themselves out there for you who will advocate for you to try different roles in an organization or even to kind of push you forward on something that you might not have tried yourself. And luckily for me, I had some of those sponsors. And they made all the difference both in helping me gain confidence in what I could do as a leader, but in sort of giving me those opportunities in venues and in front of individual senior leaders that I might not have otherwise had.

Renee DeSilva 5:26
I love that. I talk about that ladder concept of pushing you forward, even when you may not have seen that potential yourself. It’s the power of the nudge, in a well-timed prompts from people who see your guests and just encouraging you to step out of your comfort zone. I think a lot about, how do I continue to do that for people around me? As I’m sure you do as well.

Roxanna Gapstur 5:45
Yeah, absolutely. It’s so important. So important.

Renee DeSilva 5:49
So you joined WellSpan Health in January of 2019. Maybe for those that may be less familiar with the organization, can you describe WellSpan broad brush?

Roxanna Gapstur 5:58
Sure, yes. WellSpan helps an integrated delivery system in south central Pennsylvania, we serve eight different counties, because we also serve a little bit of Northern Maryland, about 20,000 employees, almost 2,000 employed providers now 220 locations, eight hospitals. So growing organization, a larger organization and exciting for us, our current strategy and mission is to really reimagine healthcare through the delivery of value-based care. And so with that strategy, we have a position of ABP provider network of 2,600 providers helping us provide the best quality and safety, the best care in our region. And we have about 200,000 patients and members in our health plan products and risk arrangements now. So it’s an exciting time for us. As you know, we’ve all been dealing with the pandemic, but we’ve been growing and we’ve been evolving to become more of a platform and to be more of a health resource, I guess, for all of the people in our communities.

Renee DeSilva 6:56
Excellent. I know that a big part of your roots, maybe starting from your nursing career is around care delivery at the core and patient experience. And a part of that has really been just having a line of sight into reimagining the patient experience as a key strategic imperative for the organization. How have you thought about bringing that to life for your team members?

Roxanna Gapstur 7:20
Well, we’re doing lots of work on that in our innovation center right now Renee, so we sort of see experience and access as two sides of the same coin. Part of our brand promise here at WellSpan is that we’re going to differentiate ourselves on experience and access, which is really imperative for growth, as you know. So using more innovative methods and technologies, really looking at our consumer research and segmentation and looking at the patient experience from the consumers point of view is something that we’ve been really deep into kind of that relentless pursuit of the consumer and their experience. So we think that’s really relevant for the future health systems of tomorrow. And again, we think we can differentiate from our competitors on those aspects.

Renee DeSilva 8:07
I love that, the relentless pursuit of consumer— Say that one more time for me. Relentless pursuit…

Roxanna Gapstur 8:08
…of consumer, both experience and access, from the consumer point of view. So I sometimes think what consumers see as access and experience are maybe a bit different than what healthcare professionals see as patient experience and accents. And we can see it from our own point of view, but I think it really requires us to work deeply with consumers to totally understand that from their perspective.

Renee DeSilva 8:38
That’s right. So part of that is certainly the four walls of the organization of the health system, but I know that you’ve also been thinking about that through the lens of WellSpan hospital at home. Was the initial prompt for that just response to managing the pandemic?

Roxanna Gapstur 8:58
We had been talking about it just before the pandemic, Renee and we were starting to put some pieces in place. And then of course, the pandemic really accelerated our work there. Because we want to provide the right care at the right place at the right time. That’s part of our value-based promise. But really making sure that the home as the place for care is convenient and cost-effective, was sort of an imperative to free up hospital beds really during the pandemic. And so we’ve seen over 800 patients narrow either hospital at Home program, we have all kinds of different, you know, technology, including remote monitoring and video visits which assist us with that care. But it has been a fantastic success here. Not only has it helped us with the pandemic, but he has provided an experience for our patients and consumers here in south central Pennsylvania that they absolutely love. I mean, who wouldn’t rather be calm and they’re on the bed receiving care if they had pneumonia that could be in the hospital.

Renee DeSilva 9:53
Agree. I was gonna ask you, as you sort of prioritized where to apply that that way of delivering care, you mentioned pneumonia. What are some other examples of where that’s been pretty well received?

Roxanna Gapstur 10:05
Yeah, certainly. Like I said, pneumonia and things like asthma and chronic obstructive pulmonary disease, heart failure. Those are some of the most common diagnoses that we see in our hospital-at-home program.

Renee DeSilva 10:16
That’s fantastic. So another place where I feel like you as an organization have really leaned into is just the way that you think about technology to reimagine the patient experience. Maybe in some ways, too, the caregiver/provider experience. Talk a bit about just how you’ve approached that.

Roxanna Gapstur 10:38
We are so fortunate here at WellSpan that our chief information officer is also a physician, a practicing physician, and his ability to think through the care pathway and the actual experience of the patient and how technology people and process can impact that is really amazing. It’s definitely a talent that he has. And not everyone can think about how do I do my work differently? Or how do I use technology to enhance my work. So some of the things that we’ve done here are certainly in our imaging area where we are using something called ADOC, which is artificial intelligence that actually reads scans, but also prioritizes scans for the radiologist quickly. So when you come in as a radiologist to do your readings, you’re seeing a list of scans that the ADOC program has said, Hey, these are the scans you should look at first. So instead of having 30 scans in front of you got a really a prioritized list, which has been fantastic and the ADOC program has actually picked up some things that our radiologists didn’t pick up. So that has been incredibly important to and has impacted patient outcomes. So that’s one way we use technology. Another way is actually voice-recognition software, which is a product from Nuance that we are using with our primary care physicians. It’s an incredible voice-activated technology that really listens to the office visit allows the physician and the patient to talk to each other in real time and really pay attention to each other, it creates the options for our physicians to not be on the computer while they’re interacting with the patient. And then as they come out of the room, they just hit the stop button. And within an hour or so they have a written note that is really, truly as good as anything that they could have done themselves if they had been typing on a computer, we actually have cut documentation time for our providers by almost 50%. And over 80% of our providers and patients have said that it improved the overall care experience tremendously, where patients are feeling like the physicians really paying attention to me, and physicians are feeling like oh my gosh, I can really pay attention to the patient, I don’t have to be on her computer. So we’re expanding that voice recognition technology across our entire primary care network this year. And we’re so excited about what that can do for both the patient experience but also for provider burnout.

Renee DeSilva 13:00
Yeah, I love that example. A lot of times to unlock the patient experience it does come down to it’s an inside-out job in some ways, right? Like you’ve got to start with your caregivers find ways to free them up, give them the capacity to go back to finding joy and meaning and work. And I think these two examples that you mentioned are really good examples of that. Is there typically any initial work to be done to get buy-in from frontline clinical staff? Or how have you approached that?

Roxanna Gapstur 13:32
We did a pilot for about a year or so with around 100 of our providers, Renee, and we use the learnings from that pilot to help us with a specific training and then with at the elbow support for our providers as they move into the DAX, or software. And that has been that has worked really, really well. There have been only a few of our positions, not many who have just found it too difficult to change their workflows that because certainly, technology does involve sometimes changing our workflows or trying to enhance our workflows. But for the most part, over 95% of our providers have figured out how to use the software, and really believe that it adds value to their practice.

Renee DeSilva 14:15
Carrying on from there, I’m just struck by—as I’m talking to your colleagues across the country—this notion of, how do we think about building external partnerships in a way that allow us to sort of leverage capacity and extend ourselves? And so maybe just your reflections on how you’ve thought about partnership? What makes for a good partner? Just broadly, and not just specific to imaging and voice recognition software, but just generally. How have you thought about partnership as a key part of achieving the strategy of the organization?

Roxanna Gapstur 14:48
Yeah, well, I think all of us in healthcare realize that things are changing rapidly. And we need to consider what things will be our core business and that we can really be good at and what things do We need to have a partner that can really enhance that strategy. So we think about partnerships really broadly. And whether they align with our values, our mission, a vision for the organization, and whether they help bring new capabilities to the table that can help us bring those big ideas to life. And so some of those partnerships include things like within our innovation structure, partnerships, like the DAX example that I just gave, where they certainly have an aligned mission to assist providers with improving both documentation, but decreasing the administrative work for physicians. And so I think when we have those kinds of partnerships that align with our values and help us solve a problem and bring new capabilities to the table, we can give the very best of what we need and what we can uniquely do for our patients.

Renee DeSilva 15:50
And let me ask that question. As you think about how your organization can also be a good partner, how have you thought about sort of building that partnership mindset DNA from a WellSpan perspective?

Roxanna Gapstur 16:05
Yeah, that’s really a great question. Well, one of the things we’ve thought about is, if we’re expecting partners to align with our values, what are their values? And how do we align with those. And then as we’re using technologies like DAX, or like a back, are we able to help or assist those companies with developing their product, with enhancing workflows with understanding how it actually works in a health system. And we’ve done that with a number of companies now across WellSpan, where we’ve found value in their products and in the things that they can do for our patients that I think that we’ve also helped them work out the bugs on their products, and also enhance their ability to communicate to others how the value proposition for their, their software or their digital technology.

Renee DeSilva 16:55
I love that. One of the things that I’ve been encouraged by as I’ve spanned across the folks that I chat with is one of the byproducts of the pandemic response for providers has been this command center-like mentality where what may have taken years is down to months. I’m seeing that play out and just the ease of decision making in how providers are trying to move more quickly. And I think some of what you’re talking about goes to that ethic of, can we move faster in parallel to get things done more quickly?

Roxanna Gapstur 17:25
Yeah, absolutely. I don’t think there’s anything like a pandemic to help you be more agile and flexible.

Renee DeSilva 17:33
I want to change gears a bit. So we noted at the start of our conversation that your background is in nursing. And I get the pleasure of meeting with so many fabulous nurse executives across healthcare. What’s striking to me is that 76% of our healthcare workforce are female. 87% of nurses are also female, but women represent just about 50% of CEOs. And so the question when I’m sitting in these rooms with fabulous nurse leaders as why are we not seeing more CEOs who come from a nursing background?

Roxanna Gapstur 18:06
Oh, that’s a great question. As you noted, Renee, only 15% of our industry CEOs are nurses. And I think there’s probably a variety of reasons for that, one of those is that females don’t make up very, a very large percentage of CEOs. So there, there’s a gender piece to that. But I also believe that, when you think about how clinical people are trained, our training process and our education don’t really set us up for the expectation that, hey, you could lead an entire health system in the future, it’s really setting us up to care for patients and families in the best possible way, either in a hospital in a clinic setting in research in home care. So I think it’s a little bit the training too because if you think about how folks who go to an MHA program or an MBA program, think about what role they’ll take after graduating from school, they really do have kind of, I think more of an expectation that they’ll be in leadership or that they’ll be leading in some way in a health system. So I think there’s a bit of that, that framework to that really hasn’t been there in healthcare clinical programs.

Renee DeSilva 19:17
I think that’s right. I wonder how your clinical background shows up in your day-to-day health system leadership. Just talk more about that a bit.

Roxanna Gapstur 19:30
Yeah, well, I’m constantly using my clinical background, even sometimes without realizing. I have this sort of understanding of what patients experience what that therapeutic relationship is like with a healthcare professional, what quality and safety looks like on the front line, that probably some of my business counterparts don’t have that same perspective or that same lens that they can look through. And I think those lenses greatly affect how I look at everything. from both the financial performance of the organization to the productivity to the skill sets that we need in the future to career development, so I would say that it’s just a constant kind of lens that I use. And as I said, sometimes maybe without even realizing it to make decisions.

Renee DeSilva 20:16
I agree with that. I also just note that I think nursing right now is sort of, in some ways, feeling like they have more of a seat at the table. And it’s probably driven by how challenging the workforce challenges have been, both in staffing and trying to manage labor expense. The fact that 60% of the total cost of running the health system is in labor, and in nursing is such a big part of that. So I am seeing this, this shift in sort of mindset, and also just elevation of the chief physician, sorry, the Chief Nurse executive position. And so it’ll be interesting to see how that plays out across the next couple of years especially, there’s certainly a generational shift happening among health system CEO roles. And so it’ll be I’m watching with an open mind to sort of see how that plays out.

Roxanna Gapstur 21:05
Yeah, I agree with you. I think that’s going to be really fascinating as well. And I think what we’ve seen over the last 10 or 15 years is that there are more and more clinical people, both physicians and nurses and others moving into health system leadership roles. And certainly that fits so well for us at WellSpan with our value-based philosophy, because we’re really looking at the triple aim in terms of what we’d like to try and accomplish. So I agree to that. I think there’ll be more and more medical people that continue to surface and lead health systems into the future.

Renee DeSilva 21:37
Okay, great. So then maybe just zooming out a bit. As you think through the developing next gen next-generation leaders within your own team, what are some ways that you think about building those pathways to executive leadership?

Roxanna Gapstur 21:51
Yeah, that’s a really great question. We’re actually redesigning right now and taking a step back with a workforce shortage to sort of examine, have our old approaches been, are we thinking through all the complexities of what we are going to be facing in the future. And so we have a number of ways that we are building pathways to executive leadership for people within our organization, but then also trying to entice people to come to our organization. One is our leadership academies that we have for nurses, physicians and high-potential leaders. And we have a special track there for minority leaders as well, that Leadership Academy is something where we really are examining and assessing people that identify whether they are high potential is competitive to get in. And but then it is an 18-month program that where people really have an opportunity to both shadow and develop their own career path within Bob’s banner. It’s a really neat program. And we also monitor metrics on that program so that we can identify did those people actually go on to become leaders and WellSpan? What happened to them one, two, three years down the road? How can we continually improve that program? So that’s one of the ways along with, of course, an entire organizational learning and development program where there are all kinds of career pathways and classes and courses that people can take here to advance, we have to have formal mentorship programs and coaching programs to help people move towards their career goal.

Renee DeSilva 23:19
It’s been interesting on that front, and we’re spending some time on this in our CEO programming plan for July. But this concept of I think the way that the workforce, imagines their compact with their employers has shifted, and this concept of—we’ll talk more about this—but am I net better off in the place that I’m working and how, as employers, we need to continually think through really what motivates and drives loyalty to the work and I think you’re onto something in terms of the investment feeling see, really recognize the investment in Korea Palace to be really important way for people to feel like they are really willing to spend five, 10 plus year career path at one place. It’s interesting to see how all those shifts are happening.

Roxanna Gapstur 24:05
Yeah, it has been—as you know, Renee—a really particularly challenging time. And I also think it’s an opportunity for us to step up our game to great.

Renee DeSilva 24:15
So Roxanna, my final question that I asked all of my guests is the following. If you could invite two people to a table that you curate, which two people would you invite and why?

Roxanna Gapstur 24:27
This was a fun one to think about, Renee. So the first person I would invite was Lord St. Gail, because I think she was really a keen observer. She was also a scientist, and I can’t think of anyone better during a pandemic to really be thinking about generating hypotheses, testing them. She was a leader. She wasn’t afraid to bring her ideas forward even when they were almost unknown or really not thought to be something that should be brought forward by a nurse. So I appreciated her courage and also her scientists. thinking so she would be one. The second light I think about is Clayton Christensen and his theory of disruptive innovation. I feel like that’s never been more relevant than today for healthcare. And not even necessarily those breakthrough innovations, but rather thinking about innovation the way he did, which is that products need to be accessible and affordable to a large population of people in order for them to be successful. So I love Clayton. I love his theories. And I think he’s definitely one of the role models for innovation.

Renee DeSilva 25:30
Indeed. That’s a great place to land. Thank you for joining me this afternoon. I’ve enjoyed our chat.

Roxanna Gapstur 25:34
Thank you. Rene was delighted to be here. Thank you.

Renee DeSilva 25:37
Thanks again for joining me at the table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website, TheAcademyTable.com, or by subscribing on the podcast platform of your choice, and if you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at renee@hmacademy.com. I look forward to talking with you soon.