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This is Laura Ddo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Cliff Neen,
chief Executive Officer of University Hospital's Health System in Cleveland. Dr.
McAllen, it's a pleasure to have you on the podcast today.
It's a pleasure to be here. Thank you.
Now, I know we have a lot to talk about.
There's so much happening in healthcare right now and,
and really a space for a lot of innovation and exciting things too.
But before we dive into my questions,
can you tell us a little bit more about yourself and your background?
Sure. It's a pleasure. You know, uh, I trained as a physician, um,
at the University of Michigan. Got my MD there. And, uh, to be honest with you,
never really, uh, had designs on, uh, administrative role in my life.
My whole goal was to be a, a, a competent and, uh,
maybe a meaningful surgeon who, uh, is helpful to the field that I chose.
I went into otolaryngology, which is ear, nose and throat,
and I did my residency actually here at the hospital, uh, back in,
started in 1988. Um, and, um, after I finished,
I was fortunate enough to get a fellowship in Boston in what's called Neuro
Otologic Surgery. And when I was there, I was really, um,
surrounded by a lot of leaders in my field,
and I really got the bug of wanting to get involved in,
in leadership and medicine. But, um, my,
my vision was maybe one day becoming a chairman of a department.
And so I ultimately, uh, started my career,
but then returned back to Cleveland about 21 years ago with the goal of
building, um, the Cochlear Implant Program, and then later became chair.
And it was really during the time I was chairman of the department here at, uh,
in case Western Reserve,
that I really found a bug of realizing that,
um, if you run your organization at the time, it was simply our department,
our small department, well, you can better serve your patients.
And to do so, I had to study lot of business principles and, um,
I did not plan for this. But in a few years into my chairmanship, uh,
the CEO at the time, uh,
Tom Zny asked me to be the president of the physician group.
And that was very serendipitous because to run that group,
which eventually became 2,500 employed physicians,
I was really overseeing a large e l uh, a large business. In other words,
I was fully responsible for the profit loss, uh, of that business.
And I was think, I think through that experience,
which really went from 2014 to 2019, I, um,
started to see the bigger aspects of the responsibility of leadership of
a hospital system,
which includes everything from creating a culture or a strategic plan.
And, um, ultimately, although I never really planned on it happening, I,
um, I was selected, uh, to be CEO at the end of 2019.
And so it's been a really a,
a three year journey of taking an unbelievably powerful brand in
this region and a historically important organization,
nearly 160 years old that has had decades,
really century or and a half of success. And, um,
having inherited the responsibilities for the period of time that I'm here
to, uh, take it, uh, to the next level. And, um, I've been very,
very fortunate in being able to have a number of fantastic
teammates, both in the clinical leadership, senior leadership,
and the board that came together with me and helped me, frankly,
create a strategic plan and vision that was in line with
the needs of the emerging healthcare economy.
So again, I think that,
that interesting is I never started my career with the goal of becoming a ceo,
uh, of a healthcare organization. Um, I'm a surgeon by training, and, um,
I fell into it by a series of serendipitous events, but I'm very happy I'm here.
That's such a fascinating story,
and definitely to see how far you've come and then to take over as c e o in
2019, right before the pandemic and everything that's happened over the last few
years, what an amazing time to be leading the organization and really, uh,
being focused on, you know, uh,
trying to treat patients and lead through this time.
And then now I know digital transformation is a huge part of what you're doing
as well.
Right? Absolutely, absolutely. You know,
if you think about digital transformation,
obviously it's something that you don't just choose to do, you have to do.
And in the end of the day, to me, and I think to our team,
what digital transformation really entails is
the notion of using the most advanced tools to make it easy
as possible for your patients to seek care,
continue receiving care, and to get care in the right place and time.
In other words,
moving from the phone call and having to touch
a number of different people in different departments to get an appointment,
at least on the access side. And, uh, we're doing that really with, um,
our transition to Epic, but the latest possible,
most sophisticated version of Epic, uh, that we're installing, uh,
to help us with that. But we're also using, um,
AI technology bot technology with the agile scheduling solutions
that allow us to predict demand in, in,
in staff accordingly, not only in our clinics, uh,
our ambulatory surgery centers and our,
in our inpatient acute care service sites. And, and we use, uh,
partnerships with Agility, which is a great company with Epic,
but we also have a tremendous amount of homegrown brilliant people
in our innovations department helping us.
Everything from workforce management, digitizing HR functions, uh,
we work with Axo Wall, uh,
that helps us and is gonna help us streamline credentialing.
We have stepped up and optimized our virtual telehealth,
uh, capacities, not only with our ambulatory visits, but even in our, uh,
urgent care program.
And now we're partnering with WellCare to stand up 36 urgent care sites.
And obviously we even use AI to optimize patient experience wait times in the
er.
But really where the rubber meets the road is in using, uh,
digital mechanisms and, uh, artificial intelligence technologies,
for example, like temp, temp track, um,
it's a continuous temper mon temp temperature monitoring patches that
enable us to predict up to eight hours earlier than current
standards of care to detect when someone may be having an infection or worse,
um, moving along the path to sepsis.
And this has really important implications and has shown great benefit,
for example, in our bone marrow transplant patients. So the notion of a digital,
um, transformation is multifactorial.
It should involve your patient access, your throughput,
your scheduling, your flow.
It should also touch your workforce management as it relates to understanding
load balancing. You know, we have 21 hospitals,
50 major medical office buildings in over 300 practice sites,
and this allows us to load balance throughout the system,
whether it's intensive care, but using these digital strategies.
But finally,
I think where the real value is gonna be as it relates to digital strategies and
artificial intelligence, which obviously is a digital strategy,
is being able to be predictive in patient care,
not only in the acute setting, like I mentioned with temp track,
but also in population health. You know,
we touch about 1.6 million individual patients a year,
and we have one of the largest primary care networks. And really the,
the value is preventing disease
and to be able to have digital technologies that are warming their
ways through our EMR in helping our primary care doctors and
our population health teams predict where patients could potentially
be vulnerable to a test that's not done,
or a screening mammography that should have been done and hasn't been done,
and or technology that allow us to see if we have a new patient with a
particular set of conditions,
what's the most beneficial pathway for that patient,
even using genomic background.
So I think the notion of digital transformation is really multifactorial.
Absolutely. I,
I love that kind of overview of all the different initiatives that you're doing
at university hospitals. I think, you know,
it's so fascinating to look at how the digital technologies really have advanced
so far in the last two years,
especially from the virtual care to how it's being used on the operational side
of the health system and the data that you can collect. And,
and I love the idea of getting more predictive with it,
and that's certainly a jersey journey as well. Um, when you think about the,
the predictive nature in moving in that direction,
what have been some of the challenges in doing that? And, and, uh, you know,
how far are you, I guess, on your journal of be becoming more predictive in, in,
where are you headed in the future?
Well, I think there's, there's, there's always the big one, right? The big,
if you will,
obstacle of making any sort of change is the normal human tendencies
to at times resist change, uh, because it's something new.
And you know, there's this old book that is that,
that I think you probably remember, it's called Who Moved My Cheese.
And the human tendency of just doing something different,
even if it intellectually or academically is improving to be better
outcome, there is still the training, the adoption,
the buy-in of whatever constituency is
going to do something different. So that's number one, right? And that has to,
that has to do with culture.
And can your culture allow for swift implementation
of positive change and get through the notion that someone has to do something
different than they're used to doing? So that's always number one.
That's why a culture is very, very important.
I think the second is always cost, but if your organization is picking,
looking at the big picture and looking at the notion
that increased safety, improved outcomes,
ultimately will provide value, and you are a value provider and your
contracts allow for provisions for, uh, rewarding,
if you will value attainment,
then you could do the math to justify some of these investments.
Um, I think, you know, those are the big things.
And ultimately where you really want to get to the point, in my opinion,
is to the point which I think we're getting there,
where these ideas about innovative digital strategy and
sometimes not even digital, just process change,
is not coming from the top down.
It's bubbling up from the individual constituencies.
So we have so many different teams that are creating
their own solutions because we've adopted a culture of welcoming
change in a speak up culture where people are allowed to give ideas.
So I think that's really where you want to get to because if you want
senior leadership to be the only driver
of change as it relates to whatever strategy,
but let's talk about digital transformation and, and innovative, uh,
artificial intelligence, uh, transformations,
you're never gonna get as far as you can.
You need a group of people running with you to get far.
And that's what I'm so proud of is, is our teams,
we get ideation and positive momentum out of all of our
service lines now because we encourage them to think differently.
That's amazing.
I love that philosophy and certainly seems to be working really well at, uh,
so that, thank you for laying that out for us. Now,
I know we've talked a little bit about the workforce shortages and challenges
which are significant for health systems across the country, um, and,
and really industries, uh, beyond healthcare as well.
So what are you doing at, um, university hospitals to boost your workforce?
How do you think about that, uh, for what you're able to do now and then,
you know, growth in the future?
You know, this is a question that I've thought a lot about, of, a lot about,
and, um, and we've thought a lot about and, and, and I'll give you,
uh, three answers and then I could elaborate.
What are we doing about workforce shortage? The three answers are, number one,
keeping the workers. We have,
that's the most important part of anybody's workforce strategy
today based on the escalation of turnover rates.
And I'll get into how we're doing that.
Number two is to increase your pipeline.
In other words, realize that this is not going away. For example, in nursing,
we have 1.5 million nurses short in the United States,
and that's predicted to grow.
So you have to figure out how to increase your pipeline.
We're fortunate enough in Cleveland and northeast Ohio to have nearly 30 nursing
schools.
So we are working with each of 'em with a separate strategy to help
them grow their classes,
but also help them by providing clerkship training opportunities that we hope
if they have a good experience at, uh,
will increase the movement of people here.
The third major strategy of dealing with the workforce shortages
is ideating about what is the workforce of tomorrow?
Does it have to mirror today's workforce? In other words,
if you have a particular unit,
let's say that today in the last 30 years has been made up
of one phenotype of a clinical professional,
does that have to go on that way?
Or could it be made up of a team of professionals with people with
different levels of certification who could work together as a team?
So you may not need as many of one particular phenotype,
but you could grow a diverse workforce store modeling that as well.
But let's get back, I think to the first strategy,
which I mentioned as a, as it relates to workforce,
which is keeping the poise that you have. In other words, reducing turnover.
What we're doing here is trying to,
and I think we're being successful cause the numbers are showing,
it is leveraging our university hospitals as a unique culture
and that culture as a differentiator to keep people here.
And also for option two,
drive more people to work here and really done this through, if you will,
six different ways. Number one,
very clear transparency during good times as well as bad times,
not hiding facts, being completely transparent through town hall's.
Constant communication by myself and other leaders about what's going on during
covid and they gained trust during the financial challenges of 22.
And now number two,
it involves engaging and connecting with caregivers in ways that are even unique
and clever. So obviously I mentioned town halls,
we've started executive rounding. We have constant entity visits.
We've even started things like book clubs where we,
where I lead a book club every month.
And it's grown people from all walks of life,
from pharmacy to environmental services to the physician staff,
to the nursing staff,
to the accounting staff gather to discuss books,
oftentimes very powerful books.
And they're available online for free through our partnership with, um,
overdrive and Libby, which is a, um, fantastic Cleveland based company that,
uh, digitizes library books. And this has grown into almost a form of a,
uh,
safe space for us to get together with me to discuss very
challenging topics, uh, both in life and healthcare.
These sort of cultural things I think are helpful. Number three,
we encourage a speak up culture. We reward people for coming up with new ideas.
We encourage people to constructively criticize
the organization or what we're doing to see if there's a better way.
Number four, we solicit ideas from everyone. For example,
when we were going through a cost reduction strategy last year
and we took out nearly 350 million out of our 5.6 billion budget,
which we had to, to lower our cost structure,
we solicited ideas from the entire 32,000 employees.
We called it the Value ideas prize competition.
And we elicited nearly 600 ideas from people in all walks of life in the
organization and gave prizes, uh, cash prizes, um,
if they would lead to a meaningful
improvement in process cost savings and or safety improvement. Number five,
we have a very vigorous program of recognition.
We have what's called the cliff appreciates where I have coffee, uh,
and it's videotaped of a hero, we'll call them,
who does something very special,
whether it be delivers kind care and is recognized for that
or has come up with a new solution or has been recognized repeatedly by patients
for their excellence.
We have a dinner with the doc where I take doctors out who've been nominated by
their peers for excellence in professionalism or kindness or
service or many other things.
And these are broadcast and reported.
We do a frontline heroes blog almost every month where we
highlight people who have done special things.
We have a blog from me and many other leaders that comes out every month that
really talks about excellence within our midst at every level, right?
It has to be every level. It cannot be just doctors and nurses.
This goes to valets,
this goes to people who work in, interestingly,
the Leech facility.
We have a bunch of people who do free flaps surgeries,
which is a procedure where you move the body part to another body part to
fill in a defect, a wound defect. Interestingly,
from time to time those free flaps can engorged with blood and we have
to buy leeches. Can you imagine? It's a medieval thing,
but it's standard practice.
We had someone figured out how to make our own leach colony that are sterile
in the pharmacy department, so we have a ready supply.
And that person was one of those heroes
and we're constantly trying to create a sense of belonging.
Going back to recognition,
we have rolling out a new program called Kindness Matters.
One of our major differentiators is an organization and we're noted for is the
brand of care that they deliver,
which is characterized by kindness and compassion,
where the patient feels they're treated as an individual and not as a number.
And that actually has been validated through focus groups.
And now we are rewarding in having leaders in kindness matters.
And we constantly are creating a sense of belonging through a number of
initiatives including diversity, equity, and belonging, and, um, employee, uh,
resource groups around different groups of employees who have different
interests and shared interests. And this takes a lot of work,
but it is paying off cuz as you may or may not know,
Forbes Magazine just recognized us as the top workplace for a hospital our
second year in a row in Ohio. And I don't think those are coincidences.
We also have workforce development programs where we have a step up to, uh,
program where recruit in parts of our city and our communities that are
chronically underemployed and unemployed for workforce
readiness coaching. And we've gotten grants for this as well.
We do job specific training, they get entry level jobs at, uh,
and then we create tuition reimbursement to help 'em create their careers.
Here at, uh,
we have earned and learned apprenticeship programs for in-demand positions.
We have pathway programs for, uh,
non-degree to non-credentialed employees work who are being paid less than a
certain amount an hour.
And we provide coaching and career management to get them into the next level
job. We have a program called Bridge Your Future and College Readiness,
where we help try to encourage people to take our tuition
reimbursement and go on to a college and higher level degree so they can come
back as long as they stay at, uh, for our physicians.
We've created the, uh, health Scholars program,
which is where we go into the high schools and we've created a five year
educational opportunity for underrepresented minority Cleveland area high school
students and get them into STEM programs where we actually help
coach them and mentor them with a goal of
allowing them to be competitive for great colleges,
but also with an emphasis on creating the future doctors and nurses of tomorrow.
And this has been highly successful.
We just graduated our first class last year of the,
from high school and of the 18 students graduating,
all 17 of them were accepted to college and have gone to college.
The one took a year off to do a gap year because that person wanted to go do a,
uh, a particular college which required a gap year.
So through these programs, through these programs,
step up lake programs,
we've hired or promoted nearly 300 new caregivers in 2022 with an
88% retention rate in the first year. Which as you know, around the country,
retention rates in the first year in some cases are less than 50%.
So we think this is very successful.
That's amazing. Wow. What a, what a great program and certainly something that,
um, you know, I can imagine is really motivating.
I I know you went through several different action items here in terms of what
really makes, uh, a great workplace and something that, um, you know,
is is is just a place where they can, like you said, feel like they belong and,
um, share their ideas and are recognized for the great ideas that they have.
And so, you know,
it's very inspiring to hear everything that you're doing and you know,
from your perspective. Um,
I know you talked just your last example in particular about the education kind
of growing and measuring how successful people are. You know, when you look at,
uh, some of the different initiatives that you have in ways that you're really
improving the culture and, um,
making u a a a better place and better experience for patients as well.
How do you really look at that? You know,
is there a way that you measure success of,
of those initiative tips more broadly or,
or really just look at the feedback that you're getting and the engagement that
you get with from your team, um, you know, to, to really move the needle?
You know, that's a great question. I think you have to look at both. Uh,
I don't think you would,
we would be honest with ourselves if we just felt the love and the
happiness and the accolades of the success of the program,
you have to measure it. And I, so for example, we,
we look at our, obviously if we're doing all these things,
we better see that our job fill rate is trending positive.
And the good news in Q 1 20 23, it's very, very positive.
Our total external fills are up 10% over last year.
Our RN nursing job fills are up 37% over
last year. Our turnover rate has dropped significantly,
uh, both in overall turnover rate in first year to turnover rate.
And I think the thing that the audience would be interested in,
which was a challenge that beel beel all of us last year,
is our agency count.
An estimated spend has dropped close to 50% in
terms of spend from last year, month to month.
So that I think is very, very important. You have to measure it.
And the good news is,
if you were doing all those things and nothing was changing,
I think that you'd have to question the validity of it.
But the good news is it's working,
but I don't think we should measure as a large academic health system
only, um,
in only staffing physicians positions.
We also have to look at really the, the, um,
the clinicians as well, the department chairs, scientists,
and we've been able to recruit and retain absolute clinical and research
superstars, uh, including MDs and PhDs
when we have openings or when we have a retirement, um,
in pathology, urology, surgery, medicine,
radiology, pediatrics, radiation oncology, psychiatry, biochemistry,
cancer immunology. We've recently, you know, had, uh,
a need based on a movement of one of our leaders in, uh, hematology oncology.
We were able to recruit one of the nation superstars from Columbia University.
We were searching for a new chief of, uh,
transplant surgery and we were able to recruit an incredible leader.
Zoe Stewart, uh,
from NYU is one of the leading leaders in the solid organ transplantation.
So I feel very good that in all levels we're able to, uh,
recruit, uh, really rock stars and we really have an eye toward diversity in,
uh, as well and making sure that we are, uh,
attracting, uh, diverse candidates of, uh, both gender,
uh, race. And, uh, we are, uh,
tracking very well in that regard. There's a couple of accolades. You know,
I mentioned one of them, certainly, uh, the Forbes best large employer, uh,
for hospital, uh, one of the top in the country, uh, but certainly best in Ohio.
Uh, we won, uh, this year, uh, fortunes, uh, one of the, uh,
innovation awards.
We were ranked number one for innovation culture
among health systems in Ohio.
We recently won, um,
the award for the best online reputation, uh, in the state.
And I think number 17 in the nation and, um,
atmosphere, which I think goes to the culture.
It's our 11th year in a row as being one of America's most ethical companies.
And I think you have to play that game because you could feel really good about
what you're doing,
but if you don't have external validation that you really are distinguishing
yourself, um, then you may not be as good as you think.
And I'm not saying we're where we need to be, we need to be better every day.
Absolutely. That's such a great point. And you know, I,
I really just appreciate you talking through the things that you're doing to
become a great workplace and of innovative workplace that's so impressive. Um,
but then too, you know, ethical and, you know,
workplace with the culture of diversity, equity, and inclusion as well, um,
is just, is really, really amazing to see how that could, um,
be effective and, and, uh, know that your culture is so ingrained, um,
or that's so ingrained in your culture because like you said, you know,
internally you can look and move in any way that you feel, but, um,
to have that external validation is really, really, um, impressive.
And I think though I have to add, you know, modern healthcare, uh,
the last two years has selected us as one of the top 10
hospital systems in the US as it relates to diversity, equity,
and inclusion as it relates to the diversity in our, uh, our staff,
our senior leadership in our board. So last two years, you can look it up,
we were, uh, in the top 10.
Wow, that's amazing. Um, so, such a, so impressive.
And to really have that as an intentional goal of yours, um, you know,
is awesome to see and something that I know a lot of other organizations aspire
to. So, um, that, that's really great. Now, you know, before we wrap up here,
and I know we've, uh, had you here for a while, so I appreciate your time,
right. What are, what are your big, uh,
opportunities for growth over the next two to three years here?
Well, you know, I, I think that it, it,
it really falls around the notion of combining our four major differentiators,
specifically being an organization whose brand of care is kindness and
compassion, coupled with being a value maximizer, uh,
coupled with the third being a leader in scientific discovery and
a beacon of hope for patients.
But the fourth being a partner with all of our communities and being the
hometown team. But I, I think the growth, uh,
that we expect to see are, uh, that are already beginning,
are in our centers of excellence,
where we have really developed bundles and carve outs for excellent care in a
variety of different, uh, venues and sometimes direct to employer, um,
be being perceived by insurance companies as a value maximizer and
creating more and more narrow network, uh,
programs and preventive care is very important.
Growing the excellence of our cancer center,
which is one of the top in the nation, uh,
with particular attention to immunotherapy and, um, CAR T-cell therapy,
which has, has grown, uh, significantly are, um,
very innovative high-end surgical programs,
particularly around heart and vascular neurosciences,
transplant, cancer, surgery,
and specifically in our relationship, uh,
with the NFL and the Cleveland Browns as becoming, um,
really the market leader in sports medicine. Um, and we're seeing,
uh, all those things, uh, come to fruition.
Got it. Yeah. Yeah, I think a lot of exciting things on the board and,
and definitely, um, you know,
looking forward to seeing them grow and pan out and, um, hopefully, you know,
everything will just fall into place. So I'm looking forward to that.
And definitely seems like you're making a huge impact on so many people,
whether it's the internal teams and the communities you serve, and then,
you know, through other partnerships, uh, expanding just well beyond the, uh,
Cleveland and Ohio area. So thank you so much Dr.
Mcon for being here on the podcast today.
And thank you as well for speaking at our annual meeting in April. It was just,
you know, so much fun to have you there and, uh, really learn from you.
Thank you. It's always a pleasure to work with you and, and, and with Beckers,
and I look forward to more opportunities.