Leadership Dialogue Series: The Dynamic Work of Boards With Saint Luke’s Health System

00;00;00;25 - 00;00;31;29
Tom Haederle
Hospitals and health systems have navigated some pretty choppy waters over the past several years. Most are not anchored in a safe harbor even now. The many pressures squeezing health care providers - finances, workforce retention, supply chain issues - have all served to make the role of hospital trustee or governing board member more challenging than ever. Hospital boards have accurately been described as the North Saintar in hospital operations, charged with making sure that quality metrics are met and that strategic priorities guide the mission.

00;00;32;02 - 00;01;11;25
Tom Haederle
Not an easy lift. But it is doable. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. On this leadership dialog series podcast, John Haupert, AHA’s board chair and president and CEO of Grady Health, is in dialog with Greg Bentz, board chair of Saint Luke's Health System in Kansas City, Missouri, and also the current chair of AHA’s Committee on Governance.

00;01;11;28 - 00;01;34;16
Tom Haederle
Saint Luke's Health System is big. It includes 14 hospitals and campuses across the Kansas City region and offers home care, hospice and behavioral health care, dozens of physician practices, a life care senior living community and more. Providing effective board oversight is a daily challenge and as Bentz says "it feels like the past three years have been a pretty intense time in the governance world.

00;01;34;23 - 00;01;42;07
Tom Haederle
The margin of error feels like it's pretty thin, so we focused our efforts very intently on governance."

00;01;42;09 - 00;02;30;26
John Haupert
Good afternoon and thank you everyone for joining me today for another leadership dialog session. I'm John Haupert, president and CEO of Grady Health System in Atlanta and board chair of the American Hospital Association. I am looking forward to our conversation today as we take a look at the important role of hospital and health system governance. Hospital trustees have been an important part and do an important job as they work to foster a positive and productive culture within their organization, ensure their hospitals are meeting high quality and patient focused performance metrics and act as a North Saintar in always ensuring that strategic priorities guide the mission by providing needed medical care, as well as supporting the broader

00;02;30;26 - 00;02;58;02
John Haupert
health and wellness of the communities they serve. Here at Grady, it's been fun to see the evolution of our board of directors. It's a 17-member board, so it's manageable. It meets quarterly, which I think is appropriate. But as many hospital boards experience, oftentimes the board members are already very familiar with things like financial acumen and the performance on customer service.

00;02;58;04 - 00;03;20;17
John Haupert
But sometimes they struggle to understand what is good quality and what does quality mean. So we've invested a lot of time in educating our board around where we are, where we're positioned and providing high quality care. But what should the goal be and what does that look like? And so for us, that's been a big focus. So today I want to introduce Greg Bentz.

00;03;20;18 - 00;04;01;22
John Haupert
Greg spent his days as a trial attorney with Wallace Saunders in Overland Park, Kansas, but he is here with us today in a different capacity, and that is as chair of Saint Luke's Health System, board of directors. The Saint Luke's Health System is a fully integrated regional health system with about 13,000 employees based in Missouri and Kansas. The health system has 13 hospitals ranging from a large tertiary hospital in the middle of Kansas City to metro hospitals outside the city to critical access hospitals, as well as a children's behavioral health hospital and a rehabilitation hospital.

00;04;01;27 - 00;04;30;04
John Haupert
I will say serving as the chair of that board really is extensive, given the broad range of types of facilities that are being served by Saint Luke's. Greg first started his service to Saint Luke's by serving on the board of one of their individual hospitals before being elected to the system Board and becoming chair in 2022. Additionally, Greg also serves as the chair of AHA's Committee on Governance.

00;04;30;07 - 00;04;34;26
John Haupert
So Greg, thank you for joining me today. And we're going to jump in with our first question.

00;04;34;29 - 00;04;36;19
Greg Bentz
Thank you, John.

00;04;36;22 - 00;04;55;04
John Haupert
It goes without saying that hospitals and health systems have faced some tremendous and I mean tremendous challenges these past few years with the pandemic and then grappling with the significant financial pressures that followed. What has that looked like from a governance perspective at Saint Luke's?

00;04;55;06 - 00;05;26;11
Greg Bentz
As we tried to move through COVID and past it, whether we'll ever really be past it remains to be seen. But we really focused everything we were doing on trying to invest in those things that would help us maintain the quality of our care and improve and reshape the efficiency with which we provided that care. It feels like the last three years have been a pretty intense time in the governance world.

00;05;26;14 - 00;06;04;03
Greg Bentz
The margin of error feels like it's pretty thin, and so we've really focused our efforts very intently on governance. Really we've invested primarily in our people and technology. You know, we've had a situation where health care's lost half a million workers in the last few years through burnout and retirement, illness and even sometimes death. And so it's really been critical that we focused on employee retention.

00;06;04;06 - 00;06;35;28
Greg Bentz
We made sure that we tried to keep our team together. We felt like if we could do that, we would be ahead of the game. We've invested a lot of time and effort in retention. We've listened carefully to what our team has been living through these past few years and tried to provide support for them, both technologically and with programs that would provide them both physical and mental support.

00;06;36;01 - 00;07;15;06
Greg Bentz
We've expanded our digital care as part of our investment in technology and that's been very well received by our patients. And so we've really tried to stay with our culture and be transparent with our patients and with the physicians as we try and govern during what the last few years has been a very challenging time. One thing we did change is we went a lot more virtual in our meetings with our boards, and we certainly needed to improve our technology related to that type of access for the board members.

00;07;15;09 - 00;07;36;08
Greg Bentz
As I mentioned, we made significant investments in digital care and also Hospital in Your Home, which is a program that is technologically intensive but has been very well received by the patients and more and more people are signing up for that type of program.

00;07;36;11 - 00;08;02;13
John Haupert
Great. Thank you. That was very good information and I appreciate that greatly. You're a great person to have answering these questions because you served on both a hospital specific board, but then on the broader health system. Which really I know is two different perspectives. In your experience so far and in both of those roles, have you seen changes in the structure or makeup of boards or focus of boards over time?

00;08;02;16 - 00;08;30;17
Greg Bentz
I sure have, John. I think there's been a big shift to the intentionality that it takes to develop a diverse board. I think that has become a higher and higher priority for boards and it's something we should all strive to do. The statistics, though, are still not fabulous. The AHA did a governance survey recently and the results of that are improving.

00;08;30;17 - 00;09;10;26
Greg Bentz
But we still have a situation where over 60% of the board members are over age 50. 80% of them are white and 65% of them are male. But those numbers are all better than they were five years ago. We have started using more out (?). At Saint Luke's we haven't done this, but nationally, more and more boards are reaching out to people from beyond their geographic region and bringing them on to boards to try and bring in diverse views and views that are not necessarily limited by parochial concerns.

00;09;10;29 - 00;09;42;00
Greg Bentz
One other area that is interesting to me is that nurses have been kind of overlooked as potential board members, and we found that having nurses who have their feet on the carpet of the hospital rooms are a great source of information for a board. As you mentioned, we've got a very diverse set of hospitals and delivery systems throughout a large geographic area.

00;09;42;03 - 00;10;11;27
Greg Bentz
And so trying to build a diverse board takes a lot of effort. It takes building relationships and sometimes you have to go out of your comfort zone to do that. But we think it's very important to kind of rebalance the table and make sure that all the communities we serve have a voice on the board so that we can be aware of their concerns and their needs so we can try and serve those as best we can.

00;10;11;29 - 00;10;41;13
Greg Bentz
There's been a effort to build a what we call leadership pipeline so that we can bring people in and educate them about the health system even prior to them being on the board. And then, of course, once they're on the board orientation is critical. There's been a big focus on diversity, equity and inclusion in governance recently, and that's something everybody needs to spend time thinking about.

00;10;41;20 - 00;11;14;23
Greg Bentz
And we do that. Workforce, as you mentioned, quality. I love the true North Saintar. That's a term I use a lot because I really believe that. But we've also been focused on workforce and trying to make sure that their needs are being met. And I actually noticed, or I've recently read some AHA Trustee Services board briefs that were very good on workforce, including physical safety, but also behavioral health support.

00;11;14;26 - 00;11;54;01
John Haupert
You brought up some really great points. And one of the ones that I have thought about often is bringing in someone from beyond your borders. And we did that here at Grady so that we could assure the board that the direction we were heading in from a quality and equity point of view was on target. And so we went outside our market and brought in a chief quality officer from another health system who's really well known to both support us and provide input, but also to assure the board from their position on our quality committee that we were headed in the right direction.

00;11;54;01 - 00;12;20;28
John Haupert
So I'm glad to hear that you see that as a priority. Now, this next one I know has received a little criticism, but we are increasingly hearing criticism of health systems or large health systems with multiple hospitals. And some of the naysayers are saying health systems are not in tune with the needs of the individual communities where they have all of these facilities.

00;12;21;00 - 00;12;39;05
John Haupert
So can you share your insights on how at Saint Luke's and as chair of that board, how are you all balance seeing that system oversight along with assuring that the voice of those very different communities that you serve are heard?

00;12;39;08 - 00;13;14;24
Greg Bentz
It's always a challenge. We've got a system board similar in size to yours with 15 members, but there are also 15 subsidiary boards that are at the entity level. I've been, as you mentioned, on several of those boards. I started on what we call the Plaza Board, which is our tertiary quaternary hospital in the center of Kansas City and served on that board for a while, was also during that time period on the South Board, which is a suburban hospital, and had the opportunity to serve as chair on that.

00;13;14;26 - 00;13;42;21
Greg Bentz
And now, of course, the system board. Five years ago we reorganized our system structure in a drive toward a higher level of systemization, and we've been successful with that and it's been a very strong and positive thing for us. But one of the decisions we made while we were doing that was to retain all of our subsidiary boards.

00;13;42;23 - 00;14;23;07
Greg Bentz
And we felt very strongly that those subsidiary boards provide a great amount of information and advocacy and potentially philanthropy that we really could not go without. So we retain those boards. We think it's important to get tuned in to them and to hear the voice of the communities that we serve. They play a critical role in that. But we also get an opportunity to educate them about what's going on at the national level through AHA information.

00;14;23;13 - 00;14;47;20
Greg Bentz
As you know, Mindy Estes, our CEO, was a chair as you are now, and it was a great source of information for all of us at the system and that the entity levels. We need to explain to them how Saint Luke's fits into the solutions that are necessary for the community and how each entity also fits into those solutions.

00;14;47;22 - 00;15;21;22
Greg Bentz
You know, local boards tend to focus on quality credentialing, financial, local issues, advocacy, those are all super important and they have to share that information with the system so we can build it in. The system boards are faced with a difficult task, and that is prioritization of decisions.And the system board has to take that all in and use it to make these hard allocation issues.

00;15;21;24 - 00;15;53;10
Greg Bentz
And, you know, being part of a system includes the possibility that a decision will not be the best one for an individual hospital, but it is the best one for the system overall. And those are hard decisions, but they're decisions that have to be made at the system level. And we think that it's important for the good of the entire system that they're made with the input from the individual hospitals.

00;15;53;13 - 00;16;15;07
John Haupert
Well, Greg, I really appreciate your answer to that question, because it sounds to me as if Saint Luke's and knowing Mindy and now having met you, you all have done this the right way by maintaining that open communication channel between all of the different entities that fold up under the Saint Luke's umbrella and getting that input from the communities.

00;16;15;07 - 00;16;46;27
John Haupert
And the reality is allocation of resources at a system level is one of the key roles that a system board plays. And so the way you describe that to me really sounds like you all have that one under control and doing well with that. Kind of tying into that, what role do you think board members can play in reputation management for a health system  - serving, as you said - as advocates, being a voice in the community, telling the hospital's story.

00;16;47;00 - 00;16;49;12
John Haupert
What does that look like at Saint Luke's?

00;16;49;14 - 00;17;19;13
Greg Bentz
Yeah, sure, John. We feel like our board members, not only at the system but at all of the entity levels, are our greatest advocates. They are a great source of credibility in the community. They have the ability to go out and explain the how and why of what's going on at the hospital to the community. They also internally provide information to our medical staff.

00;17;19;15 - 00;17;50;11
Greg Bentz
The medical staff is really almost like a community unto itself, and we certainly have doctors who are on our boards so that they can share and educate their colleagues about what's happening at the health system and the individual hospitals and why. They kind of act as educators. All of our board members act as educators in the community and a great source of feedback from the community, which we think is very important.

00;17;50;13 - 00;18;29;28
Greg Bentz
We need to arm our trustees with talking points to let them know what's going on, what information is important for us to share with the community, what information we're looking to get back from the community. The AHA's Seizing the Conversation process is a great example of that. Wonderful program. Actually, the trustee insight piece that goes out monthly in June had a very nice piece on board advocacy and the proper use of board members and advocacy in the community.

00;18;30;00 - 00;18;56;07
Greg Bentz
John, many hospitals are making significant community contributions, but their stories aren't always effectively being told or fully understood. And trustees can do a great job telling the story about what a hospital is doing in the community, its financial contribution, its health care contribution, its social contribution.

00;18;56;10 - 00;19;24;25
John Haupert
Well, that's music to my ears, by the way, because as you know, as chair of the AHA, one of our biggest priorities is getting the true and real story out into the community. As of late, there's been a little bit of hospital and health system bashing, and I think the AHA is doing an incredible job of arming hospitals and health system staff within our facilities with the right information then to go forth and share.

00;19;24;28 - 00;19;50;02
John Haupert
And I'm really pleased to hear you talk that you all are doing that throughout your system. That's just great work. So earlier on, you shared some pretty innovative things with us. Like Hospital at Home and expansion of your digital platform that's already happening at Saint Luke's. But when you look beyond that, are there some innovations or new care models or other things that Saint Luke's Board is focusing on?

00;19;50;05 - 00;20;20;20
Greg Bentz
We are, John. We actually have been working very diligently the last two years on reimagining and reinventing our care model. We realized that the care model was 30, 40, 50 years old and that it really needed a very strong analysis of the pros and cons of it. We worked hard to try and get nurses to be doing the work that they trained for, to be practicing at the top of their license.

00;20;20;23 - 00;20;47;13
Greg Bentz
We found, as we did an analysis of nursing at Saint Luke's, we found that nurses were spending what I would call it inordinate amount of time taking menu selections down, ordering food for patients. That's certainly something that you don't need a nursing degree to do. And so we've gone about hiring additional staff, which is a challenge right now.

00;20;47;13 - 00;21;30;25
Greg Bentz
But trying to remove the burdens that are unnecessarily placed on our nursing staff so that they can spend their time providing health care to the patient rather than doing what I would call more ministerial jobs. One interesting thing that we've tried and it's only been recently is we've actually purchased some robots and we have these robots and they're trained to travel back and forth from the nursing station to the pharmacy so they can go and get the medications and bring them back to the nursing station so the nurses don't have to leave the floor to do that.

00;21;30;28 - 00;21;59;01
Greg Bentz
And not only is it kind of fun to see a robot puttering around the halls, but it we found it's relieved our nurses of time that they can now spend with the patient in a meaningful way. So looking forward, we also are in the middle of the discussion with BJC Healthcare in Saint Louis about joining forces and becoming an integrated health system with them.

00;21;59;04 - 00;22;31;21
Greg Bentz
We have not received regulatory approval yet, but we hope that joinder can occur by the end of the year. And that would give us a large presence on both the west side and the east side of the state of Missouri and in Kansas and Illinois. So we're very excited about that and we hope that that'll go forward. And that will then, of course, cause us to spend a significant amount of time working on integrating the two health systems to become one efficient unit.

00;22;31;24 - 00;22;57;09
Greg Bentz
And then, as you know, I believe our fearless leader, Dr. Estes, is going to take a well-deserved retirement. That's a major issue for us. I mean, Mindy has done unbelievable things from Saint Luke's and as well for the AHA, and I know we're both going to miss her as far as her being retired from us. We're immensely grateful to her

00;22;57;09 - 00;23;14;22
Greg Bentz
and I think the AHA feels the same way. But we're going to have to come up with somebody that can try and fill her ample size shoes. And so those are kind of the biggest things that we're focused on for the coming year or so.

00;23;14;24 - 00;23;42;06
John Haupert
Yeah, Thanks, Greg. That's really great. The comments about looking at the care model and care model redesign is so critical and we have a committee on workforce that's doing some fantastic work and all throughout the pandemic was getting information out available to us in the field, even regionally, about workforce issues, best practices. They, too, are going to be moving into this

00;23;42;09 - 00;24;14;17
John Haupert
look at how do we redesign the care model to get nurses at the bedside and get them away from doing tasks they don't need to do like you have already brought up. So as you all work through that, I know with Mindy and you, you'll share that great work with us at the AHA and that can really become part of our research we're doing around defining what these models could be, because I know there'll be different models for different types of facilities, but I couldn't agree with you more about needing to revolutionize that model.

00;24;14;17 - 00;24;19;09
John Haupert
We are sitting on a 40 and 50 year old model and that has to be very different.

00;24;19;11 - 00;24;27;02
Greg Bentz
We'll be pleased, John, to share anything we've come up with or we've had some good findings and good results. So we'll be happy to bring that to the table.

00;24;27;04 - 00;24;51;22
John Haupert
Great. I really appreciate that. I appreciate you sharing the great work you're doing at Saint Luke's, as well as your insights into the important role that hospitals and health systems can play in both positioning organizations for success and also in helping to communicate the tremendous value that hospitals and health systems provide to their communities. Until next time, thank you to everyone for joining us today.

00;24;51;25 - 00;24;56;06
John Haupert
I hope you'll be back next month for our next Leadership Dialog. Thank you.