Executing a Game Plan

Baystate’s New COO Puts the Focus on Quality and Value

Greg Harb was asked about the job description for the title on his business card — chief operating officer/executive vice president at Baystate Health, a newly created position at the region’s largest health network.
He said part of it is creating an operational road map for this system, which has a wide array of facilities stretched across three counties and more than 10,000 employees, a task he says involves everyone at Baystate Health. “But it’s more about keeping everyone on course — following that map and getting to where we want to go.”
Elaborating, he said that it’s one thing to have a plan or a multi-faceted strategy for providing quality care in an increasingly challenging environment for all providers (and Baystate has one, which he would expand on in great detail), and it’s quite another to properly execute that plan. And in many ways, his job description comes down to leading, or enabling, effective execution.
“I’m working closely with physician leaders, and also interacting frequently with front-line co-workers,” he said by way of explaining his role within the system. “We’ll have open forums on a regular basis, and I’m also working with the leaders of our different operating entities — the hospitals, the physician practices, our home health and visiting nurses associations — to make sure we’re executing those system objectives and system strategies.
“We’re constantly spending time evaluating our strategies,” he continued, making use of the collective ‘we,’ as he would repeatedly as he talked with BusinessWest, “and ensuring that we’ve got the right tactics to execute those strategies.”
And, as he said, there are many components to the system’s strategic plan. He identified five core strategic objectives, all in support of the integrated health network he says is the model of the future:
• A focus on quality of care provided;
• “Financial stewardship of this community resource”;
• Ensuring that the system is providing innovation in how it provides care;
• Commitment to academic endeavors; “we want to continue to educate health care professionals in the future”; and
• Ensuring that the system “has the most talented group of co-workers in this part of the country.”
Summing all that up, while also condensing his own job description even further, he said it comes down to that simple (yet also exceedingly complex) term ‘value’ and how to provide it in everything the system does.
For this issue, BusinessWest talked at length with Harb about his new assignment at Baystate Health, the many components of his job description, and that all-important focus on value.

Background Check
Harb comes to Baystate from the St. Joseph’s/Candler (SJC) Health System in Savannah, Ga., where he took the same title he has now: chief operating officer. Prior to that, he was COO and executive vice president of the Baptist Health System of East Tennessee, and held similar positions at Valley Baptist Health System in Harlington, Texas, and Memorial Hermann Healthcare System in Houston.
Like Baystate, SJC is an integrated system with a number of components, including two hospitals (St. Joseph’s and Candler, each with roughly 300 beds), a home-health component, the Lewis Cancer and Research Pavilion, and many other programs.
Harb listed a number of accomplishments from his five-year stint at SJC, including an improvement in net operating income from $336,516 in FY 2007 to $3.1 million in FY 2008 and $8.6 million in FY 2010; development and implementation of a strategy that decreaed premium pay 30% compared to the same period the prior year, resulting in a $4.4 million annual savings; decreasing labor as a percentage of net patient revenue from 44.6% in FY 2005 to 39.9% in FY 2010; work with the system’s board to establish a ‘collaborative’ with a competing health care system, with the primary objective of reducing supply cost; and co-leadership of an enterprise-wide “patient throughput initiative,” which resulted in a 0.4-day reduction in average length of stay at each hospital.
He told BusinessWest that recruiters brought him into the search for a COO at Baystate last fall, and he was attracted by the prospect of working with others there to lead the system through a challenging period of transition for all providers.
“What was most appealing about Baystate is that this is truly one of those integrated regional health networks,” he explained, “where you’ve got Health New England as the payer partner, comprehensive and regionally distributed acute-care hospitals, an integrated, multi-specialty physician practice within the system, all the outpatient services, and parts of the continuum of health with home care and hospice,” he explained. “So Baystate is very well-positioned to really lead the transformation of care, and that was very exciting to me as a professional.”
During the interview process, he said he had the opportunity to meet with Baystate leadership, including CEO Mark Tolosky, whom Harb described as “dynamic,” as well as board members, and came away impressed with the common vision and the basic approach to achieving it.
“There was singularity in terms of their focus on wanting to be that integrated regional system and trying to position Baystate to really change the way care is delivered,” he explained.
Upon arriving in March, Harb said he spent a considerable amount of time acclimating himself to the Baystate system and understanding the dynamics of the many moving parts within the delivery network.
When asked what he took away from that acclimation process and the many forums he had with administrators, physicians, and employees at every level, he said it was the sense that everyone is pulling in the same direction.
“There’s a real commitment to Baystate Health’s strategies, a commitment to the execution of those initiatives, and a real positive outlook that, if we do execute those strategies, we’ll continue to be a leader in Western Massachusetts,” he said. “There was a positive outlook that we’re well-positioned as a system, but that doesn’t mean that there weren’t or aren’t significant challenges facing Baystate and everyone else in health care.”

Care Package
Which brings him back to the five core strategic objectives he mentioned earlier, and how they are all integral to that process of providing value and enabling systems to effectively serve the public when the costs of providing services (especially in the case of Medicaid and Medicare) are not fully reimbursed by payers.
Starting with that term, or philosophy, of quality, he said that it comes in three areas: clinical — the outcomes provided — as well as patient experience, which Harb described as a “core deliverable,” and access. “We want to ensure that our community has access to our physician practices, acute-care services, as well as our outpatient services.”
And a big component in the effort to deliver quality is transparency, he told BusinessWest, adding that the system posts all clinical outcomes on its Web site.
Regarding financial stewardship, Harb said a key part of this strategic initiative is removing waste from the system in order to provide care in the most cost-efficient manner.  As part of that effort, the system started down what he called a “lean journey” nearly 18 months ago, and now applies lean practices in a number of departments, leading to significant gains in efficiency and plans to expand the program.
Meanwhile, the system, which has undergone a large reduction in force (185 positions were eliminated in late June), has also focused on non-labor expenses, such as costs within the supply chain, he continued, and has managed to reduce expenses by roughly $40 million to $50 million over the past several years. “We’re constantly looking at ways to remove waste without compromising quality,” he explained, adding that such efforts are helping Baystate toward its three-year goal of breaking even on Medicare services (which constitute a large percentage of total volume within the system).
Innovation in the delivery of services plays a part in both the achievement of quality and financial stewardship, he continued, citing as one example, the advent of patient-centered medical homes (the system has 16 of them), a relatively new model of the organization of primary care. It involves an individual’s primary-care physician and family and focuses on care needs, including prevention and wellness.
“These homes, which coordinate care across the entire continuum, are a real innovation and an opportunity to improve the way in which we provide care,” Harb said, adding that another key to Baystate’s success quotient is recruitment of top talent across the board.
“We need to make sure that we recruit, retain, and develop the best physicians, the best nurses … all parts of our delivery system,” he said. “We have an aging workforce, so the constant challenge of recruiting and retaining our caregivers is something we spend a lot of time on. And we understand that this is at the core of all that we provide; the people — the team — are the most important element in the process.”
And the ongoing task of proper execution of strategic initiatives is a total team effort, he went on, summing up the many financial and operational challenges facing providers by saying that they must continue to “appropriately redesign care and remove waste, but not impact quality of care.”
Elaborating on this redesign process, he said it involves reduction, or elimination, of the fragmentation process in health care today, and the creation of truly integrated systems. This is a large component of Harb’s assignment, and one of the many motivations behind the $250 million Hospital of the Future expansion now taking shape on the Baystate campus.
“One of the core parts of my responsibility is seeing that we’re truly integrating our care,” he said, “and that we’re not just approaching it from a hospital perspective, or from a physician-practice perspective, or a post-acute perspective, but making sure that we are truly coordinating that across the system.”

Bottom Line
When asked how he would evaluate his level of success in his new position, Harb said there would be a number of effective measures.
“Are we hitting our quality metrics? Are we hitting our patient-experience metrics? Are we performing well financially? Are we recruiting and retaining our talent? Are our co-worker engagement scores improving? It’s very much based on how we perform against the measured objectives of our system,” he explained.
In more simple terms, though, he’ll be successful if he can keep the system on course, able to follow that roadmap for progress in a changing health care landscape, and, in a word, execute.