“What’s our guiding light?” That was the question Andrew Ray and his team at Stanford Children’s Health had to ask.
The organization and its hospital, the Lucile Packard Children’s Hospital Stanford, were operating well as a specialty care institution, but they weren’t viewed as a place that could cover the full continuum of care and bridge the gap between primary and specialty forms of healthcare. Stanford Children’s Health wanted to extend beyond its immediate location in Palo Alto, California, to stretch further across the Bay Area and engage with the community in ways it previously hadn’t.
As the director of professional revenue cycle for Stanford Children’s Health, Ray has led the charge for revenue operations in building out Stanford’s community presence over the past four years. This first meant a series of acquisitions of local physician practices to relocate many of the hospital’s more routine care practices—a new addition of services for the organization that helped build out a more complete continuum of care.
Next, Stanford Children’s Health established multispecialty sites across the Bay Area, in which specialty physicians could extend their reach within the community. Then came new joint ventures and partnerships with other hospitals that helped to make Stanford Children’s Health’s maternity and pediatric care, as well as its partners’ care, far more robust. Finally, in late fall of 2017, the organization will open a 500,000-square-foot expansion to the Lucile Packard Children’s Hospital Stanford, which will add 149 beds and expand procedural, diagnostic, and acute services.
All of the above has amounted to Stanford Children’s Health’s ambulatory visits tripling over the past four years, from roughly 170,000 to 515,000 today. Physicians’ revenue, in turn, has doubled during that same time. And most importantly, care has vastly improved. In a fairly short time, Stanford Children’s Health has come to realize a full spectrum of pediatric and maternity care.
“As we’ve expanded and created this network of businesses while heeding that expansion, we’ve connected more directly with patients than we had previously,” Ray says. “Previously, we were fully reliant on referrals coming in from community providers, but now that we have a more robust network that process is more established. And it’s smoother for both physicians and patients who need that specialized care.”
“The constant question I ask myself is, ʻHow can I empower our people to be more effective in their roles?ʼ”
Ray approached the major expansion as a series of mini start-ups. Every acquisition and specialty site was new to the organization and the people involved, so leadership had to be fully focused on getting each new component onboarded and working properly.
“One of the big drivers—and this has been a challenge that I’ve had—is how we do that in a way that’s not inflating our cost at the same time,” Ray says. “How do we achieve those economies of scale that we’re looking for?”
This shift also culminated in a number of technology challenges. Only within the past two years did Stanford manage to shift over to an enterprise-wide medical record system. Individual physician practices all had disparate systems, and Ray says trying to manage them all jointly proved to be a nearly impossible task.
“We had so many different processes, systems, and reports that we didn’t have a single source of truth,” Ray says. “Do I spend all my time trying to wrangle all these things in a single matter, or do I continually spend my time working on issues? From a management perspective, it was basically a lot of putting out fires as they popped up and managing those on the fly. Now, we’ve got a lot more tools in place that allow us to identify issues more proactively and address them instead of having it become a fire drill, all hands on deck.”
The healthcare industry on the whole is no stranger to this challenge. Ray recommends creating consistent processes and frameworks for each new acquisition and says it will go a long way to making sure each new acquisition knows its role within the organization and what steps it needs to take to perform a smooth transition. Stanford didn’t have this solved from day one, but Ray says working through it has been a learning process.
“Initially, a new acquisition or venture used to take almost a year to stabilize. Now, it only takes a couple of months,” Ray says. “We’ve learned it’s just getting a consistent process in place supported by a single, enterprise-wide technology strategy.”
Of course, any leader—not just those in the healthcare space—can relate to trying to coach a team through a hectic period of transition and growth.
“Change can be very arresting to individuals,” Ray says. “They see a lot of change going on, and they seize up and don’t work as well as they otherwise would. A lot of what we’ve tried to do is explain what the change is and provide that vision of where the organization is going so that our teams can more effectively help drive us toward those goals.”
Many organizations, Ray says, aren’t able to communicate an overall vision beyond the executive team. And in the healthcare space especially, freeing up physicians to do their job is a critical facet of strong leadership.
“It’s about realizing that I have no ability or capacity to have my hands in everything—realizing that I have a great team of people that I work with, both those who work for me and others within the organization,” Ray says. “The constant question I ask myself is, ‘How can I empower our people to be more effective in their roles?’”
One of the things that gives Ray satisfaction in working in the healthcare space, specifically at Lucile Packard Children’s Hospital Stanford, is that he supports physicians who might be the only ones in the world performing a pioneering procedure. It’s his job to justify that procedure as something that will yield financial results for Stanford so it can continue to grow and provide a consistent standard of care.
“It’s about giving our physicians the comfort of knowing that the financial aspects related to their work are handled and handled well so that they can focus on providing care to our patients. Our physicians are very engaged in the financial aspects of our business, which provides a great balance between the clinical and fiscal aspects of supporting our mission,” Ray explains. “The more efficient we are, the better we can control our costs, and more of those resources can go to treating patients and advancing pediatric and maternal care .”
