Ep. 1 | Renown Rounds: What’s Next for Healthcare in Northern Nevada?

Hi everyone, my name is Mike Higden from Mike Higden Storytelling Studio. I'm here with Dr. Brian Erling, the CEO and President of Renown Health. And we're going to chat about the strategic plan today. We have six episodes planned for you. This is the first one where we kind of get an overview and an idea of what the strategic plan is and we'll ask a bunch of questions. And I actually want to highlight that we have not pre-planned this conversation. We met a little bit on teams just to talk about being here, but these will be new for both of us and I will be learning along with you. We're going to play a couple different role plays with audiences too, which is going to be a surprise for you. So I would like you to introduce yourself a little bit more than what I had to just your name if you can tell us more about you. Yeah, so Brian Erling started as the Presidency over-known in November of 2022. Started my health care career as an emergency medicine physician. In Denver, Level 1 trauma center, progressive leadership roles in that health system. I was working as the Chief Clinical Officer for another health system and then the CEO of a market Colorado Springs and then came out here in November. But just super excited to be out here with you now. It came out at a difficult time as you know with coming out of the pandemic and it was just a tough time for everybody to be in health care. And I've really enjoyed the last two and a half years as we've transformed as we've come out of the pandemic. Awesome. One of the things I actually wanted to know more about you as I noticed your letters are MD for medical doctor and then MBA. What got you interested in moving from MD to MBA status? Yeah, that's a good question. I think most people as you go into leadership, certainly if you come from a clinical track, one of the requirements is you're generally, I hope pretty good at what to do. But then transitioning into learning more on the business side, that can be where the challenge is. And I readily admitted I needed it. I mean, I was a biology major, chemistry minor, pre-med, professional student all the way through and didn't do a lot of the business stuff. So I learned a ton. I did a health care administration focused MBA. And got my feet wet with that. So I needed it and it certainly served me well. Awesome. Do you get to work in the pit or anything at all anymore? They don't let you do that? No, in 2013, 2013, I sort of jumped with both feet into a leadership role. I thought I was going to continue to work shifts in the emergency department, but I was traveling four or five days a week and young kids at home and it just wasn't working out. And I'm very pragmatic about it. I don't want to go to an ER and get seen by a physician who's working two shifts a month. So I said, okay, I had to make a decision, but for a lot of different reasons, I thought I could have a larger impact on the leadership side. So, it's pretty cool. So hopefully you're enjoying it. It's been a while, then almost 12 years. It sounds like. Yeah, absolutely. No regrets. Awesome. That's great. So, in getting into the strategic plan conversation, I think it's actually important to talk about, what is the strategic plan for like the average person? Because it sounds like you and the C-suite have been steeped in it for quite a while, but can you back up and explain it to me like I've never heard of it before? Yeah, so in, what's saying, when I joined Renown in 2022, it was a challenge across the healthcare industry, you know, coast to coast, everybody was struggling. And Renown was no different. So, 23 was a year of sort of getting our feet back underneath us. And then, 2024, we spent 10 months on the strategic plan. And the way I describe it, I should have some of this anecdote in our new employee orientations every other week, but it's everybody sort of has a strategic plan. You know, I know I have to make enough money as an organization to pay our debt service, just like people have, if they have a mortgage, they have to pay their mortgage. I know I got to have money for break fix and fixing the heater, replacing the cat scanner. That's what we call routine capital. And then anything we have left over, we call strategic capital, but you need to sort of set your priorities. And that's what the strategic plan does, just like we all do in our life, what's important to us to our personal missions. Well, what lines up with the mission of our organization? And so, the strategic plan guides that. And actually in our process, we actually also looked back 160 years and said, where's Renown Ben? Where are we now? How are we? How have we changed? And we actually took a fresh look at our mission vision values as well. Yeah, that was the process. Awesome. Do you want to talk about what the mission vision values is since it sounds like that's changed a bit? Yeah, so we really wanted to represent who we are and our essentiality to our community and sort of what we've been serving. So our mission, and I'll read it just so I don't stutter on camera here, is established in 1864 as an Nevada's first hospital. We proudly serve our community as the only not-for-profit academic health system, committed to saving lives, nurturing minds, and caring for all people. And that process to draft that was very inclusive. We started with a survey to all of our employees. Our physicians on the medical staff and said, hey, this is our current mission statement. What words resonate? What maybe are some new words we should be thinking about? And so we, and then we worked with our leader forum and our VP group and our board and said, what really encompasses who we are, where we've been, and what's our purpose. Our vision statement is create a healthier future through exceptional care and discovery. Also, same process infused through that work. And we really wanted to capture our affiliation with the University of Nevada, Reno School of Medicine. That includes, as well as, our affiliations with the Orva School of Nursing. But this idea of training the next generation of our workforce, cutting edge, also bringing research and discovery to our community's clinical trial opportunities for our patients that are interested in it. Our values we took a fresh look at. And Montress and Sci-Walked in the door in November 2022 was that we were going to be a people-first organization. So that became our first value. That, I think, resonated with all of our associates, all of our physicians, this idea that we're going to put our people first. That includes patients. But it's putting people first, because a lot of healthcare organizations come out of the pandemic. We're treating it, treating labor like a widget, a lever to pull. And it is our largest expense. But it's also what makes us special and what makes us important for our community, what allows us to execute on our mission. So we want to be people first. We want to be the best healthcare employer in the region. And so that was our number one value. The other values were our compassion, integrity, collaboration, and excellence. And they are all three of those are the same values that we had before. And we pivoted one slightly. Which one did you pivot? We had caring. And we actually inserted caring into our mission statement and elaborated that to compassion. I think caring is a great description of what we do in healthcare. But compassion is how we do it. And so, you know, it's one thing to care for people that we want to care with compassion. That's great. I don't think I've ever really heard companies talk about using a employee survey to create their mission. It seems like more often than that. You get like a group that comes in and everyone sits in a room for 62 hours until a mission comes out the other side. Can you, is that something that you've experienced in other places? Or is that kind of novel here? Well, I'm sure others have done it. It was, it was the same way we approached the strategic plan. What I didn't want the end of the day for for people in the organization, whether it be our frontline staff or someone who works in accounting or our physicians on medical services. I didn't want people to say, oh, that's, that's renowns a new strategic plan. That's an early strategic plan. It was, no, this is our strategic plan. So that we use the same process. So we wanted to use the same process for our mission vision values. And I think it's, I think it, it's more meaningful that way. Yeah, it definitely sounds like it. And do you think the, we might get into this more, but how does, do you get the sense that people already resonate with it, or is that kind of what comes next to have people feel like they're part of that mission? Yeah, I think it comes with time. I think it does resonate. But we are just in the early stages, also of socializing. We haven't, we haven't repainted walls and changed mission statements. We're so, we're doing it organically. The intent wasn't to, to do something that then, now we got to spend, you know, tens of thousands of dollars on signage. That, that was not the intent of this. It was, it was really to just try to represent who we are and where we're going. And, you know, I, I think the only negative I've heard is, wow, that's longer than the last one. I have more to memorize. It's like, well, I can't argue with that. There is more to it. But I think it also, really, I mean, I'm, when I read it, I get proud. And I know I get that same feedback from others, because I mean, 160 years, it's a long time to be here for our community. Yeah, that's a huge deal. And I think that footprint is expanding, which will, I think touch on in a bit. One of the words that comes up in the plan a lot, and you said it was essentiality. It sounds almost like a made up word. It's probably not. Do you want to talk more about what that means to you? It might be a made up word. I think in medicine, we, we figure at some point that we can make up words as we put landlords together. But, um, yeah. So one of our pillars talks about advancing essential and advanced care. I know we'll get into the pillars, but of our strategic plan. But, might as well hit that one now. There's so much healthcare that our community needs. But if you look at our 100,000 square mile catchment area, basically from, you know, Sacramento or the Sierra is all the way out into far west or far Eastern Nevada. If you look at all that, there is, there's so many things that, and so many clinical services that you can only get it right now. And we're very proud of that. It's, it's, again, what, what gives us a big sense of pride. So whether it's trauma, whether it's comprehensive stroke and neurosciences, advanced heart and vascular care, pediatric care, as the only children's hospital in that area, all of that, you know, we're here to serve our community. And so one of the exercises we've gone through is what, what more can we we provide that helps us keep as much care local as possible, while also being realistic about who, you know, the size of the population that we're serving. So, two of the most recent programs we added, ECMO, which for clinicians is a, they know what that is, but it's basically heart-lung bypass for ICU patients. It's very high-end. It's not something that a lot of hospitals do, but we had a need in our, in Northern Nevada and people are having to leave our community. A little bit more tangible one is kidney transplant. So, people getting on the transplant list, we're having to leave our community and our organs were leaving our community to go to Salt Lake City and, and Northern California. So, we knew that our population was big enough. We needed to make an investment, sometimes with some support through philanthropy and sometimes just through our community benefit and what we provide for our community. We made those investments to try to keep as much care local. Are we doing pediatric heart transplants? No, because we need a metropolitan area to, I don't know, three million, four million people. A big metropolitan area to do something that's very rare. So, some kids and some patients still need to leave our community and that'll be a reality for a long time, but we're trying to keep that, make that as small a percentage as possible. That's really interesting, because I mean, I think all of us have probably heard stories of some specialty care where they had to go to Davis or somewhere else to get that done. But it also sounds like you're not trying to be everything to everyone. Is it just kind of nice? So, are you, is there a really specific, thoughtful targeting that's going on about what you want to cover in the hospital? Yeah, and I'll say it's not driven by me. Not driven by my team is driven by the clinicians. So, they will say, hey, this is a service that we are seeing more and more of that if we, you know, that we're having to transfer patients out of the community. And then we look at it, we run an analysis. Usually, there's some pretty good population, type, you know, ex, that prevalence of that is x per 100,000, whatever it is. And we can say, yeah, that's enough to, to do it well. And that's the key. I've had this same question multiple times in some of our public venues, like interacting with the community. And, and one of the questions is about specifically not heart transplant, but pediatric heart surgery. And I mean, if the volume means that we're going to do one a month, that means we're not going to be good at it. Volume drives high quality and healthcare. You have to do a lot and to get the whole to this, not just is the physician good. It's the whole team good that's going to take care of them in the ICU and all of that. And then are you really going to find a physician who's chosen to make that their specialty come and do one a month? They're not going to have any professional satisfaction. We're not going to get the level of clinician that we would want to bring to our community. So those are the questions we ask ourselves when we decide what can we, what should be done here and what might need to leave our community. Actually, that's a really nice approach to it, especially you can imagine a pediatric heart surgeon sitting around waiting for a month for one at a time. I don't imagine filling their time with other things that they're not as interested in or maybe it's not their practice. Exactly. And anyone would lose skills in that situation. That's what we want to avoid. Gotcha. So practice makes more skills than. Gotcha. So let's get into some of the pillars. Unless there's anything you wanted to add about the vision of values. Let's do it. So our strategic plan, really, we landed on five pillars for our strategic plan. I'll talk about there's a couple of foundational elements. And so one of the things that you don't see in the strategic plan is a lot of conversation of, you know, operational excellence as a health system, things like that. We call that foundational. So if we're not going to try to be the absolute best at providing clinical care, high quality, safe care, good outcomes, then we shouldn't be in the healthcare business. So we really put that as a foundation under the strategic plan. Say we're going to be the best at delivering healthcare in our region. And then our pillars are, again, in no specific order, but the first one that we've already touched on is commit to a people first culture and mindset. And that's really just taking it, taking that idea and really hardwiring it into all of our activities. So not just, you know, if you're a leader or a manager and you're with your team and you're trying to make a decision, it's that last question. Is, is this, are we making a people first decision? And sometimes you have to make decisions that are, you still got to make business decision. We have to run our organization. Sometimes, sometimes they, there is no good options. So to speak, but then you can take a step back and say, are we going to, are we going to handle this in a people first way? And so, and then of course, interacting, how do we interact with colleagues? How do we interact and collaborate across departments? All of that, you'll see under the people first pillar. Can you think of an example that might show that conflict that you were describing, like a changeable one that maybe you've encountered or maybe you can invent one if, well, we, yeah, we've had, I mean, sometimes it's a, it might be a service that we can't provide to our community anymore. And maybe there just isn't the volume, there isn't the reimbursement, whatever it is. And I don't have a great example of that. But are we handling it in a people first way? Are we making, trying to keep everybody in the organization, even if that means we have to train people differently in the different roles, things like that? That's probably, that's probably the most tangible. But there's a lot in here as well around up training folks asking people, what do you want to do in your career? What would make you a long time employee with renown? And if it's you're here and you want to get here, how do I get you there over time? Gotcha. That's cool. Hopefully we can jump into those or maybe bring in people that represent that later. Absolutely. We should do a whole session on people first. One of the comments I heard is that I had an employee had thrown back into their manager's direction, a comment about, well, you know, you're not letting me do this. That's not people first. And I'm kind of joked at the time. I'm like, well, it's not me first. It's more about, it's the opposite, right? It's how do we treat everybody equitably and fairly? And not, you know, you can't have favorites. Can't let some people break the rules and others can't. So there's a lot to it. Oh, that's, yes. I could see how it would be really easy as someone who really wants something to kind of throw that in and see if my manager, yeah, let's me go with that. Exactly. What's the next one? Again, no, no specific order. Actually, I'll talk about since we touched on already the provide essential and advanced care options. So that's really about, we talked about the essential, essential care and or the advanced care. And then the essential care as well being the kind of base of the pyramid. So this is our primary care network, making sure people have access just to get into doctors, routine care, urgent care network, behavioral health network. So it's really creating the base of the pyramid where we're trying to touch as many lives as possible and ensure that people are making the right decisions and helping people make the right decisions. But then also, all the way up to specialty, specialty triangle. And so that's that's provide a essential advance care options. The next one's expand renowns not for profit mission. And this is some, this has a lot to do with, first of all, just making sure people know that we're not for profit, that we reinvest every penny of what we do back into the healthcare of our community. And we do that in a lot of different ways. But it's also about this idea that if we believe in our hearts that the best care you can get in Northern Nevada is at renown, then we need to make sure that it's available to as many people as possible. So something that that means growing our, our acute care capabilities so that we aren't saying no to patients that need to be transferred in. It's about working with our rural hospitals to again, keep as much care local, but to help them keep as much care local. So maybe that's telehealth specialty care so that they can keep people and take care of them out in their in their home community. But we're here for them if they need more advanced care. And then just kind of concentric circles of growth. We just, we have to grow from Washoe County to continue to provide what we do to as many people as possible. Is the requirement of not for profit simply just the reinvestment mission or is there more to it than that? You know, it's, it's probably the one of the larger talking points I get both with employees and community members because I have people that all the time will say, wait, renown's not for profit. I, I, I mean, you have this big billboards and the shiny building and these commercials you do, because they think not for profit. They think the food bank or boys and girls club and yes, we're absolutely not for profit. So we talked about some of the capital things there. I mean, we still have to make money as an organization because what isn't included in your income statement is replacing the carpet, replacing the cat scanner that's into life. And every year we spend between $55 and $70 million a year just to keep doing everything that we are already doing on a daily basis. Oh wow. No new patients, no new service lines, no new clinics, just keep doing what we're doing. And that's just break fix and, you know, replacing the robot that that whatever it is. And then we have our debt service like I talked about and our strategic and our strategic capital. But we have everything is reinvested basically back into people, bricks and mortar programs. And as well as our community benefit program where we have a process where not for profit in the community who are like-minded, who are trying to achieve the same goals that we identify in our community health needs assessment, we help support them through a grant process as well. Gotcha. So there's a lot of things going. I mean, $50 to $70 million just to keep the lights on essentially. That's just to keep the lights on. And we use the term routine because it's, again, it doesn't provide it. It's just replacing your water heater when it breaks at home and all the other things you got to do. Well, especially if you have, you know, 6,000 water heaters and a health kit and a water heater in your house is, you know, a tenth of the cost of anything that's in a hospital, right? There's this tax that goes into just because of the regulatory environment and how construction has to be done and everything. It's just everything's more expensive. Yes, that makes sense. Yeah. What else you have there? We've only done three so far. Yep. So we have, we have, we have, in sure, access to high quality and affordable care. So this idea that that we are very committed to keep care affordable for our community. When you're providing ECMO and kidney transplant and we'll talk about the last pillar of our own academics, none of that is inexpensive to do. We did a study that showed that Reno is actually just a little bit below the national median for health care cost per capita. And that's probably an okay place to be. What we don't want to be is We don't want to be, we just don't want to drive the cost to care. We want to keep it as affordable as possible with as much access as possible, both for the consumer, for our patients, but also for employers that seek out medical care. So we are the owner of a health plan. We have hometown health, and that's probably the largest vehicle as well as our medical group to try to drive that pillar. Actually, so the hometown health helps, is it help to keep it affordable for the region as well as essentially, or is there something else behind it? Yeah, absolutely. So it is, you know, hometown health contracts with renown, and then we have a narrower network that we can provide to employers that want to take advantage of that. We want to be a part of renown, and we can provide significant discounts on their premiums. And that also includes for larger employers who are self-insured, so we just do what's called TPA, third party administration, where we help them manage their healthcare spend by, you know, ensuring that it's appropriate. Gotcha. So other ways or programs that help with affordable care, or is there something that you guys do over-arcing that helps with that to keep that you mentioned? Yeah, there's lots of other things. I mean, one of my favorite examples. I'm an ER doc. I can't stand freestanding ERs. I'll just say it. I think that I don't think they're appropriate for the community, because generally, you can go into an urgent care and get essentially the same level of care for a, and then your health insurance coverage, $30, $50, $50, whatever it is, or you can go into a freestanding ER, not connected to a hospital and get a much expensive care. We have no freestanding emergency departments. Gotcha. That's really interesting dichotomy. So you're just essentially thinking that the urgent care can cover a good deal on their own, and then if you're in a worse situation, the ER is more appropriate with the whole hospital behind you. Absolutely. I mean, an ER charges higher rates, and we all know that ER care is expensive, because it's attached to a hospital that has ORs that are ready to go, and Cathlabs ready to go, and stroke teams on call, all of that is what costs money. And so just building a, you know, a building with 12 rooms and a CAT scan or doesn't, it's, it's not the ideal place to get care. Gotcha. Right. So what is number five? And the last one is building integrated academic health system. And so we're really excited about that. We're in our fourth year with our affiliation with the, you and our school of medicine. We have residencies in family medicine, psychiatry, internal medicine. We started pediatrics. We're in our, going into our third year right now of the pediatric residency, and we are, have applied to start an OBGYN residency, and the next one we're excited about is surgery. So general surgery. So those are, it's our commitment to sort of help train more providers for our community. They also have a PA school. And as I mentioned, we have an affiliation with the Orva School of Nursing as well, who is a wonderful nursing school and nurse practitioner school. So we're trying to just, and then we have some other cool partnerships with some of the community colleges around tech training and training our workforce. And we've started some integrated training programs to train techs in our facilities. So we couldn't find any echo techs. And there's no echo tech training program. And then those who don't know what that is, basically cardiac ultrasound. And we said, all right, we found a guy who was running a program and he came and, and we graduated our first class of 11 and we're in our second cohort right now. So it's trying to be creative and say, we can't wait around for someone to solve these problems for us. If not us, who let's take the reins and solve the problem. That's it. So I would assume that you and our becomes a pipeline to renown, but maybe I'd, I think I'd write a smaller percentage than I initially thought. I thought maybe every student graduates. I would say a pipeline to our community. Okay. So there's some really good statistics on, you know, if you graduate from the school of medicine, I think that I've heard you have a 40% chance of staying in Nevada, which is what's important staying in Nevada, not to be at renown. And then if you do a residency, it's like a 60% chance. And then if you do go to med school and do your residency, you have like an 80% chance. So there's no guarantees. There's some cool programs at the state level around student loan reimbursement and stuff to help get folks to stay in Nevada. Maybe maybe to set up practice out in our rural communities, but yeah, that's the goal. And do you get to interact with students and see what their interests are not in medicine, but in the area? Is there something about Nevada that they love or? I think it's, I think it's like any community. There's, we have a draw here because of the lake and the mountains and it's, it is a great place. But, you know, our biggest success is people that have grown up in our community, right? And we, and it's if they need to, they want to go train somewhere else? Please go train. So please come back. And so those are the, those are the programs that we're trying to put in place. Gotcha. Have you seen some of them? So Peds is, you said third year, but that doesn't, how many years is it to come out and become a pediatrician? Yeah, so it's three. Okay. So we started with, and you just start with your first year, you see, bring a group in turns in and then they went to their second year we brought in the, and we just, we just matched actually to start this July, the third year. Oh, great. So then they'll be coming out and ready to get started, hopefully in the community then something. Absolutely. Awesome. Yeah. So how would you, if you had to elevator pitch this to a person in the community, you know, at a, at a bar, if you go to bars. Yeah. How would you explain this in a quicker way than like, why is it important to the person who doesn't work here? Yeah. I think I would, I would hate to bore somebody with my strategic plan over a cocktail, but yeah, really it comes down to, I'm going to use the word again, but it's, it's a reflection on our history in our community. It is, it is our path forward to ensure that we continue to grow with our community and meet the healthcare needs of our community. So we have a lot of headwinds. We have headwinds at the federal level around reimbursement cuts, grants being cut, and, and we're, you know, workforce shortages that are projected to get worse, both in nursing and other areas. And so we're, we just can't sit, sit back and, and let these things happen. We have to be as proactive as possible. The strategic plan is a 10 year view that is really taking a very long view. And obviously anytime you try to do that in your personal life or otherwise, you can get a little hazy after three, four, five years. So we have these inflection points built in, you know, if there's major Medicaid cuts, what would we need to maybe think about and do differently? But we have all those, we at least have a path. We have a vision. We know where we think we need to go to fulfill our mission to our community and, and so everybody's rolling in the right direction. That's good. And the inflection points make sense. So it would be terrible to be rigid and stubborn against a series of other headwinds or maybe something changes against better. That's exactly right. And we don't, we may have opportunities pop up that we couldn't even anticipate. We will have headwinds pop up that we haven't even thought of. And so, and you can't plan for all of them. So it's this idea that we have a, we have a road map, but we're going to be periodically checking it against reality and, and see if we make any pivots. We'll do that. Awesome. And then if you wanted to say the same thing to a doctor who was thinking about moving here and does know all the nitty gritty, what is, is there a recruitment pitch or anything that works on them and it comes to these types of changes? I just love this, I share this. I share that, you know, there's some things really positive about our community. We're a growth community. And we have, we have, I think we're known as a huge community asset. We have a very supportive board. So we are, we are letting the clinicians drive the service line priorities. And on, I think the easiest thing to do is actually introduce, if there's physicians and nurses or anybody that's interested in coming to our community, we introduce them to people that are living it right now. And they go, yeah, this is a, this is a team at Renown that is saying what they're going to do. And then they do what they say. And, and again, it's a collaborative process. And I think people, that's what people want to be a part of. Open transparent, good communication and all trying to accomplish the same thing. Awesome. Is there anything that I haven't asked that you're like, I can't wait to tell what you haven't asked me yet? [laughs] I think you've asked me a lot actually. No, just super excited. What I'm excited about is this process. I get a chance to share some of this every two weeks with our, with our new employee orientation. We have a monthly employee forum that's virtual where I share some highlights. But this is an opportunity, hopefully, for folks internally, externally, whoever looks at this to get an idea of where we're going. But I'm really excited to have the, the folks on the team who are, we have such a great leadership team at Renown at all levels. We have them sit down and answer questions to you about how they're thinking about each of these. Yeah, that's definitely the one I'm excited about also is just jumping into each and, digging. It's really hard not to dig into each one of these. It's always my habit is like, let's spend, you know, 30 minutes just on one of them. But we'll be able to do that in the next episodes. And I think we've picked out a great of folks to talk with. So we may change up the set here and have more of a roundtable in the next one. Awesome. So, if there's nothing else, I think we're almost about out of time. So, pretty excited to jump in with the audience back in Renown and learn more in the coming weeks. Awesome. Thanks, Mike. Thanks.