‘Move in a direction which really makes the difference’

22 February 2019
At the beginning of February 2019 Dr. Shrestha moved into the role of Executive Vice President and Chief Strategy Officer at Atrium Health, a large healthcare provider active in the American states of North and South Carolina. Lucien Engelen, who, like Shrestha, chose to make a career switch to a strategic post in the area of healthcare innovation, talked with him about his experiences at UPMC and his expectations for the future. Who is Rasu Shrestha and what is his mission? “I am builder of bridges who wants to make a positive difference in the lives of others. I was trained as a radiologist and after my medical training I also did a degree in informatics. After working as a doctor for some time, I switched to developing digital medical applications, because this meant I could have a wider impact on people’s health. This was about twenty years ago, and I soon realised that developing an innovation is very different from implementing an innovation and ensuring its long-term success,  which needs a completely different culture. In order to create this culture, I stepped into the role of bridge builder with the following mission: to bring together all the people and resources that matter in sustainable care innovation, from leaders, doers and technology to capability and businesses, into teams in order to accelerate the transformation that is needed to take healthcare to a higher level.” What are the greatest challenges and obstacles you have come across during your time with UPMC? “The greatest challenge is the culture. It is important to understand what our motives are and why we take certain decisions. And to understand what resistance you are going to encounter if you implement a particular solution or if you want to form teams to work on innovation together.
Culture is both the greatest opportunity and the greatest obstacle
There are always dynamics at work within teams and organizations and this is mostly shaped by the culture you create. I think that if you work with these dynamics in the right way, you can enable people who are independently working on important issues  to experience the idea that the whole is larger than the sum of the parts. That is the ideal situation to me. That is what I have tried to achieve at UPMC all the time and that is what I would like to continue to do at Atrium. I see culture not only as the greatest challenge but also as the greatest obstacle. Because if you are not able to create the right atmosphere, an innovation is doomed to failure.” How do you view the next step in your career, with Atrium Health? “Atrium is a healthcare organization which has a big impact on the communities where it is active, both in the Carolinas and outside that area. The role of Chief Strategy Officer is interesting and yet different from my role with UPMC. There is an overlap with innovation, but as head of strategy and together with the right leaders, partners and community members, I will be able to transform healthcare into a more future-proof system. Healthcare no longer just takes place within the walls of an institution, but is based around the question of how you affect people’s daily lives. We have to develop solutions and new business models in order to give patients and consumers more control over their health data and to motivate them to take greater care of their health and well-being. The healthcare focus is moving from ‘surviving’ to ‘thriving’. In order to realise that we have to let go of the current paternalistic system and move to a participatory system, where care professionals and patients work together and feel comfortable. This is a logical steps, as patients are more involved than ever these days, thanks to information they gather via the internet, their smart phone and other mobile devices such as wearables.” A greater focus on prevention, this is what I am working on at Deloitte’s, too. It is a different perspective. “Indeed it is. It is not just about giving patients access to their medical data, but also to the capabilities and tools to interpret them in the right way. This requires a bridge to be built between the EHRs of care providers and medical apps for patients and even consumers. It should be possible to exchange data in both directions, so that care professionals can access up to date patient data, place them in the right context and so that patients know how they are doing and what they need to do. UMPC has already picked up on this and is working together with third party companies on developing these interfaces. The aim of these types of applications is for people to be more consciously engaged with their own health and therefore are at less risk of ending up in hospital. This does mean that we have to change the way in which healthcare costs are reimbursed, in order to keep hospitals financially healthy.
First find the people who really feel the pressure points
I have some questions with two options. Could you please choose an option and then tell me why? The first question is: ‘push’ or ‘pull’ as far as strategic innovation is concerned? “Both, innovation is done both top down and bottom up. You need commitment at management level, including financially, but you cannot just impose new developments from the top. You need to create an atmosphere where people feel positive about  change and want to and are enabled to contribute to it. So at UPMC we always start innovation from empathy. Before we think about a solution, we first talk to the people in the field about the pressure points they experience so that we gain good insight into the situation. We do not just talk to doctors but also to nursing staff, operational staff, IT people and patients. Together with these experience experts, we then set up a trajectory in order to co-create and develop new methods and technological applications, or to leverage existing solutions in a different way. Because innovation does not always mean developing something new. Within UMPC, the Enterprises division is responsible for innovation and the other branches of the organization are used as a living lab. It is important to create a ‘safe space’, where tricky questions can and indeed should be asked, where there is room to make mistakes and learn from them, as happens in the Radboudumc REshape Center. Another integral part of an innovation project is to develop a business model in order to be able to roll out a pioneering innovation outside your own organization.  If you want to up scale a new solution, commercial success is an absolute necessity. That is why we make sure a commercial partner participates in an innovation from the very start. From a scientific viewpoint: trails with n = 500 or n = 100 x 1? “The latter. I think in science it is about scale. Being evidence based is important in medicine and healthcare. From a scientific viewpoint you need the right level of evidence and research data for innovations in order to be able to scale them up, regardless of whether it is a medical treatment or a digital solution. In order for an innovation to have a wide impact, it must be used by wider populations. Thinking about training: master class or curriculum? “Curriculum. We have long viewed 2020 as the future, but actually, it is next year. If we really want to be prepared for the near future, it is very important to change the curriculum of degree courses, in particular for Medicine, Nursing, Informatics and Business Studies. There should be a lot more cross-fertilisation between the different specialisms. For instance, data science should become a specialisation within the degree course of Medicine, considering the huge influence of big data on treatment decisions and protocols.” How do you innovate more successfully: with short term goals or with a long-term strategy? “I think you need a long-term strategy which is justified by short-term successes. You cannot just focus on a vision or projects with a long-term horizon, you need to make it tangible through successes, through innovations which have a positive impact on the work floor. So you demonstrate a successful innovation and then you scale it up. Of course you need a clear vision, so long-term strategy is important, too. Who are more important for innovation: doctors or nurses? “It really needs to be both. I think this is one of the major challenges of today. Up until now, innovation has mainly been led by doctors. In the past, nursing staff have been involved with healthcare renewal as required, but doctors have been the ones in the limelight. I do not think that is positive situation. Because who are on the front-line and who know all the ins and outs and short cuts in healthcare? The nursing staff. So it is a great shortcoming if there are no nurses on an innovation team. Doctors and nurses together should determine how, where and why we innovate. Rasu Shrestha, Atrium Health, ICT&health What should you definitely avoid when you start innovating? What is the biggest mistake you have come across in the past ten years during your time at UPMC? “So many silly mistakes are made that I think that together we could write a complete book about it! One of the biggest mistakes I see companies make over and over again, from start-ups to large companies, is to let marketing get ahead of product development. If the marketing team have made a fancy website and are telling great stories, when the product actually still needs to be developed, you will inevitably crash. Style and substance should balance each other out. You can only start marketing and give yourself a chance of success once your product or service is actually of high quality.  If you could advise health care organizations about innovation, what would be the two most important points they should bear in mind at all times? “The first thing I would want to say is this: there is no ‘one size fits all’ where innovation is concerned. Each organization is different, there is no best way of innovating, but you can develop an ‘innovation blueprint’ for your organization. You should always remember that most people do not like change. So it is important first of all to find people in the field who really feel the pressure points and who would love for them to be solved. Whether it is medical treatments, nursing, the supply of drugs or the supply chain: find the people who experience the pressure points first hand, add them to the innovation team and engage them in the innovation journey. In addition, you should always ask yourself whether you are moving in the direction which is going to make the difference. I see so many innovations which are really a ‘me too’ moment. Sometimes there is nothing wrong with that, because sometimes you need different approaches to solve a problem. But the innovations which are really necessary in practice, the developments which survive the start-up phase and initial investments and can be up scaled, those are the truly pioneering innovations. Innovations which have a real impact on results and the experience of patients and which also deliver cost savings. So before you start innovating you should always ask yourself: am I creating more impact than the alternative solutions which are already available?

Developing for convenience

I personally think it is important to develop new solutions for our own convenience. Healthcare is typified by complexity. Medical research, our healthcare system and humans themselves are complex, not just biologically but also from the point of view of behaviour and how to change it. Unfortunately, I often see that in practice, technological solutions contribute to complexity. In my opinion we should use design thinking, a totally different way of thinking, to make healthcare a lot simpler. It is not about adding bells and whistles, but about making applications as simple as possible. Digital solutions should be so intuitive that they help patients to get more of a grip on their patient journey and to experience it more positively. And to support care professionals in such a way that they can focus on their actual tasks, have time for a proper conversation with the patient and experience greater job satisfaction. That is the only way to make healthcare truly future proof.” Rasu Shrestha, Atrium Health, ICT&health, digital health, healthcare The complete healthcare innovator In 2018, Rasu Shrestha was named one of the 26 ‘smartest people in health IT’ by the prominent health magazine Becker’s Hospital Review and one of the ‘Top 20 health IT leaders driving change’ by the digital magazine InformationWeek. Healthcare innovator Shrestha worked at the University of Pittsburgh Medical Center (UPMC) for the past 12 years and has been Chief Innovation Officer and Executive Vice President of the UPMC Enterprises divisions since 2014, where he was responsible for the development and commercial up scaling of innovative healthcare solutions. UPMC is an internationally active ‘payer-provider’ organization, which is both healthcare provider and health insurer. The organization has 40 hospitals, 85,000 employees and over 3.4 million insured. Shrestha moved into the role of Executive Vice President and  Chief Strategy Officer at Atrium Health this month. This healthcare organization (previously the Carolinas Healthcare System) runs more than 900 healthcare institutions in North and South Carolina. Atrium Health has 45 hospitals, 35 emergency departments and over 25 cancer centers. It has a total of around 65,000 employees and the annual turnover is over 12 billion dollars. Focus on strategic innovation Dr. Rasu Shrestha is a radiologist, computer scientist and MBA. In addition to his work with UPMC, he was chairman of the Informatics Scientific Program Committee of the Radiological Society of North America (RSNA). Since March 2018 he leads a program aimed at the interoperability and the development of open APIs (Application Programming Interface) for the U.S. Department of Veterans Affairs. Since febryary 2019 Shrestha is Chief Strategy Officer and Executive Vice President at Atrium Health Shrestha is also a member of the board of HIMSS and co-chairman of the Health Datapalooza, an annual conference where experts from politics, the public sector and business come together to talk about the future of digitization in healthcare. In all his roles, Shrestha calls on his many years of experience in medicine, informatics, technology and business to pursue one goal: using strategic innovation to both improve the quality of healthcare and lower the costs.