Recruit and train for the future of health care and medicine. — By creating interprofessional education programs, health sciences students will graduate already working in teams, speaking a common language and having a common understanding of the clinical path to deliver care. It makes health care more effective, more efficient and more patient-centered.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Dr. Harold L. Paz.
Dr. Harold L. Paz is the executive vice president and chancellor for Health Affairs at The Ohio State University and chief executive officer of The Ohio State University Wexner Medical Center.
Paz is hyper-focused on creating the academic health center of the future. Rather than focusing on specific treatments or devices as the vital innovations of the 2020s, he believes that the modern world demands a new model of academic health care. He’s begun pushing for these changes and is set on championing them to adoption.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
There are many people and experiences that influenced my decision to pursue leadership in health care, but one in particular stands out. Early on in my career, when I was an intensive care unit director, the leadership at my institution asked me to participate in an experiment they were launching to create a one-year training program focused on building future physician leaders. They selected me to be the inaugural leader in this role, and I spent a year learning about leadership, administration and all of the intricacies of running a health system. I found this experience to be rewarding, with many lessons learned.
I believe it is the job of leaders to think about developing talent and an individual’s career, along with succession planning. This opportunity put me on the trajectory I am on today, because someone took the time to help me grow by developing a program to invest in talent, and it afforded me many opportunities to learn and be mentored.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Mistakes are essential building blocks to success. They are lessons in disguise that we learn from.
When I first became dean of the Robert Wood Johnson Medical School at now Rutgers University, we had a visiting delegation from our sister hospital in Shanghai, China, and I was asked to make remarks on the history of the medical school and hospital.
Almost an hour into my remarks, the individual who drafted the speech was in the back of the room flailing her arms to get my attention. Needless to say, 45 minutes is a long time for anyone to sit and listen to a speech. However, a very important detail was somewhat overlooked when crafting the remarks — the delegation did not speak a word of English and everything needed to be translated.
I learned about a million great lessons from this one experience, but one specific lesson that sticks with me today is, know your audience, understand what is important to them and keep your remarks brief and as personalized as possible. While it was painful in the moment, we were able to laugh about it and learn from this unfortunate episode.
What do you think makes your company stand out? Can you share a story?
Ohio State is well known for its tremendous size, being one of the largest universities in the country. And that size gives us the ability to examine global issues with a multidisciplinary approach that few other universities and academic health centers can match. The collaboration of so many dedicated individuals has enabled us to innovate and lead in research, education and patient care.
But what makes The Ohio State University’s seven health science colleges and The Ohio State University Wexner Medical Center truly unique is what we call the Buckeye Spirit. This is the culture that exists everywhere at Ohio State and is carried on throughout the world by its alumni — a collaborative spirit, a dedication to service for others and a relentless pursuit of excellence in the face of challenges. It is what makes an organization of more than 30,000 employees at Ohio State Wexner Medical Center and Ohio State’s seven health science colleges feel like a family; what makes our graduating students well-rounded, capable and confident; and what reassures our patients that we will do everything we can for their health and well-being.
We have seen countless examples of the Buckeye Spirit, especially during this pandemic — scientists working overnight to create the recipe for viral transport media needed to complete COVID-19 tests when it was in scarce supply, and then sharing that recipe across the country with organizations that needed it; clinical staff innovating new ways to preserve PPE and other resources; patient transporters decorating their masks with smiley faces to brighten the days of lonely patients; exhausted nurses holding the hands of patients and giving them comfort for hours, in full PPE, because COVID-19 safety restrictions prevented visitors.
That Buckeye Spirit is intangible, yet you can feel it in every corner of Ohio State’s sprawling influence.
What advice would you give to other health care leaders to help their team to thrive?
The job of any leader is to focus on the vision. We must work with internal and external constituencies to formulate the vision for the organization, then work together to develop an implementable strategic plan to achieve it. Implementable being the operative word.
There are only two other things a leader needs to do to achieve this vision:
- ensure the organization recruits and retains the best possible leaders to build effective teams that work collaboratively both horizontally and vertically to align with the strategic plan, and
- identify and secure the necessary resources to support the individuals in the achievement of a plan as they advance the vision.
I believe that leadership is about empowering individuals and teams to do their best work. Leaders who micromanage do so at the detriment of the organization and the individual’s success.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the U.S. health care system is ranked as the worst among high-income nations. This seems shocking. Can you share with us 3–5 reasons why you think the U.S. is ranked so poorly?
It might seem counterintuitive, but most “health” is not determined by clinical medicine at all. It is estimated that 70% of a person’s health outcomes are determined by factors other than health care or one’s own genetics. These “determinants of health” are predominantly “social” — things like access to healthy foods, neighborhood safety, availability of transportation, housing, financial security, education and even racism. There are behavioral determinants of health, including addiction to nicotine, drugs and alcohol, as well as diet, exercise and obesity. And finally, environmental determinants of health such as climate change, air and water pollution. As we think about how we compare as a nation in terms of our health outcomes, we must recognize that health care, per se, is only one part of a large number of factors that impact health and well-being and the risk of premature death.
Here at Ohio State, we are working to provide health care education that not only trains the next generation of providers, but really works to educate the community on advancements in health care. We are striving to improve the overall health of the communities we serve by increasing access to care, improving the quality of the care we provide, and partnering to address social, behavioral and environmental determinants of health.
You are a “health care insider.” If you had the power to make a change, can you share 5 changes that need to be made to improve the overall U.S. health care system? Please share a story or example for each.
1. Harness the power of digital/mobile technology, including telemedicine, to drive care into the home.
Like in every other sector of the economy, our patients have become accustomed to using mobile devices for all kinds of things. We all expect to be able to shop online, bank online and arrange transportation and housing — why should we not also use our smartphones in our own health care? The use of telehealth has exploded this year as physical clinics close for many appointments, and I do not see the growth of virtual health care slowing post-pandemic. In fact, I hope it does not, because this technology makes care more accessible, more convenient and, in many ways, more affordable for patients everywhere.
Here at Ohio State Wexner Medical Center, we know that the aggressive telehealth strategy we launched in response to COVID-19 resulted in patient travel distance savings of 12.2 million miles, or approximately 1.1 million dollars in fuel costs. Missed appointments also dropped 3%.
It is not just telemedicine that needs to grow, either — online patient portals, other mobile apps, wearables and other technology can truly personalize the health care experience when incorporated seamlessly.
2. Address the social determinants of health in vulnerable communities.
We know that an individual’s health outcome is actually determined by much more than clinical care.
What is more likely to affect their health is their socioeconomic circumstances — the safety of their neighborhood, the availability of stable employment and housing, quality education, clean air and water, and other factors. Universities and academic health centers are uniquely positioned to tackle the disparities brought on by poor social determinants of health. They can bring together experts from across disciplines and invest in hard-hit communities.
3. Acknowledge and end systemic racism.
We must do all we can to eliminate the structural racism that affects the health and well-being of our communities. Because of how strongly research supports the idea that racism leads to poorer health outcomes, Ohio State has taken the stance that racism itself is a social determinant of health. We also believe that every institution like ours should enact an anti-racism action plan to help prevent and end racism for their students, faculty, workforce and the communities that they serve.
4. Expand the use of personalized medicine.
It is vital that we take advantage of opportunities to improve health outcomes through personalized medicine, leveraging analytics to create an ecosystem of interoperable, value-based solutions that optimize each individual’s chances of achieving their peak health.
5. Recruit and train for the future of health care and medicine.
By creating interprofessional education programs, health sciences students will graduate already working in teams, speaking a common language and having a common understanding of the clinical path to deliver care. It makes health care more effective, more efficient and more patient-centered.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
Let us talk about concrete steps for these five areas separately again.
1. One way to embrace digital technology in various areas of health care is to make the continuum of care more seamless and connect patients more fully with their care providers. For example, we have launched the app “Care Companions” for a growing number of medical conditions, including heart failure, pregnancy, and COVID-19, that allows patients to easily record health metrics; see checklists for medications, exercises and other tasks; and read individualized information about their condition. Their provider helps control what appears within the patient’s app, and they can see how well their patient is able to follow along on the care plan they have developed together. It truly emphasizes that health care can be a personal partnership between provider and patient.
2. To address social determinants of health at Ohio State, we have created a model of supporting the vulnerable neighborhoods in our region, especially on Columbus’ Near East Side.
More than 20 years ago, Ohio State began buying abandoned facilities in the neighborhood. We have established a full-service community hospital, a separate outpatient care facility, an intergenerational community center and other valuable resources. Currently, we are transforming an old Columbus library site into a “healthy community center” with meeting spaces, a café, a subsidized fresh food market and more. We have deployed a mobile clinic to increase access to primary and Ob/Gyn care, we host Healthy Community Days with free health care and medical advice, we provide health-focused programs and partnerships in schools and we partner with community stakeholders to drive the change that they need in the ways that best benefit them.
Our combined efforts, often through a partnership called PACT (Partners Achieving Community Transformation), are successfully reducing food insecurity, infant mortality and other important factors affecting individual health.
3. I urge academic and health care institutions to launch anti-racism action plans to address systemic racism as soon as possible. At the Ohio State Wexner Medical Center and Ohio State’s seven health science colleges, the action plan consists of four key pillars, with concrete steps and action teams associated with each area, along with an oversight committee. Those four pillars are:
– Elevate the cause — Raise awareness within and outside of our institution, focusing on education/curriculum reform, community engagement and strategy. One of our early steps was launching Roundtables On Actions Against Racism (ROAAR), a series of facilitated discussions, policy recommendations and best-practices disseminations.
– Engage — We are making efforts to engage employees, faculty, staff, students and other learners and stakeholders in activities to confront and reduce racism. That includes anti-racism town halls and listening sessions, racism dialogue toolkits for leaders and anti-racism training resources.
– Equip — We must equip our communities, employees and learners with the funding, training, toolkits and other resources necessary to create a culture of anti-racism. This includes training on implicit bias, system-sponsored interactive workshops on equitable clinical decision making and more.
– Empower the marginalized — We have to recognize our own faults. Racism has been allowed to fester and grow in our institutions. Toyota uses a “Stop the Line” initiative that we have now adopted for creating a safe environment for anyone to speak out if they see a problem. We must invest in the voices of the unheard to lead to better self-evaluation and make lasting change.
4. At Ohio State, personalized medicine informs many of our initiatives. To optimize our care, we want to improve health outcomes through personalized medicine, leveraging analytics to create an ecosystem of interoperable, value-based solutions that optimize every patient’s chance at achieving their peak health.
It is very important that providers work to expand personalized medicine. We recently celebrated the first year of the Pelotonia Institute for Immuno-Oncology at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. This is a really amazing institute, because it is focused on expanding the research in this field that harnesses a person’s own immune system in a personalized treatment to battle cancer.
5. One way that we can emphasize interprofessional collaboration in the health sciences is by making it easier to access one another, both through curriculum and through physical spaces.
For example, in the Ohio State College of Medicine, medical students can learn how to use ultrasound technology in their first year and are capable of using this valuable diagnostic tool in the clinical environment by the time they graduate — something that, in the United States, is actually rare among physicians who have not specialized in ultrasound. Here, certain trainings are made more universally available.
Ohio State also is fortunate to be able to invest in new, state-of-the-art collaborative spaces, such as our current projects to build a 225,000-square-foot interdisciplinary health sciences education center and a new interdisciplinary research facility that will house 305,000 square feet of discovery in the biomedical, engineering and environmental sciences, among others. Creating spaces that encourage new ideas among different areas of study is an important component to our vision of the future of medicine.
I’m interested in the interplay between the general health care system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
We know that there is no such thing as good physical health without good mental health. And while most people are proactive in treating physical ailments, the same cannot always be said for mental health. At Ohio State, we are working to break down the stigma associated with mental health and we are focused on offering personalized and compassionate care for mental and behavioral health.
How would you define an “excellent” health care provider?
Someone who is compassionate, listens well to their patients, facilitates trust and respect, and is well-trained and knowledgeable. I think an excellent health care provider really facilitates a culture of interdisciplinary collaboration and solicits participation from a range of backgrounds and specialties. We are teaching our future doctors, nurses, public health officials, veterinarians and all health professionals to work together, because that is what they will need to do in the future to make our world a better place. This is how, at Ohio State, we continue to be a leading force of innovation and change.
We are also focused on preparing the next generation of health professionals for the academic health model of the future. To do that, we are giving our students tools like virtual patients and emergency medicine simulators in an effort to prepare them for the challenges they will face. We are also giving them real-world experiences with scientists who are leading groundbreaking research that will impact the larger community.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
The strength of an organization is measured by its succession plan.
There are so many great quotes from wise and influential leaders, and while this is more of a mantra, it is something that has stuck with me and influenced my leadership focus. In every organization I have served, it is always my goal to make sure I leave with a strong succession plan in place. With both of my previous CEO roles at organizations I have left, the individuals I had been grooming and mentoring to step into my role wound up succeeding me.
I am a big believer in preparing the next generation of leaders, as this is a differentiator in ensuring the continuity and success of an organization.
Are you working on any exciting new projects now? How do you think that will help people?
The most exciting project I am working on right now is advancing our vision to create a health system for individuals that resembles every other experience they have in their day-to-day lives. Future generations want individualized health care that is personalized, and we must design a system to achieve that mission.
As I mentioned earlier, utilizing technology and providing personalized health are key elements to delivering health care for generations to come, and this is an expectation here at Ohio State. The philosophy in health care has always been that the patient comes to you.
That way of thinking has run its course.
Health systems must adapt and find ways to take personalized care directly to the patient instead of them having to come to us. This is an expectation and we have a responsibility to train our future doctors, nurses, public health officials and others to operate in this way.
Even with continued focus on the significant challenges the entire health care industry continues to face, I am focused on advancing Ohio State Wexner Medical Center’s strategy to transform the health system to a health “platform” focused on driving care into the home using virtual and digital solutions, a new Community Care Coach and a fleet of other mobile health units to address social determinants of health. This model serves as the platform to educate health science students at Ohio State’s seven health science colleges through new and innovative interprofessional programs.
What are your favorite books, podcasts, or resources that inspire you to be a better health care leader? Can you explain why you like them?
Right now, I’m reading The Great Influenza, a fascinating and, unfortunately, timely story about the 1918 flu pandemic. A few of my recent favorites include The Splendid and the Vile, The Ride of a Lifetime, Designing the New American University, Principles and a Gentleman in Moscow.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
If given the opportunity, I would inspire a movement to make well-being and happiness accessible to all and have this be a measure of success. How do we shift the mindset from measuring our success and worth based on financial indicators and focus more on our own happiness? In Bhutan, a country in the Eastern Himalayas in South Asia, the success of the nation is based on a happiness scale. It is not measured by economic growth, but by gross national happiness (GNH).
From my perspective, the concept of happiness and well-being is not viewed in the same way in the United States, but we know that happiness and well-being are directly tied to a person’s overall health. That is part of why I am so passionate about addressing social determinants of health, especially when it comes to increasing access to quality health care. We have to recognize the importance of addressing factors outside of the health system that impact a person’s health and well-being and work collaboratively across sectors to support essential needs within the most vulnerable communities.
This movement is not a way for me and other clinicians to tell individuals how to live their lives, but it is for us to help each individual achieve their best possible quality of life and full potential. If we could do that, we would have greater equity for all.
How can our readers follow you online?
Thank you so much for these insights!