Q&A with UCSF CEO Suresh Gunasekaran: “The Next Decade Is Going to Focus on Health Equity.”

There’s perhaps no better preparation for becoming a healthcare CEO than having spent time both in the CIO and COO roles, according to Suresh Gunasekaran, who recently took the helm at UCSF Health.

“I take a great deal from my time as CIO,” including how to run a reliable IT organization, he said during a recent interview with Kate Gamble, Managing Editor at healthsystemCIO.com. What he really loved about being CIO, however, was the opportunity to “partner on virtually every aspect of the healthcare enterprise,” whether it was clinical quality and efficiency, disaster response, or a number of other areas.

Now, Gunasekaran is able to leverage that experience — partnered with his time as a COO, which focused largely on transforming operations to deliver new clinical capabilities — at UCSF, where he started as CEO in March. In the interview, he talks about why he has always gravitated toward academic medical centers; the challenges leaders face in maintaining growth while still offering quality care; how he has benefited from having mentors; and why he believes collaboration will be a critical component in improving health equity.

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Bold Statements

When you’re in a pandemic, so much is changing within your own institution and within the industry, and I think that really created a burning platform where so many of our staff had questions.

Every healthcare leader from my generation remembers what it was like before and after the EMR. It was a huge moment, and I think that for me, it defined a lot of being a CIO.

You spend a lot of time as a CIO strategizing over how to use technology to help enhance the business; as a COO, you think strategically about how you can transform operations to deliver new clinical capabilities.

I think the next decade or two is really going to focus on health equity. UCSF is at the forefront in that area and will continue to push forward.

There are a lot of different organizations that many community members touch, and so it’s incumbent on us to forge the right partnerships and to promote the right kinds of collaboration for the benefit of the community.

Gamble:  Hi Suresh, thanks so much for taking the time to speak with us. And of course, congratulations on the new position! What was it about this role — and this organization — that most appealed to you?

Suresh:  I’ve always been attracted to working for academic medical centers because I really believe that the best environment to deliver excellent patient care is an environment in which we care deeply about the education mission, making sure we train the next generation of healthcare professionals. It’s an environment that’s really committed to doing world class research in advancing medicine, while at the same time having a deep patient care mission where you’re really dedicated to serving the needs of the entire community.

Academic medical centers have a unique role in bringing all three of those things together, and UCSF is simply one of the best in the country at doing that. We have a long tradition of excellence in our training and research programs and a really strong commitment to the healthcare of the Bay Area and the country.

 

Leading through “a time of growth” at UI Health Care

Gamble:  Looking back at your time at University of Iowa — you were there about three years — it seems like there was a lot of growth during that time; not just in terms of physical footprint, but also through collaboration and partnerships. Can you talk a bit about that experience and what it was like to be part of that growth?

Suresh:  You’re absolutely right; it was a time of growth. University of Iowa Hospitals and Clinics is the only university hospital in the entire state and serves Iowans from across all 99 counties, which means patients travel hundreds of miles to get their care because we offer programs that are really needed for the state.

For UI Health, the challenge has always been what can we do to benefit the state the most. Some of that, as you mentioned, can be done by building facilities and creating capacity in Iowa City. The other way to have a statewide impact is to have more partnerships and collaborations with other healthcare organizations across the state so we can meet Iowans where they are, and hopefully help them not just at UIHC, but in their local communities. And so, a lot of our work has been very collaborative.

 

Challenge of “keeping up”

Gamble:  What was the biggest challenge with sustaining growth but making sure you didn’t grow too fast or too big, and that patients could still access care?

Suresh:  It’s a unique situation. There’s so much demand for our services; at any given time, it can take weeks to get in for an appointment, and other hospitals want to transfer patients to us, but we’re out of space. That’s the most difficult part — how do you not fulfill all of that’s being requested of you?

We’d prefer to see more patients. We’d prefer more space, but I think the goal is really how can we do a good job at delivering high quality patient care and take care of our employees when we’re taking care of so many patients? It’s such a big workload and then when you pile on the pandemic, it’s been a really challenging time to keep up.

 

Covid & the “burning platform”

Gamble:  As CEO, I’m sure maintaining a high level of communication was a key focus for you, especially during Covid. Can you talk about how you approached that?

Suresh:  Communication is really important in any organization, especially one with 12,000 people. What really changed is that when you’re in a pandemic, so much is changing within your own institution and within the industry, and I think that really created a burning platform where so many of our staff had questions. They wanted to know things like, what’s the plan? How are we going to stay safe? How are we going to take care of patients? How are we going to make sure we don’t run out of supplies? How do we work with other hospitals from around the state?

There is an endless stream of questions that are really relevant to getting the work done, and so, we tried our best to communicate with our teams through all the mechanisms possible.

Sometimes we held town halls. Sometimes we did video conferences. We used a multifaced strategy to make sure our teams felt informed and knew what was going on.

 

“Returning to my roots”

Gamble:  Prior to UI Health, you were with University of Texas Southwestern, where you held both the CIO and COO role. Can you talk about what it was like to make that transition?

Suresh:  I didn’t have a very traditional route to be a CIO. I started my career in operations, then took a turn into IT. For me, the journey from CIO to COO was more of returning to my roots more than anything else.

But the real reason being a CIO was so meaningful to me and so impactful is that the CIO is fundamentally partnering on virtually every aspect of the healthcare enterprise. Through my decade of being a CIO, I was able to work with colleagues from across UT Southwestern on various initiatives to improve clinical quality and efficiency, improve financial or operationally efficiency, improve marketing, and improve our ability to respond to disasters or open new locations. There are so many different opportunities as CIO to be a partner in that journey; that was really compelling to me.

Before & after the EMR

At the same time, I was CIO during an era in which everyone was doing enterprise EMR implementations. We were no different at UT Southwestern and it was very valuable to be part of the leadership team that was rolling out this very transformational investment in our infrastructure.

From CIO to COO

I think that every healthcare leader from my generation remembers what it was like before and after the EMR. It was a huge moment, and I think that for me, it defined a lot of being a CIO. But ultimately, the transition back to COO enabled me to work on different problems and to add value in different ways. I believed I could make a contribution working in operations and working across departments, like I did as a CIO. Only now, I wasn’t just focused on technology; I was focused on the bedside, on the clinics, on the OR — those areas where we touch patients and ensure we’re making an impact. That was really the basis of the transition.

 

Reliability, efficiency & strategy

Gamble:  Looking at the CEO role, I can imagine you’ve been able to draw from both of those experiences to carve out your own path.

Suresh:  Absolutely. I think anyone that becomes a CEO draws on different areas of expertise in their own personal journey, and for me, I think that I take a great deal from being a CIO. I think CIOs focus on a few things that are taken for granted; for example, how to run a really reliable IT organization where things don’t go down and are always available for the organization.

Similarly in operations, most healthcare organizations are focused on a high reliability paradigm around quality to make sure we are always highly reliable and safe in our practices around patients. Both the CIO role and the COO role have competencies in that.

It’s the same with efficiency. As CIOs, we’re always focused on how we can use resources most efficiently, how we can save money for the organization, and how we can improve throughput. There’s also a big focus on efficiency in the COO role by utilizing staff more efficiently and minimizing wait times for patients.

The third piece that applies to both roles is strategy. You spend a lot of time as a CIO strategizing over how to use technology to help enhance the business; as a COO, you think strategically about how you can transform operations to deliver new clinical capabilities. And so, I think both of these roles were very important in helping me to be successful as a CEO.

 

“Reaching out to peers”

Gamble:  When you made that transition, did you reach out to others who have been in similar situations? What was your approach there?

Suresh:  I did. Throughout my career, whether it’s before I was a senior leader or even when I was a CIO, COO, or CEO, I’ve always had bosses and mentors that have helped me continue to develop, learn new things, and analyze new situations, while also modeling behavior I can use to be a better leader.

The other technique speaks to what you said, which is to reach out to peers who are going through similar challenges or have more experience in a given area. I’ve been lucky enough to reach out to colleagues who were very helpful to me, both with on-boarding, and challenges I faced after I had started. I’ve gotten a lot of really good advice from my colleagues.

 

Focusing on health equity

Gamble:  In terms of your role at UCSF Health, I’m sure there are a lot of areas to focus on, one of which is health equity. What are your thoughts there?

Suresh:  UCSF already has such a rich tradition in focusing on health equity. It’s very similar to what we’ve seen with clinical quality; the IOM study on medical errors in 2001 spawned within the industry a multi-decade focus on the need for patient safety and clinical quality outcomes as a real focus in figuring out whether we are successful as healthcare organizations.

I think the next decade or two is really going to focus on health equity. UCSF is at the forefront in that area and will continue to push forward. There are simpler things to understand like access; making sure patients are able to access healthcare services, regardless of their socioeconomic background, the zip code they were born in or live in, their racial or ethnic background, or their gender identification.

The next frontier is to design healthcare systems that are successful at ensuring all community members have the same outcomes — that’s really the heart of health equity. How can we make sure that our healthcare system delivers appropriately for all citizens who are trying to access the system?

 

Gamble:  One thing we’ve heard is critical when it comes to improving equity is forming partnerships with community organizations. It seems like a lot of the groundwork is in place, especially in California, so now it’s matter of moving that forward.

Suresh:  Absolutely. When we started thinking about clinical quality, we realized that organizations have to collaborate in order to achieve the best clinical quality for patients. I think the same is true with health equity; there are a lot of different organizations that many community members touch, and so it’s incumbent on us to forge the right partnerships and to promote the right kinds of collaboration for the benefit of the community.

 

Gamble:  Right. And finally, when you’re taking on a new role with a large organization, does that affect your approach in getting to know your colleagues and prioritizing?

Suresh:  It does. It’s going to take me a while to figure out the organization. And the only way I’m going to be able to do that is by engaging with my colleagues — learning from them, listening to them, understanding what they’re seeing and facing on the frontlines, and doing my best to support them.

It’s going to be a journey, but one I’m really excited about. UCSF is a wonderful organization. It’s a remarkable community in the Bay Area, and I’m privileged to be part of the team.