Q&A: UH Chief Strategy & Innovation Officer David Sylvan on Removing Barriers to Access

It’s not exactly a stretch to say that the American healthcare system is flawed, with seemingly endless questions to answer and gaps to fill. The good news is that there’s a great deal of interest in solving those problems, largely through technology.

The downside is that not every idea — or startup, for that matter — is ready for primetime. For healthcare leaders, the challenge is in identifying the solutions that “drive definitive, sustainable, and scalable value to the way care is delivered.” That’s where programs like UH Ventures, the venture capital arm of University Hospitals, hope to make a mark by “identifying opportunities that can be commercially viable and be worthy of a platform,” said David Sylvan.

There is, however, both an art and a science to that. “We have to be very discerning when it comes to ensuring that the solution has a well-defined problem associated with it,” he noted in an interview with Kate Gamble, Managing Editor at healthsystemCIO. “We need to make sure we’re matching the opportunities we’re looking at with strategic imperatives and it’s not a spaghetti against the wall approach.”

In addition to his role as president of UH Ventures, Sylvan also serves as Chief Strategy & Innovation Officer for University Hospitals, where his team is focused on three core pillars: patient access/experience, transitioning to value-based care, and right-sizing through optimization. During the conversation, Sylvan shared his insights on what it takes to foster innovation; why he must be “joined at the hip” with UH’s CIO; the approach he utilized to become immersed in healthcare; and why outside experience is so important.

LISTEN HERE USING THE PLAYER BELOW OR SUBSCRIBE THROUGH YOUR FAVORITE PODCASTING SERVICE. 

Podcast: Play in new window | Download (Duration: 25:07 — 14.0MB)

Subscribe: Apple Podcasts | Spotify | Android | Pandora | iHeartRadio | Podchaser | Podcast Index | Email | TuneIn | RSS

Bold Statements

We can use tools and technologies to identify blank spaces in schedules, but we can’t always just jam every blank space with an appointment. We have to be cognizant of the provider’s needs as well. Threading that needle between the payer and the provider experience is sacrosanct.

We have to be very discerning when it comes to ensuring that the solution has a well-defined and sufficiently audacious problem associated with it. And so, we look to areas of the organization where we solicit problem statements and ask, how might we help you solve them? They fill in the blanks and we source against those.

We have to be prescriptive about what we’re looking to solve for — the milestones to attainment, and the measurement and reporting against those milestones once an initiative has gone live.

Six months came and went, and I fell in love with the mission of what we were trying to achieve: impacting communities and families. It’s a very humbling, powerful opportunity.

If we don’t chip away at these problems with discernment and with aggression, they will create an existential threat for us. We will be disintermediated out of the continuum, so to speak. And so, we have to stay pretty relentlessly focused on being our own change agents.

Q&A with David Sylvan, Chief Strategy & Innovation Officer, University Hospitals

Gamble:  Hi David, thanks for joining us. I look forward to speaking about some of your core objectives, what you’re doing with UH Ventures, and what it takes to build a culture of innovation. So, for some background information, UH Hospitals is a system with 21 hospitals, including 5 joint ventures and 50 health centers. And you have a big geographic span. Does that cover it?

Sylvan:  Yes. We’re in about 20 counties in Northeast Ohio. We have some offshore affiliations with the likes of the Oxford University in the UK, Technion in Israel, and other places centered on specific disease stages or focus areas. But we’re primarily in Northeast Ohio and are roughly a $6 billion system.

 

Gamble:  And you’re chief strategy and innovation officer. Can you talk about some of your core responsibilities in that role?

Sylvan:  Sure. This is a new designation. We had a chief strategy officer and a president of ventures, that was me. The construct and concept was upon the announcement of my predecessor’s decision to retire, we would look for ways to contemporize the manner in which we impacted strategy from a system level. Primarily using the discipline engine of our innovations platform, which is very focused on gathering insights and using that discipline engine to, instead of merely acquiescing to the next opportunity that comes through the front door, take a disciplined approach to defining from either a time to value, impact, quality quotient, the sequence with which we would conduct our strategic initiatives. Teasing out those areas that we should over-index and double down on because we have a differentiated offering. By the same token, identifying those areas where we might need to consider deselection, because either we didn’t differentiate it or it’s not an accretive offering for our patients or our providers.

It’s thinking very mindfully about partnerships at large — strategic partnerships, not just from a healthcare lens perspective, but partnerships with industry, either from the perspective of harnessing their core competencies, perhaps back-office areas where we aren’t as efficient as we could be, or thinking about point-of-care solutions and technology enablement to help change efficiencies and throughput.

It’s also non-traditional partnerships. We don’t always have to think about healthcare industries and systems, but how might we work with aerospace? How might we work with large industrial or other areas that might have already begun to solve for some of the challenges that we still face and have not yet perfected.

 

“A strange business model”

Gamble:  That’s a really interesting area and something we’re seeing more of now as far as partnering outside of healthcare. As you said, there are a lot of problems that have been solved, but of course, healthcare comes with its own set of challenges. So there has to be a balance.

Sylvan:  Well, we are a strange business model, right? We don’t have a purely traditional arms-length relationship with our clients, our patients. They’re the intermediaries, like the payers, like government, like pharma — those intermediaries wield potentially disproportional market strength. And so, at times we’re attempting to negotiate and play the appropriate intermediary whilst not allowing patient care quality and outcomes to degredate. But in other areas we’re negotiating for our very survival because our source of payment comes from at least two of those three sources. So, it’s a bit of a nuanced walk.

 

Pillar #1: Access & experience

Gamble:  That’s putting it lightly. So, what are some of your core objectives right now?

Sylvan:  We’ve distilled it down to some primary areas of strategic importance that are near term. First, this notion of access and experience. How do we avail our patients of the appropriate care from the right provider at the right location in a manner that’s accessible and attainable for everyone? And how do we ensure, therefore, that we use the finite capacity of our providers, our clinicians, physicians, nurses, and others to ensure that their experiences in those interactions are optimized as well? We can use tools and technologies to identify blank spaces in schedules, but we can’t always just jam every blank space with an appointment. We have to be cognizant of the provider’s needs as well. Threading that needle between the payer and the provider experience, I think, is sacrosanct.  

And it will help us from the perspective of creating this differentiated offering. Pay delivery by and large is relatively ubiquitous. I mean, there are some exceptions from a quality perspective, but how do we remove barriers to access? How do we make sure those offerings are equitable? How do we ensure that we’re committed to compassionate, thoughtful, and respectful care? So that would be an area.

Pillar #2: Value-based care

Another area is how do we transition — and it will never be 100 percent — toward value? How do we appropriately move from purely fee-for-service into an environment that deploys our capabilities, maximizes our value for our patients, and enables us to take more holistic ownership of lifestyles, reaching back into the home to impact wellness versus merely waiting for someone to show up when they’re on the threshold, whether that be the emergency room or otherwise. We continue to bolster a version of primary care that enables digital tethering and digital connectivity. That’s an area that we’re focusing on, and it includes our relationships with our payers. Are there novel relationships we might be able to co-design to create that value quotient for our patients?

Pillar #3: Right-sizing through Optimization

The third area is optimization through rightsizing our offerings and our footprint. As we’re doing the expanse of bricks and mortar, we can try to create volume centers and areas of coalescence between specialties to enable one-stop shopping for our patients, versus the dispersed offerings that many of our systems have ended up creating, some by M&A and some through happenstance. Are there areas of our overall clinical offering that we think we aren’t differentiated in? And how might we begin to deselect against some of those whilst we over-index in areas where we do have a differentiated offering? Those are some of the areas we’re thinking about when it comes to rightsizing through optimization.

 

UH Ventures

Gamble:  So, certainly a lot there, and it’s obvious with everything you’re doing that there’s a strong need for innovation. Can you talk about UH Ventures and how that is structured?

Sylvan:  Ventures was originally conceived to be the commercialization and investment platform for the system. That includes our own intellectual property, our technology, and the technology transfer and commercialization of our IP, either wholly on our own or in partnership with some of our affiliates like Case Western Reserve University. What are the opportunities that will rise to the occasion of being protectable, of being commercially viable, of being perhaps even worthy of platform or company formation? That’s an area. And of course, it bolsters our academic mission, and continues to reinforce the culture of innovation and entrepreneurism.

The corollary to that would be outside it. We can’t solve for all of our problems. How do we forge and form relationships across the country and internationally with entities that we would be deemed to be at the top of the proverbial funnel? How can they be our eyes and ears when we’re looking to solve for a very specific high value problem? What is in their respective portfolios that they can show us against which we can adjudicate the efficacy of that company’s offering against the magnitude of our problem statement? We would then work to effectuate that proof of concept or that trial or that pilot agreement.

We’re also looking at, is this an investable opportunity? So, we keep multiple eyes on the same opportunity as it funnels through our continuum. That, in essence, is what the Ventures platform does. Think of it as capital deployment, as company formation, and as facilitation for strategic partnerships.

 

Filling in the blanks

Gamble:  I would imagine it runs the gamut in terms of what has come out of it. Can you talk about some of the solutions or initiatives that have emerged or that you’re looking at?

Sylvan:  We see about 500 opportunities a year. If we didn’t put up some stage gates, we’d try to do something with all 500 of them, because they all look great, but we can’t do that. We can do maybe 7 of them. And so, we have to be very discerning when it comes to ensuring that the solution has a well-defined and sufficiently audacious problem associated with it. And so, we look to areas of the organization where we solicit problem statements and ask, how might we help you solve them? They fill in the blanks and we source against those.

We really make sure we are matching the opportunities that we’re looking at with strategic imperatives, and it’s not a spaghetti against the wall approach. There are certain areas we look at from a clinical focus perspective, whether that be cancer or heart, etc. We also have a strong degree of focus on orthopedics and sports medicine. Other areas might not represent the opportunity for a meaningful enough impact. We can use that filter to determine the things that we could, should, and want to work on.

 

Catalyzing discussions

Gamble:  That’s really important. I had read that one of the objectives of UH Innovations is to catalyze discussions between UH and the community. How are you approaching that?

Sylvan:  We are very actively participating in and encouraging partnership with other entities, whether that be from a co-development perspective or a co-diligence perspective — and certainly from a co-investment perspective; we do that all the time.  But the modality is for us to impart knowledge.

And so, we will convene forums. We’ll partner with other entities who are standing up very issue-specific forums, and we’ll participate in those. We’ll provide subject matter experts or key opinion leaders. And it has a dual-fold impact of amplifying our brand and awareness of our presence, but also there is a give-back component in terms of imparting that knowledge and inviting others to partner with members of the ecosystem, and it’s been successful. We have formal partnerships with a number of entities locally and regionally, some in the funding continuum, some in the product development space, and some in the peer ideation space. They become sort of an extension of our bench, and to some extent, vice versa.

 

Gamble:  In our discussions, we’ve found that innovation arms and idea-thons are becoming more common, but the challenge seems to lie in what happens next. What are your thoughts there?

Sylvan:  If it’s open-ended and it’s unbounded, we’re going to be building a whole bunch of very pretty bridges to nowhere. We have to be prescriptive about what we’re looking to solve for — the milestones to attainment, and the measurement and reporting against those milestones once an initiative has gone live. And without being presumptuous that we’re going to bat 1,000, because we’ll never do that. Inaction or inappropriate action are both evils we want to avoid. We’d rather get out of the gate with some activity, gather insights, glean the data to determine if a pivot is or rework is necessary, and effectuate progress and momentum in that regard. But stay with the opportunity post-go-live, post-implementation, so that there can be a report-back loop, either assessing viability against originally stated goals, or informing that a different outcome might have been more opportune.

 

“Joined at the hip” with the CIO

Gamble:  Of course, all of this requires a great deal of collaboration. What is your relationship with the CIO of University Hospitals? How often are you in communication?

Sylvan:  We’re joined at the hips, and I’ll give you a very simple example of why. We, as a healthcare system, cut over to Epic in the last six months. We were an Allscripts shop prior to that. You can imagine the two years of run-up just to be in a position to put a system of our size onto Epic. That meant we had to be joined at the hip with our CIO and his team to ensure that we weren’t merely looking to introduce new IT tools and technologies that might potentially be eventually solved for by the Epic suite, and/or take time and bandwidth away from his team as he was thinking about this all-hands singular priority. It meant we had to be very in sync with the manner in which he was thinking about rollout and cadence — including which modules would go live and when and which service lines would be impacted — so that we could begin to spectate where there might be white space for us to create valuable suggestions and offerings versus attempting to get the next piece of nondescript software into workflow. It really requires that we be very closely coordinated in all things with our CIO and his team.

 

Gamble:  That’s obviously a big undertaking with Epic; you don’t just put it in and walk away.

Sylvan:  Not at all. You have to think about stabilization, and you have to think about optimization. We placed some very aggressive value attainment parameters and goals around what post-go-live would look like. I’m pleased to announce, although we’re only live for five or six months, we’re already beginning to see material lift. Granted, we still have things we need to work on tweaks still to be made, but we are already beginning to glean the benefits of this cutover. And of course, staying vigilant and not just assuming it’ll be self-running and self-sufficient is important. And continuing to keep very tight and close lines of open communication with our clinical and operational teams, obviously with the CIO’s office standing in the middle and as the conduit to the support that we’ll get from Epic themselves.

 

Gamble:  So that’s still pretty new. But at this point, what are you doing about the functionalities that aren’t yet offered by Epic. I’m sure you want to stay in suite, but it’s not always possible.

Sylvan:  If someone sells you a tool or technology, of course they’re going to imply that they can do it all. Now granted, there are many things on the Epic roadmap, but we have to balance that. Something might be on the roadmap, but do we have the 7 months to 2 years to wait for it? Should we put in a solution in the interim as a stopgap? Should we put in a solution right now as the permanent patch and perhaps move on for what might be ultimately developed by Epic? That’s more art than science, but we have to be realists as well, and waiting too long for something that might not happen is potentially detrimental.

 

Coming to healthcare

Gamble:  Especially when you’re talking about access and patient experience, which are so incredibly important. So, you’ve been with UH since 2015. Was this your first role on the provider side?

Sylvan:  My first role in healthcare, Kate. I came from professional sports for a decade with a company called IMG, and I followed that with about 15-16 years in investment banking and capital markets. This was my first foray into healthcare period, any side of the proverbial table.

 

Falling in love with the mission

Gamble:  And what made you want to make the move to healthcare?

Sylvan:  I had my own consultancy practice. After I had left the investment bank, I was teaching at a local university — actually it was our affiliate partner, Case Western Reserve — on an adjunct basis in the business school. My consultancy practice caught the attention of certain individuals; they wanted me to come on board to assist with a six-month discreet engagement, which I did. Six months came and went, and I fell in love with the mission of what we were trying to achieve: impacting communities and families. It’s a very humbling, powerful opportunity to acknowledge and absorb as a non-clinician. And that really appealed to me from a mission and a true north perspective.

 

Gamble:  I guess it could go one of two ways when it’s a six-month engagement.

Sylvan:  That’s correct. The enormity of what you have to learn in order to understand the complexities of the back office of healthcare, and go from being the patient to being the provider, is a monumental leap.

 

Gamble:  I’m sure that given your background in banking, there were lessons you were able to draw from and apply to this role.

Sylvan:  No question. You want to bring the pace of business, the pace of for-profit business discipline, to the table, which is far easier said than done. You want to take a little bit of the appropriately sized risk acceptance mantra into the role, especially on the innovation side, never taking our eye off patient care, patient quality, and patient safety, of course. But there are certain areas that might be deemed to be more back office and support where you can take more of an aspirational view. And so, it’s really trying to bring a little bit of the pace of for-profit business into the manner in which we think about effectuating change in our platform.

 

“Relentless listening”

Gamble:  What about healthcare and all of its nuance? What was your strategy for learning and understanding that?

Sylvan:  You know, it’s relentless listening. It is being relentlessly inquisitive and not making any presumptions or assumptions. It’s surrounding yourself with people who do have deep domain expertise and then candidly enabling them to do what they do, providing lead blocking for them, and getting out of the way. But I think open, honest, and discerning information sharing is probably the best manner in which we can think about being change agents when you don’t come from the space.

 

UH Ventures’ unique opportunity

Gamble:  What about taking on the role as president of UH Ventures? What made you interested in that?

Sylvan:  I think the role with UH Ventures offered me another chance at team building. I’ve been successful in building teams with other organizations, and I was now being asked to play a similar role in a relatively nontraditional sense. A fair number of the early team members did not come from healthcare, and that was by design. It was an opportunity to bring diversity of thought and disparate opinion to a business model that candidly did need to be challenged and to bring the discipline of human-centered design to the way in which we think about problem identification and sizing. That notion of building a new team in a new environment was very, very appealing to me.

 

Gamble:  And I would imagine the learning never stops; you’re still learning.

Sylvan:  Every single day. With some roles, we hear that every day starts to blend a little bit and you can mail it in or you can go on autopilot. I’m nine years in and I couldn’t even think about trying to do that on any particular day. As long as that’s the pathway, I’m in it for the long haul.

 

“Chipping away” at healthcare’s issues

Gamble:  Clearly there are a lot of things that need to be solved in healthcare. For someone in your position, is that difficult to face, or is it part of the challenge? Maybe even part of the appeal?

Sylvan:  I think it initiates the appropriate threshold of positive anxiety. There are so many things to solve for, and you can’t do them simultaneously. And so, you have to use that sort of adjudication between speed to impact and the value of impact to assess sequence. But one thing is certain; if we don’t chip away at these problems with discernment and with aggression, they will create an existential threat for us. We will be disintermediated out of the continuum, so to speak. And so, we have to stay pretty relentlessly focused on being our own change agents and bringing about our own disruption, some of it generated internally and some of it attracted from the outside, in order to remain viable.

 

Gamble:  And celebrating those wins, right? Even the small wins.

Sylvan:  Absolutely. Not all the wins have to be a swing for the fences, but you have to use the power of story. And the power of story from a ‘could have, should have’ perspective, using concentric circles approach to disseminate those learnings so that they can inspire and induce the next actions.