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Executive Q&A with Steven Spalding, MD, VP of Population Health at Akron Children’s Hospital

Improving access is perhaps the hallmark challenge for healthcare organizations today. More and more, patients want a care experience that’s as easily accessible as a visit to a retail shop.  And many organizations are struggling to provide it.

We’ve already heard from Steve Spalding, MD, VP of Population Health (and pediatric rheumatologist) at Akron Children’s Hospital. His thoughts on organizational approaches to population health were invaluable. In this installment of Executive Q&A, he continues that conversation by turning his attention to the problem of access in healthcare.


  1. What are you doing to strengthen your relationship with patients in today’s consumer-driven economy?

Here at Akron Children’s we are highly focused on access—focused on providing various routes of access to meet consumer expectations and clinical needs at the same time. The access challenge does not only involve access via brick and mortar, but also includes virtual-health capabilities and access to consumer information (through physical and digital materials). We are also constantly looking at our value proposition and asking ourselves, “How are we different from other health systems that are nearby?” Those two strategies are what we are using as our consumer-facing strategy in a competitor-driven market.

To give you an idea of how competitive our market is: in the state of Ohio we are blessed, as we have multiple children’s hospitals and pediatric specialties. When looking at my specialty, pediatric rheumatology, there are about 350 pediatric rheumatologists in the United States. Ohio will soon have 33 rheumatologists. This means that Ohio has almost 10% of the workforce for this specialty, and as a state we have almost 3% of the pediatric population in the United States. When you are a free-standing children’s hospital in this competitive landscape, and you do not have the luxury of being subsidized by an adult component to your organization, it makes you think in very different ways. We have fantastic partnerships with the other children’s hospitals throughout Ohio. As a stand-alone children’s hospital in this competitive landscape, you have to be thinking about how to best serve your community and how to grow and sustain.

  1. How is your organization preparing for and responding to Millennial consumers?

There are some basic trends around Millennials that inform our approach and strategy. There is a fundamental understanding that Millennials are about access to information. They have grown up with the iPhone, and they expect to have access to information in a very expedient fashion. This translates into access, with the encounter with the provider. Millennials will start to differentiate themselves from other cohorts when it comes to an encounter with a provider. They are more likely to use a virtual visit–type encounter. Millennials are not as invested in coming into the doctor’s office, filling out all the paperwork, and then sitting and waiting in the waiting room for 20 minutes. They want on-demand satisfaction and access to the provider, or to the knowledge the provider has. Using email or text and these types of communication modalities is critical for this generation.

The other thing we are going to see in Millennials is that they will be more likely to seek second opinions. In other generations this is not as common—for example, Baby Boomers are more of the mindset that that they have the doctor they prefer, and they do not question the advice their doctor is giving them. Generation X will do some external verification, but not as much as Millennials. Millennials have access to information and are tech-savvy, and so they are going to compare what the provider is telling them to information they find on the Internet, and then possibly seek a second opinion from another provider.

The other area where they will push the envelope, which I think is fantastic, is in integrative or alternative therapies. Again, Baby Boomers are more apt to take the pill the provider is recommending and not ask too many further questions. Generation X will take the pill as well, but still look at some other things, like whether they should be adding more fiber or going gluten-free. Millennials being very focused on health for themselves and their children, they are looking at medication as just part of their treatment strategy. They will not only take the pill, but they will research and change their diet, and then add in meditation, yoga, or other complementary therapies. They are going to look for providers who offer all of those things: the access to information, the ability to handle them wanting to get a second opinion, and a more holistic approach to care.

  1. As a physician, what are your thoughts on Millennials using the Internet for their research? How can we educate them to use credible sites rather than non-credible ones?

We have a huge gap in the market right now, and in provider awareness. Right now, most providers are just naturally resistant to that type of therapy; however, that will correct itself over time. Currently there is a generational component that plays into this gap, and also a training component—but again, that will correct itself over time. Most providers right now do not want to address this, so they are not going to give that family direction. However, if they do not give the family direction, that is a missed opportunity, because that family is going to go and look for that information anyway—especially if they are Millennials.

I think that forward-thinking organizations are going to be more proactive, and will develop out a strategy for that. When looking at health systems right now, there are not many that are putting forward that type of patient-facing educational material and then directing their patients there, or asking their providers to direct families to their sites. So forward-looking organizations will use this as an opportunity to differentiate themselves and show Millennials how they are really responding to their needs.

  1. How does your organization capitalize on the opportunity to break down silos within traditional healthcare?

Akron Children’s is a fantastic organization and has been around for almost 128 years, and they have constantly reinvented themselves to respond to the needs to the children in Ohio, especially in northern Ohio. One way they have done this is by looking at the organization’s operating model and care model. They have reshuffled and restacked these when the needs of the children in the market have changed. We are doing this again right now; we have a very traditional, academic, division-based structure. We have gained more information about becoming a more integrated practice unit, and want to change our model to be more customer-centric.

One example of how we have become more integrated is the work we have done with adolescent children with idiopathic scoliosis. These are children who have a curved spine that is so severe it requires a major surgery. We had a very traditional model in the past, according to which the treatment of this patient was of a very specialty-specific type. They were all great specialists working with the child, but the specialties weren’t integrated around the patient. We had a champion here, Todd Ritzman, a pediatric orthopedic surgeon, who said there was a better way to do this. He took two years in building a multi-disciplinary team that has now standardized the care for these patients pre-operatively, peri-operatively, and post-operatively. It has demonstrated amazing improvements in the care model. They reduced the length of stay from six days to three days for these patients—the children no longer stay in the ICU, but get up and out of bed on day one to ambulate. They have a very multifaceted approach to pain management; physical therapy is now highly involved. With all of this, we have only had one readmission in two years and no surgical-site infections. The families are so appreciative, and have more confidence in their providers, because they are hearing the same, consistent message from all the people on the care team (surgeon, anesthesiologist, nurse, physical therapist, etc.). This is the model that Akron Children’s is trying to look at and further evolve to break down the traditional silos at our organization.

  1. In what areas do you feel your organization—and your patients—could most benefit from innovation?

The area in which innovation could have the biggest impact on child health is in the reimbursement methodology for providers in health systems. To drive everything from developing more collaborative and integrated care models, to the adoption of alternative and complementary therapies, and ultimately improved access, we have to move away from fee-for-service care. This is the only way we are going to be able to change these things in a sustainable and fundamental fashion. Until this payment model to providers in the health system changes, all this great innovation work won’t have the same level of impact that it could have if we were truly paid based on the outcomes, and were truly accountable for the cost that it took to provide those outcomes. Not a simple answer, but I think that would have the biggest impact.

  1. Why is it important for healthcare providers and executives to embrace transparency?

We have transparency in almost every industry at this point. Healthcare is a service industry, and honestly, we are no different than retail, dining, or travel. When you think about the number of applications and entities that are measuring satisfaction with retail, dining, or travel, healthcare should be no different. Thinking back again to Millennials: they are used to going on Amazon and looking at purchasing a new television. They are able to see all the ratings and reviews from actual consumers. They are also used to being able to price-compare online at different stores. If you want to differentiate yourself in healthcare, and you want to respond to the needs of this Millennial generation—which is going to be playing a larger and larger role in the success and sustainability of health systems—transparency is a foundational aspect of that.

  1. What is one piece of advice you can share with health-system boards or leaders to get them started down a path to make their care delivery more customer-centric?

Have an honest discussion with yourselves and really think about, how you are differentiating yourself from your regional competition. I think the solution for that differentiation often lies in making the organization more accessible and helping consumers make that decision. Ask yourself how much time you are spending on strategies that are just an iteration of the current strategy, versus the time you and your board spend on whatever things can help you transform to be more responsive to consumers and your other partners in your service area. Lots of organizations get comfortable doing what they know how to do. As fast as healthcare is now changing, that can carry you only so far if you are not consciously asking yourself those hard questions and really thinking about where you need to be in the next three to five years that is fundamentally different from where you are today. Those executive teams and boards are leaving their organizations open to being left behind as the pace to change accelerates around them.


Dr. Spalding’s parting words are good advice for any business. Leaders everywhere should carefully consider how they distinguish themselves from their competitors—and this is especially true in healthcare. His call for more transparency and patient access echoes NRC Health’s own recommendations—they’re truly the best ways for organizations to stand out from the crowd.

How is your organization approaching its competition? If you’d like to share some advice, we’d love to hear it. Email Megan Charko to set up a time to talk.