Leadership in a competitive market: Cleveland Clinic's Dr. Michael Steinmetz on the trends in spine today + the qualities he looks for in tomorrow's leaders

Laura Dyrda -   Print  |

Michael Steinmetz, MD, is chairman of the department of neurosurgery at Cleveland Clinic. He has expertise in minimally invasive surgery, complex spine surgery, trauma and spinal cord injury.

Here, Dr. Steinmetz discusses how leading a neurosurgery department has changed over the past few years and the big future opportunities for Cleveland Clinic in spine.

Q: How has your role as a spine department leader evolved over the past two to three years? How have your responsibilities changed?

Dr. Michael Steinmetz: If you consider the past few years, it was easier to take your practice for granted. You could turn your lights on and patients would show up. Things were easier. Competition has grown substantially. Insurance contracting has narrowed the market, driving patients to one institution over another. Surgeons are doing more complex surgeries and we are seeing much more regulation from the payer end, and even institutional changes with regards to implant use have made it harder to practice the way we did in the past.

We're moving rapidly into an idea of outcomes-based clinical care as opposed to outcomes -based research. We've had to evolve and as a leader I had to help lead that change. We have had to be much more creative in the marketing space, which is something that I wasn't involved in until recently. We are now focusing more on “customer” service than we did a decade ago.

Q: How do you differentiate yourself in a competitive market when consumers have so many options?

MS: We look at cutting costs, but all systems have done that so we need to do something different to achieve an advantage. We meet regularly with our physician groups and look at opportunities for continuous improvement projects. An example is an operating room block utilization project. We looked three months into the future with the OR and found where we had the opportunity to maximize utilization. That has been an effective way of making sure patients have access to the OR without having to ask for more operating rooms. We don't really need more operating room time, but we do need to use it in a more efficient way.

We have also been active in clinical outcomes research, and that is a shift from examining radiographic outcomes to patient outcomes. We are looking at basing our care on that research and using artificial intelligence as well as predictive modeling to make sure we get the right patient to the right surgeon in the right facility as efficiently as possible, at the right cost.

Q: When you are adding new surgeons and trainees to your team, and what qualities have changed over the past five years in the applicants? What is most attractive now?

MS: When we looked at recruits and trainees five years ago, we looked for people well-versed in basic science and clinical research. Now we look for people with backgrounds in data science and machine learning. Our research is now in big data. We have had a data registry since 2007, and we have to figure out what to do with all that data. We are using AI and machine-based learning to do data analysis of our outcomes and facilities to make that information more predictive. We consider which treatments will be best for each specific patient and whether there are factors that would affect the patient's outcome that we can mitigate. We can also see who the best surgeon would be to operate on each patient to achieve the best outcome.

That's the direction we are trying to go, and I think that's the direction of spine surgery. We've gone from a concept to data science, and we can do that because we're a large academic medical center. The data gathering capabilities will be a limiting factor for small groups. Now we are looking at how we can export the data we have at Cleveland Clinic to other practices and facilities; there are many challenges out there. We are just getting our feet wet in the whole arena.

Q: What changes are you seeing in the payer landscape? How are the financial challenges of the healthcare system affecting your practice and leadership role?

MS: There have been dramatic changes in payer regulation, and a big shift in what we can do. We focus our efforts on understanding the payer changes and being nimble so we stay proactive and document everything we need to document for payer approvals. I wouldn't have thought that would be a big part of my role five years ago, but now we spend time in administrative meetings making sure we stay on top of the care response, understand the payer's rules and make changes as necessary.

Other institutional changes we've seen include the drive toward more standardization within the healthcare system. It's a challenge to convince a group of surgeons that it makes sense to use one single implant vendor. As a leader, we have to show how it benefits the healthcare system and us as physicians. We spend time convincing the surgeons that standardization is a good idea and we will see the rewards of that as a department. Surgeons are less likely to go into private practice today and more likely to work for health systems, so if the health system succeeds, we as surgeons succeed.

Q: What do you consider your No. 1 priority to ensure departmental success?

MS: As a leader, I think the way that I go about this is to have a clear vision in mind. Ambiguity in vision breaks apart a team. We have a clear vision of where we are going and understand why we are going there. It's important to explain the rationale behind the vision and make sure there isn't any confusion. Not everyone will agree with the vision, but as long as we are transparent as leadership to what we want to do and why, people will get behind that idea. The world of healthcare and surgery is evolving.

What we try to do is to have a team of teams; it's key to decentralize a lot of what we do and develop strong leaders who have their own smaller teams that understand the vision and mission to make decisions and changes on their own, so it won't be the control and command model from above.

It can be hard to have dissension in the ranks. Anyone in leadership positions have a group of people who aren't on the same page, and sometimes they are actively working against the process and that can be hard to deal with. But a good leader is someone who can get others on their side.

Q: What is the biggest challenge you are facing as head of the department and how are you overcoming that?

MS: Due to the increased competition in the market, in 2019 we are looking at a strategic goal of expanding our business in regions where we do not have the greatest market share. We are focusing our strategy on areas where we haven't traditionally been the strongest. How do we go into those markets, understand the market and build in that market to provide the same care we do at Cleveland Clinic's central location there?

Cleveland is a flat market. It's shrinking, and most private practices are aligned with health systems already. If I want to grow market share by 5 percent, I have to get it somewhere else. We have to be strategic with our marketing, interaction with providers and relationships with primary care physicians to grow our business. For us, that's one of the biggest challenges for 2019. We are continuously working to innovate the care we deliver and broaden our outcomes-based care in the real world. That will allow us as a business to flourish to a greater extent because if we can provide the most appropriate care for the patient and get the best outcome, that's not only great for patient care but great for business.

Q: Are there any new expansion projects you can discuss at this time?

MS: We are continuously expanding [our] spinal oncology and deformity surgery brand; those are two areas where we are expanding clinical research, but what is new is endoscopic minimally invasive spine surgery. We are aggressively moving into the endoscopic space and offering a niche product for patients who want to fly in, stay at a hotel and undergo endoscopic spine surgery at a nice hospital off the main campus. It's near the airport and will offer a concierge-type service. We are trying to develop that as an aspect of our clinical armamentarium.

Q: What is one piece of advice you would give emerging spine surgeon leaders who aim to head spine departments or practices in the future?

MS: One piece of advice I have is to get involved. We see a lot of surgeons who have been in practice for a while and wonder why they don't have leadership roles. Well, typically it's because every time they are offered a project, they turn it down. Get involved with leading projects and committee work. Leaders are the ones who help develop themselves.

The second piece of advice is to get some sort of advanced education in leadership. It's not necessary to get an MBA; you don't need that to be a department chair, but some education with regards to strategy, finance and operation as well as emotional intelligence is helpful. A lot of this can be done online.

Finally, mentorship is key. Young surgeons should make sure they get a leadership mentor. It doesn't have to be someone in their service, but someone at their institution who will answer their questions and be someone they can learn from. This should be a seasoned individual who has experience leading teams. That person will seek out opportunities for you, and then you have to take advantage of the opportunities when they are available. You can't turn them down. That's critical.


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