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'Our challenge is to proactively change ...'

By Dr. David C. Pate, News and Community
January 22, 2013

I’ve asked St. Luke’s Health System Vice President for Clinical Integration Dr. Geoff Swanson to share his perspectives on the transformation of care. His thoughts are presented here. You’ll be hearing more from Dr. Swanson and other members of our executive team in this space in the future.

Having the opportunity to transform health care with St. Luke’s is what motivates me for many reasons. One of them is because I started life at St. Luke’s.

I was born at our Boise hospital and have come full circle; I now have privileges there as a primary care physician, and I also serve as St. Luke’s Health System’s vice president for clinical integration and president of the Select Medical Network of Idaho, Inc.

Working with and for St. Luke’s makes good sense to me. I like the challenge of improving health care for the benefit of my community. This is my home, and changing things for the better where I grew up is powerful. 

I graduated from Borah High School and the College of Idaho in Caldwell, continued my studies through a combined M.D./Ph.D. program at the University of Utah and Washington State University, and completed training at the University of Washington. 

I put myself through college by working as a mechanic at an open-pit lignite coal mine in Texas. At first, this might seem like odd training for a physician, but in reality, the experience is not as different as you would think. There are a lot of similarities between understanding how machines work and function and how we human beings work and function. 

I’m a detail guy, a reductionist. It is how I think about things, from the smallest component up, thinking about how it all comes together and what potentially could go awry. It’s at the core of who I am. I have to understand things from the grassroots level, and that’s what I’ve tried to do in health care.

I’m a primary care doc, but with a detailed basic science research background. I have experience in insurance, working in administration, and across the functions of health care, and I’ve come to understand a lot about how care could be delivered better and what functions a true delivery system must represent. 

I returned to Idaho to be in primary care practice, and started working with St. Luke’s in 1993. With eight other primary care practices, I formed the Select Medical Network with St. Luke’s in 2001.

The network was very ahead of its time. It was created to deliver on the quality and value of care, elements that only now are becoming an area of focus across the country. In 2008, I took on other management functions with St. Luke’s Health System, largely to put the ideas of the network into operation across our System and across the region. 

The network and the network philosophy are about patient care and new ways of doing things, as is my philosophy. My outlook, from the detail to the global, is different than that of many in health care. But I think health care needs a look from outside of the box if we are going to be successful at being proactive and in front of the disruption that the economics of health care is forcing. 

I’m a primary care doc, so I have a connection to people, to patients. I’ve spent my life doing that. I’m a regular guy, and I think that’s part of the perspective I bring. I have a ranch. I step in cow manure. I change my own oil. I can weld your car back together. (In high school, a friend and I rebuilt VWs, many of them and all from pieces, which also has informed my perspective.)

I think I understand most of how health insurance works, how finance and administration work, how care works, how people sometimes need care and how sometimes they just need reassurance, and how end of life works. Maybe I’m not an expert on anything, but I have a unique perspective on how to transform health care, and of all the pieces that are necessary to do that.

And all of it needs a fresh look. Most health systems have never thought about doing health care for populations. To do that, we need to transform how we do health care. Now, it’s really just sick care —care after the fact, and largely based on measures that sometimes are not important to patients.

I think about my practice experience. We tried to have a core philosophy about care built on seeing patients only when needed. It was a team-based approach, and we did lots of things over the phone. Nurses worked at the top of their licenses. And we had a very large population of patients, most of whom I think we helped.

We weren’t necessarily good at measuring things, but we were as efficient, cost-effective, and clinically appropriate as we could be. We treated an admission to the hospital as a failure of outpatient management, and held ourselves accountable for these events. If someone got a pneumonia, we’d ask ourselves, “Why did this happen?” “Did we miss an opportunity to intervene?”  

I believe that basic core philosophy — that of being accountable for a population — is transferrable to systems of care. And I think it’s beginning to happen. But it’s change management, and this is the most difficult of tasks. Our challenge is to proactively change, and health care has traditionally been a reactive industry.

That’s a lot like people. Some are proactive, but many only do things reactively.

And so that’s the question for us of St. Luke’s, and really for our community and all health care stakeholders. Do we have the intestinal fortitude — the guts — to proactively change? Can we mutually cooperate for the benefit of all of us, to execute on our St. Luke’s mission to improve the health of people in our region?

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.