Episode 98

A Graceful Leadership Journey

with Steve Hester, M.D.

February 2, 2023

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Steve Hester, M.D.
Senior Vice President, System Chief Clinical & Strategy Officer, Norton Healthcare

Dr. Steven T. Hester is Senior Vice President, System Chief Clinical and Strategy Officer, Norton Healthcare. He joined Norton in 2004 as chief medical information officer, and has served in a number of medical staff and leadership positions in his time since. Prior to joining Norton Healthcare, Dr. Hester practiced emergency medicine full time, working for Kentuckiana Emergency Physicians to improve quality and volume. Dr. Hester hold’s a bachelor’s and medical degree from the University of Louisville and an MBA from Bellarmine University. He serves on multiple national committees and boards focused on improving the delivery of health care for patients. He also serves on the board of directors of the Christian Academy School System and Leadership Louisville.


The game is about how you get the best talent, to take care of patients, and that'll be the continuing challenge in the future.



Dr. Gary Bisbee: Good afternoon, Steve, and welcome.

Dr. Steven Hester: Thanks Gary. So good to be here.

Dr. Gary Bisbee: It’s great to have you at the microphone. You know this show is about leadership excellence. You’ve certainly displayed that in your multiple year career at Norton Health. What did the young Steve think about leadership?

Dr. Steven Hester: It was interesting. So I was fortunate to grow up here in Louisville, and so from that standpoint I’ve been able to stay at home, which has been great. But you know, one of the things from a leadership perspective really had an interest growing up early, even in high school was. Involved in a number of student government activities. I think back and remember that, I started out, one of the first things I did, I was president of Students against Drunk Driving. And I remember leading a large meeting and somebody leaning over and saying, Hey, as the leader of the meeting, you don’t necessarily need to speak as much and when you’re at the chair, it seems easy to take control of things and run. And so a little life lesson I’ve had.

Dr. Gary Bisbee: When did you become interested in medicine, Steve?

Dr. Steven Hester: I was really fortunate that when I was a freshman in high school, one of the there was a local surgeon here who did the first artificial heart transplant.

Dr. Gary Bisbee: Ah.

Dr. Steven Hester: And he showed up and actually just re recently after he had done that and showed us videos in the OR and everything. And, from that point I was really just fascinated by it. I I’ve always liked science, but really fascinated by the impact. And so I’d say that was a big piece for me to really just to develop the overall interest. And he made an impact on me.

Dr. Gary Bisbee: So were you always interested in emergency medicine or did that come once you worked your way through medical school?

Dr. Steven Hester: Interestingly, I was the first person in my family to graduate from college, and when you look at that I would say that I really went to medical school, to be honest, not even knowing about all the subspecialties. And so learned a lot in that phase as I got there and found out where I had interest. And, I loved the ability to quickly solve problems and be able to move on to the next. And so enjoyed that a lot early in my career.

Dr. Gary Bisbee: For sure. You practiced as. Physician for, I think roughly five years and then went to Norton as a full-time leader as a C M I O. What prompted that move from being a practicing physician to basically a hospital administrator?

Dr. Steven Hester: One of the things I was fortunate earlier in my career is we had a group of about 75 physicians. . And from that perspective, we didn’t oftentimes we didn’t have somebody who really wanted to step up and be the lead for the group. And so there was a leadership position that opened I took on from a managing partners standpoint. And really got involved from a leadership perspective in the practice. And actually did that. And then when I switched into the C M I O role, continued to practice for a number of years after that as well, but at a different pace for sure. And but really just enjoyed the leadership opportunities because, the ability to make a big impact in a different way I thought was something I was really excited about, and somebody who likes change. And so it was a good opportunity to make a.

Dr. Gary Bisbee: You’ve certainly been a terrific leader during your time there. So can you describe Norton Healthcare for us please, Steve?

Dr. Steven Hester: Sure. So we’re, we’re a regional system, health system located in Louisville, Kentucky. We’ve got six hospitals that basically we do about 70,000 admissions a year, about three and a half billion in revenue. And 18,000 employees. We’re fortunate that we’ve got pretty nice density here in this region and a little bit in southern Indiana. We’ve also got the state’s only freestanding pediatric hospital. And so from that perspective, have been fortunate to be able to see growth. know, Over the years that I’ve been here, we started out, I think we had about 145 employed physicians, and we’ve got about 1800 employed providers now. So a lot of growth over that time, and certainly a lot of.

Dr. Gary Bisbee: You’re now. President and system chief Medical Officer, can you share your responsibilities and your priorities for us, Steve?

Dr. Steven Hester: One of the things that comes in first there is just quality of patient care. We wanna make sure we’re doing the right things for patients and for our employees as well, so they can, provide the best care for patients. But from a responsibility standpoint, again, over the years, been fortunate to have a great team of people do a tremendous number of things and big responsibilities, obviously for our practices. We’ve got nearly 300 locations there and that’s a big piece of the work, the service line work have a tremendous responsibility for quality for clinics and clinical operations. Care management, care and process improvement. Got teams who work on those things. Then also really for strategy for the organization. And strategic. That’s been a big part of that, so I’ve been fortunate to be able to have a great team and be able to have a breadth of responsibilities.

Dr. Gary Bisbee: So how have how does the division president separate from the system C M O? What’s the distinction there, Steve?

Dr. Steven Hester: Really just a lot more operational expo responsibilities. When you look at that, it’s more of breaking that into those those individual practices making sure, and again, a lot of that is the way we organize service lines interacts really across the entire enterprise. And when you think about the growth opportunities and what happened in the organization it really does center around that programmatic subspecialty service line structure. And so that’s a big part of that.

Dr. Gary Bisbee: It’s hard to go. Interview with an executive of a large health system without asking about Covid. What toll did Covid take on Norton Healthcare?

Dr. Steven Hester: We were certainly more fortunate than some of the other areas, and there were some places that really got hit hard. But I would say that we did have a really tough battle with that as well. And the challenge I think was just the day-to-day. Operational challenges of knowing if you had supplies, what was going to come next. I We deal with just like this year, a flu or an RSV season. We’ve got experience there. We know what’s gonna happen. I think the unknown was what created a lot of challenges for our healthcare staff, our providers , and I think that beared a toll over a long period of time. On the flip side of that, I would say there were some things that I would say really did were somewhat of a positive one of the challenges where we got very nimble there were a number of times you needed to make a decision and we would action on it the next day. You also looked around and found young talent that you needed to take on a big responsibility and where you might have spent more time, letting them slowly go into that. We just said, Hey, you’ve gotta run and we need the help in going with it. And so those people were able to excel and show their talents. And it certainly was a challenge and I think that we’ve seen. We saw a lot of resiliency through that, but we’re still feeling the effects of that as we go on every day.

Dr. Gary Bisbee: Is there anything special that you can do for the medical staff to try to make things better for them when they’re under all the stress that Covid and now the flu and R S V suggests?

Dr. Steven Hester: One of the things in terms of making sure everybody can. Do their jobs efficiently as possible, I think is oftentimes, in healthcare we have a significant amount of bureaucratic layers that we’re required to do. But oftentimes we make things harder than they need to be. And so from that perspective, we’ve really spent a lot of time looking to say, how do we optimize that workflow? How do we take away some of that burden? How do we look at additional resources that can help, physicians practice and focus on patients rather than some of. tasks and challenges that creep in?

Dr. Gary Bisbee: Let’s look at some healthcare trends in particular, chief Medical Officer, which has been a key role in the large health systems as they’ve evolved. How would you say the C M O role Steve has changed over, let’s say the last 10 or 15 years?

Dr. Steven Hester: Yeah, I would say, traditionally this role I think was much more of the medical. What I would consider, you found a physician who was nearing the end of their career and maybe would say, Hey, do you want to do some things to help us on some peer review and look at some quality metrics and some things of that nature? But I think the role has certainly evolved and I’ve been fortunate to be here during that evolution. And I think a lot of that I think is allowing that role to be much more operat. I think you’re seeing a lot more physicians with the business acumen that are driving and getting even further education on that from that perspective as well. But I think also even on the analytics side, we’re seeing such change from that perspective and the way we’re using analytics and healthcare, that’s a big part of what we do. And I think on the CMO side, it’s more of how you’re translating that analytics to look for operational efficiencies. And then a big part also in the strategic planning because I think it’s so crucial now that you get that sort of physician translation as to what’s happening, in, in the community and how you can be nimble to be successful for a business perspective.

Dr. Gary Bisbee: How are physicians handling innovation in everything from pharmacies to arthroscopic surgery, to technology? Is it. Overwhelming or exciting, or how do physicians look at these major changes in clinical practice?

Dr. Steven Hester: I think it’s, there’s a couple phases of that. First, it depends on what age you are in terms of how long you’ve been practicing. . I think as we age we get probably a little less nimble and and certainly in terms of that and a little farther away from some of the technologies, but, we’ve got certainly as an exam, a great example of that is just the robotics and surgery.

Dr. Gary Bisbee: Yep.

Dr. Steven Hester: clinicians coming out of fellowship and residency couldn’t be more comfortable with that technology. Where folks who’ve been out for a while may still be adapting to that. And I think one of the things that we’re seeing a lot of is subspecialization for all areas. And I think to get to your point about new technologies, new therapeutics, all of that, we’re seeing that no longer can you be the generalist of all things. And even in the specialty side. So you may see in, we see it really obviously in orthopedics. A clinician will come out and focused on hips or knees. They’ll focus on shoulder, they’ll focus on. . And so they want to get that excellence they can to that pro permit perspective. But even in areas like neurology, someone will focus on seizure ms. And so those are some of the things that I think we’re seeing a change where folks are trying to get to a place, clinicians are trying to get to a place where they’re subspecialized and that really allows them to have a greater focus and I think be up to date on new technologies and new therapeutic.

Dr. Gary Bisbee: what does that mean for primary care? Are we seeing. Shortfall in primary care physicians.

Dr. Steven Hester: For sure. We don’t nearly have enough primary care physicians and you combine that and we’re seeing a lot of advanced practice providers for providing that primary care. I think I, I saw a recent statistic that sort of, that showed that 25% of all primary care is happening in an urgent care center.

Dr. Gary Bisbee: Ah.

Dr. Steven Hester: And I think, what we traditionally think of as a relationship for primary care, traditionally we’ll think of, I want a primary care doctor who cares with me and is through me year after year. We’re seeing a change. And right now I think if you are, if you’re under 40 you see primary care as a commodity. It’s when I need it when I need it. When I. . And so a little bit of that, you’re seeing people choose different avenues than you would’ve normally exposed in terms of that. So I think as health systems, we have to be adapting to provide that because there’s a difference in a healthy 45 year old who may need some screenings here and there versus a 50 year old with diabetes and maybe another comorbidity that needs more chronic care. And so if China traditionally done primary care is a one size fits. and I think as healthcare entities, we have to evolve.

Dr. Gary Bisbee: It seems like most graduates of the residencies and fellowship programs are becoming employed big change from 10 or 15 years ago. Is that influencing the, your point about subspecialties? Does the employment model allow them to focus more on a subspecialty or.

Dr. Steven Hester: I think it does. There was a book, and I don’t remember the exact date, but I’m thinking about 2008, redefining Healthcare about Michael Porter, and it’s interesting because one of the things he highlighted in that book was creating disease specific clinics. . And I remember reading through that at the time and thinking how challenging that is to get that to function in that way. But I do think we’re starting to evolve that way now with employment models because you’re finding patients with a primary chronic disease process and saying, how do I get them into the most efficient model of care? And a great example of that is patient with ms. They’ve got clinics that are subspecialized there with not just the neurologist who’s doing that subspecialization, but someone who helps manage the other portions of that disease. And we’re seeing that happen in the employment structure. And I think that does drive individuals to have the opportunity to be more subspecialized. Then maybe they would’ve been certainly in a primary, in a PR private practice. You wouldn’t do that with those support resources or be able to financially sustain it?

Dr. Gary Bisbee: Let’s look at the EMR for a moment because it relates to this discussion. Is the E M R actually changing the practice of medicine, Steve?

Dr. Steven Hester: I think it is. I think it’s in a number of ways and I think we are still, one of the things and there are some to take that no one should take this wrong, but there are some great EMRs out there to do great things. I think when I think of the evolution of the EMR right now the challenge is if you’ve ever seen NBA A two K it’s a fun game. Fun game, great graphics, everything works great on it almost looks like a real game. We think that the EMR should be that advanced. The challenge is the emr. In terms of EMRs I feel like we’re still at the pong stage. And we’re advancing and I think it’s advancing really quickly. But you think about things about how we document, we’ve still in that phase where we took paper charts and created the paper charts in an electronic format. And that next evolution of things I think will certainly change for providers. Whether it’s how we do dictation to text, or how we do video documentation. All of those pieces are going to evolve, as storage capacity increases and things of that nature. I think right now the E M R is still a bit of a challenge in a practice setting for providers because it puts a significant burden on documentation and I’m not sure we completely get the value out of all of that documentation. I do think one of the things that, certainly the portability of the information’s incredible. You don’t no longer have a single chart in one. Patients have access through patient portals they’re able to get that access instantly. They get results instantly. So I think there’s so many positive things there, but we’ve got a long way to go in terms of, I think making it a great process for us.

Dr. Gary Bisbee: To the consumer, access to the portal and the information, is that allowing? Norton to be more responsive to consumer and get them more involved.

Dr. Steven Hester: Absolutely. And I think, one of the great examples I’ll give on that is, we want, our goal is to get a mammogram result to a patient really in less than an hour. and we’re close to that, Abby. We’re right there on the cusp of that. And it’s, how do we do that in such a way that, a woman comes in for a mammogram and the worst part about that is the anxiety of knowing you’ve had that exam, not knowing the result. And so how do we get through that process quickly for all patients as they come in? And so I think you can replicate that in a number of areas, but that’s a great example of where the EMR is offering efficiency for. And I think that rapid access to results really does change online scheduling, great opportunity in terms of patient efficiency. And so we really do need to work as we continue to see how we minimize that chaos and challenges for patients.

Dr. Gary Bisbee: Looking at large cap companies like C V s and Walgreens, Walmart now Amazon, that are elbowing their way into primary care. Does that concern you, Steve?

Dr. Steven Hester: And I think from a competitive standpoint, those are great. They make everybody better. We’re all looking for new ideas and new innovations, and so I think it advances markets. I think the challenge is , it does get hard when you picked certain pieces off of an overall business entity. To give you an example, I was talking with a large group of CMOs earlier this week and we talked about investments in the underserved areas and the importance of that. We’re making a significant investment in a hospital, in an underserved area of the community. , and that’s very important for the health and wellness of those patients, as well as the wellness of our community. But that happens when you have an entire ecosystem of care happening in terms of the way reimbursements function. And so that’s an important piece for us to be able to look at that ecosystem. And when you, I think oftentimes you find that areas that are making huge investments pull off those areas that. those investments in underserved areas and and for care that’s needed for individuals who have difficulty with.

Dr. Gary Bisbee: Yeah, it certainly seems to give physicians another option. What’s your thought about that and are the physicians happy at C V S and Optum and so on?

Dr. Steven Hester: I think, again, I think part of it is we’re seeing it more than ever, not just with physicians, but with nursing. Every techs, every employee. We have that through the pandemic. I think we’ve all reset. What work looks like. And, based on that, everybody’s still trying to figure out what they want from a work perspective. And so I think there are a number of individuals. A great example of that is behavioral health. One of the things we saw during the pandemic was that behavioral health really did take off from a telemedicine stand. I think there are a lot of great things there because some individuals aren’t comfortable talking in person and you can do some things over a screen for privacy. And so I think you’re seeing an area where those individuals who want to deliver behavioral health via telemedicine are able to do that. And so I think we’re gonna see that a lot of these, a lot of these groups are trying to find individuals to attract talent see what they can. and I think everybody’s gonna be vying as we have for years. Every game is about how you get the best talent to take care of patients and that’ll be the continuing challenges in the future.

Dr. Gary Bisbee: So Steve, this has been a terrific interview as we fully expected. I’ve got two last questions if I could. One is, and I’m sure you’re asked this all the time, what advice do you give for young people that might be interested in medicine when they come to you and ask you that question?

Dr. Steven Hester: One of the things for me is there’s nothing better than taking care of patient. There’s no better reward when you go home in the day and know that you’ve made an impact to change somebody’s life. And I heard a speech a number of years ago from it’s been on YouTube’s viral. It’s Admiral McCraven giving the commencement address at University of Texas. And one of the things he talks about is if you wanna change the world, and, and he really focuses on you do it one sort of one person at a time. And I think there’s no better place in he. than healthcare than to say that you can make changes and you can change the world one person at a time. And I think it’s easy for individuals to say, Hey, it’s stressful, it’s challenging, and it is. But it’s very rewarding because there’s no better thing to do than to make an impact on someone and share your talents to help make a change in.

Dr. Gary Bisbee: Same question about healthcare leaders. Coming leaders. Steve, what advice do you give to those who come to you for advice on how to proceed in their career?

Dr. Steven Hester: One of the things for me first, and I think they’ve gotta be comfortable with change. It’s one of the things when you think about healthcare, we’re constantly evolving. It feels like there are a lot of similarities, but there are constant changes and , you’ve gotta be a comfortable as a change leader. And I think that’s one of the things that, that is very hard. It’s hard to get individuals to follow you when you’re constantly trying to innovate and make change. And so to me, that’s one of the things that I think is gonna be important for anyone that’s a leader. And then one of the things that I’m constantly reminding my my team about is to make sure that if you want grace, as you’re going through your leadership journey you need to be sure you give grace because there is a lot of challenges that are ahead and you can only do that with great people around you. And so making sure you’re focused on that’s gonna be so important.

Dr. Gary Bisbee: This is great, Steve. Thanks so much again. We really appreciate your time today.

Dr. Steven Hester: Thanks.

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