First installment of a new video series in which retiring health system CEOs reflect on the changing healthcare landscape and the challenges that await the next generation of healthcare leaders.
Today, we bring readers of Chief Healthcare Executive™ a new video series, Turning Points, which invites retiring health system CEOs to reflect on the revolution they have witnessed in healthcare, the growth of healthcare technology, and what challenges they foresee for the next generation of healthcare leaders.
Our first guest is David Spillers, who will retire this month after 40 years in healthcare, including the last 15 as CEO of Huntsville Hospital Health System. Spillers has seen his health system grow from a single hospital to a dozen and seen revenues multiply five-fold, all while reaching smaller communities in Alabama.
This transcript is lightly edited for clarity.
Chief Healthcare Executive™: As you retire from Huntsville Hospital, what initiatives are you most proud of?
Spillers: Building a system—it’s got to be right up there at the top. When I got here, we were basically one hospital, [and] we just added our 12th this week. So, [there’s been] some fairly substantial growth.
We've gone from net revenues of about $400 million to just over $2 billion. So, [there’s been] substantial growth over those years. And I'm proud of that because we're public, not-for-profit. We've been able to really go out into the region, and a lot of these smaller communities wouldn't have health care if we hadn't reached agreements to work with those communities and bring those hospitals into our system. So, I’m very proud of the fact that we have extended the reach of health care, and we're trying to meet the needs of multiple communities.
CHE: If you could select one major healthcare advance that you knew would be important as soon as it happened, what was it and why?
Spillers: When you ask that question, I immediately think of something clinical, and I'm not a clinical person, certainly not a doctor. But I'll never forget the first conversation we had about transaortic valve repairs—TAVRs—and thinking about the change of opening someone's chest to do valve repairs versus going through a catheter, and how that would change cardiac care.
But then, [there’s] the thought of, as I've watched it develop, the numerous things we can do using catheters as opposed to opening up the body to do procedures. When TAVR started, it was experimental; there were very few patients that we would do it on. But as with most things, once it proved to be effective, and the price came down—which happens with that type of new procedure and technology—a lot of people were benefiting from very minimally invasive procedures that at one time were major procedures.
CHE: Conversely, is there something that happened in healthcare during your career that was dismissed as unimportant early on, that turned out to be extremely important—for good or ill?
Spillers: So, this one affects healthcare, just as any other business.
You know, I've got an IT background, so you would think I would have thought about this. But the iPhone really changed everything in healthcare and every other business. But I look at what we do today, I looked at the past year with COVID, and the way we communicate, the way we work in different locations, and how much more productive we are now and how much easier it is to communicate with people. And I think that really started with the iPhone.
The other [would be] handheld computers, which today are so unbelievably powerful that I can be anywhere having this conversation with you. I could be between meetings having this conversation with you.
And I think when used appropriately, not only does it make you much more efficient than I ever thought we would be, but there’s virtually no reason not to be able to communicate information to people in a very, very quick way. And that's important for a variety of reasons, right?
CHE: What are some challenges you’ve faced during your career? How did these challenges impact your leadership?
Spillers: I've thought about this question, and there's been a variety of challenges. I mean, we just got through COVID, which was something that none of us had ever experienced before. Clearly there was no playbook for COVID—we didn't know what to do in a worldwide pandemic. And I learned from that process—or at least it reinforced what I thought I knew in that process—and that is when you have built an organization with really bright, talented people in times of crisis, they get very creative and do whatever it takes to get the job done.
And I would expand that, too. In my career here, the 15 years I've been here, we've had at least four major healthcare incidents. We had a huge bus wreck, we had a major mass shooting, at one time. We had tornadoes that came to our area and pretty much devastated us—took our power away for almost a week—and devastated a lot of homes, injured a lot of people. And then COVID. And again, in every one of those, you got to plan but you don't follow the plan. You do whatever it requires at that point in time, and [the] people that you least expect to show up to help, show up to help. And it gives me faith and optimism in the human race, because whenever there's a problem we all seem to put aside our differences and help other people. It's just too bad that we have to have a crisis for people to do that.
CHE: Can you discuss the growth of technology during your time in healthcare? What has been good—and not so good—about the growth of technology in healthcare?
Spillers: I think the move from invasive to minimally invasive [procedures] in a variety of areas. And we just talked about TAVR, we could talk about interventional neuro [and] interventional radiology and the ability to take stroke patients and get the clot out very quickly so there's no long-term damage. And now we're doing joint replacements in an outpatient basis and sending people home the same day.
Technology is certainly allowing people who previously may not have been strong enough to have surgery to have procedures. So, it's opened up healthcare to other people; it's allowed people to recover quicker, get back to work, [experience] much less pain and much shorter recovery times. I think all those are very positive for the people and for the hospital because we can get people through the system quicker.
I think the downside is the cost of that technology. It's just hard to imagine how we're going to be able to afford healthcare in the future, because every time one of these technologies becomes available, it quickly becomes the standard. And then the requirement to capitalize the equipment you need and the supplies you need to do those types of things can be massive. If the reimbursement takes a long time to catch up, and if it does catch up, then you've got the whole insurance issue. How does insurance pay for a procedure that used to be $10,000 that's now $30,000 because you're using a $2 million piece of equipment [and] $2,000 worth of disposable [supplies]? So, somewhere along the way, our country's gonna have to rationalize all that benefit versus cost, and how we pay for it in the long run.
CHE: What changes to the use of technology would you recommend?
Spillers: We're in an environment where, and I can give you this whole discussion on healthcare economics, why I think costs are way too high in healthcare. But, if somebody comes out with a better device, or perceived better device, physicians have to adapt to that better device or patients will go there under the perception that it's better. So, that gives vendors a lot of leverage on the cost side of what they charge.
And, you know, I don't know the best way to fix that. I wish I did. If I did, I could probably go on the road and make a fortune after I retire from this job. But again, as to one of those things I think that [the] country is gonna have to address over the next five to 10 years, we do not have an unlimited amount of money to spend on all this new technology. [It's] sometimes very beneficial, but sometimes it's not.
CHE: What are the one or two biggest challenges that you see for the next generation of healthcare leaders?
Spillers: You know, my top two, one I just talked about [is] how do you afford it all? And how do we afford the healthcare system that we've got in the way that the costs are growing and the technology [is trending]? And I think that the whole country is going to have to grapple with that.
But, there's the second one that I worry about, is the availability of people, just you know, the human resource capital you need to run an organization. You know, [with] fewer nurses it just gets harder to recruit physicians and other types of clinical staff.
There's a lot of pressure in a place like this, where we've got 16,000 employees, everything from environmental services, to food services to security personnel to the people who do HVAC, plumbing, etc. All of those trade jobs and all those entry level jobs, the prices keep going up and so even if you can afford the people and some money and there's a supply shortage on the other end, and you still got patients coming in the door, you're growing, and more and more patients. So, it's going to be a difficult thing to balance because in the end, even though we're a public, not-for-profit hospital, we can't lose money. We don't get tax support, we're a public not-for-profit hospital, so we don't get tax support. So, we got to figure out how to balance that equation.
CHE: What advances do you see at Huntsville Hospital in the next five years?
Spillers: Yeah, post retirement I'm very bullish on Huntsville and Huntsville Hospital Health System. One, because I'm extremely proud of the succession plan we have in place and the team that's going to take over. Our system is blessed to be in an area of Alabama and an area of the country that is just exploding with growth.
And, while I've spent a lot of my 15 years here, building a system, I think a lot of the time over the next five to 10 years is going to be what I'll call same-store growth. We've got to really focus on the facilities and the locations we have and make sure we're capitalizing those and growing those to take care of the populations that are just exploding around all of our facilities.
You know, and the other big part of that, I believe that we'll have to do far more in the ambulatory arena than we have in the past. We're in the ambulatory arena, but we're more of a hospital system, than we probably will be based in the future, I think will be more ambulatory [and] obviously recruiting more physicians.
But you know, as far as clinically what we'll do, we'll continue to expand services. We added TAVR, we added neurointerventional radiology, things like that, over my 15 years. We will add more services that are appropriate for a large tertiary trauma center like we are. We're not a teaching facility, I don't see us getting into that; we won't have a burn unit, we won't be doing transplants and those types of things. We want to do stuff that we can do really well and do enough of to be very, very good at doing them. So, we'll grow that side of the business as appropriate.
CHE: What are you looking forward to in retirement?
Well, you know, I've been doing this for over 40 years and work has been my priority. I was raised [to] work really, really hard, do a really, really good job, [and] work for a long time. And so, for 40 years, I've lived a very structured, planned life.
The schedule for someone like me is planned out weeks in advance and, every Friday, you're looking at your calendar, trying to figure out where you can find a hole in the calendar in the next two weeks just to do something you might have to do on the side. And I'm looking forward to not having all that planned. And I'm looking forward to a non-structured, non-planned life for a little while. And I may not like it, and I may want to go back at some point and be planned again, but you know, for the first six months or so I'm going to look forward to getting up in the morning, having my coffee, going to the gym and working out, and then deciding what the rest of the day is going to be as opposed to just planning out everything. For that reason, I haven't planned. Everyone says, well, have you planned a big vacation? No, I'll decide that after I retire. I'm not planning anything right now. So, I'm looking forward to that.