Glenn D. Steele Jr., M.D., Ph.D.
President and Chief Executive Officer, Geisinger Health System
May 11, 2014
I was honored when your president Jay Lemons asked me to address you at this commencement. But then the fear set in. I immediately realized that of three personal commencements, 10 family commencements (that’s a lot of investment isn’t it?) and another 18 commencements when I was a dean at the University of Chicago, I could only recall one. And not because it was positive. The year was 1966. The valedictory was read in Latin. And when I got the translation (after the fact of course, since no one understood a word of the speech), I found out we’d been told that our lives had peaked as undergraduates and life would be irretrievably downhill from then on! A stupid way to send us off, but probably understandable given the institutional ego and self-satisfied milieu of the time at Harvard.
Let me say at the outset, that your president, your faculty, and most of your colleagues at Susquehanna University fully expect your trajectory to be upward after graduation today. And if it’s not, I suspect the fault is not the university’s!
So a few personal comments and then a bit of advice about your place in one of the great transformations presently underway in our country—how healthcare will be paid for and how it will be provided in the future.
I’ve had an unusual career trajectory having started as a real doctor taking care of real patients at three great medical-school-associated hospitals in Boston. Then I survived being a dean at a great research university in Chicago. And all of this “in preparation” for the last 14 years of a magnificent adventure here in central Pennsylvania.
What has happened at Geisinger is partly the luck of right time, right people, and particularly right place, plus my personal and family’s ability to take a big risk—seeing a potential new model of healthcare delivery growing out of what was 15 years ago a failed merger between two very different cultures and missions, at Geisinger and at Hershey-Penn State Medical School.
The ongoing transformation of one sixth of the U.S. economy (that’s what healthcare totals) is an attack on too much cost for not enough quality, an attempt to emancipate businesses from the burden of funding so much of the cost (average of $12,000 per employee per year for employer-based medical insurance plus another $6,000 per year kicked in by the employee) and the realization that forcing an average U.S. family to spend one third of their discretionary family budget on their own portion of healthcare costs (co-pays, co-insurances, caps) is unsustainable both economically and politically.
These forces have pushed us into what I believe will be looked back on in the future as our present healthcare revolution. And in this great transformation, what was a credible but small, regional health system at Geisinger, coming off of a failed three-and-a-half-year merger—has become a national model of how healthcare should be delivered and how healthcare should be paid for. How could this have happened? There are many detailed, complicated reasons why institutions that are good become great—superb trustees, strong balance sheets, committed “real workers” (docs, nurses, loyal employees), wise (or lucky) decisions—e.g. going electronic almost 20 years ago, not selling the insurance company, etc.—all typifying an institutional dynamic that evolves, is resilient, and learns from its mistakes. I am sure this will someday be a book. In fact, I may write it!
But I believe there is another more important underlying predicate—more subtle than the other possibilities. And that is the power of place. There is something special about where we work, where I have been blessed to be a part of the Geisinger family for the past 14 years, where you have gone to school for the last few years—this power of place connects the physical qualities of our surroundings with a set of necessary qualities—key human values, enough room for the kind of human interaction that leads to creativity and real innovation, the right balance between energy and serenity to allow humans to work together, think together, and move together to accomplish things not accomplishable by an individual (even a strong individual leader) alone. But not too much energy, too many people, or too much frenzy! Just enough isolation (two-and-a-half to three hours from anywhere most of my old Boston or Chicago colleagues have ever heard of!!) to allow us to try new stuff, some of which just might not work! And if we fail, as individuals or as institutions (like the above cited merger), we learn from it and evolve forward. And most important, “place” includes the right people who help structure and support the institutional missions of remarkable organizations like Susquehanna University, Geisinger, Bucknell, and the many other eleemosynary successes that surround us. I’m talking about the Degenstein Foundation, the Weis family, and the amazing folks who have actually found a way to run viable businesses located here in central Pennsylvania. And of course, the dedicated family members who volunteer so much of themselves to lead our governance bodies and endow our efforts.
So this special “place” in my view, so essential to the success of both Geisinger and Susquehanna University—should stay with you no matter where you go physically. Remember it. Revisit it. Try to find a little piece of it to carry with you no matter where you end up.
Finally, some advice. This is mandatory in any commencement address, but let me avoid the usual clichés. I’ll be specific about my view of your responsibilities as “liberally” educated men and women on the topic of our transforming healthcare. And remember, technically in a few moments you will have a document that attests to your being educated men and women!
First of all, many of you will be employed in or at least be connected to healthcare economically during your career paths, since it represents over 18 percent of the U.S. economy. Secondly, all of you will eventually be users of the system. When I was in the honorable part of my medical career as a real doctor (actually a surgeon), we put this more crudely by noting that “everyone is pre-op”!
So either as a participant or a recipient, here is your responsibility according to Steele:
1) Work toward or vote to enable everyone access to healthcare. If part of our population is unable to get affordable healthcare, all of us will suffer—not only financially, but also in our individual health status. My oldest daughter is a veterinarian and in vet school she was taught not only individual animal health, but also about the health of the herd! Medical schools are just now trying to catch up in this dual aspiration of optimizing individual as well as population health.
2) Be actively involved in understanding what value is in health outcomes for you and your loved ones and for the population at large. Believe no ads on TV or on billboards, even Geisinger ads. For the parents in the audience, beware of the purple pill advertisements during those national news programs on evening TV that have 10 minutes of news and 20 minutes of ads. And remember, if the warnings for a special new medicine take longer than the positive claims and particularly, if the announcer begins to talk faster and faster to get all of the warnings in—this is a bad sign. Stop listening.
3) Find out who your doc is and what he or she is good at. Don’t take your well-meaning but clueless neighbor’s advice. Comparative data are now available on the internet. And if you or your loved ones should need hospital care, find out how many people die there before you go into a specific hospital. These data are available. And nowadays you can tell if the hospital death rate is appropriate for the seriousness of those treated or if it is too high. If the hospital claims it doesn’t have those data, choose another place straightaway, even if it’s less convenient.
4) Remember that more care is not always better. Ask “why” when a test, or a procedure, or a medical suggestion comes your way. Don’t be afraid to ask your doc, “What difference will this test or this procedure make for me or my loved one?” “Does this change in my diet or my activity have real proof behind it, or is it simply the latest fad?” In short, be an active participant in your well-being—not a passive recipient of bad or unfounded advice.
5) Be open to change. Like most everything in life, medicine and health is an intricate and dynamic balancing act. No decision is without upsides and possible downsides—so you are the decider after getting information, sifting through it, comparing opinions of the so called “experts.” Even if it seems to offend one of the experts from time to time, you are the decider. As an educated person (or one soon to be declared so) the balancing of expert opinion (in areas where you are not the expert) will be what most of your life will be about, I suspect.
6) And finally, be positive. When things change, personal and societal opportunity abounds and stress occurs. Like your own individual trajectory, most of our societal aspirations and a great deal of our social accomplishments have been upward and will continue to be upward. Even if it’s not warranted all the time, feeling positive about change is more often than not linked to individual success. Oops, a cliché. Sorry.
So once again President Lemons, thank you and your Susquehanna family for this singular honor. Sharing a remarkable sense of place with Susquehanna University has been a great privilege for me and for Geisinger. I look forward to our institutions continuing to move forward together in a dynamic partnership and I congratulate your graduates on the beginnings of their own personal growth trajectories.
Glenn D. Steele Jr., M.D., Ph.D., is president and chief executive officer of Geisinger Health System, an integrated health services organization in central and northeastern Pennsylvania nationally recognized for its innovative use of the electronic health record and the development and implementation of innovative care models. Steele earned his bachelor’s degree in history and literature from Harvard University and his medical degree from New York University School of Medicine. He completed his internship and residency in surgery at the University of Colorado, where he was also a fellow of the American Cancer Society. He earned his Ph.D. in microbiology at Lund University in Sweden.