Interview With Kenneth R. White, PhD, FACHE, Associate Dean for Strategic Partnerships and Innovation and the University of Virginia Medical Center Professor of Nursing, University of Virginia School of Nursing

Abstract

Kenneth R. White, PhD, APRN-BC, FACHE, FAAN, associate dean for strategic partnerships and innovation at the University of Virginia (U.Va.) School of Nursing, holds the University of Virginia Medical Center Professorship in Nursing. In addition to honorary faculty appointments at U.Va.'s Darden School of Business and the Mclntire School of Commerce, he is a visiting professor at LUISS Guido Cadi University Business School in Rome, Italy, and at the University of Lugano in Switzerland.From 1994 to 2013, Dr. White was a faculty member at Virginia Commonwealth University (VCU), where he directed health administration graduate programs between 1994 and 2008. At VCU, he also served as the Charles P. Cardwell, Jr., Professor of Health Administration and the Sentara Healthcare Professor. Between 1980 and 1993, Dr. White was a senior executive in marketing, operations, and international healthcare consulting with Mercy Health Services.A widely published author, Dr. White cowrote The Well-Managed Healthcare Organization and Reaching Excellence in Healthcare Management with John R. Griffith, LFACHE (both published by Health Administration Press). He holds undergraduate degrees in biology and nursing, master's degrees in health administration and nursing administration, and a PhD in health services organization and research. He is also an adult-gerontology acute care nurse practitioner with a specialization in palliative care. Dr. White is a Fellow of the American College of Healthcare Executives and the American Academy of Nursing as well as a former ACHE Regent and member of ACHE's Board of Governors.Dr. O'Connor: Your background has provided you with a unique opportunity to view and experience healthcare from many perspectives and to work with some of the best thinkers in the field. What change strategies do you see as essential for ensuring the delivery of highvalue healthcare?Dr. White: This question offers me a great opportunity to reflect on the people I have worked with and how they have influenced my thinking. For any change strategy to be effective, it must include a viable approach to changing the organization's culture. The people who have helped me understand this concept are James W. Begun, PhD, and John Griffith. Jim introduced me to complexity science 20 years ago, and John has influenced my thinking on the topic as well.Complexity science alters the way we typically view change. It shows us that we cannot effect a culture change until we shift from a transactional management perspective to a transformational leadership focus. We have to change the culture to completely refocus on what the goals should be, which brings me to my second point: defining the goals of care.We tend to favor efforts to reduce costs and increase volumes, but those activities will not change a culture. We need to attend to outcomes that matter to the patient. Furthermore, we must improve outcomes that matter to patients relative to the cost of those improvements. The work of Michael Porter and Thomas Lee (2013) on integrated practice units provides a good model for organizing care and structuring our healthcare organizations around the patient's medical condition.Integrated care would contribute to the value proposition, but most organizations are not doing it. Some of the very best healthcare organizations in the United States have made terrific changes, but the diffusion of those best practices is slow. We wonder why many organizations haven't adopted some of the best practices that are working elsewhere. For instance, the integrated practice unit would take all of the healthcare providers and bring them to the patient-rather than being organized by departments in different buildings-but that idea has been slow to spread.This model is related to interprofessional teamwork, which I have studied with Jim Begun and Gordon Mosser (2011). The University of Virginia's Center for Academic Strategic Partnerships for Interprofessional Research and Education (ASPIRE) uses the interprofessional care model as an integral component of its day-to-day operations. …