Change has been a constant at University Health System for the past few years; a clear strategy has helped smooth the transition.

Established in the 1950s, University Health System needed not just a physical overhaul, but a culture change as well. George Hernández, CEO since 2005, has led the large Texas teaching hospital and trauma center through new construction, the launch of a strategy that looks to the needs of current and future patients, and a revitalization of learning's role in supporting excellent care.

University Health System has a strategy known as Triple Aim Plus directed at improving the quality of the patient experience, improving the health of the populations you serve, and reducing the cost of healthcare. What's the context for that strategy?

The Triple Aim Plus is a way of focusing staff around the pursuit of four goals: quality patient care, a positive patient experience, health system efficiency, and improving patient access. Quality is always our number one focus. Every patient expects to receive high-quality care. Our priority is to meet or exceed those expectations. The focus on patient experience is treating the patient or customer the way we would wish to be treated, with compassion and dignity.

Reducing the cost of healthcare is not unique to us. The U.S. spends the most for healthcare of any nation in the world, and yet we're not in the top 10 in terms of healthcare outcomes. Across the country, healthcare is under attack for being inefficient and for not addressing people's needs. We need to do our part and be good stewards of our healthcare resources.

We're also a public system. We were created in the 1950s, by a vote of the people of Bexar County, as a hospital to take care of the county's indigent and needy. But there are challenges. Texas leads the nation in the number of uninsured. Texas has not rolled out all aspects of the Affordable Care Act, particularly for low-income folks, and so access to healthcare also is important. That's why access is part of our focus and why we say we have a Triple Aim Plus strategy.

How does the hospital's talent development function contribute to the implementation of the Triple Aim Plus strategy?

Even though Triple Aim Plus is a clear message, it's a challenge to convey it fully to everyone on our very large staff. It's in our literature, but that doesn't go far enough. You have to get buy-in, and that's what Jacque Burandt's folks do. [Burandt is executive director of the organization's Center for Learning Excellence.]

They put our strategy message into the fabric of who we are. It's everywhere: in onboarding and orientation, in leadership development programs, and in other kinds of talent development.

University Health System recently rolled out a new core capability in pediatric care for children with routine and severe medical needs. The learning function played a major part in preparing employees for this new challenge. Tell us about their role.

Preparing people for a new core capability was particularly daunting. We wanted to get back into pediatric care, which had been turned over to other local healthcare systems in the 1990s. Since then, with the exception of children's trauma and burns or premature infants needing neonatology care, we served primarily adult patients.

But pediatrics care is an important part of serving our community better. In Bexar County today, Hispanics make up 59.1 percent of the population, and most of the people in that demographic are extremely young. The largest segment is children under five, the second largest is children six to 10 years old, and the third largest is children 11 to 15. We need to address the health of this young population now to improve health outcomes of this community in the future.

Our dedicated pediatric staff went from 40 to 200 people in about six months. Jacque's group added onboarding sessions and integrated pediatrics into nurses' orientation. They had boot camps and competency checks in specialties such as pediatric oncology and cardiology. And while they don't train our physicians in medicine, they do develop their cultural competency because it contributes to the quality of care and patient satisfaction.

As the third largest public health system in Texas, University Health System operates a teaching hospital, maintains a trauma unit, does transplants, has a neuroscience center, and serves the needs of pediatric patients. How do you keep the talent pipeline full enough to meet those diverse needs?

Because of the current shortage of healthcare workers, we recruit all the time. You see very complex patient cases at an academic medical center, so we look for individuals who have the smarts to handle that. We look for people who have the heart for this kind of work, who love providing care.

We also work with local schools to strengthen the healthcare education system. I think the most important obligation we have as a society is education. We helped motivate one school district to open a health careers school at Fox Tech, a public, tuition-free, college-prep, high school in San Antonio, specializing in the medical sciences, law, and public policy.

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We opened two school-based clinics within the past year. Besides providing care, this may perhaps indirectly influence kids to consider health careers. If you never see a doctor or nurse, how would you know whether or not you might want to be one?

How do you know the learning and development that the hospital provides is effective? How do you measure its contribution?

I know it's working. One measure is the small number of folks who leave. Our turnover rate among nurses is one of the lowest in the area.

Another sign is how well staff can articulate the Triple Aim Plus strategy. That's important to me. And I get many letters from people thanking me for the care they or their families received here. That shows me that everything has come together.

What do you expect from your chief talent development officer, Jacqueline Burandt?

I'm a change agent and I measure Jacque's success in large part by how she and her staff help me make change happen here.

When I became CEO in 2005, I thought we were too separated from the community, especially for a hospital system that is funded in part by taxpayers. But taxes only provide 24 percent of our revenue, so we also must look aggressively for alternative sources of funding, and provide the kind of value that makes people want to come here for medical care. So I've made changes to take us in some new directions, and that requires a strong learning environment. Jacque has helped provide that support.

How do you manage to make innovative changes in such a highly regulated, conservative industry as healthcare?

It's sink or swim. We have to be innovative to be able to do the things we want to do, and to predict where the industry's going. Healthcare is very complex in Texas. Care is based on a county system. Texas has 254 counties, so there are at least 254 ways of doing things.

I give credit to our board and our commissioners for supporting innovation in our strategic plan. For example, we knew our hospital, built in the 1960s, needed to be upgraded. Research shows that after 25 years, medical facilities need a major overhaul, and after 50 years, they're pretty much useless for healthcare purposes. Semiprivate hospital rooms are no longer the norm. One reason is the privacy for patients required by HIPAA [the Health Insurance Portability and Accountability Act]. Another is the need for infection control. And semiprivate rooms are not a patient satisfier.

We're also putting more emphasis on preventive medicine and population-based care. Our school-based clinics and our return to pediatrics are two good examples.

You also reinstated a leadership institute and doubled the funding for continuing education. What drives your support for learning?

Before I was named CEO, I was the attorney for the health system. As a lawyer, I had a mandatory annual obligation of 15 hours of continuing legal education. I went to countless seminars on healthcare law. Later, I realized that this training and education gave me an advantage in getting the job of CEO.

I wanted to make it easier for people here to get training. It was important to me to lift all boats by making learning accessible to as many people as possible. The best way to do that was to develop it internally.

Another big influence was my mother's belief in the value of education. She was a cowgirl from West Texas who grew up in Big Bend country where schools were few and far between in the 1920s and 1930s. She had only four years of school, but she made sure that my three siblings and I received good educations. She ingrained in us the value of learning and that's what I'm trying to do here at UHS, with Jacque's help—make learning part of the culture.