Rural Health Summit: Bob Riney, CEO of Henry Ford Health

Bob, I’m going to start right out. I have listened to your podcast and I have, as I shared with Kyrsten, one of the first asks that I had early on was to interview you because of your remarkable journey. I’ve interviewed congressional leaders. Supreme Court justices have been on this podcast, but nothing warms my heart more and excites me than the opportunity to introduce our listeners to one of the great doers in healthcare. Now, there’s a lot of talkers of healthcare, and my God, we see them, we hear them, but you’re a doer, and it speaks volumes to the work that you’ve done at Henry Ford. So, let’s talk about Henry Ford Health because, man, you’ve taken it so far. I’ve watched that journey with you. Talk to us a little bit about Henry Ford and your mission and why it’s important.

RR: Yeah, I’m really happy to. We were actually founded by Henry Ford himself, one of the greatest innovators in the world’s history. He was the one that put the shovel in the ground to build it. I only say that because we’ve had the privilege of the Ford family caring about the place and it continues today. Even more importantly, we carry that innovation in our DNA. We almost feel like it’s an obligation to be an innovator. Part of innovation is placing the right bets but it’s also failing when you fail, and learning from that and kind of rebuilding, retooling and moving on. So, innovations a big part of our organization. We sit here today, we’re 52,000 employees and we’re the largest healthcare provider in Southeast Michigan. More importantly, we serve all communities. I wish I could say that was true about everybody, but it’s not. We both know that. We find it a real privilege to serve all communities from the wealthiest of the wealthiest that could go anywhere and choose to come to Henry Ford because of the complex issues they’re facing and our incredible care team, to people that don’t even have a home address because they’re homeless and our employees wouldn’t want it any other way. They really love that mission of serving all, but when you’re serving all, you have to make the math work. So, you have to diversify and broaden your portfolio in a lot of different ways.

So, we have 550 clinical sites, 13 hospitals, 3 behavioral health hospitals, a health insurance plan called Health Alliance Plan.

JH: Which is nothing small in and of itself. I mean, it’s significant.

RR: It’s not, but our whole purpose is really to bring as much high value, integrated, holistic care and support to communities. One of the things I’ve always admired about rural health is that rural health and urban health have a lot more in common than people realize, and that some of the populations we serve don’t have the same means that others do and require some additional support. The second thing I’ve always admired about rural health is, I looked to rural health for innovation. I can brag about Henry Ford’s innovation, but rural health doesn’t have a choice but to innovate and get really creative. So, often say to my team, when you’re going out for best practices, don’t just look at the big systems in the country, look at the rural health. I can bet you they figured something out, out of necessity.

JH: Yeah, I don’t know how many times. So, you’ve helped Detroit come back and I’ve had many conversations in fact, was around a table with a former governor candidate who dropped out. He shared about the success of the Bob Rainey effect. So, you have been super focused on social determinants of health. I remember that as a board member when we were transitioning together; MHA, you’ve been super focused on that. You’ve launched many initiatives healthcare literacy, food insecurity, housing, the list goes on and on; to improve the social needs of our communities. You see those disparities and you’ve addressed those. Can you talk to us about those healthcare disparities and what concerns you the most and what we’re doing to bridge that?

RR: Yeah, absolutely. I really believe that our responsibility is that of a health company. If you think of yourself as a health company versus a hospital, then you realize that you can be outstanding at what happens in your emergency rooms and your OR’s, but if people don’t have the rest of the things that are necessary to actually improve health, they’re not going to really live their best life. We can’t do it all. So, we really partner with lots of people.

You mentioned a few things. If people are going home to a food desert, then they’re not likely to recover in the most effective way. If they are really stressed out in a hospital because something as simple as they have a pet at home and no one to take care of it, and we don’t find a way to meet those needs, that anxiety is going to overtake their recovery process. We do a lot of things on social determinants of health. First of all, we do a lot of things to help people get into a preventative mode. We have mobile health clinics that go to the neighborhoods, and we’re just adding dental services to that, because we found out that the number one cause of absenteeism with young people is oral medical issues. If you have pain in your mouth, pain from teeth, you’re not going to school. We’ve taken our mobile clinics and expanded; are in the process of expanding on that. We’ve created food vouchers that people can go to Eastern Market, a great site in the city of Detroit, and get fresh vegetables as part of their discharge planning process. We help with transportation. The other reason that we’re very much involved in Detroit’s improvements, and if you haven’t been to the city of Detroit, it’s just the comeback kid, man. One of the reasons for that is actually health, because you don’t have healthy communities if you don’t have development; you don’t have jobs. So, we take a really holistic view. One of the byproducts of doing that is it attracts the best and brightest talent because they want to be part of something big and we really make it big.

JH: You really do. Changing lives is what you’re doing, Bob. It’s changing lives. I remember I was with Randy Oostra from ProMedica, CEO in Chicago, and I was talking about social determinants of health. He looked at me. He said, “You talked to Riney about that”. I think that’s the golden standard of what you’ve done and what you’ve been able to establish like yourself.

RR: Well, that’s a nice compliment. Like yourself though, for me, it’s very personal. I didn’t grow up dirt poor, but I grew up with a family that were stressed out, figuring out when they could write the checks to pay bills before they got paid and when it would hit the bank. I mean, just a lot of that kind of real struggle. I know how distracting that can be from taking care of your own health.

JH: Absolutely. Well, the work that you’ve done in social determinants of health also improves communities, impacts the financial well-being of communities. We watch that happen. There was a shift in your leadership with focusing on global health initiatives, because you took it beyond Detroit and you’re the global leader. I would say, honestly, we have a lot of guests on the program, but I can say you’ve done some fascinating work around healthcare delivery from a very high-level global perspective, working closely epidemiology, infection control leaders, researchers. I want you to talk to our listeners a little bit more about that, because you go beyond just taking care of the patient at the bedside.

RR: I think it’s an extension of our philosophy. If Covid taught us one lesson, and it’s a really important one, disease does not have geographic boundaries. The more we can help build capacity and learn from others about how to deliver best in class healthcare, how to create an infectious disease, a public health approach. We’re very fortunate in the metro Detroit area and that we have incredible diversity of talent that comes from all over the world, which means they have connections all over the world, and we’ve leveraged those relationships. So, we have support that we do in global countries within the Middle East. We have some relationships in India. We do a lot of work in Canada because Canada is like our cousin. I mean, it’s our nearby neighbor. What’s fascinating about that is it’s like anything; if you combine the best and brightest, not only from an intellect but from an experience standpoint, and they’re all focused on things because guess what? Whether you’re in a rural community in Northern Michigan or you’re in a remote part of India, you have the same needs and you have the same. So, how do we leverage technology? How do we leverage education? How do we leverage learnings? Then, of course, many countries don’t have the high-end tertiary and quaternary complex care that we’re privileged to have in the US. So, we’re also a destination site for people that need those really unique procedures, whether they’re surgical or interventional. So, it’s a growing part of our portfolio to see people choose to come to Detroit for their care.

JH: Almost five decades ago when you were a security officer, obviously, you didn’t ever think that we’d probably see an AI component of your of your life and your job. How has Henry Ford integrated some of those AI and as you look at telemedicine, you were the leader of telemedicine because we reached out to you and you just shared a story recently when we were in Detroit together about some work that you’re doing, where you’re doing telemetry type monitoring in the patient room if they get up to prevent falls. I went back and told my team this. Can you talk about the integration of technology?

RR: Yeah, because AI is mind boggling, right? To all of us. I mean, because it’s so ill defined. It’s moving fast. We don’t know what all the implications are. Our focus right now is one; you can’t hide from technology. It doesn’t serve you well. What you can do is really build up a priority list. For us, it’s about first and foremost; how do we bring joy back to caregivers by reducing the things that stress them. So, the ambient listening AI, which allows our physicians to have an electronic download of their conversations and not sit in the evenings in their studies at home doing that work when they should be focusing on their children. The one you referenced is a really cool tool in that it’s basically a little camera. It doesn’t keep any records, but it monitors patient’s movements, and it can tell within a couple of minutes based on movements when those movements are going to mean that they’re getting up; and falls are a big deal in hospitals. We’re all proud. We don’t want to call for help. We don’t want to bother people. We get ahead of ourselves, and then we fall and we end up in the hospital for 2 or 3 more days. This warns the nurses. It gives them a little ting that, “Hey, patient, in bed A is getting ready to get up” and the nurse has the ability to just instantly then through the remote monitor say “Mrs. Jones, I have a feeling you’re getting up to go to the restroom. Wait, I’m going to be right there.”

What’s interesting about technology is you have to allow cynicism to be there. We had a nurse that is very well respected when we first implemented this, that said, “Okay, you guys have given some doozies, but this may be the doozy of them all” and after experiencing it, came back and said, “I couldn’t have been more wrong. This is a game changer to my routine on a unit”. We’re looking at first and foremost; how does it help improve effectiveness of the caregivers so they can do what they do absolutely best and eliminate unnecessary tasks or things that cause harm? Then ultimately, we want to see how it can apply further to empowering patients to use information in the right way. Right now, everyone Googles everything and they come in just full of information, not data, just information. We want to help organize that for people. It’s great that they’re invested in their own care, but to not sleep for four nights because you got told something on Google that’s not exactly right for your situation; not good for anybody.

JH: Or by influencers that are telling you. Absolutely. We see that. Well, you’re leading that and I look forward to what the next few years are going to bring, because that type of technology will truly save lives. Individual gets up, they fall, they break their hip. We know a 74-year-old that falls, breaks their hip; probably the outcome is not going to be very good.

RR: You’re right and when people talk about healthcare cost. This is one that kind of checks all the boxes. It reduces unnecessary costs. It reduces unnecessary pain. It helps the person get back to independence in the right way. One of the things I’m really proud about, Henry Ford, is that we feel it’s an obligation back to our founder to share whatever we learn. Success and failures. So, we don’t keep it for competitive reasons. We don’t think that’s the role for health organizations. Ultimately, you compete on service, you compete on value, but if there’s a safety mechanism you’ve discovered, share it. You don’t want to harm anybody.

JH: Absolutely. So, let’s dive into some rural issues if I could. As you expand your footprint throughout Michigan, which you have, what do you see as the CEO; Henry Ford’s role in rural health? How do you see the future of rural healthcare delivery? I want to tell you; I had Scott Becker on the podcast several times. Scott shared with us the work his team did recently. They partnered with several search companies, research companies looking at 734 hospital closures in this country. It’s a lot.

RR: It’s devastating on so many levels. Not only safety in terms of access to healthcare, but in many rural communities, those facilities were their largest employer. So, it becomes like a downward spiral that is really unfortunate. Now, we all have to deal with the realities that populations have shrunk in some rural communities, and the young people aren’t staying in those communities. So, I’m also a pragmatic realist.

JH: You have to be pragmatic. Yeah, you do.

RR: I think that there is a way to kind of create a healthy intersect. So, we don’t believe at Henry Ford Health that there’s a one size all model. We think that organizations that want to become a part of something larger and have a good reason to do it, we welcome. At the same time, organizations that want to stay independent but need some clinical partnerships, need some help with education, some help with some back-end kind of support tools. We’re very happy to do that, and some organizations, they have a playbook and it’s one playbook. There’s nothing wrong with that. We’re quite flexible because we think that every community has different circumstances and every hospital has different circumstances. Having said all that, I think the way that we can partner is, first of all, helping find the talent of the future, because there are portals that can create a great pipeline and we can help feed that, and we have certainly found that true in Jackson, where they had a really tough time recruiting top talent, but once it was through a pipeline from Henry Ford it changed the dynamics, because people are looking for something that’s got connective tissue, right.

So that’s one way. The second way is leveraging technology. So, that virtual connections for care. Second opinions from specialists that can be done without the person having to leave the rural hospital that may not have the volume to have that sub specialist present there. Technology is only going to make that more and more helpful. Certainly, if the person does need a transfer for very complex care, making sure that the physician and the team at that rural hospital is an intimate part of the care, and that that patient is being sent back to that community with full knowledge and a full sense of partnership. I think our physicians, no groups perfect, but they’ve gotten so, so good at making sure that they’re enlarging the care team to include that. It makes for a better experience for the patient and the family. So that’s another way.

Then I also think that we’re going to find ways to create support for social determinants of health in rural communities as well, because while rural communities and urban communities oftentimes will see themselves as total opposites in terms of their life experiences, when it comes to social determinants of health, it’s not, there’s much more in common. So, the things that we can unleash, for example, I’ll give you an example. I mean, we’re working right now with a couple of innovation companies at Michigan Central, and we’re working on drone delivery of healthcare related supplies. Think of what that would do for rural health.

JH: So, you’re working on that right now? That’s incredible.

RR: We are yeah; we’re working with two startup companies through Ford Motor Company.

JH: So, you drop someone’s insulin who does not have access to the pharmacy?

RR: Who does not have access, yes. You could drop theoretically a box of fresh foods consistent with what they need based on their particular health issues like if they’re a diabetic. So, technology can be kind of scary for good reasons, but when you think about using it like this, it can also be a game changer.

JH: As I travel throughout the country and speak with rural hospital CEOs, many of them are scared of the relationship with big health. They feel that big health is going to try to absorb them. Truly, Bob, right here today, I think you would submit and say that you don’t have the capacity to address all of the local issues, so we need our local hospitals to be addressing some of those core issues.

RR: We don’t, we don’t.  Plus, we really believe philosophically that most care belongs close to home or even at home. So, there are organizations that have a different model. So, people have a right to be skeptical. I tell people when it comes to our organization, I can only speak for ours, look at our track record, our track record is to help people add value. We’re not interested in centralizing everything because at the end of the day, if a person can get care in Hillsdale, why would we want them to travel outside of Hillsdale, and why would we expect they would want to? I mean, would I want to travel if I didn’t have to? Of course not. You want your family there. You want your support system there.

JH: I’ve been working with Karen Yakubu from your organization and we’re working on some oncology service lines. It’s the opportunity we can be independent, but we can be interdependent upon each other. I think that’s what’s missing out of this conversation at times. So, what I appreciate about you is the perspective of, listen, we’re not big health here to help or just here to say we’re moving into town. How can we collaborate and how can we build partnerships?

RR: If you look partnerships I mean, again, let’s be frank, there has to be a win in it for all parties, but you just you identify the win for the all parties and especially the win for the community and the patients. If we stay focused on that, there’s a way to make this all balance. If you start with, “it’s just an extraction”, then it’s not going to work.

JH: So, we’re on to our last question. I’ve really obviously enjoyed our time together. Hopefully in the future we can have you back to talk about some of the great initiatives. You did inspire me with about a four-minute speech before we left, actually this room, several years ago; you left our last MHA board meeting. You spoke about the need for civility in our public discourse, in our public actions and interactions. I would say today we’re facing the most wretched of times in public discourse. Name calling: waste, fraud, abuse, the list goes on. We then at the same time face real issues like hospital closures. Just one next to me, Sturgis closed. It’s going to impact the entire community. We have care deserts, whether it’s obstetrical access to healthcare is being sidelined. All of that gets lost in the translation of the name calling. So, I want to ask you. You led that discussion, which is very memorable to me. How can healthcare leaders bridge this gap? What can we say? How can we be heard?

RR: You know this this may sound a little bit out there, but I really believe that we have to call out this behavior as a public health crisis. If we focus on the health issues that are emanating from lack of civility, I think that there is plenty of research to show that when people are anxious every day, when they have been led to believe that truly they should not trust anything, then guess what? Mental health is messed up, and then physical health gets messed up.

So, you don’t have to be on one side or the other to align around the fact that there’s nothing good that comes from adults behaving like kids when they’re making really important decisions. I just shared a major national conference in the theme was ‘A quest for Common Ground’. I’m an Irish Catholic. I know how to fight like the best of them, you know? I mean, I grew up in a family that, oh my God, we debated and people would say, “whoa, do you guys love each other?” And we’re like, “of course we do. I mean, this is why we love each other”. We never resorted to ugly behavior because it was about winning an argument on a topic, not denigrating the other person. We’ve lost that.

I think the way we have to raise this issue up is that we can’t be a healthy nation if we have this kind of daily stress and rhetoric, and I think we have to demand of elected officials and elected official wannabes from both parties. We want diverse opinions, we want debates, we want hard conversations that come at it from different angles. We don’t want stupid rhetoric. We don’t want name calling, because you know what it is? It’s a distraction from whether you really know your stuff or not. I think we have to call that out. I know for me personally, I’m not writing checks to candidates if they behave in total lack of civility, because you have to ultimately say, even if I agree with you on issues, we all know cultures are created by behaviors, and if behavior is horrible, we’re going to have a horrible culture. That’s not the country I want.

JH: Lot of work ahead of us.

RR: It is. But you know what? I wake up every day with a little fire in my belly. I think that you always have to believe that there’s solutions and you have to believe those solutions start with conversations like this. They start with role-modeling. All of sudden it’s right, the winds change and people are being more civil and it feels good.

JH: It feels good. Back to where we need to be. Bob Rainey, great to have you here. One last question I have for you is; we have individuals that are in healthcare, executive leader positions that are listening to this podcast across the country. Some are new to healthcare; some are transitioning their roles. We know that right now, there’s a mass exodus of healthcare leaders across this country. They’re getting out, but we have leaders that are stepping up into this role and it’s tough. I mean, tumultuous times. We’re told we’re bad people. We’re fighting not only the government; we’re fighting insurance companies. We’re fighting everyone. So what advice, what sage advice would you give to a new leader who’s trying to make it today in healthcare?

RR: I really believe that you’ve got to wake up every day with a sense of curiosity. That means really open to learning something new. It could be small, it could be big, but it helps balance out all the bad stuff. So, that’s number one. Number two; I have found myself in times like this actually connecting with patients more, not less; because I need to be reminded in a very personal way, the impact we’re having on people, because if not, you just get buried in numbers and you get buried in these bad issues and all the stress.

I also think that we have to continue to tell our story, and our story can’t be just about what great care we provide, but the role we play in our communities, in our states, the role we play economically, the role we play. I think we have to help educate people. Get a little critical thinking skills. If someone is telling you really bad stuff and they’re telling these healthcare executives are bad, what’s their motivation? Take a little look; you’ll usually find they have an ulterior motive, a political agenda. It doesn’t help solve problems. Problems are going to be solved when you’re actually working on the problem, not the rhetoric. Fraud and abuse. Is there some fraud and abuse in any industry? Of course, but it’s being used to scare people and it’s being used to create a narrative that’s just not true.

The last comment I’ll make is 99% of people; nurses, doctors, technologists, pharmacists, they go into healthcare because they are good people and they want to do great things. How do you think it helps their motivation when they have slingshots going at them that they’re just thinking, ‘This isn’t my reality. I gave up Christmas to work the hospital so that patients’ families could be there and you’re telling me I don’t care?’ It’s not healthy, right?

JH: Stay the course. Tell your story,

RR: And be bold! Not boasting, but be bold about what we do. Not just in care, but in everything we do to support communities. I think that we need to be more assertive at calling out the motivations of people that are trying to paint us in a different light.

JH: That’s right. 48 years of experience Bob Riney, chief executive officer at Henry Ford Health, definitely should write a book about being bold, because that is what he’s been able to do to transform healthcare not only in Michigan but throughout this country.

RR: Well, you’re right there yourself, JJ.

JH: Well, Bob, it’s been great to have you on the podcast today, and I look forward to having you back again in the future as we talk about some great things.

RR: I do too.

JH: All right. Thanks for joining us today.

RR: Thank you.

JH: And thank you to our listeners for tuning in to Rural Health Today! Catch our next segment, Rural Health News, to stay up-to-date on the current state of rural health every Monday wherever you get your podcasts. Don’t forget to check out the latest updates and resources from Rural Health Today at ruralhealthtoday.com and make sure you’re subscribed to the show so you never miss an episode. Until next time, remember the power of rural!