Friends,

This week’s interview is nothing less than awesome, and it’s awesome for three reasons.  First, Dr. Rishi Sikka is a brilliant and accomplished physician executive with an incredibly diverse professional background. He brings that diversity of thought and vision into his work and into our dialogue. Second, we’re going to discuss some key new leadership competencies that both Dr. Sikka and I believe are critical for the future advancement of healthcare delivery in our country. Third, as I mention in the intro to this interview, I’m about to publish a second book entitled Beyond the Walls.  It’s a market-based, three-part strategy for the transformation of American healthcare. What was so confirming to me is that Dr. Sikka’s perspective, as well as his strategic and tactical vision, is fully aligned with what I’ve written in that book. Of note, he has not yet read the book. As you can tell, I’m incredibly excited about this interview, and once you listen, I suspect you’ll be as well. 

Dr. Rishi Sikka is currently a venture partner at Lifeforce Capital, and a Professor of the Health Services, Policy and Practice at Brown University School of Public Health. His past executive roles include: President of System Enterprises at Sutter Health as well as Senior Vice President of Clinical Operations & President of the Advocate Insurance Segregated Portfolio Company. He earned his bachelor’s in economics at the Wharton School at the University of Pennsylvania and his medical degree from the Mayo Clinic Medical School.  He is co-author of the book Leading Healthcare Transformation: A Primer for Clinical Leaders, and has written for the Wall Street Journal and Harvard Business Review. In 2021, he was recognized as a Top 50 Clinical Executive by Modern Healthcare.

In this interview, we’ll discuss:

1. Why Dr. Sikka believes that diverse backgrounds and disciplines foster opportunity in healthcare delivery. 
2. Dr. Sikka’s recommendation for how leaders can tactically embed relationship-centered care into daily clinical practice. 
3. The importance of ‘Championing the Trust Agenda’ – both for patients as well as providers.  
4. The issue of provider burnout and demoralization, and a tactical approach to addressing it – an approach that Dr. Sikka has some experience with. 
5. The notion of partnering and collaborating, which is a reframe of the old ‘buy it or build it’ paradigm.   
6. A few new and promising trends in healthcare delivery – based on Dr. Sikka’s VC experience working with a portfolio of entrepreneurial companies.  

This conversation with Dr. Rishi Sikka was enlightening, inspiring, encouraging, and quite honestly, fun. He’s a bold thinker and doer, but he shares his point of view in a collaborative and humble way. 

This interview touches upon a number of really important lessons for a new leadership – what I would label ‘beyond the walls’ leadership. I’ll briefly touch upon a few of these.

1. Seeking diversity of experience and disciplines. Most of us recognize the critical importance of diversity, but do we recognize the importance of diversity of experience, disciplines and thought? Dr. Sikka brings an incredibly broad and diverse background to bear. He was initially an economics major prior to going to medical school. As a medical student, he took off a few months to work as a managed care researcher, learning how to use big data (claims data) to assess quality and outcomes of care. While in medical school he also spent time as a reporter and on-air broadcaster for a local NBC affiliate.  In addition, Dr. Sikka is a student of other industries – proactively borrowing and learning the lessons that others have had to learn the hard way. His own healthcare leadership perspective is imbued with these diversities of experience and thought, which he believes is supremely helpful in creating new ideas and opportunities in healthcare delivery.  
2. Deploying Relationship Centered Care.   Most of us are familiar with this phrase, but Dr Sikka believes it’s essential to not just voice that sentiment, but also to operationalize it.  He provides a number of examples of how to tactically deploy relationship centered care. One that he shares is the notion that, as we leverage AI to increase productivity, we should divert some of that enhanced capacity into time that providers can spend with their patients.  
3. Fostering ‘mastery, autonomy and purpose’. Borrowing from Daniel Pink’s book Drive – The Surprising Truth About What Motivates Us, Dr. Sikka discusses how we can and must leverage mastery, autonomy and purpose in combating provider demoralization and burnout. Once again, he takes this from the strategic level to tactical deployment – sharing his own experience as a physician executive in shared governance organizations, in which physicians are treated not as employees but as true partners. 
4. ‘Championing the Trust Agenda’. Once again, borrowing from hard-earned lessons in other industries, Dr. Sikka shares a phrase he heard directly from the leadership team at SC Johnson. He points out that healthcare has become highly transactional, and that we must refocus on building trusting relationships with patients as well as with our providers. One key part of championing the trust agenda is to align what’s happening on the front lines of care and in daily operations, to the stated purpose and mission of our organizations and our industry. The larger the delta is between what actually happens in reality and what leaders espouse is a chasm of distrust and disillusionment. He points out that it’s all about leadership – a topic he notes I’ve discussed at length in this podcast series and in my books. 
5. Shifting to partnership and collaboration, This is a bit of a reframe on the old ‘buy it or build it’ paradigm. Dr. Sikka borrows a lesson from the automotive industry, which was illustrated in Ram Charan’s 2021 book, Rethinking Competitive Advantage: New Rules for the Digital Age.  Professor Charan points out that as automotive companies entered the digital age, rather than attempt to build new capabilities and assets themselves, they partnered and collaborated with companies that have this experience – for example, in building batteries. They realized that attempting to build all of the new capabilities and assets was an outdated and limiting strategy. One company, Volkswagen, decided to take the legacy tack of building batteries themselves, attempting to hire thousands of engineers. The outcome? VW has fallen far behind its competitors and its CEO was ousted for deploying this non-competitive strategy of ‘building it all ourselves’.  What’s important to note is that we’re seeing a similar transformation in healthcare. In fact, in Beyond The Walls, I devote an entire chapter to the “The power of platforms” and provide numerous examples of how payers as well as hospital systems are shifting from the traditional ‘build it or buy it’ model to a partnering and collaboration one, with great success. 
6. Building strategic ecosystems of care. At one point in our dialogue, Dr. Sikka mentions the notion of hospital systems building strategic ecosystems of care. I believe this is an integral corollary to the partnership and collaboration transformation mentioned above. This shift, from attempting to build or be an entire ecosystem, to convening and leading a broader strategic ecosystem based on collaborations and partnerships is a concept I illustrate in Beyond The Walls. We have witnessed a ‘platform revolution’ in other industries (think Amazon or Uber), and we have already entered that revolutionary transformation in healthcare delivery. I provide a number of examples of platforms in Beyond The Walls, and many more are about to enter onto the healthcare scene.  As with partnerships and collaborations, platforms represent a new leadership competency.  
7. Approaching care from a customized and segmented perspective. In his current role, as a venture partner at Lifeforce Capital, Dr. Sikka is constantly evaluating and engaging with a portfolio of entrepreneurial companies. One of the new and promising directions he sees is a movement in value-based care to “carve outs” – organizations that are managing specialty-specific or condition specific risk-based contracts within a group of patients. One example would be an organization that manages the renal risk exclusively in a capitation or shared savings contract. Another he points might be a company that manages orthopedic risk, and yet another would be a company that manages oncology spend. This segmentation of clinical care and value-based risk is one I discuss in my first book on Reframing Healthcare, and once again, we’re witnessing its early manifestation in the healthcare market. I believe this also represents a new leadership competency: the ability to segment and customize clinical care and operations, as well as assume segmented risk within a population, based on specialty or conditions. 

In this interview, Dr. Sikka and I quickly leapt into the ‘why’ – the purpose and mission of healthcare delivery, and the leadership competencies required to carry out the mission. I’ve attempted to capture some of those key leadership competencies above. 

What I find most enlightening about this discussion, however, aren’t the specific concepts themselves. Instead, it’s the fact that Dr. Sikka is actually recognizing that there are new core competencies in healthcare leadership. Competencies that we need to discern and learn, especially as we enter the digital era. I’ve not heard many people articulate this understanding. 

During the course of this interview, we not only attend to the ‘why’ but also discuss the ‘what’ and the ‘how’ – the tactical deployment of these leadership competencies and directions. And we connect the two – aligning stated purpose and mission with tactical operational deployment. Dr. Sikka sums this all up well toward the end of our conversation. “There’s a saying in our business, ‘No margin, no mission’… The interesting thing is that that’s actually not the original saying. The actual saying, attributed to Sister Generose Gervais, one of the co-founders of the Mayo Clinic is, ‘No margin, no mission. No mission, no need for money’. What it’s saying is that mission comes first, and mission matters the most. I think this is a very pivotal moment for healthcare organizations to put mission first, to return to mission, to connect to purpose, and to champion the trust agenda with our patients, providers and employees… It’s a fundamental belief that if we return to mission, the positive economic and financial results will follow. That’s the core of some of the pieces that need to be put into place now.” 

Until next time, be well. Zeev Neuwirth, MD