Atrium's Rasu Shrestha, MD, Shares The Art of Intentional Strategy

A visionary transformation executive outlines how to create "stickiness" for innovations that have sprung from the pandemic, as well as how to create a culture of innovation.

Rasu Shrestha, MD, MBA, has the uncanny ability to keep his feet grounded in the present, as his mind operates in the future. As executive vice president and chief strategy and transformation officer for Atrium Health, the renowned innovator has been a force for positive change throughout the COVID-19 pandemic, seeking opportunities that will permanently transform the way the Charlotte, North Carolina–based nonprofit health system delivers care. 

Another of Shrestha's gifts is the ability to cleverly communicate concepts. Words matter to him. For example, Shrestha has coined a term for the current era of healthcare as the "next normal."

"We're calling it the 'next normal' versus the 'new normal' because it depicts a level of intense and intentional strategic pursuit versus essentially being dragged into a new reality that we have very little control over," he says. "There's never been a greater opportunity to truly regroup, reimagine, and re-emerge winning in this next normal," he says.

Shrestha is responsible for Atrium Health’s enterprise strategy, including planning and tactical direction for the organization’s current strategic road map and beyond. In addition, he spearheads a renewed focus on innovation, launching new healthcare inventions, discoveries, and ideas to benefit patients and the communities Atrium's 42 hospitals serve. He also provides executive leadership for corporate communications and marketing, as well as enterprise analytics.

HealthLeaders spoke with Shrestha recently, as he enters his third year at Atrium. He shares the art of intentional strategy with ideas that could prove helpful to other health systems as they plan their own vision for the next normal.

"Never Let A Good Crisis Go to Waste"

Even as activities related to the pandemic were ramping up, Shrestha's mind had already charged down the road, thinking about "how we come out of this on the other side," he says. "We were very intentional in how we approached this, so right at the beginning, even as we were pulling the trigger on a number of innovations and newer ways of protecting our teammates and communities, we started putting in place a number of different strategic pursuits."

This included the launch of a "Rapid Scan and Plan" process, which involved rigorous internal and external reviews of initiatives, as well as identifying and prioritizing potential post-crisis opportunities and their implications.

Ultimately, the health system created an 18-month Rise and Reshape Strategic Plan. "Right there in the middle of the pandemic—in this VUCA [Volatility, Uncertainty, Complexity and Ambiguity] environment that we were dealing with—we launched this plan," Shrestha says. "In many ways, that's positioned us to look at things in a very realistic way." The bimodal design focuses on predictable elements based on "what's happening on the ground," as well as the "art of the possible and re-imagining what this next normal could be," he says.

The plan is "positioning us to truly transform the face of what healthcare is going to look like on the other side of this pandemic," Shrestha says. "We're of the mindset here at Atrium that we should never let a good crisis go to waste."

Rasu Shrestha, MD, executive vice president and chief strategy and transformation officer, Atrium Health (Photo courtesy of Atrium Health)

How to Make Progress Stick

The COVID-19 public health crisis upended much of the bureaucracy associated with healthcare and suspended, perhaps only temporarily, some of the rules that traditionally govern it. Innovation flourished.

As the industry moves to the next normal, Shrestha is on a mission to ensure the best ideas, philosophies, and practices that blossomed during the pandemic are retained. "What's going to stick?" he asks.

"It's a dialogue that I have with my strategy peers across the industry quite a bit these days," Shrestha says. "For example, we talk a lot about the embrace of virtual [care]. We led that charge at Atrium." Virtual video visits and AI-powered chatbots were "turned on almost overnight and usage was through the roof," he says. Yet as frequency began to wane, some of his peers lamented that the pendulum was now swinging back the other way.

Shrestha is using the following guidelines to ensure that beneficial practices "stick" to ensure long-term change:  

• Think of progress on a continuum. The road to virtual care is "not a binary on-and-off switch," says Shrestha. "It's not black and white. The care transformation work that we're moving ahead with here at Atrium is more of a continuum approach. We're focused not on the care venue, but on the care experience for our patients and consumers. What we're pushing forward with, regardless of what other provider organizations do, is a hyper-focus on experience versus the transactional elements of what healthcare has been known for. That's one element that I hope will be sticky for us at Atrium as we continue to push forward with our transformation."
   
• Accelerate decision-making. Another beneficial practice during the pandemic was the accelerated speed of decision-making, Shrestha says. Decisions that traditionally took months and years were suddenly made in weeks, if not days. "We've been intentional in asking, 'How do we [continue] that level of agility and nimbleness in the rapid decision-making cycles that we need to put in place?'—almost in a non-healthcare-esque way."
   
• Consider the power of partnerships. "I think it was Helen Keller who said, 'Alone, we can do so little, and together we can do so much,' Shrestha recalls. "That level of realization is something that we hold very close to our heart, especially as we're coming together with Wake Forest Baptist Health [the two organizations completed a "strategic combination" in October 2020] and as we're working with innovators, entrepreneurs, investors, startups, and big tech. How do we come together in meaningful partnerships that move the needle to push ahead on this transformation agenda with a level of urgency that we've not been able to execute to in the past?"
   
• Build a connection between strategy, transformation, and innovation. "We're being intentional in the way that we're embracing the power of partnerships, but we're also being intentional in the construct of our strategic pursuits," Shrestha says.
  
  As a result, Shrestha has established a Strategy and Transformation Office at Atrium.  "We're taking a very agile approach to how we've set up the integration between innovation and strategy," he says. "It has both strategy and planning elements." Among the factors that will be considered: clinical service lines, virtual care, and care transformation, as well as the health system's five-year strategic planning work. All of this will be directly tied to Atrium's innovation engine, along with examining the role of partnerships and strategic venture investments.

"We're basing all of this on the notion of Atrium Health being a living lab for these innovations, but doing it in such a way that we're expediting the pace of innovation so that we're able to move the needle from idea to impact in a much more intentional way," Shrestha says. "The structure that we've created is what's going to continue to sustain that level of stickiness, even as we come out on the other side of the pandemic."

Related: 5 Truths: COVID-19's Wake-Up Call for Healthcare

Building a Culture of Innovation

As Shrestha forges into the future, he's retaining the best elements of the past.

"Atrium's had a rich history around innovation," he says. "I was really proud of that coming into Atrium, given the many things that I've done in the last couple of decades."

As he eyes the horizon, he's incorporating the design-thinking capabilities and fast-fail methodologies  Atrium is known for, and aligning all new pursuits to the health system's strategic objectives.

"There is strong muscle behind it in terms of the business acumen of not just focusing in on shiny objects, but focusing in on the impact that we can create on the ground," he says. The hope is to launch pilots so that projects become "scalable, sustainable, and actually move the needle in terms of … a tangible outcome."

Yet the vision is much bigger. Atrium Health, Wake Forest Baptist Health and Wake Forest School of Medicine are building a second medical school in Charlotte, where Atrium is headquartered. Shrestha says it will be a "first-of-its-kind" medical school with innovation capabilities built into the learning process. Design thinking, entrepreneurship, and social impact will serve as key drivers of the curriculum itself. "What we're doing here is not just a flash in the pan, once and done kind of a thing," he says.

"As we then broaden the aperture with us now having become one with Wake Forest Baptist Health, we're really excited about building on the Innovation Quarter that exists in Winston-Salem," he says. The combined "innovation muscle" between the two organizations will help create "what we believe will be the leading edge of healthcare innovation, even nationally, but based out of the Southeast."

Ultimately, says Shrestha, "We're building a culture of innovation. We're building businesses and capabilities that will essentially be ingrained into the fabric of how we operate as a health system, but also how it's going to affect the communities and create an ecosystem of innovation across the Southeast. I'm most excited about focusing in on that ecosystem play because it is about the most meaningful partnerships coming together. It's never really about any one institution. It is about formulating the right partnerships in service of the communities of patients and people that we serve."