The Board of Trustees of Northwestern Health Sciences University meets soon with an unexpectedly complicated agenda. The tragic loss of its recently-hired president and CEO puts the institution in a difficult position. With his hiring, a new direction had been charted and promoted, and significant structural changes were taking place on the Bloomington campus. Because of its newness, the main ‘owner’ of the direction was the president; it had not yet been driven deeply into the organizational culture. There are also new people in place, people with direct connections to Mr. Nelson. Significant commitments to consultants and business relationships were just coming to be understood by the campus community and actualized. So what now?
By its selection of Mr. Nelson the Board’s direction for the institution was established, and by the goals that came out of the work his administration accomplished in its first several months, elements of that direction have been clearly visible. These goals have included broadening Northwestern’s educational offerings, increasing its enrollment and other supporting resources, and becoming a source of commercially-offered clinical services. As a ‘value added’ quality, NW has also sought to establish a reputation as a leader in integrative health care, although its vision for this has not been as clearly described.
There are collateral consequences and implications to these goals, as new strategic directions of businesses and organizations often cause, intentionally or not. One of the more significant implications to this observer is that the University leadership chose to move forward seeking to strengthen its identity as a University while not appearing (at least to outsiders) to prioritize efforts to strengthen its professional programs. Why should this matter? Because the health care marketplace will be increasingly unforgiving for weak players, and right now the reality is that chiropractors, acupuncturists and massage therapists are weak players. The identity of the chiropractic profession is diffuse and confusing to consumers, and the educational ‘product’ of the institution–its new doctors–struggle financially, more often than not, to achieve viability. Acupuncturists, despite the breadth of their philosophy and paradigm, are niche resources in the current system. And like DCs, Massage Therapists who graduate from NW’s strong program face a marketplace where others (often those with inferior training) are undercutting their fees with services that, to consumers, look the same.
It’s impossible to know how Mr. Nelson viewed University chiropractic alumni, but aspects of the institution’s process and direction sharply polarized a number of its graduates. Those of us around at the inception of the University understood that at some point the Board and the University would likely need to outgrow its ‘chiro-centric’ orientation, and to achieve its potential as a University, that is likely to be required. But the institution’s alumni are a critical source of its primary revenue source (students) and the degree of disaffection evident in the community has been enough to cause concern.
The source of concern for many of those in the field and in other ways aligned with Northwestern has been the troubling apparent confluence of a number of trends: escalating professional program tuition and costs; a shrinking pool of potential applicants, at least for its main revenue driver (the chiropractic program); declining market share for chiropractic utilization; and an extremely dynamic and rapidly changing health care marketplace where the outcomes of what any ‘system’ looks like and can be presumed to operate like are very difficult to discern.
Without knowing where the leadership for direction is coming from in the Board of Trustees, here are three unsolicited recommendations for consideration:
Treat the needs of its professional cultures as resources. Northwestern is a steward of three very distinct and interconnected professional cultures that are united by a vitalistic paradigm. That is their strength, but they each also suffer from intrinsic weaknesses related to identity, marketplace perception, competition and business pressures. All three professional cultures need care, nurturing, and strengthening, and it’s in the University’s interests to shepherd them carefully, understanding that they are resources critical to its future.
It is difficult to see how the University can achieve its promise without improving the viability of each of these ‘three legs of the stool’ to build upon. While it aspires to be a ‘real university,’ it does not have the kinds of resources that most universities do: it doesn’t have a viable undergraduate program; its alumni are almost exclusively professionals who (like other professions) don’t usually make significant contributions to annual or specialized funds; and it does not have a strong footprint in this market for the uniqueness of its offerings. If the University can effectively make its main three professional stakeholder sets stronger, it can have the flexibility to explore what it can then potentially achieve as a ‘container’ for these more vital and viable groups. That may seem like a subtle shift, but as a vision it would require very different and specific tactics.
Define its vision for integrative care. Integrative health care is the proverbial elephant being touched in different places by a group of blind people. There is no way to know what ‘it’ really is without it really being something. There is a huge marketplace opportunity for a clearly defined vision; a set of demonstrated, tested and viable versions of that vision; and examples of viable business models that can become compelling for prospective students, for graduates, and for any commercial interests and opportunities.
The chiropractic profession has struggled for more than the last decade to arrive at a clear idea of what its place is in the health services marketplace. Is it a unique, standalone and distinct profession that isn’t medical? Is it aligned with medicine in ways that require a limited application of its scope? Is it capable of offering primary care, portal of entry services, or such a unique assessment of neurological function that those questions aren’t even relevant? The truth may be that it’s possible to arrive at consensus that all of those expressions of professional identity, capability and training are viable options. But arriving at any degree of consensus will require very visible, strong, and compassionate leadership. That opportunity in the upper Midwest is really at Northwestern’s doorstep. We shall see if it accepts that responsibility and challenge.
Reframe its educational products for marketplace relevance. Health care’s identity has historically been based on its position in the supply side of the supply/demand dynamic. As written here before, that dynamic is rapidly changing, and if health care providers (and the institutions that train them) don’t reposition themselves in relation to those who are consuming their services–consumers who have a spectacular range of options–staying in business will become very, very challenging. The health care marketplace is shaping up to look more and more like retail marketplaces do: similar products and segmented options for segmented customer sets who are sensitive to various things that align with lifestyles, values, location and finance, to name just a few. We may bemoan the reality of this, but standing pat is not an option.
Health care services are, at their heart, products. And as neither chiropractic, Asian medicine nor massage therapy are monolithic, there will be an inevitable dispersion of how they are applied, expressed, monetized, defined and consumed. This is a marketplace reality, and rather than railing against that fact, the school and its professions should instead mobilize and organize around it, giving its stakeholders a set of options that can appeal to the range of their own interests and capacities. Executive spa clinic services like at Mayo and Cleveland clinics aren’t going away. Neither is The Joint or Massage Envy. So let’s figure out how to prepare people to operate in, in competition with, or in spite of those environments and businesses.
Northwestern’s Board has (again) a significant opportunity in seeking a chief executive who can execute its vision. It must be an extraordinarily fatiguing prospect; they only recently finished a long search. But the institution of a size that it’s potentially nimble enough to survive this latest setback and reaffirm a direction that gives it a good chance for thriving in the years to come. The hope here is that it recognizes and acknowledges the importance of the dynamics cited above; moving in accordance with that knowledge and respect is much more likely to give it a chance to really succeed and achieve its promise and potential. The archaic language in the title of this post reflects what is really at stake: the need for a new covenant, a new agreement, with the stakeholders of Northwestern Health Sciences University. The hope here is that this becomes an express and valued goal.