Tar Heel Footprints in Health Care

When Jeff Spade was young, he knew he would likely end up in one of the family businesses: health care or baseball. His great-grandfather was a pitcher for the Cincinnati Reds, and his father was a hospital executive. Thanks in part to the hours spent shadowing the latter, Spade ended up going the health care route, and today he is responsible for major contributions to the health of rural hospitals across North Carolina.

Spade earned a master's degree in health care administration at Duke University, but it was during a fellowship at Burlington County Memorial Hospital in Mount Holly, New Jersey, that he decided to focus his career on hospital and health systems, viewing that as the best approach toward improving population health. Since then, his goal has been to focus on determining the financing models that best lead to improvement in health outcomes.

“How we finance health care is very critical to how health care is designed,” he said recently, adding that “rural health is really the canary in the coal mine when it comes to transformation of the US health care system.”

In 1996, Spade brought his system-focused approach back to North Carolina to help start the Center for Rural Health at the North Carolina Healthcare Association, which was then known as the North Carolina Hospital Association. There he worked with state health director Leah Devlin to create a state health improvement plan, Healthy Carolinians, that aimed to help every county engage community partners in health assessment, planning, and implementation of health-improvement strategies.

“Jeff has always been concerned about the health of North Carolinians and how the health and health care systems can be strengthened to have greater impact in communities,” said Devlin. “He has been a pioneer in working to support rural hospitals caring for vulnerable populations. He was early in bringing attention to the enormous needs of rural areas in our state.”

Spade also worked closely with Jim Bernstein at the inception of the North Carolina Office of Rural Health. Early on, the Hospital Association worked together with the Office of Rural Health to support system development in North Carolina.

“Improving North Carolina rural health is entirely dependent on the ideas and partnerships of a whole village—a statewide village,” Spade said, highlighting partnerships with, among others, the Kate B. Reynolds Charitable Trust, the Duke Endowment, the North Carolina Medical Society, the Cecil B. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, the North Carolina Community Health Center Association, and the North Carolina Area Health Education Centers.

Several of these partnerships were integral in North Carolina's participation in the national Critical Access Hospital Program in 1998, supporting the conversion or designation of small rural hospitals and introducing enhanced reimbursement. The Center for Rural Health, along with the Office of Rural Health, achieved designation for 23 small rural hospitals in the state, every one of which was able to implement more sustainable financing models. North Carolina was one of the earliest states to adopt this strategy, and 20 of those 23 rural hospitals are still open and serving their rural communities.

Spade attributes much of this success to the implementation of a management style popularized by Toyota, known as Lean, which he researched and implemented at the North Carolina Hospital Association. Through the Carolinas Lean Collaborative, the Center for Rural Health trained 29 rural hospital leadership teams in North and South Carolina to implement Lean techniques, such as performing “rapid improvement events” that identify current workflow and potential areas of waste and quickly implement changes to increase value. The initiative trained more than 5,000 staff members and developed more than 60 Lean coordinators who conducted more than 1,000 rapid improvement events during weeklong improvement sessions over the course of three years. This saved a total of around $73 million for those hospitals.

Though Spade's tenure with the North Carolina Hospital Association recently ended, his impact on the health of North Carolinians will continue to be felt.

“Jeff is a visionary thinker and a knowledgeable leader in health care and public health,” said Devlin. “We are a healthier state because of the many contributions of Jeff Spade.”

• ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.