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A burst of growth in Nashville, Tennessee, is fueling expansion of the city's health care providers, but at the same time the city is experiencing some growing pains.

As president and CEO of the 16-hospitalAscension Saint Thomas and ministry market executive for Ascension Tennessee, Fahad Tahir says the boom has come with significant workforce and access-to-care demands.

According to an analysis this summer from the Nashville Area Chamber of Commerce, the metropolitan area has emerged as one of the top five in the nation for job growth post-COVID. The chamber put that rate at 10% from February 2020 through June 2023. Meanwhile, the Census Bureau says the population grew to 684,000 last year, as compared to just over 601,000 in 2010.

Tahir assumed his current role in early 2023. He also is a CHA board trustee and a 2011 recipient of CHA's Tomorrow's Leaders award. He spoke to Catholic Health World about how Ascension Saint Thomas is responding to the opportunities and challenges of Nashville's success. His responses have been edited for length and clarity.

What does Nashville's boom time look like?

The region is growing, and we have a growing job market. Our market is among the top for manufacturing in the U.S., including increasingly for electric vehicles and batteries. Our tax climate is attractive, as is our cost of living. There's a warm and kind southern feel — which some call "Nashville nice" — and there's been a natural collaborative environment in the business and health care communities, where we are trying to make each other better.

But the challenge for our region has been keeping up with all the growth. There's been tension on the infrastructure, including for transportation and housing. Unfortunately, we see the classic inequity in Nashville, and now it's more pronounced and pressing on the poor and vulnerable, many of them are African American.

You need to name a problem to address it, and I'm proud of Nashville because I see a recognition and a sense of ownership of the problems by the city and community leaders.

You've spoken in the past about Ascension Saint Thomas being a "health care destination." What does that mean?

Nashville has been referred to as the health care services capital of the U.S. We're strong in terms of our investor-owned, academic and nonprofit health care. And we at Ascension Saint Thomas want to be a health care destination among these great providers.

To do that we need to offer the best of health care services along with an experience which reflects the warmth and compassion that we are known for. We have to be intentional in how we do this.

We've built up the largest cardiac network in the region. We're increasing our use of robotic technology as an elective surgical destination. We have the largest spine program in the region, treating some of the most complex spine conditions. We deliver more babies than any other hospital or health system in the state. We've developed a cutting-edge brain tumor program. We treat our physicians as thought partners and innovators and work to avoid the bureaucracy of an academic medical system, and that is enabling our clinical experts to look ahead to develop what is needed for our growing region.

How are you using those "thought partners" to determine how best to grow?

We want to provide health care access anytime for our growing community that has a more pronounced need for services and access. So we're looking at where geographically this growth is happening and what the disease burden is there. We are sensitive to financial affordability issues, since there are more financial pressures on families now, so we're looking at affordability of care too. So, for instance, we've developed a network of ambulatory surgery centers, and this environment lets us offer certain appropriate surgeries for patients close to home and in a more affordable setting. We've done similar things with our freestanding imaging centers throughout the region, and with cardiology and certain subspecialist outreach clinics offered in the community.

What are some of the greatest challenges Ascension Saint Thomas is facing in the near term?

We don't just want to be a destination for our patients but also for physicians, nurses and team members. We need to ensure we have the workforce we need. And there are shortages of talent available, given both the current state of our industry and the unique level of demand in our area.

The other big challenge is access. We need to ensure we make it easy for our physicians, clinicians and patients to access the system — it needs to be frictionless. We think through the experience of physicians, clinicians and patients. We think through every stage of the care journey and make it as easy as possible.

Essentially, when it comes to challenges, I reflect on how we differentiate ourselves in an environment with a lot of health care providers, we don't want to just be like everyone else. We listen to what our physicians, clinicians and patients are saying and we look at the long view to stay on track.

What are the implications of not addressing the access issues appropriately?

At Ascension nationally, we've made a purposeful commitment to equity. We focus on our clinical quality goals, and we look at all our service lines and programming with an eye towards equity. There are national disparities that we need to address. All should have access to care, and that's what we're charged to do and to lead on.

But if it's not addressed, it means a chronic disease burden will grow in its negative impact on the individual patient but also in aggregate on our community as a whole. And that can also have an effect on our region's success: Chronic disease affects upward mobility, it affects productivity, and that can make Nashville a less attractive destination for future employers.

What has Ascension Saint Thomas' focus been when it comes to advocacy?

Ascension nationally has a very involved and highly engaged advocacy team, but it's everyone's responsibility to address access gaps.

Tennessee is one of the 10 states that have not expanded Medicaid, and so hundreds of thousands of citizens in the state do not have access to it. Along with the Tennessee Hospital Association, Ascension and CHA, we are advocating for 100% access and coverage. We're also looking at other policies that burden families. We work with like-minded organizations to join together to advocate for our patients and community members. In Catholic health care, we proactively seek to support the most vulnerable in our country. To do so in a sustainable way, we have to consider the policy context and guide national policy proactively to enable the impact of our mission.

What has Ascension Saint Thomas been doing when it comes to diversity, equity and inclusion goals?

Ascension has the ABIDE framework that we use to ensure that we're appropriately addressing those goals. (ABIDE stands for appreciation, belongingness, inclusivity, diversity and equity.) We look at diversity, equity and inclusion when it comes to patient health equity, maternal morbidity and mortality. For instance, given that we are a destination for women, especially when it comes to maternal care, that position comes with a responsibility. We address the disparities about the care Black women get, we have programs to address the disparities, such as unconscious bias training.

What has Ascension Saint Thomas been focusing on when it comes to environmental stewardship?

Ascension has an environmental stewardship commitment — we are heading toward zero waste by 2040. We're using evidence-based, science-based methods, including for our new facility construction, energy use standards and maintenance. We're working with community organizations to build tree canopies to address air quality. We're sensitive to food waste. Those are just some of the examples of the response we have to the challenge of reducing waste.

What is ahead for Ascension Saint Thomas?

During this past year, I've been listening and seeking input, visiting and getting to know and understand the caregivers and their experience. Society has changed and the workforce has changed but we have to start by being present and to be willing to adapt. We must challenge ourselves as an organization to make a big organization feel small in terms of culture. It's about building a culture of trust. We're energizing the organization to build and have confidence in who we are. We are building our destination programming, we're modernizing our campuses, expanding our geographic footprint to serve our community close to home, we're adding clinical services and expanding services to the community. And we have the goal to deliver all this care in a warm, faith-based environment in care settings across the region.