Helen Darling: “All you have to do is look at every report written concerning the national debt or the annual deficit and see that healthcare is the driver.”

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

The healthcare industry is undergoing major changes, but Helen Darling says the providers and payers who comprise much of the industry aren’t doing enough to control costs and improve quality. Her words carry a lot of weight – she’s the president and CEO of the National Business Group on Health, which represents many of the large employers in the U.S. Darling says her membership would like to see big improvements in safety, quality and costs, but have doubts about whether that could actually happen in an industry with limited competition.

“With our healthcare system, there are no countervailing forces that will essentially force organizations to reduce costs and improve quality and safety,” she says. “We saw very little attention paid to patient safety until the federal government took this tiny amount of money and said, ‘We’re going to hold this back if you don’t meet certain Partnership for Patients goals.’ And that did get people’s attention, but that’s what it took.”

Darling’s non-profit organization represents many Fortune 500 and other large companies, serving as a united voice on healthcare policy and offering solutions to healthcare issues in the marketplace. She says her membership is concerned about where healthcare is headed.

“All you have to do is look at every report written concerning the national debt or the annual deficit and see that healthcare is the driver,” she says. “It’s not Social Security. It’s not education. It’s not feeding children. It’s all about healthcare.”

Darling herself has led a storied career, directing studies at the Institute of Medicine before becoming the health legislative aide for U.S. Sen. Dave Durenberger (R-Minn.). She later worked as a senior executive for Mercer, Xerox and Watson Wyatt (now Towers Watson) before agreeing to lead NBGH. She is a member, and co-chair for ten years, of the Committee on Performance Measurement of the National Committee for Quality Assurance and is Vice Chair of the Board of the National Quality Forum.

Patient safety, she said, is a key concern for her and NBGH.

“There’s nothing like statistics having to do with patient safety to galvanize attention to the problem,” she says. “Just think about the amount of harm or death because somebody, for example, gets an infection. Even if they don’t die, they suffer. I’m sure everybody knows families of someone who got C-Diff or MRSA in the hospital. All you have to do is look at the data and see how much human suffering and wasted cost are behind healthcare associated harm.” The lack of progress on that front, she says, is perplexing.

“What I don’t understand, to be honest, is why there isn’t more of an outcry,” she adds. “If somebody eats a hamburger that has some contamination, it’s all over the television. If a plane goes down, people are on it for days in the 24/7 news cycle. And yet every day, in hospitals across the United States, people are being harmed and in some instances are dying from conditions that are preventable and avoidable.”

Darling encourages the executives she represents to serve on the boards of hospitals (something she herself has done), and her group offers them a patient safety toolkit. She encourages trustees to press for frequent safety reports to be given to the CEO and the Board of Directors.

“Historically, hospitals have a risk-management report, and they might have a quality report if, say, the Joint Commission did its audit and found something. The risk-management report will say things like, ‘There was a patient fall this month and we have booked $3 million as part of the liability reserved to take care of it.’ That’s it. Historically, there has been no root cause analysis, no report on what changes they’re making to stop that from ever happening again. That is changing but it isn’t fast enough or universal.”

To be fair, a few of the major employers who make up NBGH’s membership have similarly been criticized for their reaction to healthcare reform, including some who have changed terms of employment that make fewer employees eligible for health insurance. But Darling says health insurance has never been an automatic benefit for the workforce.

“At any given time during the year, we have 60 million people without coverage, and most of them are working people. Health insurance has always been a perk,” she says. “It’s never been something that everybody has, and it is very much related to wages. The irony is, the people with the lowest wages get the least benefits. But I don’t think it’s going to get worse. If the insurance marketplaces work the way they’re supposed to work, we will be better off in terms of coverage (although not in terms of the costs of health benefits coverage on a net basis).”

But the penalties for lack of coverage will need to change before that happens, Darling adds.

“The penalty is not as much as it will cost people to get the coverage. They can’t tell people they have to have a package that will cost, on average, $7,000, and then tell them the penalty for not buying coverage is $1,000. They’re going to have to change the package because it makes the subsidies much richer. They will bankrupt the country on that one.”

Still, she says she’s confident that the gap will be bridged.

“All that needs to be sorted out, but I actually think we will have more people covered. Nobody will be happy about a lot of the details. In the end, I think more states will look a little more like Massachusetts.”

Darling has been selected numerous times by Modern Healthcare as one of the Top 100 Most Powerful People in Healthcare in addition to her new award as one of the Top 25 Women in Healthcare. The Modern Healthcare article announcing the Top 25 Women was headlined, “Beyond the Glass Ceiling,” and Darling said she thinks some of that ceiling is self-imposed among women.

“I belong more to the Sheryl Sandberg ‘Lean In’ school,” she says. “I’ve been hiring men and women and mentoring them for a long time. I still see significant differences in the way men and women assess themselves, in the way they think about their careers and their families.”

She laughs as she relates a humorous story she heard on the radio recently. “It said that if women miss a child’s school event, they are just wracked with guilt. But if a man merely drops the child off at the event, he feels like he made a major contribution. That’s pretty funny, and pretty accurate.

“And as long as that’s true, women won’t always be able to have the same kind of executive career that men do. They can have the combined benefits of living in both worlds but as long as executive careers require the kind of 24/7 commitment to work that most do, women and men will have to choose what balance or lack of balance they really want.”

Shirley Weis: “We do guard our brand jealously. It’s one of the most trusted names in healthcare and part of the promise we have to our patients.”

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

It’s a busy time at Mayo Clinic. Plans for the new Destination Medical Center are in full swing. New affiliates are being added to the Mayo Clinic Care Network. A new partnership with Optum Labs is taking the venerable institution into the realm of big data. So why would Chief Administrative Officer Shirley Weis decide to retire now?

Because, she says simply, that’s been the plan all along.

“One of the hallmarks of Mayo is excellent succession planning,” she says. “We’ve put even more attention into it in recent years, making sure that we have a good stable of folks ready from all different backgrounds of diversity and talents.”

And, for those keeping score at home, she says, you’ll notice a pattern to their planning. Weis was named to the No. 2 role at Mayo about halfway through the tenure of then-CEO Denis Cortese, MD. Weis is leaving four years after John Noseworthy, MD, succeeded Cortese. Mayo’s initiative of staggering C-suite entrances and exits keeps disruption to a minimum.

“People don’t understand that Mayo has a term-limit process for these top jobs,” Weis says. “Usually, you’re in these roles for about six to eight years as CEO, CAO or department chair. It’s one of the ways we keep ideas fresh. In some settings, you’ll see people who are named to a role and they’re in it for 30 years. That may work for some organizations but I think that after six or seven years, you’ve done what you came to do.”

Among the tasks that Weis says she is gratified to have accomplished since she stepped into the CAO role seven years ago is changing the structure of the company.

“I have really felt proud of the fact that we were able to get our governance in good shape,” she says. “We went from being a holding company to an integrated operating company. Most of the things I wanted to get underway are now, in fact, underway and are in good hands.”

One of those key ventures is the Mayo Clinic Care Network, in which health systems and physician groups affiliate with Mayo, extending the clinic’s reach beyond its bases of the upper Midwest, Arizona and Florida to the rest of the country. The idea had been created during Dr. Cortese’s tenure but truly came into being about two and a half years ago under Dr. Noseworthy’s leadership, Weis says.

“We have built a very successful Mayo Clinic Health System in the upper Midwest but we understood that merger and acquisition was probably not the best course for us,” she says. “We came up with the idea to start building a network, but we also found more and more hospitals and physician practices approaching us – they wanted to be affiliated.” Mayo is up to 18 affiliate agreements but Weis sees a limit to the system’s capacity.

“We do guard our brand jealously. It’s one of the most trusted names in healthcare and part of the promise we have to our patients,” she says. What helps, she adds, is that “the patients are very savvy and sophisticated. They understand that these groups are not Mayo Clinic – they simply have a connection to Mayo Clinic.”

Mayo staff are consulting via phone and doing some cases together electronically. “We think it’s going to be a real model for the patients’ network of care,” Weis says. “Eventually, there may be some insurance products that go on top of the network.”

The blurring of lines between providers and payers is accelerating in the healthcare industry, and Weis has been a key person to lead that charge at Mayo. She was the chief operating officer at Blue Care Network of Michigan, a large HMO, before coming to Minnesota.

”I feel blessed that I had 10 years of actual care delivery with my emergency-room background, and that I followed that with 10 years in the payer industry,” Weis says. “I wouldn’t trade that for anything. I think it’s helped the organization and, frankly, it is probably why I was selected for this job seven years ago.”

Weis says both providers and payers need to focus on what’s best for the patient – and both need to collaborate more.

“The payer world has the claims information but they don’t have a lot of rich clinical data. The provider world has the rich clinical data but they don’t know what happens after the patient leaves the hospital or the outpatient center, or after they pick up their prescription.”

No matter what happens with healthcare reform, Weis adds, “there’s no more money, so it makes it more incumbent on all of us to figure out how we’re going to meet those patients’ needs and how we can engage the patients better.”

Working with fewer dollars is something Weis experienced a few years ago during the recession when she put in place an administrative shared services program and an enterprise project management office, while also implementing cutting-edge tools for financing and reimbursement. All those things, and a few more, helped Mayo weather the recession without layoffs, though some employees shifted jobs and some changes were made to benefit packages and retirement plans.

Weis had originally come to Mayo in 1995 to lead the Clinic’s managed care division. She resisted the overtures from a recruiter for a time, but finally agreed to a visit.

“I already had a career path, thank you very much,” she says. “But I came to Rochester and started to meet folks, and I was struck by how patient-centered the organization was.”

As she got to know Al Schilmoeller, who was her first boss, she noted that one of his daughters was a pilot and another worked for the Department of Natural Resources. That convinced her that here was a man who knew how to support women in their varied career aspirations. She remembers that, she says, as she mentors early- and mid-career women and men.

“For women or men, for anyone to make it to the next level in your career, you have to be willing to take some risks,” she says.

But she notes that young executives who only know the sound-bite version of Sheryl Sandberg’s “Lean In” best-seller do need to consider work-life balance.

“I would not be where I am today if I didn’t have a supportive husband. Period. I see many people who want to have that balance, and the one thing I know for a fact is that you can’t always have it all. You can have it all in stages. But I do think that as long as women are in a traditional caregiver, chief household operating officer role, it’s tough to balance that.

“So, particularly with families with young children, I always encourage them to put those kids first because they’re only there for a few years. And then your career is still there.”

Weis came of age at a time when she often was the only woman on the leadership team, and she says progress has been made in gender equity – progress, but not equality.

“I’m a tennis player, and I think of the days of Billie Jean King when Virginia Slims was a sponsor with their slogan, ‘You’ve come a long way, baby.’

“We have come a long way. But I don’t think we’re there yet.”

Modern Healthcare's April 8 issue

Furst Group is proud to continue to sponsor the Top 25 Women In Healthcare awards for Modern Healthcare.

This week’s issue of Modern Healthcare has all the details on this year’s honorees. First-time winners include Leah Binder, CEO of Leapfrog Group; Sharon O’Keefe, president of the University of Chicago Medical Center; Deborah Bowen, incoming president of the American College of Healthcare Executives; and Marna Borgstrom, president and CEO of Yale-New Haven Health System. Others selected include HHS Secretary Kathleen Sebelius, CMS Administrator Marilyn Tavenner, Leapfrog Group CEO Leah Binder and Patricia Hemingway Hall, CEO of HCSC.

“The Top 25 Women in Healthcare have battled through a lot to get to this moment, and we applaud their talent and perseverance. Gender inequities remain in opportunities, compensation and societal and family expectations,” Furst Group President Sherrie Barch says. “These women are among the top leaders in our country regardless of gender.”

The program, along with the “Top 25 Minority Executives in Healthcare” awards, also sponsored by Furst Group, continues the firm’s efforts to ensure that the leadership of healthcare organizations reflects the communities they serve. This is the fifth year that Furst Group has sponsored the awards.The awards will be presented at the gala Aug. 6 in Nashville, Tenn. We hope you will consider attending.

To see the full list of honorees, please click here.

By Bob Clarke

When the dust settled on the 2012 elections, healthcare leaders could finally exhale and look out at a landscape that had a bit more certainty about the future. For one thing, healthcare reform emerged as a winner, just as it had five months earlier in the Supreme Court. But the certainty of reform’s forward momentum means there won’t be any dust on the calendars of healthcare decision-makers, who have much to do in a short amount of time as reform’s deadlines approach.

Beyond that busyness, here are a few trends to keep your eye on in 2013:

The march of the ACOs and exchanges. The number of ACOs continues to grow as reform takes hold as a reality. Tellingly, for-profits are sitting this one out. And when it comes to exchanges, a number of GOP-controlled states are opting for the sidelines as well, as the government scrambles to get its own infrastructure up and running in those vacuums. Will it be ready in time? Hard to say.

Political fireworks. Reform remains a divisive force in the land, with congressional GOP leaders still looking for ways to block its implementation. Obamacare is even more of a lightning rod at the state level. For example, nine Wisconsin lawmakers want to pass a bill that would allow the state to arrest any federal workers who attempt to enforce the ACA’s requirements in their state.

Learn the lingo. Former Modern Healthcare editor David Burda notes that “Manage by Medicare” and “What’s your number?” are the new catchphrases in the healthcare industry as organizations wrestle with ways to cut operating costs so they can stay in business at a time when Medicare and Medicaid reimbursement rates are dropping.

Whose job is it anyway? DaVita buys Newt Gingrich’s think tank. Duke and Lifepoint team up. Health systems roll out insurance products. Insurers buy hospitals. Look for more of the above as consolidations continue – not just consolidation of care, but of financing and insurance.

Watch the quiet giant. We can talk all we want about United, Wellpoint, CHA or Kindred. They have a large footprint in the industry and deservedly so. But watch to see what Walmart does in 2013. They are already providing immunizations. They recently contracted with the likes of Mayo Clinic and Geisinger to provide certain types of free operations for employees. On the financial side, they recently partnered with American Express to provide free checking accounts to consumers. What’s next?

Squeeze play. Many independent community and rural hospitals are carefully considering their future, as the swell of mergers and acquisitions imposes unwanted pressure. Some have joined systems or affiliated with a larger player, but many believe they have a commitment to their community to stand alone and resist the pressure.

A new breed of executive. Not that long ago, many healthcare executives didn’t even have smartphones. The healthcare leaders of the future will need a skill set that incorporates technological savvy with the proliferation of IT. But they’ll also need to be skilled in assessing risk like an underwriter, predictive modeling, and understanding analytics to measure clinical and financial performance. Watch to see a new generation of leaders begin to make their mark in an industry where most of the workers, including the C-suite, view their jobs as a calling.

Kimberlydawn Wisdom: “As an emergency medicine physician, the community comes to you in various states of disarray. I thought that, if I could go out and meet them where they are, I could have a greater impact.”

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

As a successful physician executive at Henry Ford Health System, Kimberlydawn Wisdom, MD, has attracted the attention of governmental leaders far and wide. Jennifer Granholm, then governor of Michigan, named her as the state surgeon general in 2003, a post she held for eight years. More recently, President Obama appointed her to his Advisory Group on Prevention, Health Promotion and Integrative Public Health. But the path to a medical degree was one that Wisdom had to clear of a number of obstacles.

First and foremost was the era in which she grew up, a formidable boulder indeed.

“In the 1950s and ‘60s, there wasn’t a plethora of physicians of color,” notes Wisdom, Senior Vice President of Community Health & Equity and Chief Wellness Officer of Henry Ford Health System in Detroit and an assistant professor for the University of Michigan Medical Center. “In my junior year of high school, my guidance counselor said I should choose a profession that was more suited for my race. For her, saying ‘I want to be a doctor’ was like someone saying, ‘I want to be an astronaut.’ She actually did want to ensure my success. But I think her sense was, ‘Let me bring you back down to something that’s manageable and achievable.’ “

Yet Wisdom’s mother, who grew up in the small community of Coatesville, Pa., did in fact have an African-American physician. And Wisdom became a caregiver for her mom at home as she dealt with severe migraines.

“During my childhood, she spent a lot of time in bed and I was regularly bringing her aspirin or some other type of pain medication,” Wisdom says. “It was very impactful to me as a young child to watch her go through that. But on another level, I could bring her water, I could bring her comfort. That began to ignite this desire to consider how I could care for people long-term.”

She was exposed to a wonderful hospital atmosphere from a tonsillectomy as a child, and soon had dolls and bears lined up in shoeboxes around her room, where she would tend to their medical needs. She graduated 20th in her high school class of 600, but her supportive parents weren’t so sure that marrying a young mechanical engineer was the best way to get through medical school. But when she crossed the stage to become an M.D., both her husband and parents celebrated together.

“They were all very proud,” she remembers. “It was a tremendous sense of accomplishment, and a tremendous sense of being thankful, because I couldn’t have done it without the support of family and without a strong spiritual grounding. It took a lot of prayer. I beat the odds in many respects.”

Despite her challenges, Wisdom says she had an idyllic childhood growing up in Mystic, Conn., the town made semi-famous by Julia Roberts’ first movie, “Mystic Pizza.” Those experiences, she says, have shaped her career as she sought to give her patients and her community the opportunities she was afforded.

“In part, I wanted to create a Mystic for the community in which I practiced, so they would have a safe place to grow up. So families could thrive. So people could reach their maximum potential, because they had a place where they felt they could achieve all that they were expected to achieve.”

But Wisdom has spent more than 30 years in Detroit at Henry Ford Health System – more than 20 as an emergency room physician – and she readily acknowledges that Detroit is worlds away from Mystic. As she saw the issues confronting her patients – violence, diabetes, obesity, teen pregnancy – she determined to take healthcare to them and not wait for them to come to her. Today, such goals are commonplace in any metro hospital, but back then her ideas were seen as unorthodox. Nonetheless, her bosses at Henry Ford told her to go for it.

“As an emergency medicine physician, the community comes to you in various states of disarray. I thought that, if I could go out and meet them where they are, I could have a greater impact,” she says. “When I look at many communities, so many people have not had the ability to realize their potential because they have made choices based on the choices they had available, not based on the best choices that would be ideal for them at any given time.”

So Wisdom started small, taking physicians, nurses and social workers out into the community, setting up shop in a community center or a faith-based organization. With each endeavor, Wisdom received more funding as she slowly and quietly attempted to address health disparities in the African-American community.

She and the health system now have major grant funding from the U.S. Department of Agriculture to address child obesity reduction. Several foundations fund her work in attempting to reduce infant mortality in the Detroit area, a region that has one of the highest rates in the country. A faith-based program she designed received funding from the National Institutes of Health, and she serves on the president’s group that advises his cabinet regarding the National Prevention Strategy, a wellness initiative created by U.S. Surgeon General Regina Benjamin.

The Ford system recently earned the Malcolm Baldrige Quality Award, one of the highest honors for any industry, in terms of service excellence, and has established the Wellness Center of Excellence, called “Henry Ford LiveWell” for short, that focuses on preventative and lifestyle health.

It’s a long way from dolls in shoeboxes, but Wisdom says that, if anything, her passion and excitement for healthcare have grown.

“Empowering people,” she says. “That’s what it’s all about.”

Wright Lassiter III: “I think it’s important for CEOs to partner with their boards to drive change.”

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

Back in 2005, before Wright Lassiter III interviewed for the position of CEO at the then-beleaguered Alameda County Medical Center in Oakland, Calif., he decided to see for himself if there were some signals of hope in an institution that had seen 10 CEOs crash and burn in the previous 11 years.

“I flew in the afternoon before and grabbed a taxi over to the hospital,” he says. “I was in street clothes; I wasn’t in a suit. No one knew who I was. I walked into the ER waiting room and then walked the hallways. I wanted to get a sense of how the staff functioned; to see if people might help you find your way.”

What he found surprised him, especially for an organization with such a troubled recent past. Everyone he encountered was consistently courteous and helpful to him as a visitor, and to patients.

“There wasn’t one interaction that was negative,” Lassiter remembers. “The people doing the work in the trenches serving the community were doing the best they could.”

That, Lassiter says, gave him some hope that the health system could be turned around with the right moves. It also helped persuade him to give up a solid, comfortable position at JPS Health Network in the Dallas-Fort Worth area where he was senior vice president of operations.

Fast-forward a few years and the work that Lassiter has accomplished earned him a glowing write-up in Fast Company magazine, a spotlight that brought him national attention as well as some good-natured ribbing from his peers, he adds.

But to Lassiter, none of it would have happened without the backing of his board of trustees, a source of strength that is sometimes overlooked in the business world, he says.

“Two board members who served on the search committee that selected me are a large part of the reason why I considered the job in the first place,” Lassiter says. “They were instrumental in the turnaround. I think it’s important for CEOs to partner with their boards to drive change.”

It was the board’s backing that enabled him, he says, to press forward with an aggressive plan to reduce errors and champion quality and patient safety.

“I generally take my board members to health care conferences to help them understand the nuances of what’s being presented,” he says. “But I purposely did not go with my vice chair when he attended an IHI conference on quality because I didn’t want to influence him. He went with our chief medical officer instead. When he came back, he told me, ‘OK, Wright, I get it. I am scared out of my mind, but we have to do this.’ ”

The leaders at Alameda County Medical Center presented a plan for “harm reduction” and, in 18 months, reduced incidents of harm by 48.5 percent across the system.

“People get uncomfortable with the word ‘harm,’ but the board agreed that it was the correct word to use. The groundbreaking report “To err is human” found that harm was happening in hospitals and we were willing to acknowledge that a problem existed,” Lassiter says bluntly. “Our work drew glowing comments from the Joint Commission and Donald Berwick, a member of the original committee that published the report on errors. That’s what happens when you educate a board well and then engage them.”

Healthcare and leadership are part of Lassiter’s heritage. His mother is a nurse, and his father is chancellor of the Dallas County Community College District. What he’s learned from them, and from his career, is that a critical factor in leadership is simply courage, like the move he made in accepting the Alameda position. “That doesn’t mean blind courage,” he notes, “or taking risks that are inappropriate. But when the lights are off and you don’t know what’s around the corner, you have to lead with courage.”

Closely aligned with courage, he says, are transparent communication and flexibility. “Communication is especially important with the medical staff,” Lassiter notes. “You tell them, ‘Here is our plan, and we will keep communicating with you all the way through this process.’ ” It’s a reason why he still takes part in new employee orientations, he says.

Flexibility is based in honesty, Lassiter says. “You have to do your planning with flexibility. You can plan so that you have a baseline for your actions as an organization, but you have to be willing to be flexible if conditions change.”

And as conditions change within the healthcare industry itself, he says, building a leadership team requires flexible people. “Healthcare is a relationship business, and I’m always looking for folks who can foster, build and maintain strong relationships. It takes perseverance too. You can’t be dissuaded easily by problems or challenges.”

At Alameda, the challenges have been formidable, but Lassiter and his team have stepped up to the task, stopping seven-figure financial losses and building a new facility while dealing with all the issues that come with being a safety-net hospital.

“When I talk to our people, I say, ‘Think of your loved ones and put their faces on the patients and families you’re caring for.’ When you approach your work with this in mind, you will do all you can to provide excellent service.”

Geeta Nayyar: “If you really want to have the impact in healthcare delivery that we are all talking about all of the time, it has to be done with doctors and patients.”

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

She’s the chief medical information officer for one of the largest firms in the world, but AT&T’s Geeta Nayyar, M.D, MBA, wants you to know that it’s not about the technology.

“It’s about people, and finding out how to make their lives better.”

At 33, she’s one of the youngest honorees of Modern Healthcare’s Top 25 Minority Executives in Healthcare awards program, but she’s been at this medicine thing a long time – she got into medical school at age 17.

“Both of my parents are physicians,” she explained. “I always was, and still am, a geeky science person, really fascinated by biology. But at the same time, I was always a very social person. So, clinical medicine just made sense because it was a joining of the best of both worlds.”

Her current role doesn’t call for it, but Nayyar made sure her employer would allow her to keep that aspect as an active part of her life.

“AT&T has been very supportive, and I am still on faculty at George Washington University in the department of rheumatology,” she says. “I still see patients. It’s only part-time, but I really enjoy it. And as much as healthcare keeps changing, it really is a valuable asset in my role.”

Nayyar says she sees technology as just another tool for physicians, like a stethoscope. She says her students at George Washington agree.

“The doctors that I teach now, in medical school and residency, can’t live without their tablets and smartphones – so why would they practice without them?” she says. “It is becoming so much more intuitive to use them. So if it helps you practice better medicine, why wouldn’t you?”

Beyond physicians, Nayyar believes patients are forcing the issue for the healthcare industry as well. “Patients say, ‘I can make a dinner reservation on my smartphone, but I can’t make my doctor’s appointment online. Why is that?’ ”

Although healthcare has lagged behind in adopting technology, Nayyar says the industry can use this to its advantage, by learning from the experiences of other businesses. The aviation industry, for example, has inspired strides in patient safety. Nayyar points to the banking industry as a more mundane model for how technology can transform patient care.

“The majority of people use online banking,” she says. “There are apps now where you can cash your checks; you don’t even have to go to the ATM. People are able to see in real time what their financial health is – how much has gone in, how much has gone out. We don’t have that right now for diabetes or hypertension or heart disease.”

Then there’s the bedrock necessity of clear doctor-patient communication.

“Often, patients leave the doctor’s office and forget 50 percent of what they were told, especially if there are prescriptions involved. There can be language and cultural barriers too,” Nayyar says. “In rheumatology, we give a lot of medications once a week or every other week. Patients sometimes misunderstand you and take them every day. Something really simple like that can have all kinds of astronomical side effects for patients. Technology can give patients a reference at home for these kinds of things that are hard to explain in a 10-minute visit.”

Nayyar says she sees her role at AT&T as part consultant (advising what products would appeal to what parts of the industry), part physician and patient advocate, and part ambassador (being the public face of AT&T healthcare and talking with stakeholders and policymakers about healthcare technology). She says she came to the company because she saw an opportunity to make a difference for more patients than she could ever see strictly as a clinician.

Like many in the industry, she and AT&T see the cloud as a definite part of the solution. “The problem is that our systems don’t talk to each other and there are barriers, including geographical ones, to getting access to records,” Nayyar says. “One of the beauties of the cloud is that, just like email, you can get it from anywhere, at any time, on any mobile device. In healthcare, that seamless transition hasn’t happened yet.”

The cloud, she notes, could help ACOs “lay out that clinical integration road map. If an organization is looking to become an ACO and integrate between their hospital and their outpatient center and with their patients who might be at home, the cloud can be a great integrator.”

While healthcare is facing seismic change, she said she thinks the business world could learn a few things from medicine as well.

“I think one of the most beautiful things we have in medicine is something called ‘M&M’ – morbidity and mortality rounds,” she says. “It’s where we reflect on a case where it just went wrong. We dissect where something went wrong, or we did our best but the patient didn’t make it, or there was this horrible, adverse effect. We try to understand what went wrong and we think about what we can do to make it go better. But what I have noticed in the corporate world is that there is no interest in doing ‘M&M’ rounds on a strategy or a solution. But life is about learning. Let’s learn from our mistakes It takes a certain amount of courage to say that.”

As healthcare evolves, Nayyar says those types of qualities are one reason there is an upswing in the number of physician executives at healthcare organizations.

“Too often, the forces outside of the hospital walls dictate what happens inside of the hospital walls,” she says. “That dynamic really has to flip, and I think the possibilities are just endless right now. If healthcare is going to change, it has to be done with doctors and patients and with all of those involved in medicine – and not done to them. If you really want to have the impact in healthcare delivery that we are all talking about all of the time, it has to be done with doctors and patients.”

Not every physician is interested in leading an organization, and Nayyar understands that.

“Plenty of my colleagues and friends have no clue what I do and no interest in knowing what I do,” she says with a chuckle. “They just want to see patients. My job is to help them see patients better. And to help myself see patients better.”

Ben Chu: “If you talk to the hospital leaders and members of the boards across the country, there is an enormous amount of energy working to find ways of taking care of their communities.”

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

Benjamin Chu, MD, MPH, MACP, oversees Kaiser Permanente Southern California and Hawaii as group president. In the seven years since he arrived, Kaiser Permanente has amassed many awards for quality. He also is chairman-elect of the American Hospital Association and will begin serving in that capacity in 2013. Prior to joining Kaiser, he was president of New York City’s Health and Hospitals Corp., the largest public health system in the country. He also served as associate dean at both Columbia University and New York University.

Following is an edited transcript of the conversation:

You have a Bachelor’s degree in Psychology. What spurred you to go for an M.D.?

I think I always was going to be a doctor. Unlike a lot of people who have a core basic science orientation, I was always more interested in the human side of medicine. Psychology, child development, and anthropology are more in line with things I was thinking about. As you know, in medicine, there are a lot of behavioral and developmental aspects. In order to be effective, you have to understand the cultural determinants of health. All of these factors led me to pursue work in a field where I could actually help people. There is a whole sociology and culture of medicine that one cannot fully understand unless viewed from the psychological perspective.

You spent most of your life out East before moving to California. What spurred that move, and has it worked out as you expected?

I was running the NYC public hospital system under Mayor Bloomberg. It was an incredible experience and an incredible job. We were doing very innovative things in that system. It is a huge system that cares for 1.3 million NYC residents. When the opportunity arose to move to California and run a large chunk of Kaiser Permanente, the prospect piqued my interest. How far can you take a systems approach to delivering on improving the health of the population under the care of a large system? In Southern California, Kaiser Permanente has 3.6 million members, three times the size of the population we were caring for in NYC. The nice part about it is that the components and pieces are linked in a large multi-physician group that only works with the health plan and the hospitals. The health plan allows for pre-payment for care of the population. There is an entire delivery system under us that allows us to decide how to parcel resources in order to achieve the goal of maximizing the health of the population we serve.

How do you get a big system like KP to deliver on its promise and to take healthcare to a whole different level?

That was both the challenge and the fun part of coming to KP & California. I didn’t know many people when I was coming to Kaiser – primarily George Halvorson [chairman and CEO] and Ray Baxter [senior vice president for Community Benefit, Research and Health Policy]. It’s been an incredibly rewarding experience. We had to put systems in place – our electronic health record and other systems – to allow us to look at our performance in a very open, honest, and critical way. We had to reconfigure the system. KP had been better than average on quality and outcome for our members. Now, because of what we’ve been able to do with tools, reconfiguring our system, and getting complete alignment of our systems, components and people (including the 60,000 employees in Southern California), we are pretty close to leading the country on many metrics.

From Leapfrog to NCQA, KP across the board has achieved some remarkable ratings for quality.

There has been a steady progression over the last half dozen years. We’ve taken a systematic approach. We engaged every member of our staff, from doctors to non-doctors and from professionals to frontline workers, to get to that point. It has been very rewarding and a lot of fun to do.

The last six years coincide with your arrival. What role did you play in these changes? What role did you leadership team play? What did you look for when bringing a new leader on board?

To tell you the truth, I don’t think I have brought anyone new in, believe it or not. I spent time getting to know the people here. We have a wonderful leadership group, and there have been very few changes. The changes were largely to replace people who left. What would be the key to our success? It hovers around getting complete alignment over what we wanted to do.

Much of the alignment was around trying to make sure we did everything possible to benefit our members. It was not a financial decision. While financials are important, they aren’t driving our goals at this point. The larger point was to make sure everyone understood that at the end of the day, it is our members and patients, and how we perform for them, both in the individual aspect and aggregate aspect.

People rallied to this message of reaching for the higher mission. It’s hokey to think about in that way, but you’d be surprised. Everyone comes into healthcare to make a difference in another person’s life. One of the things we did as a leadership team was to galvanize everyone’s desire to make a difference and reminded people of this. I think this is the key to leadership overall. I am blessed to have a lot of incredible people working with me on much of this.

Obviously we had to put in the systems to give us the information to know if we were making a difference in people’s lives. Once we got that in place and held that mirror up, the ideas came flowing out, and we could tap into this wellspring of creativity and desire to do the right thing. I am a doctor by training in a non-clinician role right now, but it is a pleasure to see that marriage of clinical outcomes and my public health background on population health outcomes come together in a delivery system.

As you look at your role at the American Hospital Association as chairman-elect beginning in 2013, do you get the sense that part of what they are looking to you for is to help other hospitals across country pick up on what Kaiser has done and get the quality scores up and make a difference nationally?

If you actually talk to the hospital leaders and members of the boards across the country, there is an enormous amount of energy working to find ways of taking care of their communities. Part of this is the quality agenda. Thousands of hospitals have joined the hospital engagement networks that are forming right now and are trying to learn from each other and optimize the quality of care given in the hospitals themselves. Hospitals are beginning to see that they play a pivotal role in their communities.

Rather than be passive and wait for people to get sick and come in, there is a role to be played more upstream – to make a difference in the community’s fabric and in its health. Some of it has a lot to do with impacting the developing ACOs. It is an often misunderstood, yet often used, term. The idea is to get an organization and care delivery system to care for a population and try to go as upstream as possible to find strategies that lead to good health and mitigate things that lead to bad health, not just treat emergency situations. It means partnership with providers who work in the upstream levels. Doctors who see patients in an outpatient setting tied to the hospital or in their practices – we need to link the two together.

There is a lot of energy in the hospital world. One of the reasons I was asked to chair in 2013 is that there are tremendous, yet uncertain, changes that are happening. There are also these powerful positive forces that can help hospitals and health systems come together in a better way to take better care of their communities. I think I was asked to chair so we can engage in a system-wide and country-wide dialogue to help each other overall.

Given the uncertainty around reform – does that make leadership harder for you and the people running hospitals round the country?

It depends on what you mean by harder. It certainly makes it much more interesting. The pathways to choose are much more ambiguous. In uncertain times, leadership needs to focus energy on the right things. I think that is why the AHA is working with our member hospitals to determine the higher-order outcome. If we dive into the weeds and get into the arcana of legislation and stay there, we will get lost. That is not to say reimbursement and policy changes aren’t important, but if that is all we think about, there is no ability to guide organizations through a field of uncertainty.

If you can’t pick up your head to see where you are going, you cannot mobilize physicians and institutions to move in the same direction, and we will be mired in the field and will not get anywhere. That is the difference between someone who is good operationally and a leader who can engage people in dialogue to get everyone to a place where we want to be.

There seems to be a growing consensus among healthcare leaders that we are on a course of change that will continue whether mandated or not.

I think that is absolutely correct. Healthcare is changing in a good way, I think. I know people worry about losing the good things in uncertain times. When you think about what we are capable of doing and how many people we are capable of doing things for, I am convinced that with a little change in perspective and focus, we can utilize the dollars we spend in healthcare and create a lot more healthy communities. It is a journey in a lot of ways – a very uncertain journey. I think the focus is changing. Payment reform is happening. A lot more transparency is coming. There will be changes to tell us how we are really doing. Once you are confronted with that information, it is a compelling force driving changes that could get us to a better place.

I think that in the best framing of what is happening now, that is the direction the country’s healthcare systems is headed. Probably the direction the world’s healthcare system is headed. Even though we are making a difference, how do we know we couldn’t be making a bigger difference? When you think of disparities in healthcare and how uneven results are, I think in this day and age, there is little the systems cannot tackle. We won’t all get there at the same time, but if we focus right, there’s a lot more good that we can do.

There seems to be an increasing interest in physician executive leadership. As a doctor and physician yourself, what is your take on that?

The lesson we’ve all learned is that in order to take on the larger tasks, the triple aim, all of the key pieces must be aligned. Physicians and other healthcare professionals have to be integrated into the whole system. We are trained to be separate. Even though hospitals are a part of the action where people are treated and where doctors do what they do, they are still only a piece of the puzzle. To integrate the perspectives, many places are looking towards physician leadership, whether as an administrator or at a Medical Director/CMO level. We need voices there and to be open and honest about the larger goal. We cannot just see hospitals as a doctor’s workshop. That will only get us so far. Obviously, we want someone to care for patients and bring their expertise. However, it is not just a single doctor, but multiple healthcare professionals. We want to see the larger role for the community.

We need to make decisions on the deployment of resources and make a bigger difference than just delivering the best care in the ER. I’m not saying the best care shouldn’t be delivered in the ER, but when you think about it, it may not be the optimum expenditure of resources if you only concentrate on the ER.

In my opinion, there should be more doctors at senior levels of health systems. Having everyone’s perspective is important and makes a difference.

You spent time working in the office of Sen. Bill Bradley. What insights from that time guide your perspective in today’s healthcare climate?

I’m not sure there is a tremendous amount of insight but, when I worked for Senator Bill Bradley, it was one of the last times for major Medicaid expansion. The American with Disabilities Act was passed the year I was there; we passed the Medicaid Best Price legislation for pharmaceuticals, and expanded Medicaid to children up to 133% of the poverty line and pregnant women up to 185% of poverty. That was really the last big expansion before the children’s health program came in.

When I think of that era, it was a time of greater bipartisan collaboration. I worked for a Democratic senator when the first George Bush was president. There was a lot more collegiality. That’s not to say that cannot happen again, but I’m hoping after the upcoming, probably raucous, presidential campaign, that people will be more realistic in looking at the problems of our country and figure out how to solve them.

Even if we concentrate on legislation, that’s not always where the action is. Many core changes are already starting to happen. Core systems changes are being worked on. I don’t think there is a way back. From the hospital perspective, one of the opportunities was finally being able to count on some sort of payment for care of the significant portion of uninsured patients that would come in to the ER and hospitals. This includes upstream care and hospitalization. From the community and hospital point of view, that was one of the best parts of healthcare reform. I hope that will continue. I know it presents problems for many aspects of the healthcare world, the Medicaid expansion, as well as the exchanges, but I hope that some sort of increase in uninsured care will continue. We will always muddle our way through. We always have muddled our way through, based on my experience with Senator Bradley. It was not always clear then (1989-1990).

Healthcare organizations, particular in the inner cities, are creating senior housing, opening banking centers, farmers’ markets, and developing other innovative systems and ideas such as free surgery day. Some might think it’s a bit far afield of healthcare, but it seems to be a growing part of preventive care. Is this part of the equation at Kaiser Permanente as well?

Every one of KP’s medical centers runs a farmers market. In fact, we run the only farmers market in Los Angeles. This is illustrative of what I was talking about earlier – the tremendous amount of energy spent in the hospital world trying to figure out how we go upstream. The medical model is individual – one person at a time. When someone is sick, you care for them and send them back out. This is an important function for every community. The underlying premise is that the sum of all the good one-on-one work will translate into a healthier community. Clearly, this model leaves huge gaps. The medical model really is not directly focused on the population’s and the community’s total health.

There is a broader understanding that what makes a person healthy or not is as much about the health of the community and total health of the environment as it is to prescribing the right medicine. Eighty percent of the determinants of health are not linked to care. Smoking, exercise, drug use – these are things people need to think about if we are going to make a greater impact on the community and population health.

At Kaiser, we have a theater troupe that goes into grade schools to do thousands of performances on healthy eating to influence kids on eating habits. Collectively, if 5,000 hospitals and health systems can get it together and start moving upstream together, it could be a very powerful force. To become a vibrant part of the community is key. We helped invest in parks. We have beautiful weather in Southern California, but unless you have good outdoor spaces, people will stay in their homes or in their cars to go from place to place. The built environment in the community makes a difference. Do people have the choice to make better decisions? We need to provide spaces to make better decisions.

Saad Ehtisham: “If you can lead people, you’ll be much more successful than having to manage people.”

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

If Saad Ehtisham is something of an expert at change management, you might say it’s because those skills began to be honed at a young age.

After graduating high school in Pakistan, he began to look for a solid university for pre-med studies in the Dallas-Fort Worth area, where the majority of his mother’s family resides. (He’d been inspired to pursue a career in healthcare after helping to take care of his grandmother after she was diagnosed with ovarian cancer.) Ehtisham ultimately chose Baylor and, while he ultimately chose a route in nursing and healthcare administration instead of pursuing an MD, he cites that experience as a building block in his rapid rise through the healthcare industry.

“When you emigrate to a country at a young age, you tend to grow up a lot faster,” said Ehtisham, 42, the CEO of University Medical Center in Lebanon, Tenn., in a calm voice that sounds as Texan as a 10-gallon hat. “Going to Baylor was one of the best decisions I ever made. I was one of two students of Asian-Indian-Pakistani descent, and we were able to open up the university to greater diversity. It was a great atmosphere and I made some lifelong friends.”

He finished up with bachelor’s degrees in science and biology at Baylor, then continued his studies at Texas Woman’s University, where he earned bachelor of science degree in nursing, a master’s in business administration, and a master’s in health care administration. He took his degrees and started his medical career as a phlebotomist, drawing blood from patients. He became a nurse and worked his way up. He’s been a medical and surgical director, a chief nursing officer, a chief operating officer, and even served as an interim CEO in a career that has taken him all over the country, from Texas to New Mexico, Kentucky, Indiana and now the Nashville area. Ehtisham says the changes he’s experienced in his wide-ranging career have helped him better understand healthcare.

“One of the things I have learned in moving around the country is that healthcare is regionalized,” he says. “It really is different in different parts of the country. That’s helped me to become more diverse in my approach to healthcare.”

Having experience on the front lines as a nurse has helped him relate more easily to clinicians in his roles as an administrator, says Ehtisham, who has helped reduce turnover and increase patient and staff satisfaction at a number of his career stops.

“For me, clinical knowledge has been my greatest asset,” he says. “It’s helped me to get farther with physicians and get them more involved, usually with educating the front-line staff about different diseases. And it’s helped me to a better advocate for patients.”

Ehtisham describes his management style as “patient-centric.”

“When I approach decisions, I want to know two things: how does it improve patient care, and how does it improve my outcomes? If we’re evaluating a process and it doesn’t improve patient care, is it worth doing? Let’s think that through first, because anything else is wasteful and we don’t need it.”

Although success has come swiftly for him, he is quick to credit three mentors for shaping his leadership in key ways.

“Tim Charles was my first CEO, at Presbyterian Hospital (in Denton, Texas). I learned a lot from him—the way he interacted with physicians and his community involvement. I spent about 18 months with Dewey Greene in Albuquerque (when Greene was COO of Lovelace Health System). I would meet with him and barrage him with questions. He had a significant impact in preparing me for the CEO role.

“And Angela Marchi was my CEO at Albuquerque. She taught me how to stop being uptight and relate to employees in a way that would empower them to be more effective. She was very skilled at relationship building. Leadership is about relationships, and she taught me that if you can lead people, you’ll be much more successful than having to manage people.”

So Ehtisham has worked on his relationships, and on building his own leadership team as a CEO.

“To build a good team,” he says, “I look for diversity among the team members – not just ethnic diversity, but diversity in the way we approach things and the beliefs that we hold as a team. I like people who are comfortable with ambiguity, and I look for perseverance – anybody can lead through the easy times.”

In the rapidly changing world of healthcare, there’s a lot of ambiguity right now, but Ehtisham doesn’t see that as a barrier at all.

“I’m excited and energized by the uncertainty in healthcare right now. We’re ready to rise to the challenge.”

Michael Ugwueke: “If you try to wait till everything’s perfect, you’ll never get off the ground.”

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

Michael Ugwueke is CEO of Methodist South and Methodist North hospitals in Memphis, Tenn., where he also serves as senior vice president of the Methodist Le Bonheur Healthcare system. He came to Methodist in 2007 from Provena St. Joseph Medical Center in Joliet, Ill., where he worked as vice president of operations. Ugwueke, who came to the U.S. from his native Nigeria as a college student, turned around the troubled Methodist South facility, instituting a 30-minute emergency-room guarantee to the community in the process. His success led his bosses to add Methodist North to his responsibilities. Following is an edited transcript of the conversation:

Do your ERs still have the 30-minute guarantee in place?

Yes, we’re still doing it. When I first got into town, Methodist South was not very highly regarded. We were trying to turn the hospital around. There were a lot of issues stemming from perception of poor quality, low volume and low employee morale.

And one of the things that occurred to me is that most of our patients – over 80 percent – came through the emergency room. To make any noticeable impact, change had to start from the emergency room. When we went about trying to improve the turnaround process in the ED, that equally meant that we also needed to improve the turnaround process for major ancillary departments, specifically the lab and radiology departments. We wanted to make sure we streamlined our operations to remove all bottlenecks that affect quality and efficient delivery of service to our ED patients.

The 30-minute guarantee was part of my overall strategy, because what I really wanted to do was to create a new story about Methodist South. I knew that if we were able to create a new story, it would eventually take over and the old story of Methodist South would gradually die away.

So we took the 30-minute guarantee very seriously, and made it happen. That was almost five years ago, and it hasn’t stopped. Back then, we saw 37,000 visits a year. We ended 2011 with more than 61,000 visits and, with the current first quarter trend, we’re probably going to end up with 69,000 in 2012.

It helped to change the whole dynamic of the hospital, not just the emergency department. The operating room has to be efficient, the floors have to turn over very quickly, and everything from the laboratory to housekeeping is critical in our success.

There’s a sense of pride for all the associates who were involved in this initiative, especially when they hear from their family or other members of the community.

Tell me about your role and Methodist’s role in domestic violence prevention. How did that come about?

Community involvement is very, very important to me, but my involvement in working to end domestic violence came about strictly by accident. There was a nurse at another hospital who was killed in the parking lot when she came to work by an ex-boyfriend who was stalking her. It became a big news story here. It prompted one of our doctors, Todd Motley, to start talking about incidents of domestic abuse he believed were happening to some of his patients. He created a program so that victims of abuse could call his office for an immediate appointment, receive some shelter and notify the police. He came to me and it didn’t take but a minute for us to get behind what he was doing.

So we ask our associates to donate clothes and toiletries, among other things, to help these women. But Todd Motley is the brains behind this.

You recently paid a visit to the White House. What will you remember from that day?

It’s the first time l’ve ever been there. I lived in D.C. for a brief period of time and always said, “I’ll do this, or I’ll go there,” and I never did.

Steve Cohen, the congressman from my hospital district, extended an invitation from the White House to meet with key minority business leaders to brainstorm about job creation and various other opportunities. So about 20 business leaders from Memphis sat down with the White House staff. I was truly honored to be invited as part of the delegation that met with them.

Where have you learned the most about leadership? And from whom?

Actually, it started at home. My dad was the primary person in my life that I felt believed in me and provided guidance to me as a kid growing up in Nigeria. I watched him as he struggled to raise us up with limited resources; he was my inspiration in every way imaginable because he was looked upon in the community as a leader even without a formal education. Having the guts to leave your country at the age of 21 to come to the U.S. where you don’t know anyone, and believe that you’re going to survive with no money – that came from my dad’s ability to instill in me the knowledge that the world did not owe me anything and I had to create opportunities for myself.

My dad did not have a formal education. He was self-taught but was able to become a foreman in a construction company and eventually was able to start his own construction business. He wanted to make sure all his kids had the opportunities for education he didn’t have. I was very fortunate to have such a person in my life during my formative years.

A number of other people also have been very instrumental in my life. I’m forever grateful to Michael Covert. I met Covert when I was working at Sarasota Memorial Hospital in Florida. He provided me with lots of growth opportunities and was my first formal mentor. When he left the hospital to become the CEO of Washington Hospital Center, he asked me to come with him as one of his executive team members. He was very instrumental in mentoring me and providing needed guidance as I continue to take on additional challenges within the hospital. The second person is my current System CEO Gary Shorb – he is one of the people who nominated me for this award. He is a wonderful mentor and the reason why I came to Memphis; he too has provided me with lots of growth opportunities. He is a servant leader who is extremely passionate about patient care.

What makes a good leader?

For me, a number of things make up a very good leader. A leader is someone who is willing to step up and do those things that most folks are unwilling to do, to have the intestinal fortitude to make tough decisions, who is visionary and willing to lead from the front. A leader creates the environment that empowers others to equally step up and lead.

You have to make sure that you have clarity in your organization with total transparency in all communications with your associates as well as other key stakeholders. For example, we conduct four town halls a year to ensure that everyone is on board with our goals and objectives. We share the results of our activities during these sessions – good, bad and ugly – so everyone knows exactly what is happening at any given time. It takes away the “we” and “they” mentality which ultimately leads to trust.

What are the keys to building a good team?

No one can do anything by themselves. In my early years, I realized the importance of teamwork. There are certain guiding principles one develops. In my case, I like to have a very diverse team that reflects the community we serve.

I also like to pick out people who are much smarter than me and passionate about making a difference because that’s what it takes to do this kind of work. I inherited the leadership team here; my philosophy is not one of blowing things up and bringing in all new people without giving the existing team members the opportunity to prove themselves. I like to believe that most leaders, given the opportunity with clarity in expectations and support, can get the work done. I like to make sure they understand the reasons behind the new vision and what implications it has on their success. Obviously, you give everybody a chance, and some will self-select when they realize that they’re better suited for another environment.

But I try to build my team in four ways:

The first is to try to create a culture of accountability, to be very clear with the goals of the organization. We set clear priorities and expectations with timelines and metrics to gauge and measure our progress. All my leaders have actionable plans that support their goals and priorities for all of their areas. To be effective, one has to know their business in and out and able to explain positive or negative variations from their goals. We track our goals on a quarterly basis, and plan for where the metrics need to be on a monthly basis in order for us to accomplish our 90-day goals.

It’s very important in developing a high-performing team that you have a sense of trust. You have to create a level playing field – no one has a monopoly on good ideas. Everybody’s goal is shared with everyone. There are no hidden agendas.

Second, is to create a culture of rapid execution of ideas. We don’t want analysis paralysis with several meetings and no results. We try not to wait till we have 100% of the data before execution of great ideas, What typically happens is that if we are comfortable with 70 percent of what we need, we will go ahead with our plans, with the expectation that we may have to refine and course-correct as needed. If you try to wait till everything’s perfect, you’ll never get off the ground.

When we started the 30-minute guarantee for our emergency department, we met every afternoon. We shared yesterday’s data – everybody knew exactly how we did, and then we made immediate changes to address variations from our targets.

Third, is leadership and associate engagement. I strongly believe that the engagement factor with your team is important. I conduct 90-day meetings with all new associates to ensure that we are still meeting their expectations and I often meet with leaders and seasoned associates to learn about their challenges to ensure that we are providing adequate resources and tools that they need to accomplish their goals. In addition, it provides me the opportunity to recognize their efforts. You need to devote time to this and make those connections.

Fourth, is total transparency in everything that we do – data and results are shared liberally, with clear understanding of our strengths and shortfalls with no excuses. We do this during our town hall meetings, annual retreats and operational efficiency presentations by department leaders.

You’ve spent a lot of time at faith-based institutions. How different are the challenges there?

For one thing, the mission is very clear. There is very little ambiguity as to what the mission is. I believe that the difference is how we go about providing care for everyone regardless of their ability to pay. Also, we invest a lot in the community, trying to improve the health of our community – as you well know we don’t expect for anyone to reimburse us for the things that we do in the community. By virtue of being a faith-based organization sponsored by the United Methodist Church, you feel like you have the moral authority to look at things in a slightly different way. At the end of the day, my expectation is that we are going to treat the patient holistically in a patient-, family-centered environment. We do the best we can with limited resources to make sure people who ordinarily don’t have access to healthcare have the opportunity to experience excellence in healthcare.

In terms of diversity in healthcare, what kind of changes have you seen since coming to the U.S.?

No doubt there’s been some improvement, but we still have a ways to go. As long as we are still talking about disparity in care among different groups, we know that we are not there yet. I think the gap is closing within the ranks of supervisors and middle managers. The area of greatest opportunity is within the director level and senior teams.

Is leadership harder today given all the uncertainty around reform?

It will be easier to say yes, but I am certain that every generation of healthcare leaders probably thought that things were harder for them. I think that healthcare reform definitely presents lots of challenges which are opportunities in disguise. Regardless of the outcome of the Supreme Court ruling, changes have been made throughout the industry because the payment model that we have is just not sustainable. The challenge is having one foot on the throttle and the other foot on the brakes as we move from a fee for service to value-based purchasing.

Samuel Ross is the CEO of Bon Secours Baltimore Health System.

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

As a young man growing up in Texas, Samuel Ross says he wanted to be “the black Marcus Welby,” a family physician who returned to his hometown and found great success, just like the ‘70s TV doctor portrayed by Robert Young.

While Ross did indeed become a family physician in private practice, real life had different plans for him. He eventually served as chief medical officer, among other jobs, at Parkland Hospital & Health System in Dallas before becoming CEO of the Bon Secours Baltimore Health System. He also oversees Bon Secours’ Kentucky facilities and its system-wide Supply Chain.

And, far from the middle-class patients Welby tended to, Ross’ experiences in the poor neighborhood surrounding Bon Secours sometimes have less to do with the medicine he studied, and more to do with population health. In the last twenty years, including time under Ross’ watch, Bon Secours has built apartment buildings for seniors and opened a banking center for the community. They don’t teach much about that in medical school.

“These ideas came from the community,” noted Ross. “I’ve been influenced by the concept of Community-Oriented Primary Care that came out of South Africa by Dr. Sidney Kark. He built a number of facilities with the notion of one-stop shopping for the poor related to social determinants.”

Bon Secours was on the brink of closing a couple years ago. Its safety net for the poor was fraying badly as residents without insurance comprised a disproportionate amount of the patients. In fact, Ross determined that 50 patients alone accounted for 2,287 visits in a three-year period.

The state of Maryland came through with funding to right the ship, and Ross and his organization have done the rest. Ross is putting a focus on patient safety and quality and has announced plans to hire more physicians and other staff to develop a “primary care medical home.” Bon Secours has invested many dollars and a lot of hours in the community. “This is about the charism of the Sisters of Bon Secours to extend healing and compassion and liberation,” Ross said. But Ross is far from done and is determined that Bon Secours make a lasting impression, because the hospital – and West Baltimore – have been down this road before.

“A lot of people and foundations and government agencies have come in before and tried to make things better for the community,” Ross said. “But when the money runs out and the programs go away, a lack of trust develops in the community. We need to be partners working with them, not doing it for them.”

The needs are great in Baltimore, where the Sisters of Bon Secours came more than a century ago to begin to care for the sick. A study by the city of Baltimore and Johns Hopkins determined that life expectancy for a resident of West Baltimore is 20 years less than someone who lives in the affluent neighborhood of Roland Park.

“That’s unacceptable,” Ross said.

So Bon Secours went to the neighborhood and asked the residents what their needs were. The response wasn’t what the hospital expected.

“Getting rid of rats and trash – that’s what people said was important,” Ross related. “There were a lot of vacant houses where those things were a problem for the whole neighborhood. So we helped the community get rid of those houses and build community gardens. Housing was a major concern too, and that’s where the senior apartments came from.”

Ross hopes he and his staff have learned from their own and previous generations’ mistakes.

“Oftentimes, we go in to the community with our statistics and say, ‘Here’s what the stats say your problems are.’ But the people don’t always agree. You can talk about heart disease and diabetes all you want, but first you have to get rid of the rats and trash.”

Yet in the boardroom and in the community, Ross says he draws many lessons from his days as a family physician – he was a solo practitioner for five years before friends at Parkland convinced him to create a primary care clinic.

“The life of a family physician is really about right relationships,” Ross said. “It’s through those relationships that opportunities and success come. You can’t accomplish anything alone. Communication is critical, especially when you’re trying to impact an organization and a community.”

Ross says he was an accidental leader at first, but has grown to embrace the role.

“I didn’t want to become an administrator,” he said. “People saw leadership things in me that I didn’t necessarily see in myself. But administrators and clinicians do speak a different language, and I saw that as a physician leader I had the ability to translate for them. I was able to discern the interests of both sides.”

The obstacles Ross has faced in Baltimore are a long way from the made-for-TV crises that Marcus Welby faced each week, but Ross sounds a bit like his hero as he assesses the challenges, not only in Baltimore but in the industry as a whole.

“I’ve heard it said that leadership is optimism beyond the available data,” he said. “If you look at the situation here in the U.S. with all the uncertainty around healthcare reform, you could become paralyzed in the face of the facts. But if you’re doing the right things with patients and their families in mind, you should be in a good position to adapt to whatever comes along.”

Tim Frischmon

By Tim Frischmon

Principal, Furst Group

A recent op-ed in the New York Times by two former advisers to the Obama administration has caused a stir in healthcare circles with its assertion that health insurers will be “extinct” by 2020 due to the introduction of accountable care organizations (ACOs). Other industry veterans like Vince Kuraitis and Gregg Masters (see post and comments) have weighed in with rebuttals but, as someone who speaks with industry leaders on both the payer and provider side on a daily basis, I think there are a few points that need to be made.

There is a basic truth to the article by Ezekiel J. Emanuel and Jeffrey B. Liebman. The number of people who are enrolled in a fully insured HMO benefit plan has been diminishing and will continue to be squeezed by the development of health exchanges and ACOs. With 60% of the employer market in self-funded/Administrative Service Only products, the health insurance industry has been responsive to the needs of large employers looking for new and more innovative ways to increase quality of care while helping to minimize costs (i.e., Wellness, Disease Management, greater consumer involvement in key health care decisions).

But too many of Emanuel and Liebman’s arguments are knee-jerk attempts to throw dirt at insurance companies, and too much of their praise of ACOs> ignore the fact that ACOs aren’t truly functioning yet.

The writers fall back on the cliché that insurers “discourage patients from receiving care they need, as well as impose administrative burdens on doctors and patients.” The reality is this: An insurance company is administering the healthcare benefits that the employer agreed to with the benefit design. If the health plan were truly inappropriately withholding care or doing wrong, the employer would be screaming – not just the individual. Bottom line: The insurance company is there to be the bad guy and say no to some requests on behalf of the employer who didn’t want to pay for it.

There are plenty of opinions about the effects of reform on our healthcare system, but one that most parties can agree with is this: the fee-for-service environment has created perverse incentives, and most hospitals and physicians have been built up around volume regardless of their operational efficiency and quality. But ACOs certainly can’t take credit for this; they are simply one possible solution in retooling a system that’s needed it for a long time.

Emanuel and Liebman may see themselves as provocateurs, but they come off as a bit naïve when they charge that ACOs will certainly deliver on the failed promise of HMOs: “In the 1990s, we lacked the information technology and proven models of integrated care delivery that we have now. These advances will be crucial in developing a foundation that will allow ACOs to simultaneously improve health outcomes and reduce costs.” They speak as if these providers/ACOs are fully prepared and have been doing this for a generation. In reality, most ACO leaders are waiting to see how their new order will perform in its debut, even though some of the ACO concepts are déjà vu to those of us who have been observing managed care for two decades.

There is going to be an enormous learning curve for ACOs, through Primary Care Centered/Clinical Integrated Care, to be able to efficiently manage these populations while maintaining the utmost quality. This shift from an FFS-volume mindset to a capitated population health mindset is going to be a huge cultural change. And as we know, change brings pain, naysayers, and those who will fight to the finish.

The Times article says “a few health insurers see the asteroid coming.” In truth, I think the majority have anticipated some type of significant change coming for a long time, and the wisest ones have been working furiously to transform their business models. The payer side of the healthcare industry has seen rumors of its demise exaggerated at least as much as Mark Twain, but their leaders have been remarkably adept at adaptation.

If you really want to learn about the future of health insurers, take a long look at the leaders, and follow the money. Even as I write this, they are making enormous calculated bets on where the industry will be when the dust settles. No one knows what that will look like, but I expect to see the revamped insurers still standing in eight more years.

Watch this video on YouTube.

A holiday message from Furst Group CEO Bob Clarke:

We are all very busy in the healthcare industry.

We work diligently and frantically all year to ensure that the business operations run smoothly, that our EMR system is implemented and codes are properly entered, that our business development efforts are hitting their targets, that our inventory of supplies is properly managed, that our underwriting and pricing is set appropriately, that our bills are being collected, that the products and services we offer are enough to capture market share.

Those are all important tasks. But let’s remember why we work in healthcare in the first place and the impact we have on others.

The video above is another of our occasional examples.

Martha Irvine of the Associated Press reports on the legacy of Mark Staehely, a young cancer patient at Children’s Memorial Hospital in Chicago, and his concern that no child in the hospital feel forgotten at Christmas. Mark’s toy drive is the largest in Children’s history. In 2005, the hospital honored him with its highest leadership award. His mom and other friends have kept his toy drive going since his 2006 death, and they continue to raise tens of thousands of dollars a year for neuroblastoma research.

Please watch the video. You may also want to visit the website of Mark’s foundation at www.makeyourmark7.org.

Sherrie Barch

By Sherrie Barch

Furst Group President

The hospital’s search for a new executive was down to two finalists. They were leaning toward Mark, but it was clear to me that John was a better fit and a stronger leader. So why was John lagging behind as the final interviews approached?

It was simple. John knew he was initially the underdog, and he became so focused on his competition that he neglected the very qualities that had brought him to the table. I pulled him aside.

“This job is yours to lose,” I told him. “You’re managing to your competition instead of touting your strengths. You’re the best candidate. The board likes you. They want to hire you. But you have to forget about the other guy and focus on who you are and what you can do for this organization.”

It worked. John took the hint, got the job, and has been thriving ever since.

I was reminded of this recently as I read an article by Joan Magretta in Harvard Business Review, “Stop Competing to Be The Best.”

Magretta, a frequent champion of management strategist Michael Porter, says we should “compete to be unique. Focus on innovating to create superior value for your chosen customers, not on imitating and matching rivals.”

“In War, there can only be one winner,” she adds. “Not so in business, where companies like WalMart and Target can thrive and co-exist.”

That is why we warn our clients to beware of hiring the perfect candidate. Sometimes “the best” isn’t always what the search profile dictates. “The best” isn’t necessarily the most experienced or the most visionary. “The best” is what the best fit is for your company, bearing in mind the culture and the timing. “The best” is also the one who represents where you want to be as an organization, the one who can craft and attain that vision — not just what you are today.

So stop worrying about the competition and, more important, don’t limit your goals to competing with them. You may end up adding to their success without even knowing it. As branding expert Rob Frankel notes, success is when your customer sees you as the only solution to their problem – a decision in which the competition has faded from view.

Bob Clarke: Leadership “is about the individuals and families who rely on you to act in their best interest.”

At least two more leaders appear to have had their legacy tarnished in the current 24/7 news cycle – one a presidential candidate and one a legendary football coach. One is in trouble for what he is alleged to have done, the other for actions he failed to take. But there’s a key lesson about leadership in these events, and the nature of the behavior is merely the symptom of a root issue: selfish leadership.

The best leaders, says Bob Clarke, CEO of Furst Group, are selfless, putting others first.

“I’ve had the opportunity to recruit and develop leaders since the early ‘80s,” Clarke said, “and have witnessed some outstanding executives. Leadership is all about having those you lead achieve things they themselves didn’t think possible.”

Leaders, said Clarke, need to remember that their actions don’t occur in a vacuum and can have a long-term and widespread impact.

“This is especially true in healthcare,” he said. “The ripples of your leadership can be a potent force for good in your community. It is about the individuals and families who rely on you to act in their best interest. They depend on you — at times, their lives or livelihoods depend on you. In healthcare, you see the results of your efforts outside of those you lead and often outside of the organization you lead.”

Col. Eric Kail, PhD, the course director of military leadership at the U.S. Military Academy at West Point, wrote recently in the Washington Post that the best leaders earn their authority by their selflessness:

“Being selfless is one of the hardest things you’ll ever do as a leader, and it requires competence. … As leaders, we hold others – especially subordinate leaders – accountable. And yet we must be even more accountable to them. … Without regulation, we’re all vulnerable to leading selfishly.”

That is one reason, Clarke said, that the importance of leadership development throughout an organization cannot be underestimated. “It is common to mentor hard-working people in your organization until they are ready for a promotion,” he said. “But sometimes, we assume that they know how to lead and discontinue the training that made them ready for a move into an executive position in the first place. We need to train them how to lead, and to lead in a selfless manner that benefits our organization and our community.”

Robert L. Johnson

Robert L. Johnson, the African-American billionaire who founded the BET television network, is calling on U.S. companies to follow in the footsteps of pro football’s so-called Rooney Rule, which requires NFL teams to interview African-Americans for head coaching openings.

Johnson wants companies to interview two African-Americans for executive openings at the VP level and higher.

NAHSE is a non-profit association of African-American healthcare executives that promotes the advancement and development of diverse healthcare leaders, as well as improving the quality of care for underserved communities.

At Furst Group, we’ve long been champions for greater diversity in healthcare through cultivating a network that yields access and relationships with ethnically diverse talent. We also promote that through our sponsorship of the Top 25 Minority Executives awards for Modern Healthcare and by providing educational opportunities for career advancement to current and future healthcare leaders. As you can imagine, we’ve also seen companies sometimes approach diversity the wrong way. Some organizations pay lip service to diversity but do little about it.

Deanna Banks

Leaders and boards must be willing to look beyond a candidate’s ability to line up with a job description and start assessing candidates based upon professional competence and future potential. Yes, there are some innate risks in that for a leader, but taking risks is part of what leadership is all about.

Furst Group principal Deanna Banks, who was a featured speaker at the NAHSE conference, agrees with Johnson’s comments, but notes, “It’s only a start.”

Banks outlined three additional areas that need some clarification.

“First of all, the rule needs to apply to all ethnic minorities, not just African-Americans,” she says. “Secondly, for a diversity strategy to be successful, it must have metrics that are linked to leadership’s performance incentives.”

Lastly, ethnically diverse executives themselves should look at the healthcare industry more strategically. “There is a dearth of experienced, diverse executives in areas like finance, IT, compliance and clinical leadership,” Banks adds. “Candidates who can specialize will have a greater opportunity for advancement given the industry’s evolving needs in this post-healthcare reform era and given the significant influence of technology.”

What do you think of Johnson’s comments? Let’s continue the conversation.

Watch this video on YouTube.

Derek Sivers’ presentation at last year’s TED Conference earned a standing ovation and then caused a long stir in cyberspace with his musings on the role of the “first follower.” We saw the video again recently and it got us thinking about all the uncertainty that still remains in healthcare as political and legal battles over reform continue.

Wherever we end up, it seems to us that there are some definite dance lessons here about good leadership and good followership in the world of healthcare.

So take a look at the video above and then see what you think about the steps we’ve broken down below.

Sivers’ video shows a solitary person willing to look like a fool as he dances to music from an unseen band.

“A leader,” he says, “needs the guts to stand alone and look ridiculous. But what he’s doing is so simple, it’s almost instructional. This is key. You must be easy to follow!”

In healthcare, is our leadership easy to follow? Is it too complicated and making people stumble? Simplify, simplify.

Back to the video: Eventually, another dancer (the first follower) joins him, then another and another until the few who remain in their seats realize that it’s too late (uncool) to join because they’re now in the minority.

Sivers says, “Being a first follower is an under-appreciated form of leadership. The first follower transforms a lone nut into a leader.”

If nothing else, healthcare reform has upped the ante on the need for innovation. Those who say, “This is the way we’ve always done it,” will not thrive. We need bold, aggressive leaders willing to take a risk.

Sivers concludes: “When you find a lone nut doing something great, have the guts to be the first person to stand up and join in.” In so doing, he says, you help to create a movement.

Applications for healthcare? Here are three. Feel free to add your own.

Release your leaders to be followers as well. Let the roles blur from time to time. Anyone can be a leader. It’s OK for an SVP to follow (and champion) a nurse or help-desk person who has a great idea.

Concern yourself with the movement, not the acknowledgment. In the video, who is the leader? Is it really the first dancer, the guy footloose and shirtless? Or is it the unseen, unacknowledged musician(s)? Who has created the music for the dancers to step to? Does it matter? They both add value to each other. Harry Truman once said, “It is amazing what you can accomplish if you do not care who gets the credit.”

Keep the focus on people. Notice the simplicity of the dancers. They have no tools, no technology. Just themselves. In an age fraught with the stress of change and economic upheaval, keep an eye on your people. When they are “doing something great,” join in their dance. When they need a valve to release pressure, create a dance for them.

Above all, keep your focus on the people you serve — the patients and communities who put themselves and their families in your hands during a vulnerable time in their lives.

Maureen Bisognano: “In every country that we work in, there are insufficient numbers of skilled people to do the kind of work we need.”

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

In her travels around the world as the president and CEO of the Institute for Healthcare Improvement, Maureen Bisognano has discovered something: healthcare reform isn’t an exclusively American issue. Many countries, she says, are realizing they need to make some fundamental changes in their healthcare systems.

“There are so many similarities that it’s uncanny,” she says. “You need to use different languages in different countries, but the fundamental problems are very, very similar.”

Bisognano sees several universal issues, including finances, labor and patient-centered care.

“In every country that we work in, there are insufficient numbers of skilled people to do the kind of work we need,” she notes. “Even here in the United States, we’ve got a graying population and fewer people coming into the healthcare systems as caregivers.”

And, while American expenditures on healthcare outpace the rest of the world, Bisognano says the rest of the world is still wrestling with a lack of funds in that area.

“Even in the developing countries, and the low and middle-income countries, finances are an issue. We need new designs in order to provide the care with limited resources. All over Europe and the U.K., we’re seeing budgets needing to be constrained.”

Patients’ voices are being heard now more than ever in most sections of the globe, but Bisognano says they sometimes have a different idea of patient focus than in the U.S.

“When I’m in Malawi or Ghana, in talking about patient-centered care, they actually kind of chuckle because they think that we don’t understand what patient-centered care is – and, in a sense, they’re right,” she says. “Because there, it’s not just the patient. It’s the family, it’s the village, it’s the tribe. And if you don’t get all these supports lined up, then a woman will not get to the hospital for a delivery. So they have a much more sophisticated understanding about what patient-centered care means.”

IHI has long been known for its championing of patient-centered care. Bisognano and former CEO Don Berwick worked side by side for 16 years. She said she is encouraged by the strides she is seeing in this area, citing four examples:

**In Sweden, a young aerospace technician wanted to do his own dialysis. A nurse taught him. He taught another patient. And now, in this Swedish hospital, 60 percent of the patients run their own dialysis, and their outcomes are better than those that don’t.

**At Cincinnati Children’s Hospital, the staff conducts “Huddles” every few hours to coordinate patient care where the focus is always on the future – what might happen. “In many hospitals, you’ll see nurses meet periodically to discuss what happened, but it’s always in the past tense,” Bisognano says.

**In Cedar Rapids, Iowa, Mercy Medical Center, without the benefit of being part of a large health system, has drastically reduced mortality rates and made patient-centeredness part of its DNA.

**In Pittsburgh, orthopedic surgeon Anthony Digioia has redesigned the way hips and knees get replaced. Patients who go through the new process spend an average of 2-1/2 days in the hospital and 95 percent go home without a walker or a cane.

Bisognano says these examples illustrate how innovation can revitalize healthcare.

“I think the old methods of management that were much more top-down control don’t work when you’re undergoing transformations as radical as we need to undertake in these times,” she says. “And so, people are turning to innovation, and they’re turning to quality improvement and design.”

As a former nurse herself, she sees nurses as an undertapped resource for driving improvement and innovation, because nurses have long had to troubleshoot at every turn.

“If the medication wasn’t there, if supplies weren’t available, if the IV pole wasn’t there or a patient was late in arriving at the operating room, the nurse would scurry around to make up for that deficit in the process,” she says. “Nurses were rewarded for being able to adapt and overcome process-level problems.

“We need to be trained a bit to be able to stop in the midst of fixing something and say, ‘Am I the only person this has happened to today? Is this a problem that happens frequently? Do I predict this will happen again tomorrow? If so, how do I use quality improvement methods to prevent this from happening tomorrow and to any other patient?’ ”

Proctor: “You keep measuring the outcome and you adapt the strategies if they’re not getting you to the outcome.”

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

Outcome vs. strategy: which takes the lead?

Deborah Proctor, president and CEO of St. Joseph Health System in Orange, Calif., makes it clear where she stands on that age-old business dilemma.

“One of the things that I learned in my career is that most people will develop a strategy and then measure how well they’re accomplishing that strategy. To me, that’s an insufficient process,” she says. “I think you have to first determine what outcomes you’re trying to achieve and then develop strategies to get to those outcomes.

“But you keep measuring the outcome and you adapt the strategies if they’re not getting you to the outcome.”

Proctor’s belief in outcomes colored the strategic plan that she and her staff created in 2006, and she made sure it was tangible and accessible for all St. Joseph employees.

“Instead of sharing strategies like improving financial performance or aligning with physicians –which are certainly important – we focused on talking to employees about outcomes,” she says.

St. Joseph identified three goals “that every employee could relate to,” says Proctor:

**That the employees of our system would strive to provide perfect care.

**That the communities served by St. Joseph Health System and its hospitals would be among the healthiest in the nation.

**That every encounter with patients, community members, and one another would be a sacred encounter.

“Perfect care” sounds like an unattainable goal but, to Proctor, who began her career at St. Joseph Hospital in Orange, California as a registered nurse, it has to do with focus.

“Obviously that’s a very tough standard to live up to,” she admits. “But what are you going to say, that I want to give people the best care 90 percent of the time? I don’t think we can say the aim is anything less. Perfect care doesn’t mean perfect outcome, but it means that everything that’s within our control will be done exceptionally without errors.”

Proctor’s insistence on a culture of safety stems from her experience in another health system.

“We were having a strategic meeting and, in the middle of the meeting, one of the physicians got a phone call that informed him of an unnecessary death had occurred in one of our facilities,” she remembers. “From that time, it really became a focus area for me.”

To make it tangible, St. Joseph Health System set out to improve its record with ventilator-associated pneumonia, which was straggling behind more than 60 percent of other U.S. hospitals. In one year, it moved up to the top 10 percent in the country.

“Quality,” she says, “has always been given an equal standing with finance in terms of what executives are held accountable for on their goals.”

If Proctor sounds like a decisive executive, it’s because she is. But the faith element of her career is never far below the surface.

“My faith is a critical part of my life,” she says. “That ability to have coherence between my personal values and what I’m doing at work – to me, there’s nothing better because it’s so much more than a job.”

And St. Joseph Health System’s mission, “extending the healing ministry of Jesus in the tradition of the Sisters of St. Joseph,” is key to Proctor’s motivation.

“I use all my best business knowledge. But to me, working in a faith-based system is more fulfilling because I’m very clear about our mission and what we’re trying to accomplish – which then makes the business decisions have more relevance and meaning.”

Sally Jeffcoat: “A focus on prevention and wellness is where we need to reform the system.”

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

A lot of the dialogue about healthcare reform is focused on cost, but Sally Jeffcoat, president and CEO of Saint Alphonsus Health System in Boise, Idaho, says she thinks there’s an equally important element that is being overshadowed.

“Health reform has really taken shape in the form of financing reform, but what we haven’t done yet is the care-delivery reform that’s required,” she says. “This gets to the heart of operational effectiveness: how are we going to reorganize care delivery that shifts patients to lower cost environments so that we can still deliver better quality than what we have today?”

To do that, she says, some of the responsibility needs to shift to the patients.

“A focus on prevention and wellness is where we need to reform the system because, right now, there really aren’t any incentives and reimbursement for that type of care,” Jeffcoat says. “It’s difficult to manage the transition unless we reward our providers to deliver that kind of care and we shift some of the risk for those expectations to those patients and populations that we are trying to serve.

“Healthy behaviors are really where we can address some of the problems of our healthcare system today.”

All of that speaks to change, and that is something that Jeffcoat is comfortable with herself. A native Texan whose father was an Army surgeon, she worked for many years in her home state and Arizona, rising to a CEO position in the Ascension system, before taking her current role with Trinity Health.

“I’ve had the blessing of working in organizations that have a strong management development program, but I would not have been able to advance if I wasn’t willing to take on different roles that I had to grow into, or move to different locations,” she says. “Working in different environments shapes you as a leader, because you learn from the positive and negative experiences and integrate them into your leadership style.”

Strategic vision tops the list when Jeffcoat lists the qualities that rising female executives need in today’s environment. But vision must work in tandem with operational effectiveness, she says.

“You need to have the ability to take strategic vision and operationalize it,” she says. “You need to be connecting the dots from strategy to effective implementation to be successful. I also think the ability to communicate vision – the what and the why – is important for a female executive. If you can’t get people wrapped around the why, it makes it more difficult to implement your vision.”

Jeffcoat is known for her dedication to quality and safety, traits that were shaped not only by her pivotal role in Ascension’s “Journey to Zero” program but also by her history as a nurse.

“It’s so important to never get too far away from the bedside or from direct patient care,” she says. “I probably get a lot of my satisfaction from being able to interface directly with the caregivers who are on the front lines. The other thing I derive from that is the teamwork it takes to produce the kind of high reliability that we are all trying to achieve as an organization.”

And a clinical background, she says, can sometimes help a female leader shine.

“It’s important to have the business skills necessary to perform a CEO role. But some of the characteristics of women leaders that bring a balance, such as compassion and collaboration, are very important, particularly in an industry in which 50 percent of the workforce is made up of clinical caregivers.”

Donovan: “Hospitals are like running 40 different businesses.”

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

As the daughter of a surgeon and an operating room nurse and now as one of the leading healthcare executives in the nation, Gail Donovan has been around hospitals all her life. So when she says she’s a bit worried about healthcare reform, one tends to listen more intently.

“Hospitals are like running 40 different businesses,” says Donovan, Executive Vice President and Chief Operating Officer of Continuum Health Partners, Inc. “As a large provider system, our hospital emergency rooms care for 250,000 visits a year in our system and we have very large ambulatory services handling more than 3 million visits a year. I love being able to provide access and to make sure that, as much as possible, we’re able to meet the needs of the very large and diverse communities we serve.”

While she agrees that changes are necessary, Donovan says some of the details, like value-based purchasing, need to take into recognition the realities that urban hospitals and systems wrestle with every day.

“We know how to run financially distressed hospitals because we’ve had to learn how to do that, and move from operating in the red to operating in the black, all the while we’re trying to improve and demonstrate improvements in quality,” she says.

It’s the details that matter to Donovan in reform and in healthcare in general.

“The absolute top quality that an executive needs to have is operational effectiveness,” she says. “Essentially, you must be grounded in details and be able to be not just productive but effective in managing the details of your work and your job.

“It’s through this that you can then have strategic vision. I don’t think you can really have strategic vision unless you understand what you’re managing today.”

Donovan and her team long have been visionary about the need for electronic medical records, but she credits her board with having the courage to invest more than $100 million in EMRs even as the system was struggling to provide basic core services. With an eye to the future, Continuum is well-positioned for whatever reform may bring, but Donovan wonders where the funds to help urban hospitals with compliance will come from as value-based purchasing expands from six core measures to 30 or 40.

“For urban hospitals to potentially be penalized and have reimbursement taken away could take a very fragile healthcare structure and create significant problems and an inability to maintain services.”

Many urban hospitals, Donovan says, are capital-starved and have a high dependence on Medicare, Medicaid and the bad-debt charity care pools.

“If those dynamics are altered without having a proper definition of safety-net facilities, like a number of my institutions are, then that dynamic could completely upend our ability to meet the needs of the very large communities we serve.”

Despite that sober warning, Donovan clearly enjoys her chosen field. To varying degrees, she has been serving since she was 12 and first became a hospital volunteer. She interned in health administration before going to graduate school and did a residency as part of her graduate degree that was “pivotal,” she says.

“I still strongly advise graduate students to seek internships and residencies. They’re called different things now, but exposure early on to a number of different organizations and their components led to job opportunities for me.”

She also credits luck in finding professional mentors who championed her early in her career.

“I was usually the youngest in the room – and the only woman,” Donovan says. “I think that has changed in certain settings, but there continues to be a lack of women in the most senior of positions in hospitals and healthcare systems.

“I think we’re changing that, but it’s a little bit slower, perhaps because of some concerns about work-life balance. As a mother, I know that if I did not have a supportive husband who had greater flexibility, I wouldn’t have been able to put in the time and the commitment to do what I needed to do professionally as well as support my family.”

Her professional reach has extended far beyond her system. She was president of the Metropolitan Health Administrators Association before it became the New York chapter of ACHE. And, with Susan Waltman, Executive Vice President and General Counsel for the Greater New York Hospital Association, Donovan spearheaded emergency preparedness measures in the wake of 9/11 that the Joint Commission has adopted as standards for all U.S. hospitals. Such responses, applicable to natural disasters as well as terrorist attacks, go beyond medicine, she says.

“So much of emergency response ends up dealing with adequate communications structures and systems,” she says. “And even in a sophisticated environment like New York, that continues to be one of the top challenges. So one of the outgrowths of the post-9/11 work was ongoing emergency preparedness that includes all the municipal structures and systems with the provider community.

“It’s why my job is fun,” she adds. “I actually love my job. Always have.”

Leckman was the first woman resident to finish the surgery program at the University of Utah.

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

Linda Leckman was in her car – again – driving up to Ogden, Utah, from Salt Lake City, to meet with a group of thoracic surgeons. Road trips like this one – which Leckman actively seeks out to keep in touch with her colleagues and staff — are common for the vice president of Intermountain Healthcare and the CEO of the Intermountain Medical Group.

“I’ve learned the value,” says Leckman, a general surgeon herself, “of sitting down face to face and actively listening to people.”

While Leckman’s reputation precedes her as one of the Top 25 Women in Healthcare, she is transparent about her growing pains in moving from a career as a surgeon in private practice to an administrator. Listening, she says, was actually something she had to grow into.

“One of the things I did not do very well, initially, was to listen. I guess, as a cliché, you could say, ‘Well, what would you expect from a surgeon?’ ” she jokes. “But I also got some bad advice in regard to approaching a contract situation, and I learned from that.”

Leckman is not one to waste a lesson. These days, the people around her know “listening” is a Leckman staple. Another is consistency.

“The medical group is spread across the whole state of Utah,” she says. “We have more than 130 clinics, so my management structure is geographic. My managers need to be able to make decisions on their own that will be consistent across the organization, so it’s very important that I be consistent, that we set up procedures and standards that are consistent.”

What’s also consistent is the way Leckman diverts attention away from herself and toward Intermountain.

“I believe one of the reasons I was recognized by Modern Healthcare was because I work for Intermountain Healthcare,” she says simply. “I take it as much of an acknowledgement of Intermountain’s role in leading clinical quality development as of anything that I specifically did. But that’s OK, because I’m a real cheerleader for my organization.”

Intermountain was in the spotlight several months ago when it was one of several prestigious systems, along with Mayo, Cleveland Clinic and Geisinger, to announce it had no plans to sign up for the government’s ACO program as it was then structured.

“The idea of accountable care is one that we totally support, the idea that quality needs to be improved and costs need to be reduced – that’s something we’ve been doing for years,” Leckman says. “One of the big concerns was that we were going to be measured basically against ourselves in terms of whether there is improvement or not. And since we have been working on it for a long time, a lot of what would be considered as potential gains for managing better are things we have already achieved. And so we really had more to lose than gain from being involved.”

If such a stance surprised the industry, it was not out of character for Intermountain, or for Leckman, who has been something of an unintentional pioneer. After graduating from Texas Christian University with a degree in history (and a minor in combined science, which included pre-med classes), Leckman enrolled at the University of Nevada to work on a master’s in history. It didn’t last. In her second year, she decided she really wanted to become a physician. A surgeon, no less.

“But this was the 1960s, and it was unusual for a woman to go to medical school,” she says. “And I was raised by my mom to be a housewife.”

Undaunted, she got her M.D. from the University of New Mexico in Albuquerque and became the first woman resident to finish the surgery program at the University of Utah.

“That’s been a pattern in my life – I end up in areas dominated by men,” Leckman says with a laugh. “But it’s worked out OK.”

O'Kane: “There is great work being done, but it's uneven.”

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

If healthcare has anything like the Good Housekeeping seal of approval, it is probably accreditation by the National Committee for Quality Assurance, the organization that Margaret “Peggy” O’Kane founded in 1990.

Besides her appearance as one of Modern Healthcare’s Top 25 Women in Healthcare, O’Kane often is also recognized as one of the 100 Most Powerful People in Healthcare by the magazine. And for good reason. The Healthcare Effectiveness Data and Information Set is NCQA’s quality measurement tool that is the gold standard in the industry.

O’Kane is a champion of healthcare institutions, but she is also tough on them.

“In an emergency situation, you’re often not in a position to make a choice – you go wherever the ambulance takes you,” she says. “We need to have hospitals that are uniformly safe.”

Safety, as one might imagine, is paramount to O’Kane.

“Safety resonates with the public,” she says. “When you tell an audience how many people die because of medical errors, people are completely astounded and appalled. There is great work being done, but it’s uneven.”

The beauty of NCQA’s work is that it sets a bar high without condemning the caregivers, whom O’Kane believes are “great people who want to do the right things. People go into healthcare to do good for patients and by patients.”

O’Kane has a master’s in health administration and planning from Johns Hopkins and worked for several years with an HMO trade association, but also has a renaissance background that includes a degree in French and work as a respiratory therapist and as an elementary school teacher. She says she believes healthcare is “behind other sectors” when it comes to women in leadership.

“I continue to be struck by how few women and minorities are in leadership in healthcare organizations aside from traditional roles like heads of nursing,” she says. “One of the great things that diversity brings is different perspectives. Healthcare still has a ways to go to be more representative of patients.”

For women emerging as leaders in healthcare, O’Kane’s counsel is twofold:

“Be stubborn”: “We’re in a period where change is the right thing to do. You’ve got to be really determined to bring that change.”

And “listen”: “Listening to patients is one of the major tasks of healthcare.”

Bride Taryn Bragg, M.D., visits with her patients.

The true meaning of healthcare can sometimes get lost beneath the necessary distractions of governmental agencies, provider and payor budgets, accountable care organizations and health insurance exchanges. But every once in a while, we get a poignant reminder about why we are involved in this great industry – to find and develop the best leaders possible so they in turn will build organizations that make a difference in people’s lives.

This week’s example comes from Madison, Wis. We were first tipped to it by Fierce Healthcare’s Twitter feed. The Wisconsin State Journal reported on the recent nuptials of pediatric surgeon Taryn Bragg, M.D., who held her wedding at American Family Children’s Hospital so her young patients, past and present, could attend.

Hope Elliott, 5, a former patient, gave her own diagnosis: the bride looked “cute.”

“This is exactly what I wanted,” Bragg told reporter Patricia Simms. “They are a part of my life, and they are a part of my happiness. That’s what today was all about.”

For more of the heartwarming story – and more photos – read the Journal story here.

McNutt: “There is a sense that healthcare has been behind other industries in adopting information technology.”

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

Computerworld Magazine covers its industry to a T – make that IT. But amid major stories on automakers (“How IT is fueling Ford’s turnaround”) and competing systems (“Clash of the Clouds”), last Nov. 22’s cover features senior vice president and chief information officer Pamela McNutt of Methodist Health System in Dallas, who weighs in on “Healthcare IT: No Quick Cure.”

McNutt’s national stature also made her a wise choice to chair the policy steering committee for the College of Healthcare Information Management Executives, and she and her colleagues have spent time advising the CMS on what works and what doesn’t in the federal government’s new regulations.

“One reason I’ve been so active nationally is there’s a lot of concern about meaningful use,” she says. “Are the incentives achievable? Are we moving too fast on some things? Too slow on others?”

Besides CHIME, McNutt is active in HIMSS and AHA. She earned a Leadership Award from HIMSS in 2001 and was named CHIME’s CIO of the Year in 2002.

While she is very hopeful about the future of electronic medical records, she cautions that there is a long road ahead.

“There is a sense that healthcare has been behind other industries in adopting information technology,” she says, noting that healthcare traditionally spends 2.5 percent of its budget on IT while other businesses devote 5 to 10 percent on new technology.

But shedding ink-on-paper for computer records isn’t as easy as some people think, notes McNutt.

“We still have issues with normalizing the way data is collected,” she says. “Even being on the same vendor platform doesn’t mean you’re going to be able to exchange data seamlessly.”

Beyond that are the issues raised by HIPAA.

“ ‘Contradiction’ may be too strong of a word, but we face a real dilemma as healthcare providers in reconciling privacy and security of records. We want to provide quick and easy access to provide the best possible care, but at the same time providing privacy and security.

“The whole industry is struggling with this on a national basis,” she adds. “What rights does a patient have to control, restrict or direct where their data goes and, on the flipside, what right does the caregiver have to see a complete and accurate picture?”

That dilemma won’t be resolved any time soon. But the growing role of IT in healthcare means that there are opportunities for workers in that field. McNutt suggests it’s also a window for women to move into leadership.

In fact, one area where healthcare has shone, she says, is in the development of female leaders.

“Healthcare has always been ahead of other business sectors in having female leadership,” she notes. “When I started in IT years ago, it was a male-dominated field. When you go to meetings of our professional societies today, there are so many more women. I think healthcare was a field that was ripe.”

IT workers with nursing backgrounds are proving especially valuable, she says, but adds that there is plenty of room for more. “Clinical informatics is a very special skill set, and we’re 50,000 people short nationally,” she adds.

If Methodist has a head start, it’s because McNutt had the foresight to revamp its IT system in 2003.

“We made a conscious decision to start over in 2003,” she says. “Rather than continue to put puzzle pieces together, we decided to bring in a bulldozer. At the time, it was a bit of a radical approach, but it’s working very well.”

Nancy Schlichting became an EVP and COO at 28.

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

If you ask Nancy Schlichting about what sparked the most professional growth in her career as she rose to become chief executive officer of Henry Ford Health System in Detroit, she is quick to point to people other than herself.

“Having strong mentors has probably been the most important element of my career,” she says.

The two key ones, she adds, are Al Gilbert and Gail Warden, who led Summa Health System in Ohio and Henry Ford, respectively.

“They are two individuals who had profound impact on my career,” Schlichting says. “Al Gilbert appointed me at the ripe old age of 28 to be executive vice president and chief operating officer of a 650-bed teaching hospital. That was what launched my career in so many ways.”

If there is one skill Schlichting learned from her mentors, and one that she made all her own, it is taking risks. In Schlichting’s case, she opened a new, $360 million hospital, West Bloomfield, during the worst economic downturn since the 1930s in a region of the country that has not seen an abundance of success stories in recent years. She topped off that move by hiring a non-healthcare executive to run the place.

Gerard van Grinsven became president and CEO of West Bloomfield after a successful career as vice president of the Ritz Carlton hotel chain. Schlichting calls his hiring one of her best moves.

“Gerard is my poster child for taking risks on people,” she says. “He came to us through his involvement on our board. I got to know him. He told me he did not want to be traveling as much for personal reasons. I had no clue what to do with him at first.

“But the more I thought about it, I realized that he had opened more than 20 hotels around the world and was an incredible leader of people – smart and competitive.”

In two years, West Bloomfield has surpassed all of Ford’s financial projections, and Schlichting says van Grinsven’s work has been “nothing short of phenomenal.” Simultaneous to West Bloomfield’s debut was a renovation of the Detroit flagship hospital that cost $300 million. Revenue has doubled in the last ten years.

No wonder, then, that Fast Company co-founder William C. Taylor talked about Schlichting’s work in transforming her health system in his new book “Practically Radical: Not-So-Crazy Ways to Transform Your Company, Shake Up Your Industry, and Challenge Yourself” (William Murrow).

Given her successes, Schlichting believes that financial acumen is an overlooked but mandatory part of an up-and-coming executive’s skill set. “Many of my colleagues, both male and female, need to have a more in-depth understanding of finances. We are running very large enterprises. How we use resources affects the overall financial health of a hospital.”

The other key to focus on, she says, is simple – people. “Healthcare organizations are very people-centric,” she says. “Having good relationship skills is important. It’s about creating a positive environment for people to work in and helping everyone reach their potential.”

To that end, Schlichting has launched several leadership academies to develop leaders and help retention in a market that has its challenges.

“If you don’t have a good culture,” she says simply, “you’re not going to be successful.”

Pete Eisenbarth

The winners in any organization think beyond their role. This is especially true in staffing and recruiting. Understanding the impact individuals will make far beyond the “must-have” qualities in the defined job description is paramount. One needs to think boldly. In some industries, the bottom dollar rides on it. In healthcare, the quality of patient care, safety and, ultimately, people’s lives are at stake.

When you’re interviewing a slate of candidates and begin to narrow the field, it’s very important to ask yourself some questions that go against the grain of standard hiring practices. These questions won’t always be a major factor in your ultimate decision, but they are worth considering:

Culture: Regardless of someone’s career accomplishments, ask yourself: Should this person fit in with the team we have? Sometimes an organization needs someone to fit in neatly with the rest of the team. At other times, an organization’s best decision is to hire someone whose personality or style is a marked contrast to many others in the company. Do you need someone who will come in, work hard, be successful and not stir up the waters? Or do you need a change agent who will be successful and may challenge the status quo (including you)? Talk openly to the candidate about the current state of your culture, its challenges and what changes you believe may be needed.

Tenure: Ask yourself: Does the role demand that this person be a long-term (5-plus years) employee? At times, organizations can focus too much on the question, “Will this person be here for a long time?” Ideally, all hires will be part of the organization for many years to come. However, there are instances when the best person for the role may be someone who comes in for 2 or 3 years and creates much needed change. Someone like this cannot be overlooked, especially if they have the most experience to help get the department or organization to a place it’s never been before.

Flexibility: Successful organizations hire good people and don’t simply fill roles. Regardless of the position you are trying to fill, is this someone who could help your organization in another role? Some of the most exciting roles and some of the most successful people hired are individuals who did not have a job description laid out in black-and-white terms. Many times, they interviewed for another role and the strategic mind of the hiring manager/human capital partner recommended other individuals speak to the candidate even though they weren’t a fit for the original role.

What counterintuitive questions do you ask yourself or your team when filling key positions?

In his classic comic strip “Pogo,” artist Walt Kelly came up with a number of classic lines, but the most famous is this one:

“We have met the enemy and he is us.”

That’s the sentiment on display in a new website created by BlueCross BlueShield of North Carolina to discuss the rising cost of healthcare, www.letstalkcost.com.

While some have pointed out that BCBS forgot one target — politicians — the site offers facts and encourages dialogue on the six scapegoats most often blamed for the economic impact of healthcare. They are: Attorneys, Doctors, Hospitals, Individuals, Insurers, and Pharmaceuticals. TV ads have been used to spread the compelling message as well.

It’s hard to argue that all of us can share in the blame for the issues that face us in the healthcare industry. And while dialogue can be an important part of finding solutions, it could be argued that times like these cry out more for true leadership than a message board. Yes, we’ve all made things difficult. But who has the courage and the ideas to lead the way out of the thicket?

It will be interesting to see who emerges in the months and years to come. Which “scapegoat” are you part of? What kind of leaders do you think are needed for the task at hand?

Organizational consultant and author Joseph Michelli has previously mined the inner workings of a coffee revolution (“The Starbucks Experience,” McGraw-Hill, 2006) and hotel king Ritz-Carlton (“The Gold Standard,” McGraw-Hill, 2008). Now, he’s trained his gaze on healthcare, and the inside view is one we’ve been privileged to witness as well.

Watch this video on YouTube.

Michelli’s new book, “Prescription for Excellence: Leadership Lessons for Creating a World-Class Customer Experience from UCLA Health System” (McGraw-Hill, 2011) comes from his team spending a year observing the inner workings of the organization. Furst Group’s involvement with UCLA comes from helping to fill the system’s roster with more than 15 leaders, in addition to several consulting projects.

One of Michelli’s conclusions has deep implications for leadership and hiring.

He writes: “Talent selection and retention is the single most pressing issue for business success over the foreseeable future.”

Dr. David T. Feinberg, CEO of the UCLA Hospital System and associate vice chancellor for health sciences, is eager to share his organization’s strategies with other firms, including competitors.

“We are owned by the people of California,” he says in a statement, “and I believe we have an obligation to share what we have learned so that our friends and neighbors who trust us have access to safe, clinically excellent healthcare that is delivered with the highest level of compassion, dignity and privacy – regardless of where they receive medical care.”

Michelli found five principles at work in how UCLA operates as a system: 1) commit to care, 2) leave no room for error, 3) make “the best” better, 4) create the future and 5) service serves us.

“It’s been a privilege to work so closely with the leadership at UCLA,” says Furst Group vice president Joni Robbins, who has been heavily involved in helping the health system with its recruiting. “They are visionaries in the healthcare field who put a premium on innovation and excellence.”

Michelli apparently was impressed enough to donate the proceeds from the book to benefit UCLA’s Operation Mend program, which provides free reconstructive and other medical care to severely wounded U.S. soldiers returning from Iraq and Afghanistan.

Archelle Georgiou

In a thought-provoking blog post at “Archelle on Health,” she suggests an experiment. Write the words “Healthcare is important” on a sheet of paper, and ask a few people to describe what “healthcare” means.

“What is the first thing they say?” she writes. “Most likely, they refer to insurance, access, costs, and/or health reform. Do any even refer to the quality of care that they receive from doctors or other care providers? Do they refer to the importance of their own lifestyle behaviors? Probably not.”

So Georgiou is changing her usage. “Healthcare,” she says, evokes the system and the industry — not wellness, not humanness.

Georgiou gives us a great reminder about the nature of our work as our organizations grow more complex by the day. The truth is, we need both “healthcare” and “health care.” We can’t turn back the clock to a simpler time, but we can make sure that we as leaders and organizations keep dignity and empathy in the forefront of some very tough decisions we have before us as an industry and a nation.

What about you? Does a simple space between words affect how you view your place as a leader? How does “care” shape your decisions? What conscious choices have you made with these types of values in mind?

The Medical University of South Carolina recently endowed a chair in Joanne Conroy's honor.

As long as she can remember, Joanne Conroy has been a risk taker.

But the biggest roll of the dice of her career may have come in 2008, when she resigned as a hospital president to become chief healthcare officer for the Association of American Medical Colleges (AAMC).

Three years later, it’s evident the risk paid off – she’s been honored as one of the top influencers in healthcare.

“I love running a hospital, walking the halls at 2 in the morning,” she says of the 700-bed Morristown Memorial Hospital, part of Atlantic Health, where she served. “Every single day, there are great miracles that happen. But I realized that I could only affect care in a very small area, and even then I could be hamstrung by external forces. I could stay there, or I could actually go where I could be part of change on a national level.”

At the AAMC, she leads CEOs, CMOs and others in discussing readiness for reform and other pressing policy issues.

“At our spring meeting, we had 100 deans and 100 CEOs in the same room talking about two big issues – financial sustainability, and quality and patient safety,” she says. “We spent time drilling it down into educational components we could use to achieve those goals. I had one CEO tell me, ‘The deans and I agree on far more than I thought we would.’ ”

But Conroy and the AAMC have not been afraid to tackle controversial issues head-on as well. Last year, the association concluded its work on conflicts of interest by focusing on clinical care in a 46-page study, “In the Interest of Patients.” It had previously addressed conflicts of interest in medical education and research.

“Let’s say a physician has invented a device,” Conroy says. “He or she receives royalties from sales of the device. What’s the infrastructure so that the physician and the academic medical center where the doctor works do not profit when this device is prescribed for patients there? How is that disclosed to patients? The Mayo Clinic, for example, has a strong policy in this area.”

As she considers her honor at being named one of the Top 25 Women in Healthcare, Conroy says one key attribute for up-and-coming female executives is to “lead through influence,” a quality that just about defines her current position. But she also says that being “very skilled at building teams” can be a career catalyst as well.

That’s something she’s done since the birth of her career at the Medical University of South Carolina, where the school recently established the Joanne M. Conroy, M.D. Endowed Chair for Education and Leadership Development. It was and is a testament to a career of firsts – Conroy was the first woman clinical chair, the first female president of the medical staff and the first female president of the state society of anesthesiologists.

When she started as a resident at MUSC, the written anesthesia board exam pass rate was only 50 percent. When Conroy became chief resident, she was determined to make a difference.

“I made my colleagues meet every Sunday for 3 hours to prepare for the written board exams. We had a 100 percent pass rate for written and orals from then on for at least 7 years.”

And the leaders she trained are now running the place.

“That,” Conroy says, “is the only real reward and acknowledgment I need to keep going.

The news arrived just as a study was released by the American Hospital Association reporting that the cost of getting an ACO off the ground could be many times what HHS has previously estimated.

CQ reports that the institutions in question — the Mayo Clinic, Cleveland Clinic, Geisinger Health System and Intermountain Healthcare — seem to agree that the ACO concept is a good one, but that the law contains obstacles that make it problematic for them to sign up.  

After the issue was raised, the Centers for Medicare and Medicaid Services were quick to signal anew a desire to work with the dissenting organizations to address their concerns.

“We will take the comments very seriously,” said Health and Human Services Secretary Kathleen Sebelius. “It is a proposed rule, so we’re listening closely to healthcare providers, to hospital groups.”

In the months to come, C-Suite Conversations will take a closer look at ACOs. Please give us your feedback on this issue with far-reaching implications for leaders.

Wright Lassiter on the job./Fast Company photo

The latest issue of Fast Company magazine has a remarkable story about a turnaround at a public hospital – Alameda County Medical Center in Oakland, Calif. The article seems destined to make the architect of that renaissance, CEO Wright L. Lassiter III, a national figure.

Besides the inspirational aspect, there is plenty to discuss in leadership and healthcare circles about the article:

• Does Alameda’s success provide a blueprint, or at least a framework, for other public hospitals in the U.S. to consider?
• How will reform change the jobs of public-hospital executives like Lassiter?
• What are some of the best turnarounds you have seen?

While you ponder those questions (and please consider using the “comment” link right below the headline of this story to respond), C-Suite Conversations caught up with one of the people responsible for launching Lassiter’s career.

David Cecero was CEO of JPS Health Network in Ft. Worth, Texas, when he hired Lassiter as vice president of operations. Cecero was so impressed with Lassiter’s work that he promoted him to senior vice president after just one year. He said Lassiter possesses an abundance of two key qualities he looks for in building his leadership team.

“It’s always about character and commitment,” Cecero tells us. “Competency is something I assume all candidates will have – you look at the pedigree and resume for that. But Wright has heart and soul.”

Cecero, now a top executive with QHR in Texas, says it would be a mistake to underestimate what Lassiter has achieved at a public hospital.

“Public hospitals are large political animals with a lot of special interests and a lot of governmental influence. That can be good, but it also can keep an organization from achieving its true potential.”

Joel Allison: 'Safe, quality care is cost-effective care."

The banner headline in the photo at left comes from a recent edition of the Chicago Tribune, where a front-page story on the release of Hospital Acquired Conditions (HAC) data shows how patient safety has breached the walls of the healthcare industry and has become a viral topic of sorts, growing increasingly important to the public at large.

Segments of the healthcare industry were not happy with those statistics (which showed 13.5 percent of Medicare patients are harmed by errors), contending the numbers were unreliable because of the way portions of the data were coded. But some of the criticism was muted recently when the HHS announced it was releasing a full $1 billion in funding for safety.

Joel Allison is president and CEO of the acclaimed Baylor Health Care System in Dallas, where the vision statement speaks directly to the need to “give and receive safe, quality, compassionate care.” He told us he sees the release of these government dollars as “recognition of what I believe is vital for the future of healthcare delivery – quality and outcomes and commitment.”

As he talks with his peers, Allison says there is a clear understanding that the surging path of quality and safety does not merely make sense economically, “but is the right thing to do for patients and their families.”

“I’ve always maintained that safe, quality care is cost-effective care,” he adds.

As for the release of the safety data, Allison said he sees it as a teachable moment for hospitals and health systems. “It should cause us to do a better job in our reporting, to make sure we’re accurate,” he says.

Under the new paradigm, Allison says, quality and safety can help leaders and their staffs flourish.

“I think high-performing healthcare systems and hospitals can become models of transparency and demonstrate the importance of outcomes and safe environments for patients and their families.”

The winners are:

Audrey Andrews, Maureen Bisognano, Gail Boudreaux, Angela Braly, Sandra Bruce, Linda Burnes Bolton, Debra Cafaro, Joanne Conroy, Karen Davis, Gail Donovan, Tracy Gaudet, Karen Ignagni, Sally Jeffcoat, Sister Carol Keehan, Linda Leckman, Joan Magruder, Pamela McNutt, Margaret O’Kane, Debra Osteen, Deborah Proctor, Lois Quam, Patricia Rice, Nancy Schlichting, Kathleen Sebelius, and Mary Wakefield.

Returning honorees are Braly, Davis, Ignagni, Keehan, O’Kane, Sebelius and Wakefield. Davis and Ignagni have made the Top 25 on all four occasions: 2005, 2007, 2009 and 2011.

In their intro, Bob Clarke and Sherrie Barch wrote: “If you look back over the history of healthcare in the U.S., one fact is impossible to ignore: Most of the pioneers were female.”

We congratulate this year’s class of honorees, who are steering a course through territories that are just as uncharted as those the early trailblazers faced. The articles can be found here. (Note: Registration is required.)

The announcement of this year’s honorees comes Monday, and we’re pleased to continue our involvement. The awards banquet will take place July 12 in Atlanta.

Our staff pitched in to help get the word out about the nominating process among our friends in the healthcare industry. It must have helped, because there was a large increase in the number of nominations.

So, watch this space Monday.

Barch: Self-awareness is critical for leaders.

“The patterns we observe,” researchers said, “are consistent with the hypothesis that time spent with outsiders is on average less beneficial to the firm and more beneficial to the CEO.”

Furst Group president Sherrie Barch finds that a bit simplistic.

“Organizations go through seasons,” she says. “If you’re in a growth mode, for example, it might be more beneficial to concentrate on reaching outward to drive sales.”

Similarly, “if you need to build efficiency and quality into your organization, or increase camaraderie and trust, you’ll need internal focus,” she added.

What’s critical for the CEO in all of this, Barch says, is self-awareness.

“If my default is to be Mr. Outside, then I’m going to make sure I balance that by having key people on my leadership team who are more focused on the inside.”

So does this translate to the C-suite level in healthcare as well? That’s a complex question, says Bob Clarke, Furst Group CEO.

On one hand, healthcare executives have been subject to the same economic issues as everyone else. Yet those conditions have been exacerbated by the continuing political stalemate over healthcare reform.

“Executives have been tolerating uncertainty but have grown very restless and are ready to make a change,” Clarke said. “After a brutal economy made it difficult to relocate or contemplate a career transition, there is now a palpable shift in expectations.”

But in healthcare, Clarke added, the impetus for change isn’t solely financial.

“While compensation stability and benefits all play a significant role in employee satisfaction, things are a little different at the executive level. Executives are seeking opportunities to make a difference,” he said. “They want to know if their efforts are working toward a better organization and are making an impact. This is particularly true in healthcare.”

So how can healthcare leaders keep their own teams engaged and committed?

“More than compensation, leaders seek opportunities to lead,” Clarke said. “They seek an ability to grow and to be personally challenged. Allow others to take risks, to take control of strategic initiatives. Include leaders in discussions about the future. Allow them an opportunity to challenge the status quo — provide a platform to seek a higher level of influence.”

Carson

Stacey

Like most healthcare firms, a contingent of Furst Group executives is in Chicago this week for one of the major events of the year: the ACHE Congress. It’s quite a large gathering this year with attendance of 5,000 expected. And the Congress has not disappointed, with strong challenges in inspirational speeches from the likes of Ben Carson and Rulon Stacey.

Dr. Carson, the renowned neurosurgeon from Johns Hopkins, encouraged leaders that they often carry the best hope for families facing medical crises, and reminded them to put patients’ needs first.

“It’s important to have your heart in the right place if you’re going to be dealing with people’s lives,” he told the luncheon.

And he encouraged his audience to be brave and persistent, recalling the story of Walter Dandy, one of his predecessors at Hopkins, whose first 13 patients to undergo a risky brain surgery died. But the procedure Dandy revolutionized is now standard and safe today. ACHE has a clip of Carson’s speech on their Facebook page and Modern Healthcare recapped his talk here.

Stacey, the president and CEO of Poudre Valley Health System and the incoming chairman of ACHE, used a powerful story about Canadian telegraph operator Vince Coleman, who sacrificed his life during World War I as he warned a train full of people about an impending explosion, to illustrate how healthcare executives have a unique opportunity to use their leadership to help the lives of others:

“I have learned,” Stacey said, “that if each practicing physician alters how he or she provides care to their patients, they will impact the 10 to 40 patients they see each day. However, if a healthcare executive identifies a best practice and effectively implements that change, he or she can impact 100,000 patients a year – more than any single physician can impact in a lifetime.”

That’s heady stuff. And it’s also refreshing to see an exec of his stature so plugged into social media. His entire speech can be found here; it is referenced on his extensive Twitter feed. Portions of his speech can also be found on YouTube though the camera work is a bit shaky.

Let’s close with some wisdom from Stacey on how healthcare is changing, and how organizations must change:

“During the next few years, one of the significant challenges for healthcare executives will be transitioning from the “sick-care” system of the past to the “healthcare” system of the future. Financial incentives will change, and during the transition, successful organizations will be the ones nimble enough to keep people healthy while the reimbursement system still pays to take care of people when they are sick. We all know that keeping people healthy is simply the right thing to do. But, make no mistake, those who don’t plan well will run the risk of going out of business altogether.”

We’ve heard some friends say their true business is financial services. Other say EMRs are making them more of an information firm. How about you? E-mail us with your thoughts at blog@furstgroup.com as we take the pulse of our industry. All responses will be kept confidential. We hope to share some of our findings here next week.

It’s a time when leadership is paramount and creativity is nothing less than a mandate. And for that, there are some definite role models in the faith-based history of healthcare.

The recent “Health System Benchmarks” study from Thomson Reuters discovered that faith-based health systems provided better quality of care than their secular counterparts.

In addition to dedicated professionals serving Catholic and other faith-based institutions today, we like to think that part of the reason for the success of these hospitals has more than a little to do with the lingering legacy of the founders, many of whom were sisters who arrived in their communities with little training and fewer resources.

We also find some qualities in them that would make today’s administrators and caregivers stand out in an industry hungry for leadership — innovation, courage, preventive care, patient-centered care.

Read more in the latest edition of Furst Group’s thought-leadership series, “PPACA and the Pioneer Spirit.”

Silverstein: Demand for informatics growing.

“Recruitment of the Emerging Health Care Leader” was the second event of the year staged by ACHE’s Regents Advisory Council and CHEF. Early careerists, mid-careerists and students gained insights on everything from the role of mentoring to the importance of cultural fit from a panel that included senior executives from organizations such as United Healthcare, ACHE and Vanguard, as well as Furst Group principal Deanna Banks.

In addition to the panel discussion, guests took part in speed networking with representatives from 35 companies across the healthcare spectrum, from academic medical centers to associations to consulting firms.

Despite the uncertainty around reform, “healthcare is still a great place to build a long and distinguished career,” said panel moderator Douglas Silverstein, FACHE, President of NorthShore University HealthSystem’s Glenbrook Hospital, who’s also the ACHE Regent of Metropolitan Chicago. Leaders are proceeding cautiously around reform, he said, because of past experiences. “In the early ’90s, we heard over and over again that capitation was coming, and we’d better get ready. And then it never came.”

“The need for talented and energetic healthcare management talent has never been greater,” Silverstein added. “The greatest need right now is probably in the area of healthcare informatics with the advent of electronic medical records. We have more than a dozen openings in Medical Informatics at NorthShore. I recently spoke to an executive for a large consulting firm who told me that they are overwhelmed by meaningful use assignments. There are a lot of career opportunities in this arena.”

“Recruitment of the Emerging Health Care Leader” promises to help young executives and students get some help in navigating the healthcare industry.

A panel discussion with healthcare executives will be moderated by Douglas Silverstein, FACHE, President and CEO of NorthShore University HealthSystem Glenbrook Hospital, who’s also the ACHE Regent of Metropolitan Chicago.

The swift growth of the industry makes forums like this crucial, said Furst Group principal Deanna Banks, one of the panelists at the event.

“As an industry, we are not developing emerging leaders fast enough to keep pace with some of our longer-term talent needs,” she said. “And so our ability to engage these young leaders early and to help support and nurture their goals will only serve to sustain their interest in the industry and long-term value as future executives.”

For more information on the event, click here.

“[G]overnment officials are poised to see more merger and acquisition plans from health systems across the country as they look to bolster their resources before national health care reform changes the game entirely by 2014.

Competition and the costs of doing business are a bigger concern to the health care industry, with health care regulations still being written, said Bob Clarke, co-founder and CEO of Furst Group, a health care executive search and research firm.

‘Rockford has been very well-served by three good institutions,” he said. “But there’s a difficulty to being independent now. … I think it’s great news and doing this makes a lot of sense considering what’s going on in the industry. I’m not at all concerned about the loss of potential services. It will make them more effective.’ ”

To read the full article from the Rockford Register Star, click here.

If you know a woman executive who is making a “positive difference in the [healthcare] industry,” please click here for more information on the program.

Modern Healthcare editors select the honorees based on five criteria:

“Has the candidate:

1. Successfully served as a leader or managed an organization or company?
2. Shown the ability or power to effect change in the healthcare industry?
3. Demonstrated a willingness to share expertise with others in the field?
4. Served as a role model or mentor to other female healthcare executives?
5. Assumed a leadership position in the industry outside of the candidates’ own organization or company?”

How do you nominate someone? The answer is:

“Send Modern Healthcare a detailed cover letter explaining how the candidate meets or exceeds the five criteria. Submissions must include the nominee‚Äôs resume or curriculum vitae, age and a color photo. Please send the material to David Burda, Editor, Modern Healthcare, (at) dburda@modernhealthcare.com.”

No fee is required. Again, full details are here.

Clarke: "It is the uncertainty in the business model that has been so disruptive."

“A majority of organizations are not counting on repeal. They are seeking guidance and moving forward to make sure they comply with the law.” The poll also showed a “growing number” of firms have decided not to drop healthcare coverage for employees.

Furst Group CEO Bob Clarke views the poll as a positive for healthcare leaders. “There is a general attitude among our clients that reform, in one way or another, will continue to move forward. And, as such, they have a focus on moving forward versus waiting to see what happens. Based on this survey, it appears that employers feel the same. This results collectively in a more positive attitude about the business climate. It is the uncertainty in the business model that has been so disruptive.”

Clarke said the news is welcome to all sectors of the healthcare industry. “This certainly is good news to payers as there will be more people enrolled in health insurance plans. And it’s good for providers — more people with health insurance means more elective procedures, less charity care and healthier reimbursements.”

But do safety and quality have staying power in the age of reform? Healthcare executives and safety experts weigh in on the topic. Plus, Furst Group vice president Dan Ford, one of the deans of healthcare executive search, shares his own family’s unwanted odyssey into the world of medical errors. Click here to read more.