Today's hospital and health system leaders can learn a lot from George Bernard Shaw, the famed Irish writer and social critic. He is renowned for the following passage: "The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man."
Now, more than ever, hospitals and health system CEOs cannot sit on their hands as new care delivery models, payment systems and other changes flood the healthcare system. For CEOs and other leaders who may believe the new healthcare reforms and social norms will not apply to their institutions, there is no more time to be "unreasonable," as Mr. Shaw put it.
Several of the nation's most progressive CEOs have signed onto this thought process — David Feinberg, MD, Chris Van Gorder, Dean Gruner, MD, Bill Carpenter and many others outlined below. More specifically, here are 10 ideas that CEOs need to cast aside and what the alternative leadership strategy should be, and how those hospital and health system CEOs embody "new school" ways of being "reasonable" and progressive.
1. Old: Micromanage your employees. New: Empower your employees. Micromanagement usually has the reputation of being occasionally effective but highly unpopular with employees. Employees may get their tasks done if leaders consistently round in, but that lack of trust and overt shoulder-watching could erode the employee base.
Paul Spiegelman, author and founder/CEO of BerylHealth, a firm focused on improving healthcare experiences, says this new school strategy of empowering employees — along with the other nine strategies he outlined — is vital for CEOs to adopt if they want to attain success within today's healthcare environment and their own organization.
David Feinberg, MD, CEO of Ronald Reagan UCLA Medical Center and president of the UCLA Health System, agrees that a forward-thinking health system leader must empower his or her employees to do the right work instead of hounding for results. If a hospital or health system is looking for the right physicians, nurses, frontline staff and other caretakers during the hiring process, then trust should come easily.
"It's very clear no matter how skilled I am as a physician, I can't care for 1.5 million patients per year," Dr. Feinberg says. "That requires a workforce that's completely engaged. We just have the expectation that [employees] will treat everyone with the highest level of care and will be kind to everyone along the way."
2. Old: Management by walking around. New: Management by watching and listening. CEOs that believe roaming the halls will suffice as a positive management style may need to think again. Hospital administrations need feedback and criticism to know what they are doing right and what needs improvement, and those elements can only be found by talking to the lifeblood of the organization, Mr. Spiegelman says.
Dr. Feinberg takes this idea to heart at UCLA, especially when it comes to the health system's patients. Every day for a couple of hours, he meets with patients to ask how they are doing and what he can do to assist in their care. He even dishes out his business card and cell phone number — available 24 hours a day — to make sure patients have what they need.
Consequently, UCLA has some of the highest patient satisfaction rankings in the country, hovering around the 99th percentile. Dr. Feinberg says healthcare leaders shouldn't rest on those types of laurels, though. They need to watch and listen to their employee and patient base continually to ensure they get as close as possible to total systemic satisfaction.
"The reality is, we don't think it's good enough," Dr. Feinberg says. "Despite having the best doctors, an incredible nursing staff, great new buildings, the highest level of quality, the 99th percentile means that only 85 out of 100 patients would recommend us to family and friends. That's still failing. That's someone's mom or brother or co-worker. New patients that come don't care what we've done. They just care how we treat them and what's affecting them at that moment. It's a very focused environment on the current patient because we want perfect care today."
3. Old: Knowing everything and dictating the work. New: Knowing your leadership and trusting them. The title of hospital or health system CEO has the most name recognition of anyone on staff, but that does not mean an authoritarian type of leadership should prevail. Instead, Mr. Spiegelman says CEOs need to have loyal staff around them, especially in the C-suite and upper management positions.
Bill Carpenter, CEO of LifePoint Hospitals based in Brentwood, Tenn., says that idea is at the forefront of his company — and it has to be for health systems as large as LifePoint. LifePoint operates 56 hospitals across the country. Without his individual hospital C-suite leaders, division managers and other headquarters management team members, Mr. Carpenter says he would not have a culture conducive to progressive change.
"I don't think any single leader can make an organization successful on his or her own," Mr. Carpenter says. "I think leaders have to surround themselves with talented people in order to be successful and for the organization to be successful. The primary responsibility of a CEO is to establish a culture and strategy that will guide an organization through a period of time. Great leaders help other people understand what their role is, what their contributions are and help keep them focused on the key things that are going to make a difference for the organization."
4. Old: No mistakes are allowed. New: We learn from our mistakes. While this is not groundbreaking news, it never hurts to remember that humans are not error-free. Mistakes happen, and ignoring that fact would only be an impediment to becoming a more "reasonable" leader.
Gary Newsome, CEO of Health Management Associates based in Naples, Fla., believes learning from decisions gone awry makes CEOs and other executives stronger — and at the very least, mistakes give a dose of humility for future decisions to be made.
"I think probably what I've learned the most [over the years] is when I failed to make a hard decision that needed to be made in a timely basis," Mr. Newsome says. "When you're dealing with people and dealing with people's lives, it's hard to make difficult decisions. In reality, to guide an organization of this size, 40,000 associates, you have to make hard decisions sometimes…and the best way is to hit [those decisions] head on."
5. Old: Physicians are the customers. New: Physicians are our partners. Physicians have always been the cornerstone care provider in the health delivery system, and they are becoming even more important as hospitals and health systems partner with physicians through employment agreements, accountable care organizations, bundled payments and other physician-centric reform efforts.
With that in mind, it's essential for CEOs to not make the mistakes of the past. Namely, don't treat physicians as if they are merely consumers that need to be sold something. Glenn Fosdick, president and CEO of The Nebraska Medical Center in Omaha, says hospital leaders need to foster an environment of collaboration in both recruitment efforts as well as ACO-type initiatives because hospitals need physician support to have a chance of being successful.
"When it comes to our staff, it's not just one physician. Our high-performing staff is physicians, their supporting staff and the environment that is needed to attract these types of high-quality physicians," Mr. Fosdick says. "We've been fortunate that we have some incredibly talented people here, and in my years of experience, good physicians attract other good physicians."
6. Old: Having clinical competency is enough. New: Clinical competency is expected, and collaboration is required. In order to be a CEO of a hospital or health system, it is generally expected that person knows the basics of clinically important routines. This is not to say a CEO must be a physician or other provider, but a certain level of "clinical competency" was expected, Mr. Spiegelman says.
However, clinical competency is not enough anymore. Case in point is Fred Hunter, RN, president and CEO of Marina Del Rey (Calif.) Hospital. Mr. Hunter began his career as a nurse, and as he worked his way up the ranks, he realized his clinical background and ability to collaborate with clinicians gave him an advantage, especially when it came to communication. Physicians and nurses becoming CEOs of healthcare organizations is certainly on the rise, but the business-minded CEO certainly still has a place — he or she just has to take that clinical competency to the floors to further communication.
"Even to this day, I'm able to put myself in the nurses' place or employees' position, understand what they [may be] experiencing at a point in time and explain my vision," Mr. Hunter says. "I'm able to empathize with them [regarding] the challenges they're going to experience and put in safeguards to address those concerns that they may experience."
7. Old: Buy a lot of new technology. New: Invest in people and culture. While new CT scanners and electronic health records are vital components of any 2000s-era hospital and health system, they alone do not keep patients well. It is the physicians, nurses, staff — the people — that create a culture of comfort and stability.
Two health system CEOs epitomize this leadership strategy: Dean Gruner, MD, president and CEO of ThedaCare in Appleton, Wis., and Chris Van Gorder, president and CEO of Scripps Health in San Diego. Both men are so convinced their employees and people make for the best environment that they have adopted "no layoff" philosophies, meaning their employees will not see layoff notices unless there is a catastrophic event or hospitals close down.
A "no layoff" philosophy sounds bold amidst the toughest economic recession since the Great Depression, but both Dr. Gruner and Mr. Van Gorder say their organizations have become better holistic institutions due to their commitment to their employees.
"I'd get emails from employees, saying thank you because they were the only person in the family who has a job," Mr. Van Gorder says. "People can count on their job at Scripps to get through the recession without families falling apart. By supporting people, you end up with a much better culture and employees that are more motivated to help you through these challenges ahead."
8. Old: Demand change. New: Nurture change. CEOs who desire to become more "reasonable" in their leadership styles must define the fine line between demanding change and nurturing change. Demands can often come across as commandeering and overbearing, but CEOs still must prod employees toward a new norm.
Paul Levy, former CEO of Boston-based Beth Israel Deaconess Medical Center, recommends hospital leaders lose the old idea of martial law leadership and instead nurture new outcomes through Lean principles. Lean techniques, which are centered on preserving a group's value-based motives, aim to reduce the waste, and leaders can drive Lean principles by training the staff to identify immediately when something goes wrong. This process allows CEOs to set a framework for the change desired, but physicians, nurses and other employees are the actual agents of change.
9. Old: Gloss over drivers of chronic diseases. New: Promote holistic health and well-being programs. Chronic diseases are the leading drivers of higher healthcare costs, and many chronic diseases can be avoided through improved lifestyle decisions.
For example, many of the nation's preeminent health systems, such as Cleveland Clinic, have honed in on one specific lifestyle decision: eliminating fried foods from their cafeterias. Hospitals and health systems are going after fried foods and unhealthy diets for one obvious reason: They contradict the health system's visions of curbing chronic diseases.
Kaiser Permanente in Oakland, Calif., recently signed a commitment with Partnership for a Healthier America, an initiative to solve the country's obesity crisis, to improve food offerings in its 37 hospitals, and other hospitals are also looking to end contracts with fast food chains like McDonald's. Executives at Children's Mercy Hospitals and Clinics in Kansas City, Mo., took an extra step, as they recently announced the hospital will no longer offer soda or sugary beverages in its cafeteria, vending machines or gift shops.
UCLA Health System also does not sell fried food, encourages "Meatless Mondays" and always has a vegetarian option on hand. Additionally, any revenue from soda and other sugary drinks is used to subsidize UCLA's salad bar, which is organically grown and locally sourced, which Dr. Feinberg believes helps root out a major cause of today's chronic disease epidemic.
"We believe in promoting health," Dr. Feinberg says. "We serve roughly 12,000 meals a day, and none involve fried food. We are trying to promote this type of healthy eating."
In addition, many large hospitals and health systems throughout the country — Detroit Medical Center, Baylor Health Care System in Dallas, Henry Ford Health System in Detroit, Geisinger Health System in Danville, Pa., Massachusetts General Hospital in Boston and most hospitals in California, among numerous others — have banned tobacco and/or smoking from their campuses due to the undeniable link between tobacco and cancer/chronic disease. Some health systems have even stopped hiring smokers and tobacco users altogether.
10. Old: Formal leadership. New: Informal leadership. While formal business attire was practically mandatory decades ago, the same is not true today in many work environments. In fact, the example of business attire is only a metaphor for the evolving informality of today's businesses.
Mr. Spiegelman says hospital CEOs have to let go of the idea that suit coats are the only way to present oneself — in other words, don't be constricted to the formalities of the past because they will only hinder from embracing the widely accepted informalities of today.
Mr. Spiegelman says all of the 10 "new school" ideas revolve around the theme that leaders must conduct introspective evaluations of their own leadership styles. To reiterate George Bernard Shaw, no CEO should want to be the "reasonable" person that stands in the way of healthcare reform.
"Everyone is scrambling to do things a different way," Mr. Spiegelman says. "While there is a big focus on patient-centric care, I believe we're missing the point if we don't realize that before we improve patient care, we have to change the way we lead in our organizations. It requires looking inside first, and all of these ideas relate to methods of leadership if we're going to survive over time."
Now, more than ever, hospitals and health system CEOs cannot sit on their hands as new care delivery models, payment systems and other changes flood the healthcare system. For CEOs and other leaders who may believe the new healthcare reforms and social norms will not apply to their institutions, there is no more time to be "unreasonable," as Mr. Shaw put it.
Several of the nation's most progressive CEOs have signed onto this thought process — David Feinberg, MD, Chris Van Gorder, Dean Gruner, MD, Bill Carpenter and many others outlined below. More specifically, here are 10 ideas that CEOs need to cast aside and what the alternative leadership strategy should be, and how those hospital and health system CEOs embody "new school" ways of being "reasonable" and progressive.
1. Old: Micromanage your employees. New: Empower your employees. Micromanagement usually has the reputation of being occasionally effective but highly unpopular with employees. Employees may get their tasks done if leaders consistently round in, but that lack of trust and overt shoulder-watching could erode the employee base.
Paul Spiegelman, author and founder/CEO of BerylHealth, a firm focused on improving healthcare experiences, says this new school strategy of empowering employees — along with the other nine strategies he outlined — is vital for CEOs to adopt if they want to attain success within today's healthcare environment and their own organization.
David Feinberg, MD, CEO of Ronald Reagan UCLA Medical Center and president of the UCLA Health System, agrees that a forward-thinking health system leader must empower his or her employees to do the right work instead of hounding for results. If a hospital or health system is looking for the right physicians, nurses, frontline staff and other caretakers during the hiring process, then trust should come easily."It's very clear no matter how skilled I am as a physician, I can't care for 1.5 million patients per year," Dr. Feinberg says. "That requires a workforce that's completely engaged. We just have the expectation that [employees] will treat everyone with the highest level of care and will be kind to everyone along the way."
2. Old: Management by walking around. New: Management by watching and listening. CEOs that believe roaming the halls will suffice as a positive management style may need to think again. Hospital administrations need feedback and criticism to know what they are doing right and what needs improvement, and those elements can only be found by talking to the lifeblood of the organization, Mr. Spiegelman says.
Dr. Feinberg takes this idea to heart at UCLA, especially when it comes to the health system's patients. Every day for a couple of hours, he meets with patients to ask how they are doing and what he can do to assist in their care. He even dishes out his business card and cell phone number — available 24 hours a day — to make sure patients have what they need.
Consequently, UCLA has some of the highest patient satisfaction rankings in the country, hovering around the 99th percentile. Dr. Feinberg says healthcare leaders shouldn't rest on those types of laurels, though. They need to watch and listen to their employee and patient base continually to ensure they get as close as possible to total systemic satisfaction.
"The reality is, we don't think it's good enough," Dr. Feinberg says. "Despite having the best doctors, an incredible nursing staff, great new buildings, the highest level of quality, the 99th percentile means that only 85 out of 100 patients would recommend us to family and friends. That's still failing. That's someone's mom or brother or co-worker. New patients that come don't care what we've done. They just care how we treat them and what's affecting them at that moment. It's a very focused environment on the current patient because we want perfect care today."
3. Old: Knowing everything and dictating the work. New: Knowing your leadership and trusting them. The title of hospital or health system CEO has the most name recognition of anyone on staff, but that does not mean an authoritarian type of leadership should prevail. Instead, Mr. Spiegelman says CEOs need to have loyal staff around them, especially in the C-suite and upper management positions.
Bill Carpenter, CEO of LifePoint Hospitals based in Brentwood, Tenn., says that idea is at the forefront of his company — and it has to be for health systems as large as LifePoint. LifePoint operates 56 hospitals across the country. Without his individual hospital C-suite leaders, division managers and other headquarters management team members, Mr. Carpenter says he would not have a culture conducive to progressive change.
"I don't think any single leader can make an organization successful on his or her own," Mr. Carpenter says. "I think leaders have to surround themselves with talented people in order to be successful and for the organization to be successful. The primary responsibility of a CEO is to establish a culture and strategy that will guide an organization through a period of time. Great leaders help other people understand what their role is, what their contributions are and help keep them focused on the key things that are going to make a difference for the organization."
4. Old: No mistakes are allowed. New: We learn from our mistakes. While this is not groundbreaking news, it never hurts to remember that humans are not error-free. Mistakes happen, and ignoring that fact would only be an impediment to becoming a more "reasonable" leader.
Gary Newsome, CEO of Health Management Associates based in Naples, Fla., believes learning from decisions gone awry makes CEOs and other executives stronger — and at the very least, mistakes give a dose of humility for future decisions to be made.
"I think probably what I've learned the most [over the years] is when I failed to make a hard decision that needed to be made in a timely basis," Mr. Newsome says. "When you're dealing with people and dealing with people's lives, it's hard to make difficult decisions. In reality, to guide an organization of this size, 40,000 associates, you have to make hard decisions sometimes…and the best way is to hit [those decisions] head on."
5. Old: Physicians are the customers. New: Physicians are our partners. Physicians have always been the cornerstone care provider in the health delivery system, and they are becoming even more important as hospitals and health systems partner with physicians through employment agreements, accountable care organizations, bundled payments and other physician-centric reform efforts.
With that in mind, it's essential for CEOs to not make the mistakes of the past. Namely, don't treat physicians as if they are merely consumers that need to be sold something. Glenn Fosdick, president and CEO of The Nebraska Medical Center in Omaha, says hospital leaders need to foster an environment of collaboration in both recruitment efforts as well as ACO-type initiatives because hospitals need physician support to have a chance of being successful.
"When it comes to our staff, it's not just one physician. Our high-performing staff is physicians, their supporting staff and the environment that is needed to attract these types of high-quality physicians," Mr. Fosdick says. "We've been fortunate that we have some incredibly talented people here, and in my years of experience, good physicians attract other good physicians."
6. Old: Having clinical competency is enough. New: Clinical competency is expected, and collaboration is required. In order to be a CEO of a hospital or health system, it is generally expected that person knows the basics of clinically important routines. This is not to say a CEO must be a physician or other provider, but a certain level of "clinical competency" was expected, Mr. Spiegelman says.
However, clinical competency is not enough anymore. Case in point is Fred Hunter, RN, president and CEO of Marina Del Rey (Calif.) Hospital. Mr. Hunter began his career as a nurse, and as he worked his way up the ranks, he realized his clinical background and ability to collaborate with clinicians gave him an advantage, especially when it came to communication. Physicians and nurses becoming CEOs of healthcare organizations is certainly on the rise, but the business-minded CEO certainly still has a place — he or she just has to take that clinical competency to the floors to further communication.
"Even to this day, I'm able to put myself in the nurses' place or employees' position, understand what they [may be] experiencing at a point in time and explain my vision," Mr. Hunter says. "I'm able to empathize with them [regarding] the challenges they're going to experience and put in safeguards to address those concerns that they may experience."
7. Old: Buy a lot of new technology. New: Invest in people and culture. While new CT scanners and electronic health records are vital components of any 2000s-era hospital and health system, they alone do not keep patients well. It is the physicians, nurses, staff — the people — that create a culture of comfort and stability.
Two health system CEOs epitomize this leadership strategy: Dean Gruner, MD, president and CEO of ThedaCare in Appleton, Wis., and Chris Van Gorder, president and CEO of Scripps Health in San Diego. Both men are so convinced their employees and people make for the best environment that they have adopted "no layoff" philosophies, meaning their employees will not see layoff notices unless there is a catastrophic event or hospitals close down.
A "no layoff" philosophy sounds bold amidst the toughest economic recession since the Great Depression, but both Dr. Gruner and Mr. Van Gorder say their organizations have become better holistic institutions due to their commitment to their employees.
"I'd get emails from employees, saying thank you because they were the only person in the family who has a job," Mr. Van Gorder says. "People can count on their job at Scripps to get through the recession without families falling apart. By supporting people, you end up with a much better culture and employees that are more motivated to help you through these challenges ahead."
8. Old: Demand change. New: Nurture change. CEOs who desire to become more "reasonable" in their leadership styles must define the fine line between demanding change and nurturing change. Demands can often come across as commandeering and overbearing, but CEOs still must prod employees toward a new norm.
Paul Levy, former CEO of Boston-based Beth Israel Deaconess Medical Center, recommends hospital leaders lose the old idea of martial law leadership and instead nurture new outcomes through Lean principles. Lean techniques, which are centered on preserving a group's value-based motives, aim to reduce the waste, and leaders can drive Lean principles by training the staff to identify immediately when something goes wrong. This process allows CEOs to set a framework for the change desired, but physicians, nurses and other employees are the actual agents of change.
9. Old: Gloss over drivers of chronic diseases. New: Promote holistic health and well-being programs. Chronic diseases are the leading drivers of higher healthcare costs, and many chronic diseases can be avoided through improved lifestyle decisions.
For example, many of the nation's preeminent health systems, such as Cleveland Clinic, have honed in on one specific lifestyle decision: eliminating fried foods from their cafeterias. Hospitals and health systems are going after fried foods and unhealthy diets for one obvious reason: They contradict the health system's visions of curbing chronic diseases.
Kaiser Permanente in Oakland, Calif., recently signed a commitment with Partnership for a Healthier America, an initiative to solve the country's obesity crisis, to improve food offerings in its 37 hospitals, and other hospitals are also looking to end contracts with fast food chains like McDonald's. Executives at Children's Mercy Hospitals and Clinics in Kansas City, Mo., took an extra step, as they recently announced the hospital will no longer offer soda or sugary beverages in its cafeteria, vending machines or gift shops.
UCLA Health System also does not sell fried food, encourages "Meatless Mondays" and always has a vegetarian option on hand. Additionally, any revenue from soda and other sugary drinks is used to subsidize UCLA's salad bar, which is organically grown and locally sourced, which Dr. Feinberg believes helps root out a major cause of today's chronic disease epidemic.
"We believe in promoting health," Dr. Feinberg says. "We serve roughly 12,000 meals a day, and none involve fried food. We are trying to promote this type of healthy eating."
In addition, many large hospitals and health systems throughout the country — Detroit Medical Center, Baylor Health Care System in Dallas, Henry Ford Health System in Detroit, Geisinger Health System in Danville, Pa., Massachusetts General Hospital in Boston and most hospitals in California, among numerous others — have banned tobacco and/or smoking from their campuses due to the undeniable link between tobacco and cancer/chronic disease. Some health systems have even stopped hiring smokers and tobacco users altogether.
10. Old: Formal leadership. New: Informal leadership. While formal business attire was practically mandatory decades ago, the same is not true today in many work environments. In fact, the example of business attire is only a metaphor for the evolving informality of today's businesses.
Mr. Spiegelman says hospital CEOs have to let go of the idea that suit coats are the only way to present oneself — in other words, don't be constricted to the formalities of the past because they will only hinder from embracing the widely accepted informalities of today.
Mr. Spiegelman says all of the 10 "new school" ideas revolve around the theme that leaders must conduct introspective evaluations of their own leadership styles. To reiterate George Bernard Shaw, no CEO should want to be the "reasonable" person that stands in the way of healthcare reform.
"Everyone is scrambling to do things a different way," Mr. Spiegelman says. "While there is a big focus on patient-centric care, I believe we're missing the point if we don't realize that before we improve patient care, we have to change the way we lead in our organizations. It requires looking inside first, and all of these ideas relate to methods of leadership if we're going to survive over time."
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