Often, when we think of legacies we tend to think of figures from the past. In healthcare, some of the greatest legacies are those who continue to lead their organizations today. Having guided their organizations through innumerous policy changes, increasingly complex regulations and high rates of executive turnover, some of the longest-tenured leaders stand out as healthcare's greatest contemporary leaders.
In this CEO roundtable, James Elrod, who has served as president and CEO of Shreveport, La.-based Willis-Knighton Health System for nearly 50 years, Richard Roodman, CEO of Valley Medical Center in Renton, Wash., for 32 years, Bill Considine, president and CEO of Akron (Ohio) Children's Hospital for 36 years and Rick Anderson, who will celebrate his 30th anniversary as president and CEO of Bethlehem, Pa.-based St. Luke's University Health Network in June, define what makes a healthcare leader a legacy.
Note: Responses have been lightly edited for length and clarity.
Question: As the longtime leader of your organization, how do you approach your legacy?
James Elrod: I hope and believe that my legacy is entwined with the legacy of the health system and the many employees and doctors who have made 
an impact on Willis-Knighton and our community. I don't really have to "approach" my legacy, because, as I often tell people, "It is what it is."
When I came to work in 1965, I soon discovered the small neighborhood hospital where I was employed had great doctors, great employees but was in a state of undeclared bankruptcy. Building on its strengths, building on its people, we were able to make it financially solvent and grow it to become one coordinated healthcare provider with four hospital locations to make healthcare more convenient to everyone in our community. Keeping our community's needs in mind throughout the last 50 years has helped assure that my legacy is to leave Willis-Knighton in much better shape than I found it. And I think that's what legacy is all about, handing down something that has value, something to build on, something to grow and make it even better.
Richard Roodman: I really haven't thought much about a legacy, because as the leader of Valley Medical Center, I need to always try to accomplish what lies in front of me every day. If I can do a good job, then hopefully we'll have a stable and productive environment that will allow us to fulfill our mission. Our secret sauce is our staff, who accomplish the objectives and goals that are set out before us. I've never received a thank-you letter for a facility, a piece of equipment or technology. Any thank-you letter I've received was for how a patient was treated by a staff member and his or her care. That speaks volumes to me.
Bill Considine: My approach as the longtime leader at Children's is to serve this organization to the best of my ability, to be a role model through my actions and uphold our longstanding mission to serve this community. I feel if I do that and engage with people, celebrate with people, celebrate our culture and continue to shine the jewel that is known as Akron Children's Hospital, then the families we are so privileged to serve will be the benefactors, and that's what we're here to do.
Rick Anderson: When I think of legacy, I think of someone's track record, or what he has been able to accomplish in his career. One of the things I keep in the forefront of my mind is that in healthcare, hospitals are very complicated bureaucratic organizations made up of different individuals with varying backgrounds. At the top of the food chain there are the physicians with their knowledge, education and training. When you put everyone together and make the organization run like a fine Swiss clock, you have to remember that it isn't the person in charge that makes it happen — it's the people with all of those different backgrounds and knowledge bases. A CEO is blessed and privileged to lead a healthcare organization.
I don't think about a legacy or think about what people are going to say after I've left. I think about what I can do to make the organization effective and continue to think about how we deliver quality care to the individuals who put their lives in our hands every single day. I come into work with a passion for the job and feel good about what I'm doing.
Q: Is your legacy something you think about once a day, once a year or even less?
J.E.: As a young man with a new job, young family and business in undeclared bankruptcy, I doubt I ever thought about my legacy. But several years ago I was persuaded to write a book about the history of the hospital, understanding that so many of the people who had seen us through the hardest times were no longer with us. So, obviously, my legacy and that of the health system was top-of-mind information. Writing the book and then working with staff to create a medical museum, I began to have a deeper understanding of just how much this health system has meant not just to the people who worked here but to the community at large. So now, at this time and at this age, I am aware of it more than ever. And I suppose with my 50th anniversary coming up, it's something that I will be very cognizant of this year.
R.R.: The longer I'm in this position, the more I'm asked about it. At least for me, if I were to focus on building a legacy consciously, I would just keep trying to do my best on a daily basis. Legacies are written by other people, and I try to focus on my actions, vision and mission.
B.C.: Akron Children's was founded in 1890. I'm a native Akronite, so I knew a little about the hospital coming in. When I arrived as the CEO in 1979, I learned more about the history. One of its components that is really powerful is that the women who started the hospital — initially as a nursery — listed three promises on the wall behind the reception desk: We promise to treat every child that comes to the nursery as if that child was our own; we promise to treat the parent the way any parent would want to be treated; and we promise to never turn a child away for any reason.
One of my main guiding principles for 36 years now has been to keep those promises alive. Not a day goes by that I don't think about them, or the values that are part of the organization: Respect, trustworthiness, caring, fairness, responsibility and citizenship. Making sure my actions speak louder than words relative to keeping those promises alive, embracing those values and being a family care-centered organization is what is important to me.
R.A.: I have a view that when you start thinking about retirement or what you've done, it's time to leave. I wish I had 10 more years because there are so many things I feel I could do to make a positive contribution to the organization, but I don't dwell on it. I focus on the day at hand and try to do the best I can to make sure everyone has the resources they need to be successful, stay focused on getting things done and keep the organization agile so they can make decisions quickly and effectively.
Q: Is a legacy the product of deliberate actions, or is it something that develops over time as a result of decisions and leadership style?
J.E.: A legacy is made by all of this. Certainly, there are deliberate actions I have taken, but not specifically to promote my legacy. If you have a heart for healthcare, for the people you work with and for the community, you will make decisions that focus on them and the mission, not on you. I think that's what makes a successful hospital executive. Those who may be ego-driven and focused heavily on the social aspects and financial benefits of a career in healthcare administration will probably not be the ones who leave positive legacies.
It's important to remember that your legacy is built not just on your successes but on your mistakes and how you address them. Making tough decisions, recovering from mistakes and dreaming big dreams — that's what makes a positive legacy. And one thing I noted in my book is that many of our successes here at Willis-Knighton can be attributed to the mistakes of those leading our competitors — that's something you can't control.
R.R.: It's been a long time since I began here. Over 30 years ago, I thought my primary purpose was to change the image of the organization though public relations. Later, I thought one of the best ways to enhance the care we provided was teaching, and so we created the residency program with the [Seattle-based] University of Washington, which became one of the biggest residency programs in the northwest. Then, over the years, technology capabilities became our focus.
There are actually several other accomplishments that probably deserve more consideration. The culture of our system — making it a great place to work and a great place to receive care — is the legacy I would like to try to continue to build. And alternatively, if there was one specific vision, it would be the strategic alliance with the University of Washington that has contributed to what will be the best future for the organization and will allow us to thrive in an environment that is changing at a rapid pace.
B.C.: I don't really think about legacy in those terms, but I do believe it gets developed over a period of time and a series of actions, in addition to how genuine you are, and how transparent and honest. The leadership medal we have we need to earn every day. You need to bring positive energy and a positive attitude to the table, and you need to be someone who can talk about the future, excite and energize people. It's not a one-person show. We couldn't have cared for 800,000 children last year unless we had the powerful team that believes in our work. That's how legacies evolve.
One of the things I really underestimated is how much I could learn from the children and families we serve. We see their strength and courage in times of adversity. I have a sun catcher in my office that was painted by a young girl named Angie who was fighting cancer 20 years ago. She died when she was 13. She would paint sun catchers through our art therapy program and give them to her caregivers, family and friends. She was extremely positive — even when she was so sick and going through treatment. She became the caregiver, really. It's her legacy I want to keep alive, and that of the kids and families that we see everyday in our organization. This is the blessing of the role I have. When Angie died, there were two sun catchers she never finished. Her mother gave me one to remind me we always have work to do to benefit the children we care for. Together, Angie's mother and I created a parent advisory board and a parent mentoring program to help make care better.
R.A.: I definitely think of tenure and accomplishments as the important elements that make a legacy. When you come to work every day, it occurs to you from time to time these positions experience significant turnover. There are many competent CEOs who lose their jobs, not because of inability or bad decisions, but because politics get the best of them and they don't know how to be flexible. If one possesses solid decision-making abilities, leadership skills and surrounds oneself with individuals with talent and good character, one will be successful. History will decide later if you were an effective leader.
My 30-year anniversary will be in June. It's a testimony not only to being a survivor, but that the organization has great culture, character, strong values and loyal people.
Q: In an era of the highest CEO turnover in healthcare, are legacies even more meaningful than in prior years?
J.E.: I don't know that you can have a meaningful legacy if you only stay with a hospital for a couple of years. Perhaps if you are present and handle a disaster or crisis well, something like Katrina or the 9/11 response, you can leave a legacy.
Healthcare is constantly changing these days and how you plan for and adapt to change is critical — and it's never instant. A legacy is not like a popularity contest. It requires vision, meaningful decisions focused on mission, focused on objectives, and a passion to make things better.
As I look back, the legacy I leave Willis-Knighton will have been built over more than five decades — that's certainly enough time to envision the future and help to make it happen. I have been blessed with the support of our board of trustees, doctors and employees who have reinforced my decision to come here and to stay here, to be happy to get up and come to work every day. I often repeat the quote from Confucius: "Choose a job you love and you will never have to work a day in your life."
R.R.: I think leaders need to be tenacious and continuously reinvent themselves. In a fast-changing environment and industry, this becomes an exciting challenge, and it is extremely energizing and rewarding.
B.C.: I do think that with the rapid change in our healthcare environment, there is a place for institutional memory, for reflecting on tradition and the life lessons from those who walked the halls before us. I'm not suggesting we live in the past, but that we learn from the past and celebrate the volunteers and soldiers — the caregivers — who were before us, and who brought our country's healthcare system to become arguably the best in the world. I do think having stability in leadership is a calming force that helps people direct their positive energy to advancing the mission of the organization they're a part of. I realize it's very unusual to have only two CEOs over a 70-year period. I see how that benefited our organization, and I've also witnessed other organizations that have had four or five CEOs in a seven or eight year period, which creates anxiety and negative energy.
One of the important things about a long tenure is the need to reinvent yourself and your organization to respond to the changes in the industry. I readily admit the organization we are today is much different than the one we were when I became CEO in 1979. You can stay fresh and active and bring that kind of energy to the table you often see when a new leader steps in, but you don't necessarily need a turnover for a CEO to reengineer and reinvent himself.
R.A.: I believe if you look at any successful organization — a football team, basketball team, healthcare organization or church — they have continuity of superb leadership. Not just with the CEO, but all of the individuals who are on the team. Continuity and the ability to trust one another and work together ensure a successful organization.