Mark Keroack, MD, who began his career as an internal medicine and infectious disease specialist, has served as president and CEO of Springfield, Mass.-based Baystate Health since 2014.
In this role, from which he will retire in July, Dr. Keroack helms an organization that includes a teaching hospital; a full-service children's hospital; three community hospitals; a network of more than 80 medical practices; a subsidiary health plan, Health New England; home care and hospice services; and comprehensive regional lab and diagnostic services.
He told Becker's he has learned various lessons throughout his tenure as CEO, in addition to helpful lessons he learned as a teenager at his first job. Dr. Keroack shared details about these lessons, discussed an "unpopular" opinion he holds and walked through his hardest day as CEO.
Editor's note: This is a regular series of conversations with CEOs of the nation's health systems. Responses were lightly edited for length and clarity.
Question: What was your first job? How old were you? Biggest thing you learned?
Dr. Mark Keroack: I went to work at age 14 on a summer job at an aircraft parts distribution warehouse. I was sort of a stock boy and a shipping clerk and that sort of thing. I was given the princely sum of $1 an hour. That was my starting pay. With any first job, you learn that you need to be dependable and do what you say. You need to own up to your mistakes. The other thing I learned was that you don't have to take things at face value. I was working with a good friend of mine from high school, and we came up with some new ways of doing the basic work. Putting forward innovations on how to do the work from kind of a grassroots perspective was something that our bosses were OK with. I learned that there's more than one way to sort of solve a problem, and thinking about that can be helpful.
Q: What's an unpopular (or uncommon) leadership or healthcare opinion you have?
MK: I know this is an unpopular opinion because I've chatted with folks from around the country about it. I'm a physician, but I'm also trained in public health. So I firmly believe that we're better off as a country when we cover all of our citizens with a basic set of health benefits. And I think we as a health system deliver better care when we're under a globally budgeted or capitated payment arrangement. I think they create proper incentives around wellness and prevention. They also help us focus on some of the social issues that impact health. And I think that's easier to say when you're from Massachusetts where we've made a big commitment about that. But it is kind of foreign territory for folks in more traditional states where things are still kind of fee-for -service.
Q: What was the hardest day of your career? How did you get through it?
MK: I'm going to focus on my hardest day as a CEO. I look back and it was probably in the early days of COVID, probably middle of March 2020. You could probably pick any of those days. We had just seen the first few COVID-19 cases a week before and things were skyrocketing. We got up to over 100 cases across our health system within about a week or 10 days en route to the total peak — the highest in our 1,000-bed hospital was 320 being COVID-19 patients. But early in those early days with these skyrocketing numbers, it was pretty clear things were out of control. You couldn't test. You couldn't get tests back in less than 10 days. We had no idea how to treat it. We really weren't totally sure about how to protect people. We were doing it by extension from other respiratory viruses. So I had this feeling I was putting people in harm's way. That total feeling of powerlessness and not knowing what the right thing was to do made it a very stressful time.
So I was in this thing where things were out of control, and I had no idea what to do. And probably the best thing I did was to delegate the incident command of the response to the virus to our chief physician, who had a military background. And I realized that as a leader, I tend to sort of be deliberative and think things through, and I'm not a fast decision-maker, whereas he was. He could step into situations, and I think we needed that. It freed me up to work on the outside political stuff, public education and advocacy with the state so we could become a regional testing center and a regional vaccine center. So the whole political health policy, public relations side of COVID-19 became my full-time job, and I didn't have to worry about the coordination of our response within the system because I had a person who was really better at that than I was.
Q: If you could go back in time 10 years, what would you tell yourself to start doing, or start learning about? What ended up being a bigger deal than it might have seemed at one point?
MK: If I were to go back 10 years, there were some early signals that the healthcare workforce was going to be a big deal. We had done some demographic analyses on our workforce, and we knew that, let's say, the average age of OR nurses was in the mid-50s. So we looked at that and said, "That's a problem. Not sure how to fix it, but it's a problem." But other things were more urgent. And here in the western part of the state, we have our demographic challenges. We have a somewhat older population than the rest of the state. And I think that my own learning in this space happened, I would say, about five years after that, when I was serving as the chair of the Massachusetts Hospital Association and we did a number of workforce initiatives. I'm glad that there were people in the organization that were focused on this issue, that we're connecting with our educational partners and running high school programs and working with the regional employment boards. But it was not a high priority on my radar screen until maybe five years into my tenure. And now I think we've executed on a number of things, which, if we had done it five years earlier, we would be that much more ahead of the game.
The workforce [struggles] came on really fast in the pandemic and … the "Great Resignation" hit us like a ton of bricks, and we've got 13,500 employees and our average vacancy rate might have been 500 to 700 before the pandemic, and it shot up to 2,100 in just months.
Addressing the workforce [requires a multifaceted approach], we've found. We've had to deal with issues of workplace safety, for example, implementing far more flexible schedules than we used to, really tackling DEI and combating structural racism right here at Baystate, working on wellness, developing new pipeline programs, and all kinds of wraparound services for new employees. So it's a suite of things we've had to implement, and we're starting to turn the corner. Our vacancy rate is down to 1,400, so we're about halfway back to where we were pre-pandemic.