Akram Boutros, MD, just started his term as president and CEO of The MetroHealth System June 1, but he has already jumped in head first to his new duties at the helm of the Cleveland-based safety-net system.
Dr. Boutros brought more than 20 years of leadership experience with him to Ohio, where he is helping the system refocus its mission in light of healthcare changes and tackling a state that is not expanding Medicaid coverage.
Here, Dr. Boutros shares the challenges of joining a system as a new CEO, how to retool a system's mission in six weeks and what he's looking closest at for the rest of 2013.
Question: As a brand-new CEO, what attracted you to the job at MetroHealth?
Dr. Akram Boutros: I would say three things: the mission of the organization, the people and the culture.
MetroHealth, for 175 years, has been focused on taking care of the most vulnerable in the city. Not only need those who can’t afford care, but those patients who are in dire of care. If you look at the physicians and nurses here, they are some of the nation's finest. Their work ethic and skills are incredible, and the staff is really used to treating the worst health concerns you could imagine. MetroHealth is a national leader in patient-centered medical homes as well as meaningful use and electronic medical records. We have been using Epic incredibly well throughout the organization for more than 20 years now.
Q: How would others describe your leadership style?
AB: Many people have described me as engaging. I think that’s a pretty good summary of my leadership style. I believe it's really important to make sure every stakeholder at every level of the organization is highly engaged with our goals and future vision. People in my position have an ability to impact the organization, but if you look at what we really do, we play a support role to those who deliver care. So we need to be able to make sure these front-line people are empowered to do the right thing. We often are focused on policies and procedures and processes — and that's much more about doing things right and is very important in healthcare as we are highly regulated — but we want to be able to have shared decision making for folks to be able to do the right thing.
I make a strong effort to be transparent. My natural state is that I believe in the goodness of those who are in healthcare. I believe in people and don't micromanage — I want them to do their job, and, at MetroHealth, they are all really good at it.
Q: What are some of the challenges associated with becoming a new CEO at a hospital, and how are you working to overcome them?
AB: The first challenge is that the executive team has a cadence, a rhythm about them. That's the biggest change that you make, the rhythm of the team. How do you figure out a comfortable way to move them from one way of doing business to a different way of doing business? I'm very fortunate to have an extraordinary executive council, the people who report and work with me, but their daily routine is changed. For instance, I don't use slide decks for making decisions, and I ask to be informed of only things that are particularly important and have critical impact on the organization. Also, I asked them to come to me with solutions rather than problems and to figure out what support they need from me. In this way, I am getting the very best from them and they are accountable for the results, since it was their solutions they implemented.
The other challenge, which happens not only at MetroHealth but at almost any organization I've worked at, is how to have everyone in the organization rowing in the same direction — alignment. Often, we have different interpretations of what the mission and vision of the organization are.
Q: I understand one of your first initiatives as CEO has been creating a new mission and vision. What led you to the decision to create new mission and vision statements and core values? How is that process going?
AB: I'm not creating a new one; we are renewing it and making it more relevant to today's healthcare environment. The current mission is old, wordy and doesn't resonate as much with all our constituents. I see my role as a facilitator of the mission, as I said to the board and the entire team. It's their role to figure out the mission of the organization. My only response is if the mission does not align with my views, I would need to find an appropriate way to separate from the organization. I don't get to tell the organization what the mission is, but I've been facilitating the work.
As we move to the vision, I get to influence the process. That's what they hired me for. The values are nonnegotiable. The people here need to define them so that every stakeholder can count on us acting that way all the time. The mission of MetroHealth has always been strong, it just needed some updating. Similarly, the values have been strong but not specifically expressed as clearly as they need to be. So it's important that we make these words really relevant to all stakeholders but mostly our internal team. It will be a strong beacon for our future and help them with decision making on day-to-day basis.
For example, if the patient is the most important component of our mission, then when we're making decisions about whether to make things easier for our patients or easier for ourselves, it's much easier to make our call to make things easier for our patient.
On the team, all together we have five members of the board, five members of the medical staff and five members of the administration. Additionally, the head of the foundation and even the president of the union are involved in creating the mission, vision, values and pillars of the organization. I promised a six-week turnaround for the project, and I am proud to report that our work was completed on time.
We've been communicating with all employees every week, filling them in on any suggestions or alterations made by the team. We hired a graphic recorder, and she is graphically depicting the discussion. She has also been charged with taking the final product and creating a poster for it so we can easily share it with everyone. We will also hold town hall meetings with constituents, including our government leaders from the county, city and state, the newspapers and the leaders of the other healthcare organizations in the area so they can understand what our position is to better coordinate our efforts.
Q: Ohio decided not to expand Medicaid — as a safety-net hospital system, how do you feel about the decision? How will it impact MetroHealth going forward?
AB: I have faith in our elected representatives that they will work their way through it. MetroHealth has been proactive with Medicaid and actually implemented a Medicaid waiver program. The program, MetroHealth Care Plus, allows 30,000 people who were not eligible for Medicaid to receive assistance. It goes up to 135 percent of the poverty line. We've already enrolled 22,000 people, and by the end of summer, we'll be up to the 30,000 mark.
Q: What issue will be top-of-mind for you for the rest of 2013?
AB: We are no longer working in a vacuum. I don't believe that patients need to come to hospitals to receive care. So what we're trying to do is transform our organization from reliance on bricks and mortar to be more aligned and patient-centered in our delivery model. So, I'd say, making that transition, and then getting the entire organization driving in same direction is probably the biggest challenge. It requires over-communication. You've got to communicate very transparently as you're going through process. Seek input and wisdom from those that are actually doing the work and be able to correct mid-course when you need to — there are a lot of mid-course corrections. We must constantly evolve to the market.
We are experimenting with models like having pediatricians provide care in schools. Instead of a mom taking her kid out of school to go see a pediatrician, why not have a mom come to the child's school for the appointment? It reduces anxiety. Most children are not afraid to go to the nurse's office in school. That's just one facet. We're going to be involving first-year medical students, training them to be emergency medical technicians so they can provide care and become an important part of care transition from the very first day of their enrollment.
We will be very responsive to our stakeholders and our patients, and we're going to need to become a stronger unified organization. We have an incredibly bright future if we focus on the outcomes of better care, better health and lower costs. We probably hold the preeminent position as the lowest-cost, highest-quality provider in the area, and we are working to get recognized for it. We are applying to be a 2014 Medicare Shared Savings Program accountable care organization.