Chris Van Gorder was named CEO of the five-hospital Scripps Health, based in San Diego, in 2000. Under his tenure, the health system has experienced a $150 million financial turnaround and plans to invest more than $3 billion in inpatient and outpatient expansion projects across the region over the next 20 years. A former police officer, Mr. Van Gorder's approach to management improved physician relations and boosted employee satisfaction, leaving Scripps as one of Fortune's "100 Best Companies to Work For" for the past four years.
Mr. Van Gorder discusses his role as a teacher, the importance of prompt decision-making, and why the title "hospital CEO" may become extinct in the years to come.
Q: You were critically injured after responding to a family dispute call as a police officer in 1978. During your nearly year-long hospital stay that followed, what observations about healthcare jumped out at you most? What drew you in?
Chris Van Gorder: I had been a patient on and off for almost a year. Professionally, I felt vulnerable. I realized I wasn't going to go back and become a policeman, and the future was unknown. Fortunately, I was lucky enough to have been cared for by good physicians and a great staff. I had worked in an emergency room before I became a policeman, so hospitals weren't foreign to me. But it's different when you're lying on a hospital bed. There was an election that year, and I figured there was no way I could vote, but people came in with ballots and allowed me to do that. They really took care of everything. I was very impressed with the care and compassion I received.
I didn't really think about [going into] to healthcare, but when I went back to the police department, they said they were going to retire me. Honestly, I thought I'd like healthcare — that's one thing that drew me into this position. The other is that I needed a job. As a former policeman, I've always been interested in public service, so I applied for a job at the same hospital that had cared for me. The CEO said to me, "You really haven't done that much in healthcare," and I asked him to give me a shot. Give me minimum wage and 90 days and I'll prove to you that you have not made a mistake. After 90 days he said, "You're right. You're good at this." I realized shortly thereafter that I had found my calling. I started as the department director of safety and security at Los Angeles' Orthopaedic Hospital, earned my credentials and eventually grew into an executive role at Anaheim Memorial Medical Center.
Q: What is the hardest part of your day?
CVG: The nice thing about my job is that my days vary a lot. I started today by mentoring one of our interns who is here from Alabama. Then I talked to the sheriff of San Diego County, then one of our physicians at Scripps Mercy Hospital. I met with the editorial team for the development of a book that is being written about the history of Scripps, and later I'm having a meeting with a hotel CEO. The commonality is that I meet with people. That's really what I do — talk with individuals and groups, communicate direction and motivate people.
The best part of my job is being a teacher and explaining what is going on in healthcare around the country. I enjoy explaining why we need to be more accountable and what is driving healthcare reform. Some people in a hospital are so busy with their work they might not understand what is happening or why. The hardest part of my job? There's nothing individually hard, really — maybe just the very long days.
Q: Do you find yourself working longer days compared to your early days in healthcare?
CVG: I think being CEO has always demanded a lot of time, but probably more today. It's a 24-hour per day job, seven days a week. I'm on my BlackBerry seven days a week. If someone emails me, they'll hear back that same day. The last thing I do every night before I go to bed is answer any unanswered emails. The first thing I do every morning is answer emails that came in overnight.
The people who work with me deserve that responsiveness. I do the same thing on vacation, along with literature searches. Every day of the year, I'll put together a list of stories and reports from various news and healthcare publications and send it to all the senior leadership in the company. That's part of teaching.
Q: How does your background as a police officer influence your leadership style?
CVG: Management is all about people. All police do is work with people. I learned important skills very early on, like how to read body language and how to make quick decisions. As a policeman, you have to make decisions in split seconds. You don't have the luxury of having a day, week or month to decide. I always told my trainees not to be afraid of making a decision. If you make a mistake, be upfront about it. Taking action without the proper knowledge or information can be dangerous but one can also overanalyze, be indecisive and still kill a company. I have to know when to act quickly and decisively and also when to back off and study the situation a little more. This is all about experience.
Q: It sounds like you've mastered tough-love management. There's an art to that — not everyone can pull it off. Any tips for hospital leaders that are trying to be more stern but supportive?
CVG: It's funny you say "tough love," because I'm not stern at all. I can be, but the bottom line is this: My people know my philosophy, [which is] "miss your targets once, and you won't be here to miss them twice." I have found that people will be very responsive if they understand you're holding them accountable and they understand what they are being held accountable to accomplish. The problem is when senior management doesn't make accountabilities clear or inconsistently enforces accountabilities. Some might call it tough love, but I've never had to terminate someone under this philosophy. Our organization has hit all its targets for 10 years in a row, and we've essentially had the same senior management team for most of that time.
I have always believed that there's a natural tendency for everybody to spend their day doing what they would like to do versus what they have to do. This is particularly true if nobody has told employees what they are accountable for. We make it very clear that there are certain targets we have to meet — financial, quality, patient satisfaction and employee satisfaction, among others. That's what I'm holding the management team and employees accountable for. People focus their time and energy on those tasks, and when that happens, you accomplish them. It's a management issue and responsibility when people miss targets.
Q: A crucial component of your turnaround plan was to improve relationships between management and physicians. What did you learn about physicians and management through the process?
CVG: My father-in-law was a physician, and I spent a lot of time talking to him when he was practicing. He told me to remember physicians believe philosophically they own the hospital. He said, "CEOs will come and go, but physicians will probably spend most of [their] careers at that one hospital. If you treat us with an ownership kind of respect, you will earn back the respect from the physicians." I really think this concept of an adversarial relationship between hospital administrators and physicians is completely false. It's built on this premise that hospital administrators only care about money and not patient care, which is dead wrong, as is the assumption that physicians only care about patient care and not financial issues.
The reason physicians and CEOs can disagree on an issue is because we were trained differently, and since we come from different training we can have different perspectives on issues. I have always believed that if we can find a way to fill the gap of information — physicians giving us important clinical perspectives and administrators sharing the necessary business perspectives — we would agree 99 percent of the time. And I have found that to be true. We really embraced the concept of physician co-management 12 years ago when we established our Physician Leadership Cabinet. To date we have accepted 100 percent of the recommendations and decisions over the 12 years. Three years ago we established the Physician Business Leader Cabinet with our affiliated medical groups and IPAs, and last week we incorporated it into ScrippsCare — our operating board for our ACO.
Q: What is going on at Scripps that excites you most right now?
CVG: There are a lot of things going on here. We just started the construction of the Scripps Prebys Cardiovascular Institute, which will be one of the top cardiovascular centers on the West Coast. It is named for San Diego philanthropist Conrad Prebys, who donated $45 million to Scripps to fund its construction. It will bring together a number of programs including our wireless technology program, graduate medical education, genomics, clinical research and integrative medicine. It will also bring together the cardiovascular programs from across Scripps Health and Kaiser Permanente in San Diego into one clinical care line.
We're doing some great research in genomics and translational science, and our work around wireless technology is really exciting. We are working with GE to research the VScan, which is a pocket ultrasound that a physician can hold for echocardiograms. Our Proton Therapy Center is underway, which will offer advanced, non-invasive proton therapy to San Diego for the first time. There are so many exciting things. I'm more bullish about healthcare right now than ever before.
Q: Let's say a man or woman is starting their first day as a hospital CEO tomorrow. If you called them and offered one piece of advice, what would it be?
CVG: You're not going to be a hospital CEO. You're going to be a healthcare CEO. You're going to integrate ambulatory care, ambulatory surgery centers, imaging services, ancillary services and many other parts of healthcare. We're trying to keep people well and not just treat them when they're sick — that's part of this move away from being a sick business to a wellness business. We're spending more time and money keeping people well, so that's a brand new world for tomorrow's healthcare leaders.
Learn more about Scripps Health.
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Mr. Van Gorder discusses his role as a teacher, the importance of prompt decision-making, and why the title "hospital CEO" may become extinct in the years to come.
Q: You were critically injured after responding to a family dispute call as a police officer in 1978. During your nearly year-long hospital stay that followed, what observations about healthcare jumped out at you most? What drew you in?
Chris Van Gorder: I had been a patient on and off for almost a year. Professionally, I felt vulnerable. I realized I wasn't going to go back and become a policeman, and the future was unknown. Fortunately, I was lucky enough to have been cared for by good physicians and a great staff. I had worked in an emergency room before I became a policeman, so hospitals weren't foreign to me. But it's different when you're lying on a hospital bed. There was an election that year, and I figured there was no way I could vote, but people came in with ballots and allowed me to do that. They really took care of everything. I was very impressed with the care and compassion I received.
I didn't really think about [going into] to healthcare, but when I went back to the police department, they said they were going to retire me. Honestly, I thought I'd like healthcare — that's one thing that drew me into this position. The other is that I needed a job. As a former policeman, I've always been interested in public service, so I applied for a job at the same hospital that had cared for me. The CEO said to me, "You really haven't done that much in healthcare," and I asked him to give me a shot. Give me minimum wage and 90 days and I'll prove to you that you have not made a mistake. After 90 days he said, "You're right. You're good at this." I realized shortly thereafter that I had found my calling. I started as the department director of safety and security at Los Angeles' Orthopaedic Hospital, earned my credentials and eventually grew into an executive role at Anaheim Memorial Medical Center.
Q: What is the hardest part of your day?
CVG: The nice thing about my job is that my days vary a lot. I started today by mentoring one of our interns who is here from Alabama. Then I talked to the sheriff of San Diego County, then one of our physicians at Scripps Mercy Hospital. I met with the editorial team for the development of a book that is being written about the history of Scripps, and later I'm having a meeting with a hotel CEO. The commonality is that I meet with people. That's really what I do — talk with individuals and groups, communicate direction and motivate people.
The best part of my job is being a teacher and explaining what is going on in healthcare around the country. I enjoy explaining why we need to be more accountable and what is driving healthcare reform. Some people in a hospital are so busy with their work they might not understand what is happening or why. The hardest part of my job? There's nothing individually hard, really — maybe just the very long days.
Q: Do you find yourself working longer days compared to your early days in healthcare?
CVG: I think being CEO has always demanded a lot of time, but probably more today. It's a 24-hour per day job, seven days a week. I'm on my BlackBerry seven days a week. If someone emails me, they'll hear back that same day. The last thing I do every night before I go to bed is answer any unanswered emails. The first thing I do every morning is answer emails that came in overnight.
The people who work with me deserve that responsiveness. I do the same thing on vacation, along with literature searches. Every day of the year, I'll put together a list of stories and reports from various news and healthcare publications and send it to all the senior leadership in the company. That's part of teaching.
Q: How does your background as a police officer influence your leadership style?
CVG: Management is all about people. All police do is work with people. I learned important skills very early on, like how to read body language and how to make quick decisions. As a policeman, you have to make decisions in split seconds. You don't have the luxury of having a day, week or month to decide. I always told my trainees not to be afraid of making a decision. If you make a mistake, be upfront about it. Taking action without the proper knowledge or information can be dangerous but one can also overanalyze, be indecisive and still kill a company. I have to know when to act quickly and decisively and also when to back off and study the situation a little more. This is all about experience.
Q: It sounds like you've mastered tough-love management. There's an art to that — not everyone can pull it off. Any tips for hospital leaders that are trying to be more stern but supportive?
CVG: It's funny you say "tough love," because I'm not stern at all. I can be, but the bottom line is this: My people know my philosophy, [which is] "miss your targets once, and you won't be here to miss them twice." I have found that people will be very responsive if they understand you're holding them accountable and they understand what they are being held accountable to accomplish. The problem is when senior management doesn't make accountabilities clear or inconsistently enforces accountabilities. Some might call it tough love, but I've never had to terminate someone under this philosophy. Our organization has hit all its targets for 10 years in a row, and we've essentially had the same senior management team for most of that time.
I have always believed that there's a natural tendency for everybody to spend their day doing what they would like to do versus what they have to do. This is particularly true if nobody has told employees what they are accountable for. We make it very clear that there are certain targets we have to meet — financial, quality, patient satisfaction and employee satisfaction, among others. That's what I'm holding the management team and employees accountable for. People focus their time and energy on those tasks, and when that happens, you accomplish them. It's a management issue and responsibility when people miss targets.
Q: A crucial component of your turnaround plan was to improve relationships between management and physicians. What did you learn about physicians and management through the process?
CVG: My father-in-law was a physician, and I spent a lot of time talking to him when he was practicing. He told me to remember physicians believe philosophically they own the hospital. He said, "CEOs will come and go, but physicians will probably spend most of [their] careers at that one hospital. If you treat us with an ownership kind of respect, you will earn back the respect from the physicians." I really think this concept of an adversarial relationship between hospital administrators and physicians is completely false. It's built on this premise that hospital administrators only care about money and not patient care, which is dead wrong, as is the assumption that physicians only care about patient care and not financial issues.
The reason physicians and CEOs can disagree on an issue is because we were trained differently, and since we come from different training we can have different perspectives on issues. I have always believed that if we can find a way to fill the gap of information — physicians giving us important clinical perspectives and administrators sharing the necessary business perspectives — we would agree 99 percent of the time. And I have found that to be true. We really embraced the concept of physician co-management 12 years ago when we established our Physician Leadership Cabinet. To date we have accepted 100 percent of the recommendations and decisions over the 12 years. Three years ago we established the Physician Business Leader Cabinet with our affiliated medical groups and IPAs, and last week we incorporated it into ScrippsCare — our operating board for our ACO.
Q: What is going on at Scripps that excites you most right now?
CVG: There are a lot of things going on here. We just started the construction of the Scripps Prebys Cardiovascular Institute, which will be one of the top cardiovascular centers on the West Coast. It is named for San Diego philanthropist Conrad Prebys, who donated $45 million to Scripps to fund its construction. It will bring together a number of programs including our wireless technology program, graduate medical education, genomics, clinical research and integrative medicine. It will also bring together the cardiovascular programs from across Scripps Health and Kaiser Permanente in San Diego into one clinical care line.
We're doing some great research in genomics and translational science, and our work around wireless technology is really exciting. We are working with GE to research the VScan, which is a pocket ultrasound that a physician can hold for echocardiograms. Our Proton Therapy Center is underway, which will offer advanced, non-invasive proton therapy to San Diego for the first time. There are so many exciting things. I'm more bullish about healthcare right now than ever before.
Q: Let's say a man or woman is starting their first day as a hospital CEO tomorrow. If you called them and offered one piece of advice, what would it be?
CVG: You're not going to be a hospital CEO. You're going to be a healthcare CEO. You're going to integrate ambulatory care, ambulatory surgery centers, imaging services, ancillary services and many other parts of healthcare. We're trying to keep people well and not just treat them when they're sick — that's part of this move away from being a sick business to a wellness business. We're spending more time and money keeping people well, so that's a brand new world for tomorrow's healthcare leaders.
Learn more about Scripps Health.
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