Chief executive officers sit at the helm of the healthcare industry's often tumultuous ebbs and flows — from the adoption of new technologies, to increasing conversations about diversity and equity, to shifting workplace norms, to the COVID-19 pandemic that created chaos in health systems. To keep pace, CEOs must stay nimble.
Becker's spoke with six health system CEOs about the evolution of their role over the past several years. Many said that as their role changed, they changed with it.
Note: Some responses have been lightly edited for brevity.
Q: Think back to when you first assumed the role of CEO. To the best of your memory, What were your aspirations? What were you most concerned about?
Nancy Agee. CEO of Carilion Clinic (Roanoke, Va.) since 2011: I was named CEO more than a decade ago, in 2011, in the early days of our transition from a collection of hospitals to an integrated care delivery system. We were among the first in the nation with an enterprisewide electronic health record and a pilot site for accountable care. We had just opened a medical school. So much was new and different. Helping our patients and the community understand and accept the change was, admittedly, hard, and we endured a period of public backlash. My biggest concerns then were making sure our transformation was successful both in terms of financial viability and elevating care for our region. Oh, and did I mention it was in the middle of a recession?
Marcy Doderer. President and CEO of Arkansas Children's Hospital (Little Rock) since 2013: Historically, Arkansas has not been a very healthy or safe place to be a child. Growing up, my father was a pediatric cardiologist at Arkansas Children's, so I was personally aware of how the hospital served the children of the state. I recognized that in a state with the challenges that Arkansas has, a singular hospital was a limiting factor in having a broad impact on child health. My aspiration was to create a health system with more than one hospital, geographically distributed clinics to increase access and partners throughout the state to reach more kids. I was honored to join a team that was committed to advancing child health initiatives across the state to strengthen our continuum of care, improve outcomes and serve more children.
Moving beyond the expansion of services, I also focused purposefully on our quality journey. We implement high-reliability leadership methods, participated deeply in the national Solutions for Patient Safety network, enjoyed ever-increasing support from the Arkansas Children’s governance boards, created a robust quality and safety division and reinforced an intense focus on safety that is reflected today in our culture.
Michael Dowling. President and CEO of Northwell Health (New Hyde Park, N.Y) since 2002: Before I became CEO, I was in the COO role, so I was very familiar with the inner workings of the organization. At the time we were deep into the process of creating an integrated health system — the first of its kind in New York. My aspiration was to continue the work and build an organization that was distinctive for its culture, its operational structure and its vision. The transition to CEO was therefore relatively easy — though I had to advance the process of developing a leadership team with the values and the behavior characteristics consistent with the desired mission of the organization. This required multiple changes in personnel.
Richard Liekweg. President and CEO of BJC HealthCare (St. Louis) since 2018, former CEO of UC San Diego Medical Center: I wanted to make a positive impact. I stepped into a situation where the hospital had just joined a larger system and was losing money on operations. Our aspirations were fairly short term: to get back to breakeven or better in order to continue serving the community while managing the challenges that come with integrating and merging two different cultures, one from our community-based organizations and one from our large academic medical center.
It was important we avoid losing the hearts and minds of the leadership team, medical staff, caregivers and community as we charted a new course to help ensure long-term viability and relevance.
Chris Van Gorder. President and CEO of Scripps Health (San Diego) since 2000, former CEO of Long Beach (Calif.) Memorial Medical Center and Anaheim (Calif.) Memorial Medical Center: To be honest, at that point in my life, my aspiration was to be a COO, not a CEO. I loved hospital/healthcare operations and wanted to be responsible for an entire hospital from an operational perspective. But shortly after I became a COO, I was asked to come back to the hospital where I had been a vice president and gained all of my experience to be the CEO — actually to replace my former boss and mentor. I turned that job down initially but then accepted it a few months later after speaking to my former boss/mentor and gaining his support.
Now as a CEO my aspirations were simple: to do what was necessary to turn the hospital around, as it was in default of its bond insurance covenants. Fortunately, I knew the hospital well and the staff and physicians trusted me, and we turned the economics around in about six months. But I realized that a standalone hospital was not going to survive, so I started a process with the board to merge the hospital with a larger system, which was accomplished. I suppose in retrospect that I was concerned about many things, but mostly wondering if I had what it would take to help the organization to succeed. But we were successful at Anaheim Memorial Hospital, my first CEO position, and I was ultimately transferred to the system flagship hospital [Long Beach Memorial/Miller Children’s Hospital] as its CEO.
Kate Walsh. President and CEO of Boston Medical Center since 2010: When I was named president and CEO of Boston Medical Center in 2010, what resonated with me was how essential this hospital was to our patients and community. As the largest safety-net hospital in New England and as an academic medical center, we've developed expertise and a deep track record in caring for a Medicaid population, not only clinically, but also in wraparound support programs like the first hospital-based food pantry in the United States, as well as housing and job training assistance. My goal then as now was to make sure that our hospital lives up to our mission of "exceptional care without exception," that we are on sound financial footing and that all of our staff can find a place where their professional lives can flourish.
Q: What do you aspire to now? How have your points of concern shifted?
Ms. Agee: No one could have imagined a global health pandemic. Our experience over the past three years has been historic. We were privileged to serve our community at a time they needed us most, caring for the seriously ill and delivering life-saving vaccines. The challenges facing us now, while different, are historic as well. As a field, we're struggling to recruit and retain employees — nurses especially — while at the same time digging out of the deep financial hole that has forced hospitals across the country to close. The pandemic illustrated the vital role of hospitals and healthcare systems in our national infrastructure, yet also our fragility. My focus has become financial sustainability, building the workforce for tomorrow and rethinking entirely how we deliver care to a growing number of patients at price they can afford.
Ms. Doderer: I’m very proud of the work our team has accomplished over the past nine years to improve child health in Arkansas. We've established the only pediatric health system in the state with two hospitals, a dedicated pediatric research institute, a philanthropic foundation, regional clinics and alliances, telemedicine and statewide outreach programs. But the challenges we continue to face are going to require broader community partnerships and more strategic focus on health equity and other nonmedical contributing factors. Our next challenge as a system will be in forging those partnerships and amplifying our efforts in sometimes nontraditional ways to better serve children.
Additionally, pediatric healthcare is faced with significant headwinds related to the growing mental health crisis for kids, workforce shortages of providers and other skilled professionals, and understanding the impact the global pandemic had on children and their families. While we intensify efforts outside the walls of our facilities, focused attention will still be required to ensure operational excellence inside the hospital.
Mr. Dowling: Now, post-COVID and like all organizations, we had to pivot to the realities of a new and different environment. We have to respond to increased cost pressures, the changing nature of work, the dramatic advances in the utilization of technology, the advances in science, new changes in the nature of care delivery, new consumer expectations and the promotion of prevention and wellness.
These are exciting and for the most part positive developments. It demands new thinking. It is a rightful test of leadership. We must embrace it. If we respond correctly, we will create a better future. As the largest health system and employer in New York with all the services from birth to end of life, an expansive academic and research portfolio, we are well positioned to innovate and succeed in this environment. Covid was in many ways an experiment in creativity (we were at the epicenter) — we learned so much that can benefit us going forward. We embrace change.
Mr. Liekweg: Today, I’m focused on transforming the care model so health systems, especially integrated academic health systems, remain viable and relevant in order to continue work to eliminate health disparities and improve the overall health of our communities. The systems in our society have created wide gaps in health outcomes, but BJC believes they are preventable. We recognize that a community’s well-being is tied to much more than healthcare alone. We will use our influence to address the social determinants of health — education, financial security, employment — to make the best long term impact so everyone has equal opportunity to achieve a healthy, productive life. The years have taught me that impact needs to be inclusive and equitable. And what we have the privilege to do, regardless of how we have innovated and transformed, is all about the people we serve.
Mr. Van Gorder: I've now spent over 30 years as a CEO and the last 23 of those years as the CEO of Scripps Health. Now I want to leave the organization in a few years better than I found it and better than it is now. We made it through COVID and now face enormous challenges that are impacting all hospitals in the nation — and maybe even more in California — with all of our unfunded mandates, like the Seismic Safety Act.
My concerns range from improving operations, enhancing our quality, retaining a tired-but-dedicated workforce and physician colleagues, healthcare equity, sustainability and financial/balance sheet strength. I'm also concerned about hospitals' ability to shift fast enough to deal with new competition from ambulatory startups and large technology companies that want to get a piece of the healthcare dollar.
The other concern now is succession planning. One of the key traits of a leader is to be a teacher/mentor and to prepare others to step up. We have several leadership academies at Scripps. I've been a preceptor for many administrative residents and fellows, so our bench is deep. Of course when I leave in the future, the board will be responsible for my succession with my help.
Ms. Walsh: Many of the same things, but with a much sharper focus. The COVID pandemic and the reckoning on race that was long overdue in our country changed the way all of us think about healthcare and racial health equity. COVID exacerbated and really drove home the health disparities that have existed in communities of color for generations. We are taking a deep look at ourselves, to think about how our hospital can better serve all of our patients. In the fall of 2021, we launched our Health Equity Accelerator to focus resources in an intentional way on the most entrenched racial health disparities we can find, using data, clinical study, and most importantly, by listening to our patients about their own experiences. We fully expect it will result in new care models that will improve our patients' lives and further our understanding of what is driving disparities and what more needs to be done. This is exciting and transformative work.
Q: How has your leadership style changed since you first took office? What factors, internal or external, contributed to your evolution?
Ms. Agee: I ascribe to the style of leadership known as servant leadership that focuses on supporting and developing others. That hasn't changed. And I'm still a bit of a "unicorn" as a female CEO, which I find odd in a field dominated by women. I've made a point to use my voice to empower other women to lead. We need more leaders — men and women — now more than ever to solve today's incredibly complex problems.
So I don't believe my style has changed so much as the issues that we face. I use the same skills today, although the challenges we face now are largely externally driven and out of our control — COVID-19, economic and workforce pressures.
Ms. Doderer: Like any leader assuming a new role, I had to quickly put in place a leadership team made up of both existing and new senior leaders. Now I'm nearly a decade in, and I couldn't imagine where we would be without the tremendous leadership team that drives the work of Arkansas Children's each and every day.
When I first got to Arkansas Children's, I was probably more hands on and internally focused on really learning what makes Arkansas Children's "tick." I think my most important role now is identifying, supporting, developing and inspiring my team of senior executives as we work together to advance child health. This includes continually evolving our approach to a leadership philosophy grounded in promoting diversity, equity and inclusion in the workplace to ensure all team members can be their authentic selves as they serve our patients and families.
I am also more externally facing and involved in state and national child health-centric activities than in the early years of my tenure.
Mr. Dowling: I don't believe that my leadership style has dramatically changed since I became CEO — the same principles, traits and values that I believed in at the beginning still remain. How I work has evolved, however. I am less involved in day-to-day operations — I delegate more, which is a necessary result of our growing size ($16.5 billion total revenue with 81,000 employees) and our geographic reach. It is also the result of being able, over the years, to build a very collaborative and skilled leadership team. With such, it is easier to stand back and take what I call the "balcony" view as well as spend more time on long-term strategy. I still, however, walk the floors, engage continuously with staff and participate directly in the orientation of all new employees.
Mr. Liekweg: I am more curious. I listen for the most respectful interpretation — of somebody's words, actions or comments. I lead by the platinum rule — to treat others as they would want to be treated. It’s a slight twist on the golden rule — to do unto others as you would have them do unto you, which assumes everyone wants to be treated the same way.
And I focus more time on vision, culture, people-development and strategy. I was allowed to make mistakes and have learned from those mistakes. And I have worked with an executive coach for 20 years; I know I have room to grow and adapt every day.
Mr. Van Gorder: Time changes all things. I suppose I was a bit of a micromanager when I first started out — in my mind I was trying to help, but in my subordinates' minds, I was micromanaging. Over time I was promoted and did not have as much time to "mentor." My subordinates appeared much happier. So over time I've learned to hire the right people, guide as necessary and be available to answer questions and let them do their thing, just as I wanted to learn how to do my thing a few decades ago. I'm clearly a situational manager/leader today — diving into the details or taking control when necessary or in an emergency or disaster, then backing off with a more look, watch, listen and guide style. I also believe that I'm a better teacher and mentor today than when I first started in leadership.
Ms. Walsh: No one does this job alone or has all the solutions. Amazing things happen here every day, thanks to the hard work and dedication of my 9,000 colleagues in every part of the hospital. And they have great ideas. For instance, during the early days of COVID, when families couldn't come to the hospital, our pediatric department converted an ambulance into a mobile clinic to go into neighborhoods to make sure our patients were able to get their routine immunizations. They realized families were struggling, so in addition to medicine, they added food, diapers and books for families who were "locked down" and unable to go outside. Or I could point to our rooftop farm (which I initially opposed), but our staff was undeterred and now we have fresh food for our inpatients and therapeutic food pantry. Sometimes I think I'm at my best as a leader when I actively get out of the way!
Q: Healthcare C-suites tend to ebb and flow, with a variety of new positions gaining traction in recent years. How has the composition of your leadership team — and thus, your role as chief executive — changed over time? How do you see it changing in the future?
Ms. Agee: We've had a chief medical information officer for several years and within the past year named a chief diversity, equity and inclusion officer. These additions are significant and reflect the growing relevance of these perspectives in organizational decision making. As the financial pressures in healthcare mount, I see a growing role for philanthropy at the senior executive level.
Ms. Doderer: To support the growth of the Arkansas Children's statewide system, we've evolved our executive leadership team, elevating and expanding system-level positions like chief information officer, chief strategy officer and chief people officer.
I have also created more physician executive roles. The most senior physician role is the chief clinical and academic officer, who works closely with our university partner and affiliated providers to advance innovative care and further our research efforts. And, given the mental health crisis, we are thrilled to add a chief of behavioral health position to the senior team. We continually assess internal talent, external trends and our evolving strategy to create or modify senior leadership roles as we grow, though I am very mindful of becoming overly top heavy.
Mr. Dowling: Change is constant. As it should be. My leadership team is much different today than it was a decade ago. They are almost all new, more diverse and more optimistic, total team players and very comfortable with being uncomfortable. Almost all progressed from inside the organization; we have comprehensive leadership development programs.
There are new roles, however, in disaster management, customer service, digital health and innovation. The team principle is paramount especially in a clinical, research and educational organization — silos are toxic and dysfunctional. I watch continuously for signs of unproductive and bad behavior, which must be quickly responded to. Success, ongoing success, is built on having a strong integrated, optimistic and collaborative culture. Our goal is more forward and to not be prisoners of tradition or history — other than learning from them.
Mr. Liekweg: Our team is more diverse; i.e. age, gender, race, clinical, non-clinical backgrounds. It’s so important that our leaders — and our entire team — reflect the community we serve. We have also recruited some leadership from outside health care to accelerate innovation, digital transformation, consumer experience and community health improvement, while promoting many from within to new roles.
Mr. Van Gorder: I'm very excited about the changes. When I first started in the C-suite, physicians were not part of the senior team. In addition, the historical adversarial relationship between the medical staff and administration was almost part of the expected culture. I never liked that and made a point of working with the physicians closely. When I became CEO at Scripps after votes of no confidence in my predecessor, I created a committee at Scripps we call the Physician Leadership Cabinet. It consists of the elected chiefs of staff and vice chiefs of staff and each of my campus chief executives. My hypothesis was that we would almost always agree if we were transparent with each other and if we could fill the gap of information.
Fast forward 23 years and we have found that to be true. In fact we have accepted 100 percent of the recommendations from the PLC over that course of time. The committee is chaired by our chief medical officer for the hospitals and me. Over the course of time we are bringing more physicians into senior leadership positions — we have two chief medical officers (acute and ambulatory) in the C-suite and now physician operations executives at each hospital as a dyad partner with the chief operating executive. The medical directors report to the physician operations executives who report to the chief medical officer — and all work closely with the elected members of the organized medical staff. Our chief medical officers are also our chief equity officers, and our sustainability program reports up as well.
I see more physicians and clinicians in the C-suite in the future along with leaders in diversity, equity and sustainability if those functions cannot be absorbed by existing members of the team. Much of that will be determined by the size of the organization.
Ms. Walsh: We learned a great deal over the past decade about the intersection of so many co-occurring conditions, including housing instability, mental health and addiction, and the need to coordinate treatment strategies. So now, Boston Medical Center Health System is comprised of not just an academic medical center, but also a Medicaid managed-care plan, WellSense Health Plan and a network of 12 community health centers in the neighborhoods we serve, so we can look at this from all angles. Recently we established an inpatient behavioral health and clinical stabilization services center designed to address co-occurring substance use and behavioral health disorders.
Our health system leadership team has grown to include roles that support a data-driven and value-based approach through an ACO model to maximize our resources while improving the health of the communities we serve.