Between driving growth, meeting clinical objectives and navigating complex payer dynamics, there don’t seem to be enough hours in the day for healthcare executives.
Leaders succeed despite these challenges, each with their own habits, hacks, styles and methods — and Andrew Agwunobi, MD, CEO and executive vice president for health affairs for UConn Health, is no exception.
Dr. Agwunobi has led the health system since 2015, overseeing its main campus in Farmington and community locations across the state, as well as the UConn School of Medicine and UConn School of Dental Medicine.
He has prior experience as managing director and a co-leader of Berkeley Research Group’s health system performance improvement consulting practice, and as CEO of Providence Health Care, a five-hospital region in Spokane, Wash., part of Renton, Wash.-based Providence Health & Services.
He was also secretary of the Florida Agency for Health Care Administration, responsible for the state’s $16 billion healthcare administration budget.
Dr. Agwunobi has authored two healthcare management books.
Here, Dr. Agwunobi speaks with Becker’s Hospital Review for our “Living like a leader” series, which examines the daily routines of influential decision-makers to offer readers an idea of how they manage their energy, teams and time.
Editor’s note: Responses have been lightly edited for length and clarity.
Question: What is the first thing you do when you wake up?
Dr. Andrew Agwunobi: On most weekdays, I wake up at 5:30 to 6 a.m., and the first thing I try to do every day is to write, even if only for 45 minutes. It’s amazing how much you can accomplish with a routine. During the last three years I published two healthcare management books, namely An Insider’s Guide to Physician Engagement and An Insider’s Guide to Working with Healthcare Consultants. I find writing to be therapeutic, and it’s a great way to calm myself for a busy day while also helping to mentor other leaders.
Q: What’s the first thing you do when you arrive at work?
AA: The first thing I do is to check my calendar to ensure that I am prepared for each meeting. Many years ago, a colleague introduced me to the saying, “prior preparation prevents poor performance,” and I have adhered to that wise advice ever since. The second is, whenever possible, to attend the hospital’s 8:30 a.m., 30-minute, daily “safety huddle” where unit and department directors report in rapid-fire fashion on quality, safety and important operational challenges. Some might consider this as being too “in the weeds” for a CEO, but I find that it grounds me in what my real job is. It also demonstrates to the managers that I know and care about their work.
Q: Is there anything that makes your office setup unique?
AA: I wouldn’t say unique, but I like an understated office. Mine has old scuffed chairs around a chipped table — I do need to get that repaired. My goal is to avoid intimidating those who visit me but also to demonstrate that applying resources to patient care, teaching and research are my primary focus. This all supports my management philosophy of servant leadership.
Q: What does your routine look like in the morning versus afternoon?
AA: I don’t divide my routine based on morning versus afternoon. Rather, I base it on the needs of the organization. However, a good day for me is one where I have several meetings with physicians either individually or in groups. I have found that directly understanding and supporting the needs of front-line physicians is one of the key drivers of success in any hospital or health system.
Q: How often do you round or meet with clinical staff?
AA: I try to walk each floor of our hospital, including the emergency department, two to three times a week. My mantra is that if staff are surprised or flattered to see you on their unit, you are not rounding enough. In UConn John Dempsey Hospital, staff barely look up from their duties, unless they have a concern they want to share, when I arrive, so I think I am meeting my goal. I haven’t done so well in getting out frequently to our satellite locations, but I am working on that. When I round, I do so unaccompanied and without any prior scheduling or ceremony. This helps with my ability to sustain the rounding; for example, I can squeeze rounds in when someone cancels a meeting at short notice. It also helps the staff to view me as part of the team rather than a visiting dignitary.
Q: How much time do you spend with your direct reports?
AA: A lot. I have senior team meetings every two weeks with all my direct reports; I also have routine one-on-one meetings with each of them, usually every two weeks, no less frequently than monthly, and finally I encourage my reports to walk in, call my cellphone, text or email me anytime they need to do so. My goal is to never allow a lack of access to hinder their effectiveness or morale.
Q: How do you think your routine differs from that of other healthcare executives?
AA: I am not sure if it differs, but my routine is heavily focused on understanding and serving the needs of everyone in the organization, no matter the level, so that we can together accomplish our mission. For example, I spend some time each day answering an inbox I instituted called “Dear Dr. Andy” that I set up to communicate directly with front-line employees, whether janitors, security guards, kitchen staff, nurses, surgeons, researchers or anyone else. Any one of our thousands of employees can write to me anonymously or by name on any topic — and they do. I respond personally usually within a few hours, sometimes immediately, but I also simultaneously copy the relevant direct reports to give more detailed responses.
This also ensures my direct reports are included in the process real time. Every week we post one of the questions and answers in our employee e-newsletter. It is one of the most-read sections. I also spend an hour or two several times a week in what we call “physician empowerment” meetings. In these meetings I and key executives meet with physician leaders to ensure that administrative decision-making related to their specialty is a shared effort, that is, a co-leadership model with physicians.
Q: What is the hardest part of your day?
AA: The hardest part of my day occurs when we lose, or are facing the possible loss of, good talent. For example, when nurses, physicians or talented executives leave or are considering leaving for positions in other health systems. It is particularly hard when this occurs for preventable reasons such as poor management or not adequately responding to their needs. The loss of talent is one of the most damaging occurrences that can happen to an organization. It goes without saying that I spend a lot of my time trying to anticipate employees’ needs, developing our leaders and working to ensure we retain our staff. It is one of the reasons I am so passionate about driving employee and physician engagement, as well as combating physician burnout.
Q: What would you consider the most rewarding?
AA: I love to see innovative solutions go from idea to reality. Particularly when such solutions solve problems that everyone thinks are unsolvable. For example, when in a previous organization we merged a long-struggling public hospital with a private system in such a manner that it improved the quality and finances of the hospital, while at the same time improving access to care for vulnerable populations. I like to call such creative, win-win solutions, “elegant” solutions. They are a lot of fun.
Q: What is the last thing you do before you leave your office?
AA: I usually make sure I have answered all my emails for the day, even if just a one-word response such as “Thanks!” It’s not always possible, and by the time I get home I have at least 10 more, but as I progressed in my career, I always respected those I reported to who responded quickly. I try to set the same example myself. It’s based on the understanding that although I may have hundreds of emails a day, each sender doesn’t know that. To them their email is paramount, and they usually desire a timely response.
After answering my remaining emails, I then text my wife and two teenage daughters to let them know when I will be home.
Q: Do you work at home?
AA: I try not to but I often do. Although I strongly believe leaders shouldn’t expect or require their direct reports to work during personal and family time, CEOs shouldn’t necessarily expect the same work-life balance for themselves. Being a leader of an organization that operates 365 days a year, 24 hours a day, in a patient care industry means being available to solve problems after hours. When working at home, I handle this contradiction in philosophies by, for example, making the subject line of an email to a direct report “For handling tomorrow” so that they don’t feel compelled to answer during their off hours.
Q: How do you unwind at the end of the day?
AA: I love to walk around the neighborhood with my wife, and my daughters when they are so inclined. We are both busy people, so walking and talking is a great opportunity to reconnect while also getting our exercise. I also love to read. I just finished Scott’s Last Expedition by Robert Falcon Scott. Reading about a man who between 1910 and 1912, led the British Antarctic Expedition to the South Pole and died, along with four team members, on the return journey puts our day-to-day leadership challenges into perspective.