Facing Challenges With Meaningful Affiliations: Q&A With The Mount Sinai Medical Center CEO Dr. Kenneth Davis
Dr. Davis is a widely recognized leader who has led Mount Sinai to receive many awards and recognition. For instance, the 2012-2013 Best Hospitals issue of U.S. News & World Report ranked the medical center 14 out of nearly 5,000 hospitals nationwide, earning it a spot on the Honor Roll, while Mount Sinai School of Medicine is ranked 18th in the nation.
Here, Dr. Davis discusses how he handles the pressure of leading Mount Sinai through a challenging healthcare landscape, how affiliations help Mount Sinai remain an excellent academic medical center and how effective leadership means congratulating all members of the team no matter how major or minor their role.
Question: What are the greatest challenges for Mount Sinai currently and how do those compare to current national challenges?
Dr. Kenneth Davis: We are seeing what everyone is seeing. Revenues to providers are not increasing as fast as expenses, and margins are shrinking. Although the full impact on providers in Medicare and Medicaid [reimbursements] will not be felt fully for some time, we do expect the margins to continue to erode. [Hospitals like Mount Sinai] are directed the question of how to preserve the margins that we have while our revenues are decreasing and our expenses are increasingly difficult to control.
Healthcare is changing rapidly. [Mount Sinai] recognizes that providers don't want to be in a fee-for-service universe anymore. [Hospitals] have prospered in that universe and built a model around the fee-for-service world for quite some time. Now we are having to think more and more about population management and integrating different forms of care. We have to accept that payments may come in bundles and we won't be paid "per click," which is to say by every bit of service we provide. Instead, hospitals will receive payments by episodes of care. The incentive before was to do as much as you could and, now it is it do as little as you can with the same outcome. Ultimately, the biggest challenge moving forward is that we have to change our business model and how we develop healthcare.
Q: What is your overall philosophy for Mount Sinai? Where would you like to see the health system progress?
KD: Our commitment is to being the absolute best provider of care and the best academic medical center in the universe of biomedical sciences and healthcare delivery. We try to be the best at everything we do. I want to see the system progress to a sustainable platform where we don't have to worry from year-to-year about the fiscal health of the medical center; where we are secure in the funding for the science that we conduct; and where we can continue to meet the demand of the communities we serve and the students we educate.
[In order to do this,] we need to develop programs and relationships that cater to Mount Sinai's complex patients. Those patients need our care and provide us with the margin that we need. That may mean Mount Sinai integrates with other systems, like the potential affiliation with N.Y. City-based Continuum Health Partners; that we support our existing affiliations with N.Y. City-based Richmond University Medical Center, Lutheran Medical Center in Brooklyn, N.Y., or St. John's Riverside Health in Yonkers, N.Y.; or that we build large ambulatory platforms. We will pursue all of those elements because they are synergistic and bring to Mount Sinai the complexity of patients that we are staffed and equipped to treat.
In addition, the responsibility of being an academic medical center involves providing the most complex care. If we left that, we would be leaving our mission as an academic medical center. We are not trying to be a community hospital. We are trying to have cutting-edge treatments and complex services, and extend this care to everyone in our community and to people from all over the world who come here for highly specialized treatments. That comes from a leading faculty comprised of the most intelligent scientists and physicians in the world.
Q: You mentioned affiliations with other hospitals and health systems — like the potential Continuum Health Partners deal — as a means for Mount Sinai to support its infrastructure and progress as an academic medical center. How does Mount Sinai approach partnerships and affiliations?
KD: When Mount Sinai looks to partner, we look to develop a meaningful relationship with an affiliate that is clearly mutually beneficial. We don't look for a lot of affiliations or relationships. We look for a handful of meaningful relationships. If we can't bring value to our affiliates, the relationship will not survive. In turn, if they are not bringing value to Mount Sinai, we won't do it.
Finding organizations to create mutually beneficial relationships takes due diligence. There is no substitute for putting in the time it takes to really know your partner.
It is also important for our management team to know the personalities of the hospital executives and to understand the services that the hospital delivers. As well, it is important for the potential partner to know what they want from a large academic medical center, at least when they consider affiliating with Mount Sinai. Once you decide to affiliate, then it takes a great deal of time to foster a strong relationship.
Q: Do you have any personal routines or guideposts when you come to difficult decisions?
KD: It is important for me to make decisions with my senior management. Unless I am absolutely convinced of a particular direction and it is necessary for me to make a decision individually, which would be very unusual, I review my decisions and often develop with them with at least three to four senior managers at Mount Sinai.
In terms of guideposts, I assess whether we have consensus from the critical individuals. Usually that involves the individuals in charge of data analysis, operations, finances and academics. If I have the support of them — whether the decision was made collectively or not — I know it is the right way to go. Rarely is our group divided about our decision. In the occasional time they may be, I make the final decision.
Q: How do you handle that pressure and come out with a no-regrets answer?
KD: No one can have no-regrets answer if they are completely honest. Rarely are decisions so black and white that you have absolute certitude that you made the right decision. Time often tells you that you were right, but if you used a logical and extensive decision-making process you usually are right. If you didn't come to the right answer, you have to look at the process and apologize for the decision that you made and now regret.
As for how to handle the pressure, it is important to step out of the environment whether that means I am swimming in a pool for 45 minutes or just not in New York City. In today's world we are connected constantly. So, no matter how far away I am, I still receive my usual 350 emails a day. However, getting away gives me a chance to be in a different environment; it gives me more time to pause and reflect and to think about the issues without having to manage moment-to-moment the crises that may be occurring around me.
Q: Can you share one piece of advice or one lesson you've received in your career that was most impactful to you?
KD: I have received a lot of great advice of the years; however, one piece of advice that has always stuck with me came from my 11th grade history teacher: "Smart kids are a dime a dozen, but the ones who are successful are the ones who do the work."
In all the great academic places I have been in, including Mount Sinai, I have met loads of smart individuals. The people that are the most successful are the ones who cross the finish line because they are dedicated to completing the work. What truly matters is if you deliver the final product. It is not as important to have all the answers of the top of your head. To me, this advice means not just talking about what we will give to an affiliate but doing it. It is not talking about who you want to hire or that you would like to renovate the operating room, it is about doing it and taking the steps to finish the job. That was the advice of my 11th grade advice history teacher, and it was pretty good advice.
Q: Who has most inspired your personal leadership style? What did he/she teach you?
KD: No single person has done that for me. I have borrowed a leadership style from lots of individuals that I have met along the way; a lot of whom probably didn't know they were influencing me. One that I can think of right now was my track coach in high school. He taught me what it meant to be a part of a team and to work hard at something that was painful to do; that there is a reward at the end of the day if you put in the time to get really good at a skill. He was also a man who was tremendously generous with his encouragement, from what may have been the most important to the least important person on the team in terms of skill contributions.
For instance, when I was a sophomore, my track team was in huge [track] meet that would determine who would be champion of our division. There were three runners from our high school and three from the other. The result from this race would determine if we won and if we were champion of our league for the first time in our high school's history.
While I finished last, the two other runners from my high school finished first and second, so we won the meet. We had just won the meet and the coach won the division for the first time, but he didn't congratulate the first and second runners. He ran to me and said, "You were great. Great race, congrats!" I felt awful that I was last, but he wanted me to feel good. He was thinking about all of the members of his team, which included me and my sadness in my last-place finish. It has taught me that everyone on the team really matters. That generosity of spirit is important in building a strong team around you.
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