10 thoughts from 5 great healthcare minds

From admirable colleagues to high-price medicine to taking vacation days, here are thoughts from some of the most respected voices in healthcare.

Jonathan Bush, founder and CEO of athenahealth (Watertown, Mass.)

On recognizing organization's strengths
"It will be impossible for Rush [University Medical Center in Chicago] to ever develop the convenience and retail brand of Target. That's not a bad on [Rush]. Target will never do brain surgery as well as [Rush]. [Rush should] stop trying to be Target and they promise to never be Rush."

On healthcare's sustainability
"I have this fundamental belief the infrastructure of healthcare is obsolete. It's all pre-Internet. But because we love healthcare and because it's a public good, we create a regulatory environment where it's hard for it to die. And I'm always saying, 'These have to die or be disrupted.' The fact that all of the last remaining dinosaurs in the payer space are merging to me is evidence that this is going on, and I think what's coming after that — I do believe there will be a collapse.

What we do in healthcare to avoid a collapse is merge. The hospitals try to create a monopoly, buy doctors, put it all together and raise the price. It doesn't work, so they merge with competition, create a new thing, try to get cost savings out of that. Then they merge again. Eventually, I assume one day they just can't — their credit rating is just too weak. We've seen a fair amount of hospitals' credit ratings go backwards."

On CEOs he admires
"Toby Cosgrove closed two hospitals and chased high-profit care away from his system. He's attempting to replace it with a sales force flying in tertiary care [under bundled payments with employers]. The fact that a CEO with such market dominance — who could spend the rest of his life patting himself on the back — actually cut himself to grow back a healthier part is inspiring to me. It's hard to cut away what you have already and insist on what, strategically, you should have instead."

Malcolm Gladwell, journalist and best-selling author

On changing the practice of medicine
"You have to change the structure of the profession. I always use my 85-year-old mother as an example. What does my mother want from the medical profession? She uses far more of the healthcare profession than I do. Her needs are much greater than mine, as is typical of all of us. At her age, what does she want?

She wants someone who can guide her through what is becoming an increasingly complicated, confusing and terrifying period in her life. She doesn't just need someone capable of having those conversations with her. She needs a system that allows that physician to spend 25 minutes with my mother when she needs 25 minutes, which is not every time she goes. Maybe it is just twice a year, but right now we have a system where finding 25 minutes twice a year is really hard.

So we can change who we select for medicine all we want, but unless we change the nature of medical practice, it is pointless. We are just going to have brilliantly gifted doctors capable of having these kinds of discussions who are forced into a system where they have got to run the patients through an electronic treadmill."

On high-price medicine
"If you want pharma to produce first-class drugs, when they hit a home run, you have to let them charge home-run prices. At the same time, when they don't hit a home run, you have to stand up and say, 'You can't charge home-run prices.'

We can't make a blanket objection to expensive treatments or care of any kind. We have to say, when it is merited, that we will take out our wallets and pay; that will send the right message to people who are in research and development, and thinking about the future of medicine.

When it is not warranted, we are going to stop wasting our money. That is what I want to see — some correlation between what we pay and what we get back."

Chuck Lauer, former publisher of Modern Healthcare, and author, public speaker and career coach

On nonnegotiable traits for healthcare colleagues
"A willingness to be both flexible and caring when dealing with colleagues is essential. I am a firm believer in teamwork and therefore I put great emphasis on subjugating one's ego to help the team achieve success! A positive attitude is a trait I believe is essential for anyone who wants to grow and become a true leader. Too often leaders overlook the fundamental essentials that are inherent in gifted employees. They include good character, honesty, respect for others and a relentless pursuit of excellence!"

On leadership in healthcare
"The healthcare field needs new ideas and courageous leaders to make them happen. Leaders must show resolve and a willingness to change if the conditions merit doing so. On the other hand, a leader must also be consistent and mature in their personal behavior. After all, a leader sets the tone of a given organization and if they are not consistent that can often sow the seeds of unrest and stress. Any of those things can be a major component of failure and consequently must be avoided!"

Nancy Schlichting, CEO of Henry Ford Health System (Detroit)

On taking vacations
"I've taken all of my vacation days for the last 35 years," says Ms. Schlichting. "Life is short — it's finite and time is the one resource that is equal to everyone. Having time for travel, family events and spending time with friends has been absolutely essential to keeping some balance in my life.

Vacation days are intended to reward seniority in the organization, which is why employees get more as they move up. I worry about the people who say they can't take a vacation. Why can't they? You start to worry that they aren't leaving work because they have something to protect, as opposed to feeling good about taking time off. The way I look at it: For executives, if they're doing their job really well, they should be able to take time off."

John Halamka, MD, CIO of Beth Israel Deaconess Medical Center (Boston)

On sharing healthcare data
"If individuals can determine their own destiny data and not be forced into openness — or trapped behind privacy walls — by governments or corporations, then I believe our culture will shift towards the open sharing of healthcare data. And cultural values will shift away from keeping health information locked up, and toward the benefits of data sharing for wellness."

On managing demands and saying "no"
"People say, 'Okay, I get it, we need to be prepared for the accountable care future, we need to prepare for care management and care in the home, and even though there's this cool project that some stakeholder wants, we really don't have the bandwidth for that.' And so what not to do is as important as what to do, because each of us gets this laundry list of hundreds of things that stakeholders want. ...The technique I usually use is not to say 'No.' 'No' is such a negative word, so loaded with emotion. So, I say, 'Not now.' My role on the resource side is not to create fear, uncertainty and doubt, but to explain to the board what we need to do."

More articles on leadership:

MetroHealth CEO Dr. Akram Boutros on healthcare in 2030
Where CEOs of 50 great health systems went to school
The best of Quint Studer: 10 must-read insights for healthcare leaders

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