24 thoughts from 5 healthcare leaders

What is the best management advice you've ever received? What are you most excited about today? How large must a health system be these days to thrive? What about healthcare is most interesting to you right now?

We asked several healthcare leaders — hospital and health system CEOs, along with respected thought leaders — to answer these questions and more. Here's what they had to say.

Chuck Lauer
With years of experience in healthcare, leadership and publishing, Chuck Lauer has cemented himself as a mentor, leader and friend to many. The former publisher of Modern Healthcare took some time to share 16 pieces of advice for new healthcare leaders, along with his thoughts about the importance of consistency and face-to-face communication.

Question: The workforce seems to be filled with a mix of really focused motivated people and some people that seem to have somewhat of an entitled attitude. How does a great manager or leader mesh a team coming from different backgrounds?

Chuck Lauer: Great leaders set goals and priorities for their organization and then they communicate what those goals are in person to the total workforce through onsite visits! E-mails and memos serve a purpose, but in order to inspire a workforce, the CEO must make it his or her priority to communicate their vision and sense of mission personally. It is a commitment that all highly effective leaders make.

Q: What is an example or two of a great leader? And why?

CL: Two of the most effective and inspirational leaders in healthcare are Michael Dowling, president and CEO of Great Neck, N.Y.-based North Shore-Long Island Jewish Health System, and Chris Van Gorder, president and CEO of Scripps Health in San Diego. Either one of them could have been successful in any field they chose. They believe in the dignity of the workforce and make it clear on a regular basis to their people that every single individual is critical to the success of the organization. Both are men who have great conviction, passion and integrity and do not abide incompetence and casualness in attaining excellence within their institutions. Both have great character as well and are recognized for their innovation, risk-taking and creativity.

Q: How do you keep yourself and an organization focused on a mission day after day? Month after month?

CL: Of course, communication is the answer. A leader must instill in his or her leadership team that they must reinforce the organization's goals on a regular and consistent basis. It isn't easy, and too often leaders become distracted for whatever reason and forget how important open communication is to the workforce. Too often leaders become distracted for a variety of reasons and forget that if they become distracted, oftentimes that becomes evident to their people who then can become distracted as well. So consistency of the message, mission and vision to the workforce is essential to consistency of productivity by the workforce.
Q: You have had a magnificent career as a leader and have been an extraordinary mentor to many across the healthcare and media world, what advice to you have for someone moving into leadership?

CL: Over the years I have been in leadership positions, I learned that a leader must always have an open-door policy so every one in the organization knows they are willing to hear what their people have to say. It is really a simple matter of treating every single individual with dignity and respect. For any leader coming into healthcare, I believe it is important that they try new ideas and take risks. Mr. Dowling and Mr. Van Gorder are risk-takers, and what they have done has paid off for their respective organizations and consequently their success.

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!

My advice to anyone coming into healthcare in a leadership position involves these basic tenets:
1.    Hire people who show creativity, innovation and passion.
2.    Don't be afraid to also hire people who are smarter than you.
3.    Be a leader who is consistent, mature and handles adversity and stress with patience and calmness.
4.    Listen to everybody no matter what station they have in your organization.
5.    Don't play favorites.
6.    Make a conscious and consistent effort to hire minorities.
7.    Listen and listen and listen more. If you do, you will learn many important things that will help you be a better leader.
8.    Talk to other healthcare leaders and learn from them.
9.    The most important thing you can do every day is mentor your people. Help them to become leaders and help them to succeed.
10.    Encourage celebrations when goals are met and be there to celebrate with your people.
11.    Remember your success is dependent on others, so treat others always as respected peers.
12.    Be you and don't try to be someone you are not You must be a special person already or you wouldn't be where you are now!
13.    Hire the handicapped. There are many bright people that are handicapped and have first-rate minds and intellect. Help them in every way you can to succeed.
14.    Be a leader by acting like one so that your people are proud of having you as their leader.
15.    Your success and the success of the organization depends on others, so treat everyone you meet with the utmost respect and dignity.
16.    Keep it simple!

Quint Studer
With nearly 30 years of healthcare experience, Quint Studer has established himself as a strong advocate for change and improvement and as a go-to expert for management advice. The founder of Pensacola, Fla.-based Studer Group took some time to share his insights about the best management advice he's ever received, the most interesting issue facing healthcare leaders today and his concerns about physician morale.

Question: What is the best management advice you ever received?

Quint Studer: Pause. While procrastination is not good, leaders (including me) feel the need to act and find they did not pause enough. I say often I have never regretted a pause, however I have many instances of regretting not pausing. Years ago, I asked my boss why he was not taking action on a situation. He said he usually gives a situation between 24 and 72 hours and finds many times they work themselves out.

Q: What do you see as the most interesting issue facing healthcare and healthcare leadership today?

QS: Ambiguity. In the book "Switch: How to Change Things When Change Is Hard," the Heath brothers [authors Chip Heath and Dan Heath] state that 80 percent of failure to succeed is based on ambiguity. I find today an unclear external reimbursement environment is causing leaders to be very cautious in direction, which is understood. However, this also creates ambiguity in the organization, which is not good. [Editor's note: The

Q: When you talk to health system leadership today, what is the biggest challenge you hear about?

QS: Timing. While we can hear talk of payment of value and population health, the providers are still paid in different ways. So while a leader may know when to get to a goal, getting to that goal too early or too late can have consequences.

Q: How do health systems perceive the change in healthcare delivery (i.e., as part of the Patient Protection and Affordable Care Act)? Are they largely adjusting today or wringing their hands?

QS: I feel leaders clearly know that the payment system changes combined with transparency on quality and experience are present, but their actions may still not address the toughest issue facing organizations, which is not the structure or strategy but the execution. Systems still lag behind where they want and need to be in evidence-based medicine, access to care, clinical quality and people engagement, especially with physicians.

Q: How do physicians feel about the changes in healthcare?   

QS: Physician morale today is what nurse morale was in the mid 1990s. This is a feeling of a loss of control of their environment and future. Over 50 percent of primary care, critical care and emergency physicians report being burned out. If we cannot improve the current environment of the physicians today, we will lose the future physicians. Based on intelligence, skill and education, physicians are the best of the best. Other industries treat their top performers much better than we treat physicians in their work environment.

Pat Fry
Pat Fry, president and CEO of Sacramento, Calif.-based Sutter Health since 2005, has a front-row seat to one of the most interesting healthcare environments in the country, as California is home to many health systems and insurers rapidly implementing value-based care. Mr. Fry took some time to share his thoughts about the pace of change in California, the most interesting changes he sees today and the common attributes that make health systems function best.

Question: Is there still a big difference in the pace of change in healthcare delivery in California versus the rest of the country?

Pat Fry: The pace of change in California is moving at a good clip. My observations and conversations with other leaders suggest a fairly rapid move toward population health management. This requires systems to have a suitable infrastructure to successfully manage a population, and we're seeing a significant focus on building ambulatory networks, care coordination systems and post-acute (SNF, acute rehab, home health, etc.) strategies.

Q: How quickly is the pace of change occurring? How much is staying the same in terms of the core delivery of care and the business of running a system?
PF: There is much more focus on ambulatory services today than I have seen over the course of my career. Also, there is broad recognition and acceptance that the historical fee-for-service payment model is not sustainable. Accordingly, there is much more focus on building networks of care and changing the historical relationship between providers and payers.
Q: On a system level, at Sutter Health, what are the most interesting changes or efforts you see today?

PF: Around our Sutter Health network, there is tremendous focus on ensuring a personalized patient experience and on the external market. We understand our patients want to interact with our system in a new and different way. They want to make appointments online, have access to physicians after hours and on weekends, and be able to access their medical information 24/7. We are spending a great deal of time better understanding how we need to deliver care in a way that creates a truly unique experience.
Q: Is there an ideal health system size today? How does one assess this?

PF: While I don't believe there is an "ideal" health system, all great systems share multiple common attributes. They commit to providing care in an integrated manner, to physician leadership at all levels of the organization, to delivering services the way patients want and expect it, and to focusing on the "whole" individual's needs. This means partnering with patients and families before they actually need care.

Dr. Stephen Mansfield
Stephen Mansfield, PhD, has led Dallas-based Methodist Health System as president and CEO since 2006. As a seasoned leader well-versed in both healthcare administration and organizational leadership, Dr. Mansfield brings a unique perspective to the table. Here he took some time to discuss Methodist's strategic transformation, the pace of change in Texas and the four attributes he seeks in fellow leaders.

Question: What is the most interesting issue you see in your work today?

Dr. Stephen Mansfield: I've always been fascinated by people, by medicine and by the challenge healthcare leaders have in trying to optimize the talent of their organization's people and the quality of their organization's product. I just find that amazingly interesting work.

Q: What is the most interesting challenge your system is facing?

SM: Apart from the comment I just expressed, I think the most interesting challenge is trying to optimize Methodist's strategic transformation to value-based reimbursement and a "health optimization" versus "illness treatment organizational mindset." I can't imagine an industry undergoing a more tectonic shift.

Q: What are you most excited about today?

SM: I'm just excited to still be in the game. As difficult and as frustrating as it is some days, I feel so blessed to have a small part in transitioning the American healthcare system from the broken and patched system we have today to what I believe can be the most value-added health system in the world.

Q: How quickly is change occurring in Texas as to healthcare delivery?

SM: The pace of change in Texas varies by part of the state. Some urban markets are narrowing networks and repricing hospital services pretty aggressively, but much of Texas is rural and those [rural] markets may be moving a bit more slowly. All of the Texas healthcare market is severely impacted by the combination of having the highest percentage of uninsured [patients] in America and having a legislature that has been unwilling to expand Medicaid eligibility as part of healthcare reform.

Q: How is your physician community reacting to change?

SM: Physician commercial reimbursement rates in Texas have generally held up pretty well comparatively, which has shielded them, somewhat, from some of the pressure to consolidate that we see in many parts of the country. A preponderance of Texas physicians continue to practice independently and do so quite successfully for now.

Q: What is your best piece of advice in developing leaders today?

SM: As a life-long student of leadership effectiveness, there are a myriad of potential answers to this question, but as a huge fan of [James] Kouzes and [Barry] Posner, I don't think you can go wrong with citing the four elements they have identified over 30 years of multicultural longitudinal study about what tens of thousands of workers say are the most preeminent attributes contributing to their eagerness to willingly follow a leader. The four attributes most frequently cited in there study were: honesty, forward-looking, inspiring and competent. I think those form a good basis for development of stellar leaders today.

Q: How do you develop an exceptional team and system?

SM: I think those concepts are inseparable, i.e., you don't have an exceptional system without exceptional talent. Building a team around the concepts of honesty/integrity, forward-looking or strategic-thinking, interacting with all customers, employees, partners, etc., inspirationally, and continually honing your own skill set or competence may not guarantee success, but it certainly augments it.

Steven Goldstein
Steven Goldstein, president and CEO of Rochester, N.Y.-based Strong Memorial Hospital, part of University of Rochester Medical Center, is an experienced and refined healthcare leader and advocate. With a nuanced understanding of healthcare's many challenges, Mr. Goldstein sees new opportunities to improve care delivery and the promise of new medical developments. Mr. Goldstein took the time to describe some of these challenges, along with his thoughts on the importance of scale in today's healthcare environment, the biggest changes he is observing and what excites him most.

Question: What are the most interesting issues that you see in healthcare today?

Steven Goldstein: From my point of view, the consolidation of providers into more cohesive networks is one of the most interesting issues in healthcare today. Certainly, this brings enormous challenges in terms of blending disparate groups, but there is also an unprecedented opportunity to maximize our healthcare assets by bringing together institutions and providers that have not collaborated in the past.  

Developing models of care that are high-quality and cost-effective, and that provide care to patients in the least expensive setting, is one of the great management challenges that the healthcare industry faces. In addition, how to sustain care models in rural areas, which are neither population- nor resource-rich, is an enormous challenge as well. Safety-net institutions represent a separate category of challenges. Capital, sufficient operating revenue and philanthropy are frequently lacking, thereby making the transformation of care to population health and the ability to assume risk for populations with high needs incredibly difficult, if not impossible.  

How we will develop a healthcare system that is responsive and affordable to all across the continuum — in both urban and rural settings — is a tremendous challenge requiring more efficient management and financial systems that must be developed and implemented.

Q: How large does a system need to be today, and why?

SG: In the new delivery and risk-payment models, scale matters. Networks must be large enough to spread risk and take advantage of efficiencies of scale. The exact size depends on the mission that one is trying to support. Academic medical centers, for instance, must be able to draw upon a large population to support specialized services for high-complexity patients. For those institutions with quaternary and tertiary programs, a service area of three-to-five million people may be necessary to support highly specialized patient care programs. For insurance contracts with risk arrangements, covered lives in the range of 300,000 to 500,000 would seem to be reasonable in distributing risk effectively.  

What is interesting is that within the population health framework, the definition of system is evolving. No longer does the number of participating hospitals define a system. Systems are ecosystems comprised of diverse practitioners, multiple access points like urgent care centers and free-standing emergency departments, institutions that span the continuum of care, insurance entities, educational institutions, management service organizations and more, all powered by information technology. The focus of a system is now on the provision of cost-effective, high-quality care that appropriately uses the most expensive components of healthcare and manages information and the business components within the system effectively.

Q: What is the biggest change happening in patient care?

SG: I posed this question to our medical director, who is a practicing internist. He noted that the sequencing and exploration of the human genome has opened the door to "tailored" therapy that heretofore has not been possible. "Big data" analysis of the genome has not only enabled breakthrough, targeted therapy, but it also allows us to clearly assess just how well existing treatments work for individuals based on their distinct genomic characteristics. Examples of this are in breast cancer, where high-risk individuals can be identified using genomic markers and treatment plans, which can be personalized based on the specific genetic characteristics of the patient.

By focusing on value rather than volume, we have the potential to positively affect both the cost and quality of care delivered and raise the standard of health for specific groups as well as the population as a whole. This is made possible by the computerization of the medical record, which gives us the ability to share information across the spectrum of providers and settings, and the analytics to prove just how well we are preventing and intercepting illness and driving down costs.  

From the patient's perspective, the efforts to improve access and the rise in consumerism have been dramatic. More choices exist for patients to seek accessible care, whether through walk-in clinics, free-standing emergency departments, urgent care centers or ambulatory surgery centers, all located in easily accessible locations. The quest for patient satisfaction has never been greater in the industry and is truly becoming the norm rather than the exception.

Q: What excited you about the future of healthcare?

SG: America's healthcare system is unsustainably high-cost, with variable quality and access. New delivery systems must be developed that seek to solve these problems in the decades ahead. As we look at each of these components, we understand that sweeping changes must occur to provide affordable, high-quality healthcare to all citizens regardless of where they reside. Devising the right approach is, of course, the challenge at hand. The strategic alignment of institutions and individual practitioners are important components of the healthcare system, which will affect how and if they provide services in the future.

While much has been written about health reform, much is still unknown. The efficacy of population health approaches are still a matter of conjecture and experimentation. The movement from volume to value is still, for many, a transformation goal. Whether institutions can align themselves in ways that truly bend the cost curve, provide high-quality care and do so in a way that is financially sustainable is truly a challenge of our time. What is exciting about being a part of the healthcare delivery system today is that the stakes have never been higher to find real solutions that address the fundamental issues driving healthcare reform. Whether it is new organizational forms or fundamental incentive adjustments to the system, the challenge — and the opportunity — for management at all levels has never been greater.

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