7 questions with MetroHealth CEO Dr. Akram Boutros

Akram Boutros, MD, has served as president and CEO of The MetroHealth System in Cleveland since June 2013. Dr. Boutros, who has more than two decades of leadership experience in large community hospitals, specialty hospitals and academic medical centers, most recently was president of New York-based consultancy BusinessFirst Healthcare Solutions.

His previous roles also include executive vice president and chief administrative officer of St. Francis Hospital – The Heart Center in Roslyn, N.Y., and executive vice president, CMO and COO of South Nassau Hospital in Oceanside, N.Y.

Dr. Boutros, an internist, earned his medical degree at from the State University of New York Health Sciences Center at Brooklyn and also graduated from Harvard Business School's Advanced Management Program.

Dr. Boutros recently spoke with Becker's Hospital Review about the biggest challenge he's facing as CEO, his goals for MetroHealth and more.

Note: Responses have been lightly edited for length and clarity.

Question: What's the biggest challenge you're facing as CEO?

Dr. Akram Boutros: The military has a term they developed called VUCA, and it's an acronym for volatility, uncertainty, complexity and ambiguity. Nothing could describe the healthcare industry today better than that term. So the biggest challenge today is operating within the new environment, and the level of comfort that people have to develop with ambiguity, making decisions with incomplete and sometimes less than optimal information and data. It's also trying to reduce the complexity that keeps getting piled on to the healthcare delivery system. So that's really the biggest challenge, and the way we try to cut through that is we focus on our mission and values, both of which offer clarity about decision-making and offer the support for us to be courageous.

Q: How do you approach the CEO role?

AB: I believe the CEO role has evolved, at least for me, to be one of support. Help identify excellent talent, help develop a great team structure so it's a very high-functioning team, give people the support to make decisions and even help them understand failure is OK if we fail effectively. If we fail small, if we fail fast and if we fail forward. It is also important to give them the leeway, the breadth, the decision-making ability to do what they do best. It is no longer acceptable in our knowledge environment to have commanding control structures.

Q: What was the last memorable thing you read?

The Story of Ferdinand. I just have it here in my office, and I was trying to explain to someone the difference between kindness and weakness. As an executive, some folks believe they can't show kindness because it will be misinterpreted as weakness. I believe you should always be kind.

Q: What is one of your daily routines?

AB: You make a lot of decisions in an organization that affect a lot of people. I look for an opportunity each day to touch someone's life. Yesterday, it was about giving one of our senior executives a hug because it was a really rough day for them and they needed that hug. Today, this morning, it was about holding an employee's hand as they told me about their mom's illness and how it's impacting their family. And when I don't find an opportunity to do that at work, I will drive by an area where there is a gentleman who is hungry, and I will always purchase dinner for him before I go home. It's about knowing that you made a difference to someone today in a small way.

Q: What are your goals for MetroHealth?

It's actually pretty simple. It's leading the way to a healthier you and a healthier community. We're accepting responsibility for the entire community's health, and we want to improve everyone's access to healthcare, everyone's healthcare outcomes. And we want to be able to take the disenfranchised, the folks who do not have opportunities, and provide them a pathway to do that.

Q: What is one phrase you think we should use less in healthcare?

AB: "It's the patient's fault." We have been blaming the patient for generations. We either preach at them, we call them noncompliant, we do a lot of things that are judgmental. To improve healthcare, we have to accept people for who they are. You must accept them with all their blemishes and look to help them in their current situation. We have patients here, even though they have insurance, who are so busy figuring out where their children are going to sleep tonight or whether they're going to have food on the table, that their diabetes medication is not in the top 10 of their priorities on a daily basis.

Q: What are some areas where the healthcare industry can improve?

AB: Today, even with the ACA, we don't have enough collaborative effort between the consumers, providers and payers. And those unaligned incentives are a significant obstacle to investments for long-term healthcare. We also have this unorganized and uninformed care system, so we're doing a lot of acute things that are not creating long-term outcomes. Hospitals have frequently become expensive buffer stops for lack of social progress. But MetroHealth, for example, put together a program in 2013 that began dealing with these things. We had a Medicaid 1115 waiver we developed called MetroHealth Care Plus, [which offers free medical care for people with low incomes who do not qualify for Medicaid and are uninsured]. The program can help you get the services and medications you need to stay healthy.

We provided care for more than 28,000 new patients and by focusing on all of those things, we were able to reduce the total cost of care for these patients by nearly 29 percent compared to what CMS allotted to us. That was approximately $1,500 per patient per year. We also improved blood pressure outcomes by 8 percent in a one-year period. For me, these are the kinds of programs that need to be replicated. I think MetroHealth has figured out a formula for taking care of the highest risk socioeconomic patients, and I think we have the opportunity to create models that engage the consumers, the providers and the payers.


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