'Focused on looking forward': How 4 hospital CEOs view their legacies

A person's legacy as a leader can be focused on the individual themselves, as well as on past initiatives or efforts. But some of healthcare's longest-tenured CEOs say they focus on the legacy of their organizations and how their teams are positioning their organizations for long-term success.

Here, Kimberly Chavalas Cripe, president and CEO of Children's Health of Orange County in Orange, Calif., since 1997; Mark Wallace, president and CEO of Texas Children's Hospital in Houston since 1989; Chris Van Gorder, president and CEO of San Diego-based Scripps Health since 2000; and Michael Dowling, president and CEO of New Hyde Park, N.Y.-based Northwell Health since 2002, discuss what defines a healthcare leader's legacy.

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

Question: As the longtime leader of your organization, how do you approach your legacy?

Chris Van Gorder: During an interview a few years ago, an executive candidate asked me what I wanted my legacy to be. I told him at the time that it was not about my legacy. It was about our founders' legacies — Miss Ellen Browning Scripps, who founded our organization almost 100 years ago in 1924 and Mother Mary Michael Cummings, who founded Mercy Hospital (now Scripps Mercy Hospital) in 1890. I explained that my job was to extend their legacies as the founders of our organization. In fact, at the end of every day, I ask myself whether our two founders would be proud of what I/we did today. It's a good reflection on the day and a reminder of my job as the current custodian of their legacies. Having said that, there are some cultural, collaborative, transparency and educational programs I have established in my tenure that I would like to see extended after I leave that probably are pieces of my legacy.

Kimberly Chavalas Cripe: I find it difficult to believe I have just celebrated my 30th anniversary at Children's Health of Orange County and my 25th year as CHOC's president and CEO. Since the day I arrived, my approach has changed very little. I always look to our mission and vision as our collective North Star. With a mission "to nurture, advance and protect the health and well-being of children" and a vision "to be the leading destination for children's health by providing exceptional and innovative care," we try to optimize the present as well as prepare for the future. As I have advanced in my career, I have been fortunate to fulfill some lifelong goals. One example would be the opening, in 2018, of CHOC's Cherese Marie Laulhere Mental Health Inpatient Center, an inpatient psychiatric center exclusively dedicated to the treatment of children ages 3 to 17 with mental illness who are in immediate risk of hurting themselves or others. At the time, some viewed this investment in mental health as bold and daring, and now more people recognize the absolute necessity for robust mental health programs for both pediatric and adult populations. 

Mark Wallace: I'm incredibly grateful to have been president and CEO of Texas Children's Hospital for 33 years and still counting. I truly believe that the most important thing a leader can do is focus on the organization's legacy over their own. I consider it an honor to lead an organization that has not only built a remarkable legacy but has also helped create and strengthen legacies for every patient and family who walks through our doors. In the more than three decades I've been here, we've seen incredible success and growth in terms of people, programs and buildings, but a legacy is much more than numbers. Legacy is about what you've done for those you serve, those who need your help, and that's what Texas Children's legacy will always be about, even after my time has come and gone.

Michael Dowling: I tell staff, "We're on a very short journey through life. We're only here for a very short period of time." And the question everyone should be asking themselves is, "What am I going to do during that brief journey that I'm on? Am I going to do something that makes a difference, or am I just going to exist?" That's how I look at it, not so much about me personally, but I think everybody should be asking that question on a general basis. If you're focused on trying to make a difference, then you will improve the lives of others around you. 

If you say to yourself, "I really want to make a difference," then you're going to continuously raise the bar. Every day, you should be asking yourself, "What can I do more and better today than I did yesterday?" It's competing with yourself about what you can contribute. If you think that way, you will end up making a difference. Call it a legacy if you wish, but you will leave something behind that is better than what you found. 

Q: Is your legacy something you think about once a day, once a year or even less?

CVG: I ask myself daily about our original founders; it's a daily thought and routine. Otherwise, it's not something I've really thought about from a personal perspective until the last few years. Now, I think about it in almost every decision we make — patient quality and safety, strategy, employee relations, physician leadership, management, and leadership development and even in succession planning.

KCC: I have not really given much thought to my legacy until the last year or two. And even then, it is less about legacy and more about putting the infrastructure — programmatic, physical and people — in place to continue pursuing our mission and vision, and ensuring CHOC is well prepared to continue serving our community for decades to come. The pandemic has certainly put a greater sense of urgency on my timeline for advancing certain initiatives. I'm certain that CHOC's mission and vision will remain relevant and continue to guide the organization for many years ahead. 

MW: To be honest, I never think about my legacy. CEOs need to guard against that, especially as you near the end of your career. The No. 1 priority is to always think about what is best for the organization and not what is best for our own personal gain. CEOs can't focus on padding their legacies; I've seen others do it — and it is not good for the organization or the individual. Legacies look backward, and I am focused on looking forward. We have a lot to accomplish at Texas Children's and I am focused on that and I'm in a hurry.

MD: I think about the difference I can make every day. I'm one of those people who is constantly a little bit unhappy about what it is I don't do. If you're an athlete — which I was at one time — you're always wondering, "How much better can I become?" In the roles I'm in, I'm always thinking about, "How do I improve what I do? And can I make a bigger difference tomorrow than I did yesterday?" If you can, then you're obviously leaving a legacy. But it's not just in terms of what you've accomplished in your professional work. Are you living life better? Are you relating to people better? Are you demonstrating integrity and kindness in a different way? Are you building friendships in a different way? Are you dealing with your family in an improved way? Then obviously in your work life, am I something more than I did yesterday in my work life? 

Your legacy has to be holistic, in my view. At the end of the day, people remember you for what kind of person you were. Were you a decent, kind individual who cared about doing what was right? And if the answer is yes and people remember you that way, I think that's probably the best legacy you can leave. 

Q: Is a legacy the product of deliberate actions, or is it something that develops over time because of decisions and leadership style?

CVG: Probably both — the CEO working with the board, leadership teams and medical staffs make decisions daily that can impact legacy. If wrong or not positive for the organization over time, it can certainly shorten tenure and therefore legacy. But there are also CEO-driven philosophies that develop over time that will have an impact on daily decisions — philosophies around engagement, leadership development, physician leader development, ethics and doing the right thing — even if difficult or painful. That comes from the leader's style and philosophies and impacts the organization over time. Remember, we leave two kinds of legacies: the organizations we are responsible for and the people we care for and develop — they are the living legacies.

KCC: When I think of someone's legacy in general, I think of it in terms of both a deliberate approach and outcome, as well as a leadership style that ultimately influences the culture of an organization. Some may view my legacy in terms of accomplishments and initiatives, and others may view it in terms of my leadership style and approach. I believe it fair to say both would be correct. 

MW: It's an accumulation of all of these things, but it's also a product of working with sincere honesty and integrity and staying true to your organization's mission. A CEO must choose to always focus on doing what is best for our organization, employees, faculty, patients and families. On my first day at Texas Children's in 1989, I made a commitment to this organization to uphold the foundation it was built upon and do everything in my power to help bring it to its fullest potential. When I look back on my 33 years here, I can honestly say that I've stayed true to my promise, and that is something I'm truly proud of.

MD: Both. It can be deliberate, and it definitely develops over time. You have the quick win, which may not survive, but what you want to do is have things that survive and that other things can build upon. I think it's over a long period of time if you want to develop something that has sustainability. And I think you have to be deliberately thinking about the kind of a life you should live. I often say to staff, "If you work here for 10 years, how do you want to be remembered?" After 10 years, if you leave, do you want to be remembered for something good, or do you want people to say, "I don't remember that person was ever here?" If they remember you for the way you behaved and the way you acted and the contributions you made, you've left a legacy. 

Q: In the current healthcare environment, are legacies even more meaningful than in prior years?

CVG: I think sustaining the historical legacy of an organization is meaningful for a short- and long-tenured CEO if possible, but I'm afraid many of those legacies are being lost in an era of mergers, acquisitions and system consolidations. But I also understand the need in this challenging time for hospitals and healthcare. Having said that, I think the legacies we leave on the individuals we build and develop will live on even if the organization does not; perhaps that's the greatest legacy of all.  

KCC: We recently held our annual service awards ceremony (honoring staff longevity), and I cannot describe how inspiring it was to hear the roll call of the many employees with 10, 20, 30 and even 40 years of experience at CHOC. Now more than ever, experience and legacies have enormous meaning. As I often remind our staff, "healthcare is not a profession, it is a calling" and this calling becomes even more meaningful when seasoned veterans can share their legacy of service by mentoring their younger colleagues. 

MW: A sincere and significant legacy is always meaningful. If you can't commit to dedicating your full attention to growing and fulfilling your organization's legacy over your own, you should think twice about accepting a role in leadership.

MD: I think they're much more meaningful now coming out of COVID. COVID now has forced us all to reimagine our organizations, reimagine our roles in the world, reimagine how we relate to people because COVID has changed our perspective on almost everything. The question now is, "How am I going to change what I've been doing all along? How do I become more creative, more innovative and take advantage of the opportunities that develop all around us?" I ask myself all the time, "Based upon what we learned during COVID, how can I now fill in the gaps, fix those things that are obviously wrong during COVID, build upon that which is positive, but be a different organization five years from now than we are today?" The key is making sure your whole team of people thinks the same way, so that whatever is left behind is a result of the team, not the individual. 

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