How one health system CEO wards off mediocrity

After leading Houston Methodist through a pandemic, CEO Marc Boom, MD, is committed to fighting off another threat: complacency. 

Much of work-life industrywide is centered around discontent or indifference right now. Social media amplifies variations of professional disengagement, which now have their own handles — quiet quitting, coffee-badging or lazy girl jobs, to name a few. Six in 10 workers say they're putting in less than maximum effort, according to Gallup's State of the Global Workplace: 2023 Report. The Wall Street Journal recently published a story with business and work-life leaders contending that 85 percent of effort is the reframed 100 percent: "Try hard, but not that hard." 

Less-engaged workers may generate a great deal of noise, but the engaged and motivated members of teams likely feel a quiet and complicated tension right now with the status quo. The subset of people who, whether one year or 30 into their career, remain intrinsically motivated to do their best work and hold themselves to a high bar are game-changers on healthcare teams, as managers, and to patients. They are also arguably underrepresented and at risk of going underappreciated. 

With this group in mind, I set out to learn about what striving for excellence as a healthcare leader means and looks like today. Marc Boom, MD, CEO of Houston Methodist, was my first call.

"I wholeheartedly and passionately disagree with an article that says 85% is the new a hundred percent and somehow justifies that as OK. That's not OK at all," Dr. Boom said all but two minutes into our conversation. 

Houston Methodist, founded in 1919, is an eight-hospital system with over 30,000 employees. Dr. Boom, the organization's first physician-CEO who also earned an MBA from the Wharton School of the University of Pennsylvania, has led Houston Methodist since 2012 surrounded by an executive team that shares more than 150 years of experience with the system.

More than 10 years ago, Dr. Boom crafted a vision for Houston Methodist's second century. It is six words: unparalleled safety, quality, service and innovation. 

"When you have 'unparalleled' as the first word of your vision, clearly that's not 85%, right? 'Unparalleled' says there's nobody better, and you are going to always strive to be better than where you are today. So I tell people the two elements about that are: We have to be the best today. But we also can never be satisfied with where we are today." 

What follows is a conversation for any leader or professional in healthcare driven to uphold high quality in their work, on their team, and with their direct reports or managers. Dialogue has been lightly edited for concision and clarity. 

Molly Gamble: Interpersonally, if you have a high bar or you're pursuing excellence in a pretty relentless way — that comes with its own risks at times. You can wear people out, or it might feel like nothing is ever good enough. Do you have any insights about how to channel this aspiration effectively?

Dr. Marc Boom: One of the first things I'd say is I believe in work-life integration, not work-life balance. 'Work-life balance' sort of implies that one is good and one is bad. 'Integration' says if you have a job that's filled with passion and purpose, you're incredibly privileged and the ability to integrate that with the rest of your life is huge. For most people in all realms of healthcare, who they are is intertwined with what they do and who they serve.

I believe that many times the way we recharge batteries in life is by doing good for others. What a wonderful thing to be in healthcare and know that you have the opportunity to do good for others. That's critically important. Healthcare is a wonderful, wonderful field in that way, and one that I often consider a calling for most people. But you should work for an institution that values you, gives you opportunity, listens to you, communicates with you and has a great culture. 

You should be working on a team that exhibits all of those attributes. If not, you need to ask yourself, 'Well why not?' If you're the leader of that team or the leader of that institution, your biggest job is making sure you fit all the boxes of what I just said. When you do that, you're going to have a team that's ready to give their all in a way that is energy-enhancing rather than energy-draining for them. 

MG: If you take a step back, as an individual or as the leader of an entire institution, what is the most challenging part of upholding standards of excellence? What can get in your way?

MB: People need us in healthcare to be at our 100% best at every moment. That is tiring. Work life integration doesn't mean you're not going to have a bad day. You got into a fight with your spouse, your teenage kid was a real pain in the neck that morning on the way to school, you had a sick baby last night and now you've got to go into work on four and a half hours of decent sleep. 

Obviously, life happens, but it's the organizational support structure and a culture that enables people to have places to blow off steam, to find support from people along the way, to access assistance programs, return to a warm embracing culture — all of the above. 

It can be very tiring to always be on, but you have to always remind yourself that what is fairly routine sometimes to us is anything but routine to the people we serve. This is why that 100% is so important. Most of the time, the hospital is not where people want to be. It is oftentimes someone's worst day they've had that year or in their life. Maybe they're receiving bad news or dealing with the inevitable mortality we all have to come to grips with at some time. That is a very important thing to remember and why we have to be at 100% in our work. You need a lot of insight and reflection on this. 

MG: Is there any detail or any piece of the system that you consider too small for the CEO's attention? As you're leading, how do you discern what, if anything, is too in the weeds for you?

MB: Ultimately, the buck stops with you as the leader. You are accountable for every iota of what happens in your system. 

That applies if you are the leader of a nursing unit, the accounting office or the IT team — whatever that is, it applies to that domain as well. I encourage people to think of the institution like it's home. People need to see that there is no detail too small and that [leadership is] going to pay attention to detail. For example, we expect that if a member of senior leadership sees a piece of paper on the floor, they pick it up. You'll see me do that multiple times a day. That's one example. I think that attention to detail is very important. Leaders set a tone that says, 'Hey, we're accountable for all of this.'

I have this slide I like to show during new leader orientation oftentimes with interns and others. It's a quiz question that asks how many housekeepers work at Houston Methodist. Responses are like A through D, so 800, 2,000, 3,000 or 32,000. People will look at that and think, 2,000. That sounds about right. And I'll usually kind of sit there and listen, talk a little bit, and eventually they'll come to the right answer — 32,000 — because what I'm asking is a cultural question.

MG: One of my relatives was in the hospital recently. It's been a mainstay in our family for a long time. But we noticed in this case, speaking of detail, that the furniture was deteriorated, the TV was broken and things about the care and communication raised more questions than usual. I was thinking about what could have contributed to the decline at this organization, and I went right away to staffing shortages. I immediately built defenses of why shortcomings were to be expected. It made me curious: If I'm in your shoes and someone comes to me with rationale for why something fell short or why the experience of a family or patient was poor, what do you do? How do you distinguish between excuses and actual contributing factors to less-than-excellent outcomes?

MB: COVID-19 may be a reason [things fall short], but it's not an excuse. We'd be naive, obviously, not to acknowledge that it's had a significant impact on our teams, on their morale, psyche, people who retired. But the strong message is look, I don't want to hear you make an excuse. You can explain to me why something is the way it is. If something has become a problem, then you're having an issue factually, but it's not an excuse. And that mindset says, OK, so what's our job? Our job is to fix it if things are not quite right. 

There will be challenges. We're all facing challenges. And then it's how do we rise to those challenges? How do we prioritize those challenges? How do we focus on them? So the big one coming out of the bulk of COVID-19 was — everyone's burned out. We've had people retire early, we've had all these dynamics with nursing shortages. How do we stabilize the shift? We really built our efforts back on the cultural side and connecting people to the mission.

The other is going back to the unparalleled safety, quality, service and innovation. I said it's six simple words. I used to say, 'Here's these five important words.' Now I use six simple words because the word 'and' is really, really important. We expect that superior and superb leaders from an institution that needs to thrive figure out how to do it all. It's a challenge. But we can achieve it all and we expect to achieve it all. So safety is not a choice, for example. We can be efficient and we can be high quality. Those are not a choice. You have to go into it with that mindset.

MG: It's funny, I remember when we spoke in late 2021, we talked about how much effort you put into the leadership of walking people away from either-or thinking. At that time, you called it "the sacred 'and.'" When people are in a scarcity mindset and think they have to compromise on one thing for another, it can be so impactful for a leader to help them better see that both are possible. How often do you find yourself doing that? 

MB: I believe passionately in that "and" thinking and that there is a solution that can be found. To be exceptional, we don't have it all and we've got to figure out how to have it all. Part of that involves making good decisions, and asking whose voices do I need to hear? Who feels empowered to express their voices even if their voices aren't exactly what they think you want to hear or you don't necessarily agree with. How do you make sure you don't just surround yourself with the people you are most comfortable with, but embrace people and grow as an institution? 

I am worried about some of the direction of where our country is. We're seeing a lot of that play out right now. There is nothing but 'or thinking' when you get into politics. We've gotten so bad at that that we can't get anything done. It's really divisive and it's really disruptive. One of the things I worry about a lot is how those external cultural influences bleed into an organization like ours. 

What I often say is, listen, 32,000 people in our institution can have 32,000 different perspectives on life. Thirty-two thousand people think differently and have different politics somewhere on a spectrum, right? And we can still share one common culture, one common goal, and we can have people work tightly together on a team who come from all different degrees. That 'and' word continues to be a major team effort.

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