Jim Skogsbergh's frank advice on 7 CEO issues

Advocate Health co-CEO Jim Skogsbergh stepped down from the organization May 31. Before his departure, Becker's caught up with him to capture his takeaways and advice on seven topics core to health system CEOs — in his signature straightforward style. 

Mr. Skogsbergh joined Advocate Health Care, then headquartered in Oak Brook, Ill., in 2001, assuming the role of president and CEO a year later. At the time, the organization was a $2.5 billion, eight-hospital nonprofit system with 24,500 employees. Under his leadership, it underwent several transformations and two significant mergers, including its 2022 combination with Charlotte, N.C.-based Atrium Health that culminated in the $31.7 billion system it is today. 

Mr. Skogsbergh's departure is well planned. A timeline was established for him to serve as co-CEO alongside Eugene A. Woods for 18 months following the merger of Atrium and Advocate Aurora in 2022. 

Born and raised in the Midwest, Mr. Skogsbergh is described by many as a deeply inquisitive thinker and clear communicator. Becker's caught up with him in the week before his departure to capture his thinking and advice when it comes to prioritizing patient safety, strategic plans, building executive teams, assessing partners for M&A, co-leading an organization as CEO, and engaging with the local community. 

Here are Mr. Skogsbergh's insights in his own words, which have been lightly edited for clarity.

1. Prioritizing patient safety

"This was back when Lee Sacks, MD, was chief medical officer of Advocate Health Care. One day, early on in my tenure as president and CEO, we said, 'Let's decide what we want to be known for. Let's decide what's going to be our legacy, and let's work towards that.' 

"We put a lot of things up on the board. You can talk about being the biggest, you can talk about being the best service, so on and so forth. We obviously landed on safety and health outcomes. Everything else is in second place. Everything else. Now, some of those are a very close second. You have to do well financially if you're going to do good in your communities, et cetera. But we said early on, this is where we're going to plant our flag: safety and health outcomes. 

"We are first and foremost a safe clinical enterprise. That clarity around who you are, what you believe in and what you want to accomplish is critical. For us, it's safety and health outcomes, and everything else is in second place. 

"The other thing that's good about that clarity is people then hold you accountable to what you say. 'Oh, you believe in safety and health outcomes? Then why aren't we doing this, this and this?' I have loved that about our organization. People will challenge me, and I love that. There's a certain accountability that comes when you declare yourself, and we declared ourselves around safety and health outcomes. It has served us immensely well."

2. 5- or 10-year strategic plans 

"I've always thought strategic plans were always fungible and flexible. You have to be ready to pivot. The world moves at different speeds at different times and in different directions. I think it's good to have a sort of a big-picture grasp of where you're going, but be willing to adjust your course to get there. 

"I laugh when I hear '10-year strategic plan.' I just don't think the world works that way. But the notion of being clear about where you want to go I think is critical, and then how you get there is the flexible part."

3. Building a great executive team 

"I have always hired for values and spirit rather than skill set, necessarily. I think skills are something that can be acquired, learned and taught. Now, having said that, believe me: The people we hire are unbelievably skilled. It's not like we took folks that didn't have any experience, but for me it's really the heart. 

"Do you care deeply? Do you put the organization first? Do you put people first? Are you building people up? What's your personal style? Do you praise in public and criticize in private? Because that's the way we want to do things. 

"I don't know that anybody ever bats a thousand in terms of selection, but for the most part, I think we've chosen very, very well. First of all, the leadership team that I surrounded myself with? They're all smarter than me. You want that. I think you have to be surrounded by people smarter than you, people who challenge you and cause you to rethink, back up, slow down and think more deeply. 

"I've always thought that two heads are better than one and three heads are better than two. In our team meetings, we're very much a team, no matter what the topic was. We might be talking about our financials, but I expected our human resource leader, our mission and spiritual care leader, and our strategy leader to weigh in just like our chief financial officer would weigh in. That way, the right hand knows what the left hand is doing, and we all benefit from some really smart people and some good thinking."  

4. Finding and assessing partners

"I think the most critical piece is worldview. Where do you think healthcare is going? Where do we think healthcare should go? What's your big-picture worldview? The other criteria that we always looked for was commitment to safety and quality, being a great employer and community citizen, and diversity, equity and inclusion.

"How quickly or how deeply does the board get involved early on in merger discussions? Is the board fully engaged? If not, it's kind of a bad sign. We've learned that over time. You really want to have a fully engaged board. 

"I'll tell you, I think the absolute most critical piece for successful partnership is the ability and the willingness to compromise. If you've got to have your way on every matter, then that is not a partnership. You've got to have win-win solutions, not win-lose, which are oftentimes the case. 

"Obviously financial health was important, or I should say the ability to get healthy financially. Years ago, when Condell Medical Center [in Libertyville, Ill.] became part of Advocate, Condell was on the brink of bankruptcy and defaulting on their bonds because they were out of contract with Blue Cross of Illinois. But we knew that we could get them back into Blue Cross of Illinois, and if that was the case, then we could turn that around and become successful. Condell is very successful today. It's a great addition to Advocate Health, and the service and quality of care we provide there is just outstanding. So it's not about being healthy right now, but the ability to get healthy from a financial point of view. 

"There are all kinds of criteria, but the most important I think is worldview. Where do you think healthcare is going? And do you believe in value-based care or do you believe in fee for service? The more I do, the more I get — we think that's a problem. That's not our mantra. We want to be paid for the good work that we do. When you find partners that see the world the same way, you solve differences quicker and easier and you can move a lot faster."

5. Co-leading as co-CEO

"Well, first of all, I don't think it's for everybody. I think you've got to have a pretty healthy sense of both humility and ego. What I mean by that is I was always confident enough that it didn't bother me to share the spotlight or share the decision-making. Again, two heads are better than one. 

"But I also think that you need some humility to be willing to do that, to say, 'Hey, I'm not quite sure that that's the direction I would go, but I'm willing to give it a try if you feel that strongly about it.' That sort of humility is pretty important. 

"I also think those [shared arrangements] should be perhaps time limited. I'm not saying that there's an amount of time that's right. When I approached [Gene Woods, former CEO of Atrium Health] about coming together and creating one organization, I told him my timeframe and I said, 'Listen, we're going to be co-CEOs for the next 18 months. Let's announce my timeframe when we announce the deal, because that immediately puts you in the driver's seat.' 

"And I said, 'I'm not the least bit concerned about being a lame duck.' That's not me. That's not my style. So that's something that I think served the organization well right away." 

6. Payer relationships 

"Very, very challenging. I think that we both need each other. The sooner we kind of get down to business, recognizing that we both need each other to be successful, then the sooner we can get to the important matters at hand. 

"I have always thought our biggest threat to our organization was not another organization. It was really a stroke of a pen. I worried about what was going on at the statehouse, in Washington, D.C., and I was worried about our contracts. I mean, the stroke of a pen can have a huge influence over the organization. I always felt like most of the other problems we could figure our way out of. I wasn't always like that, but after a while, you get some confidence and say, 'Listen, if we end up zigging when we should have zagged, we will reroute and get back on course.'

"I think the payer relationships are something that you need to invest in. You need to become partners. I don't know that there's enough of a partnership mentality out there today. I think part of that is because the payers are so large — they're just so large, and the market share and presence is so vast and great. It's always been kind of a conundrum to me that there's great concern about healthcare organizations that have 30%, 40% market share, and you're looking at payers that have 70%, 75% and 77% market share. That's odd to me. But that is the world that we live in. 

"We need to work together to be successful, for both parties. And if you've got that spirit of, 'Hey, let's work together and figure out a win-win situation,' then I think that's a pretty tenable position."

7. Community engagement 

"There are many people out there who I admire and respect that are doing great jobs, leading their organizations. All of them would say when it comes to community relations, you got to listen. "You've got to engage the people that live in the community to achieve solutions to the challenges that they face.

"This notion that I'm from Washington, D.C., and I'm here to help you just doesn't sell, nor should it. It's all about boots on the ground, listening, listening, listening, and then the willingness to pilot and try something. 'Hey, that didn't work. We've not gotten the results that we were expecting. It's time for us to pivot and do something else.' That is better instead of sticking with, 'Well, we've decided what our course is and we're going to stay the course.' 

"But the biggest thing is listening. You want to build community relationships. You got to have boots on the ground in the community, and you got to listen to the people who are impacted by the decisions that you're making." 

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