He led St. Luke’s Hospital through a major merger in 1998 to create Covenant as it is today, a 643-acute-care-bed nonprofit system that reaches out into east central Michigan.
Mr. Maidlow recently received the 2013 Michigan Health & Hospital Association’s Healthcare Leadership Award for his work in his organization and community. Here, he explains two major ongoing projects happening at Covenant that helped earn him that award. He also gives a peek into his 2014 plans and shares how his leadership style and job description have changed throughout his tenure with the system.
Question: You’ve been with Covenant for 31 years. How does that longevity affect your leadership style?
Spence Maidlow: It has given me the opportunity to use personal feedback to make changes both to my personal style and leadership behaviors, and to make changes in the organization that I’ve been here long enough to see have a positive effect. It really is a satisfaction to see that the investments we’ve made in leadership development and culture have made a difference.
Q: What changes have you made to your leadership style?
SM: I think I’ve become less directive and more of a coach and mentor to the people I work with, and that has come with trusting those people to do the things they were hired to do. I believe trust permeates all levels of the organization. We have a tremendous leadership group that I think is very well selected and trained.
Q: Throughout your tenure, how has your job description changed?
SM: The world when I started was much simpler — it was very competitive, but had a lot more to do with internal operations. Even though I was CEO, Covenant’s strategy had much more to do with how things were going to run inside the organization.
Since then, we have acquired two other large hospitals. That has meant the patient volumes required for the larger organization were great enough that we have to reach out to communities 100 miles beyond Saginaw for referrals. That led to a whole new set of responsibilities, like developing relationships with executives, boards and medical staffs in communities some distance from Covenant. I’m pleased to say that’s been successful, largely due to the ready and enthusiastic acceptance of referral patients by our 600 doctor medical staff.
Q: I understand you’re working on a creative way to tackle the physician shortage though the development of a medical school — tell me more about that venture.
SM: [Covenant] and a St. Mary’s in Saginaw have joined together to support the development of a new medical school that will be based in Mt. Pleasant with Mt. Pleasant-based Central Michigan University, and in Saginaw for practical training. Two academic facilities are being built here that will have library, labs, simulation labs, classrooms, lecture theaters and practical training for third and fourth year students.
In addition, CMU has adopted a residency training program that Covenant and St. Mary’s had been operating for 42 years. It has about 100 residents. It’s a decent sized educational endeavor, beginning with 66 medical students in Mt. Pleasant, which will eventually increase to 100 students a year. When we see third and fourth year students, we’ll be taking care of a large population of students and residents. There will be 200 students between Covenant and St Mary’s, as well as 100 residents working between the two campuses.
Q: Why partner with a competitor?
SM: The size of the two institutions — it made a lot more sense in terms of numbers of volunteer faculty from our medical staffs who need to be qualified and given academic appointments. There are 300 volunteer faculties from Covenant and a slightly smaller number at St. Mary’s. It takes a large number of physicians to teach the large number of students.
Q: I’ve also heard that Covenant is on a journey to become a Highly Reliable Organization. What drove that pursuit? How is that progressing?
SM: All of management at Covenant is bonused on three annual targets: (1) patient satisfaction (2) clinical quality and (3) financial performance. It struck us while in the throws of devising the quality targets three years ago that we needed a more holistic approach. Why were we dealing with individual items like reducing cardiac mortality when, if we dealt with the entire culture of the hospital and physician staff, we’d be able to accomplish a lot more. That’s what drove us to take on high reliability.
Over the last three years, we’ve been educating ourselves about HRO through site visits and working on a system developed by Children’s Hospital in Cincinnati. We’re being assisted by Spectrum in Grand Rapids, which has been an early adopter of HRO, and we’re using their methods, experiences and training programs. High reliability was pioneered in the airline industry, adopted by nuclear submarine folk in the Navy and is now getting a toehold in healthcare. It has already demonstrated very positive effects. You can feel the initiation of a quality culture in this organization, and that is something that’s hard to achieve.
It’s easy to get hospital staff to [buy in], that’s why [they] signed on to healthcare in the first place. Physician leaders are enthusiastic; in fact, the medical executive committee recently passed a rule that all medical staff must go through high reliability training to remain on staff. That training has not yet begun, but medical staff [leaders] understand high reliability and thoroughly endorse it.
A good number of surgeons recognize the value of teamwork and are seeking help in the operating room when procedures are underway, counting on staff to assist them with any questions or concerns. Other physicians are not as familiar with those principles, so it’s going to be a fascinating to watch it unfold.
Q: What is your outlook for 2014, both for Covenant and for the whole healthcare industry?
SM: I think the major challenge for everyone is what I call a “straddle strategy” in terms of planning for the future. We need to keep one foot in the DRG or fee-dominated world, but at the same time be planning for exchanges and new insurance plans that are part of the [Patient Protection and] Affordable Care Act.
That brings up one of the most interesting opportunities — rural partners. We have 10 rural partners that work closely with us in our role as a tertiary referral center. They will be planning with us to evaluate what is coming in population health management so we can decide whether we will play a role together and what role that would be.
As an institution, about half of our patients come from outside the county, and we need those relationships to survive. I believe that in many instances, care can be delivered in a more cost-effective way in smaller organizations. I can see a future that involves us pushing out some services that don’t require the [level of] care we provide here to a lower cost setting. I’m looking forward to working with our partners on that planning.
I think the unfolding of the ObamaCare exchanges we’ve been reading about is going to be fascinating. The delays will give us a little more time to plan how to accommodate the insurance changes.
Q: Since Thanksgiving just passed, what are some things you are thankful for?
SM: Well, I’ve thankful for my family and friends. Many of them are folks I work with here, who are extremely competent, dedicated people whom I learn from every day. From the board through the ranks of organization, we’ve got a great team of people.
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