The hardest thing I've ever done: 12 physicians, CEOs and nurses on a tough professional moment

Healthcare leaders encounter challenges on a daily basis. Although some are easy to overcome, others take a more substantial toll on not only the leader, but his or her team and organization.

From changing relationships with colleagues to handling layoffs to protecting their employees and patients during national disasters, these men and women have put their leadership to the test.

Joel T. Allison, CEO of Dallas-based Baylor Health System and Baylor Scott & White Health

"The first time I ever served in a CEO role, I was recruited to do a turnaround. At the time, that particular hospital was experiencing major financial challenges. To stay viable, we determined we needed to reduce our workforce by 200.

I felt it was my responsibility to meet with those employees face-to-face. That was one of the hardest days of my professional life as I knew our decision would have a significant impact on each one of those employees and their family members. In the end, we were able to keep the hospital financially viable so, in turn, hundreds of other employees kept their jobs. Sometimes you have to make those tough calls, but they should never be easy."

Sue Eckert, CNO of Washington, D.C.-based MedStar Washington Hospital Center

"For me, the hardest leadership moment was September 11, 2001. As we all know, the attacks on the nation were so shocking and catastrophic. At that time, I was serving as senior nursing director for critical care and emergency services [at MedStar Washington Hospital Center].

When we understood New York was attacked, we began to prepare to receive people. As the plane hit the Pentagon, we actually went into preparing and planning for what we hoped was going to be a large number of victims from that particular site.

I went through three phases that day. The first phase was not particularly difficult because my staff and I are well-trained on how to activate our emergency response system. We all understand how to compartmentalize, but it was more complex because of the emotions.

What was hard was what was to come. So many lives were lost in New York City and Washington, D.C., and it became evident as time passed that there would not be victims coming. We were literally just waiting to receive the patients, but we began to realize with horror that it was not going to happen. I had to lead a team that was energized to support so many, then grapple with the realization that it wasn't going to happen.

The third phase is that everybody is human. There were so many people who had lost loved ones in New York and in the Pentagon. I heard story after story after story of people worried about their mother, father, husband, child or sister. I had to be realistic and understand there would need to be support for the teams.

We ultimately did receive all the survivors from the Pentagon who needed hospitalization. We received 14 people when we wanted 300. I also had to prepare the team to stand down. They understood that by leaving, the reality was true. I had to help people feel that their contribution was important, but it wasn't going to be used at that point in time.

The whole day is a bit of a blur. At some points, time seemed to be in agonizingly slow motion, but at other points it moved at warp speed. As a leader, you have to make sure your personnel feel valued and supported. You're able to provide them the solace needed to get through such a catastrophic event."

Thomas L. "Tim" Stover, MD, president and CEO of Akron (Ohio) General Health System

"My toughest moment was when we had to do a reduction in force three-and-a-half years ago. We had to take cost out and eventually it got down to employees, although they didn't do anything wrong. While it did help our financial turnaround, I hope I never have to do it again."

Kim Bordenkircher, CEO of Napoleon, Ohio-based Henry County Hospital

"My toughest moments are the times when I have to support or counsel a healthcare practitioner who's had a tough professional moment. I have to help them figure out that they're not a failure.

Immediately a few instances come to mind. For example, one physician sat with me and said he was just burned out. He was one of the most compassionate doctors I knew. I had to figure out how to help him regain that spirit. It was also challenging for me to reflect on my encounters with him and wonder why I didn't notice he was burned out.

Another was a physician for whom I had the utmost respect. While resuscitating one of his patients, he left and didn't return. I asked his secretary to track him down. She called his wife, who told her he was sitting in a chair and not talking to her.

Healthcare is a physically, emotionally and psychologically demanding profession. As an administrator, I feel it's my job to take care of the caregivers and provide the environment for people to save lives. You encounter people all the time who are heroes, and it's tough when you see the lights go out in somebody that's a hero."

Michael Ugwueke, president and CEO of Methodist Healthcare Memphis (Tenn.) Hospitals

"In the 29 years I've been doing this, I've experienced a number of challenges in all situations. What comes to mind is dealing with physicians not as your employees, but as your partners. You may have a very talented physician who has issues with something, but you must try to deal with this situation and get him or her to try to understand that they're going to derail. With all the talent they have, trying to salvage situations like that is difficult.

Situations where there's a group trying to break up are also difficult. From an administrator's point of view, you need and would like them to stay in tact. But sometimes it comes down to personalities, which makes it harder to reason. You become the mediator and the go-between, which is very time-consuming. It's rewarding when you're able to resolve those issues to, hopefully, everyone's satisfaction."

Sandra Bruce, president and CEO of Chicago-based Presence Health

"One of my worst moments was when I had to suspend a physician from the medical staff for poor clinical outcomes. The physician had been a mentor to me and had helped promote me for my first CEO job."

Cliff Robertson, MD, president and CEO of Omaha, Neb.-based CHI Health and Senior Vice President of Divisional Operations for CHI

"Early in my career as a physician leader, I was thrust into a tense situation in which our organization was faced with the recognition that a major strategic initiative — a joint venture medical group — was failing and needed to be completely unwound.

While I wasn't involved in the initial decision, I was in the middle of a very difficult, rigorous internal debate about whether to stay the course with this fairly dramatic decision — and if we did stay the course, how were we going to make the new strategy successful after we separated from this medical group?

The hardest thing I had to do was take a step back, acknowledge the facts didn't support continuing our relationship with the group, and understand that leadership — myself included — needed to accept this reality and successfully lead a complete directional change in a very important part of our operations. As a leader, I recognized how tough it was not to be demoralized by the failed initiative.

But then I related this particular episode back to the thousands of treatment decisions I had made as a clinician, some of which didn't result in the desired outcome. As a physician, it's second nature to accept the need for course corrections or alternative treatment plans and to listen to contradictory opinions from consulting specialists.

As leaders, we must listen to others and be willing to correct our course when needed."

Chris Van Gorder, president and CEO of San Diego-based Scripps Health

"When I arrived at Scripps more than 15 years ago, the organization was struggling and there was little cooperation between the physicians and the administration — in fact, there was a lot of anger. The previous CEO had unveiled a new strategic direction and an operational approach to achieve the strategy but it was not supported much outside the corporate office. Things got to the point where medical staff at four of our five hospitals held no confidence votes and soon the board of trustees asked the CEO to resign.

When I was appointed interim CEO, I had to find a solution to bring our physicians and administration together. One of the first things I did was form the Physician Leadership Cabinet, made up of the system's elected physician leaders, with the CMO and me as co-chairs. I told the doctors we needed to mutually share our concerns and knowledge — fill the gap of information — to make better decisions for Scripps. Based on my past experience, I had learned that when gaps of information exist, conflict occurs. I wanted to bridge that gap.

At first, the physicians wanted the PLC to be a board with formal powers. But I didn't have the authority to do that and told them so. I reminded them they didn't need formal power to affect change. I explained that their 'informal power' was actually more powerful than any formal power I could give them. I also wanted to build trust between both groups of leaders.

The first thing the newly-formed PLC asked for was $4 million more to support the emergency call room panels. At that time we were struggling financially, so I let them know I could either give staff raises that year or give the physicians the money for the call panels.

Information about our available resources and demands for those resources had never been shared with our physicians before. To their credit, they pulled back on the demand and agreed to study the situation — administration and physicians together. The organizational challenge was now owned by all of us. In the end, the physician leaders did consider all the facts and came back with a new solution: a $2 million increase to the emergency room call panels and the other $2 million for the staff raises. The information gap had been bridged — we owned the problem and solution together. We had turned a corner.

It was indeed one of the most difficult moments I've ever faced professionally. But it became the foundation of a trusting, open working relationship between administration and medical staff. Since that first meeting more than 15 years ago, management and the board of trustees have accepted every one of the PLC's recommendations."

Gyasi C. Chisley, CEO of Memphis, Tenn.-based Methodist North Hospital

"I have faced many challenges throughout my career, likely too many to enumerate. I have been able to overcome them through the support of my team, careful consideration of facts and incorporating an evidence-based approach to the problem. I am grateful for these challenges because it has only deepened my resolve toward organizational performance, furthered my passion to partner and fostered most of the relationships with my colleagues. Moreover, I know I have grown as a person and a healthcare professional because of these challenges.

I take great comfort knowing I can always resort to our mission, vision and core values as guideposts, which are aligned with my own personal precepts and principles, when faced with difficult decisions. As leaders, I know we are fully aware that many of the decisions we make will ultimately impact entire communities and generations to come. It is certainly sobering, but serves as inspiration to do the right thing. I have always been told that the 'harder right is more difficult to execute in business than the easier wrong.'"

Teri Fontenot, president and CEO of Baton Rouge, La.-based Woman's Hospital

"The month after I became CEO nearly 20 years ago, the executive team met to strategize our future, and it was clear we were going to have to eliminate several positions hospital-wide. Our organization had never had a full scale layoff, and it seemed inconsistent with our values and strong culture.

Through the process, however, we were transparent, sensitive and available around the clock to answer questions and reassure staff that this was the only one. We also vowed we would never get in that position again and it has been a strong reminder to be vigilant with managing operations out of respect to our team and our obligation to be stewards of our organization."

William Considine, president and CEO of Akron (Ohio) Children's Hospital

"The meaningful mission of Akron Children's Hospital and the precious bond we have with the children and families we serve creates a magical positive energy. That energy presents enormous opportunities for us to partner, develop new programs and reach more children. The challenge is prioritizing those opportunities in a way that enables our communities to develop sustainable programs with a true family-centered care focus supported by our Children's culture. Haste makes waste and our children deserve an approach that is sustainable."

Mitch Wasden, EdD, CEO and COO of Columbia, Mo.-based University of Missouri Health Care

"The most difficult time I've experienced in healthcare was Hurricane Gustav in 2008. While serving as a CEO in southeast Louisiana, our organization had just acquired a new hospital and we were experiencing all the difficulties of merging two cultures. There was uncertainty about how processes would change as well as a feeling that the acquiring organization felt superior to the acquired facility.

At about this time we noticed a tropical depression in the Gulf of Mexico and began hearing the usual drills on the news about hurricane preparedness. We weren't too worried given we were 100 miles inland, and our organization had already successfully survived Hurricane Katrina in 2005 and won national acclaim for our preparedness efforts.

As the storm drew closer, it looked like it would hit the West Bank of New Orleans and would likely affect us very little. As a precautionary measure, we decided to rent a semi truck-sized generator that we could power the hospital on in a worst-case scenario. Thank goodness we did because a worst case scenario is what we got.

The storm shifted away from the West Bank and headed straight for Baton Rouge, the location of our hospital. We knew being 100 miles inland wouldn't be the problem, but wind definitely would be. We divided up the staff into A and B teams. The A teams would spend the night and ride out the storm. Once roads were cleared, the B teams would relieve the A teams. We spent several days stock piling supplies and fuel to make sure our patients and staff were safe.

And then it happened: The storm hit. From inside the hospital it sounded like a freight train was running on top of the roof. We duct taped windows to prevent glass from shattering on patients and staff. All night you could hear the cracking of trees and highway signs.

In the first hour, the phones were working and I talked long enough to my wife and three small children to hear that the shingles were flying off our roof and that several neighbors had their large oak trees 'tomahawk' their homes. Then the phones went dead. Luckily we had a safe place in our home for my wife and kids to take shelter free of windows and falling trees. Texting was the only thing that would work and only occasionally.

We had learned lessons from Katrina that were invaluable. Namely, staff won't come in to take care of patients if their own family and pets aren't taken care of. As a result, we advised everyone to send family out of town or find accommodations with other friends and family in a safe place. There were some who couldn't find accommodations, so we housed a limited number of family and pets and created a makeshift kennel.

Before the storm hit, we knew all our jobs would change. After all, who needed an accountant, CEO or marketing department during a hurricane? What we needed was people to clean pet cages, feed patients and visitors and help security protect the perimeter so we weren't overwhelmed by looters or those seeking the food and fuel we'd need for patient care.

As the morning came and the storm passed, we learned the power was out everywhere in town and roads were impassable due to trees and fallen power lines. Our team A would need to stay another night until team B could get in. We couldn't make contact with other area hospitals, so we made the decision to carefully drive to nearby hospitals to see if they had patients they may need to transfer. We made arrangements for the transport of some of the most critical patients and then made our way back to our facility.

After a few days we had gotten into a rhythm. But after the fourth day we had a problem. Although the B team had relieved the A team, the A team couldn't come back to work because they couldn't buy gas. There was plenty of gas at gas stations, but without power it couldn't be pumped. We determined we'd have to find a tanker to bring us gas so we could begin rationing it to employees so they could make their way to and from work. We had a large fuel tank that we filled every two days and even had a way to clock how many seconds of pumping was equal to one gallon of gas.

After nearly two weeks, the power was finally restored and things were back to normal. We had undergone one of the most difficult and chaotic times in our careers, but at the same time, it was amazing how well the team pulled together. Our response during the crisis was a point of pride for the staff for many years to come."

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