The stakes for health system CEOs are higher: CommonSpirit CEO Lloyd H. Dean explains how

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Retirement makes for a big transition in an executive's day-to-day life. This is especially the case when the executive has been working since age 10, like CommonSpirit Health CEO Lloyd Dean.

Mr. Dean, CEO of 140-hospital CommonSpirit Health, will retire from the Chicago-based organization next summer. His tenure at the top of the nonprofit, Catholic health system spans 22 years, but his work life and commitment to service spans decades before he ever set foot in a health system. 

At 10, he began shoveling neighbors' snow and a third of his pay went to his father for rent. It was a defining moment when he learned the importance of making a contribution. Today, Mr. Dean's voice is one of the country's most influential in the fight for health equity, and he has worked with four presidential administrations to move the idea of healthcare for all closer to reality. 

Becker's sat down with Mr. Dean to learn what he's been reflecting upon since announcing his retirement, the expectation of health system CEOs today, how his leadership style evolved after the formation of $30 billion CommonSpirit Health in 2019, what healthcare needs more and less of, and his persistence in rejecting superficial solutions to systemic problems. 

Editor's note: This interview was lightly edited for length and clarity. 

Question: As you prepare for your next chapter, this is an interesting time to reflect on where the hospital or health system CEO fits into society today. Pre-pandemic, many Americans may have carried on with little awareness as to who, precisely, was at the top of their local hospital or health system. 

The past 19 months challenged that status quo, throwing hospital leaders and executives into the limelight as many Americans sought leadership, expertise, scientific evidence and local voices to make sense of what, in many cases, felt unsensible. Have the stakes gotten higher for you and your colleagues? What is expected from this role today that leaders must be prepared to meet?

Lloyd Dean: I think the role and expectations of CEOs have changed dramatically, and over the last couple of years in particular. 

There's no question that you have to be able to articulate a vision for your organization in a way that you've never been called to do before. That vision can't be about products or services, or physically what you hope to accomplish. It has to have values in it, and you have to be able to articulate in a very concise way what it is you stand for. What is your relationship to communities and those you serve, what's the value set underlining the organization? You are called to be able to advocate for those things important not only for your company but for the community.

There's no question, too, that the social consciousness of what you do, why you do it and how you do it is something that consumers and others expect to hear about. You've got to be able to articulate that. It's not just about your organization solely, but what are you doing to make communities and our nation stronger, and how are you using resources you have to accomplish that goal? There is a much greater expectation of how you use your voice and the pulpit you've been given. 

Q: When you participated in a Becker's event about racism in healthcare in June 2020, you voiced disappointment with the incremental solutions that are raised and accepted to solve a systemic, multifaceted and enduring problem. "We cannot accept as a nation Band-Aids being put on cancers," you said. 

A lot of people and companies out there are OK with Band-Aids, though. What's your advice for the lone voice in the room who isn't ready to accept superficial or short-term fixes? 

LD: I'm not willing to accept those. One of the things the pandemic has shown us is that we have to have sustainable, long-term solutions for many of the issues that have lingered for decades. There is some immediacy to some. For some problems, you have to take immediate actions and crisis management. But if we have learned anything, it's that these systemic issues will continue to rise at different times if we don't address them in a comprehensive way. Short-term solutions for long-term issues are diametrically a plan for continued complex issues being in our face, day after day after day. 

Q: Not every executive will be closely involved in a merger that slingshots their organization from 100 hospitals to 140 as you were in the formation of CommonSpirit. That is significant growth, and there's an adage out there that "growth and comfort do not coexist." In what ways did you need to evolve or adapt as a leader to meet the needs of a merged $30 billion health system? 

LD: I think that with size and scale comes an enhanced set of accountabilities and expectations. Scale for the sake of scale — we've seen the problems with that. As you think about evolving to the footprint we have in this nation — potentially positioned to serve 1 out of every 4 Americans — with that comes great accountability. We serve some of the most challenged and vulnerable in our society. 

When I think about scale and the journey to become a $30 billion organization and the responsibilities that go with having 150,000 employees serving the communities we are blessed to serve, you have to think about leadership. Making sure you have the right skills, experiences and vision for the organization. You have to be a good partner. With scale and its responsibilities, you have to realize you can't do it all alone. Who should you be partnering with? 

You also have to understand that you're in a position in which you will likely be one of the major voices for a sector or for an industry. You have to be a convener of others within that sector and not just speak for yourself solely. You understand whether it's around policy, financing models, issues like equity, diversity and inclusion, that your voice is weighted because of your scale. Yet you cannot rest just on your scale alone. You have to understand that with that scale comes an enormous responsibility that employees, consumers and your peers will hold you accountable for. 

Q: What does healthcare need more of?

LD: That's one of my favorite questions. 

First, we need more complete work around equity, justice and fairness as it relates to having clinical, staff and leadership that is reflective of the communities we serve. We need to go deeper and be more purposeful to ensure our care provider categories represent our communities. 

Second, we need to keep pushing for a sustainable method of financing healthcare in this country. 

Third, we need to ensure that everyone has fair and just access to healthcare. We must use our collective voices to ensure that we have some provision that everyone in this country has access to care. 

Fourth, we need to ensure we are enablers and adapters of technologies and innovations that may be used in other sectors to provide quality, more affordable healthcare for consumers. 

Then we need to double and triple down on workforce development issues. We know that as a nation we are facing retirements in our professional categories like we never have in the last few decades. How do we make sure we are addressing work-life balance issues? How do we make sure we are an attractive sector? How do we make sure we are doing those things, so people can feel they not only have balance within their life, but also serve others?

Q: What does healthcare need less of? 

LD: I think we need to have less talk and more action. That may sound critical, and I don't mean it in a critical sense. I'm referring to everyone in this sector. 

When you talk about things like chronic conditions, institutional racism, access — these have been on agendas for a long time. I think we have to be more forceful. I think we have to hold ourselves accountable and be leaders and voices — whether that's with legislators or policymakers — around ensuring access for all. Less talk and less acceptance of variation in the quality of service that is dependent on where you live as opposed to having a fair, just and equal system for all. 

Q: What would you say is your greatest strength as a leader? 

LD: That's a humbling question to ask one, about what they think is their greatest strength. I would say it's my commitment to fairness and justice, not only in healthcare but as a person. I'm happy I've been able to share my voice, experiences and things I've learned with a wide audience, and to try to convince those who fall within my voice of the power of giving to others. We are only as strong as our weakest in communities, and we are all human beings who share more in common than differences. It is essential that, as a leader, I use my voice to ensure others will follow. Healthcare is still a service and a calling, doing things for and with others. 

Q: What have you been reflecting on since announcing your plans for retirement in 2022? 

LD: I'll be very candid with you: There have been a lot of nights where I've been laying in bed, reflecting after my announcement. One of the reflections is, 'Have I done all I could do to leave this nation and this world and to leave the most vulnerable in communities like I grew up in — have I done all I can do with this gift I've been given to be a voice, leader and executive in healthcare?' 

Number two is, while I'm still in this position, I'm reflecting on unfinished business. Things I want to say, things I want to accomplish at CommonSpirit Health, things I want to work with others to ensure that as a nation we address. I've been reflecting on how I take lessons I've learned, gifts I've had to serve with others, and mistakes I've made and transfer that knowledge not just to my successor, but with others.

Q: I'd imagine some tossing and turning is quite natural with questions like that.

LD: Yes. I have worked since I was 10. I come from a big family, and my parents did not have a lot of fiscal resources. Everyone tells you about retirement, and everybody has a different opinion on it. I'm excited in many, many ways. I have a life agenda with some chapters yet to be written. There's my family, grandkids, wife — many things to look forward to. I do wonder what that first day will be like. For a moment, I will wake up and not know exactly where I'm supposed to be and when I'm supposed to be there. I also look forward to continuing to live my life to serve others in different ways. These jobs can be very consuming, so [I'll be] doing things on my bucket list and with my family and my wife, but I'll continue to try and make a difference while I have a breath in my body. 

Q: May I ask what your first job was at 10?  

LD: Shoveling snow. 

I grew up in Michigan, and there were seven boys and two sisters, with my two sisters at the end. I was the second oldest. My dad was kind of an old-school, military type guy. He started telling all the boys at age 8, 'Well, you'll be working soon.' I thought he meant at school. No, he meant we'd be doing something to contribute to the family. 

At 10, I'd go to my neighbors and ask if I could shovel their snow. If I made $5 a week from shoveling snow, my dad got a third of it for rent and family expenses. At the time, I thought it was criminal. But it taught me about responsibility to family. It taught me nothing is free in life. It created a work ethic. At the time, I thought there's something wrong with my dad. But with nine kids and the income that he was able to make from the factory, which was not enough, it was more than just a philosophical thing. We all needed to contribute to the welfare of the family. 

At the time, these lessons … you know, I just thought it was so harsh. But once I understood the pressure of living in a three-bedroom home with 11 people, trying to feed them on a meager salary, working in a factory where he knew he would — and he did — end up with black lung disease. The pressure of that. I didn't connect the dots until I got older, but it is a great life lesson.

Q: What would you say is the most fulfilling or proudest accomplishment of your career? 

LD: I'm not trying to be trite in my answer, but being part of the creation of one of the largest health ministries in this country, CommonSpirit Health, is something I'll always cherish. Also, having the opportunity to work with four [presidential] administrations and be part of healthcare for all in this country. Third, being able to serve with some of the most dedicated and committed employees and leaders in healthcare is one of the greatest gifts I've ever been given. 

Q: Toughest part of your career? Anything you know now that you wish you'd known then? 

LD: The toughest part has been recent: living through the pandemic. The number of personal friends I have lost, employees I've lost and in the quest to have access to healthcare for all — the devastation of 700,000 dying that we've all witnessed has been one of the toughest parts of my life. Lastly, in terms of the toughest part of my career, that has been the pace of change for equity and healthcare for all. 

Q: Tell me what you most want to see from the next generation of healthcare leaders, who are reading this and may succeed you and many of your colleagues one day. The more specific the better.

LD: It's pretty simple. It's collaboration, imagination and inspiration. Focus on ensuring that people in our country but also around the world ... for them to live a fruitful life, they have to have access to healthcare. My hope is they will use their voice to carry that forward. I'm hopeful. They may do it differently, or certainly with more innovation or resources than we currently have available to us. People will see this is a worthy calling. 

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