Every health system CEO has a defining leadership experience and Scripps president and CEO Chrs Van Gorder’s happened years ago at an Orange County-based hospital he joined as a vice president.
A conflict between clinicians and administration had been building long before he arrived and by the time he got there the relationship between the medical staff, administration and board had collapsed into open hostility. Tension was bad enough that the physicians had organized a boycott and held it until the institution parted ways with its CEO.
But anger persisted and the doctors continued to boycott until they pushed through a critical next demand: maximum board representation. In California at the time, that meant 49%, and they won it. They chose who to send into those seats with particular care — electing, by Mr. Van Gorder’s account, strong and confrontational physicians from their ranks.
What happened next was not what anyone expected.
Once inside the boardroom, the physicians who had led the revolt began voting with the administration on virtually everything. When the physicians who had elected them demanded to know why they had stopped fighting, the physician board members had a flat answer: the administration was right. They had seen the numbers and now understood the pressures. The decisions that had looked like overreach from outside the room made sense once they understood the reasons behind them.
“What was the difference?” said Mr. Van Gorder, looking back on that episode during a recent “Becker’s Healthcare Podcast” interview. “The difference was now they had information they didn’t have before. They got the why. And that’s when I learned how important the why was.”
That lesson — and it was not an obvious one — became the organizing principle of the leadership philosophy Mr. Van Gorder has applied for the 26 years he has run Scripps, which he joined as COO after the physician leadership had issued votes of no confidence in the previous CEO. Six months later, he was running the system.
He established a physician leadership cabinet when he arrived and extended academies across every level of the organization. He holds monthly open Q&As with hundreds of former participants as well traces back that early discovery: information changes behavior more reliably than authority does.
“I put together a group we call the physician leadership cabinet,” Mr. Van Gorder said during a recent “Becker’s Healthcare Podcast” interview. “It consists of the chiefs of staff and vice chiefs of staff and my hospital administrators, with this hypothesis that if we could find a way of filling the gap of information — which we do every month — we would reach the same conclusion.”
The cabinet has accepted 100% of the recommendations that have come out of it, with only one vote falling short of unanimous — and that one by a single vote. The same principle drives the three leadership academies he runs for different levels of the organization: managers and above, supervisors and frontline employees. He attends every session and stays the full day. Each one opens the same way.
“They all start with a wide open Q&A,” he said. “So I get the chance to explain why.”
His commitment to transparency has explicit and publicly stated limits. There are only three categories of questions he will not answer: those that would violate HIPAA, those involving individual personnel matters and those touching active business transactions covered by nondisclosure agreements.
“Those are the only three things that are off limits,” he said.
Everything else is on the table. Leaders who withhold context push the people around them toward speculation and resistance. Those who share it find that people tend to reach the same conclusions on their own.
“When people understand the why, they most likely would make the same decisions we’re making and they can support it,” Mr. Van Gorder said.
The structure extends beyond the formal sessions. He holds a monthly call with Scripps Leadership Academy alumni — several hundred people, typically around 400 on the line — that runs the same way: open question and answer, no agenda beyond what participants want to raise. The investment of time is deliberate.
“That’s the kind of time leaders have to spend their time doing, or they’re going to be reacting and spending time doing reactionary things,” he said.
Mr. Van Gorder came to healthcare from an unusual direction. He worked as a police officer before being injured in the line of duty, when a woman attacked him during a family dispute call. The injury ended his law enforcement career and left him in a hospital as a patient, surrounded by caregivers whose work he came to see differently from that side of it.
“In many ways, I started in this business as a patient,” Mr. Van Gorder said. “It’s pretty easy for me to always remind myself and everybody else that that’s the most important thing we do every single day. No matter all the rest of the noise that goes on around us, taking care of that patient, an individual patient, and that family is the most important thing that any of us should be considering on any day.”
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