Living Like a Leader: A day in the life of Paul Viviano, CEO of Children's Hospital Los Angeles

Paul_larger_pic.jpg"When the pandemic first showed up, I asked our leaders who could do so safely to be present, to be here, be visible and ensure we are leading by example since we are designated as an essential service. There was a lot of pressure to have team members work remotely, but I asked my direct reports to refrain from working from home routinely. I wanted our presence to be felt by the entire team."

Between driving growth, meeting clinical objectives and navigating complex payer dynamics, there don't seem to be enough hours in the day for healthcare executives.

Leaders succeed despite these challenges, each with their own habits, hacks, styles and methods — and Paul Viviano, president and CEO of Children's Hospital Los Angeles, is no exception.

Mr. Viviano, who began leading the hospital in late 2015, oversees the oldest freestanding children's hospital in California that has grown to employmore than 7,000 team members, cares for 17,576 inpatients per year and sees more than 600,000 patient visits annually. 

Before joining Children's Hospital Los Angeles, Mr. Viviano led the UC San Diego Health System as president and CEO and also served as associate vice chancellor of UC San Diego Health Sciences. Mr. Viviano has also held chief executive positions at USC University Hospital and USC/Norris Cancer Hospital in Los Angeles; St. Joseph Hospital of Orange, St. Jude Medical Center; and Los Alamitos (Calif.) Medical Center. 

When people ask Mr. Viviano why he decided to take a role leading the top safety net children's hospital in California, he says, "I see it as we're giving every single child — regardless of their family’s financial status — the best chance to survive and thrive, to have a life that's productive and promising. No one could do better in providing that opportunity to the precious children that have been entrusted to us."

Giving children the best chance to survive is a great way to describe the hospital, which has been named a top pediatric hospital by U.S. News & World Reporteach year since the magazine began ranking children's hospitals in 1990. In the most recent edition, Children's Hospital Los Angeles was the highest-ranked hospital for children in California and among the top five pediatric hospitals in the nation.

For this installment of Becker's Hospital Review's Living Like a Leader series, Mr. Viviano offers a glimpse into how he manages his energy, team and time. He also shares how the pandemic changed his daily routine and how he is ensuring Children's Hospital Los Angeles is addressing systemic racism.

Editor's Note: Responses have been edited for length and clarity.

Question: What's the first thing you do when you wake up?

Paul Viviano: I'm an early riser. The latest I wake up would be 4 a.m. Three days a week I just get up, get in the shower and come to work. I literally can't wait to get to the hospital to start my day. About two days a week, I will start my day with a workout. I have a small gym in the garage. The Peloton bike has become a favorite, but I also have an elliptical, weight machine and heavy  bag. I mix it up every day. Each morning, I'm up instantaneously and am either getting ready to come into the office or exercising and then coming into the office. 

Q: What's the first thing you do when you get to work?

PV:  
I come in through the main hospital entrance and I undergo a COVID-19 health screening like every team member and visitor to the hospital. I go to the front desk and greet the team welcoming early-arriving patients for surgical and other operative procedures. I'll say hello and offer to buy them a cup of coffee or tea. From there I'll walk to my office, past the surgical admitting area, and say hello to families as well. When I get to my physical office, I will immediately check my emails. 

Q: Is there anything that makes your office setup unique?

PV: The offices for our senior leaders are on the main floor of the hospital, and that is something we've maintained on purpose. I want all our leaders to be accessible to staff, faculty and anybody else who might need to find any of us.  I can literally take 10 steps from where my actual office is to the main hallway of the hospital and see our patients going to clinics, to exam rooms or to the operating rooms.  While it may not be unique, it is special to have our executive offices right in the middle of the action.

My specific office has a lot of memorabilia and a standup desk. And the door is always open. 

Q: How much of your time is spent with your direct reports?

PV: No two days are alike, but I would say 20 percent to 25 percent of my time is spent with direct reports. There are days when it's 100 percent, so it varies. The vast majority of our executive team, the people who report directly to me, are within a few steps of where I sit, and I think the frequent interaction with them is important and allows us to get together spontaneously several times a day. 

Q: How often do you meet with clinical staff or perform rounds?

PV: Every day I talk to clinical staff. Pre-pandemic, I'd say I made clinical rounds every other day. It's been a little less frequent since the pandemic started, as I want to be respectful of our protocols concerning physical distancing among caregivers, patients and their families. 

Q: How do you think your routine differs from that of other healthcare executives?

PV: It's always hard to compare with other healthcare executives. I try to get here early, typically between 5:30 a.m. and 5:45 a.m. On days when I work out, I'll probably get here by 6:15 a.m. The first hour is quiet, and I dedicate that time to responding to emails. The day usually picks up around 7:30 a.m. Then, I am typically in meetings or have scheduled phone calls until the sun sets. When the meetings end, I go back to responding to emails. Typically, there is not a lot of time in my day for returning emails, so it's always a race to keep ahead and to be current with those. Additionally, in the evenings, pre-pandemic, I would have dinner meetings or events at least three nights a week, sometimes all five week nights . Since the pandemic began, there are very few  evening events, like fundraising or dinners, but meetings may stretch later in the day instead. 

Q: How has your daily routine changed amid the pandemic? 

PV:  When the pandemic first showed up, I asked our leaders who could do so safely to be present, to be here, be visible and ensure we are leading by example since we are designated as an essential service. There was a lot of pressure to have team members work remotely, but I asked my direct reports to refrain from working from home routinely. I wanted our presence to be felt by the entire team. We also took important steps to ensure a safe environment for all – team members, patients and patient families. Today we have about 2,000 of our team members working from home out of our roughly 7,000 team members. But the vast majority of the management team is on site. 

Additionally, the composition of the day has changed. We created a COVID-19 command center, and at least once a day I connect with the response team, thanking them, getting the updates and helping to make decisions about testing, masking, supplies and new physical distancing measures. In addition, email traffic has gone up very significantly for me. I probably get 100 more emails today than I did pre-pandemic, as people are trying to communicate in a different way. In addition to my weekly newsletter update, I began recording weekly  video messages to our team members. The goal is to be as communicative and transparent as possible at a time when a lot of decisions are being made quickly and in direct response to the ever present need to assure the safety of our team members, our patients and their families.  

Also, many functions have moved online. We do many more things via video call, even ourboard meetings, which have increased their frequently so we can keep them updated on the changes that we were managing and the impact of the pandemic on our organization. The result has been meetings that are more frequent while being shorter and more efficient. 

Q: How has the COVID pandemic affected Children's Hospital of Los Angeles?

PV: The number of COVID-19 patients that are hospitalized in the adult population is significantly greater than those hospitalized in the pediatric population. But children can carry and transmit the virus, so our health and safety precautions to keep patients, families and team members safe all mirror those of an adult hospital. We developed health screening and in-house testing capabilities, acquired personal protective equipment and followed health department requirements. We have incorporated extensive health and safety measures – masking, deep cleaning, physical distancing and health screenings of staff and all visitors entering the hospital to make it a safe environment for patients, families and team members.

What has impacted us so dramatically was when early on, the state ordered us to reduce our caseloads to make room for a surge, a groundswell of other patients who would require immediate hospitalization. Emergency department visits fell when the pandemic began, and stay-at-home orders were issued. In addition, our inpatient census has been down about 20 percent and surgical procedures decreased as well, though they are returning to normal. Overall, patient volumes have decreased between 25 and 30 percent (something that is in line with many other children’s hospitals). 

While families may be reluctant to bring their child to the hospital, the emergency department, or an outpatient clinic for a doctor's visit because they're afraid that their child might be exposed to the virus, we are reminding families that it is critical for children to keep up their vaccines and treatments for chronic illnesses, and that their child’s health is essential, even during COVID-19. 

Q: How are you, as CEO, working to bring back patients and normalize operations?

PV:  We've done a lot to offset the adverse impact, including reaching out directly to patient families and launching a campaign urging families to not postpone appointments, emergency care or chronic care while assuring them that CHLA’s environment is safe. But demand is down. Because children are home and aren't congregating in daycare centers  and schools and because of physical distancing, they're not exposing each other to germs. They're not going to sports camps and therefore they're not sustaining sports injuries.  

We are responding in several ways. Our outreach campaign includes television and radio news segments, out-of-home and public service announcements. The goal is to make sure families know that we are a safe environment for every type of care we were providing before the pandemic. All inpatients and any child undergoing a medical procedure is tested. Every employee and all visitors are screened prior to entering the hospital. Wearing a mask is mandatory and physical distancing measures are in place. 

In addition, we have done a remarkable job boosting our telehealth infrastructure. We had developed a platform that wasn't being used very frequently prior to the pandemic, but now that we revamped the technology and trained our teams, telehealth has provided extensive access to families. About a quarter of our patients now are being seen via telehealth, and our doctors have conducted more than 50,000 virtual visits in the first five months of the pandemic.

We've also reached out to a number of adult hospitals in Los Angeles County that have small pediatric units and have volunteered to help them with staffing, and for those who have closed their units temporarily, we agreed to accept all transfers.

Overall, as an organization we have reached a daily cadence of meeting with senior leaders and have scaled back our weekly briefing with all other leaders – administrative, clinical services, research and providers - to every other week.          

Q: How are you ensuring that Children's Hospital Los Angeles is addressing systemic racism and promoting diversity?

PV: Racial injustice is a public health crisis. We are committed not only to establishing a diverse workforce and leadership team, but also to creating an anti-racist culture. I have received hundreds of emails around this topic, and I've answered every single one of them personally and participated in a Town Hall held on the topic. 

Children's Hospital Los Angeles formed an Office of Diversity, Equity and Inclusion just over a year ago, before racial injustice became so central to our current cultural conversation. 

We are proud we did so. In our experience, it's unusual for a freestanding children's hospital that is independent from a university system to have such an Office. This gave us the structure to commission a Racial Equity Task Force more recently to help us understand and take actions in support of racial justice; and further to ensure we articulate our values and what we stand for. 

We've hosted listening sessions with team members and boosted communication with team and faculty members. We have also participated in a White Coats for Black Lives demonstration and made it a house-wide opportunity to express solidarity with our Black colleagues. We are also curating resources to support all of our team members in learning more about this issue. The ultimate commitment for us is working to eliminate disparities in health outcomes. 

Los Angeles is a very diverse city, thank goodness. But there are differences in outcomes based on race. We have a healthcare disparities dashboard for outcomes, and we are bringing greater vigilance to attending to sharing findings to build broad awareness and develop commitment to institutional actions that will result in improvement. We have a long way to go and a lot to learn, but there's earnestness about our desire to be a more inclusive and a more culturally humble and sensitive organization. 

Q: What's the hardest part of your day?

PV: The hardest part for anybody in healthcare is circumstances where families experience a loss. While we have been recognized for fantastic clinical performance, there are still days when some of our young patients don't survive. Spending time with families who have lost a child is without doubt the hardest part of all the work that we do. I know caregivers on the front lines have it much harder than I do in that respect, but I am always humbled when I am able to be engaged in these discussions. This is the hardest part of anybody's job in healthcare — knowing that some outcomes don’t change no matter what you do.

Q: What's the most rewarding part of your day?

PV: It is the converse of my answer for what the hardest part is—to have the opportunity to do more for children and help them survive. It's rewarding to develop new programs and services. It is rewarding to demonstrate that we are creating a future for them that is promising, hopeful and healing.

Q: What is the last thing you do before you leave the office?

PV: 
I make sure there are no emails that need an answer immediately. I'll check my phone to make sure there are no text messages that similarly would need a response. 

Q: Do you do any work at home? Why or why not?

PV: After dinner I'll take a walk to get a little exercise and fresh air, and then I will check emails again, ensure that I attend to preparation for the next day. For me, I'm cleaning up my inbox and just making sure that everything is addressed and read. And while I do this work outside of typical business hours, I don't expect fellow team members to respond to me on the weekend or at night unless it's urgent. It is important to ensure that team members know that they don't need to be on their emails 24 hours a day. I'm not, and I don't expect them to be. Everybody needs private time, rest time, exercise time, family time and spiritual time. 

Q: How do you unwind at the end of the day? 

PV: Our two daughters are now grown and out of the house. When we had children at home, unwinding would be spending as much time with them as possible. Now it is having dinner with my wife, uninterrupted when possible. It is also taking a walk after work or spending my commute home reflecting on the day. Although my kids are grown, we're in this great phase of life. They each have two children, so we have four wonderful grandchildren. Pre-pandemic, we spent a lot of time with them. Now it’s obviously a little less so and very carefully structured, but it's quite special to have them live relatively close by so we can spend quality time with our entire immediate family.  

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