Living like a leader: A day with AHA chair elect and Atlantic Health System CEO Brian Gragnolati

brian gragnolati"The way the AHA works — you spend a year as chair elect, then you spend a year as the chair, and finally you spend a year as the past chair. The time obligation is pretty significant and it's not just the travel piece, it's participating in a lot of calls and making sure you're staying on top of the issues we're facing as an industry. In my year as chair elect, I'm on the road probably two to three times a month."


Between clinical objectives, financial concerns, patient needs and complex payer dynamics, there seem to be too few hours in the day for healthcare executives to address the diverse set of organizational goals they are tasked with accomplishing.

Brian Gragnolati joined Morristown, N.J.-based Atlantic Health System as CEO in 2015. He previously served as senior vice president of the community division at Baltimore-based Johns Hopkins Medicine, president and CEO of Suburban Hospital in Bethesda, Md., and president and CEO of WellSpan York (Penn.) Hospital.

In 2017, Mr. Gragnolati was selected to chair the American Hospital Association, a year-long position he will assume in January 2019.

Mr. Gragnolati took the time to speak with Becker's Hospital Review for our "Living like a leader" series, which examines the daily routines of influential decision-makers to offer readers an idea of how they manage their energy, teams and time.

Editor's note: Responses have been lightly edited for length and clarity

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

Brian Gragnolati: I usually get up pretty early, and I like to exercise early in the morning. I have some coffee and catch up with some emails while I'm stretching, and then I jump on my Peloton and do a spin. After that I grab something to eat and try to get through three or four different papers. I read The Washington Post, The New York Times, and The Wall Street Journal as well as The Star-Ledger.

Q: Do you get any work done before you get to the office?

BG: We're always on email. Whether it's a good thing or not, the minute I wake up, I look at my emails. Right before I go to bed I look at emails. Emails are a constant thing. In that context I guess yes, I do some work — but you're always doing it, it's nothing unusual.

Q: What time do you get to work usually?

BG: It depends on my travel schedule. It's actually highly unusual when I'm in the office every day. When I am in the area and not attending some sort of event or breakfast in the morning, I usually get here between 7:00 and 8:00 a.m.

The way the AHA works — you spend a year as chair elect, then you spend a year as the chair, and finally you spend a year as the past chair. The time obligation is pretty significant and it's not just the travel piece, it's participating in a lot of calls and making sure you're staying on top of the issues we're facing as an industry. In my year as chair elect, I'm on the road probably two to three times a month.

Q: What's the first thing you like to do when you arrive at work?

BG: When I get here I'm usually pretty scheduled. I spend a lot of time working with the folks who directly work with me, some of the senior VPs and some of our medical directors. I also like to spend time in our various sites of care. We have over 400 sites of care and almost 17,000 team members at Atlantic. Some sites are hospitals, others are physician practices, ambulatory practices or support facilities. I try to spend some time every week out in a variety of sites, and I do that in a pretty deliberate way.

Q: Is there anything unique about your office setup?

BG: In our office we try to create opportunities for people to come together for both structured and unstructured teamwork so a lot of voices are at the table. It's not a literal office layout, but more of the philosophy about how we work together, and I think that's really important.

Usually form follows function. I'm a big fan of people who work together, and when you put them in the same space they can't run away from each other. They've got to run into each other every day. We also have worked hard to try to get folks on the same teams situated within walking distance if possible, so they have a natural ability to communicate.

Q: How much time do you spend with direct reports?

BG: It depends on the nature of the work they do, but I spend at least 30 minutes to an hour individually with my most senior team every week. If I'm traveling, we try to do that by phone or email. We've got different levels of leadership teams, but the most senior leadership team gets together every other week as a group. I like to have a sense of an agenda, so we have a bit of a road map, but what's important to me is that whether it's free-flowing or structured, we build on the work we're doing. It's a combination of an agenda and open conversation.

Q: How much time do you visit care sites and meet with clinical staff?

BG: I try to concentrate my efforts, so if I go into a hospital I'm not going to every floor. I target a few areas depending on what that hospital president wants me to spend my time on. It gives me time to actually talk with our team members. What I don't like to do is what I call drive-bys, where you walk through, wave at people and say you've been there. I'd rather spend time talking to our team.

Something else I do, which is a continuation of how I entered the organization almost three and a half years ago, is I try to meet as many people as I can. My guess is, in the time I've been here, I've probably met around 8,000 of our team members in different ways.

When I first got here I had an initiative called 5,000 Handshakes, and I spent my first month with a deliberate onboarding process that included spending a lot of time in the field getting to know our team. That was probably the most important thing I've done, and I've continued it through my time here. This doesn't just mean performing rounds; I just hosted my 80th meal with team members. We publicize dates for lunch and breakfast, and employees across the system sign up for them. I tend to have between 15 and 20 people in a session. It's just an hour to spend with our team members talking about whatever is on their mind.

I've gotten to hear some pretty amazing stories about what our people have done and their interests. The other thing that struck me in doing these sessions is that I firmly believe our team members have the answers to a lot of our system's most complex questions. As leaders, our job is to empower them and create an environment where they can really work together and problem solve. It's fascinating to me when I listen to the conversations at the leadership level and then interact with our team. I can see what's working, what's not working and use that as a feedback loop.

Q: How do your roles at Atlantic and the AHA affect each other?

BG: One of the important things we've tried to do at Atlantic is design the organization and the leadership team around a series of principles. One of the challenges as you continue to grow, particularly as you grow geographically, is how do you stay true to those principles. As we grow, we must ensure that our structures and processes follow those principles.

The AHA is a well functioning organization, and I enjoy the travel component of the job because it's fascinating to see the differences throughout our country. The diversity in the country is really important to understand. When you sit here on the East Coast in a densely populated area, it's quite different than when I have an opportunity to go out in New Mexico and meet with some of our frontier or rural critical access hospital leaders. You learn a lot. That's one of the best things about the role at the AHA, I think — you get to see healthcare in all settings and in all circumstances. You get to see the amazing work people do every day to provide access to care.

Q: What do you like to get done before lunch?

BG: I'm a big fan of context, so I like to read the news, get current and make sure I understand what the moving parts are. Whether it's things that are happening in the healthcare industry, or any other news, local or national. To be quite honest I've never lived in a time where on an hourly basis things change so much in Washington, D.C. Staying connected on social media is another important thing. I want to put myself in a position where I'm not surprised by the things that occur after lunch.

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

BG: I think there's a big difference between running a large system and running a hospital in terms of your daily routine. I miss being in a clinical area, I really do. I started my career as an emergency medical technician, so I have this natural gravitation toward emergency departments. When I was directly running hospitals, whenever I would need a break from the office, I'd just walk out the door and go down the hall and I'd be in a clinical area. That's a lot of fun and I miss it.

Being in a corporate office, you've got to plan now and it's an entirely different thing. My days are probably a little different than a lot of others, because I'm not in a clinical area, which is why I try to get out to clinical areas as much as a I can. One aspect of my routine that I hope is not different than my colleagues at other systems is a focus on staying healthy, because these are pretty rigorous jobs. These are not eight-hour jobs five days a week. I think a focus on exercise and staying well is an important element of my routine and the routines of others.

Q: What would you say is the hardest part of your day?

BG: Managing my time. Time is the enemy, there's just not enough of it. The team I work with is great at managing me and keeping me on task, and the team at the AHA has a great support system for their officers and the chair. They include your family in the scheduling, which is really important. The other piece that's critically important is that the team at the AHA and the team that supports me here at AHS are very connected and coordinated, and they do a great job working together since scheduling conflicts inherently occur. What we try to do is get a schedule a year or two ahead of time. Folks on my team make it look easy, so by the time it gets to me it's all solved. They work great together.

Q: What is the most rewarding part of your day?

BG: Spending time in our clinical areas with our team members is really the most rewarding part for me. Seeing the work we do to support patients and communities is clearly the best part of my day. I think it's a privilege to do what I do, and I appreciate every day that I've spent in my career being able to do this. I can't think of a better job.

Q: What's the last thing you like to do before you leave the office?

BG: I like to make sure I'm ready for the next day. Again, I've got a great team that supports me. They lay the next day out for me. They've got all the materials I need, so I know what I need to bring with me in the event that I'm traveling or I know what I need to bring with me to make sure I'm ready for the next day's activities. Fortunately, a lot of that is done electronically now. We've got good systems to make sure I'm ready for the next day.

Q: How do you unwind when you get home?

BG: A lot of times I'm going to an event when I leave the office. Like tonight I am going to an outside board meeting and then a reception. There are very few nights when you just leave the office and go home. I usually leave the office to do something before I get home. It's not unusual for our nights to end at 9:00 or 10:00 p.m. after events or meetings. If I miss my spin in the morning, I'll hop on my Peloton and do it at night. I also have a dog at home, so I like to walk Riley and spend some time with her.

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