With balancing clinical objectives, financial concerns and complex payer dynamics, there don’t seem to be enough hours in the day for healthcare executives to address the diverse set of organizational goals they are tasked with accomplishing.
However, leaders succeed despite these challenges. And they each have their own habits, hacks, styles and methods to do so.
Divya Joshi, MD, moved to the U.S. from Austria about 26 years ago to complete her residency and fellowship at Rochester, Minn.-based Mayo Clinic. As she spent time working and helping patients in the U.S., the country quickly became her home. Upon completing her residency and fellowship she decided to stay.
Now, Dr. Joshi serves as CEO of OSF HealthCare’s Children’s Hospital and children’s service line, a role she obtained in 2015. In her leadership position, Dr. Joshi is tasked with improving the health and wellbeing of children across the 13-hospital system
Prior to joining OSF, which is based in Peoria, Ill., Dr. Joshi served as CMO of Miller Children’s and Women’s Hospital in Long Beach, CA and as faculty physician in pediatric hematology, oncology and palliative care at Marshfield (Wis.) Clinic and St. Joseph’s Children’s Hospital in Marshfield.
Here, Dr. Joshi spoke with Becker’s Hospital Review for our “Living like a leader” series, which examines influential decision-maker’s daily routines 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 is the first thing you do when you wake up?
Dr. Divya Joshi: Ensure I take time to be thankful for the wonderful people in my life like my husband, parents and friends. I look out the window, which faces trees and a river, to just enjoy the beauty of nature in my first few moments awake. My mornings are usually very slow and quiet. I will typically read the news over breakfast. and spend some time outside with my dog. I then typically look at my calendar for the day to get mentally oriented. I like to know going into the day whether it will be filled with meetings where I must be mentally agile, or if this will be a day that has time reserved for me to think, read, strategize and talk to people, which requires a different frame of mind. Then I leave for work. My entire morning routine takes about an hour and a half. I prefer to really start slow. It grounds me. It gives me a sense of balance, self, purpose and a deep energy that comes from within. I find this really sets me up for a good day.
Q: Beyond looking at your calendar, do you complete any other work before you get into the office? What about after work?
DJ: No, typically not. I look at my calendar on my iPhone. That said, if I have any texts on my iPhone, that typically means there is something that requires urgent attention. If that’s the case, I will look at those texts. However, I do not look at emails.
If I am doing any work at home, it’s “thinking” work. The brain is not something you can turn on and off like a light switch. So, work somehow always comes home with me, but not as a burden. I might not necessarily sit down and start thinking about it, but allowing the issue to stay with me sometimes allows solutions to pop into my mind.
Q: Is there a reason you choose to not work from home?
DJ: I like to have time to be balanced and to contemplate the bigger things in my life, such as my husband, friends and my parents. I think about what I want to accomplish, which is making a difference for others and being a good person, and part of that thought process is working through how I can make a difference through work. So that all kind of amalgamates, if you will, into one thought process about work in a larger sense. But it’s not that I’m looking into what meeting I have, and what’s this email? No, it’s really a contemplative phase where I really ask myself and enjoy thinking about why I do what I do and who I want to be.
Q: What’s the first thing you do when you arrive at work?
DJ: I make a point to say hello to whoever crosses my path. If it is somebody who I know is going through a beautiful phase in their life, like they are about to have a grandchild, or a sad time in their life, like losing a parent, I will inquire about that.
The first thing I do when I get to my desk is look at the calendar in detail. I like to know what is facing me and what frame of mind I need to be in.
After that, I usually try to respond to as many emails as possible, because I don’t like feeling encumbered. Number one, I don’t like things unfinished. Second, I like to be very prompt. One thing I want people to know is that when they send me something like a document, a question, a follow-up or a problem, that I will address it in a timely way. I have a rule that every email will get responded to within 24 hours. As I go through my email, I will triage and prioritize things that need to be done over the course of the day. So, I have a little list and I might write down these things need to be done and then I assign them a number based on importance.
Q: What is your daily schedule like? What kind of work do you like to get done before lunch?
DJ: I typically don’t have a before-lunch, after-lunch schedule. However, I have a rule where every single day I block two hours in my schedule. I call it my “office time” and it doesn’t have anything scheduled in it. I use that time for fleshing out an initiative I want to work on. I think about it, research it, I might pop into other people’s offices who are experts or knowledgeable on the subject or whose brains I want to pick. I might write a draft of the strategy on my board. I might read multiple magazines, journals, blogs and newsletters that pertain to my job. So, that’s what I do during my office time.
Occasionally there will be a day that gets so busy with meetings, we can’t have those two hours and I try to move them to another day. And sometimes those two hours need to be moved into a one-hour block here and a one-hour block there, and that’s okay.
Q: Is there anything that makes your office setup particularly unique?
DJ: I always request a window where I can look at nature, whether that is a tree or a view of a field. I have found it very helpful, because when I think and look out the window, thoughts come easier. A while ago I read an article, in Harvard Business Review,about research that found a person’s brain is refreshed from a few minutes of looking at something natural, even if it’s a potted plant. I found it very interesting that something I always wanted in an office has a scientific explanation.
The second thing I like in my office is very large white board. On one side I have a list of initiatives. with dates and timelines — what needs to be done by when and who’s responsible for what. On the other side, about 75 percent of the white board is left blank with space for brainstorming, drawing and writing. And the other portion of my white board has my core agenda for the fiscal year. The idea is that whenever I look at my white board, I see my goals for the entire year at a very high level and what the current initiatives are and where we stand from a timeline perspective. Where are we behind? Where are we doing well?
Q: How much time do you spend with your direct reports?
DJ: I meet with my direct reports once a week for an hour each. The organization is super matrixed. So, I will also meet with those who do not report directly to me on the organization’s chart. I will meet with anyone if it furthers the work we need to get done.
Q: How often do you perform clinical rounds?
DJ: I perform rounds in two different ways. The first is weekly, in a rotating fashion. I spend an hour on the general floor one week, the neonatal intensive care unit the next, the pediatric intensive care unit the next and the clinic the following week. During those rounds, I chat with any physicians or nurses I encounter. If they go to see a patient, I might join them to see that patient. If I see a parent, I will say hello and ask how their experience has been and what we can do better. If I see a child alone in a room, I might stop by and play with the child, so they are not alone.
The second way I complete rounds, which I normally schedule once every two months, is spending an hour with the division heads. I will rotate once a month or once every other month. I ask them to allow me to spend the hour with them, in whichever way they want. I will join them for rounds, join them in the operating room or join them for a meeting they lead. It’s just a sense of wanting to be part of their work and meet the people they work with to get a sense of the culture and dynamics. So those are two different types of rounds that have two different goals.
Q: How do you think your routine is different from other healthcare executives?
DJ: I would say that it is easy to get time with me. My assistant is wonderful, she came up with a way to make that happen. I have built into my schedule a lot of flexibility and availability for people to make appointments, such as my “office time.” Because if I’m in my office for two hours reading or strategizing that is time when people can just pop in.
Q: What is the hardest part of your day?
DJ: I think it’s when an initiative gets stuck and is unable to move forward because there are so many people involved or options to pursue. Sometimes it’s very hard to get people and ideas together. Beyond that, I would say when I don’t have the answer to something. I’m not the most patient of people, and sometimes I would like things to happen immediately.
Q: What’s the most rewarding part of your day?
DJ: The most rewarding time in my day is when a team of people who are dedicated, smart and enthusiastic decide to tackle a tough question and we move the answer a step forward. That is immensely fulfilling, gratifying and energizing — especially doing it together.
Q: What is the last thing you do before you leave the office?
DJ: I’m a little obsessive-compulsive, so I make sure my desk is picked up. I go through all my emails and make sure I leave with an empty inbox, except if the email is something that requires work, which will then have to wait until the next day. The empty mailbox, though, gives me a feeling of completion and closure. And it gives me the feeling that I have responded to everyone in a timely manner, which to me stands for respect and for trust.
From there, I look at the calendar for the next day. Not in too much detail, but to be mentally prepared. What type of day will it be? Do I start early, finish late? Will this be a day where I have to travel somewhere? And then I leave. On the way out I say goodbye to everyone I see.
Q: How do you unwind at the end of the day?
DJ: My drive home is about 20 minutes. During that time, I sit in silence — no radio, no music. I find that very soothing, and it brings my frequency down. Usually, I am pretty much in my non-work mode by the time I’m home. Another thing that helps me unwind is a routine I have with my husband. We always try to sit down together with a little glass of wine and talk to each other about the day. There’s no agenda, just how was your day? How was my day? I find that helps me unwind, too.
Q: Is there a piece of advice you live by?
DJ: I have two pieces. Time is a very precious resource. Time enables or disables communication between people, and we all know that leadership is all about communication. The day’s schedule has to accommodate the freedom to enable interpersonal communication
The second thing I live by, and always remind myself of, is that the more balanced and complete I am as a human being, the better of a leader I am. If I am unbalanced and rushing around, I send the message that I’m stressed, that I’m too busy. I might not have time to notice that somebody looks sad or worried. I might not have time to respond to requests, or might overlook solutions. Essentially, it is important to me to create a lifestyle that enables me to be balanced. For me, that is having a reflective morning, scheduling date nights with my husband, voice lessons, going to the gym and running, all these should be non-negotiable. So for me, doing all of these activities and valuing my private life equally as my work life and giving those two lives the same care and attention makes me the best person I can be. Makes me the best leader I can be.
it is also very important to remind myself that the work I do, the work we do in healthcare, translates into making the world a better place. So even if it’s a difficult day and things are not moving and it is filled with barriers and disappointments, I just remind myself of the work we do. That’s the beauty of healthcare. The work we do makes a difference, and that always lifts me up.
