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Decisive leadership: Baltimore Health Commissioner Leana Wen sees the ER as a valuable training ground for physician leaders

By | August 13 th,  2018 | Top 25 Minority Executives, women leaders, physician leadership, Leana Wen | Add A Comment

WenThe number of physicians and nurses transforming into administrative leaders capable of running major organizations is growing rapidly.

 

In the age of value-based care, organizations are leaning on clinicians to lean in to leadership. This opens new vistas for physicians and nurses, but health systems and insurers must do their homework. A physician who heads his or her own practice may have valuable leadership skills, but leading, say, a staff of 12 is different from overseeing a $2 billion budget and ensuring a board and a C-suite are in sync with your vision.

 

One such physician who has made the jump is Leana Wen, MD, the Baltimore City Health Commissioner, who leads a staff of 1,000 employees. Since being named to the role in December 2014, Wen has shown a predilection for taking decisive action, perhaps unsurprising as someone trained as an emergency room physician:

  • She led the creation of Vision for Baltimore, which provides free eye exams and glasses to children in grades K-8 in all Baltimore City public schools. She created a partnership with the schools, Johns Hopkins, the glasses manufacturer Warby Parker, and a national nonprofit, Vision to Learn, to make it happen. “That’s an example of directly translating policy into action,” she says.
  • Wen was a pioneer as a public-health leader in issuing a standing prescription for all Baltimore residents to obtain and administer naloxone, the antidote that can save a person’s life in the event of an opioid overdose. “Since then, residents have saved the lives of more than 2,500 fellow residents in the last two and a half years,” she says.
  • She supported the expansion of a program called Safe Streets, which calls upon former felons to intercede and help defuse tense situations in Baltimore. She also employs people who are in recovery from addiction, others who are living with HIV, and still others who learned about lead poisoning from home visits from the health department and now are outreach workers themselves. “It is my obligation as a leader to ensure a workplace of diversity, equity and respect, and it’s my privilege to work with those who are using their lived experience to help lift up others in similar circumstances,” Wen says.

Decisive leadership is at a premium these days. Writing in Forbes, leadership expert Sunnie Giles points out that the increasingly complex world in which we live can be paralyzing for leaders. Those who can adapt, like Wen, and use the complexity as a positive catalyst for their team are poised for success.

 

Decisive leaders should:

  • Accurately define the challenge – gathering as much information as possible in a short period of time from a number of reliable sources, being sure to gain a better holistic picture from all sides of the issue
  • Encourage constructive discourse surrounding the challenge and possible solutions and alternatives
  • Act quickly to set a course of action
  • Support the execution of that action plan by breaking down hurdles and providing additional direction as needed

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The ER as a leadership crucible

 

Wen’s transition from physician to leader had some elements of a baptism by fire. She was greeted with a measles outbreak erupting at the same time as several possible Ebola cases. Three months after she became health commissioner, Freddie Gray, an unarmed African-American man, died in police custody and riots ensued. In all, 13 pharmacies were burned down or closed. “We had to figure out how to get people food, and how to get seniors their medications because their pharmacies were closed,” Wen says. “We had to figure out how to get people to dialysis, chemotherapy and other life-saving treatments.”

 

Leading her team, in collaboration with city, state, federal, and private sector partners, she figured it out quickly. So quickly that, a year later, the American Public Health Association honored her with its highest award for local public work, the Milton and Ruth Roemer Award. Achievements have come through steely determination for Wen, who grew up as the child of Chinese political dissidents in a rough Los Angeles neighborhood.

 

Nonetheless, she graduated from college at 18, became a Rhodes Scholar and studied at Oxford, and completed her medical training at Brigham & Women’s Hospital and Massachusetts General Hospital before becoming Director of Patient-Centered Care Research and an attending physician in the Department of Emergency Medicine at George Washington University in Washington, D.C.

Wen sees three direct correlations between her ER work and her leadership role now.

 

“Working in the emergency department is all about doing what you can right now,” she says. “That bias to action is the same bias that is necessary in public health where there are so many urgent matters that demand our attention.”

 

The second lesson is “assisting those who are most vulnerable,” she says. The naloxone prescription that has saved so many people from opioid deaths is one example of this, as is providing something as basic as glasses to children who are in need.

 

Finally, Wen says she learned the importance of speaking up. “In the ER setting, you can never wait to speak up,” she notes. “If there’s something that you suspect is wrong, you need to speak up right now. And that directly translates into the workplace. There are many issues we need to speak up on right now, including issues of discrimination and harassment, health as a human right, the cost of prescription drugs, and evidence-based, science-based programs like teen pregnancy prevention.”

 

Even for those not in public health or policy-oriented roles, clinicians can sometimes underestimate the power of their voice in the age of patient-centered care. While it is true that healthcare administrators often have years of mentoring and on-the-job training for executive roles, physicians can be prepared for new opportunities through accelerated physician leadership training.

This type of training allows physicians to gain valuable skills and insights into leadership principles that challenge their core training. By working through real world scenarios, physicians can begin applying these principles right away. In our experience, many notice impactful outcomes within weeks with this type of leadership development and support.

 

The goal is to bring the physician from thinking in terms of their solitary influence on the goal to shift them into leading an enterprise, which takes a much broader perspective. An accelerated physician leadership training uses three phases:

 

Coaching and mentoring – which moves them through the leading self to leading others

 

Collaboration and change management – which transitions them into leading the business

 

Driving systemic change – which allows them to lead the enterprise

It’s no easy task to work through these phases, especially without the proper guidance. The accelerated nature of these programs helps physicians gain in months and years what may have been elusive in that solitary mindset within which they were trained to operate.   

 

Diverse voices matter at the top

 

As an immigrant, Wen experienced vivid episodes that crystallized for her the importance of speaking up.

 

Shortly after arriving in the U.S., Wen saw a neighbor die from an asthma attack; his grandmother was too afraid to call an ambulance because of their family’s immigration status. And the #MeToo groundswell in the last year refreshed Wen’s memory of watching her mother come home from a job at a video store sobbing because of an unnamed incident that occurred with her physically and verbally abusive boss.

 

“I have always thought from that time, that if I’m ever in a position of leadership where I can do something about these things, I need to speak up for her and for so many women who have suffered in silence.”

 

Wen has done just that. She’s proud to have recruited a diverse leadership team. Her Chief of Staff and all three of her deputies are women. She actively recruits from the communities the Health Department serves.

 

Commitment to diversity is a powerful engine to create organizations that are more profitable and thoughtful as they face the business world externally, and catalysts for employee engagement and leadership development internally. Leaders at the top of an organization should not underestimate the power they have to recalibrate an organization’s perspective, because many challenges remain, something Wen knows personally.

 

 “As a minority and a female, I have faced entrenched racism and sexism,” she says.

 

Some are mundane – patients requesting to see the “real” doctor, or CEOs calling her by her first name while addressing her male counterparts by their titles. Some are overt – “at one event, I was introduced as a ‘cute little thing’ and openly questioned on how a female person of color can lead 1,000 people.”

 

How to overcome that?

 

“We must foster a culture of diversity, inclusion and equity,” Wen says. “The key to doing that is for boards and management teams to have diverse leadership. We cannot expect for others to do what we are not willing to do ourselves.”

 

EXECUTIVE’S TOOLKIT: Strategies for physicians moving into leadership roles

 

Looking back, Wen sees several lessons that can help her fellow doctors if they choose to become physician executives leading the entire enterprise:

  • “Be intentional as you consider your move. Working clinically gives you many leadership skills. Channel these skills into leading on a different level.”
  • “Find multiple mentors from within and outside your organization who can help guide you and problem-solve. Gain management experience.”
  • And, finally: “Never forget why it is that you are here: to serve our most vulnerable individuals during their time of need.”

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Profiles in Leadership: Top 25 Minority Executives Kimberlydawn Wisdom overcame obstacles; now, she helps her community do the same

By | December 4 th,  2012 | Detroit, emergency medicine, Furst Group, Healthcare, executive, health system, hospital, Kimberlydawn Wisdom, Minority Executives, Modern Healthcare, Top 25 Minority Executives, Blog, Henry Ford Health System, leadership, physician leadership | Add A Comment

 

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

 

As a successful physician executive at Henry Ford Health System, Kimberlydawn Wisdom, MD, has attracted the attention of governmental leaders far and wide. Jennifer Granholm, then governor of Michigan, named her as the state surgeon general in 2003, a post she held for eight years. More recently, President Obama appointed her to his Advisory Group on Prevention, Health Promotion and Integrative Public Health. But the path to a medical degree was one that Wisdom had to clear of a number of obstacles.

 

First and foremost was the era in which she grew up, a formidable boulder indeed.

 

“In the 1950s and ‘60s, there wasn’t a plethora of physicians of color,” notes Wisdom, Senior Vice President of Community Health & Equity and Chief Wellness Officer of Henry Ford Health System in Detroit and an assistant professor for the University of Michigan Medical Center. “In my junior year of high school, my guidance counselor said I should choose a profession that was more suited for my race. For her, saying ‘I want to be a doctor’ was like someone saying, ‘I want to be an astronaut.’ She actually did want to ensure my success. But I think her sense was, ‘Let me bring you back down to something that’s manageable and achievable.’ “

 

Yet Wisdom’s mother, who grew up in the small community of Coatesville, Pa., did in fact have an African-American physician. And Wisdom became a caregiver for her mom at home as she dealt with severe migraines.

 

“During my childhood, she spent a lot of time in bed and I was regularly bringing her aspirin or some other type of pain medication,” Wisdom says. “It was very impactful to me as a young child to watch her go through that. But on another level, I could bring her water, I could bring her comfort. That began to ignite this desire to consider how I could care for people long-term.”

 


She was exposed to a wonderful hospital atmosphere from a tonsillectomy as a child, and soon had dolls and bears lined up in shoeboxes around her room, where she would tend to their medical needs. She graduated 20th in her high school class of 600, but her supportive parents weren’t so sure that marrying a young mechanical engineer was the best way to get through medical school. But when she crossed the stage to become an M.D., both her husband and parents celebrated together.

 

“They were all very proud,” she remembers. “It was a tremendous sense of accomplishment, and a tremendous sense of being thankful, because I couldn’t have done it without the support of family and without a strong spiritual grounding. It took a lot of prayer. I beat the odds in many respects.”

 

Despite her challenges, Wisdom says she had an idyllic childhood growing up in Mystic, Conn., the town made semi-famous by Julia Roberts’ first movie, “Mystic Pizza.” Those experiences, she says, have shaped her career as she sought to give her patients and her community the opportunities she was afforded.

 

“In part, I wanted to create a Mystic for the community in which I practiced, so they would have a safe place to grow up. So families could thrive. So people could reach their maximum potential, because they had a place where they felt they could achieve all that they were expected to achieve.”

 

But Wisdom has spent more than 30 years in Detroit at Henry Ford Health System – more than 20 as an emergency room physician – and she readily acknowledges that Detroit is worlds away from Mystic. As she saw the issues confronting her patients – violence, diabetes, obesity, teen pregnancy – she determined to take healthcare to them and not wait for them to come to her. Today, such goals are commonplace in any metro hospital, but back then her ideas were seen as unorthodox. Nonetheless, her bosses at Henry Ford told her to go for it.

 

“As an emergency medicine physician, the community comes to you in various states of disarray. I thought that, if I could go out and meet them where they are, I could have a greater impact,” she says. “When I look at many communities, so many people have not had the ability to realize their potential because they have made choices based on the choices they had available, not based on the best choices that would be ideal for them at any given time.”

 

So Wisdom started small, taking physicians, nurses and social workers out into the community, setting up shop in a community center or a faith-based organization. With each endeavor, Wisdom received more funding as she slowly and quietly attempted to address health disparities in the African-American community.

 

She and the health system now have major grant funding from the U.S. Department of Agriculture to address child obesity reduction. Several foundations fund her work in attempting to reduce infant mortality in the Detroit area, a region that has one of the highest rates in the country. A faith-based program she designed received funding from the National Institutes of Health, and she serves on the president’s group that advises his cabinet regarding the National Prevention Strategy, a wellness initiative created by U.S. Surgeon General Regina Benjamin.

 

The Ford system recently earned the Malcolm Baldrige Quality Award, one of the highest honors for any industry, in terms of service excellence, and has established the Wellness Center of Excellence, called “Henry Ford LiveWell” for short, that focuses on preventative and lifestyle health.

 

It’s a long way from dolls in shoeboxes, but Wisdom says that, if anything, her passion and excitement for healthcare have grown.

 

“Empowering people,” she says. “That’s what it’s all about.”

Profiles in Leadership: Top 25 Minority Executives Technology's a great tool, but AT&T's Geeta Nayyar says it's still all about the patient-physician relationship

By | August 13 th,  2012 | CMIO, Healthcare, Modern Healthcare, Top 25 Minority Executives, Blog, diversity, Geeta Nayyar, leadership, Technology, AT&T | 1 Comments

 

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

 

She’s the chief medical information officer for one of the largest firms in the world, but AT&T’s Geeta Nayyar, M.D, MBA, wants you to know that it’s not about the technology.

 

“It’s about people, and finding out how to make their lives better.”

 

At 33, she’s one of the youngest honorees of Modern Healthcare’s Top 25 Minority Executives in Healthcare awards program, but she’s been at this medicine thing a long time – she got into medical school at age 17.

 

“Both of my parents are physicians,” she explained. “I always was, and still am, a geeky science person, really fascinated by biology. But at the same time, I was always a very social person. So, clinical medicine just made sense because it was a joining of the best of both worlds.”

 

Her current role doesn’t call for it, but Nayyar made sure her employer would allow her to keep that aspect as an active part of her life.

 

“AT&T has been very supportive, and I am still on faculty at George Washington University in the department of rheumatology,” she says. “I still see patients. It’s only part-time, but I really enjoy it. And as much as healthcare keeps changing, it really is a valuable asset in my role.”

 

Nayyar says she sees technology as just another tool for physicians, like a stethoscope. She says her students at George Washington agree.

 

“The doctors that I teach now, in medical school and residency, can’t live without their tablets and smartphones – so why would they practice without them?” she says. “It is becoming so much more intuitive to use them. So if it helps you practice better medicine, why wouldn’t you?”

 


Beyond physicians, Nayyar believes patients are forcing the issue for the healthcare industry as well. “Patients say, ‘I can make a dinner reservation on my smartphone, but I can’t make my doctor’s appointment online. Why is that?’ ”

 

Although healthcare has lagged behind in adopting technology, Nayyar says the industry can use this to its advantage, by learning from the experiences of other businesses. The aviation industry, for example, has inspired strides in patient safety. Nayyar points to the banking industry as a more mundane model for how technology can transform patient care.

 

“The majority of people use online banking,” she says. “There are apps now where you can cash your checks; you don’t even have to go to the ATM. People are able to see in real time what their financial health is – how much has gone in, how much has gone out. We don’t have that right now for diabetes or hypertension or heart disease.”

 

Then there’s the bedrock necessity of clear doctor-patient communication.

 

“Often, patients leave the doctor’s office and forget 50 percent of what they were told, especially if there are prescriptions involved. There can be language and cultural barriers too,” Nayyar says. “In rheumatology, we give a lot of medications once a week or every other week. Patients sometimes misunderstand you and take them every day. Something really simple like that can have all kinds of astronomical side effects for patients. Technology can give patients a reference at home for these kinds of things that are hard to explain in a 10-minute visit.”

 

Nayyar says she sees her role at AT&T as part consultant (advising what products would appeal to what parts of the industry), part physician and patient advocate, and part ambassador (being the public face of AT&T healthcare and talking with stakeholders and policymakers about healthcare technology). She says she came to the company because she saw an opportunity to make a difference for more patients than she could ever see strictly as a clinician.

 

Like many in the industry, she and AT&T see the cloud as a definite part of the solution. “The problem is that our systems don’t talk to each other and there are barriers, including geographical ones, to getting access to records,” Nayyar says. “One of the beauties of the cloud is that, just like email, you can get it from anywhere, at any time, on any mobile device. In healthcare, that seamless transition hasn’t happened yet.”

 

The cloud, she notes, could help ACOs “lay out that clinical integration road map. If an organization is looking to become an ACO and integrate between their hospital and their outpatient center and with their patients who might be at home, the cloud can be a great integrator.”

 

While healthcare is facing seismic change, she said she thinks the business world could learn a few things from medicine as well.

 

“I think one of the most beautiful things we have in medicine is something called ‘M&M’ – morbidity and mortality rounds,” she says. “It’s where we reflect on a case where it just went wrong. We dissect where something went wrong, or we did our best but the patient didn’t make it, or there was this horrible, adverse effect. We try to understand what went wrong and we think about what we can do to make it go better. But what I have noticed in the corporate world is that there is no interest in doing ‘M&M’ rounds on a strategy or a solution. But life is about learning. Let’s learn from our mistakes It takes a certain amount of courage to say that.”

 

As healthcare evolves, Nayyar says those types of qualities are one reason there is an upswing in the number of physician executives at healthcare organizations.

 

“Too often, the forces outside of the hospital walls dictate what happens inside of the hospital walls,” she says. “That dynamic really has to flip, and I think the possibilities are just endless right now. If healthcare is going to change, it has to be done with doctors and patients and with all of those involved in medicine – and not done to them. If you really want to have the impact in healthcare delivery that we are all talking about all of the time, it has to be done with doctors and patients.”

 

Not every physician is interested in leading an organization, and Nayyar understands that.

 

“Plenty of my colleagues and friends have no clue what I do and no interest in knowing what I do,” she says with a chuckle. “They just want to see patients. My job is to help them see patients better. And to help myself see patients better.”

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