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Healthcare's volatility has Marna Borgstrom rethinking how her organization develops leaders

By | June 30 th,  2017 | Marna Borgstrom, Modern Healthcare, Blog, Yale-New Haven Health System, Top 25 Women in Healthcare | 1 Comments

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

The volatility of the healthcare industry has Yale-New Haven Health System CEO Marna Borgstrom reassessing her thinking about leadership, and how to best support the development of her executive team.

 

“The things we’re dealing with today as leaders in healthcare didn’t exist when I was coming up,” says Borgstrom, who has led the system since 2005. “There isn’t a road map to navigate today’s challenges. But what I think we can give people are opportunities and experiences that will stretch their ability to think and be comfortable with ambiguity, to teach them to lead by influence as much as by control.”

 

Borgstrom says her board has been encouraging her to spend more of her time on talent management and development. “What we’re trying to focus on,” Borgstrom says, “is evolving their roles so they can be 'tested' in situations where they have to draw on innate strengths, where they need to listen and then to exercise judgment. As part of that effort, we are an inaugural participant in the Carol Emmott Fellowship to advance women health care leaders. One of our Yale New Haven executives is just finishing a year in the Fellowship and another is just starting."

 

She’s also begun to lead more intentionally beyond Yale-New Haven. She is part of a group called Women of Influence that seeks to promote leadership development and mentorship for women in healthcare. Borgstrom is paired with a young female executive from one of the Advisory Board companies.

 

“I have had the privilege of working with an absolutely spectacular young woman in Washington, D.C.,” Borgstrom says. “She’s smart and focused and committed to healthcare. She’s a lot of fun, and is focused on developing her career.”

 

Female mentors were few and far between when Borgstrom’s own career was on the rise. She was mentored primarily by two male executives, Tom Smith and Joe Zaccagnino.

 

“Neither Tom or Joe ever made me feel like I was being treated differently than other people,” she says. “Both advocated for me as much as they could. Joe, in particular, was the master of immediate and direct feedback. He was always trying to help me grow.”

 

Borgstrom admits it took her a while to find her voice at the health system – literally. She was soft-spoken to a fault. “Joe and Tom used to say to me, ‘Speak up!’ I didn’t volunteer a lot of my thoughts. If I didn’t think I had the perfect thing to say, I generally didn’t say anything – I think women do this to themselves much more than men.”

 

Zaccagnino especially drew Borgstrom out, which led to much upward advancement.

 

“Joe said to me, ‘First of all, not everything you say is going to be brilliant. But secondly, you have as much right to be in that room and at that table as anybody else – say it like you mean it.’ ”
Borgstrom is pleased with the progress her own organization is making in terms of leadership diversity, although she is always looking for improvement.

 

“This is the result of 15 years of intentional recruitment – and we’ve made some mistakes – but I’m quite proud that we have probably one of the more diverse leadership teams in the country at Yale-New Haven Health System and particularly at Yale-New Haven Hospital,” she says. “It has been done with intentionality, but the people we have been bringing in are awesome.”

 

The healthcare industry as a whole, though, still has a lot of work to do, she says.

 

“When I get outside of our organization, I will sometimes still look around the room and say, ‘Wait a minute. I’m the only woman here,’ ” Borgstrom says. “That is still a little bit weird and a little bit uncomfortable, because it reinforces that we’re not doing enough to advance women into the senior-most positions in the healthcare field.”

 

Borgstrom’s growth as a leader has led to her becoming a valued member of national and local boards, including Vizient (formerly VHA Inc.), the Association of American Medical Colleges, The Coalition to Protect America’s Healthcare and the Connecticut Hospital Association.

 

But don’t ask her about her legacy.

 

“I hate that word,” she says, laughing. “I’m 63, but I remember when I used to be the youngest person in almost any room and ‘legacy’ wasn’t in my vocabulary. I work with a coach who tries to talk frequently about ‘legacy.’ My response is that organizations have short memories. I’ll be happy if people feel I made the organization stronger by living our values.”

 

But she is intentional about making room for new talent, and working with her board on C-suite succession plans for the future.

 

“I think leadership teams need refreshing periodically,” she says. “Also, I work with some very talented people, and the reality is that, if they don’t see a potential line of sight to grow, they are going to be more likely to be picked off by other organizations and move on.”

 

Borgstrom is in no hurry to head for the exit. But whenever the time comes, she says, “I’d like people to say that our leadership team helped build organizational strength and a corporate culture that was patient-focused, compassionate, respectful and fair.”

 

 

SIDEBAR: Making a difference through value-based care

 

 

Marna Borgstrom says Yale-New Haven Health System opens its meetings these days with patient stories. And as Yale-New Haven continues its transformation to a value-based care system, the tales that are emerging are compassionate and exciting.

 

“Our staff has been treating a gentleman who is now in his late 20s who has chronic sickle cell disease,” Borgstrom says. “As an adult, his disease is chronic with episodes of terrible pain, which are usually treated with opiates.”

 

The pain was so severe that, in fiscal year 2015, the man spent one day short of half a year in the hospital through multiple admissions.

 

“By creating an ambulatory team of caregivers who see him every month, we were able to assist in teaching him how to manage symptoms at home, among other things,” Borgstrom says. “As a result, for the first half of this fiscal year, he has spent less than two weeks in the hospital. It made sense from a financial perspective but, most importantly, he’s had a better life and, for the first time, has been able to hold down a job.”

 

But value-based care will look different in every case, she notes.

 

“What one patient would define as value is not the same as another patient,” she says. “For this patient, it was to minimize disruption in his life and to get him back to an acceptable level of functioning so that he could hold a job and have a real life.

 

“There are some clear, objective measures of quality and safety. But the real measure of what each person is looking for becomes very important to this concept of personalized care.”

 

 

Marna Borgstrom: A new era calls for a new kind of leadership

By | August 14 th,  2015 | Healthcare, Marna Borgstrom, Modern Healthcare, president, Blog, CEO, health disparities, healthcare reform, leadership, Yale-New Haven Health System, Top 25 Women in Healthcare | Add A Comment

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

 

For healthcare leaders today, it is clear that the big challenge, and the big opportunity, is to invest in the evolution of what has been a cottage industry into a true system of care. One in which efficient, integrated healthcare services are aligned with the ways in which care is paid for; where both provider and patient accountability matter.

 

While Marna Borgstrom, CEO of Yale New Haven Health System, believes we are moving in this direction, she notes that few systems, if any, are “there” yet. Many providers are not organized to take risk for populations of patients. Many payers can’t accurately and effectively take and manage capitated payment or significant risk arrangements. And the state and federal governments aren’t aligned on what or how they pay for care.

 

As Yale New Haven Health System is on its journey to provide unparalleled value to those it serves, Borgstrom stresses that at the same time health systems must continue to provide life-saving care and invest in the research and technical advances that have turned many terminal diseases into manageable chronic conditions. Borgstrom says, “We don’t want to lose that which has made us great in our quest for a more sustainable, comprehensive system of care.”

 

This need to thrive in both worlds – improving the health of the population while also healing the sick – demands effective, committed and innovative leadership in healthcare that can navigate these changing dynamics. This is a topic Borgstrom has been returning to often lately as she works with her own leadership team and her board and begins to build a template for the type of leadership that Yale New Haven will need in the years to come.

 

To that end, she has begun collecting her thoughts to share with the organization on developing executives who can guide a large, complex enterprise like Yale-New Haven. Some qualities, she says, are must-have standards that make sense in any business climate:

 

General leadership abilities. “You have to be able to get people to follow your vision and prepare for the future before change is upon us, while weighing the risks. You also have to be able to hold people accountable – sometimes we tolerate cultures of optionality that haven’t delivered well.”

 

A mastery of complexity. “Be able to juggle a lot of things as you evaluate decisions. Have an understanding that it’s not going to be linear and ambiguity rules.”

 

Able to balance “what” vs. “how”. “You can’t just say, ‘We’re getting this done at all costs.’ You can’t leave bodies in your wake; you can’t sacrifice the culture of an organization to achieve a single goal. You have to play for the long term but perform well and consistently in the interim. It’s not easy.”

 

A knack for partnership. “It’s all about partnership today . . . partnerships within your organization and with other businesses. To be a good partner, a leader needs individual qualities like integrity; like being a thoughtful listener. And you’ve got to enjoy working with others.”

 

Solid professional skills. “You need good strategic positioning skills and, in our case, a passion for academically based healthcare. You also need a depth of knowledge of healthcare as a mission and a business, and the public policy that goes with it.”

 

But then there are other intrinsic, less-obvious traits that she says are becoming just as essential given the landscape of the healthcare industry.

 

Among them, Borgstrom says, are:

 

Building cohesion. “You have to be able to bring out the best in other people because this is increasingly a team sport. It’s not just bringing people together; it is making them feel good about contributing toward specific goals together.”

 

Being open to dialogue. “I think you have you have to be receptive and responsive to feedback. You have to be able to put yourself in the other person’s shoes.”

 

Getting comfortable with ambiguity and imperfect processes. “I’m pretty good at taking the hill, but the issue of ambiguity is you’re not really sure whether that’s the hill on your left or your right. You may have to start out on the journey and have a few less than optimal experiences to inform your thinking about what is the best hill to take.”

 

Making diversity a map for improving care. “We’ve got to be committed to the principles of diversity and inclusion, not just in developing leadership teams but in eliminating healthcare disparities, being mindful that it isn’t just about running a financially successful business model if we can’t improve our communities too.”

 

With all of these qualities, Borgstrom says, the days of “command and control” leadership have disappeared. That even applies to how health systems operate, she adds.

 

“The future is going to require that we pursue partnerships rather than try to control everything in healthcare. We don’t have the competencies, the experience or the balance sheet to put together the ideal integrated delivery system. I think well-conceived and well-structured partnerships are going to end up being integral to an integrated healthcare system where the focus has to be on providing the best value to patients.”

 

 

Marna Borgstrom: In healthcare and life, relationships matter

By | July 29 th,  2013 | Connecticut legislature, Healthcare, Marna Borgstrom, Modern Healthcare, nurses, patient-centered, president, reimbursement, Smilow Cancer Hospital, Blog, CEO, children's hospital, health disparities, healthcare reform, leadership, Yale-New Haven Health System, Top 25 Women in Healthcare | Add A Comment

 

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

 

Marna Borgstrom was shopping for vegetables at a farmers’ market recently when an acquaintance approached her to say, “I just can’t thank you enough for the Smilow Cancer Hospital.”

 

It was a moment for the president and CEO of the Yale-New Haven Health System to reflect on why, ultimately, she was involved in healthcare. It didn’t matter that Yale-New Haven could boast that it was one of the largest systems in the country or that she’d enjoyed a productive career and interesting work that spanned more than three decades. It came down to one family finding the help it needed at a critical time. Just as all good healthcare does.

 

“Her kids went to school with my kids,” Borgstrom recalls. “And she was standing over the asparagus telling me about her husband’s diagnosis and the treatment. But she was really talking about all the talented people at Smilow who have been making a difference in their lives.”

 

Making a difference. That was the example she got from her parents, both of whom were first-generation Americans from families who did not have the benefit of much formal education. Borgstrom’s father became an ophthalmologist simply because the Army was doing manpower planning during World War II and they told him to go to medical school.

 

“When my dad was in private practice, house calls were de rigeur, and we’d all pile into the station wagon after church on Sundays and go to house calls to his patients, most of whom were older,” she says. “My mother would be home making a big Sunday lunch for us and extended family, and my dad’s older ethnically diverse patients would all feed us too, so we were rarely hungry when we got home.”

 

But what she and her siblings took away from those trips was much more than a full stomach.

 

“I think what we learned was that some of the real joys of healthcare are people and relationships. I have people who come up to me even now and say, ‘Your dad did my surgery.’ (He’s 90 years old and hasn’t performed an operation in 25 years.) And I don’t think that’s all that different from a lot of the people who work here now.”

 

Those warm memories help keep her going when faced with issues like the 2013 Connecticut legislature taking $550 million out of hospital-based reimbursement over a biannual budget, as it did the night before she paused to discuss her selection as one of the Top 25 Women in Healthcare as chosen by Modern Healthcare.

 

“They’re taking as much out of hospital reimbursement in 24 months as the entire industry in the state is taking under the sequester in 10 years,” she noted. “When you make dramatic cuts and you make them too fast, what you cause is more reactionary behavior than thoughtful behavior. Our system happens to be the largest provider system in the state, and we also are the largest providers of care to the medically indigent, so we got whacked disproportionately in this.”

 

No one in the industry, she adds, is arguing the contention that healthcare costs too much and that it is not always delivered in the appropriate way. Borgstrom says Yale-New Haven will weather the storm, but Connecticut healthcare as a whole may be damaged irreparably.

 

“I’ve said to members of the legislature here that there are some hospitals that will not make it with these cuts. And the irony is that some legislators think we will go in and buy them. We aren’t everybody’s savior. It’s a bad business strategy. So what the legislature may have to do in the next two years is go back and put money back in the budget to help the organizations that are really struggling. It just doesn’t make sense.”

 

Compounding the issue are an aging population and health disparities in the state.

 

“We have an older-than-average population, and we also have more people below the federal poverty level, ironically, in a very wealthy state, than most states in this country,” Borgstrom says. “A lot of what we see are diseases in the elderly that come from years and years of excess, and what we see in the younger populations are diseases and problems that come from socioeconomic disparities.

 

“Those aren’t going to change this year or next year just because somebody decided they were going to pay us less.”
The solutions that the healthcare industry is searching for under reform are pretty comparable from hospital to hospital, state to state, she adds.

 

“In this industry, I would contend that everybody has similar strategies,” Borgstrom says. “We’re all trying to get better on the value equation, we’re trying to build scale because it will help us with our business model, and we’re trying to integrate and align with other providers, most notably our physicians.”

 

The difference, she says, is in execution.

 

“The holy grail is in execution, and how people execute, I think, is based mostly on organizational values. And those have to be values that people lead by.”

 

In Yale-New Haven’s case, Borgstrom can rattle off those values pretty quickly: patient-centered, integrity, respect, being accountable, being compassionate. She learned them from her mentor, former CEO Joe Zaccagnino, who saw leadership qualities in her early on.

 

“He was somebody who gave me real and real-time feedback about what I was doing and how I was doing it. Sometimes, it really stung,” she allows. “But I knew he was not giving me the feedback for any other reason than to make me better at what I did and how I was perceived at doing it.”

 

Ultimately, she succeeded Zaccagnino as president and CEO when he retired in 2005. She’s been the architect of numerous major projects at Yale New Haven, including a children’s hospital, the cancer hospital and the recent acquisition of St. Raphael Hospital, a 520-bed facility that was teetering on the brink of bankruptcy. The Sisters of Charity of St. Elizabeth in charge of the hospital ultimately decided that Yale-New Haven was the best fit among St. Raphael’s suitors even though they gave up their Catholic affiliation in the process, a move that Borgstrom calls “one of the most courageous I’ve ever seen.”

 

Yet she is quick to deflect credit and to use self-deprecating humor to minimize it. “I’m the orchestra conductor,” she says. “I don’t do a whole lot. I just stand up in front and try to keep everybody playing and singing in harmony.”
One key, she says, is hiring good talent and then getting out of their way. Another is ensuring that the staff has a work-life balance that they are comfortable with, a prominent discussion especially among women leaders since the publication of “Lean In” by Sheryl Sandberg.

 

Borgstrom said she recently interviewed a candidate for an executive role and spent most of the time on that topic. The woman had become the breadwinner for her young family. She wondered if Yale-New Haven would be a good fit since she would have to move away from the support of extended family.

 

“What I said to her is, there’s no one answer to this, but I fundamentally believe that you cannot be a good executive if you aren’t happy and also able to manage your personal life. Because long after these jobs are gone, the people who will hopefully be in our lives will be that partner we’ve spent significant time with, our children and our extended family.

 

“If it’s the right person, the right job and the right organization – and both parties live up to their end of the bargain – I think you can have a successful and happy career and personal life. And happy is really important.”

 

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