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.”