What healthcare leaders need to know now

 

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

 

“When I wake up in the morning and look in the mirror, I see a nurse. I don’t necessarily see a healthcare executive.”

 

Those words don’t belong, say, to the CNO of a small Midwest hospital. They’re coming from Judith Persichilli, who serves as interim president and CEO of Trinity/Catholic Health East, one of the largest health systems in the country. (Prior to the merger of Trinity and Catholic Health East, Persichilli was president and CEO of CHE.)

 

Nursing, Persichilli says, “has always been in my heart. It still is.” In fact, there is no shortage of executives on Modern Healthcare’s list of the Top 25 Women in Healthcare who have a background in nursing, including Persichilli.

 

Why do many nurses become successful healthcare executives? Persichilli says she thinks she knows.

 

“The education of nurses prepares them to be leaders,” she says. “You’re educated across the continuum; you understand the clinical process. You need strong relationship and communication skills as you’re dealing with physicians and other allied health professionals to promote a plan of care. At the same time, you are responsible in many instances for the communication with the family and significant others of the patient.”

 

While Persichilli leads an organization with $12.8 billion in operating revenue, she says healthcare workers at any level can make a significant difference in safety and quality in an era in which cost has become a driving concern.

 

“With healthcare reform, I truly believe that people with clinical knowledge – including, of course, physicians – have the skills to make the right decisions about the clinical process of care and actually lower the cost of care overall. They will make the right decisions about where patients can safely be taken care of with the highest quality.”

 

The merger of CHE and Trinity created a huge, national Catholic health system. Previously, some other Catholic systems merged with secular counterparts, but Persichilli said that doesn’t mean they’ve abandoned their faith-based roots.

 

“The other systems that have merged may organize themselves differently, but they still have a faith orientation within their organization,” she says. “We have decided, based on the heritage and the tradition of the women religious who sponsored the healthcare entities that formed into a system, that our system would be Catholic. That doesn’t mean we won’t be welcoming to secular relationships that share our vision and values.”

 

In fact, prior to the merger, Persichilli was part of a team at CHE that made the difficult decision to sell Sisters of Mercy Hospital in Pittsburgh to the University of Pittsburgh Medical Center system. The move enabled CHE to create a foundation that enabled the sisters to continue their work with the homeless, a population that depended on the faith-based care in the community.

 

“One of the Trinity CHE values is courage, taking risks,” she explains. “Our founding congregations came to this country with 50 cents in their pockets to take care of people. Mercy was an excellent hospital, but UPMC was so large. The situation gave us an opportunity to say, what are the unmet needs? How can we continue this ministry that was started more than 100 years ago by the Sisters of Mercy?”

 

Persichilli says she believes similar crossroads are in the future of many communities.

 

“I think we’re going to be making more of these decisions in healthcare as you look at the community needs assessments that are required under healthcare reform.”

 

Reform, she adds, resonates with the work that faith-based systems have been doing for years.

 

“That’s who we are in Catholic healthcare. It’s not just CHE and Trinity – that’s who we are. Sometimes it means saying, there’s enough acute care. How can we creatively develop the structures and the financial foundation to meet the unmet need? It definitely pulls us into environments that perhaps other people don’t want to go into – the homeless, the vulnerable.”

 

While it’s a well-known fact that the U.S. spends more than any other country on healthcare with less than stellar results, Persichilli says the belt-tightening prevalent in the industry doesn’t have to make quality decline at all.
“I spent three weeks with Catholic Relief Services in Uganda visiting AIDS clinics and looking at their ‘hospitals,’ ” she says. “And I came back to the United States with the understanding that, even in a time of constraint, we live in an era of abundance. We have to figure out how to tap that strength, to do things better at a higher quality and a lower cost.”

 

One idea on how to do that? Better communication.

 

“We can do it. It’s there. It will take people in the provider sector and the payer sector to talk to one another, not past one another.”

 

Persichilli says industry executives need to know their numbers, but also understand that healthcare goes beyond costs.
“No matter what, you need to know that you’re doing really important work. You have the privilege of taking part in and changing people’s lives. When I was a nurse, I used to say, ‘Let’s all stand together and ask the question: ‘What difference did you make in the lives of your patients today?’ ”

 

That kind of attitude is especially important to people at the beginning of their healthcare careers, she adds.

 

“Once you bring meaning to your work,” she explains, “you go about it with such commitment and passion that it’s hard not to be recognized. And once you’re recognized, you’re appreciated. Once you’re appreciated, you’re promoted. And once you’re promoted – if you bring that same passion and commitment forward – you will reach an executive level.”

 

Persichilli mentors a number of young female executives, but says she doesn’t get sucked into the “Lean In” debate.

 

“Work-life balance transcends gender when it comes to these executive positions,” she says. “I don’t ever step into somebody’s life and say, ‘You should do this or that.’ I always tell younger women, ‘It has to feel comfortable for you.’ And if it doesn’t feel comfortable for you and your career is going to be stalled as a result, understand the choices you make and be happy that at least you can make them.”

 

Today, she notes, stress about family isn’t confined to children – it could just as easily be about caring for one’s parents as part of the “sandwich generation.”

 

“If it’s too stressful and the children or your parents are not being taken care of the way you want, it’s not going to do anyone any good at work or at home. So understand who you are and what’s important to you. I don’t have any children, but I can tell you there’s nothing more important than raising good kids.

 

“I don’t have the answers here. I just know that, if you’re uncomfortable, own it and figure it out.”

 

 

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

 

Karen Daley loved being a nurse, and she was a good one. But all that changed one day in 1998 when she was stuck by a needle while treating a patient. From that one needle stick, she contracted HIV and hepatitis C.

 

Her clinical nursing days were over. Over the next couple of years, she would undergo exhausting treatment regimens. But she was determined that the incident would not end her healthcare career.

 

“I learned how resilient I was physically and emotionally,” says Daley today, now president of the American Nurses Association and one of the 2013 Top 25 Women in Healthcare as chosen by Modern Healthcare. “It was a grueling time. I was constantly worried about fatigue, falling and exposing others to my blood, and I had little appetite because of the drugs. I looked sick.”

 

Yet while she underwent treatment, she plunged into advocacy, petitioning the U.S. Congress to change laws to reduce the odds that other nurses would have to face what she was going through. The laws were eventually changed to mandate use of safety-engineered sharps devices that could prevent similar injuries. Now, more than a decade later, compliance isn’t where it could or should be.

 

“We had to educate the healthcare system that these injuries and associated bloodborne pathogen exposures were preventable,” Daley explains. “Not only were they losing workers to these injuries, they were risking the goodwill of workers who learned over time that these were injuries that should not have occurred.”

 

In hospitals, she says, “prevention often is not seen as a viable strategy because it often costs money on the front end versus money you may or may not have to pay on the back end.”

 

While more safety needles are on the market and in greater use, Daley says the price drop that was promised by the medical device industry for the costlier devices as market penetration increased has not occurred. She also says federal enforcement of OSHA requirements is now a priority issue because “we know there are employers who are still not compliant with the requirements under the law.”

 

Beyond the institutional level and despite evidence that the overall number of these injuries has declined since the law was enacted, Daley says operating rooms remain a very high-risk area because surgeons control the kits and sharps that are used in each procedure, and are often resistant to changing their instruments or sharps devices. That has to change, she says. “Everyone’s health and safety is at risk with these injuries. It really is about what’s right across the board for a safer work environment.”

 

And medical device companies haven’t stopped making conventional or less effective early-generation safety needles and devices , nor have hospitals stopped buying them, she laments. “Today, despite the fact that the technology has improved significantly, we have some of the same devices on the market as when the law was passed.”

 

In the process of advocating around this issue, she says she’s learned that change is never simple, and that it’s important to get all stakeholders to the table, even congressional leaders who are feeling pressure from constituents and lobbying groups.

 

“For any movement, persistence is necessary,” she says. “It’s seeing the change through. We are still not where we need to be on needlestick injury prevention, so the need for persistence is another lesson learned.”

 

That’s a lesson she’s taken to heart in her own life, where she has gone back to the classroom numerous times to earn advanced degrees. Beyond her bachelor’s degree in nursing, she has earned a master’s in public health from Boston University School of Public Health, and a master’s in science and a PhD in nursing from Boston College.

 

To keep up with technological advances, the growing complexity of the healthcare system and patient healthcare needs, and to help combat the shortage of providers in healthcare, nurses need more education, she says.

 

“We need to make sure we’re helping nurses go back to school to advance their education. It’s an expensive proposition and that investment doesn’t always get recouped when they go back into the workforce,” Daley adds. “We also need to continue to grow the number of advanced practice registered nurses to provide care that is not going to be met by primary-care physician workforce, just based on numbers and geography.”

 

But shortages of all kinds are facing the practice of nursing, Daley says. There is an impending shortage of nurses, of nursing faculty, of chief nursing officers, and nursing-school deans – due to age, experienced nurses are retiring in large numbers. But the lack of adequate numbers of qualified nursing faculty is particularly vexing, she says.

 

“The faculty shortage represents a huge barrier for educating enough nurses. In fact, over the past several years, we’ve turned away more than 70,000 qualified applicants from nursing programs each year in this country because we don’t have enough faculty or clinical sites to accommodate them.”

 

Taken together, those numbers mean Daley will often be headed back to Capitol Hill to ask for more government funding to help to ease the crunch, exacerbated by the prospect of 2 to 3 million Baby Boomers aging into Medicare every year for the foreseeable future.

 

“We have to make sure the supply of care providers meets the demand,” she adds. “That care is largely going to be nursing care. So we have to feed the pipeline, and I’m concerned when I see so much reticence in Congress around the budget regardless of the issue, that we might not be able to keep up with what is going to be a very unusual shortage and critical demand over the next decade.”

 

Part of the issue, she suggests, is a lack of understanding of the value the nursing profession brings to patient care.
“What has to happen,” she adds, “is nurses need to be better understood as not simply compassionate caregivers, but as knowledgeable and skilled providers who impact patient outcomes and are licensed and accountable as part of their societal contract to assure patients of safe, quality care.”

 

She notes the case of two nurses in Texas’ Winkler County who anonymously reported a physician for unsafe practices (their allegations were proven to be true). But a law-enforcement official who was friends with the doctor uncovered the nurses’ identities and they were fired, prosecuted and indicted. Though they were later vindicated and won a settlement, the entire episode gives other nurses pause about speaking up, Daley says.

 

She is no less candid in describing the state of women in the C-suite, noting the paucity of female leaders in healthcare. “If I were to characterize it in one sentence, I would say we’re not doing very well at all in shattering the glass ceiling. We need to make a lot of progress to raze that ceiling.”

 

Daley hopes she can play a small role in changing that view of the ceiling.

 

“As I go out and speak with nurses and other leaders around the country, my job is to inspire and empower them to find their own voice, and to encourage them to take the risks that are necessary for making change. I want to help them continue in their own journey to be effective change agents within a larger system.”

 

Undaunted by the setback that ended her nursing career, Daley is taking her own advice to heart.

 

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

 

It’s a busy time at Mayo Clinic. Plans for the new Destination Medical Center are in full swing. New affiliates are being added to the Mayo Clinic Care Network. A new partnership with Optum Labs is taking the venerable institution into the realm of big data. So why would Chief Administrative Officer Shirley Weis decide to retire now?

 

Because, she says simply, that’s been the plan all along.

 

“One of the hallmarks of Mayo is excellent succession planning,” she says. “We’ve put even more attention into it in recent years, making sure that we have a good stable of folks ready from all different backgrounds of diversity and talents.”

 

And, for those keeping score at home, she says, you’ll notice a pattern to their planning. Weis was named to the No. 2 role at Mayo about halfway through the tenure of then-CEO Denis Cortese, MD. Weis is leaving four years after John Noseworthy, MD, succeeded Cortese. Mayo’s initiative of staggering C-suite entrances and exits keeps disruption to a minimum.

 

“People don’t understand that Mayo has a term-limit process for these top jobs,” Weis says. “Usually, you’re in these roles for about six to eight years as CEO, CAO or department chair. It’s one of the ways we keep ideas fresh. In some settings, you’ll see people who are named to a role and they’re in it for 30 years. That may work for some organizations but I think that after six or seven years, you’ve done what you came to do.”

 

Among the tasks that Weis says she is gratified to have accomplished since she stepped into the CAO role seven years ago is changing the structure of the company.

 

“I have really felt proud of the fact that we were able to get our governance in good shape,” she says. “We went from being a holding company to an integrated operating company. Most of the things I wanted to get underway are now, in fact, underway and are in good hands.”

 

One of those key ventures is the Mayo Clinic Care Network, in which health systems and physician groups affiliate with Mayo, extending the clinic’s reach beyond its bases of the upper Midwest, Arizona and Florida to the rest of the country. The idea had been created during Dr. Cortese’s tenure but truly came into being about two and a half years ago under Dr. Noseworthy’s leadership, Weis says.

 

“We have built a very successful Mayo Clinic Health System in the upper Midwest but we understood that merger and acquisition was probably not the best course for us,” she says. “We came up with the idea to start building a network, but we also found more and more hospitals and physician practices approaching us – they wanted to be affiliated.”
Mayo is up to 18 affiliate agreements but Weis sees a limit to the system’s capacity.

 

“We do guard our brand jealously. It’s one of the most trusted names in healthcare and part of the promise we have to our patients,” she says. What helps, she adds, is that “the patients are very savvy and sophisticated. They understand that these groups are not Mayo Clinic – they simply have a connection to Mayo Clinic.”

 

Mayo staff are consulting via phone and doing some cases together electronically. “We think it’s going to be a real model for the patients’ network of care,” Weis says. “Eventually, there may be some insurance products that go on top of the network.”

 

The blurring of lines between providers and payers is accelerating in the healthcare industry, and Weis has been a key person to lead that charge at Mayo. She was the chief operating officer at Blue Care Network of Michigan, a large HMO, before coming to Minnesota.

 

”I feel blessed that I had 10 years of actual care delivery with my emergency-room background, and that I followed that with 10 years in the payer industry,” Weis says. “I wouldn’t trade that for anything. I think it’s helped the organization and, frankly, it is probably why I was selected for this job seven years ago.”

 

Weis says both providers and payers need to focus on what’s best for the patient – and both need to collaborate more.

 

“The payer world has the claims information but they don’t have a lot of rich clinical data. The provider world has the rich clinical data but they don’t know what happens after the patient leaves the hospital or the outpatient center, or after they pick up their prescription.”

 

No matter what happens with healthcare reform, Weis adds, “there’s no more money, so it makes it more incumbent on all of us to figure out how we’re going to meet those patients’ needs and how we can engage the patients better.”

 

Working with fewer dollars is something Weis experienced a few years ago during the recession when she put in place an administrative shared services program and an enterprise project management office, while also implementing cutting-edge tools for financing and reimbursement. All those things, and a few more, helped Mayo weather the recession without layoffs, though some employees shifted jobs and some changes were made to benefit packages and retirement plans.

 

Weis had originally come to Mayo in 1995 to lead the Clinic’s managed care division. She resisted the overtures from a recruiter for a time, but finally agreed to a visit.

 

“I already had a career path, thank you very much,” she says. “But I came to Rochester and started to meet folks, and I was struck by how patient-centered the organization was.”

 

As she got to know Al Schilmoeller, who was her first boss, she noted that one of his daughters was a pilot and another worked for the Department of Natural Resources. That convinced her that here was a man who knew how to support women in their varied career aspirations. She remembers that, she says, as she mentors early- and mid-career women and men.

 

“For women or men, for anyone to make it to the next level in your career, you have to be willing to take some risks,” she says.

 

But she notes that young executives who only know the sound-bite version of Sheryl Sandberg’s “Lean In” best-seller do need to consider work-life balance.

 

“I would not be where I am today if I didn’t have a supportive husband. Period. I see many people who want to have that balance, and the one thing I know for a fact is that you can’t always have it all. You can have it all in stages. But I do think that as long as women are in a traditional caregiver, chief household operating officer role, it’s tough to balance that.

 

“So, particularly with families with young children, I always encourage them to put those kids first because they’re only there for a few years. And then your career is still there.”

 

Weis came of age at a time when she often was the only woman on the leadership team, and she says progress has been made in gender equity – progress, but not equality.

 

“I’m a tennis player, and I think of the days of Billie Jean King when Virginia Slims was a sponsor with their slogan, ‘You’ve come a long way, baby.’

 

“We have come a long way. But I don’t think we’re there yet.”