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Georges Benjamin advocates for a better health system

By | August 7 th,  2014 | Affordable Care Act, Furst Group, Georges Benjamin, Healthcare, politics, Top 25 Minority Executives in Healthcare, executive, health system, Modern Healthcare, Blog, diversity, leadership, public health, affirmative action, APHA | Add A Comment


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


Georges Benjamin had a wonderful experience as a military physician, eventually rising to become chief of emergency medicine for Walter Reed Army Medical Center in Washington, D.C. But the diverse environment he experienced in those days bore little resemblance to what he encountered when he returned to life as a civilian.


“I was a beneficiary of a time when we had active affirmative action programs and had a significant number of minority students in my medical school classes as well as my residency,” he says. “There were many leaders who were part of a minority when I served in the military. When I went out to the private sector I noticed that I was far too often the only minority leader in the room. Thankfully, that’s begun to change.”


Today, as the executive director of the American Public Health Association, Benjamin is a strong advocate not only for the public health workers his organization represents, but also for diversity at every level of a company.
“In a country like ours, which has such a variety of experiences, the value in having a diverse workplace is that people bring in different ways of thinking,” he says. “We bring our experiences to the problem-solving process, and I think it helps create different solutions.”


In today’s political climate, he says, “we’re all kind of living in a type of echo chamber where we will only tune in and listen to people who agree with us. If you talk to yourself and answer your own questions, you’re less likely to get the most inclusive and innovative answers.”


Benjamin and the APHA are a non-partisan organization. They have both extolled and chastised Republicans and Democrats on issues that affect public health. But Benjamin says he’s seen a change in how politics can affect public health.


“Increasingly, politics is playing a role in healthcare, for better or for worse,” he says. “Many of my colleagues just want to follow the science, and we should. But public health practice is both an art and a science that often uses the policy process to make broad system change. That makes it political. It’s increasingly difficult to appeal just to science when people are camped out in their ideology, so we also have to convince them on the merits of the evidence when it does not line up with what they believe. I tell students we should not be afraid to engage in the political process and to be an advocate. Recognize also, that sometimes you have to compromise and that negotiation is the most powerful tool in your toolkit.”


Benjamin is a leader well-versed in the nuances of the D.C. beltway, and a student of its history. During a recent sabbatical at Hunter College, where he stayed in the former home of President Franklin D. Roosevelt, he spent time collaborating on a coffee-table book that compiled political cartoons on healthcare during the past 100 years. “The Quest for Health Reform: A Satirical History,” was released in 2013.


“The thing that struck me was really how the rhetoric against health reform has not changed all that much,” he says. “Some of these arguments against it have been around for a long time and have mostly proven to be false.”


If consensus around broad health reform was hard to achieve over the past century, Benjamin bore witness to at least a temporary change in the aftermath of the 9/11 attacks for a more narrow reform of the public health system. At that time, Benjamin was the secretary of health for Maryland and was thrust into the national spotlight as his state and the nation grappled with deadly anthrax-laced letters.


Funding and support for public health reform was increased, and APHA, which Benjamin joined in 2002, was supportive of the Bush administration’s national public health preparedness program. But when the recession hit a few years later, budget cuts forced many of these public health programs to be curtailed, Benjamin says.


“The potential was there to build our public-health defense in a robust and organized manner, but then the recession came, and resources were withdrawn,” he says. “We have our first Middle Eastern Respiratory Syndrome (MERS) cases here in the U.S. right now. We’re always going to have new diseases that emerge; having an adequate health and public health system to address them is our challenge.”


Public health, Benjamin says, “is a leadership exercise.” As such, APHA works with the Department of Health and Human Services on the report for the nation’s Leading Health indicators, and partners with UnitedHealth Foundation on America’s Health Rankings. It’s also been in the forefront of warning of health risks associated with climate change, and the need for sophisticated health information technology. “We are also strong supporters of the Affordable Care Act,” he says.


While Benjamin believes the U.S. healthcare system has made progress in reducing readmissions and hospital-acquired infections, his military discipline shines through when he talks about what it will take for the industry to get where it needs to be.


“What we’d like to do,” he says, “is get a health system that is predictable and raises the bar over time.”

Foresight is the key to David Lopez's leadership

By | July 14 th,  2014 | Affordable Care Act, David Lopez, Furst Group, primary care, Top 25 Minority Executives in Healthcare, executive, Harris Health System, health system, hospital, Modern Healthcare, Blog, CEO, leadership | Add A Comment


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


Over the last several years, as many hospitals and health systems across the country were building patient towers for their acute-care needs, David Lopez, the outgoing CEO of Harris Health System in Houston, was quietly shifting his organization in anticipation of some of the changes that the Affordable Care Act has brought.


He didn’t expect more revenues from inpatient services; he worked to build a strong wellness program and to ramp up primary care heavily. There’s a reason for that.


“If you look at our statistics, 64 percent of our patients have no insurance,” he says. “For us, more volume on the acute-care side means we spend more money. For us, it’s not about generating more revenue. It’s about managing our costs.”


Harris provides 35,000 admissions every year, but Lopez notes that outpatient visits have reached 1.4 million annually, with an additional increase of 300,000 expected in the next 18 months.


“If the patient can be taken care of in a primary-care setting or another setting, the best way to lower your cost overall is to avoid the admission,” he says. “You’re better off doing that than looking at the patient as a potential revenue opportunity.”


Lopez has been in hospital work his entire adult life and served as CEO at Harris for 10 years. He notes that healthcare has become “a lot more political” than it was in the past. “When you mix politics and healthcare and money, it makes for an interesting relationship between all three of those components,” he says. “There’s a very direct relationship between what we are able to do based on the money that’s available.”


As the leader of one of the largest public health systems in the country, Lopez was used to having to deal with funding that wasn’t always available, as well as the transparency and scrutiny that comes with public governance. A couple years ago, Harris County took a penny from the hospital district’s tax rate to cover some of their expenses. The health system hasn’t gotten that penny back and, with the district’s population growing by 100,000 people a year (“the unincorporated areas have a population larger than the city of Philadelphia,” Lopez notes), it’s a struggle to have a break-even budget.


Despite the challenges, Lopez’s respected work earned him an award as one of Modern Healthcare’s Top 25 Minority Executives of the Year for 2014. John Guest, his predecessor at Harris, noted that Lopez “has the patience of Job,” a quality that was needed as Lopez and his staff worked to revamp the system so it would be less impacted by uninsured patients.


“Once you’ve established what you need to get accomplished, you’ve got to keep after it,” Lopez says. “You don’t let little things deter you. Maybe the outcome is not happening at the speed you wanted, but if your focus is right, you stay with it.”


In Lopez’s case, the focus was lessening the pressure on the emergency department by transforming the safety-net system into one more reliant on primary-care clinics.


“We want to be healthcare providers, not sick-care providers,” Lopez says. “We’ve designated all of our clinics as medical homes; they’ve all received certification. So now we’re trying to get our community members to understand that this is your doctor, and we need your help to address your health needs.”


Wellness is part of that strategy and something Lopez takes seriously. He’s been a runner for 40 years, and last year Harris ranked first among Houston’s largest employers for its wellness program. He says that, ultimately, Harris’ patients will need to do their part too.


“We’re trying to be inclusive with our patients,” he says. “It can’t just be something that we do for them. We need a partnership with them where they participate in the process and buy in to the concepts and approaches.”
Such an approach, of course, requires foresight and patience. Lopez has plenty of both.

Helen Darling: A strong voice for employers in the healthcare debate

By | June 10 th,  2013 | Furst Group, glass ceiling, Healthcare, mentoring, National Business Group on Health, payers, executive, health insurance, Lean In, Modern Healthcare, patient safety, president, providers, Sheryl Sandberg, 100 Most Powerful People in Healthcare, Blog, board of directors, CEO, employees, employers, Fortune 500, healthcare costs, healthcare reform, Helen Darling, leadership, marketplaces, national debt, quality, 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)


The healthcare industry is undergoing major changes, but Helen Darling says the providers and payers who comprise much of the industry aren’t doing enough to control costs and improve quality. Her words carry a lot of weight – she’s the president and CEO of the National Business Group on Health, which represents many of the large employers in the U.S.
Darling says her membership would like to see big improvements in safety, quality and costs, but have doubts about whether that could actually happen in an industry with limited competition.


“With our healthcare system, there are no countervailing forces that will essentially force organizations to reduce costs and improve quality and safety,” she says. “We saw very little attention paid to patient safety until the federal government took this tiny amount of money and said, ‘We’re going to hold this back if you don’t meet certain Partnership for Patients goals.’ And that did get people’s attention, but that’s what it took.”


Darling’s non-profit organization represents many Fortune 500 and other large companies, serving as a united voice on healthcare policy and offering solutions to healthcare issues in the marketplace. She says her membership is concerned about where healthcare is headed.


“All you have to do is look at every report written concerning the national debt or the annual deficit and see that healthcare is the driver,” she says. “It’s not Social Security. It’s not education. It’s not feeding children. It’s all about healthcare.”


Darling herself has led a storied career, directing studies at the Institute of Medicine before becoming the health legislative aide for U.S. Sen. Dave Durenberger (R-Minn.). She later worked as a senior executive for Mercer, Xerox and Watson Wyatt (now Towers Watson) before agreeing to lead NBGH. She is a member, and co-chair for ten years, of the Committee on Performance Measurement of the National Committee for Quality Assurance and is Vice Chair of the Board of the National Quality Forum.


Patient safety, she said, is a key concern for her and NBGH.


“There’s nothing like statistics having to do with patient safety to galvanize attention to the problem,” she says. “Just think about the amount of harm or death because somebody, for example, gets an infection. Even if they don’t die, they suffer. I’m sure everybody knows families of someone who got C-Diff or MRSA in the hospital. All you have to do is look at the data and see how much human suffering and wasted cost are behind healthcare associated harm.”
The lack of progress on that front, she says, is perplexing.


“What I don’t understand, to be honest, is why there isn’t more of an outcry,” she adds. “If somebody eats a hamburger that has some contamination, it’s all over the television. If a plane goes down, people are on it for days in the 24/7 news cycle. And yet every day, in hospitals across the United States, people are being harmed and in some instances are dying from conditions that are preventable and avoidable.”


Darling encourages the executives she represents to serve on the boards of hospitals (something she herself has done), and her group offers them a patient safety toolkit. She encourages trustees to press for frequent safety reports to be given to the CEO and the Board of Directors.


“Historically, hospitals have a risk-management report, and they might have a quality report if, say, the Joint Commission did its audit and found something. The risk-management report will say things like, ‘There was a patient fall this month and we have booked $3 million as part of the liability reserved to take care of it.’ That’s it. Historically, there has been no root cause analysis, no report on what changes they’re making to stop that from ever happening again. That is changing but it isn’t fast enough or universal.”


To be fair, a few of the major employers who make up NBGH’s membership have similarly been criticized for their reaction to healthcare reform, including some who have changed terms of employment that make fewer employees eligible for health insurance. But Darling says health insurance has never been an automatic benefit for the workforce.


“At any given time during the year, we have 60 million people without coverage, and most of them are working people. Health insurance has always been a perk,” she says. “It’s never been something that everybody has, and it is very much related to wages. The irony is, the people with the lowest wages get the least benefits. But I don’t think it’s going to get worse. If the insurance marketplaces work the way they’re supposed to work, we will be better off in terms of coverage (although not in terms of the costs of health benefits coverage on a net basis).”


But the penalties for lack of coverage will need to change before that happens, Darling adds.


“The penalty is not as much as it will cost people to get the coverage. They can’t tell people they have to have a package that will cost, on average, $7,000, and then tell them the penalty for not buying coverage is $1,000. They’re going to have to change the package because it makes the subsidies much richer. They will bankrupt the country on that one.”


Still, she says she’s confident that the gap will be bridged.


“All that needs to be sorted out, but I actually think we will have more people covered. Nobody will be happy about a lot of the details. In the end, I think more states will look a little more like Massachusetts.”


Darling has been selected numerous times by Modern Healthcare as one of the Top 100 Most Powerful People in Healthcare in addition to her new award as one of the Top 25 Women in Healthcare. The Modern Healthcare article announcing the Top 25 Women was headlined, “Beyond the Glass Ceiling,” and Darling said she thinks some of that ceiling is self-imposed among women.


“I belong more to the Sheryl Sandberg ‘Lean In’ school,” she says. “I’ve been hiring men and women and mentoring them for a long time. I still see significant differences in the way men and women assess themselves, in the way they think about their careers and their families.”


She laughs as she relates a humorous story she heard on the radio recently. “It said that if women miss a child’s school event, they are just wracked with guilt. But if a man merely drops the child off at the event, he feels like he made a major contribution. That’s pretty funny, and pretty accurate.


“And as long as that’s true, women won’t always be able to have the same kind of executive career that men do. They can have the combined benefits of living in both worlds but as long as executive careers require the kind of 24/7 commitment to work that most do, women and men will have to choose what balance or lack of balance they really want.”

The results are in: These are the Top 25 Women in Healthcare for 2013

By | April 9 th,  2013 | Furst Group, Patricia Hemingway Hall, Top 25 Women, ACHE, Deborah Bowen, gala, Leah Binder, Marna Borgstrom, Modern Healthcare, Nashville, Sherrie Barch, Blog, leadership, Leapfrog Group, Marilyn Tavenner, Kathleen Sebelius, Sharon O'Keefe, Top 25 Women in Healthcare | Add A Comment



Furst Group is proud to continue to sponsor the Top 25 Women In Healthcare awards for Modern Healthcare.


This week's issue of Modern Healthcare has all the details on this year's honorees. First-time winners include Leah Binder, CEO of Leapfrog Group; Sharon O'Keefe, president of the University of Chicago Medical Center; Deborah Bowen, incoming president of the American College of Healthcare Executives; and Marna Borgstrom, president and CEO of Yale-New Haven Health System. Others selected include HHS Secretary Kathleen Sebelius, CMS Administrator Marilyn Tavenner, Leapfrog Group CEO Leah Binder and Patricia Hemingway Hall, CEO of HCSC.


“The Top 25 Women in Healthcare have battled through a lot to get to this moment, and we applaud their talent and perseverance. Gender inequities remain in opportunities, compensation and societal and family expectations,” Furst Group President Sherrie Barch says. “These women are among the top leaders in our country regardless of gender.”


The program, along with the “Top 25 Minority Executives in Healthcare” awards, also sponsored by Furst Group, continues the firm’s efforts to ensure that the leadership of healthcare organizations reflects the communities they serve. This is the fifth year that Furst Group has sponsored the awards.The awards will be presented at the gala Aug. 6 in Nashville, Tenn. We hope you will consider attending.


To see the full list of honorees, please click here.

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 The undercover exec: Wright Lassiter III scoped out his hospital before he took the job, then forged a bond with his board to stage a remarkable turn

By | September 11 th,  2012 | board, Furst Group, Healthcare, executive, Minority Executives, Modern Healthcare, patient safety, Alameda County Medical Center, Blog, CEO, directors, leadership, Top 25, Wright Lassiter III, quality, trustee | Add A Comment



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


Back in 2005, before Wright Lassiter III interviewed for the position of CEO at the then-beleaguered Alameda County Medical Center in Oakland, Calif., he decided to see for himself if there were some signals of hope in an institution that had seen 10 CEOs crash and burn in the previous 11 years.


“I flew in the afternoon before and grabbed a taxi over to the hospital,” he says. “I was in street clothes; I wasn’t in a suit. No one knew who I was. I walked into the ER waiting room and then walked the hallways. I wanted to get a sense of how the staff functioned; to see if people might help you find your way.”


What he found surprised him, especially for an organization with such a troubled recent past. Everyone he encountered was consistently courteous and helpful to him as a visitor, and to patients.


“There wasn’t one interaction that was negative,” Lassiter remembers. “The people doing the work in the trenches serving the community were doing the best they could.”


That, Lassiter says, gave him some hope that the health system could be turned around with the right moves. It also helped persuade him to give up a solid, comfortable position at JPS Health Network in the Dallas-Fort Worth area where he was senior vice president of operations.


Fast-forward a few years and the work that Lassiter has accomplished earned him a glowing write-up in Fast Company magazine, a spotlight that brought him national attention as well as some good-natured ribbing from his peers, he adds.


But to Lassiter, none of it would have happened without the backing of his board of trustees, a source of strength that is sometimes overlooked in the business world, he says.


“Two board members who served on the search committee that selected me are a large part of the reason why I considered the job in the first place,” Lassiter says. “They were instrumental in the turnaround. I think it’s important for CEOs to partner with their boards to drive change.”


It was the board’s backing that enabled him, he says, to press forward with an aggressive plan to reduce errors and champion quality and patient safety.


“I generally take my board members to health care conferences to help them understand the nuances of what’s being presented,” he says. “But I purposely did not go with my vice chair when he attended an IHI conference on quality because I didn’t want to influence him. He went with our chief medical officer instead. When he came back, he told me, ‘OK, Wright, I get it. I am scared out of my mind, but we have to do this.’ ”


The leaders at Alameda County Medical Center presented a plan for “harm reduction” and, in 18 months, reduced incidents of harm by 48.5 percent across the system.


“People get uncomfortable with the word ‘harm,’ but the board agreed that it was the correct word to use. The groundbreaking report “To err is human” found that harm was happening in hospitals and we were willing to acknowledge that a problem existed,” Lassiter says bluntly. “Our work drew glowing comments from the Joint Commission and Donald Berwick, a member of the original committee that published the report on errors. That’s what happens when you educate a board well and then engage them.”


Healthcare and leadership are part of Lassiter’s heritage. His mother is a nurse, and his father is chancellor of the Dallas County Community College District. What he’s learned from them, and from his career, is that a critical factor in leadership is simply courage, like the move he made in accepting the Alameda position. “That doesn’t mean blind courage,” he notes, “or taking risks that are inappropriate. But when the lights are off and you don’t know what’s around the corner, you have to lead with courage.”


Closely aligned with courage, he says, are transparent communication and flexibility. “Communication is especially important with the medical staff,” Lassiter notes. “You tell them, ‘Here is our plan, and we will keep communicating with you all the way through this process.’ ” It’s a reason why he still takes part in new employee orientations, he says.


Flexibility is based in honesty, Lassiter says. “You have to do your planning with flexibility. You can plan so that you have a baseline for your actions as an organization, but you have to be willing to be flexible if conditions change.”


And as conditions change within the healthcare industry itself, he says, building a leadership team requires flexible people. “Healthcare is a relationship business, and I’m always looking for folks who can foster, build and maintain strong relationships. It takes perseverance too. You can’t be dissuaded easily by problems or challenges.”


At Alameda, the challenges have been formidable, but Lassiter and his team have stepped up to the task, stopping seven-figure financial losses and building a new facility while dealing with all the issues that come with being a safety-net hospital.


“When I talk to our people, I say, ‘Think of your loved ones and put their faces on the patients and families you’re caring for.’ When you approach your work with this in mind, you will do all you can to provide excellent service.”

Profiles in Leadership: Top 25 Minority Executives Ben Chu helps Kaiser Permanente make quality count

By | July 6 th,  2012 | American Hospital Association, change management, Furst Group, Healthcare, population health, health system, hospital, Modern Healthcare, physician, Blog, CEO, diversity, healthcare reform, Kaiser Permanente, leadership, chairman-elect | Add A Comment



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


Benjamin Chu, MD, MPH, MACP, oversees Kaiser Permanente Southern California and Hawaii as group president. In the seven years since he arrived, Kaiser Permanente has amassed many awards for quality. He also is chairman-elect of the American Hospital Association and will begin serving in that capacity in 2013.
Prior to joining Kaiser, he was president of New York City’s Health and Hospitals Corp., the largest public health system in the country. He also served as associate dean at both Columbia University and New York University.


Following is an edited transcript of the conversation:


You have a Bachelor’s degree in Psychology. What spurred you to go for an M.D.?


I think I always was going to be a doctor. Unlike a lot of people who have a core basic science orientation, I was always more interested in the human side of medicine. Psychology, child development, and anthropology are more in line with things I was thinking about. As you know, in medicine, there are a lot of behavioral and developmental aspects. In order to be effective, you have to understand the cultural determinants of health. All of these factors led me to pursue work in a field where I could actually help people. There is a whole sociology and culture of medicine that one cannot fully understand unless viewed from the psychological perspective.


You spent most of your life out East before moving to California. What spurred that move, and has it worked out as you expected?


I was running the NYC public hospital system under Mayor Bloomberg. It was an incredible experience and an incredible job. We were doing very innovative things in that system. It is a huge system that cares for 1.3 million NYC residents. When the opportunity arose to move to California and run a large chunk of Kaiser Permanente, the prospect piqued my interest. How far can you take a systems approach to delivering on improving the health of the population under the care of a large system? In Southern California, Kaiser Permanente has 3.6 million members, three times the size of the population we were caring for in NYC. The nice part about it is that the components and pieces are linked in a large multi-physician group that only works with the health plan and the hospitals. The health plan allows for pre-payment for care of the population. There is an entire delivery system under us that allows us to decide how to parcel resources in order to achieve the goal of maximizing the health of the population we serve.


How do you get a big system like KP to deliver on its promise and to take healthcare to a whole different level?


That was both the challenge and the fun part of coming to KP & California.
I didn’t know many people when I was coming to Kaiser – primarily George Halvorson [chairman and CEO] and Ray Baxter [senior vice president for Community Benefit, Research and Health Policy]. It’s been an incredibly rewarding experience. We had to put systems in place – our electronic health record and other systems – to allow us to look at our performance in a very open, honest, and critical way. We had to reconfigure the system. KP had been better than average on quality and outcome for our members. Now, because of what we’ve been able to do with tools, reconfiguring our system, and getting complete alignment of our systems, components and people (including the 60,000 employees in Southern California), we are pretty close to leading the country on many metrics.


From Leapfrog to NCQA, KP across the board has achieved some remarkable ratings for quality.


There has been a steady progression over the last half dozen years. We’ve taken a systematic approach. We engaged every member of our staff, from doctors to non-doctors and from professionals to frontline workers, to get to that point. It has been very rewarding and a lot of fun to do.


The last six years coincide with your arrival. What role did you play in these changes? What role did you leadership team play? What did you look for when bringing a new leader on board?


To tell you the truth, I don’t think I have brought anyone new in, believe it or not. I spent time getting to know the people here. We have a wonderful leadership group, and there have been very few changes. The changes were largely to replace people who left. What would be the key to our success? It hovers around getting complete alignment over what we wanted to do.


Much of the alignment was around trying to make sure we did everything possible to benefit our members. It was not a financial decision. While financials are important, they aren’t driving our goals at this point. The larger point was to make sure everyone understood that at the end of the day, it is our members and patients, and how we perform for them, both in the individual aspect and aggregate aspect.


People rallied to this message of reaching for the higher mission. It’s hokey to think about in that way, but you’d be surprised. Everyone comes into healthcare to make a difference in another person’s life. One of the things we did as a leadership team was to galvanize everyone’s desire to make a difference and reminded people of this. I think this is the key to leadership overall. I am blessed to have a lot of incredible people working with me on much of this.


Obviously we had to put in the systems to give us the information to know if we were making a difference in people’s lives. Once we got that in place and held that mirror up, the ideas came flowing out, and we could tap into this wellspring of creativity and desire to do the right thing. I am a doctor by training in a non-clinician role right now, but it is a pleasure to see that marriage of clinical outcomes and my public health background on population health outcomes come together in a delivery system.


As you look at your role at the American Hospital Association as chairman-elect beginning in 2013, do you get the sense that part of what they are looking to you for is to help other hospitals across country pick up on what Kaiser has done and get the quality scores up and make a difference nationally?


If you actually talk to the hospital leaders and members of the boards across the country, there is an enormous amount of energy working to find ways of taking care of their communities. Part of this is the quality agenda. Thousands of hospitals have joined the hospital engagement networks that are forming right now and are trying to learn from each other and optimize the quality of care given in the hospitals themselves. Hospitals are beginning to see that they play a pivotal role in their communities.


Rather than be passive and wait for people to get sick and come in, there is a role to be played more upstream – to make a difference in the community’s fabric and in its health. Some of it has a lot to do with impacting the developing ACOs. It is an often misunderstood, yet often used, term. The idea is to get an organization and care delivery system to care for a population and try to go as upstream as possible to find strategies that lead to good health and mitigate things that lead to bad health, not just treat emergency situations. It means partnership with providers who work in the upstream levels. Doctors who see patients in an outpatient setting tied to the hospital or in their practices – we need to link the two together.


There is a lot of energy in the hospital world. One of the reasons I was asked to chair in 2013 is that there are tremendous, yet uncertain, changes that are happening. There are also these powerful positive forces that can help hospitals and health systems come together in a better way to take better care of their communities. I think I was asked to chair so we can engage in a system-wide and country-wide dialogue to help each other overall.


Given the uncertainty around reform – does that make leadership harder for you and the people running hospitals round the country?


It depends on what you mean by harder. It certainly makes it much more interesting. The pathways to choose are much more ambiguous. In uncertain times, leadership needs to focus energy on the right things. I think that is why the AHA is working with our member hospitals to determine the higher-order outcome. If we dive into the weeds and get into the arcana of legislation and stay there, we will get lost. That is not to say reimbursement and policy changes aren’t important, but if that is all we think about, there is no ability to guide organizations through a field of uncertainty.


If you can’t pick up your head to see where you are going, you cannot mobilize physicians and institutions to move in the same direction, and we will be mired in the field and will not get anywhere. That is the difference between someone who is good operationally and a leader who can engage people in dialogue to get everyone to a place where we want to be.


There seems to be a growing consensus among healthcare leaders that we are on a course of change that will continue whether mandated or not.


I think that is absolutely correct. Healthcare is changing in a good way, I think. I know people worry about losing the good things in uncertain times. When you think about what we are capable of doing and how many people we are capable of doing things for, I am convinced that with a little change in perspective and focus, we can utilize the dollars we spend in healthcare and create a lot more healthy communities. It is a journey in a lot of ways – a very uncertain journey. I think the focus is changing. Payment reform is happening. A lot more transparency is coming. There will be changes to tell us how we are really doing. Once you are confronted with that information, it is a compelling force driving changes that could get us to a better place.


I think that in the best framing of what is happening now, that is the direction the country’s healthcare systems is headed. Probably the direction the world’s healthcare system is headed. Even though we are making a difference, how do we know we couldn’t be making a bigger difference? When you think of disparities in healthcare and how uneven results are, I think in this day and age, there is little the systems cannot tackle. We won’t all get there at the same time, but if we focus right, there’s a lot more good that we can do.


There seems to be an increasing interest in physician executive leadership. As a doctor and physician yourself, what is your take on that?


The lesson we’ve all learned is that in order to take on the larger tasks, the triple aim, all of the key pieces must be aligned. Physicians and other healthcare professionals have to be integrated into the whole system. We are trained to be separate. Even though hospitals are a part of the action where people are treated and where doctors do what they do, they are still only a piece of the puzzle. To integrate the perspectives, many places are looking towards physician leadership, whether as an administrator or at a Medical Director/CMO level.
We need voices there and to be open and honest about the larger goal. We cannot just see hospitals as a doctor’s workshop. That will only get us so far. Obviously, we want someone to care for patients and bring their expertise. However, it is not just a single doctor, but multiple healthcare professionals. We want to see the larger role for the community.


We need to make decisions on the deployment of resources and make a bigger difference than just delivering the best care in the ER. I’m not saying the best care shouldn’t be delivered in the ER, but when you think about it, it may not be the optimum expenditure of resources if you only concentrate on the ER.


In my opinion, there should be more doctors at senior levels of health systems. Having everyone’s perspective is important and makes a difference.


You spent time working in the office of Sen. Bill Bradley. What insights from that time guide your perspective in today’s healthcare climate?


I’m not sure there is a tremendous amount of insight but, when I worked for Senator Bill Bradley, it was one of the last times for major Medicaid expansion. The American with Disabilities Act was passed the year I was there; we passed the Medicaid Best Price legislation for pharmaceuticals, and expanded Medicaid to children up to 133% of the poverty line and pregnant women up to 185% of poverty. That was really the last big expansion before the children’s health program came in.


When I think of that era, it was a time of greater bipartisan collaboration. I worked for a Democratic senator when the first George Bush was president. There was a lot more collegiality. That’s not to say that cannot happen again, but I’m hoping after the upcoming, probably raucous, presidential campaign, that people will be more realistic in looking at the problems of our country and figure out how to solve them.


Even if we concentrate on legislation, that’s not always where the action is. Many core changes are already starting to happen. Core systems changes are being worked on. I don’t think there is a way back. From the hospital perspective, one of the opportunities was finally being able to count on some sort of payment for care of the significant portion of uninsured patients that would come in to the ER and hospitals. This includes upstream care and hospitalization. From the community and hospital point of view, that was one of the best parts of healthcare reform. I hope that will continue. I know it presents problems for many aspects of the healthcare world, the Medicaid expansion, as well as the exchanges, but I hope that some sort of increase in uninsured care will continue. We will always muddle our way through. We always have muddled our way through, based on my experience with Senator Bradley. It was not always clear then (1989-1990).


Healthcare organizations, particular in the inner cities, are creating senior housing, opening banking centers, farmers’ markets, and developing other innovative systems and ideas such as free surgery day. Some might think it’s a bit far afield of healthcare, but it seems to be a growing part of preventive care. Is this part of the equation at Kaiser Permanente as well?


Every one of KP’s medical centers runs a farmers market. In fact, we run the only farmers market in Los Angeles. This is illustrative of what I was talking about earlier – the tremendous amount of energy spent in the hospital world trying to figure out how we go upstream. The medical model is individual – one person at a time. When someone is sick, you care for them and send them back out. This is an important function for every community. The underlying premise is that the sum of all the good one-on-one work will translate into a healthier community. Clearly, this model leaves huge gaps. The medical model really is not directly focused on the population’s and the community’s total health.


There is a broader understanding that what makes a person healthy or not is as much about the health of the community and total health of the environment as it is to prescribing the right medicine. Eighty percent of the determinants of health are not linked to care. Smoking, exercise, drug use – these are things people need to think about if we are going to make a greater impact on the community and population health.


At Kaiser, we have a theater troupe that goes into grade schools to do thousands of performances on healthy eating to influence kids on eating habits. Collectively, if 5,000 hospitals and health systems can get it together and start moving upstream together, it could be a very powerful force. To become a vibrant part of the community is key. We helped invest in parks. We have beautiful weather in Southern California, but unless you have good outdoor spaces, people will stay in their homes or in their cars to go from place to place. The built environment in the community makes a difference. Do people have the choice to make better decisions? We need to provide spaces to make better decisions.

Profiles in Leadership: Top 25 Minority Executives Change, challenge invigorate Saad Ehtisham

By | June 25 th,  2012 | change management, Furst Group, Healthcare, Modern Healthcare, Saad Ehtisham, Blog, CEO, diversity, leadership, mentor, University Medical Center | Add A Comment


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


If Saad Ehtisham is something of an expert at change management, you might say it’s because those skills began to be honed at a young age.


After graduating high school in Pakistan, he began to look for a solid university for pre-med studies in the Dallas-Fort Worth area, where the majority of his mother’s family resides. (He’d been inspired to pursue a career in healthcare after helping to take care of his grandmother after she was diagnosed with ovarian cancer.) Ehtisham ultimately chose Baylor and, while he ultimately chose a route in nursing and healthcare administration instead of pursuing an MD, he cites that experience as a building block in his rapid rise through the healthcare industry.


“When you emigrate to a country at a young age, you tend to grow up a lot faster,” said Ehtisham, 42, the CEO of University Medical Center in Lebanon, Tenn., in a calm voice that sounds as Texan as a 10-gallon hat. “Going to Baylor was one of the best decisions I ever made. I was one of two students of Asian-Indian-Pakistani descent, and we were able to open up the university to greater diversity. It was a great atmosphere and I made some lifelong friends.”


He finished up with bachelor’s degrees in science and biology at Baylor, then continued his studies at Texas Woman’s University, where he earned bachelor of science degree in nursing, a master’s in business administration, and a master’s in health care administration. He took his degrees and started his medical career as a phlebotomist, drawing blood from patients. He became a nurse and worked his way up. He’s been a medical and surgical director, a chief nursing officer, a chief operating officer, and even served as an interim CEO in a career that has taken him all over the country, from Texas to New Mexico, Kentucky, Indiana and now the Nashville area. Ehtisham says the changes he’s experienced in his wide-ranging career have helped him better understand healthcare.


“One of the things I have learned in moving around the country is that healthcare is regionalized,” he says. “It really is different in different parts of the country. That’s helped me to become more diverse in my approach to healthcare.”


Having experience on the front lines as a nurse has helped him relate more easily to clinicians in his roles as an administrator, says Ehtisham, who has helped reduce turnover and increase patient and staff satisfaction at a number of his career stops.


“For me, clinical knowledge has been my greatest asset,” he says. “It’s helped me to get farther with physicians and get them more involved, usually with educating the front-line staff about different diseases. And it’s helped me to a better advocate for patients.”


Ehtisham describes his management style as “patient-centric.”


“When I approach decisions, I want to know two things: how does it improve patient care, and how does it improve my outcomes? If we’re evaluating a process and it doesn’t improve patient care, is it worth doing? Let’s think that through first, because anything else is wasteful and we don’t need it.”


Although success has come swiftly for him, he is quick to credit three mentors for shaping his leadership in key ways.


“Tim Charles was my first CEO, at Presbyterian Hospital (in Denton, Texas). I learned a lot from him—the way he interacted with physicians and his community involvement. I spent about 18 months with Dewey Greene in Albuquerque (when Greene was COO of Lovelace Health System). I would meet with him and barrage him with questions. He had a significant impact in preparing me for the CEO role.


“And Angela Marchi was my CEO at Albuquerque. She taught me how to stop being uptight and relate to employees in a way that would empower them to be more effective. She was very skilled at relationship building. Leadership is about relationships, and she taught me that if you can lead people, you’ll be much more successful than having to manage people.”


So Ehtisham has worked on his relationships, and on building his own leadership team as a CEO.


“To build a good team,” he says, “I look for diversity among the team members – not just ethnic diversity, but diversity in the way we approach things and the beliefs that we hold as a team. I like people who are comfortable with ambiguity, and I look for perseverance – anybody can lead through the easy times.”


In the rapidly changing world of healthcare, there’s a lot of ambiguity right now, but Ehtisham doesn’t see that as a barrier at all.


“I’m excited and energized by the uncertainty in healthcare right now. We’re ready to rise to the challenge.”

Profiles in Leadership: Top 25 Minority Executives Michael Ugwueke helps Methodist South turn around

By | June 5 th,  2012 | Furst Group, health system, hospital, Methodist South, Modern Healthcare, Blog, CEO, Memphis, leadership Michael Ugwueke, Methodist North | Add A Comment



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


Michael Ugwueke is CEO of Methodist South and Methodist North hospitals in Memphis, Tenn., where he also serves as senior vice president of the Methodist Le Bonheur Healthcare system. He came to Methodist in 2007 from Provena St. Joseph Medical Center in Joliet, Ill., where he worked as vice president of operations. Ugwueke, who came to the U.S. from his native Nigeria as a college student, turned around the troubled Methodist South facility, instituting a 30-minute emergency-room guarantee to the community in the process. His success led his bosses to add Methodist North to his responsibilities. Following is an edited transcript of the conversation:


Do your ERs still have the 30-minute guarantee in place?


Yes, we’re still doing it. When I first got into town, Methodist South was not very highly regarded. We were trying to turn the hospital around. There were a lot of issues stemming from perception of poor quality, low volume and low employee morale.


And one of the things that occurred to me is that most of our patients – over 80 percent – came through the emergency room. To make any noticeable impact, change had to start from the emergency room. When we went about trying to improve the turnaround process in the ED, that equally meant that we also needed to improve the turnaround process for major ancillary departments, specifically the lab and radiology departments. We wanted to make sure we streamlined our operations to remove all bottlenecks that affect quality and efficient delivery of service to our ED patients.


The 30-minute guarantee was part of my overall strategy, because what I really wanted to do was to create a new story about Methodist South. I knew that if we were able to create a new story, it would eventually take over and the old story of Methodist South would gradually die away.


So we took the 30-minute guarantee very seriously, and made it happen. That was almost five years ago, and it hasn’t stopped. Back then, we saw 37,000 visits a year. We ended 2011 with more than 61,000 visits and, with the current first quarter trend, we’re probably going to end up with 69,000 in 2012.


It helped to change the whole dynamic of the hospital, not just the emergency department. The operating room has to be efficient, the floors have to turn over very quickly, and everything from the laboratory to housekeeping is critical in our success.


There’s a sense of pride for all the associates who were involved in this initiative, especially when they hear from their family or other members of the community.


Tell me about your role and Methodist’s role in domestic violence prevention. How did that come about?


Community involvement is very, very important to me, but my involvement in working to end domestic violence came about strictly by accident. There was a nurse at another hospital who was killed in the parking lot when she came to work by an ex-boyfriend who was stalking her. It became a big news story here. It prompted one of our doctors, Todd Motley, to start talking about incidents of domestic abuse he believed were happening to some of his patients. He created a program so that victims of abuse could call his office for an immediate appointment, receive some shelter and notify the police. He came to me and it didn’t take but a minute for us to get behind what he was doing.


So we ask our associates to donate clothes and toiletries, among other things, to help these women. But Todd Motley is the brains behind this.


You recently paid a visit to the White House. What will you remember from that day?


It’s the first time l’ve ever been there. I lived in D.C. for a brief period of time and always said, “I’ll do this, or I’ll go there,” and I never did.


Steve Cohen, the congressman from my hospital district, extended an invitation from the White House to meet with key minority business leaders to brainstorm about job creation and various other opportunities. So about 20 business leaders from Memphis sat down with the White House staff. I was truly honored to be invited as part of the delegation that met with them.


Where have you learned the most about leadership? And from whom?


Actually, it started at home. My dad was the primary person in my life that I felt believed in me and provided guidance to me as a kid growing up in Nigeria. I watched him as he struggled to raise us up with limited resources; he was my inspiration in every way imaginable because he was looked upon in the community as a leader even without a formal education. Having the guts to leave your country at the age of 21 to come to the U.S. where you don’t know anyone, and believe that you’re going to survive with no money – that came from my dad’s ability to instill in me the knowledge that the world did not owe me anything and I had to create opportunities for myself.


My dad did not have a formal education. He was self-taught but was able to become a foreman in a construction company and eventually was able to start his own construction business. He wanted to make sure all his kids had the opportunities for education he didn’t have. I was very fortunate to have such a person in my life during my formative years.


A number of other people also have been very instrumental in my life. I’m forever grateful to Michael Covert. I met Covert when I was working at Sarasota Memorial Hospital in Florida. He provided me with lots of growth opportunities and was my first formal mentor. When he left the hospital to become the CEO of Washington Hospital Center, he asked me to come with him as one of his executive team members. He was very instrumental in mentoring me and providing needed guidance as I continue to take on additional challenges within the hospital. The second person is my current System CEO Gary Shorb – he is one of the people who nominated me for this award. He is a wonderful mentor and the reason why I came to Memphis; he too has provided me with lots of growth opportunities. He is a servant leader who is extremely passionate about patient care.


What makes a good leader?


For me, a number of things make up a very good leader. A leader is someone who is willing to step up and do those things that most folks are unwilling to do, to have the intestinal fortitude to make tough decisions, who is visionary and willing to lead from the front. A leader creates the environment that empowers others to equally step up and lead.


You have to make sure that you have clarity in your organization with total transparency in all communications with your associates as well as other key stakeholders. For example, we conduct four town halls a year to ensure that everyone is on board with our goals and objectives. We share the results of our activities during these sessions – good, bad and ugly – so everyone knows exactly what is happening at any given time. It takes away the “we” and “they” mentality which ultimately leads to trust.


What are the keys to building a good team?


No one can do anything by themselves. In my early years, I realized the importance of teamwork. There are certain guiding principles one develops. In my case, I like to have a very diverse team that reflects the community we serve.


I also like to pick out people who are much smarter than me and passionate about making a difference because that’s what it takes to do this kind of work. I inherited the leadership team here; my philosophy is not one of blowing things up and bringing in all new people without giving the existing team members the opportunity to prove themselves. I like to believe that most leaders, given the opportunity with clarity in expectations and support, can get the work done. I like to make sure they understand the reasons behind the new vision and what implications it has on their success. Obviously, you give everybody a chance, and some will self-select when they realize that they’re better suited for another environment.


But I try to build my team in four ways:


The first is to try to create a culture of accountability, to be very clear with the goals of the organization. We set clear priorities and expectations with timelines and metrics to gauge and measure our progress. All my leaders have actionable plans that support their goals and priorities for all of their areas. To be effective, one has to know their business in and out and able to explain positive or negative variations from their goals.
We track our goals on a quarterly basis, and plan for where the metrics need to be on a monthly basis in order for us to accomplish our 90-day goals.


It’s very important in developing a high-performing team that you have a sense of trust. You have to create a level playing field – no one has a monopoly on good ideas. Everybody’s goal is shared with everyone. There are no hidden agendas.


Second, is to create a culture of rapid execution of ideas. We don’t want analysis paralysis with several meetings and no results. We try not to wait till we have 100% of the data before execution of great ideas, What typically happens is that if we are comfortable with 70 percent of what we need, we will go ahead with our plans, with the expectation that we may have to refine and course-correct as needed. If you try to wait till everything’s perfect, you’ll never get off the ground.


When we started the 30-minute guarantee for our emergency department, we met every afternoon. We shared yesterday’s data – everybody knew exactly how we did, and then we made immediate changes to address variations from our targets.


Third, is leadership and associate engagement. I strongly believe that the engagement factor with your team is important. I conduct 90-day meetings with all new associates to ensure that we are still meeting their expectations and I often meet with leaders and seasoned associates to learn about their challenges to ensure that we are providing adequate resources and tools that they need to accomplish their goals. In addition, it provides me the opportunity to recognize their efforts. You need to devote time to this and make those connections.


Fourth, is total transparency in everything that we do – data and results are shared liberally, with clear understanding of our strengths and shortfalls with no excuses. We do this during our town hall meetings, annual retreats and operational efficiency presentations by department leaders.


You’ve spent a lot of time at faith-based institutions. How different are the challenges there?


For one thing, the mission is very clear. There is very little ambiguity as to what the mission is. I believe that the difference is how we go about providing care for everyone regardless of their ability to pay. Also, we invest a lot in the community, trying to improve the health of our community – as you well know we don’t expect for anyone to reimburse us for the things that we do in the community. By virtue of being a faith-based organization sponsored by the United Methodist Church, you feel like you have the moral authority to look at things in a slightly different way. At the end of the day, my expectation is that we are going to treat the patient holistically in a patient-, family-centered environment. We do the best we can with limited resources to make sure people who ordinarily don’t have access to healthcare have the opportunity to experience excellence in healthcare.


In terms of diversity in healthcare, what kind of changes have you seen since coming to the U.S.?


No doubt there’s been some improvement, but we still have a ways to go. As long as we are still talking about disparity in care among different groups, we know that we are not there yet. I think the gap is closing within the ranks of supervisors and middle managers. The area of greatest opportunity is within the director level and senior teams.


Is leadership harder today given all the uncertainty around reform?


It will be easier to say yes, but I am certain that every generation of healthcare leaders probably thought that things were harder for them. I think that healthcare reform definitely presents lots of challenges which are opportunities in disguise. Regardless of the outcome of the Supreme Court ruling, changes have been made throughout the industry because the payment model that we have is just not sustainable. The challenge is having one foot on the throttle and the other foot on the brakes as we move from a fee for service to value-based purchasing.