Leadership
Physicians Leading | Leading Physicians

Lessons in Leadership: James Reinertsen

Interview · August 7, 2017

Former CareGroup hospital system CEO James Reinertsen reflects on the challenge of getting individual hospitals to function as a true system. Not probing deeply enough into leaders’ seemingly unanimous and enthusiastic support for going forward as one meant that unspoken dissent was not revealed or processed. The veneer of agreement had consequences for both the CEO and for the confederated hospitals’ ability to coalesce as a system.

 

Jim Reinertsen Head Shot

 

James Reinertsen: In 1998, I went to Boston to take the role of CEO of a six-hospital system, CareGroup. I’d had a big flagship hospital at Beth Israel Deaconess, which was in itself a merged hospital between two very different hospitals, the BI and the Deaconess, but five other hospitals as well, and this system was more of a loose aggregation than a real system. Everybody understood that, were quite honest about it. Basically it went out and borrowed money together, but otherwise behaved as six independent hospitals. As I realized this, I thought it would be important to get clarity about what their long-term intentions were. Were we going to become a real system, or were we just going to be a gaggle?

I was now about 3 months into my job as CEO, and it was such an important question for me, because everything we organized and did would depend on the answer, and besides, I actually didn’t want to be the CEO of a gaggle. I realized that as well. So, it was important for me personally. After a lot of planning and discussion, we got some 60 of the most senior leaders of this entire system, of all six hospitals — the board leaders, the executive leaders, physician leaders — into a very small space called the Design Shop in Cambridge, a crucible for working out stuff like this, and we spent I believe 3 days, some 16 or 18 hours a day, all together in this space trying to work out an answer to this question: Do we really want to be a system, or are we going to be content to be a loose collection?

At the end of the 3 days, I in effect called the question, “What are we going to do?” Every single person stood up on a stage and declared in a very enthusiastic way, “We are going to be a care group.” There were songs. There were skits. People had fun. There were hugs. It was unanimous, and I drove home that evening around midnight, and I remember a feeling of disquiet. But I thought, “Wow. We are really going to do this.” And the next day, literally the next day, I started implementing the things we had decided to do, because we had to ask the question, what would it mean? And they had to have a plan. So, I put the plan out for everybody to see, and started going forward with it.

Within 24 hours after that, the undermining and dismantling of this plan began, in not rare instances led by some of the very people who were in the room, involved. And the profound lesson for me as a leader from this one was, first, that it put me in a very awkward spot. I’m up there now publicly saying we’re going to do this, right? Some of the very people who had helped me come to that conclusion — unanimously, let me remind you — were saying, “No, no, that’s not what we said,” or whatever. The leaders I’m reminded of when I tell that story to people are both Alfred Sloan and Abba Eban. Abba Eban said, “A consensus is when everybody says publicly what nobody thinks privately.”

And Alfred Sloan said something that I should have known at the time I did this. If I had seen this statement from him and thought about it, I would’ve done the right thing, but I didn’t. He said, to the board of General Motors, “Gentleman, it appears that we are in complete consensus on this issue. Therefore, I suggest that we table it, and wait for 2 or 3 weeks so we can develop some disagreement about the issue so that we can understand what it’s really about.” I did not say, “People, let’s just take a pause and develop productive disagreement,” which would have exposed some really interesting issues I should have known about. I would have done things very differently, had I actually exposed them.

I think we learn more lessons from failure than we do from success. This was a lesson I learned from failure, and a very important one. The question really remains, “What could I have done differently?” I suppose, in the moment when this consensus was now overwhelming this group.

And it would have been hard for somebody who really disagreed to actually, at that moment, late in the process, say, “No, no, no, I think this is lousy.”

There was kind of a crowd mentality, not in a riotous way, but in a unanimous way. Somebody in the room — it could have been me, it could have been somebody else — needed to raise the question, “People, is there a crack in this someplace? Is anybody in this room feeling uncomfortable right now?” That might have been a question I could have asked, and, “If so, please speak up, because we need [to hear it],” and do it in a way that’s not calling them out as somebody who’s deviant from the rest of the group, but as an important source of information for us.

If you look at the adaptive leadership model of [Ronald] Heifetz, in his model is to seek out the voices of disagreement, the ones that people aren’t listening to, and bring them out, because they often are speaking the truth. And I failed to do that. I teach Heifetz’s model. Ron and I worked together with our management team on this kind of stuff, and I failed to eat my own dog food in this particular, didn’t even use what I knew should have been done. And I think I was seduced by the same way — it was fun to realize, “Wow, they’re really committed to this, and they’re behind me, and good.” That’s sort of what I wanted them to say, so I wasn’t actually trying to bring out the other voice that was in there. So, yes, I’ve got a lot of personal responsibility for it, not having generated the productive disagreement.

I should have done what Alfred Sloan said, just, “Okay, folks, that seems great. Let’s wait 2 weeks and see if it sounds as good 2 weeks from now as it sounds now.”

 

This story was recorded at the Institute for Healthcare Improvement’s 28th Annual National Forum in Orlando, Florida, on December 4–7, 2016 by Mary Jane Kornacki on behalf of NEJM Catalyst and originally appeared on the NEJM Catalyst website on February 28, 2017. We wish to thank IHI for support of this project, especially Madge Kaplan for her technical advice and guidance. Click here for more Lessons in Leadership stories.

New Call for Submissions ­to NEJM Catalyst

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Leadership
Physicians Leading | Leading Physicians

Leadership Survey: Ability to Lead Does Not Come from a Degree

NEJM Catalyst Insights Council members strongly favor dyad leadership shared between clinical and administrative leaders and say the top attribute for health care leaders is interpersonal skills.

Physicians Leading | Leading Physicians

Leading in a VUCA World: Volatile, Uncertain, Ambiguous

Small nuances become powerful drivers of not only how we engage our patients, but also how we engage our colleagues.

Key Dates for the Affordable Care Act

Repeal efforts may be on the shelf for now, but several upcoming important milestones will affect the performance of the Affordable Care Act in the next insurance enrollment period.

Physicians Leading | Leading Physicians

My Favorite Slide: Why Emotional Intelligence Is Important for Leadership

Emotional intelligence is an important driver of organizational performance in health care.

Physicians Leading | Leading Physicians

Parental Leave Policies: Leading by Example

How we train — and treat — our resident physicians is more important now than ever.

Physicians Leading | Leading Physicians

Coaching to Enhance Individual Well-Being, Foster Teamwork, and Improve the Health Care System

Coaching interventions may help to turn the tide on physician burnout.

Physicians Leading | Leading Physicians

The Critical Window of Medical School: Learning to See People Before the Disease

How a classic experiment could shape the future of medical education.

Physicians Leading | Leading Physicians

The Real Danger of Increasing Resident Work Hours

The debate on work hours is just as unimaginative as it is outmoded.

Physicians Leading | Leading Physicians

Integrity and Reputation Are the Most Important Things One Has

The new CEO of SSM Health is listening to stories, not telling her own.

Physicians Leading | Leading Physicians

Tools to Live Your Values AND Succeed

Tools to give people in your organization a clarity of direction, the ability to work with each other, and the desire to build forward to serve a higher purpose.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Team Care

65 Articles

Surviving — and Thriving — in…

What can the health care industry learn from the 1914 Endurance expedition? For one thing:…

Leading Teams

93 Articles

Surviving — and Thriving — in…

What can the health care industry learn from the 1914 Endurance expedition? For one thing:…

Leading Transformation

143 Articles

Surviving — and Thriving — in…

What can the health care industry learn from the 1914 Endurance expedition? For one thing:…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now