As health care CEOs strive to guide their organizations through complex and uncertain times, they face increasing workloads, conflicts between time for care and time to meet regulatory demands, and a sense of loss of control. Burnout is common. Changing payment models make it even more challenging than usual to find a path to positive margins, and many CEOs become preoccupied with that path. However, even though “no margin, no mission” remains as true as it ever was, we believe that it is a mistake to place dominant emphasis on financial performance. Our study of transformational health leaders shows that it is possible to achieve both mission and margin, and avoid burnout, by focusing first on the personal and organizational values that fulfill the Triple Aim of better care, better health, and lower cost. While money is still part of the equation, these leaders keep it in its proper perspective.
One such transformational leader, Sister Mary Jean Ryan, founding CEO and former Chair of multistate system SSM Health, told us, “I worry about finances, capital, and so on. But none of it matters if we can’t provide safe care.”
We heard this message repeatedly from the 10 CEOs we studied for our book The Heart of Leadership. We chose them by polling our contacts, and their contacts, for the names of leaders they considered transformational. The 10 that we chose, all nominated by multiple people, have sustained higher levels of performance than their peers in similar circumstances across a range of measures, including safety, quality, financial health, and public recognition. They came from different kinds and sizes of health care institutions, varied geographies, and a range of backgrounds. By training, four were nurses, three were physicians, and three were non-clinicians. We interviewed them in depth and also spoke to their employees, colleagues, and board members.
We heard the same emphasis on patient-care values even more powerfully from the employees of these organizations. They were just as passionate, committed, and energized as their leaders. All were engaged and felt positive about what they could accomplish together, and they exhibited no signs of burnout.
We were interested in what made these CEOs tick and how they influenced organizational performance. Our interviews showed that they all shared personal values and similar approaches to shaping organizational priorities, culture, and decision-making.
We identified four personal values and five organizational values that all our study subjects share. (The quotes in italics each refer to a different leader.) The personal values are:
- Passion for care. Some of our subjects had been involved in a family member’s care, while others had some other type of direct experience with patient care that fired their enthusiasm. Regardless of its origins, these leaders share a personal passion for care that they communicate to those around them: “The patient matters most to her”; “He is unwavering about the mission — he has a constancy of purpose”; “She has a strong sense of integrity of what’s right for patients — she lives and breathes it.”
- Hunger for learning and reflection. These leaders are intelligent, eager for learning, and able to find time to be reflective. They see these priorities as an essential part of their responsibility: “She continues to expand her personal management toolkit and inspires me to do the same”; “He is a tremendous learner and listener”; “She has a great capacity to integrate information — a student of leadership.”
- Authenticity. These leaders’ words match their actions and are marked by authenticity and humility: “‘I’m here because of you’ is a quote from the CEO to all staff after a major national presentation”; “She is impeccably true to her words — she is a servant leader”; “I trust him with any decision because he will always do the right thing for patients, the business, employees — and he will not accept otherwise.”
- Genuine interest in people. It is obvious to employees and colleagues that these leaders care about them and trust them: “There’s a ‘thereness’ when she’s with others. She will swivel her chair, move in, and doesn’t look at her computer while listening”; “He has a desire to be with and around people to hear what is important to them, what they need.”
The organizational values are:
- Relentless patient focus. The CEOs’ personal passion for care translates into an unusually tenacious patient focus in their organizations. This focus drives the organization’s strategies and goals: “She is not distracted by the crisis of the day; she doesn’t jump around or vacillate”; “Our strategic plan is alive and well. What is best for the patient? What will make a perfect experience for the patient?”
- Constant drive to improve. Though these leaders, like all of us, face trying circumstances, they aim high and consistently challenge the status quo: “We can always be better. She’s always asking, ‘What’s the next best?’”; “Restless discontent — he is always looking for bigger impact. ‘How can we better serve our community and fulfill our vision and mission?’”; “She thinks above and outside the moment. She frames a more powerful view that offers more daylight.”
- Enterprise-wide engagement. These leaders seek to engage everyone in the organization and make them feel like part of the team. They believe that those closer to the work know best how to make changes that support the organization’s goals. This philosophy stems naturally from their care of and trust in others: “He believes in the wisdom of employees and asks them to be the architects of change”; “There are [people] you’ll run into a brick wall for. . . . She’s one of those people”; “She has the ability to make people belong and matter and want to work hard for themselves and the institution.”
- Team orientation. Though these leaders acknowledge their full accountability for all decisions, they do not see themselves as “the” decision maker but as a part of the team and part of the solution: “The toughest decisions are never made hastily or alone — he ensures that others are heard”; “He seeks advice from others and you can see your thoughts reflected in the outcome — he believes you get the best thinking when you get the positives and negatives of a decision”; “She recognizes when the team needs to do the work — she trusts in the team to find the answer.”
- A culture of mentorship. These leaders take great satisfaction in growing others, and consider mentoring an important part of their leadership obligations: “She finds out what is good in people, exposes it, grows it, and helps you master it in pursuit of the group goal”; “She hired me with no hospital operations experience — she said she was looking for leadership skills and that operations could be taught.”
Particularly in tumultuous times, transformational leaders can bring sustained success to their organizations, fueled by the clarity of their personal and organizational values. “There is a hierarchy: patient, organization, department, individual — all important and in that order,” says Gary Kaplan, MD, Chairman and CEO of the Virginia Mason Health System.
“That hierarchy is now reflected in our strategic plan. That True North has helped guide me and given me resilience in terms of dealing with tough issues. At the end of the day we have to do what’s best for patients — they are at the top.”
Patricia Gabow, MD, long-time CEO and Medical Director of Denver Health and Hospital Authority, and now a trustee of the Robert Wood Johnson Foundation, adds, “We were determined to raise the bar. We had a commitment to accountability, to adult behavior. And we were determined that those not aligned with the vision would not continue to work here.”
This article originally appeared in NEJM Catalyst on November 30, 2016.