Leadership
Clip
Balancing Mission and Margin (05:17)

“No money, no mission” is commonly heard in reference to mission-driven organizations. How do health care organizations that may not have much margin, such as VA centers and safety-net hospitals, balance their mission and margin so that they can manage resources effectively? Kimberlydawn Wisdom, Chief Wellness and Diversity Officer and Senior Vice President for Community Health and Equity at Henry Ford Health System, asks Sanjay Saint, Chief of Medicine for the VA Ann Arbor Healthcare System, for examples at the VA.

For a lot of academically affiliated VA centers, one of their key resources of excellence is the university, explains Saint. The University of Michigan, for example, provides the physicians, medical students, residents, and additional resources that the Ann Arbor VA otherwise would not have access to.

“But I think that this is a broader point, and that’s how do you keep people who want to come to the VA?” Saint adds. “We don’t pay that well. Most of my physicians can make more money working somewhere else.”

Saint points to Daniel Pink’s book Drive, which Stephen Swensen had brought up, summarizing three key points of motivation: mastery, autonomy, and purpose. To promote mastery, VA Ann Arbor invests in mentoring. And at most VAs, there is more autonomy, for example for learners. VA Ann Arbor instituted a Fellow of the Month award — many of the people who do consults there are fellows —which includes a signed paper award and a $25 gift certificate. “I’ve had some section chiefs, in cardiology for example, where if the fellow does not win, the section chief will speak to him or her and ask why they don’t,” says Saint. As for a sense of purpose, “that’s what we have,” he says, “and I would say to a greater extent than even a fantastic place like the University of Michigan. Our goal is to treat every single veteran like they are a family member.” A large percentage of people who work at the VA are also veterans and receive care there.

Continuing the thread of keeping people engaged, Wisdom asks about the final salute for veterans that Saint described in his talk. “I don’t know whether or how much that occurs across health systems in general that are not part of VAs, but other health systems can do that, correct?”

They can. Frederick Cerise, President and CEO for safety-net Parkland Health and Hospital System, notes that Parkland has a veterans resource group that recently instituted that practice. “[It’s] just a wonderful thing to do,” he says.

Saint describes a comparable end-of-life practice at hospitals in Japan. A few days after a person dies and their body lies in the morgue, the body is taken away. The physicians and nurses who cared for the patient are called to join the patient’s family, and as the hearse drives off, the family and doctors and nurses bow to each other as a sign of respect — the doctors thanking the family for the privilege of caring for their loved one and perhaps apologizing for not being able to do more, and the family thanking the doctors and nurses for that care. “The final salute is the VA’s way of also thanking a soldier for what they’ve done and what they’ve sacrificed for this country,” Saint says.

“The way we respect and regard a person even at the end of life or upon their transition is so important,” adds Wisdom. “Oftentimes, that’s what the family remembers.” She mentions how some faith traditions want the body to lay in state in the room they expired in for about 8 hours. “Being very mindful of how we regard and respect people during those end-of-life times is really key.”

From the NEJM Catalyst event Essentials of High-Performing Organizations, held at the University of Michigan’s Institute for Healthcare Policy and Innovation, July 25, 2018.

More From Leadership
Percent in Highest Bracket in Patient Satisfaction Scores - Pre-Post Arm Differences for Hospitalists - Duke Coaching Communication Skills Study

Coach, Don’t Just Teach

The effect of one-on-one communication coaching on clinicians’ communication skills and patients’ satisfaction.

Two-Thirds of Organizations Have a Nurse Leader Career Path

Survey Snapshot: Do Nurse Leaders Need Advanced Degrees?

Though NEJM Catalyst Insights Council members acknowledge a lack of advancement opportunities for nurse leaders, two-thirds of their organizations have a nurse leader career path.

Nurse Leaders and Physician Leaders Should Be Considered Equals in Care Delivery - but Views of Nurses and Non-Nurses Differ

Leadership Survey: Nurses as Leaders: Broad Acceptance, Room to Grow

Nurses are traditionally the backbone of patient care. They form the largest percentage of the health care workforce, far outstripping physicians. But are nurses leaders as well as doers?

The CMO Role of the Future - Baptist Health Survey Results

Examining the Continuously Evolving Role of the Chief Medical Officer

Hospital and system leaders need to sharpen the focus of CMO roles to include system-wide considerations beyond the walls of the hospital.

Meyer01_header - Seven Challenges and Seven Potential Solutions for Large-Scale EHR Implementation

Seven Challenges and Seven Solutions for Large-Scale EHR Implementations

Salient lessons learned over multiple electronic health record implementations.

Zuckerberg San Francisco General Hospital ZSFGH A3 thinking Personal Development Plan A3 leader standard work improvement management example board

Changing Leadership Behavior Gets Real Results

Zuckerberg San Francisco General Hospital deployed its new leadership culture, which emphasizes staff decision-making, self-reflection, and clarity in defining problems and goals, to successfully address a crisis involving record-high patient volumes.

Khatri02_pullquote Connectors

The Crucial Role of Connectors in Large Health Care Organizations

Creating a truly collaborative community involves connecting the right people at the right time and in the right places.

Women of Impact Checklist - Advancing Workplace Equity

Lead In: Women of Impact in Health Care on Advancing Equity in the Workplace

Raising the standards of equity and wellness in our workplaces so we effectively advance health for the populations we serve.

Historical and Projected Numbers of Physicians, Nurse Practitioners, and Physician Assistants.

Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce

The number of NPs and PAs is growing rapidly, while physician supply has slowed. This research projects the number of NPs, PAs, and physicians through 2030.

IBM solutions to physician burnout roundtable participants: Christina Maslach, Paul DeChant, Tait Shanafelt, Namita Seth Mohta, Karen Weiner, Edward Prewitt

NEJM Catalyst Roundtable Report: Seeking Solutions to Physician Burnout

An NEJM Catalyst roundtable sponsored by IBM Watson Health brought together four experts, all deeply engaged in reducing physician burnout from different perspectives, to share in a robust discussion.

Connect

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

Learn More »

Topics

Leading Teams

161 Articles

Survey Snapshot: Do Nurse Leaders Need…

Though NEJM Catalyst Insights Council members acknowledge a lack of advancement opportunities for nurse leaders,…

Community Health Workers Are Critical

Community health workers really do need to be from the community.

Physician Burnout

43 Articles

Patient Engagement from Both Sides of…

When patients and families are included in medical rounds as valued members of the team,…

Insights Council

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

Apply Now