Interview Series Part I: Change in Healthcare Industry
This interview was conducted by Mo Kasti, CEO and Founder of CTI Leadership and the Physician Leadership Institute. Mo interviewed the President and CEO of Mission Health, Dr. Ronald Paulus.
Mo Kasti: In a world that is changing rapidly, how do you keep your team focused and engaged?
Dr. Paulus: First, we focus on priorities on a weekly basis with Standout. Standout is based on Marcus Buckingham’s work of assessing someone’s strengths and finding his or her edge using a strengths-based engagement and performance management system. Keeping the dialog going and dedicated to short-term actions and commitment allows the team to concentrate on the business at hand. Second, on a regular basis, we look at our long-term strategies and we adjust our actions and priorities as needed. This is exactly what the Kotter change model calls for: hardwiring change in the structure. This is the way we manage change by hardwiring our focus and working together on a weekly basis.
Interview Series Part II: Engagement in Healthcare
Mo Kasti: Engagement, especially physician engagement, has proven to deliver better outcomes. How are you successfully engaging your physicians?
Dr. Paulus: I see engagement as a journey and a multi-level strategy. I started this journey in 2010 when I arrived to Mission Health, after the previous CEO was voted out by a group of key physicians and medical staff. I started by reframing the need to focus on a common vision of becoming the best in clinical quality and safety in the nation and determining how we could deliver the best outcomes for every patient in our care. Since then, we have been working together with our providers and delivering on this common vision.
Another level of our strategy is that we spent our time co-developing our guiding principles. They include for example:
- Guideline #1: Patients First. Above all, through the eyes of our patients and their families we do what is best.
- Guideline #5: Interdependence. We serve one another and our community best by working collaboratively as partners.
- Guideline #8: Benefit of the Doubt. We willingly offer one another the benefit of the doubt when circumstances are unknown, assuming the best, and yet practice and insist upon Just Culture.
These guiding principles provide common language and common ethos with our providers and staff.
Another level of engagement is through our Report Out Meetings. These are meetings with key service line leaders and their dyad partners. The conversations are grounded with data and evidence and not random opinions. These meetings are a great model of active engagement and leadership and a great format and structure to discuss successes, failures and need for help.
Furthermore, we were intentional in creating new Chief roles and cohorts of Chiefs that we mentor and develop on an ongoing basis. Using the Chief role, we add to a leader’s responsibilities an uncommon area like parking to expose the leader to areas they would not have access to normally. We then mentor these Chiefs closely.
Mo Kasti: So how do you measure engagement? How do you know you are succeeding? Engagement metrics are not reflective of what is going on in the trenches. They are a snap shot in time that may change with a change in context. A clinician may care about something today and be fully engaged but may not engage in another issue that he or she doesn’t care about. Does that mean they are not engaged?
Dr. Paulus: I agree. With engagement, it is not an absolute metric. It is about trends. I look for global trends with groups and individuals. Are we improving over time?
At Mission, our weekly Standout Check-Ins are at level one of engagement. As leaders, are we engaging our team members in our weekly check-ins? Our team members start the conversation with, ‘Here is what I need from my team leader’. This drives accountability and ultimately engagement.
Another measure is what is happening in meetings. I know engagement when I see it. In a room, in a meeting. I watch the interactions between people and watch for actual body language. Are people leaning into the conversation, building on each others thoughts and having a constructive conversation? Are they additive to each other or is the conversation dominated by a few, and is there a high level of stress in the room?
Mo Kasti: I heard you use the term Professional Medical Leadership. What do you mean by that?
Dr. Paulus: I think that what we do to our clinicians is unfair. We ask them to have a full clinical load and then expect them to step into leadership roles without any formal training, mentoring and leadership readiness. That is why we continue to invest in our physician leadership fellowship to enable our clinicians to be ready and effective leaders. In addition, a few years ago, we started hiring professional medical leaders in our service lines. These leaders are in roles that are desirable. [They want the role], they are qualified for it, and they make the time to lead.
Mo Kasti: Do you think it makes a difference being a Clinician and CEO?
Dr. Paulus: Yes it does. You bring a different perspective having been in the trenches. I see the future where our health system will be clinician led. Clinicians can relate better to providers and teams in the trenches. Whether they are nurses, pharmacists or physicians, they understand better the implications of their decisions on care delivery.
Mo Kasti: What are your thoughts on Dyad Leadership?
Dyad leadership is a middle ground for now. It is a transitional solution for today’s challenges. In the long run, it won’t be an efficient solution to leadership. We need to professionalize medical leadership.
About Physician and Staff Burnout
Mo Kasti: How are you addressing Staff and physician Burnout? The statistics are high – as much as 50 percent of providers are reporting some level of burnout. I see the big miss when an organization focuses on one element, like stress management, as a way to help prevent burnout. This is necessary but not sufficient, and they miss 80 percent of issues that are related to leadership, structure, organization and processes.
Dr. Paulus: Burnout is fundamentally a form of frustration. Someone may get frustrated when there is a disconnect between expectations and reality. The larger the gap, the higher the level of frustration that could lead to burnout.
At Mission, we are approaching wellbeing from a more comprehensive approach. We refer to it as the 3-legged stool:
- System: We call it Renew. How do we take inefficiency out of the system and out of people’s way so they can practice and deliver the best possible and safest care. By focusing on the system and processes, we are sending a message to our staff and providers that we care and understand the complexity of the systems. We may sometimes not be able to solve everything, especially when it comes to regulations, but focusing on the system and process and trying, is a show of caring.
- Strengths: We are a strengths-based culture. Our Standout program first identifies each person’s strengths and how often that person gets to use his/her strengths every day. We can use this process to match the team member to the right role, and help team members find meaning in what they do.
- Self: How do you equip yourself to deal and manage stress effectively? Our Life XT program provides our organization with the necessary tools to increase resilience to stress in order to maximize productivity, focus, and in the end, experience more joy.
To reduce burnout, most importantly again, you need to spend time on matching the expectations to the reality of today’s world of healthcare. Many people who are frustrated have gaps between expectations and reality.
Mo Kasti: What brings you joy?
Dr. Paulus: What brings me joy is transforming healthcare and Interacting with people. What saps my joy are silos and infighting.
Mo Kasti: What are you most proud of?
Dr. Paulus: I am proud that our team is providing the best care every day. I am proud of the growth in our team members. I am proud of the friendship and relationships I have established here at Mission and in Asheville.
Mo Kasti: What is your advice to other healthcare leaders?
Dr. Paulus: Enjoy what you have. Invest in your team’s strengths. Don’t look for moon shot approaches – instead work on singles.
Ronald A. Paulus, MD, is President and CEO of Mission Health (www.Mission-Health.org), a $1.7 billion integrated health system serving all of western North Carolina. Mission Health includes 6 hospitals, and insurance company (Healthy State), a post-acute company (CarePartners) and more than 550 employed providers.
Mission Health is the only health system ever designated as one of the nation’s Top 15 Health Systems for four consecutive years by Thomson Reuters in 2012, and its successor Truven Health Analytics in 2013-2015.
Before joining Mission Health System, Dr. Paulus was Executive Vice President, Clinical Operations and Chief Innovation Officer at Geisinger Health System (www.Geisinger.org), where he managed Geisinger’s hospitals and its more than 800 physician group practice. At Geisinger, he also was responsible for ensuring system-wide innovation.
Prior to joining Geisinger, Dr. Paulus was co-founder, President and later CEO of CareScience, Inc. (previously NASDAQ: CARE), now part of Premier healthcare informatics (https://www.premierinc.com/transforming-healthcare/healthcare-performance-improvement/) with the software in use in nearly 1,000 hospitals and health systems nationwide. CareScience offered a web-based analytics platform to support health systems’ quality and efficiency improvement work.
Dr. Paulus received his MD degree from The School of Medicine, University of Pennsylvania, and his MBA, concentration in healthcare management, and BS in Economics from The Wharton School, University of Pennsylvania. He has published and speaks regularly on the topics of health care quality and efficiency, using analytics to transform care delivery, innovation, physician leadership, and new models of care. In 2014, Dr. Paulus was voted one of Modern Healthcare’s Top 50 Most Influential Physician Executives and Leaders, and was among the Top 20 on that list.