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Brett D. Lee, PhD, FACHE
Chief Operating Officer
Riley Hospital for Children
“You need to make sure your staff and supervisor understand you are dedicated, even-keeled and focused on being the same person every day regardless of the situation..”
Brett D. Lee, PhD, FACHE, is the winner of ACHE’s 2011 Robert S. Hudgens Memorial Award for Young Healthcare Executive of the Year. He sat down for a Q&A during the Early Careerist Special Interest Group Breakfast at Congress, which was attended by more than 80 early careerists and students. Carrie Owen Plietz, FACHE, COO of Mills-Peninsula Health Services/Sutter Health System, Burlingame, Calif., and last year’s Hudgens Memorial Award winner, served as the facilitator of the Q&A session. The Q&A was edited for brevity.
Q. You were a physical therapist early in your career. What was the one spark that led you to become a hospital leader?
A. I didn’t plan to become a hospital leader—my initial passion was for providing clinical care. In high school I injured my knee. While going through physical therapy the experience really clicked for me, and I thought I would be a sports medicine physical therapist for my entire career. One day my supervisor, the director of Rehab Services, went on maternity leave and never came back. I was asked if I would like the job. So, the management track sort of snuck up on me. But when I got into a leadership position, it was something that resonated with me. I have been fortunate in my career to have wonderful mentors who assisted me down this path and helped me develop as a leader. Through my experiences, I believe I have been able to influence populations of patients—in my case children—and their health more so than when I was a physical therapist laying hands on patients one at a time.
Q: What has been the most challenging aspect of being a COO?
A. Managing construction projects is always a challenge. I am currently overseeing the construction of a $475 million, 10-story inpatient tower, which is the third major hospital construction project that I’ve been involved with in my career. This project was initiated when the economy was doing well. But when the recession hit, the entire project was put on hold. Getting that project up and running again and opening the facility in phases due to financing considerations was a challenge and continues to be but one that my team is responding to very well. Another challenge is that during construction, we are operating out of three different facilities. For example, we moved the medical-surgery floors into the top half of the new building while still designed and constructed the bottom six floors, so that balancing act is always tricky.
Q: What do you attribute as keys to your success?
A. For me, one key is having a wonderful network of mentors that actively give of themselves to help me grow and develop, and they continue to be great sounding boards for me. Also, when I’m interacting with clinical stakeholders, I come to the table with the understanding that they have more expertise than I do on the clinical side, but that I may bring skills that they might not have in terms of business acumen. With that in mind, I’ve been able to forge partnerships with clinicians, which has served me well in my career.
Q: What did you look for when choosing your mentors?
A. Most of my mentors I found by critically evaluating my own skill set and selecting leaders who exhibited skills I was not strong in—folks who I could learn from and emulate and who may work outside my reporting structure. No matter what kind of relationship you have with your boss, it can sometimes be a challenge to be as frank as you need to be. So, having a good network of mentors both inside and outside of your reporting structure is critical. I have also benefitted greatly from serving as a mentor to those entering this profession after me. Through formal relationships, such as serving as a preceptor to administrative fellows and more informal mentoring partnerships, I have grown my skill sets in meaningful ways.
Q: What leadership advice do you give to early careerists?
A. What I try to instill in those who will serve as leaders one day is you have to be the same person every day. By that I mean even if you are having a bad day, it’s not typically the fault of the person who is coming in to talk to you. The worst thing you can do is create a reputation of being volatile or having a difficult personality because this will limit your credibility. You need to make sure your staff and supervisor understand you are dedicated, even keeled and focused on being the same person every day regardless the situation.
Q: How did you come up with the idea for your book, Growing Leaders in Healthcare: Lessons from the Corporate World (Health Administration Press, 2009)?
A. I got the idea when I attended an executive master’s program on leadership development. As the only representative from healthcare in the program, I worked alongside chief learning officers and organizational development professionals from other industries; people who had been doing leadership development for a long time. What I learned from them and the program was that the only major sustainable competitive advantage an organization has is its employees. After completing the program, I, along with the co-author of the book, James W. Herring, PhD, gathered and shared those best practices that exist in corporate America that could be applied to the healthcare field such as how best to manage the careers of talented young executives.
Q: What is your greatest professional achievement?
A. I helped build three children’s hospitals that, once completed, will touch the lives of 2.5 million children per year, and that’s a wonderful legacy that will extend beyond my lifetime. I would say another key achievement has been the interaction I have had with students through my formal academic appointments and being fortunate to serve as preceptor for 20 administrative residents. Seeing the accomplishments they have made in their careers and knowing that I played a small part has been gratifying.
How has ACHE helped in your professional development?
A. ACHE has been significant in my career aspirations. I joined ACHE as a Student Associate, and since then, I have attended many its seminars. In my first executive role I was thrown into leading a construction project with no exposure to construction in my background. To help me gain knowledge about construction, I attended an ACHE construction management seminar that to this day really helps me create a priority list as I manage the 10-story inpatient tower project at Riley Hospital for Children. When I research the seminars I want to attend, I critically evaluate what course offerings align with the challenges I have in front of me. This process has helped in my continuous professional development. I also am involved in local chapter activities and mentoring programs.
Reducing Disparities in Care and Having a Diverse Workforce
By John M. Buell
A lecture on diversity at this year’s Congress on Healthcare Leadership in March covered two growing areas of significance: disparities in care and the importance of a diverse workforce—two relevant issues for all levels of healthcare management.
Joseph R. Betancourt, MD, director, The Disparities Solutions Center, Boston, and Joseph R. Swedish, FACHE, president, CEO and chief diversity officer, Trinity Health, Novi, Mich., gave the presentation “Diversity and Disparity: A Challenge to All Healthcare Leaders.”
Addressing Disparities of Care
Betancourt’s presentation focused on the opportunities that exist for improvement on issues of equity and disparities in quality. He pointed out, for example, that the diabetes-related death rate of African Americans in 2010 was 50.1 per 100,000 patients compared to 22.8 for whites.
Social determinants and access to care are the leading contributors for disparities of care, according to Betancourt, who is also a senior scientist at the Mongan Institute for Health Policy, program director for multicultural education at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School, all in Boston.
But even when minorities have the same level of insurance, socioeconomic status and education—and the only difference between minorities and whites is the color of their skin—disparities in care continue to exist, said Betancourt.
“Studies have found…that African American patients are less likely to be referred for cardiac catheterization, angioplasty and bypass surgery,” said Betancourt. “There are many examples of this that couldn’t be explained away because they (minority patients) lived in a bad neighborhood.”
One other contributing factor in disparities in care, according to Betancourt, is the difficulty many minorities and healthcare providers have in communicating with each other. Medical residents were surveyed a few years ago for research on their overall preparedness to provide care to diverse populations, according to Betancourt, and one question they were asked was had they ever used a child 12 years old or younger as an interpreter for a family member. And one-third of the residents said yes. But it is well known that most children do not make effective interpreters, something even Betancourt learned first-hand as a seven year old when he accompanied his Spanish-speaking grandmother to the doctor’s office to serve as an interpreter.
“My grandmother said ‘I’m not sure what the doctor said, and I’m not going to do it anyway.’ So being an interpreter was not in my future,” Betancourt joked. “We can incorporate all the best practices around improving the delivery of care in areas of hypertension and disease management, but if we can’t effectively communicate with our patients and monitor the quality we are delivering, then all of those best practices in many ways becomes worthless.”
There is no one solution to reducing or eliminating disparities of care nor is any one area to blame, said Betancourt. “But healthcare leaders can establish systems to identify, monitor and address the disparities in quality of care when they see them,” he said.
Betancourt recommends hospitals and healthcare managers do the following:
- Increase awareness of existence of disparities in care
- Address systems of care by collecting patient data on race, ethnicity, language and highest level of education so that quality of care can be monitored by these characteristics
- Use tools of quality improvement to address disparities and inequities such as evidence-based guidelines
- Incorporate effective interpreter services
- Educate staff around cross-culture communication, culture competence and how nonmedical factors might impact clinical decision making
- Implement bonus payments for programs that identify, address and improve disparities in care
For more information on addressing disparities in care, visit www.mghdisparitiessolutions.org.
Addressing a Diverse Workforce
As the United States becomes more diverse in areas of race and ethnicity, healthcare should take responsibility for changing their organizations to be more sensitive and engaged in the communities they serve, Swedish told the packed room of nearly 600 attendees.
By 2050, racial and ethnic minorities will make up nearly 54 percent of the population, according to the U.S. Census Bureau. Swedish said he has seen other statistics in which minorities will become the majority by 2040.
But the boundaries of diversity have grown beyond the often recognized areas of race, ethnicity and sex to now include a broader spectrum of religion, national origin, sexual orientation and age.
“Today, healthcare leaders and managers need to create a corporate culture of inclusion, which means embracing the benefits of a workforce that has the characteristics that represent the ethnic and cultural mosaic of the community it serves,” said Swedish, who appointed himself chief diversity officer because he believes that responsibility for diversity starts at the top. He also requires all Trinity Health hospitals’ CEOs to serve as chief diversity officers and makes diversity and inclusion results part of the incentive plan for management in order to stimulate action.
“We need to accelerate our efforts as leaders to know our markets and consumer segments and to build an organization of cultural insights, transformational infrastructure and inclusion,” he said.
The challenge before the healthcare field is how does it respond? “We need to ask, ‘do we have managers in place who can be culturally sensitive and engaged, despite the cultural differences?’”
A proactive approach to diversity and inclusion must be taken or hospitals and health systems face the risk of being forced to change in a way that is not planned, which may create a disconnect within the organization, its community and its workforce, said Swedish.
“The most effective way to serve a diverse customer marketplace is to have a workforce and leadership team that mirror that diversity,” he said. “Inclusive organizations create an environment where differences are valued and integrated into every aspect of the organization’s operations.”
Organizations’ workforces should develop cultural competences, said Swedish. Trinity Health, for example, has adopted a cultural competency, “which boils down to one equation: sensitivity + responsiveness = respect. This equation, which guides Trinity Health as a reminder of our commitment to one another, speaks to our care and how we behave and defines the underpinning of the hospital’s culture. As leaders, we have an ethical, moral and legal obligation to provide a respectful work environment for our organizations, physicians, patients and their families.”
For more information on Trinity Health’s diversity initiatives, go to www.trinity-health.org/diversityandinclusion.
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