• Five Influential Women Examine Management & Industry Issues

6/8/2009

On April 14, 2009, a packed house of over 150 people gathered to hear five influential healthcare leaders speak at a panel titled “Women Making a Difference in Health Care.” We now augment our initial story with this expanded coverage of what was a remarkable event:

Here are jump links to sections of the story below:

Sponsors & speakers
Management challenges
Organizational culture
Clinical background
Gender issues
Exercising leadership in the policy arena
Closing remarks
The audience’s contributions

Sponsors & speakers

Co-hosted by Suffolk Healthcare Programs, the Suffolk Alumni Association, The Boston Club, Healthcare Management Association of Massachusetts, and Massachusetts Hospital Association, the event was sponsored by Suffolk’s Institute for Executive Education. It took the form of a luncheon and panel.

Moderator Karen Nelson, RN, MPA/Health ’87
Senior Vice President of Clinical Affairs for the Massachusetts Hospital Association

The panel was moderated by a Suffolk healthcare graduate: Karen Nelson, now Senior Vice President of Clinical Affairs for the Massachusetts Hospital Association and a registered nurse. Panelists were

     Jeanette Clough, RN, MS, MHA ’96, President and CEO, Mount Auburn Hospital

     Sandra Fenwick, President & COO, Children’s Hospital

     Paula Johnson, MD, MPH, Executive Director, Connors Center for Women’s Health & Gender Biology; Chief, Division Women’s Health, Brigham & Women’s Hospital

     Ellen Zane, President and CEO, Tufts Medical Center

Questions for the panelists ranged widely. What follows are some of many highlights.

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Management challenges

Moderator Karen Nelson asked the panelists how they met difficult management challenges they’d inherited when they assumed their current positions. Ellen Zane stressed the importance of leadership, with a focus on “strategic planning, implementation, and follow through” in maintaining success. Sandra Fenwick stressed the need for vision, a sense of mission, and clear goals. Leadership must be passionate and focused, she said, adding that you need successes at home before you can look outward at larger issues.

Paula Johnson pointed out the need to integrate care along a continuum and to focus strongly on cost-effectiveness and outcomes. Jeanette Clough reflected that, despite problems the panelists had inherited, each panelist has “been given an incredible gift.” But, she added, “speed and strength” are required to survive in a competitive market that is focused on profitability, quality and safety, and the environment for patient care.

Quality of care is, of course, a growing industry concern. Nelson asked the panelists how they’re trying to increase quality, transparency, and accountability – and lower costs. Clough’s reply points to a dramatic advance: data on quality measures are now displayed on Mount Auburn’s web site. Transparency, she noted, is now a competitive advantage, and one that’s in patients’ best interests. (In fact, the Massachusetts Hospital Association and the Massachusetts Organization of Nurse Executives have created a Patients First web site on which hospitals voluntarily report data on quality measures.)

Panelists Jeannette Clough, Sandra Fenwick, Paula Johnson, Ellen Zane

What’s the single largest challenge your institutions are facing? Nelson asked. Fenwick replied that it’s “demand for information”; IT systems aren’t adequate from a business or quality perspective. Zane identified “access to capital.” Johnson observed that, in the past, the “bottom-line strategy has really been about growth” – continuing to do more of what makes the most money. But a shift from this model is coming, she predicted. Clough noted that the state’s population is not growing; hospital admissions won’t be rising. But, she speculated, the bad economy creates opportunities for new ideas and change.

Reflecting a question “from the MBAs in the audience,” how, Nelson asked, can you affect profitability? Fenwick suggested that heavier use of fixed assets could increase revenue. Johnson said attempts to increase patient throughput by discharging patients by 12:00 noon had not, after 8 years, produced many gains. Zane pointed out the difficulty of balancing a strong focus on mission and goals – “do the right thing” and “take the high road” – with profitability and the MBA mentality. Indeed, all panelists agreed that this balance can be difficult to strike and that revenue must not come at the cost of institutions’ missions and patients’ needs.

Clough contended that investments, time, and reengineering over the long term are required. Investments made now will pay off in the future, she predicted. Johnson urged rethinking financial structures and incentives in order to transcend the belief that “more is better.”

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Organizational culture

Do the panelists observe generation gaps in their organizations’ cultures, Nelson asked? The real issue, Zane replied, concerns secretiveness. Executives should put matters on the table. You can build a better culture (with trust, honesty, and openness) when you prove that “you’re the real deal.”

Clough suggested it’s important to share power, as this helps you build trust and integrate the organization’s culture. “Really communicate” all the time, Fenwick stressed. Put information out there, without blame; deal with issues candidly but respectfully.

Johnson, a practicing cardiologist, noted that the culture of academic medicine hasn’t nurtured and promoted clinicians, who must manage their personal lives as well as their jobs. As more women have entered the healthcare field, the need to address this has become more pressing, she said.

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Clinical background

Is Johnson’s clinical background significant in her current position, Nelson asked? It’s not necessary but is helpful, Johnson replied. It helps her see issues from MDs’ perspectives, too; she does still practice and understands the issues they face personally. Clough said she uses her background every day and doesn’t know what it would be like to not have her clinical expertise.

By contrast, Sandra Fenwick has no clinical background but is an example of the fact that excellent healthcare leaders don’t need one. Her peers regard her as excelling in strategic planning and leadership.

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Gender issues

While all the panelists are women, their concerns far transcend matters related to gender. But they did address that issue, if only to dismiss it. Zane advised, “Don’t think about it”; don’t use it as an excuse. Rather, it’s about competence; “kill them with confidence . . .
It is harder for women, but that is what makes us better.”

Similarly, Clough urged a focus on results, not gender, and on being yourself and doing what you love. Johnson cautioned against wasting energy needed elsewhere and advised relying on mentors and peers for support during tough times.

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Exercising leadership in the policy arena

With the nation watching Massachusetts, Nelson asked the panelists, what are you concentrating on as healthcare leaders? Advocacy for healthcare reform, Zane replied, cautioning that there is no “silver bullet”; there are too many “moving parts.” A balanced approach is needed. “This is not for the faint-of-heart folks,” she stated. “We are at the epicenter.”

Johnson remarked on the “enormous complexity” of the issues and the fact that value delivered by the healthcare system isn’t proportionate to investments in it. Moving forward will require “complex, intricate intertwining of disciplines,” she observed.
Fenwick stated that players aren’t taking the long view and that we need “to own some of the problem,” taking some responsibility and devising solutions. Safety must be “a given,” she declared, along with benchmarking and accountability. Clough urged communication with legislators on funding issues. Advocacy is more important than ever, she contended; there’s “tremendous momentum” for reform. But, she observed, no one “on the Hill, or in Washington” has ever run a hospital. The panel seemed in agreement that the national debate must be informed in part by the views of practicing healthcare professionals who understand the day-to-day realities of how healthcare is delivered, have been caregivers, have “the bedside perspective,” and are committed to the goal of “putting the patient first.”

Zane doubted nationalized health insurance would be enacted. Sandra Fenwick cautioned that in a worsening economy, we will see the dangerous and inevitable shift from private to public payers.  (That is, as more people lose their jobs and more companies go bankrupt, fewer people will be covered by private insurance, and hospitals and the government will bear larger costs.)

Nelson foresaw an incremental approach to reform that expands upon the current model. Clough viewed nationalized insurance as “premature.” The single-payer model is a “long, long way away,” she predicted. Care will be regionalized, but all physicians will not operate under one fee system. Johnson said standardization across payers is more achievable and could cut administrative costs.

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Closing remarks

In closing, Zane encouraged the audience to embrace risk-taking: “Risk is good,” she said, personally and professionally. Being a leader means being bold. There’s a thin line between success and failure. You need internal fortitude, but while you should be confident, don’t get cocky.

Johnson reflected that, despite all the issues, it is “truly a privilege to make the ill well and keep the well well.” And it’s exciting. “Keep the mission at the core,” she urged, and “remember why we are in this work.” Fenwick stressed perspective: it’s “not about self,” she said. “Take the long view;” this is a long-term commitment.

And, remember: it “starts and ends,” Clough concluded, “with the patient.”

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The audience’s contributions

The audience – Suffolk students and prospective students, alumni, faculty, and other healthcare professionals – contributed directly to the event’s success, submitting written questions that prompted valuable discussion. Two of many cogent, knowledgeable examples:

          How do you foresee changing the culture of the American healthcare consumer from one of “on demand” specialty care and high tech diagnostics to one of responsible participation and trust?

          What measures have you as a leader of a major health care provider taken to induce more transparency? lower healthcare costs?

Time constraints limited the number of questions that could be posed to the panelists. The entire set is interesting as a reflection of concerns that the audience brought to the event.

The morning after the panel, one attendee emailed us these reflections:

I had the full awareness of being in the presence of very powerful, articulate and commanding women – both on the stage and in the audience . . . In a nutshell it boils down to this: What can I, as a leader in my department, do to plan, prepare and participate in the healthcare model of the future?

Apart from informal feedback, a formal evaluation was conducted; to develop programs responsive to evolving market needs, Suffolk’s Institute for Executive Education routinely seeks audience feedback about its events. The evaluation form it distributed on April 14 drew a whopping 109 responses – an exceptionally high return.

Most responses were overwhelmingly positive. They were also unusually thoughtful and informative. The Institute’s quantitative analysis of responses and its compilation of qualitative comments make for impressive and fascinating reading. Substantial excerpts are offered here.

Many respondents remarked on the value of hearing different perspectives. Tellingly, two respondents said they wished panelists had spent more time discussing their experiences as women – an indication of the extent to which gender was eclipsed by policy and management issues. A number of comments indicated that networking opportunities afforded by the event itself were valuable.

The comment that perhaps best captures the spirit of the event, and the one that pleased us most, is this one: “Love the honesty!”

Indeed, on that day, the truth came shining through. We plan to host many more such events in years to come.

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We’ll welcome, and would like to share, other feedback from people who attended the April 14, panel. Please direct your comments to

     Stephanie Giordano
     Staff Assistant to the Healthcare Programs
    
sgiordano@suffolk.edu
     617.305.1769
 

Suffolk MHA student Jaclene Coit contributed to this story.

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