Living Like a Leader: A day with Scripps Health CEO Chris Van Gorder

https://www.beckershospitalreview.com/multimedia/living-like-a-leader-series/living-like-a-leader-a-day-with-scripps-health-ceo-chris-van-gorder.html?origin=qualitye&utm_source=qualitye

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“Healthcare is always going through a lot of change, and sometimes employees, managers and even physicians think we are making those changes because somebody in administration decided it’s the right thing to do. The reality is, we’re reacting to what’s changing in the marketplace or what we believe will be coming in the marketplace. If we don’t adjust fast enough then it will negatively affect our organization and employees.”

From police officer to healthcare executive, Chris Van Gorder’s career trajectory is far from ordinary.

Mr. Van Gorder began his career as a police officer in a town bordering Los Angeles. After being injured on the job and retiring from the police force, Mr. Van Gorder had to reinvent himself.

He eventually took a job as a hospital security director for the facility where he received care for his injury. This job, unbeknownst to him at the time, would shape the rest of his work life.

After spending time in the hospital as a guard and observing leadership, Mr. Van Gorder decided to return to school to get a degree in healthcare administration.

Since, Mr. Van Gorder has held several prominent healthcare leadership positions, including vice president, COO and CEO of Anaheim Memorial Hospital and CEO of Long Beach (Calif.) Memorial, the flagship facility of MemorialCare Health System in Fountain Valley, Calif.

Now Mr. Van Gorder serves as CEO of one of the top medical institutions in the U.S., San Diego-based Scripps Health, a $3.1 billion integrated network with 15,000 employees and 3,000 physicians. He has held the role since 1999.

Here, Mr. Van Gorder spoke with Becker’s Hospital Review for our “Living like a leader” series, which examines influential decision-maker’s daily routines to offer readers an idea of how they manage their energy, teams and time.

Question: What is the first thing that you do when you wake up?

Chris Van Gorder: Get a cup of coffee. Then I go to my home office and prepare what I call “market news.” I do this every day of the year, including holidays, vacations and weekends. The market news is a summary of all the major healthcare and business articles that I think may have an impact on Scripps Health. I’ll scour several websites, including The San Diego Union TribuneThe Los Angeles TimesThe New York Times, The Washington Post and Becker’s, among other healthcare publications. I’ll put those links into a document and send them to my senior leadership team, most doctors and the alumni of our leadership academies. It takes me about an hour.

My rationale for sending the relevant links to my team is that healthcare is always going through a lot of change, and sometimes employees, managers and even physicians think we are making those changes because somebody in administration decided it’s the right thing to do. The reality is, we’re reacting to what’s changing in the marketplace or what we believe will be coming in the marketplace. If we don’t adjust fast enough then it will negatively affect our organization and employees.

Q: What is the first thing you do when you arrive at work?

CVG: I will grab another cup of coffee. Then I log onto the computer and start answering emails. Daily, I will answer every email that comes to me. I don’t go to bed at night without looking at my iPhone and making sure I’ve responded to every email that came to me during the day. So the first thing I do when I get to work is respond to any emails that came during the middle of the night. One of our core values is respect, and I think it is a sign of respect when I am responsive to the people who work in this organization and people outside of it.

Q: Is there any work that you like to get done before lunch or work that you save for the afternoon?

CVG: Unless it’s a lunch meeting, I never eat lunch. What I usually do is read my own market news, because when I put it together, I don’t have enough time to thoroughly read the articles. But my daily routine is so variable. Sometimes we have board meetings that start at 7:00 a.m. It’s rare if I don’t have something that starts very early in the morning. From there, my schedule is packed, but it is always different.

Q: Is there anything that makes your physical office setup unique?

CVG: I have a Microsoft hub on the wall that allows me to have video meetings with anybody in leadership across the system. In the case of a natural disaster, the hub also allows me to monitor what’s going on inside and outside of Scripps.

I also have a picture of a patient’s heart hanging on my wall. I was working in trauma with our physicians one night and a younger patient came to the hospital with a stab wound to the heart. We cracked this patient’s chest open, stapled the heart shut and took the patient upstairs to heal. The patient came into our hospital almost dead, but the patient went home a week later. I have a picture of that heart on my wall to remind me of the work that we do every single day — the most important work we do.

I also have a few awards and about 100 challenge coins that law enforcement, fire and military units have given me. I also have my own challenge coin that I give out to employees when they’ve done something extraordinary outside their normal work responsibilities.

Q: How often do you meet with clinical staff or perform rounds?

CVG: Several times a week. I’m in a corporate office but not far from the hospitals, so I spend a lot of time with them. I also teach our leadership academies and most of the people in attendance are clinical staff. Usually rounds are on Fridays.

Q: How much of your time is spent with direct reports?

CVG: I do not have standing regular meetings with my direct reports. They are all on the same floor as me and I have an open-door policy. Some of them will schedule meetings with me to brief me on certain items, but I’m a big believer in not having redundant meetings that are just happening because they’re scheduled. I want people to meet with me when they need to meet with me. My staff are in and out of my office all day long. I see all of them daily. I have one scheduled meeting with all of them as a group once a week, but the rest of the meetings are ad hoc.

Q: How do you think your routine is different from that of other healthcare executives?

CVG: I spend a lot of time with management and employees. I suspect more than most CEOs do, because I’ve made it a personal commitment since joining Scripps. I spend a lot of time with the front-line staff and our front-line management team. The key leaders in an organization are those front-line supervisors and managers. Because of that belief, I created the Scripps Leadership Academy 18 years ago, the Front-Line Leader Academy in 2015 and The Employee 100 in 2010. These academies help develop leaders at every level.

I also spend a lot of time teaching. And after I teach, I stay. I don’t teach, make a presentation and leave. My understanding of most CEOs is that they’re very busy, and I don’t blame them, but most would depart to make it to the next meeting on time. I will never leave right at the end of the class. The reason for that is it builds trust and gives employees who may have been too shy in the lecture a chance to ask questions.

Additionally, things are constantly changing in healthcare. The “whats” and “whys” this year will likely be different next year, so I also make a point to meet with the alumni of the leadership academies once a month where we just do a Q&A about leadership and any changes.

Q: What is the hardest part of your day?

CVG: Running a big organization like Scripps is like running a city. There are great things that are happening all the time, and there are bad things that happen occasionally. That burden falls on me, and that’s probably the worst part of the job. Fortunately, those bad things don’t happen often, but when something happens to a patient that shouldn’t have happened or if one of my employees is attacked by a patient, those days are difficult. At Scripps, we’re trying to push forward legislation on workplace violence, because I’m very concerned that workplace violence is on the rise in hospitals. CMS has very strict rules about what we’re allowed to do to protect our staff, because they’re looking out for the wellbeing of the patients, as are we, but we have an obligation to protect both. That’s a very difficult thing to do.

Q: What is the most rewarding part of your day?

CVG: Any time the organization succeeds, one of our employees thrives or I get a chance to award a challenge coin — those are the rewarding moments. A few weeks ago, one of our environmental service workers broke up a fight where one patient was choking another. He broke it up and called the police. He could have very easily stood back and done nothing. He would not have been in trouble, because he’s not trained to intervene in situations like this, but he did and in a safe way. He prevented people from getting hurt or killed. That was one of our environmental service employees, who is phenomenal. So, when our employees excel and go beyond what was expected of them, it is extraordinarily rewarding. Additionally, I’m going to go visit a patient who struggled and was very sick but is now getting better. This patient and the family are thrilled with the care they received and they asked to see me. Obviously, those moments with patients are also highlights.

Q: What is the last thing you do before you leave the office?

CVG: Mother Mary Michael Cummings started the Catholic side of the health system in 1890. Ellen Browning Scripps founded the Scripps side of the system in 1924. Today, we are one system. One of the funny things I do when I get in the car at the end of the day is pause for a minute I and just ask myself, “Would Mother Mary Michael Cummings and Ellen Browning Scripps be proud of what we did today?” And the answer is almost always, “Yes.” When I answer that question, I feel good about that day. Then I drive home and start my post-work routine.

Q: Do you do any work at home?

CVG: Yes. Beyond checking emails and creating the market news reports, I also take home longer reports if I didn’t have time to read them at work. So often, I’ll just take those home and read and study those at night when I have more time.

Q: How do you unwind at the end of the day?

CVG: I volunteer with the sheriff’s department. A lot of that work is done in the evenings and on weekends. I’m a reserve assistant sheriff, which means I’m in charge of the reserves and the search and rescue team. I’m also an instructor of first aid and CPR at the search and rescue academy. My volunteer work is a complete diversion because I’m very often the caregiver, not the supervisor. It’s a great mental change from what I do on a day-to-day basis. I think that creates some balance. I also have family time. I have two boys and a wife. I always consider the weekends my family time.

 

 

 

Cheerleadership is not Leadership. Cheerleadership creates fake believers.

http://www.leadershipdigital.com/edition/daily-management-leadership-2019-04-25?open-article-id=10320579&article-title=cheerleadership-is-not-leadership–cheerleadership-creates-fake-believers&blog-domain=greatleadershipbydan.com&blog-title=great-leadership-by-dan

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Imagine for a second that your boss is miles away from the day-to-day. A sufferer of Corner Office Syndrome he or she continues to make command decisions without consulting the team. The decisions are astounding to you and you start to question these far-off choices.

Now, your attention isn’t on doing the right thing for the business, but on how to stop the wrong thing your boss has put in play. You have two options. You could bite your lip and go with the flow. …Or …try to address this head-on which is no easy feat.

It could be too big of a risk to put your livelihood at stake. Your mind drifts again — pondering if this company is the right place for you. You wonder why you care so much. The easy thing to do would be to care less.

The truth is your faith in the business has splintered.

This inner conversation happens to many of us. When it does, you are officially not a believer anymore. You are transgressing into a fake believer.

When you lose belief, or don’t have something to believe in, it’s easy to fake believe.

But as Navy SEALs Jocko Willink & Leif Babin remind us in their book, “Extreme Ownership: How U.S. Navy SEALS Lead & Win”, “They must believe in the cause for which they are fighting, they must believe in the plan they are asked to execute, and most important, they must believe in and trust the leader they are asked to follow.”

Building a cultural rocket ship is more rocket art than rocket science.

If your responsible for hiring talent in your company, then you already know it comes down to creating, retaining and sustaining internal believers.

Why is this so important?

Because believers aren’t just wanted—they are needed in order to create the necessary conviction that makes your organization thrive.

Consider these questions for a second: Do you often feel like you are on an island alone in your company? Do you have coworkers you can genuinely trust? Do you feel you’re being sucked into corporate politics? Are you in a Watch-Your-Back Culture or a Got-Your-Back Culture?

These are the questions that need to be openly talked about with your teams. And these are the types of conversations that are welcomed by true leaders.

This might be a good time to share a truth. I have a major gripe with the word leadership. Make no mistake that I believe we are in dire need of courageous leaders. However, I’ve seen too many poor leaders turn leadership into cheerleadership.

Poor leaders start ra ra’ing to their employees, which may work with some of your workforce, but your elite producers can see right through it. Internal discord starts the minute you send staff down inside themselves questioning, wondering and calling out a faulty decision.

Management guru Ken Blanchard is spot on when he writes……“It takes a whole team of people to create a great company but just one lousy leader to take the whole business down the pan.”

Making Believers all starts at the top with what I call your Believership.

I’m sure you noticed the world choice. The clear mission of leadership is to transform into the company’s Believership. The Believership’s job is to create believers in all directions: making believers out of your employees, your prospects, your customers and, when appropriate, your board.

One final reason I like calling it a “Believership” is because successful leading is not simply about one person. There’s a checks and balances system working together at the top – if you’re lucky, that group shares values but brings breadth of experience to the table. Courage and business are both team games.

Having an aligned Believership makes it easy for employees to believe. They set the vision for the company, deliver the truth (no matter how hard the circumstance) and create trust – the most essential ingredient – that unlocks a successful team.

 

WHAT’S YOUR LEADERSHIP TILT?

https://www.leadingwithhonor.com/whats-your-leadership-tilt-find-your-balance-inside/

 

 

We’ve surveyed hundreds of leaders about their greatest leader, the most important natural behaviors beyond character and hard worker were Results and Relationships.

Where do you tilt on the results and relationships scale?

Check out this free infographic, and please tell others about it!

 

 

MARKET SHARE STILL MATTERS: 3 WAYS TO WIN

https://www.healthleadersmedia.com/strategy/market-share-still-matters-3-ways-win

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For CEOs, market share is critical. But measurement of it, and tactics to grow it, are getting more complicated as patients connect with providers in more sophisticated ways.

Health system CEOs have always worked to meet their mission of caring for the poor and underserved and improving the health of their community. They often cite that mission as their top priority. But in truth, they are evaluated by how well they grow revenue and margin, both of which come through expanding market share.

Market share used to be easy to define. CEOs counted on a reliably increasing reimbursement model that exceeded inflation and an aging population that meant more hospital days every year. No longer. But even though market share growth is much more complex now, failing to achieve that growth could mean termination.

To win the market share battle, healthcare organizations must first redefine what it is (see the sidebar on new market share proxies) and then build strategies that take advantage of the shifts in healthcare delivery. Here’s how three healthcare leaders are doing it.

NORTHWELL: ‘THE CONSUMER IS THE DETERMINANT OF SUCCESS’

Michael Dowling, president and CEO of Northwell Health in Great Neck, New York, acknowledges the need to provide access, value, and convenience for consumers who are increasingly looking for a wide-ranging array of services offered by a single health system. The key to this strategy is the consumer as the focal point of healthcare decision-making.

Northwell is currently investing heavily in home health and digital care access, including a major initiative in telemedicine, but tying it all together into a seamless consumer experience is critical.

“You need hospitals as anchors, but the strategy is very consumer-focused in providing access and convenience,” Dowling says. “We’ve been doing this for 10 years, and it’s one of the reasons we’ve grown to being one of the biggest players in the New York City market. It’s the interconnection of all these pieces that makes all the difference.”

Although it’s not a perfect analogy, Dowling says Northwell wants to emulate Starbucks’ approach to market coverage. It’s not a location on every street corner, but it’s close.

“The traditional way of looking at market share isn’t valid anymore.”

—Chris Van Gorder

Also, getting critical market share mass in a variety of modalities is necessary to becoming the viable narrow network that employers and insurers are looking for. Smart health systems are spending more on smaller facilities, like micro-hospitals, or on freestanding ERs, homecare, urgent care centers, and telehealth capabilities. Such investment aims to meet the everyday health needs of consumers, not just provide for their increasingly rare inpatient stays.

This means focusing on organic growth that complements or even stands alone from the inpatient realm rather than buying hospitals, for example. Specialized areas of investment in both inpatient and outpatient care are the usual profitable service lines, such as orthopedics, neurology, and cardiac care, says Dowling.

He says he seeks two kinds of market share when it comes to reimbursement: Medicare and Medicaid, and commercial. Both kinds are needed to serve the community comprehensively, he says, but only one of the two makes a margin. Patients don’t see that distinction, though, and Northwell must serve them all.

“[Commercial] is what everyone’s going after,” he says. “So, you try to be the preferred provider. You take market share from competitors by developing the physician relationship and by the expansion of ambulatory. We’ve built a massive ambulatory network with over 650 locations. It’s a marketing and consumer experience strategy. If patients are not happy with experience, they will go somewhere else, so it’s multifaceted.”

Hospital-centric organizations used to measure market share in terms of inpatient volume or discharges, but as more services have moved outside the hospital environment, those have become less reliable measures of success.

“We’re all moving toward understanding that the consumer is the determinant of success, rather than just the patient care business,” says Dowling. “The consumer is going to be determining how they want care and where, and since more of it is not needed in the hospital, you have to create locations for cancer care and imaging and surgery where it can be done on an ambulatory basis.”

SCRIPPS: ACCENTUATE YOUR STRENGTHS

Chris Van Gorder, the longtime president and CEO of Scripps Health in San Diego, is content with a level of uncertainty around market share, and says that growing it depends partially on instinct in a time of upheaval.

“Market share’s an odd thing. Everyone still wants to gain commercial market share, of course,” he says. “But today we’re not so focused on the inpatient side. We’re doing total hips on the ambulatory side. So, the traditional way of looking at market share isn’t valid anymore.”

Even though the discharge-based methodology isn’t as relevant as it used to be, it’s still important. Rating agencies still use discharges as an important tool to measure financial health, and with the relative lack of precise alternatives, discharges can be an important factor in how they determine borrowing capacity and interest rate terms for healthcare organizations.

“As an industry, we have to figure that out,” Van Gorder says. “Rating agencies use discharges, but you could be reducing that number and getting stronger as an organization.”

Scripps went through its rating agency sessions about three months ago and has seen a small decline in those traditional market share measures, but Van Gorder says those measures don’t tell the full story anymore. Scripps’ market is dominated by three major players: itself, Kaiser Permanente, and Sharp HealthCare, so fluctuations in discharges are often small and at the edges.

Rating agencies are smart enough to recognize that healthcare is changing, Van Gorder says. For example, they know it’s the right strategy to move to ambulatory, and Scripps experienced growth in covered lives in its health plan, which is part of Scripps’ strategy to build its own narrow network. But even rating agencies are frustrated that there’s no metric to enable consistent comparisons, he says.

“We still talk about market share because I still need to make sure the hospitals are occupied enough. Half-full hospitals are the fastest way to go bankrupt,” he says.

Scripps is strong in cardiovascular services, particularly interventional cardiology. “So, we focus on maintaining our strength in that area and in ortho, which is becoming much more ambulatory than it used to be,” says Van Gorder.

One area where it’s not as strong is cancer, he says, even though Scripps is a major oncology provider in San Diego. To maintain and even buttress that market share, the health system has partnered with Houston’s MD Anderson Cancer Center to build a new comprehensive cancer program that started treating patients this summer.

“[MD Anderson] is building a network strategy, and they have 23,000 people just working on cancer, so we are taking advantage of their knowledge to make us stronger,” he says. “It was a market share play, but it’s much more than just that, with increased access to research and clinical trials.”

Facing fierce competition in ambulatory, Van Gorder says the health system is focusing on areas where it’s strongest and trying to grow there.

In all areas, he says Scripps must aggressively focus on cutting costs, because he sees cost as a proxy for quality. In fact, he notes, cost may be the major limitation for most health systems in growing market share for the foreseeable future.

“People are paying more out of pocket to come in, and insurance companies have gotten so good at narrow networks,” he says. “People tell me you can’t lead with cost, and I say no. Cost is a quality indicator.”

GRADY: INVESTING IN SPECIALTY SERVICES

Safety-net hospitals, such as Grady Health System in Atlanta, have historically been overrun by mission patients—that is, patients who do not bring margin, such as Medicaid patients. But its leadership has recognized that the health system needs to be more competitive in commercial patients.

For Grady, that hasn’t meant investment in traditional service lines, but instead investment in highly complex tertiary and quaternary services that can’t easily be found elsewhere in its market, says John Haupert, its president and CEO. With seed funding from philanthropic sources, Grady has made multimillion-dollar investments in stroke and neurological surgery, interventional cardiology, and surgical subspecialties.

“In our case, it was a matter of survival. If all your patients are Medicaid or unfunded, you’re not going to be in business. Part of Grady coming back to life 10 years ago involved developing strategies to grow in funding the mission,” says Haupert.

The complex cases that have come from Grady’s recent investments weren’t previously present in the market. Unlike many organizations, Grady needed to create additional inpatient capacity to maximize those investments in capital and talent. It will soon be operating around 700 occupied beds; 10 years ago, it was barely operating 400. It’s building new outpatient facilities as well, expanding ambulatory surgical and oncology capacity across the street to free up space in the main facility where its cancer center is now.

“In the next three years, we’ll have 750 beds in operation,” Haupert says. “We’ve gone from 9% to 20% commercial. That helps with sustainability.”

 

Independence Is Not a Strategy for Health Systems

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There are ways to keep going it alone in the face of massive consolidation, says one health system’s CEO. It’s not a strategy, but a means to end, he says.

Afraid your hospital or health system can’t compete because you lack size and scale?

A merger might help, but it’s not the only possible answer to your problems. Freehold, NJ-based CentraState Healthcare System’s top leader is certain it’s not the best solution for his organization.

Consolidation continues to upend the acute and post-acute healthcare industry. In fact, in a recent HealthLeaders Media survey, some 87% of respondents said that their organization is exploring potential deals, completing deals already under way, or both.

But CentraState isn’t among them, says John Gribbin, its president and CEO.

On a continuum basis, CentraState is already diversified. That’s one of the potential selling points of an M&A deal.

Anchored by the 248-bed CentraState Medical Center in Freehold, NJ, the 2,300-employee organization also contains three senior care facilities—one assisted living, one skilled-nursing facility, and a continuing care retirement community.

It can be argued that CentraState may not possess the scale to compete with multifacility, multistate large health systems that can take advantage of a hub-and-spoke strategy for referrals. Nor may it be able to afford expensive interconnected IT systems.

But there ways other than mergers to achieve scale and collaboration, says Gribbin.

Means to an End

Gribbin insists that he and CentraState’s board, which supports and encourages independence, are not dogmatic about it.

“Independence is not a strategy,” he says. “It’s a means to an end. The moment that ceases to be worthwhile is the moment we’ll consider another way to achieve our mission.”

Change is part of that strategy, he says, adding that healthcare in 2017 needs to be far more collaborative, not only with patients and family, but with other healthcare organizations. That’s a big difference from previous generations.

“Our real strategy is scale and relevancy,” he says.

And there are ways to create scale short of taking on all the legacy costs and “baggage,” as Gribbin calls it, inherent in any merger.

“There’s a lot of costs involved in merging… and while mergers work in some instances, they don’t work in all, and in many communities, they are increasing costs to the consumer,” he says.

In addition to the commonly stated goals of improving the community’s health and wellness, patient costs are extremely important in fulfilling CentraState’s mission, Gribbin argues.

Many mergers involve replacing hospitals and adding patient towers and high-cost equipment. That adds to their cost structure means they have to extract higher pricing, says Gribben.

“That’s the vicious circle you find yourself in. I prefer to create scale in a different manner.”

Focus on the Mission

Gribbin, who has led CentraState for 17 years, prefers to solve that challenge in part through a strong network of physicians unburdened by excessive administrative overhead.

He says the health system has to increasingly take on value-based contracting and financial risk. To be successful under such value-based reimbursement, partnerships with physicians are increasingly important, as is a redefinition of the relationship with the patient.

“We used to look at our relationship with the patient as a typical hospital stay,” says Gribbin. “What we’re preaching now is that hospital stay is a temporary interruption in our relationship. What happens before or after defines the relationship’s success.”

With its physician alliance and clinically integrated network in place, CentraState, unlike many hospitals, has been able to avoid, in large part, expensive physician practice acquisitions that can be a financial challenge.

“I’ve done it in the past, and may do it again, but we’ve tried to avoid it,” he says. Instead, contracts define the relationships and incentives.

As an example of those relationships, CentraState partners with a major patient-centered medical home primary care practice on four performance and three utilization measures.

As a result of the shared savings generated in the first year, which came largely from hospital-based savings, the physicians in that group referred 59% of their patients to CentraState.

This year they’ve referred 71% of their patients to CentraState because of its low costs, which help drive financial reward for both parties under the contract.

“On one hand, we’re keeping people appropriately out of acute care, but on the other hand, they’re sending [more] people here. So we’re experiencing higher but more appropriate volume. In this scenario, everyone wins,” Gribbin says.

A New Deal with Physicians

In order to avoid the need to acquire physician practices, Gribbin says it helps to have a suite of services to offer them as a starting point.

“Most don’t want to sell their practice, but they feel like they have to, he says. “If you give them the opportunity to stay independent, they’ll take it.”

Helping them with access to better revenue cycle management, malpractice insurance, and risk management, and helping them create the ability to enter into risk-based contracts is another big help with defining a new relationship based on shared goals with physicians that ultimately benefit the patient, he says.

Physicians can establish a relationship with CentraState through its independent practice association, or a physician hospital association, and avoid surrendering their autonomy, he says.

“The physicians got paid better, the payer saved money even including the bonus, the hospital won because it’s high value care, and the patient’s winning too,” he says. “It’s a microcosm of what we’re trying to accomplish.”

As a small organization, both Gribbin and the board worry about being frozen out of narrow networks. Much of the energy they’ve expended in being a low-cost organization is wasted, he says, if they can’t get the big payers to include them in contracting.

“As long as the market isn’t rigged against us, we’re OK, because we’re a high-value organization.”