E76: Leading A Healthcare Organization: Leadership Towards Providing Excellent Service With Phil Young

We can’t avoid challenges in our personal and professional lives. What’s important is we know how to deal with them. In this episode, Phil Young, CEO of Northeast Baptist Hospital, shares effective leadership of a healthcare organization and providing a better service to people through the right culture and vision. Through his ideas, they could deal with the recent pandemic well. Find out about his teams and organization’s ongoing activities and programs that enable them to work towards their vision. How are they coping with the different challenges they face, including the pandemic? It’s not an easy task, and thus, we can learn a lot in this episode!

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Listen to the podcast here

Leading A Healthcare Organization: Leadership Towards Providing Excellent Service With Phil Young

As always, I’m honored and excited to be joined by some friends of mine, Ben Sawyer and Darin Vercillo. Darin and Ben are Executives at ABOUT Healthcare. We always have a good time together so hopefully, we’re going to have another great show.

Absolutely, Chuck. Thanks.

We’ve got a good guest, a friend of all of ours, and that is Mr. Phillip Young, who is the CEO of Northeast Baptist Hospital, a tertiary medical center serving the greater San Antonio area. Over his 35-year career, he has led flagship hospitals and health systems focusing on leadership development, cultural enhancement, and leading organizations from worst to first in patient safety, high reliability, and operational performance improvement.

He worked with Dr. Paul Batalden early in his career. For some of you who may not know Dr. Batalden, he was one of the most prominent leaders in healthcare in the Toyota-style quality improvement model and bringing that over to the United States. I’ve had the great pleasure of hearing from Dr. Batalden.

I think many of you probably have also participated in a lot of his teachings, even in some of you in your organizations. Finally, in addition to his role as CEO, he has developed a program called Contributing To Average, why leaders and their organizations struggle to achieve extraordinary performance.

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Welcome, Phil. It’s great to have you here.

Thank you, Chuck. It’s great to be with you again. Darin and Ben, it’s good to be with you as well.

Likewise Phil.

Phil, you participated with all of us at a Baldrige Foundation in-person CEO Round Table in Atlanta. We talked about a number of interesting topics during that two-day session. We’ve had some of those topics utilized during some of our episodes. We talked a lot about leadership during turbulent times. Particularly since that meeting was one of the first times we had all been able to get together in person since COVID. Let’s start talking by having you tell us what you believe the role of leadership is primarily? How have you dealt with things like the impact of COVID, the Great Resignation, cost of labor and capital, and all the things I know that many of the folks in our audience are struggling with?

Thanks again for having me, Chuck. It’s great to be with you. With regards to leadership and the role of leadership, I often remind my team that I’m not a clinician, a physician, or a nurse. I can’t do anything at the bedside. I work in administration. For that reason, I remind them that I bring no value to the organization if I can’t bring three things. One is creating a vision. Secondly, driving a culture. Thirdly, marshaling the resources for the entire team to achieve the goals that we set out for ourselves.

With that in mind, to me, the very first step is making sure that the entire organization fully understands and buys into a vision. I would hasten to say that I’m not necessarily talking about the vision that we all have on our websites. Those tend to be fluffy. They’re genuine, but they tend not to describe what’s going on in the heart of the organization to confront the challenges that we face.

To your point, as we’ve come out of COVID, we can’t point to a single part of our organizations and industry that’s not in some turmoil. When I think of a vision and I try to communicate that vision to my team, I want to do it in the context of the challenges that we’re facing. I’ll give you one example. On my website, I have a video that is available to anyone who wants to look at it called the Value Imperative. The message behind that is that now there are a number of factors that cause us as an industry to seek value for our patients and for those who pay for services because we’re not delivering on value.

The United States is the most expensive healthcare system in the world. Click To Tweet

A couple of examples, if you agree that some of the outcome measures that mean a lot to those who seek services from us as an industry, life expectancy and infant mortality are reasonable outcomes to think about. You then layer that with the fact that the United States is the most expensive healthcare system in the world plus the fact that in both of those measures, life expectancy and infant mortality, our nation is in the bottom core tile among industrialized nations.

I’m getting too far into the weeds, but the point is that as an industry and as organizations have to focus on delivering more value to those who seek our services. The vision that I am espousing in my organization over the next few years is to achieve top decile performance in the value that we deliver to those who we serve.

I thought that was a good example of making sure that the vision is real. It’s connected to who you’re serving. To your point, the vision statement of most health systems and most organizations can be fairly generic. Your point is to make it real, connect it to the customer or client that you serve, and make sure that that’s measurable and the organization that’s galvanized to meet that need. Is that what you’re saying?

You’re spot on, Ben. That’s exactly right. We have to take that and break it down further. We have to find out where we’re doing well in quality and not, and where we’re being efficient and not. With laser focus, look at those areas where we need to improve, whether it’s on the cost efficiency side or quality side. I can give you one example of something that happened here at this hospital number of years ago, something we’re very proud of.

In the original ACE demonstration project with regards to a joint replacement, Northeast Baptist participated in that and generated extremely high-profile quality results in that project. Fast forward a couple of years ago, we were approached by a consortium of large national employers, Walmart being one, Boeing, and others to participate in a destination medicine program for joint replacement.

What we were told is we’re happy to pay $25,000 for a joint replacement procedure for our employees, including the cost of flying them across the country to have that procedure, if we can, with high reliability, know what the cost is going to be and know that we’re going to have top decile outcomes for our employees.

We want to avoid those $80,000 procedures that don’t generate great outcomes. That is a feather in our cap. We’re 1 of only 11 sites around the country that were invited to participate in this. The reason I bring that up, part of it’s to brag a little bit, but more importantly, it speaks to the direction our industry’s going. Those that pay the bills and receive the care are looking for value. Whether it is joint replacements, heart surgery, or whatever we do, we have to approach it with that focus, and that’s our vision.

When you and I were together in Atlanta, we talked about culture a lot. I want to explore a little bit how you have successfully driven the culture. I’m going to use an example that may not normally be used in the discussion of culture. One of the things you and I talked about, as you know, a lot of my background is in doing turnarounds and taking organizations from worst to first, not just in quality, but in financial distress and all the rest of it.

Kaufman Hall came out with their flash report and the first four months of 2022 don’t look good for the majority of healthcare organizations and yet I remember distinctly you telling me that even though the few years of COVID that you successfully shepherded your organization through those couple of bad years.

It seemed to me that that probably had a lot to do with culture. People are focused on doing the right things. That bled into other things like labor shortages and everything that other folks are experiencing, but who hasn’t had the good fortune that you’ve had to be able to drive the organization to reasonable margins, despite everything that’s going on. I’m curious how you’ve been able to do that.

I certainly don’t take credit. We all know that we’re part of teams. Although we lead teams, it’s the folks around us that make things happen. I will go with a story that I always share. This has nothing to do with healthcare by the way. It’s a story that I shared to bring home a point about our roles in our organizations.

In 2009, Andy Andrews wrote The Butterfly Effect. You may have read it or seen his videos. That short book was a commentary on mathematician Edward Lorenz’s theory that a butterfly could flap its wings and set molecules of air in motion that, in turn, set other molecules of air in motion. In turn, others would eventually be capable of causing a hurricane on the other side of the planet.

He was shunned for that theory for years, but the scientific community eventually embraced it and wrote it into scientific law. The point is that everyone in the organization, even the small things that we do, will have an enormous impact throughout the organization, not just now, but on how our organization performs in the future.

You mentioned cost. I’ll give you one example. When I arrived here a number of years ago, I was struck by how many times I would hear from a nurse or a nurse leader that we don’t have enough thermometers on our unit or we’re missing something. I thought, “Why should a CEO, COO, or anyone needs to be involved in marshaling the resources of thermometers in a nursing unit?”

You bring no value if you can't marshal the resources for your team to do their job. Click To Tweet

What we wanted to do in terms of culture was to push that decision-making out into the organization. If a bedside nurse needed a thermometer, he or she simply needed to go to the supply closet and get it. It was up to that unit director to make sure that along with all the other supplies and equipment were available.

It took a while because that had not been the culture before. As I said earlier, I bring no value if I can’t marshal the resources for them to do their job. I wanted to make sure that those resources were available. It’s taking little nuances in the organization and tweaking them to, first of all, make sure people understand where we’re going through the vision and we’re going to provide those resources. That creates a world-class work environment along with other things but not having those certainly prevents you from becoming a world-class work environment.

One of the things I was impressed with you by when we first met at that meeting out in Atlanta was how hands-on you were and involved in guiding your organization, but balancing that with the ability to delegate and get the decision-making down to the lowest level, so people can be efficient which is great. Don’t apologize for the fact that you’re not a clinician. Chuck and I, at least, are looking back and thinking about when we were in residency, fellowship, and all that time, we think you’re the smart one here.

I appreciate that.

With regard to culture, as a CEO, you’re dealing with a lot of different cultural areas within your organization. There’s been a huge shift in nursing staffing, their whole organization, cost, and the way that they do business have changed. I wonder to focus a little bit on, as you’re coming out now from the pandemic, and you’ve done a great job at keeping the wheels on the bus and things rolling forward. Talk to us about your provider culture or your physician culture, those that may be employed or highly affiliated. How are you managing to keep those in lock step with your vision when sometimes they may have other ideas in mind that don’t necessarily align?

It’s a simple thing, Darin. We all understand that open, honest communication is essential. We do something here called a Physician Leadership Council, and this is something that most every well-performing hospital has in place in some form or fashion. On an ongoing basis, we gather not the formal leaders but the informal leaders of the medical staff to get together. I want them to fully understand the current state of our hospital, where we are vis-a-vis our vision, and how we’re moving forward.

Also, they need to understand where the industry is. They need to understand that Becker reported that 14 of the 16 largest healthcare systems in the nation posted an operating loss and that 3 of those posted a loss in excess of $500,000 for a quarter. We’re all struggling. If everyone has that understanding, then we can share ideas that help us to overcome that.

I also do the same with employees in various forums. I had a column of 1 in 10, where we had 10 randomly selected employees come and sit down and have breakfast with me. In the end, I was explaining some of the industry conditions that we’re in. There was a respiratory therapist who, at the end, came up and thanked me because she had no idea that hospitals were struggling the way they did.

Some of the challenges he was facing, whether it was the small pay increases that they get or seeing some of these contract people come in and there’s all this animosity that’s swirling around that she better understood how we’re trying to manage through that. Again, it’s open, honest continual dialogue at all levels.

Let me ask you a concrete question around that because a lot of our readers are struggling with this. If you look at any of the recent surveys that have been done, the number one concern is around staffing. I’m curious what have you done in order to increase or manage your retention, potentially recruit new people, and keep so many of your people from leaving? Others haven’t been quite as lucky as that. I’m curious what some of the Northeast Baptist secret sauce might be.

I was going to say we don’t have a secret sauce, but it is something we have to deal with every single day. When we were in Atlanta, we had a fantastic conversation built around load balancing, matching capacity, and demand. In this early post-COVID world, we’ve seen a huge shift in demand. Some services are in much higher demand. Some are in much lower demand.

I’ll break this down into two levels. One is at a system level across our community, we need to understand those shifts in as close to real-time as possible and adjust our service lines. I gave an example in Atlanta of how we had looked at it at a shift in obstetric services. We realigned the services across our system to better match the demands that had shifted in various parts of San Antonio. That’s one level.

At another smaller level or more focused level here in our hospital with regards to load balancing, we’ve realized, along with everybody else, that we don’t have the staff each and every day to continue to staff every unit that we had in a pre-COVID world. Along with our leaders, we took data, drill down, and identify what are the highest priority needs?

We’re operating with about six fewer units open right now than we had with pre-COVID. Our census is much lower but our primary commitment was to make sure that the patients are receiving the best possible care that they can. Again, getting back to that marshaling the resources, whether it’s human resources, capital, or whatever, we want to make sure that we’re concentrating those in the area of greatest need.

We have to explore best practices, but at the same time, we have to figure out how we're going to differentiate ourselves. Click To Tweet

We happened to find, at least here, higher demand for intermediate and tertiary levels services. We have realigned our units to reflect better what that demand is. It takes a little bit of pressure, certainly not all the pressure, off of the staffing. Unfortunately, we have to rely on external staff to augment our own. In the world we’re living in, we know that over time, hopefully, a short period of time, that’s going to settle out, and we’ll know exactly when we’re going to hit that reset button. I hope that answers the question.

There are two follow-up questions in keeping with what Chuck was asking that I want to ask you about in this regard. The first is that you were talking about driving culture in that you push the decisions as close to frontline action as possible. By doing that, you empowered the team, you made the decision cycle shorter, and therefore, the organization arguably was more nimble. Is that correct?

Yes.

The second thing that I heard you talking about is when you face a problem, you use data and clarity around what the problem is to understand what the issues are before you act.

Yes, whenever possible, we want to do that.

Going back to Chuck’s question, how important were those two characteristics in leveling out the swings that everyone else felt during COVID within your organization? People were making more rapid cycle decisions because they were empowered to do so on data. It is because they were taught how to analyze that. How significant was that for Northeast Baptist in terms of weathering the storm that has been COVID?

Let me jump in one second and add one thing to that. Darin is going to want to comment on this. In addition to what Ben said to add, if you’re going to do what you did, you’re talking to also about empowering your people. You can’t empower people without giving them the information. I would be curious and I’m sure our audience would relative to the data piece that Ben asked about. What information do you give your folks that allow them to feel empowered and make in making good decisions?

The best way to answer is through an example. As we’ve come out of this last COVID wave, we’ve seen a shift in our emergency department. Overall, volumes are down, which would suggest that there are lesser resource needs in the emergency room, but the data tells you the opposite. We are seeing a significant increase in the acuity of the patients arriving. Our emergency services arrivals have increased. Part of that is due that we just enhanced our interventional stroke program, so we’re seeing a lot more of those types of patients.

The example I was going to give is those shifts have created different dynamics in our emergency department. We’ve closed some units upstairs, which hamstrings the back end. We’re seeing an increase in acuity and arrivals on the front end of admittable patients. That’s created an increase in the number of holes in the ER. We pulled a SWAT team together of the nursing leaders and a few others. We have drilled into that and said, “How many more beds do we need to satisfy the demand that we’re seeing over the last 2 or 3 weeks?”

It was fascinating for me to sit back in meetings and I didn’t say ten words. I sat back and listened to these leaders go back and forth. They figured out a way. They calculated the number of shifts they needed. In one situation, they needed 24 shifts covered over the next two weeks and they figured out a way to make that happen. The ER director is across the room doing backflips. He’s so happy because he sees the holes and the pressure on his nurses are seeing some relief coming. It’s all based on the data. These are the shifts that we’re seeing.

My turn to piggyback one thing off of that same thing, you’re a huge believer in data and transparency, and you’ve talked about that. Prior to COVID, you had gotten involved in an area where I’ve spent a lot of my career, which was the strategy around your transfer center and the referrals that were coming in through that door.

You’ve talked about ER volumes going down, although acuity levels are going up. The front door or that entry point to your hospital and healthcare system is dynamic and changing. You also talked about your new interventional stroke program, the high acuity patients, and growing service lines. How has that transfer center or that avenue of attracting those referrals now played out and where do you see that going as a strategy in the future?

We have a very large system across the San Antonio region and outlying community hospitals or rural hospitals rely on us to be able to send their patients with the highest acute needs. All of that is coordinated through our transfer center. The pressures that we’ve talked about have increased that. Again, no silver bullet here, but our teams are, every day, coordinating with the transfer center to find the best placement opportunities around the system based on clinical need, bed capacity, etc. It’s key. Not having that would be a disaster.

That whole balancing area too. That’s great.

I wanted you to talk a little bit about the program that you’ve taken out to other leaders and health systems in your community and in other areas of Contributing To Average.

I could go on and on. The website is ContributingToAverage.com and there are some videos, some podcasts, and other things out there. The essence of it is what we talked about. We have to differentiate ourselves in terms of efficiency, quality, and bringing that value. What I found is that a lot of organizations simply created a library of best practices and sent their leaders to dive into that library and find something that worked for them.

I heard a great saying one time, “If your thinking causes you to do what everybody else is doing, you’re merely contributing to average over time.” That’s where the name came from, but the point is that we have to explore best practices, but at the same time, we have to figure out how we’re going to differentiate ourselves. This whole program is built on how to explore that.

Can I ask one last question that goes right along with that? In this age of consumerism, how important is that differentiation for the success of healthcare entities going forward?

Consumerism is exploding. You could take both sides of that argument, but ultimately, we’re here for the patients. We create an environment for our physicians to take care of their patients. It’s ultimately the patient that’s going to decide. There’s a great misunderstanding about the patient experience. In fact, there’s a video on my website called The Truth About Patient Experience.

I suggest you read it, but the point is that we have to do the things that make a difference in our patient’s experiences. The traditional way is that we’ve gone about doing that perhaps hasn’t been as effective as we would want. Again, we seek to find better ways to improve that patient experience. I hope that answers your question.

It does. Thanks, Phil.

Thanks, Phil. This has been a great conversation. I appreciate seeing you again, having you on, and for contributing to the dialogue. Ben, as always, I’m going to leave you with the last word.

For our readers, we have an important executive round table coming up. It’s on Tuesday, June 14th at 12:00 PM Central, 1:00 Eastern. We will be having a round table discussion of a number of these topics that we addressed at the CEO Innovation Council that you’ve learned about that was held in Atlanta. A couple of the folks that were participating in that will be on the panel.

We’re going to be discussing the implications of the kinds of topics that you learn about in a broader way in terms of the healthcare industry. Please tune into that. There are invites that are coming out. If you need an invite sent to you or haven’t received one, you can reach out directly to Erin Sellers at BaldrigeFoundation.org. Her email address is ESellers@BaldrigeFoundation.org and she’ll make sure that you get an invite to participate in that virtual round table.

 

Important Links

• ABOUT Healthcare
• Northeast Baptist Hospital
• Contributing To Average
• Baldrige Foundation
• The Butterfly Effect
• ESellers@BaldrigeFoundation.org

About Phil Young

HEALTHCARE SENIOR EXECUTIVE
Chief Executive Officer – Tertiary / Multi-Facility Leadership
Change Leader / Leadership Development
Service Line Strategy and Development
Pioneer in Quality and Patient Safety

LEADERSHIP DEVELOPMENT PRESENTER / HEALTHCARE FUTURIST / PUBLIC SPEAKER
As featured on Becker’s Healthcare Review –
Becker’s Healthcare Podcast – Guest Presenter
Becker’s Advisory Call – The Future of Healthcare – Guest Presenter