Becker's Hospital Review

21 Leadership & Strategy ways, a management failure. At Scripps, we have followed a "no layoff philosophy" for the past 15 years. It is much more difficult to significantly reduce costs without using the layoff tool. Yet, the rewards of having a staff that believes man- agement will only use a layoff as a last result is amazing. Our no-layoff philosophy is one of the ways we show we care, especially in times of great change and financial pressure. The two-way trust we create is powerful and it aids in the willingness of staff to support change when they know their employment will remain secure. However, it also requires the leadership to look far ahead and proactively manage and anticipate changes well in advance. And that is very difficult in healthcare in the midst of constant change. It took me years to realize it is critical for a CEO to be very clear with accountability. It's very easy for those of us in healthcare to make excuses for lack of per- formance. Who knows what new changes are going to come down on us from Washington, D.C., or our states. It seems like every day, there is a new regula- tion or a new model of delivery dictated to provid- ers, and the amount of surveys and inspections from multiple agencies can be overwhelming at times. I had already been a CEO for many years when I realized that I needed to build a culture of ac- countability for our organization to succeed and to be able to create a climate where staff, physi- cians and patients would flourish. So I developed a "three-legged stool" management model. The three legs are authority, responsibility and ac- countability. When leaders are appointed at Scripps, they understand that they will be given responsibility and authority but with that comes strict accountability. As a result, Scripps has been very successful over the past 15 years hitting its targets. I also learned that all targets must be clearly defined and measurable. Absent a culture of accountability and clear and well-defined goals, staff will fill the void by doing what they want to do versus what they have to do. But when there is a culture of accountability, staff will focus on the key operational objectives and perform magnifi- cently. How many people have I terminated as a result of this culture and philosophy? None. Nobody ever told me that being CEO really was a 24/7 job, 365 days of the year, with little privacy in an environment where every decision is scruti- nized. But at the same time, nobody told me how rewarding it would be. I can't tell you how much I enjoy getting out of my office to visit a hospital department or ambulatory clinic and tour with staff and visit patients. There are few industries where the CEO can visit a trauma patient whose life was saved by our healthcare heroes. Recently, I visited one of our ambulatory clin- ics and the staff waited outside to greet me with welcoming signs and placards. An elderly patient outside waiting to leave wanted to know what the ruckus was all about. He was told I was vis- iting. He said, "I'd like to meet the president of Scripps." So I went over to see him and he told me how long he had been coming to that partic- ular clinic, how much he loved the staff and his physician, and how they were keeping him alive and healthy. He said, "You keep up the good work young man." Well, I'm not that young anymore and I did nothing to directly care for him, but I welled up with pride in the staff I have the honor of leading during these challenging times. I toured, gave a 25-year employee her service award, did a Q&A with staff and walked away with cookies and a sign from the staff that is in my office today. I also received several notes from staff thanking me for my visit, which gave me one more opportunity to thank each of them for what they do for our patients and organization. No- body told me how difficult it would be to care so much for those on the front-lines of my organi- zation — but nobody told me how rewarding it would be either. My day ended with me shaking the hand of the security officer standing watch over the staff at that clinic — and it was my true honor to do so. Michael J. Dowling, president and CEO of North Shore-LIJ Health System (Great Neck, N.Y.). First of all, nobody told me much of anything before I became CEO in 2002, but three areas where I have learned valuable lessons over the past 13 years relate to the dedication of em- ployees, the dramatic evolution of healthcare and ever-increasing government oversight. When I became CEO, I expected our employees to be caring and considerate, but their level of com- mitment and dedication has been much greater than I ever imagined. For me, it has reinforced the fact that working in healthcare is much more than a job — it's an honor and a privilege that carries with it a great degree of responsibility to the pa- tients and family members we serve. Perhaps the most unpredictable development of the past decade is how unbelievably complicated healthcare would become. We all knew healthcare was changing as we entered the new millennium, but nobody understood the degree to which healthcare would evolve. Navigating the complex- ity of how healthcare is accessed, delivered and financed has been the most rewarding challenge of my career — one that all healthcare leaders need to embrace as we transition to the health and wellness business, rather than just treating people when they're sick or injured. Another development that few saw coming was government's growing addiction to microman- agement of healthcare. While all healthcare lead- ers recognize the importance of driving reforms that tie reimbursement to patient outcomes, the excessive regulation that we've seen within the industry has little to do with improving the qual- ity of care. The level of government scrutiny that healthcare providers face far surpasses what's rea- sonable or justified. n SAVE THE DATE July 20-21, 2015, Ritz Carlton, Chicago, IL learn more & register at beckershospitalreview.com Becker's Hospital Review CIO/HIT + Revenue Cycle Summit 80 Speakers, 50 Health System and Hospital CIO & CMIO Speakers, 5 Tracks and 54 Sessions

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