Views from the Top

To gain the perspectives of leaders at the very top administrative stratum of large health care organizations, ASTROnews interviewed Edward Halperin, MD, MA, and Mohan Suntha, MD, MBA.

Dr. Suntha is President and CEO of the University of Maryland Medical System (UMMS), a private, university-based regional health system comprised of more than 29,000 employees and 4,600 affiliated providers, offering primary and specialty care at 11 hospitals, in more than 150 locations. Dr. Halperin is the Chancellor and CEO of New York Medical College (NYMC), a health sciences university with over 1,900 faculty members, approximately 2,200 students, and 600 residents and fellows practicing and learning in a network of more than 700 affiliated practice sites.

The missions and strategic plans of each of these organizations are available online,^{1, 2} but we wanted to hear a bit more about how those aspirational goals are achieved directly from the individuals at the tops of those pyramids. We posed a very similar series of open-ended questions to each leader, hoping to catch a glimpse of how they frame the issues.

ASTROnews: What do you see as the key factors for UMMS to fulfill its missions?

Dr. Mohan Suntha: We try to be very purposeful in viewing issues through our four galvanizing theme lenses. First, we are relentless in our focus of providing objectively measured, compassionate, high-quality health care, as seen through the lens of our patients and objective data relative to our performance. Second, we own the responsibilities of being anchor institutions in the communities that we're blessed to live and serve in. As the state's largest private employer, we have economic responsibilities when it comes to serving our mission. Third, we try to leverage the size and scale of our health system by acting like an integrated health care delivery system. Finally, we invest in our differentiation as an academic health system.

AN: Is there a particular business philosophy or framework that you find most effective in guiding a complex health system like UMMS?

MS: I start with a lens as physician first, and with that, apply our foundational philosophy, which is rooted in being a high-reliability organization (HRO). The principles that are part of an HRO include preoccupation with failure, commitment to expertise, sensitivity to operations, deference to expertise and reluctance to simplify. HROs exist in many industries. In health care there are few examples where a system of our scale have taken this journey. We’re an incredibly diverse health system. We encompass everything: a complex tertiary/quaternary academic medical center, urban safety net health care, rural health care, and familiar suburban health care. To maintain our high reliability as a system, we have a clear and purposeful approach to how we think about this philosophy.

AN: How do you monitor whether strategic goals are translated into actionable plans across the system?

MS: It starts at the highest levels of our organization. We’re a private not-for-profit health system with a board of directors that I’m accountable to, so we start with the strategic direction of the system, aligning governance and management, driven by clarity of strategy.

With the challenges of the external world evolving at times faster than health care has historically evolved, we have a responsibility as leaders to have clear priorities and, within each of those priorities, defined operational tactics. The tactics require organizations to have what I’ll call a progressive and modern organizational design and structure.

Our system has grown up as a confederation of states, given the diversity of our communities, our assets, with everyone living on their own bottom line. But if we’re going to be a leading-edge academic health system, we’ve got to evolve into a more integrated health system. We're doing that work now. And let me be clear, it's at times painful. It is moving a lot of people's cheese,³ changing job titles, moving accountabilities.

AN: What obstacles, expected and unexpected, have you come across?

MS: Having leaders from different contexts — physician leaders, administrative leaders, nursing leaders — develop what we call a systems-thinking mindset is often challenging. We're asking them to evolve from the traditions of how they've thought about the responsibilities they've had in whatever roles they've served. Given the historic siloed mentality, building up trust requires disproportionate skillsets in communication.

And so here's my radiation oncology pitch: we’re blessed as radiation oncologists because we’ve professionally grown up within a multidisciplinary world of care delivery. We are used to being in a room with people with different perspectives, whether medical oncology, surgical oncology, radiation oncology, pathology, etc. We have to apply systems thinking that is patient centered. And, well, we can all have our opinions but only one set of facts.

We break down silos with storytelling. We communicate the why, which is how we create the mission, not just connect to the problem. The number one skillset is emotional intelligence. At the end of the day if you don’t have that, it’ll be a real challenge to thrive in a complex organization.

AN: What metrics do you prioritize to assess the effectiveness of your approach?

MS: You have to measure the objective performance. We can all subjectively describe the reason we exist and our mission and value proposition. But if you can’t stand behind the subjective description with objective measures, then when you go to stakeholders who don’t live our reality every day, your message will fall flat. Objectively measuring quality, safety, clinical outcomes, patient experience, financial performance, return on investment, economic vibrancy, community impact is critical. As leaders we must communicate that the objective performance of our organizations supports the aspirational way we describe our missions.

AN: What are the most critical elements that will contribute to NYMC's success in fulfilling its missions?

Dr. Edward Halperin: An article in the “Bulletin of the History of Medicine” addressed the history of physician speeches about the future of medicine.⁴ For 200 years these speeches follow a predictable pattern. Whatever is the most recent technological innovation, the speaker asserts, will transform medicine…Therefore, the entirely predictable and facile way I could answer your question is to say that “our ability to adapt to artificial intelligence will be the key to New York Medical College’s success.” That would be both a predictable response and wrong.

The most critical element that contributes to success is an institution’s ability to remain true to its core values while adapting to changing times. True wisdom only is found at the confluence of knowledge and values. A health science university is a community of scholars that exists for the generation, conservation and dissemination of knowledge about the causes, prevention and treatment of human disease. If we stay true to that vision, then we not only succeed, we must prevail because our mission is too crucial to society for us not to prevail. 

AN: Is there a particular business philosophy that you find most effective in guiding a complex health system like NYMC? How do NYMC's core values inform this approach?

EH: “The main thing is keeping the main thing the main thing.” ⁵ A common mistake in leadership is to have too many “priorities” and to whipsaw from one to another.

We were founded in 1860. Our founder, William Cullen Bryant, thought that the great impediments to the success of the American experiment were racism, sexism, unbridled capitalism and alcoholism. This point-of-view led New York Medical College to begin admitting women and Black students to medical school by the 1860s, appointing women as department chairs by 1900, offering scholarships specifically designated for Black women and men by 1929, and disregarding the antisemitic admissions quotas of the 1920s-1950s.

NYMC is a health sciences university under Orthodox Jewish auspices. In the Jewish tradition the practice of medicine is as close to holy work as can be undertaken in our secular lives. When it comes to “core values informing an approach,” I don’t think it gets any better than that. 

AN: How do you monitor whether NYMC’s strategic goals are translated into actionable plans across the institution?

EH: Among the most wasteful things colleges and universities do is hire high-priced strategic planning consultants…I have always had a different attitude. It is based on a story attributed to Pablo Picasso. It is claimed that he said, “When art critics get together, they discuss truth, beauty, line, form, and whither art is going in the next half century. In contrast, when practicing artists get together, they discuss where to buy really high quality turpentine.”

I believe in strategic planning based on acquiring high quality turpentine: Pick a goal, make a list of action steps to get to that goal, identify who is responsible for each step, check off the steps as you move toward the goal until you either reach it or circumstances change, and you have to modify the goal. 

AN: What is the most common challenge you encounter in executing strategic initiatives?

EH: It is the faculty member who states, “I had no idea this was going on. Nobody discussed it with me.” As an academic leader you can conduct faculty meetings, host campus wide “Town Halls,” send out newsletters, and make speeches – and none of it is ever enough. There will always be resistance that derives from “But you didn’t notify me!”

About 12 years ago, I attended a meeting of the American Council on Education where I was paired with an experienced college President/Chancellor who asked me what troubled me most in my first six months on the job. I explained what I just articulated…the gentleman replied, “That comes with the territory with your job. Get over it.”

The moral of the story, I believe, is that communication is not about one person speaking; it is about when the other person receives and processes the information. Often that requires multiple repetitions in multiple formats. 

AN: What metrics do you prioritize to assess NYMC's performance?

EH: My most important measure of effectiveness is how good I am in meeting the first responsibility of a schoolteacher. My mother, who was an eighth grade English teacher, taught me that the first responsibility of a schoolteacher is to maintain a safe learning environment. No one can learn if they do not feel physically and emotionally safe. The treatment of the students must create an environment where they feel emotionally safe and ready to learn.

I believe there are objective measures of success. They are: (a) Are all education programs fully accredited by the best standard practice accrediting bodies with no adverse actions? (b) Is there full enrollment in all of our degree-granting programs, and do objective measures show that the entering students are of high quality? (c) Is the faculty’s research output of the highest quality as measured by external grant funding, publications and citations, and selection for membership in national and international organizations? (d) Upon graduation, are our graduates getting the kinds of job offers they want, at the places they want; and are these job offers comparable or better than peer institutions?