Unconventional Leadership

by Nancy M Schlichting

  There is more to tell about these times, and I will do so as we explore turnarounds, continuous improvement, and creating a culture of innovation—among the other topics that recur throughout the book. The fact is that all of these experiences eventually brought me to Henry Ford Health System as chief executive—the most significant and long-held leadership experience of my career.

  Before I continue, I want to discuss the challenges in my career—the bumps in the road and the times when, frankly, I wondered if I had lost my way as a leader. Without these challenges, I never could have mustered the courage and confidence to do the work I have done, together with so many great colleagues, at Henry Ford Health System.

  Obstacles Along the Path to Success

  The reality is that we all must clear the hurdles that rise from our career paths. The confident choices that I have made in my career—stepping up, striving to turn around businesses, and taking risks with jobs—all occurred largely because of the adversity in my life, not despite it.

  Being a woman—perhaps a bit less challenging in big business today—was a massive obstacle when I was rising through the ranks of organizations in the 1980s and 1990s. Now, with just 4.6 percent of S&P 500 companies being run by women,1 the statistics are still pretty grim, but they were even more sobering when I was starting to run hospitals and health systems decades ago. In fact, health care as a sector was dominated by men, especially in administration and clinical medicine—everywhere except nursing and human resources—until fairly recently. I have worked hard to change that in my own organizations, particularly at HFHS, where we went from two women in senior leadership to sixteen over a twelve-year period.

  Still, I readily admit to running up against roadblocks and gender stereotypes. When I was looking at grad schools, for instance, I was told point-blank by one administrator to forget about his alma mater. “Don’t bother with the University of Florida,” he said. “You’ll never get in because they don’t accept women into the program.” I was shocked, but I was on the path to Cornell by then anyway. Later, as one of just two women on corporate boards at Walgreens and First National Bank of Ohio, I witnessed firsthand the challenges women face in both having their voices heard and being granted pay equity. I have never succeeded a woman in any of my top leadership roles, and there have been a few instances where male direct reports had a difficult time reporting to me as a woman. Even at HFHS, I had to ask the board to increase pay for female executives in order to ensure parity with their male counterparts, which they fully supported.

  Based on my experience, and on what people have said to me over the years, I know that the bar was higher for me because I am a woman. In order to move up into leadership, women needed to be better than their male counterparts. In some ways, they have had to be perfect. But rather than resenting that, I decided to accept it until I could effect change with my own authority. Perhaps my willingness to take some of the heat myself has helped other women along the way. In addition, I should note that it was always men—mentors and managers—who promoted me and gave me the chances I have had to succeed. Many people took risks on me, and that always made me feel even more committed to making bold career choices and doing the job exceptionally well.

  Even more than being a woman, being gay has been the bigger career challenge.

  I was nineteen when I first realized I was gay. No one knew—not even my family. I found this part of my life tremendously difficult to navigate: I did not know how to come out to people. There were no gay role models at the time for me to turn to, and I found exactly one relevant book at the Duke University bookstore when I went looking for answers. So I kept my feelings mostly inside, rationalizing that my sexual orientation could be kept private. It remained largely hidden for decades.

  Finally, another person’s hatred and prejudice forced me to become more open. When I was COO of Riverside Methodist Hospital, the largest hospital in Columbus, an anonymous letter was sent to the CEO of the health system and all of the trustees of the hospital. Essentially, it said, “Congratulations on hiring a lesbian to run your hospital.” The chairman of the hospital board, Jack Chester, was a prominent attorney and former White House counsel to Richard Nixon. He was also a longtime friend and supporter of mine. He came to me and said, “Nancy, I got this letter. Is it true?” I said it was. He asked me, “What do you want me to do?” I said, “Whatever you think you should do.”

  After we talked, Jack called all twenty-six board members personally and said: “You might receive a letter. It is true, but this is not an issue for me.” After that, the matter died down for a while, despite one board member who was opposed to my leadership position at the hospital based exclusively on my sexual orientation. Within a year, I was promoted to CEO of the hospital, over the objections of that board member. Subsequently, this individual became chair of the board for the entire health system. The situation came to a head several years later when I was first in line to run the entire system. It was a tremendous opportunity for me and I was the most experienced candidate; having successfully led the flagship hospital, delivered AA credit ratings from Moody’s and Fitch, and raised patient and employee satisfaction to record levels, I was on top of the short list. But the chair stepped up his rhetoric once again. In addition to being the chair of the board of trustees, he was also a very large donor. Before the decision was made, he played his best and last card, telling board leaders, “If you follow through and she gets promoted, I am not giving this health system another dime.”

  I stepped away from the situation despite significant employee and physician support without causing any public embarrassment and left the hospital six months later without a next job waiting. I was unemployed for the first time in my life and I felt humiliated and shell-shocked by how it all went down. Having always kept my nose to the grindstone, and having focused on results over politics, I had never experienced anything like that. It was the worst time in my life in a number of ways. My mother was dying of cancer, I’d left a job I loved, and I was forced to abandon my career aspirations simply because I was gay. But I wouldn’t change what happened in Columbus because it is part of what made me who I am today. I took some time off to reflect and regroup. I resolved to stop hiding my sexuality and raise my head high to become a role model for others in the LGBT community.

  The experience in Columbus was just a speed bump. And it fired up my resolve and led me to greater things. After a short stint in Philadelphia as regional president running eleven hospitals in six states for the newly formed Catholic Health Initiatives, I was asked by my mentor Al Gilbert to return to Akron to succeed him as CEO of Summa Health System (a three hospital system with a health plan and flagship Akron City Hospital) following his retirement in two years. I accepted that wonderful opportunity, but only stayed eighteen months, because I received an unexpected call by Gail Warden, who asked me to consider coming to Henry Ford Health System as his potential successor when he retired in a few years.

  Being a woman on the rise in a male-dominated domain and being a closeted lesbian running Catholic hospitals represent two pieces in a larger puzzle of experiences that made courage and confidence mandatory for me. These experiences are also part of why I am considered unconventional—because I’m different, and I have come to see that as a major advantage. My differences have given me license to depart from business norms and traditions that are no longer effective. Despite the fact that no two journeys in leadership are ever the same, I have thought a lot about success and believe that I have advice to offer people who may follow in my footsteps. We will go much deeper into lessons for executives and organizations throughout this book. In the meantime, we will drill down deeper into career advice that is broadly applicable.

  How to Do What Is Difficult

  All of my thinking on career success can be summed up in one piece of advice: do the things that are difficult.

  My specialty has always been tackling tough tasks, in part because that is what has kept me engaged a
nd thinking creatively. I chose to play the violin when I was eight years old because it seemed the hardest to me—and I still play it today. I went after the COO job in Akron at age twenty-eight because it was a new challenge for me in terms of difficulty. Even choosing HFHS over Summa was the more difficult option of the two. Akron was my hometown, after all, and I had worked there in the past. I had friends and family close by, and it was comfortable and less complex. I was being brought in by my longtime mentor to a place where the financial outlook was relatively stable. Working in Akron would have been an honor, and I could have done meaningful work and stayed put for the rest of my career. It was the easier choice.

  HFHS presented a starkly different picture. The organization was inherently solid; it had an outstanding group of physicians and an excellent board. But HFHS was losing money, the flagship hospital was in serious financial jeopardy, patient admissions were not growing, and employee and physician morale was poor. The organization was in crisis, while metro Detroit was experiencing widespread economic instability.

  Given these two options, I would choose HFHS every single time. I gravitate toward challenging, complex problems because they present an opportunity to make things better. It may be easier to coast into safe situations, but that doesn’t move the needle. In fact, the easy parts of a job tend to concern me because challenge is what helps me work hard and test my thinking. Unconventional leadership means moving away from what is obvious and easy.

  In my view, there are four ways people can succeed on their own terms, even as they are doing what is difficult.

  1. Be a Student of Leadership

  I tell people to worry less about money and specific titles in their career and more about landing in a position where they will learn as much as possible and work with great people. With that in mind, I watch people all the time and examine their skills to see what I can learn. Early in my career, when I was at Memorial Sloan Kettering Cancer Center in New York City, one of the executive assistants stopped me and said, “Nancy, watch how Glenn Wesselmann runs a meeting.” Glenn was my predecessor for my administrative residency, so I was especially interested in his career path. I watched him and I was amazed by the way he was able to deftly draw people into a discussion and steer critical conversations. I took note, and today I still use techniques in meetings that I picked up from Glenn. Over the years, I have come to recognize that every leader brings something different to the table and it pays to notice skills that you can add to your own repertoire.

  Al Gilbert, my mentor and advocate in Akron, was someone who taught me a lot. Al had an amazing ability to work collaboratively with doctors. Many people on the business side of health care complain about physicians—it’s the classic divide between the clinical and business side of medicine. I first worked with doctors as a volunteer many years ago, and I saw the imperative of having good relationships with clinicians. Thanks to Al, I understand the importance of relating to doctors on a more personal level. Getting to know the people who can help me learn—whether these are physicians, nurses, board members, community leaders in Detroit, or experts out in the world—has been a hallmark of my career.

  I have a number of role models from history, Henry Ford being the touchstone I always return to. But studying contemporary leaders is just as critical, because you can see them in action and become acquainted with their approach to leadership. Mentors like Al and Gail were pivotal in my career, and were especially significant because there were so few female or gay role models I could turn to. Several Ford family members here in Detroit, as well, have helped keep me connected to our founder. But I have also looked up to people like Elizabeth Dole, who went to Duke and was U.S. secretary of transportation and secretary of labor before going on to lead the American Red Cross, and Juanita Kreps, a Duke professor, who was secretary of commerce and only the fourth woman ever to hold a U.S. cabinet position.

  My mother was also an important role model in my life, in addition to being my earliest and staunchest advocate. She was a fashion editor in New York in the 1940s and later became a high school teacher. More than anything, she wanted to overcome traditional gender stereotypes in her work, but she never succeeded to the degree she had hoped. She quit teaching right around the time her mother died. She had three young children at home, her babysitter quit, and of course it was 1960, so there wasn’t much support for a mother who was married and wanted to work. But she never acknowledged to me or my two sisters, as we were growing up, that there were career barriers for women. She did not want us to think that we had limitations. As a result, I don’t ever remember thinking I couldn’t do something.

  Interestingly, I am also frequently drawn to the lessons I can learn from the least likely suspects—curmudgeons, critical personalities, and people who are hard to please. There are several benefits to consorting with “difficult” people. First, they think differently than most, so there is always something distinctive to glean from them. Next, they are experts at pointing out flaws and seldom sugarcoat or euphemize. They tell it like it is. Finally, learning how to work with difficult people is vital if you’re going to be an unconventional leader yourself. You need to get comfortable with naysayers and work hard at the art of winning people over. Try it and you’ll see what I mean.

  2. Get Out of Your Comfort Zone

  Doing difficult things means taking chances. I have talked about how I’ve done it with career choices that entailed some personal risk. Another way to move out of your comfort zone is to become proficient in the skills that are daunting to you.

  Finance, for example, is an arena where many rising leaders feel out of their depth. Early on, I identified finance, accounting, and operations as areas to explore and conquer. I was uncomfortable with them at the time, but they have since become the most critical competencies I have beyond my people skills. During my MBA at Cornell, I had my eye on hospital administration and I swiftly added an accounting focus. As a woman, I saw that I needed to master the numbers in order to be taken seriously. The financial acumen I gained helped build my confidence and enabled me to go toe to toe with chief financial officers and number-crunching board members, who were mostly men and much older than me. Operations, now my lifeblood, was also totally foreign to me at the time. There were people who told me to stay away from operations because it might become my entire career. But I saw that it would help me learn the business faster and, again, give me opportunities to work directly with the board and CEO on strategic planning. The bottom line: it’s easier to be courageous and confident if you become accustomed to testing yourself and learning the skills that are most foreign and difficult for you.

  Another skill I knew I needed to tackle, if I was to be successful, was public speaking. In sixth grade I was assigned an oral presentation, but when I stood up to speak in front of the class, I flopped. It was the worst grade I got in school. I remember thinking, “How will I ever overcome my fear of public speaking?” Ultimately, I chose not to back down. Over the next few years I accepted every public speaking opportunity to confront and conquer my fear. In high school, I joined the debate team, and with the help of a great teacher, Lee Smith, became a champion debater competing at the state level. As a result, public speaking has been a hallmark of my leadership from early on. Speaking, like financial acumen, is one of those skills that can be uncomfortable and difficult at first—but facing your fears pays enormous benefits. If you can be a courageous and persuasive public speaker your chances of becoming an effective leader increase exponentially. But you need to accept that perfecting this skill requires persistence and courage.

  The last way to step out of your comfort zone is simply by being honest. This one is the most difficult to do because so many leaders feel they need to have all the answers. I learned to be honest early in my career, and it has paid enormous dividends in creating trust. To be fair, I really didn’t have much of a choice. It’s foolish to fake it when you are a young leader working with more experienced subordinates. In many senses,
they knew more than I did! I had vision and authority but they had the experience.

  The first time I supervised six seasoned department heads at Akron City Hospital, at age twenty-five, I said to them, “I’m not trying to do your job. I know that I cannot come close to your level of expertise, but I’ve learned some things so far in my education and my experience that I think can be helpful.”

  I brought something important to the table and let other people run with their strengths. Often, people come into a position of authority and act superior, or they take credit for their subordinates’ accomplishments, so the parties fail to connect. Sometimes, new leaders avoid obvious but uncomfortable truths, and relationships become awkward. When I went to Riverside Methodist Hospital, for example, there were three people working for me who had applied for my job. One woman, in particular, had been the acting chief operating officer before I was brought in, and perhaps had reason to feel resentful. The first night I arrived I took her out to dinner and said, “Mariam, I don’t know why you didn’t get the job, but I need your help. I need to work in partnership with you in order to succeed.” I was telling her the truth and it completely cleared the air. We had a solid working relationship for the next eight years, and I ultimately made her the chief nursing officer of Riverside Methodist.

  Honesty opens the door for better relationships. For me, the challenge was confronting the fact that I was a young woman coming in to lead people who were accustomed to working for older men. I just tried to be up front and show an interest in them and their work. Many of them had never experienced a leadership paradigm in which openness was at the center—and that focus had a positive impact on retention and morale.