Unconventional Leadership

by Nancy M Schlichting

  The Next Journey

  Quality is what moved the needle for HFHS in terms of improvement—through safety, efficiency, and an overall elevated performance. We got better by leaps and bounds during our Baldrige journey, and one common overlay was innovation, which I will address in chapter 4. Suffice it to say that ongoing improvement through radical moves is enabled from the top. Leaders need to empower everyone within the organization and instill a sense of urgency. More than just “saying yes” to ideas or sponsoring programs, I was orchestrating the efforts, and senior leaders across HFHS were fully involved as well, so the entire system was engaged in the pursuit of improving quality. This included our Board of Trustees, which, in 2007, made patient safety their top priority for the system.

  In the end, we got what we hoped for from the Baldrige journey. And we’ve continued to improve ever since. That translates into better financial performance, growth, higher levels of patient engagement, and lower employee turnover. In addition to the legacy of improvement, we also gained confidence. Just as athletes and musicians need confidence to perform, so, too, do people trying to accomplish great things within an organization.

  When I am asked if I believed we would win the Baldrige, I usually just smile. We weren’t exactly “in it to win it” at first—although I would never have said that when we were doing double time working on the applications. But there was a tipping point. We gained traction, and the competitive energy of the organization took on a life of its own. We grew more and more engaged, expert, and confident, which served us well. Because we were in Detroit as the auto industry imploded and the city declared bankruptcy, the fact that we won the Baldrige against all odds instilled within us a sense that we could move forward and do great things despite the seemingly intractable problems that surrounded us.

  The final word on quality and improvement is that the work itself is never complete. The goalpost is forever shifting. At HFHS, we’ve added a new clinical information system and a revenue cycle across the whole system that essentially embeds the quality work into our day-to-day efforts of caregivers and support staff. We also have a new chief quality officer whose mission it is to move us to the next level. As a part of that effort, we plan to improve our metrics dramatically. The airline and nuclear power industries have done just that, but health care has yet to get there. We are working to be out in front. Our new president, Wright L. Lassiter III, will lead us in that effort, much like my predecessor brought us to quality improvement in health care and I took us though the Baldrige journey. Wright, who is my successor, is going to be the leader who will move us to the high level of reliability that we seek to attain.

  Succession is inevitable. Despite the inescapable changes that will come, we need to have foundational principles and values that remain constant even as the people and events around us evolve. We will look at some of those bedrock ideas in the next chapter and explore how they instill a desire to innovate.

  CHAPTER FOUR

  Find the Disrupters in Your Organization—and Listen to Them

  Our invariable reply to “It can’t be done” is “Go do it.”

  —Henry Ford1

  Most people have an image in their mind about what a hospital should look like. It’s the iconic snapshot of a large, sterile institution with white walls and large, paneled elevators that go up into the sky. The gift shop in the lobby sells balloons, flowers, candy, magazines, pajamas, and a few gift items. The adjacent cafeteria serves pizza, burgers, soup, and sandwiches, and there’s a separate coffee shop or newspaper stand with additional drinks and menu items. End of story. People aren’t searching out hospitals for their world-class cuisine or shopping—they come for medical care and they come to get well. Right?

  It’s interesting to see how people react when you disrupt their core beliefs about something, like a hospital, that is seen as a public resource. Some people roll with it, while others are less accepting. Every person has a different tolerance for change, and mine happens to be fairly high, so I have always been a proponent of taking risks on innovation.

  In 2009, we opened the system’s first new hospital since 1915. We had acquired hospitals previously, but this one, in West Bloomfield, Michigan, was the only one we conceived and built from the foundation up. Deciding to build the hospital was a historic moment for us, and I saw it as an opportunity to create the hospital of the future. Still, it was a major undertaking at a time when many organizations were retrenching.

  At that time, Michigan had the highest unemployment rate of any state in the U.S. and the entire nation was reeling from the great recession and the subprime mortgage crisis that preceded it. As for Detroit, all of the economic indicators were negative: home prices were declining and poverty was rising. For me, the situation brought to mind the state of Henry Ford Hospital several years earlier, before we turned the tide. Employee morale had become a problem and the building looked like it was falling down around us. But once we were able to invest in infrastructure and attend to aesthetics and services at the hospital, moods began to improve—and so did our performance. The other thing that lifted us back up was the groundbreaking robotic surgery techniques at the Vattikuti Urology Institute. As mentioned, they altered our DNA: suddenly we were at the cutting edge, with state-of-the-art credibility to uphold.

  Fast-forward a few years to our blueprints for West Bloomfield. Given the market and our own budget constraints, it might have been easier (and some would say wiser) to build a traditional hospital without high-end amenities. Families everywhere were doing more with less, the thinking went, and we should do the same. That was one school of thought—but it didn’t happen that way, thanks in large part to the man I hired to run the new hospital. Instead, we built a “health and wellness center” that was equipped with eateries that offered gourmet cuisine, a beautiful day spa, a greenhouse and indoor farmer’s market, a demonstration kitchen, and a retail atrium filled with live plants and curved paths edged in cobblestone.

  It was a hospital that had the look and feel of a luxury hotel, right down to the trendy retailers, tea sommelier, and concierge. Young couples have had their wedding receptions at this hospital, that’s how beautiful it is.

  The visionary disruptor who was my partner in creating the $360 million facility was Gerard van Grinsven, a longtime Ritz-Carlton executive who had opened twenty properties around the world, served as VP of food and beverage, and led a turnaround of the Ritz-Carlton in Dearborn, Michigan. Gerard knew his way around a five-star hotel, but he had no hospital experience whatsoever. Still, when he met with me for coffee at my home and asked for career advice, I recognized an opportunity. He had a strong vision that coincided with my own and a reputation as an excellent leader. I hired him on the spot and decided that he could fill the high-stakes position as CEO of our new hospital. It was an unorthodox choice and there was some apprehension internally at HFHS. The wider industry, as well, was alight with disdain. Yet, based on Gerard’s unique experience, I believed that Henry Ford would approve of my choice of leaders. Ford’s attitude was this: “It is not easy to get away from tradition. That is why all our new operations are always directed by men who have had no previous knowledge of the subject and therefore have not had a chance to get on really familiar terms with the impossible.”2 Thanks to Gerard’s distinctive background, he was able to help us escape from tradition. Together, with other leaders at the organization, we changed minds and forged ahead.

  Although complicated to execute and initially somewhat unpopular externally, the maneuver was extremely innovative—and in the end the project managed to succeed beyond anyone’s expectations. It turns out that people quite like coming to a place that doesn’t remind them of a hospital, and will even change their doctor to be able to do so!3

  This type of breakthrough thinking, from Gerard and many others, is the reason I got into health care initially. My memories of hospitals growing up were grim, and I knew we could make the experience far better and perhaps set a new standar
d for the industry—not only in terms of aesthetics but also standard of care. Gerard would argue, and I concur, that West Bloomfield represents a way of rethinking the role of a hospital. In positioning ourselves as a community center for well-being, we created a destination that helps people lead healthier lives.

  West Bloomfield was a game changer for us, and it was one of the things that opened the floodgates. A century or more after Henry Ford revolutionized auto manufacturing, we at HFHS have leveraged his legacy to introduce new ideas and concepts designed to shake up both our own thinking and the world of health care. Innovation has always been one of our greatest strengths, dating back to our founder, and we started to wield it more effectively than ever before. When we went through the Baldrige application process we identified what we thought were our core competencies: care coordination, collaboration, and innovation. Innovation has been in our makeup from the beginning, but we needed to nurture it.

  Innovation in Health Care

  West Bloomfield created a stir, in part because health care is behind the curve when it comes to innovation. While the medical field has made immense strides—with treatments, drug therapies, and medical devices—health care is stuck in the dark ages in terms of financing and delivery. Similarly, while there is much to say about advances in brain research and gene sequencing, little or nothing radical comes to mind when we look at business models. The Affordable Care Act and its antecedents may eventually change the game, but for the moment we are stuck in a holding pattern, with expensive treatments and a fragmented and largely inefficient industry.

  There are a number of reasons for this. First, if you look at how most health-care organizations are structured you’ll seldom see a truly robust R&D department, whereas the pharmaceutical and biotechnology industries have R&D carved right into their business models. Next, although parts of health care are well funded, the industry is complex and its largest interest groups remain at odds with one another. They seldom work together in the direction of progress. Finally, government regulation and legislation, although necessary, slow innovation and distract the industry from becoming more effective and responsive to consumer needs.

  These are all major forces, and I can’t say that HFHS has the silver-bullet solution. However, what I can say is that HFHS is a case study in making innovation a priority. It is a noted part of our culture, first, because our legacy dates back to an innovator, Henry Ford himself, and second, because we’ve needed to be creative in order to survive in Detroit. In fact, creativity and our commitment to the surrounding community are the two reasons we are still here. The leaders who preceded me—Dr. Robin Buerki, beginning in the 1950s; Stanley Nelson, from 1971 to 1990; and my predecessor Gail Warden—each traveled different but deliberate paths toward innovation. And that’s part of the reason I came to HFHS. Innovation is our secret sauce.

  For me, a passion for progress began early, thanks to my father. Like most teenagers, I had no clue what my parents did for a living. Then, when I was in college, I worked as a summer intern at my dad’s company. I talked with people and immediately saw how much people respected him. I was astounded to learn that he was responsible for two of the most important components the company had invented. All I could say was, “Really?” His patents were related to nuclear parts made for steam generators, so this was high-end stuff. But more than anything else, he considered himself a problem solver. He was a tinkerer who never gave up. I saw that in him every day and I admired it. I also internalized it, and when I settled into my own career I felt an overwhelming desire to make things better.

  At HFHS, during his tenure as CEO, Gail Warden launched a number of important health services research centers that remain central to what we do today—and our focus on basic science and applied research has only accelerated. In fact, we receive about $70 million in annual funding for research from internal and outside sources, putting us in the top 20 percent of all institutions granted funding by the NIH and U.S. Public Health Service, and first in Michigan for NIH-research funding for non-university-based health care systems.

  Part of my contribution to accelerating innovative solutions has been to focus us beyond academia and to better integrate our R&D activities into our daily operations. Most people think “operations” is about managing the status quo but I’ve never looked at it that way. To me, operations occurs at the hospital level, where people are running the business—in the clinics and outpatient centers and even in our retail and insurance operations. My goal has been to enable and encourage innovation and make sure it’s applied and integrated at all levels for the greatest impact.

  For example, General Motors contacted us several years ago about instituting a system of e-prescribing for all HFHS physicians. E-prescriptions, or electronic prescriptions, take the place of paper and fax prescriptions, and increase the use of cost-effective generic medications while decreasing complications from medication incompatibility. Prescribing electronically also represents a more customer-friendly approach to getting medications. Given the obvious benefits, one would think that transition to such a system would be simple—but change management around this and other innovations has been difficult across the industry. When GM first approached us our IT people said, “No, we’re just not equipped to do that.” Part of the problem was the challenge of spreading this new technology not only with our system doctors but also with physicians in other HAP networks. But Fran Parker, the CEO of our health plan at the time, and I pushed. We told GM: “Yes, we absolutely can,” and I asked the medical group and HAP to work together to make it happen. Getting 1,200 doctors in the medical group on board with e-prescribing within one year was the first step and one of the fastest change processes any of us had ever seen.

  In addition to being an innovation enabler, I am a champion of the disrupters within our organization. I seek them out and listen to their ideas and aspirations. And there are a lot of disrupters. Once people see that I identify with innovators and iconoclasts, they come out of hiding with their plans and ideas. When pressure to deliver quality care to a growing population meets tight schedules and finite resources, HFHS employees—from the cafeteria to the operating rooms—find ways to innovate and disrupt old ways of working. They offer smart, quick solutions to everyday problems as well as big, bold new ideas for devices and technologies. I will talk about some of those amazing things first, and then describe how we have been able to listen to the disrupters and make innovation one of our core competencies.

  A Few Cool Things

  If you scan our media coverage over time and look at how we’re drawing in patients, you’ll see that it’s due to innovation. The approach we used in designing West Bloomfield Hospital is one innovation, but there are many more—everything from pioneering clinical services to breakthrough ideas that have captured wide attention. As I mentioned, innovation is what has driven our growth and financial success, and it gave us back our momentum at a critical time. It has put us on the map in ways too numerous to mention, but I will hit on some of my favorite advancements, to show some of the things we have accomplished in the past fifteen years.

  Minimally invasive surgery. It always seems to come back to this one for me. Dr. Mani Menon’s work did more than make Henry Ford Hospital feel special again; it also created a new foundation for clinical excellence. As part of Dr. Menon’s work, Henry Ford Medical Group physicians performed the first robotic removal of a cancerous prostate gland in the U.S. using a special nerve-sparing technique—an innovation that revolutionized prostate cancer treatment globally. Today, five surgical specialties have expanded into the robotics field, and the Medical Group is recognized for its widespread expertise in minimally invasive surgery.

  3-D printing treatments. Each person’s heart and heart valves are unique; therefore, prosthetic valves may fit imperfectly, leak, or interfere with other heart structures. Our Structural Heart Team4 at Henry Ford Hospital, under the leadership of Dr. Bill O’Neill, uses 3-D printing to create exact replicas of indiv
idual human hearts in order to precisely size and plan valve replacements. The team can look at what they had planned for that procedure and modify it in near real time. Never before could a physician examine an exact replica of a patient’s body part, with her hands outside a patient’s body and without ever making an incision. This innovation brings personalized medicine to the forefront of patient-centered care.

  Tools and devices. One frontline nurse recently worked with our Innovation Institute to develop a handy tool for opening the heavy metal containers, called Genesis containers, that hold sterilized surgical instruments. These Genesis containers must be pried apart after flipping open tight, spring-based metal tabs. Nurses in the operating room need to open dozens of these metal boxes every day, causing carpal tunnel syndrome and other serious injuries. The innovative pop-top “can opener” the team created to unseal containers is so incredibly useful that we sent one to every operating room nurse across our system on Nurse’s Day in 2015.

  Process improvement. Our chair of pathology, Dr. Richard Zarbo, came to me and the system’s medical leaders with a plan to transform our labs using Six Sigma and lean management approaches. His idea was to roll out what he called the Henry Ford Production Model. The improvements have resulted in quality and process updates that include reduced overlap, process automation, and shorter timelines as well as standardized equipment and reduced human error. In short, they have yielded some extraordinary process advances. Today, Dr. Zarbo teaches these techniques in labs across the country, and he trains teams at HFHS and beyond to improve process and drive better outcomes of care. It’s been a great success story.