Hospital and health system CEOs face a number of decisions as they navigate their organizations through evolving industry challenges. At times, this may involve a calculated risk or an uncomfortable situation, but at their core, the decisions are designed to be meaningful and may provide valuable lessons.
Several CEOs recently shared the toughest decision they had to make in the last year.
Editor's note: Responses are lightly edited for length and clarity.
Michael Cureton. CEO Sutter Amador in Jackson, Calif., and Sutter Davis (Calif.) Hospitals: In Amador County, like many rural communities, we face ongoing challenges in recruiting quality physicians for essential services such as emergency medicine and surgical coverage. A few years ago, we launched a rural health residency program that has already demonstrated its value, though it primarily addresses our primary care needs. Last year, a generous donor expressed interest in supporting our organization, contingent on a meaningful use of their gift. After exploring several options, we identified a critical need: housing for residents completing rural tracks, both from our program and others within the system.
With support from our philanthropy team, we invested in a three-bedroom home near the hospital to accommodate these residents. Our goal is to expose physicians to rural healthcare settings and, ultimately, build a sustainable pipeline of clinicians for the future. As a system, we are committed to expanding our GME programs, but with limited patient volume, our hospital alone would not qualify for most residency programs. Hence, we have had to be creative in how we can use our larger facilities in our recruitment efforts. Our first rural surgical rotation begins this November, with plans to expand into other specialties. We also have had considerable interest in medical students coming to the hospital and observing, and this home also has the great potential to increase their numbers.
This initiative is a calculated risk -- requiring significant philanthropic investment and coordination across legal, property management and GME teams. While the funds could have addressed more immediate needs at the hospital, such as medical equipment, we believe this long-term strategy will yield meaningful results in the years ahead.
Paulette Davidson. President and CEO of Monument Health (Rapid City, S.D.): I would say the toughest decision I had to make this past year was finding an effective strategy to manage external risks to the organization. As a $1.2 billion nonprofit health system located in rural Western South Dakota, we are deeply committed to our mission of providing healthcare for portions of a five-state region. Earlier this year it seemed that the number of external threats (those things that we can't control) were mounting. I have worked as a healthcare leader for 35+ years and had not experienced as much pressure and stress of the number of external threats to the organization.
As the CEO, I felt pressure to educate the board of the substantial number of increased threats to the organization and educate them of potential negative impacts. In addition, I felt responsible to lead my executive leadership in a manner that demonstrated confidence and reinforced our ability to perform well and avoid panic and doubt with so many external threats reeling over our heads.
As I thought about how to get a handle my own confidence levels and reduce my personal stress of juggling so many concerns, it reminded me about my experience with our organization's pandemic response. Through inclusivity, open communication, and a structured approach, we were able to navigate through an ambiguous time and make safe and appropriate decisions that improved our clinical outcomes along with our overall culture and financial performance. I took that lesson and brought my senior executives together. In a matter of several weeks, we identified the top external threats facing the organization. We narrowed the list down to 24 specific threats. Then we developed a "threat matrix" to gauge the negative impact of the threat.
The threat matrix helped me to educate the board and key stakeholders of our current external threats, the financial and patient impact and the probability of the impact. Once we determined the high priority threats, we assigned each specific threat to a multidisciplinary team to develop a mitigation plan for that specific threat. Those mitigation plans are working well and have brought teams of dedicated caregivers and physicians together to strengthen our organization.
Often a CEO internalizes the stress related to mounting external threats (those things we cannot control) which can lead to burn-out and ineffectiveness. By bringing in my senior leadership team and creating an inclusive process to identify the threats and determine the potential negative impact to the organization, we were able to identify all the imminent threats and develop mitigation strategies to protect our mission to serve our communities. Ultimately, I think this is a lesson for CEOs to share their concerns and leverage their capable team to address the challenges together.
Jennifer Mendrzycki. President and CEO of TMC Health (Tucson, Ariz.): In my first 16 months as CEO of TMC Health, one of the hardest decisions I made was to keep quiet. As a leader, the instinct is often to jump in with ideas and direction. Instead, I chose to lead by listening. Through town halls, one-on-one conversations, staff and physician surveys, and our "Walk in My Shoes" program, I focused on learning who we are, how we serve, and what our people and physicians need to succeed. I also spent time listening directly to patients and members of the community to better understand their experiences and expectations. Staying quiet was not always easy, but it allowed me to understand the organization as it stood and to build trust across all levels. What we heard helped shape a strategic direction and culture statement that reflects our shared values, honors our legacy and positions us to be innovative, resilient and forward-thinking in the face of the challenges ahead.