Wednesday, August 26, 2009

Health Care Leaders: Don't Know Much About Health Care

Our recent post about health care organizations recruiting executives with no experience in or knowledge about giving health care or biomedical science has attracted some attention. Some people suggested that letting some people from the "outside" into health care leadership might lead to fresh thinking and new ideas. My concern was not about that. However, I do believe that to be succesful, the leadership of health care organizations ought to collectively be knowledgeable about health care, and understand its context, culture, science base, and values. My concern was not about a few "fresh thinkers," but that the preponderance of health care leaders today know little about what it's like to actually take care of patients, have little understanding of biomedical science and health care research, and do not understand, much less share the values of clinicians.

To illustrate with some admittedly anecdotal data, I looked up the official biographies of the CEOs of some health care organizations that have recently been mentioned in Health Care Renewal. I selected the most recently mentioned examples of the following types of health care organizations: hospitals and health care systems, managed care organizations/ health care insurers, pharmaceutical companies, device companies, biotechnology companies, and health care information technology companies.

Here are the results.

Hospitals/ Health Care Systems

Example: Sutter Health

CEO: Patrick Fry


Mr. Fry joined the Sutter organization in 1982 as an administrative resident at Sutter General Hospital in Sacramento. Over the ensuing years he held increasingly responsible administrative positions both at the local affiliate level and region level, with responsibilities covering the breadth of Sutter Health's services.

After serving as regional president for Sutter Health’s affiliates in the greater Sacramento region, Mr. Fry became president of the organization’s eastern operations. He later assumed leadership of Sutter Health’s Western Division and in 2000 became Sutter Health’s second-in-command, serving as chief operating officer and executive vice president. In 2005 Mr. Fry became President and CEO.

Mr. Fry earned a bachelor’s degree in public health administration from the University of California, Davis in 1979 and earned a master’s degree in health services administration from George Washington University in Washington, D.C.

Managed Care Organizations/ Health Care Insurers

Example: WellCare

CEO: Heath Schiesser


Heath Schiesser assumed the role of president and chief executive officer in January 2008. He originally joined WellCare in 2002 as senior vice president of Marketing and Sales and focused most of his effort on the growth of the Company’s Medicaid and Medicare businesses. As president of WellCare Prescription Insurance, he led the Company's successful national entry into Medicare prescription drug plans. Between mid-2006 and the assumption of his current position in January, he served in a part-time role as a senior advisor, focusing on WellCare’s rapidly growing Medicare products.

Mr. Schiesser brings extensive experience in improving operations, developing strategies and growing businesses in several sectors. Prior to joining the Company, he worked at the management consulting firm of McKinsey & Company, co-founded an online pharmacy for pharmacy benefit manager Express Scripts and worked in the development of new ventures.

A cum laude graduate of Trinity University, Mr. Schiesser received his Master of Business Administration from Harvard University.

Pharmaceutical Companies

Example: Johnson and Johnson

CEO: William C. Weldon


William C. Weldon is Chairman of the Board and Chief Executive Officer of Johnson & Johnson, the world's most comprehensive and broadly based health care products company.

Mr. Weldon assumed his current responsibilities in April, 2002. Previously Mr. Weldon served as Worldwide Chairman, Pharmaceuticals Group, and a Vice Chairman of the Board of Directors. He was elected to the Board in February, 2001.

Mr. Weldon joined Johnson & Johnson in 1971 in the sales and marketing department of its McNeil Pharmaceutical subsidiary. In 1982 he was named manager, ICOM Regional Development Center in Southeast Asia. Mr. Weldon was appointed executive vice president and managing director of Korea McNeil, Ltd., in 1984 and managing director of Ortho-Cilag Pharmaceutical, Ltd., in the U.K. in 1986. In 1989, he was named vice president of sales and marketing at Janssen Pharmaceutica in the U.S., and in 1992 he was appointed president of Ethicon Endo-Surgery.

In 1995 Mr. Weldon was named a company group chairman of Johnson & Johnson and Worldwide Franchise Chairman of Ethicon Endo-Surgery, the Johnson & Johnson affiliate that develops new procedures for minimally-invasive surgery and designs related products. In 1998 Mr. Weldon was promoted to the Executive Committee and named Worldwide Chairman, Pharmaceuticals Group.

Among his outside activities, Mr. Weldon is a member of the Board of Directors of JPMorgan Chase & Co. He is also Chairman of the CEO Roundtable on Cancer, Vice Chair of The Business Council and a member of The Sullivan Commission on Diversity in the Health Professions Workforce. Mr. Weldon also serves on the Liberty Science Center Chairman's Advisory Council and as a member of the Board of Trustees for Quinnipiac University. He previously served as Chairman of the Pharmaceutical Research and Manufacturers of America (PhRMA).

Mr. Weldon was born in Brooklyn, NY, and is a graduate of Quinnipiac University in Hamden, Connecticut. He and his wife have two children and one grandson.

Device Companies

Example: Medtronic

CEO: William A. Hawkins


Bill Hawkins assumed the role of Chief Executive Officer of Medtronic, Inc. in August 2007 and became Chairman of the Board in August 2008. He was named President and Chief Operating Officer in May 2004 after joining Medtronic as Senior Vice President and President of Medtronic's Vascular business in January 2002.

Bill joined Medtronic from Novoste Corp., where he had been President and Chief Executive Officer since 1998. Previous positions included Corporate Vice President and President of the Sherwood Davis and Geck organization of American Home Products; President of the Ethicon Endo-Surgery organization of Johnson & Johnson; President, Devices for Vascular Intervention and U.S. Operations, for Guidant Corp.; and several increasingly responsible executive positions culminating in the presidency of the Ivac organization for Eli Lilly & Co. He began his medical technology career with Carolina Medical Electronics in 1977.

He received his bachelor’s of science degree in electrical and biomedical engineering from Duke University in 1976 where he also conducted medical research in pathology. Bill also earned a master’s degree in business administration from the Darden School of Business, University of Virginia, in 1982.

Bill is a member of the Board of Visitors of the Engineering School of Duke University and the Guthrie Theatre Board.

Biotechnology Companies

Example: Dendreon

CEO: Mitchell H Gold, MD


Dr. Gold joined Dendreon in 2001 as the vice president of business development. He subsequently was appointed a director in 2002 and was named the chief executive officer of the Company in 2003. Dr. Gold has led the Company’s corporate development, acquisition and financing efforts in recent years, completing transactions valued at approximately $225 million, including the acquisition of Corvas International, and raising approximately $350 million in capital. Prior to joining Dendreon, he served as the vice president of business development for Data Critical Corporation, a company engaged in wireless transmission of critical healthcare data, now a division of GE Medical. He also served as the co-founder, president and chief executive officer of Elixis Corporation, a medical information systems company. Dr. Gold is a former urologist at the University of Washington and currently serves on the boards of the University of Washington/Fred Hutchinson Cancer Research Center Prostate Cancer Institute and the Washington Biotechnology and Biomedical Association. Dr. Gold received his B.S. from the University of Wisconsin-Madison and his M.D. from Rush Medical College in Chicago.

Health Care Information Technology Companies

Example: Allscripts

CEO: Glen Tullman


Glen E. Tullman joined Allscripts as Chief Executive Officer in August 1997 to lead the Company's transition into the Healthcare Information Sector. He led the Company's Initial Public Offering and Secondary Offerings of the Company, which is now traded on NASDAQ (MDRX) and has driven the Company to becoming the leading provider of clinical software, connectivity and information services to physicians.

Prior to joining Allscripts, Mr. Tullman was Chief Executive Officer of Enterprise Systems, Inc., a leading healthcare information services company providing resource management solutions to large integrated healthcare networks, from October 1994 to July 1997. Mr. Tullman led the company's Initial Public Offering and secondary offerings. HBO and Company of Atlanta acquired Enterprise in 1997 in a stock transaction valued in excess of $250 million. From 1983 to 1994, Mr. Tullman served in a number of management roles including President and Chief Operating Officer of CCC Information Services, Inc., a provider of information systems to the country's largest property and casualty insurers. Under his leadership, the company grew from $17 million to more than $100 million and is publicly traded.

Mr. Tullman graduated from Bucknell University Magna Cum Laude, with a double major in Economics and Psychology. Upon graduation, he joined the Executive Office of the President of the United States in Washington, D.C. and later accepted a fellowship to study social anthropology at St. Antony's College, Oxford University, England. Mr. Tullman serves on the International Board of the Juvenile Diabetes Research Foundation and on the Board of Trustees of the Certification Commission for Healthcare Information Technology (CCHIT). He also is Co-Chair of the National ePrescribing Patient Safety Initiative (NEPSI), a $100 million campaign, led by Allscripts and Dell Computers, to deliver free electronic prescribing to every physician in America. In 2006, he was named CEO of the Year by the Illinois Information Technology Association.

So there we have the leaders of seven important health care oganizations. Only one is health care professional (although he is described as a "former urologist.") Only one of them claims any biomedical science experience, and that was in college. One has bachelors and masters level degrees in health administration, and another has a bachelors degree in electrical and biomedical engineering. That seems to be the sum total of the group's experience, expertise, and formal training in health care and biomedical science. Only one claims any experience directly taking care of patients. Only one has training in any health care profession. Only one is a (?"former"?)doctor, nurse, therapist, or biomedical scientist.

Of course, there are at least thousands of health care organizations in the US alone, each with its own often large (and some might say top-heavy) management teams. But I would wager that if there was a systematic survey of these leaders, the majority would turn out not to be health care professionals, not to be biomedical scientists, and not to have much direct health care experience. I would further wager the larger the organization, the less health care experience, knowledge and training would be found among the leadership.

I repeat, to really reform health care, we need health care leaders who actually understand health care, and support its values. But the bubble may have to burst before many people learn that lesson. For now, there is too much money to be made.


InformaticsMD said...

"Fresh ideas and new thinking" are good in concept, but can also be harmful if coming from ill informed and overly empowered domain amateurs. Such people often cannot judge the consequences of those ideas.

Perhaps it's best the "new ideas" come from people who are *not* in a position to dictate those changes over the concerns of knowledgeable experts.

Further, either we believe in the value of rigorous domain education and expertise, as hundreds of years of Western culture teach us, or we don't.

If the latter is true, that biomedical leaders do not need biomedical expertise, perhaps we should return to pre-Flexner medical education and practice, and abolish medical board certification.

After all, with the appropriate process manual, anyone can be a doctor or medical educator.

As proof, in an episode of "F Troop", Sgt. O'Rourke and Cpl. Agarn took out the Hekawi Chief's appendix via instructions in a field manual on emergency surgery.

What more proof do we need of the lack of need for expertise in biomedical leadership?

(The above, of course, contains some sarcasm).

-- SS

Anonymous said...

Dear Dr. Poses:

Frankly, I find your definition of a "health care professional" to be exceedingly narrow and your assessment of these individual's backgrounds to be incredibly biased. Biomedical expertise absent business skills is as dangerous a combination as business expertise without an understanding of medicine and biology.

The idea that ONLY those with clinical experience can manage health care organizations is ludicrous.

Gregg Masters said...

'F-Troop' wisdom to contextualize oppositional thinking to the blog author's primary thesis...this must parallel universe of some sort!

Actually, I buy the 'top heavy' claim given the overly hierarchical nature of the failed health care delivery & finance paradigms; driven in large part by organized medicine's pre-occupation with credentialed specialization, and all the downstream allied or ancillary health spin offs they've spawned.

The lack of vision and wisdom domiciled in health care oganizations' C-suites today has less to do with whether clinicians are 'driving the bus' per se, and more with failed (and tired) models of governance.

You just can't manage let alone transform a complex medical center or hospital system via the '3 legged wobbly stool' of a volunteer board, lay general management, and medical staff club (aka the medical staff organization), in constant battle with a para-military nursing organization over control and turf issues.

It's time to rethink this failed template of community hospital or general medical center governance.

Roy M. Poses MD said...

Anonymous, you might want to read my post more carefully, and also read the previous post to which it was linked (although perhaps you have, because perhaps you are the same "anonymous" who commented on that previous post.)

First, I do suspect most people would agree with me in that an informal definition of health care professional is someone with a professional degree and license in a health care field (e.g., MD, BS in Nursing, etc) and who has pledged to uphold the values of that field. Such professionals have training, direct experience in health care (required for the license), and a public commitment to certain values, including putting the care of individual patient ahead of all other concerns.

Do you seriously suggest that a business person who works in health care is somehow equivalent? One can become even the CEO of a health care corporation without any education or direct experience in health care, and certainly without a public commitment to put the care of the individual patient ahead of other considerations, like corporate profits or personal enrichment.

I also never advocated that health care organizations be only lead by people with basic biomedical science expertise as their only qualification.

I did suggest that the leadership of health care organizations should have knowledge of health care, have direct experience in health care, and be committed to certain core values. That does not necessarily require that every or even most health care leaders be licensed health care professionals, although I believe it would help if some were.

People with purely business backgrounds can acquire knowledge about health care (e.g., through course work), experience in health care (e.g., through an internship involving direct patient care, not just sitting in the management suite), and can publicly commit to patient welfare ahead of corporate profits and personal enrichment.

It's just that not many have done so.

And I suspect some would be quite threatened even by this idea.

InformaticsMD said...

Anonymous wrote:

Frankly, I find your definition of a "health care professional" to be exceedingly narrow

In my field of Biomedical Informatics, a significant area of research and applied practice is eliminating definitional ambiguity in development of controlled terminologies, in order to enhance clarity. We also study the effects of definitional ambiguity.

That said, I take the opposite view. I think the use of the vague term "health care professional" is massively overused, blurring distinctions between experts and dilettantes.

A clearer distinction would be enabled by this terminology:

- healthcare enabler: those with clinical expertise who make the provision of healthcare possible.

- healthcare facilitator: those with non medical skills who make the provision of healthcare by its enablers run more smoothly.

Note that enablers hold primary accountability for outcomes, and can more easily learn the skills of the facilitators than the reverse; there is not a symmetry between the two groups.

I am not merely spouting theory; through empirical observation I've watched overempowered facilitators (in IT, for example, overempowered in large part due to the semantic blur regarding the terms 'healthcare professional' and 'information professional') impair pharma R&D , as one example (link).

Gregg Masters wrote:

'F-Troop' wisdom to contextualize oppositional thinking to the blog author's primary thesis...this must parallel universe of some sort!

Here's the Wikipedia link to satire.

InformaticsMD said...

Gregg Masters wrote:

It's time to rethink this failed template of community hospital or general medical center governance.

What do you suggest to replace it?

-- SS

Keith said...

Gregg Masters hits the nail on the head.

The problem is not with non medical personnel heading health care organizations, but the motivation of these individuals. If they, as buisiness people equate success only as profitability, and ignor their mission to serve their community, then this is where the probelm evolves. Too often, hospitals are packed with buisiness leaders with deep pockets (further strengthening the idea the only measure of success is the size of your wallet)that all adhere to the hospital CEOs mindset. Medical personnel are increasingly pushed to the sidelines and the medical "leaders" tend to be those that bring in the most revenue to the hospital. In other words, it is not about health care, but more about profits. Until medical personnel start exerting their influence on the system, we will continue to see the same attitudes in the leadership positions. As more and more of the medical profession is forced into an employment role, rather than independent contractor, any push back by health professionals will become non existent for fear of losing your job.

Gregg Masters said...

That's an easy one! It's all about medical culture and group medical culture to be specific.

Layering complex financing or delivery system infrastrucure on medical culture adverse to the integration (both financial and clinical) only guarantees more of the same.

The 'trophy properties' to study and model for best practices are currently in the news and include: Mayo, Geisinger, GroupHealth Co-op, Kaiser/Permanente, InterMountain Health, and many others now gaining visibility in the health reform pseudo debate.

Virtually all of the 'me too' like HMO expansion (driven by proprietary HMO roll-ups circa 1980-2000) were built on a house of cards (i.e., IPAs and too often their fee-for-service yet 'production driven' network mutations), rather than cohesive interdisciplinary medical group culture. The externally imposed, yet ubiquitously applied, roll-up model was flawed in that it failed to recognize medical culture as the driver in the viability of the 'managed care' business model.

Absent success, risk was pushed back to healthplans, who in turn upped the premium ante for their group health (primarily ASO) customers, who in turn hired MBA benefit consultants that creatively cost shifted the burden from the plan sponsor (employer, trust, etc), to the employee/member and voila, we have so called 'consumer directed (aka high deductible) health plans' vs. comprehensive (wellness targeted) plans that can be found in the likes of the above 'trophy players' benefit offerings.

Just sayin'.......

Anonymous said...

MDInformatician. Trust me as I have seen multiple installations of EHRs. Too frequently for cost saving goals, RNs with limited IT experience are asked to build and support the work of doctors to the detriment of the EHR installation. On the other side, I Have seen doctors who don't understand the full functionally of the technology make bad installation decisions too. The truth is you need doctors trained in informatics. And again you can not train an IT person who doesn't know how to take care of patients in biomedical informatics.