10 Tips from a Hospital CEO – from the #SHS2012 Conference


Sunday's keynote presenter at the 2012 Society for Health Systems conference was Dr. Stephen Markovich, the CEO of Riverside Methodist Hospital, a 1000+ bed hospital that is the flagship of the Ohio Health System. Dr. Markovich is not only both a doctor and a CEO, but he achieve both of his boyhood goals of being both a doctor and a pilot (he flies in the National Guard). He was told “you can't do both,” but he found a way to do both – very inspiring.

One of the main themes of his talk was some guidance about 10 things that process improvement professionals (lean, six sigma, management engineers, etc.) can do to “create value” for their CEOs.   Ohio Health's approach of “Process Excellence” combines Lean and Six Sigma.

Since there are a lot of young professionals in the SHS crowd, this was probably a helpful perspective that they might not get from their own CEO. It's not all necessary “Lean CEO thinking,” but it's worth sharing here. Here is his Top 10 (see my grainy picture – click for larger view) and my key points and paraphrasing of what he said.

1) The most important thing to the CEO is “transformational leadership” (as opposed to transactional leadership). How do people need to be developed so the organization can go where it needs to be in the future?

Dr. Markovich raised an interesting point that he views performance measures, including safety and quality, as “lagging indicators.” But, at the same time, he showed a very strong command of his hospital's key operational metrics, including E.D. length of stay and others. He suggested that most hospital CEOs really don't know these numbers.

2) P.I. people need to really understand how the hospital operates.

He said “you can't just spend one day in a department and deem yourself an expert.” You need to “understand the hospital's mission first” and know the “origin of existing processes” to be an effective change agent.

3) Learn to change what is important to me (as CEO)

But, Markovch said that staffers need to “help me refocus as the landscape shifts.”

4) Have an understanding and appreciation of the MD perspective about hospitals.

A key point seemed to be that hospitals are dependent on physicians bringing them a good portion of their revenue (via patients they bring or refer). He also emphasized that physicians, throughout their education, really aren't encouraged to work in teams or collaborate.

5) Help me reduce subjectivity and “help turn down the emotionality of conflict” by providing data and facts

6) Identify real measurable opportunities that tie to the scorecard and goals (cost, volume and growth, quality and safety, aligning MDs)

Key points:

  • You can't do every pet project
  • You need projects to support each goal

Dr. Markovich told a story about the hospital realizing, one year, that they were halfway through the year when they realized they had NO efforts underway to support one of their goals.

My commentary is that this scenario perfectly illustrates the need for effective “strategy deployment” as practiced at ThedaCare (see the DVD) and other leading hospitals. Everybody, from top to bottom, needs to understand the goals of the organization and how that related to their work and their own local measures. ThedaCare, for example, selects and aligns projects and initiatives so that they are working toward improving all of their core measures. ThedaCare also is very disciplined about DE-selecting projects so that they aren't trying to do too many things at once.

7) Solutions should solve problems strategically, not just “fighting the fire of the day.”

8) Help create buy-in for your solutions

Some key strategies include “over communicating” and being “overly inclusive.” Markovich reminded the audience that if you need to have somebody participating in a project, you'd better invite that person to the kickoff meeting.

He also added that we should “tolerate dissent but identify and address resistance early.”

He defined dissent as a good thing — “if there's no debate, are we missing something?”

But, once a path has been decided on, you have to look for people who are nodding yes, but then “screwing with the process.” He's right in saying that “challenging ideas doesn't mean you're not on board.” I agree that we need dissent and disagreement, otherwise people are just rolling over and being compliant… and I don't think excellent organizations are full of people who just roll over and go along.

9) Acknowledge and examine mistakes

This is very much a Lean lesson, that we can't “bury problems.” Dr. Markovich said leaders need to “celebrate problems and examine them.”

He had some brilliant advice that senior leaders need to first admit “their own vulnerability to mistakes” and that will enable the staff to take more risks. An organization that won't take risks can't improve.

10) Understand the CEOs limitations

I've found that the best CEOs (and best leaders in general) are very humble people (while being confident). Dr. Markovich said that CEOs have “limited bandwidth” and are always struggling to satisfy multiple constituencies.

As a staffer or a process improvement person, you won't always get a personal reply to an email or a request (there's just not enough time in the day, said Markovich). But, you need to “keep bugging me” if the issue is important.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Mark,

    Thanks for sharing Dr. Markovich’s tips. He obviously has done a great deal of reflection – a true sign of an effective lean leader.

    I just wanted to chime in on tip #4. I totally agree.

    MD’s are not developed for leadership. Their training and focus are typically at the individual contributor/scientist level. Lean and lean leadership does not come naturally for incredibly intelligent, autonomous folks (who may have a bit of ego). So, change management can be especially challenging. That is why, among other things, someone like Dr. Markovich at the CEO level is absolutely essential.

    When the docs do “get it,” it is extremely powerful and gratifying!

  2. Great post.
    For number #4. Besides not being educated in working as a team once we enter the work force we are not incentivized to work in teams. Compensation emphasizes productivity, read that as people seen, and not so much on teamwork or on fixing the system. In many institutions it is still that you eat what you kill.

    • Tom – it’s because of those systemic factors, I’m the last one who paints doctors as the bad guy. It’s too easy for people to blame or dump on the docs with a broad brush, when they are a creation of those environments and incentives.

  3. Thank you Mark! I wonder if these tips would apply to those who find themselves at 1600 Pennsylvania Ave, or 10 Downing. Or perhaps nations no longer have CEO’s, but rather Chief Influencers.

  4. I think Tips 2 (P.I. people need to really understand how the hospital operates), 4 (Have an understanding and appreciation of the MD perspective about hospitals), and 9 (Acknowledge and examine mistakes) are especially important because employees never like people coming in, acting like experts about something they don’t really know or understand, and making changes that may or may not be the course of action taken by someone who does understand the inner-workings of the institution. That’s a surefire way to build resentment, especially if the docs aren’t consulted, and you don’t admit any fault.


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