Discussion:
Interview with Ronald G. Spaeth, FACHE, president, Evanston Northwestern Healthcare Foundation, Northbrook, Illinois
Ronald G. Spaeth, FACHE, is the recipient of the American College of Healthcare Executives's 2005 Gold Medal Award, an honor conferred on outstanding healthcare leaders for their contributions to the field. Mr. Spaeth joined Evanston Northwestern Healthcare in January 2000, when Highland Park Hospital (Highland Park, Illinois) merged with Evanston Northwestern Healthcare (Evanston, Illinois). Before this merger, he served as president and chief executive officer of Highland Park Hospital from 1983 through 2002. From 1972 through 1983, he served Evanston Hospital in various roles: as vice president of administrative services, vice president of corporate services, assistant secretary, of the board of directors, senior executive vice president, and chief administrative officer. In addition, he has served on numerous boards, including the Board of Trustees of the Illinois Hospital Association, Board of Directors of the American Hospital Association, and Board of Governors of the American College of Healthcare Executives. He is currently on the Board of Commissioners of the Joint Commission oil Accreditation of Healthcare Organizations. Mr. Spaeth is a Fellow of the American College of Healthcare Executives. He earned his bachelor of arts degree from Western Reserve University in Ohio and his master's in business administration degree from the University of Chicago in Illinois.
Dr. Grazier: You have experience as a faculty, member, president, and chief executive of different types of institutions and systems. How has each role contributed to the success of your career?
Mr. Spaeth: The benefit of the career path I have taken has been the opportunity it has afforded me to view different types of institutions and different forms of physician-hospital-community relationships. I have worked in an academic medical center, the Ohio State University Medical Center in Columbus; in a non-university-owned academic medical program, Evanston Hospital Corporation, which is now Evanston Northwestern Healthcare; and in a community hospital, Highland Park Hospital. Seeing the relationships between the communities and those institutions and particularly their ties with the physicians, has given me a broad understanding of the healthcare business.
Over the years, I have also been a faculty member at several university programs in healthcare management, including at the Ohio State University in the 1970s and at the University of Chicago in the 1980s. Bringing to the students real-world experience and teaching them how to apply what they learned in these programs were fulfilling; the experience gave me a chance to see the links between education and practice. My involvement in a major merger in 2000, in which Highland Park Hospital and Evanston Northwestern Healthcare became one system, was momentous as well. These experiences have helped me to grow and have shaped my overall career.
Dr. Grazier: Aren't physician-hospital-community relationships important in all of these institutions and somewhat generic in their nature?
Mr. Spaeth: I have seen that a little differently. In a community hospital, which the majority of the hospitals in this country are, you observe the very close knit relationship between the physicians, the community, and the institution. This is particularly true in smaller towns, where the institutions are an integral part of the fabric of the community. Such a close relationship can have both positive and negative implications. Community members get deeply involved in the hospital's activities and become knowledgeable about physicians' expertise and skill sets, but they also are vocal about any perceived blemishes in the system. In a major academic medical center; the relationship between the community, institution, and physicians is less tight, but the organizational structures are more formal. In my opinion, this arrangement leads to better control of best practices.
Dr. Grazier: Can you identify leadership skills that have endured throughout your career and those that you have developed in response to these novel situations that you have faced?
Mr. Spaeth: My leadership style is to find the best and brightest professionals, work with them on the strategic plans and goals of the organization, ensure that they are able to achieve their goals, and then stay out of their way. I don't know whether this style is reflective of my mentors', or if it is my own creation after years of management. I have never micromanaged, as micromanagement is a real deterrent for people who have developed significant skill sets. In my view, people from all walks of life and with different experiences make up a good management team. I have been a proponent of recruiting professionals from other industries to fill certain senior management positions in healthcare. I am very comfortable, for example, in hiring a chief financial officer from the banking industry, a human resources executive from a Fortune 500 company, or a chief information officer from a technology firm.
Dr. Grazier: What does that say about our health management programs? Mr. Spaeth: Nothing negative. Healthcare management has moved more toward practices in other industries than management in other industries has toward our practices. Many of us in healthcare recognize that our institutions must be run as a business, and this perspective encourages us to find people who bring various skill sets to the system. People who have worked through the challenges in the business sector are perhaps better prepared to face the business-related challenges in healthcare.
Dr. Grazier: Are leaders born, or are they bred? Can we train existing managers to be leaders?
Mr. Spaeth: I can identify those individuals who were probably born to be leaders.
Their personality allows them to relate well to others and to rally their followers to get things done effectively. Leadership is part of their core, and people can see that. Those not born with a leadership ability, however, can certainly learn it. Over the years I have made great use of the lessons learned from educational courses and seminars I have attended, and these have strengthened my leadership skills. The point is that regardless of whether a leader is born or bred, or has already established a management style, he or she can still improve.
My concern is that senior leaders are not spending enough time mentoring younger professionals. I was fortunate that early in my career I was associated with an individual who had a strong personal commitment to teaching others. Mentoring was an important part of his career, giving others a true opportunity to grow, to learn, and to try various positions within the organization. We operate in a different world today, and I attribute this change to the fact that running a healthcare organization has become so professionally consuming that it leaves a leader little time to mentor.
Dr. Grazier: What can be done about that?
Mr. Spaeth: We must start to measure our use of time. For example, some companies outside of healthcare make it a major priority to assign experienced staff to mentor a junior staff member each year. It is a formal program in which the mentor and mentee are expected to meet every couple of months, and the mentee identifies areas where he or she questions Iris or her own expertise or the company's direction. This is a model that hospital leaders should consider for middle and senior management and should make part of the core of the company.
Dr. Grazier: Who should be making the first move: the mentor or the mentee? Should we be recommending to new graduates or those changing jobs to seek out a mentor, or should the senior leaders be seeking out those who need mentoring?
Mr. Spaeth: A combination of the two is best. A graduate just entering the workforce or an experienced professional moving into a new role needs to pursue that mentor as much as the mentor needs to be open to this relationship. A formal program that allows this mentorship can be a great help.
Dr. Grazier: Are there other philosophies or strategies that you have found to be key to your success as a leader and manager?
Mr. Spaeth: For a healthcare leader, having respect and admiration for the work physicians do is as important as an effective management style. No hospital administrator can achieve much without the help and support of his or her physician providers. If there is anything that has stood me in good stead, it is my recognition of physicians as the most important cog in the wheel of healthcare delivery.
Dr. Grazier: How do you express this gratitude and reverence?
Mr. Spaeth: I spend a lot of time with physicians, applaud their efforts, commiserate with them, and assist them as needed in their activities to make them more efficient. They have to be included on boards and oil advisory councils, and their opinions and comments are extremely important.
Dr. Grazier: What are the toughest challenges ahead for healthcare and its managers?
Mr. Spaeth: Aside from the economic crisis that the industry continuously seems to be going through, the biggest problem ahead is the restructuring of the healthcare system. Alternatives to traditional hospitals, such as single-specialty hospitals, are cropping up that at the end of the day may be more efficient and may generate more dollars for the investors. With such alternatives increasing, the difficult question becomes, who takes care of the remaining services that is needed and who pays for it? How will we provide emergency care and other acute care services that are not lucrative? Another problem is the declining workforce. Recruiting nurses and technicians is challenging enough, but among the available trained and educated workers are those who do not want to work weekends or nights in a 7-days-a-week, 24-hours-a-day environment of a traditional hospital setting. We have to find a way to operate with this profile of worker.
Dr. Grazier: Are there any particular shills that you feel a graduate student should be looking to acquire, develop, or perfect to deal with these really tough issues of the workforce, finance, and restructuring?
Mr. Spaeth: Those entering the field now should possess sufficient financial acumen so that they do not have to learn finance on the job. Knowing how to deal with people and to get things done through people is more important, however. Healthcare is still a people business, and it requires its workforce to have people skills to be successful.
Dr. Grazier: Is healthcare management a field you would still recommend?
Mr. Spaeth: Absolutely. To this day when I get up in the morning, I still have no idea what my day will be like. You hear people in other professions say that they are bored in their jobs--that has never occurred to me in this profession.