Q: What’s your favorite season?
A: Summer, especially this summer because we’ve been fortunate to have San Diego style weather! I despise the cold, so winter is my least favorite season.
Q: Favorite destination?
A: Grand Cayman is my favorite destination. It’s a great place to recharge, it’s easy to manage, it has predictably warm weather, it’s got beautiful beaches, and it’s a quick flight. We’ve been going for Grand Cayman for 12 years.
Q: How do you spend most of your time?
A: Working, reading, watching the news or listening to music. Occasionally I’ll binge watch something like Breaking Bad, Homeland, or House of Cards. Bosch on Amazon is great.
A: Golf is an occasional hobby, though I would love to dedicate more time and truly learn the sport. I am also trying to allocate more time to writing.
Q: Is this where you thought you would end up?
A: Not even remotely. When I graduated college, being a hospital administrator was not even on my radar. Instead, I entered a PhD program at Brown University and was going to pursue an academic career in political science. After receiving a Masters Degree, I decided instead that I wanted to advance my public policy interests by working in government. I volunteered for a couple of local political races and landed a position working for the Supervisor of a town on Long Island. There, I was promoted to Director of Operations, which was the top appointed administrative post in the town. I developed an expertise in municipal and financial management as well as leading turnaround efforts.
On the basis of my work with the town, I was recruited to serve as Deputy County Executive for Budget and Finance for a county on Long Island, where we developed and executed a successful fiscal turnaround plan. Because of the success of this plan, I was asked to run the public hospital with which the county was affiliated. It was a steep challenge. I did not have any healthcare experience. Still, I considered this – running a large, complicated, and essential health care provider – to be the professional challenge of a lifetime. So I accepted this offer, and I believe in my 8 year tenure at the helm of this hospital we did some remarkable things. We stabilized the finances of the hospital, improved its quality, developed a clinical integration program with a major health system, secured major legislation to provide important anti-trust protections, made hundreds of millions of dollars of physical plant upgrades, and created one of the few successful “public-entity” federally qualified health centers in the country.
I committed to becoming an expert in hospital management, so I earned my MPH from the Mailman School of Public Health at Columbia University (in addition to an MBA which I had previously earned). Today, I teach hospital operations at Columbia University as well as for the Icahn School of Medicine at Mount Sinai. And I’ve had the great good fortune to serve on a number of boards, including the boards of America’s Essential Hospitals, the American Hospital Association, the Greater New York Hospital Association, Healthfirst, Health Leads, HealthIx, and of course the Hospital Leaders of New York.
Healthcare administration turned out to be at the intersection of everything about which I feel passionate: management, finance, strategy, politics, public policy and helping the most vulnerable people in our country. There’s really no better career I could have imagined pursuing.
Q: What was your biggest weaknesses and how did you overcome it?
A: I’m not naturally an extrovert. Large gatherings are challenging for me. As a hospital executive, I have to engage people through a variety of platforms: 1 on 1, in crowds, as a speaker and leader. I overcame my aversion to large crowds through self-awareness, honing my leadership skills, and by simple hard work.
I can sometimes become too invested in the people I hire, even after I know they are not going to be able to get their work done at the level of performance I had expected. Most of the time the people I hire are great, but sometimes they don’t work out. It takes me longer than maybe it should to identify mistaken personnel choices because I always believe that people can and want to succeed. Today, I involve my team in the selection of key personnel to help inform and balance my recruitment decisions.
Q: Who has influenced you the most?
A: My parents – My father was a Professor of Philosophy at St. John’s University. He just retired after teaching for 47 years. His interests are varied, but he always had a passion for government and politics. My mother was a nurse, who dedicated her career to delivering healthcare and helping others. My career track is a basically just a combination of my parents’ passions and interests.
A priest at St. John’s University ran the service learning program and was the faculty moderator of C.A.U.S.E., a student-run service organization. He attempted to recruit me to run C.A.U.S.E. when I was a sophomore in college, encouraging me by saying things like ‘You should be running something! You should be leading.’ I finally gave in to his entreaties as a senior, and this was my first exposure to managing an organization.
A Brown University professor for whom I was a Teaching Assistant was a terrific educator and captivating lecturer. I learned a lot from how he taught his class – his style, his depth of knowledge, the ways he connected with the students in his class. He was able to present complex issues in a way that was humorous, understandable, and inspiring all at the same time.
My first boss was an older woman in her 70s. Prior to serving as town Supervisor, she was politically active in the 60s. She knew Eleanor Roosevelt and Martin Luther King, Jr. As a State Assemblywoman, she introduced transformative legislation to protect women’s rights and the environment, long before such causes were popular. She taught me the importance of bringing passion to work, to sticking by your beliefs, and – interestingly – of crafting thoughtful, even poetic speeches at crucial moments to motivate the people whom you lead.
My first board chairman was an older, accomplished gentleman. He had earned his fortune and gave back by serving as a director of a number of not-for-profit boards. He showed me how to be calm under pressure. He taught me a lot about deliberately thinking things through, having a strategic outlook, how to appropriately apply pressure, when to back off and when to push forward.
Q: What are you most proud of?
A: I’m proud of the work that I’m currently doing. If I’m not, I shouldn’t be doing it. So I am most certainly proud of the transformation we are leading at Mount Sinai St. Luke’s. Neglected really for almost a generation, Mount Sinai St. Luke’s is in the midst of a renaissance. We’re investing over $100 million in upgrading the equipment and physical plant of the hospital and building a state-of-the-art ambulatory center. We’ve recruited one of the leading cardiac surgeons in the world as well as a number of other terrific surgeons. We are establishing centers of excellence in cardiology and cardiac surgery; cancer; diabetes, endocrinology and bariatric surgery; and trauma. We are building a network of well-managed, leading edge primary care practices. And we have introduced lean as the way in which we manage our hospital and ambulatory services, improve our processes and engage our employees. This work of transforming Mount Sinai St. Luke’s will take time, but the progress we’ve made to date is nothing short of extraordinary, and I am excited to see what the future holds.
But I think I will always be most proud of the work my team and I did to turn around a public hospital, which was my first experience as a hospital executive. This hospital had significant financial and quality challenges. It was underinvested for decades. And we had to operate the hospital in an immensely difficult political environment. That said, I believe that while we were there, we made a real difference. I discussed our major accomplishments in an answer to a previous question. But three stories stand out. I am genuinely proud, to the point of getting emotional, of having built a dignified space for poor people to receive cancer infusion therapy. Previously, the space in which this care was delivered was truly awful. And, I am quite proud of having secured the first “state action” legislation in the wake of a major Supreme Court decision which appeared to narrow the applicability of this doctrine. This legislation makes it possible for the public hospital I used to run to collaborate with other health systems while being protected from anti-trust challenges. It’s crucial legislation to the future success of this hospital. Finally, I remain proud of a financing vehicle that a colleague from an investment bank and I essentially created: an insured short-term cash flow note, which enabled my previous hospital to access cash at critical times at a very competitive interest rate. For a public hospital with limited resources, such a financing vehicle was – and is – critical to maintaining its operations. None of these successes were widely publicized or are well understood. But they make it possible for a struggling public hospital to endure and for poor people to receive the care they need.
Q: What motivates you?
A: My wife always tells me that if something is not hard and not in need of repair, it’s not for me. I am motivated to fix organizations that are broken and, in so doing, improve the lives of people who need the help the most.
Q: What keeps you up at night?
A: Health policy at the federal level is in a state of such fundamental uncertainty, and the decisions of our policymakers, which are infused with politics, can have devastating effects on the patients we serve, particularly those on the fringes of society. It’s crucial for those of us on the front lines of the delivery of health care to make our voices heard, to push for sanity, reasonableness, stability, and compassion in the development of our health care policy. This work is a marathon, not a sprint. It’s a life’s cause, not a hobby.
Q: How do you successfully stay connected to key influencers who do not work in same office or geographical area?
A: Primarily through social media.
Q: What professional organizations are you associated with and in what ways?
A: Up until this year, I had not actively participated in any professional organizations. Rather, I committed my time to serving on boards of organizations that advocated for the interests of hospitals and for the inclusion of social needs in the delivery of quality health care.
This year, I decided to participate much more actively in the American College of Healthcare Executives. I was elected to serve on the board of the Healthcare Leaders of New York, which is really a terrific organization dedicated to the education of its members and the development of healthcare administration as a distinct, important and essential profession. My goals for this coming year, as a member of the board of HLNY, are: (1) to take the FACHE exam, as I believe that the FACHE demonstrates a personal commitment to excellence in healthcare administration; and (2) to forge a much stronger connection between the ACHE members in the Mount Sinai Health System to HLNY and all of the professional services it has to offer.
Q: Through our careers, we are faced with difficult decisions. As a mentor, are you frequently asked questions about risk? How do you approach risk-taking?
A: This is a really good question! I’ve only ever worked in organizations that required some level of recovery, ranging from modest to extensive. The common denominator in these kinds of organizations is – ironically – to take more risks than perhaps one would normally take. If you approach the management of struggling organizations conservatively, your organization may persist, but it will not flourish. If you are willing to take risks, you might fail, but you also stand a better chance of transforming your organization from one that struggles to get by to one that thrives beyond what you could possibly imagine today.
I don’t believe that there is a risk adverse way to turn around a struggling organization.
I recommend a similar approach to career management. On the one hand, you must do everything you can to get yourself ready to excel in your chosen profession. However, you cannot succeed just on effort alone; an opportunity must present itself. Often, I analogize career management to being a running back in football. Just like a running back, you have to prepare to run through an opening in the line in front of you. Yet, you need the help of members of your team – your network – to create an opening for you to run through . Career success, then, is a combination of the intensive preparation you do and the opportunities, however fleeting, that present themselves. If you have an opportunity to do something in your career that you may never have the chance to do again, my advice is to take the risk and “Do it!”
Q: Why is mentoring important?
A: I am cognizant of the amazing opportunities I’ve had. I have been exceptionally fortunate in my career. To me, mentoring is the best way I can pay forward my good fortune. I have taught graduate students at several colleges, including St. Joseph’s College, Dowling College, and Hofstra University, as well as the Mailman School of Public Health at Columbia University and the Icahn School of Medicine at Mount Sinai. I try to help those who are aspiring to build a career in healthcare administration. It is important to help young people navigate the early stages of their careers in healthcare administration because it’s an extremely complex profession that requires a diverse array of skills and has a limited number of opportunities for career advancement.
Q: What is your personal philosophy on mentoring?
A: I am honored, at this stage in my life and my career, to be in a position to help guide the next generation of leaders in healthcare, to give professional opportunities to young people who might otherwise not have had the chance to demonstrate how special they can be, and to lead always by example, recognizing that as an executive you are always “on the stage”. Mentoring is education distilled to an individual level, where your focus is not just conveying information but lighting the fire of passion for the work on which your mentee is about to embark.
Q: How do you find time to mentor?
A: I consider mentoring an essential part of my job. When you think of it that way, you find the time.
Q: What is the recipe for a successful mentor/mentee relationship?
A: A successful mentor / mentee relationship has five elements: (1) mutual respect; (2) a joint interest in healthcare administration as a profession; (3) passion for improving the lives of vulnerable Americans; (4) a persistent and unyielding faith in the future; and (5) a commitment to serving others.
Q: Can you tell us about Mt. Sinai’s mentor program?
A: There are a number of mentorship opportunities in the Mount Sinai Health System.
I am proud of the fact that the Mount Sinai Health System has launched an Administrative Fellowship program similar to the one I introduced at my previous hospital. It’s a program that provides opportunities for ethnically diverse applicants who have earned Masters degrees in public health, health administration, healthcare leadership, or business administration. The program at my prior hospital was very successful, with many of the fellows embarking on interesting careers in hospitals and community-based clinics. Our inaugural class of fellows at Mount Sinai have been just as extraordinary, and I can’t wait to see how their careers progress in the coming years.
In the beginning of 2018, Mount Sinai St. Luke’s will launch an Administrative Internship program, where we will give applicants interested in pursuing careers in healthcare administration opportunities to volunteer for rotations that last several months and work on specific projects in their fields of interest.
And Mount Sinai Health Partners, the population health arm of the Mount Sinai Health System, has established a mentorship program for many of its aspiring leaders. I participate in this program and have been assigned one of its leaders to mentor.
Q: Are there qualities you look for in the people you mentor?
A: I want to mentor good, decent, honorable people who are committed to excellence in healthcare administration, who have chosen this field as a way of helping the most vulnerable people amongst us, and who can use my guidance and support as they navigate the complex terrain of a career in healthcare administration.
Q: Do you have any book, podcast or blog recommendations?
A: I recommend using Twitter to aggregate sources of information. I am amazed at how many articles I discover on my Twitter feed that I would not otherwise have come across.
The New England Journal Medicine Catalyst
The Healthcare Policy Podcast
- John Toussaint and Roger A. Gerard, On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.
- John Toussaint, Management on the Mend: The Healthcare Executive Guide to System Transformatio
- Ronald Heifetz, Alexander Grashow, and Marty Linsky, The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World.
The books I recommend address two main topics: the application of lean to the operations of hospitals and healthcare systems and the challenge of leading organizations through radically transformative change. In my view, lean is the most effective way to empower everyone in your hospital – from leadership to front line staff – to make improvements to the work they do and, in the process, transform how they deliver care to patients. There’s nothing more powerful in healthcare than hundreds of employees engaged in the work of continuous improvement each and every day.