Thoughts on leadership, physician culture, and performance of health practices
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Building Leaders in Healthcare with Halee Fischer-Wright, President and CEO at MGMA was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.
Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.
Saul Marquez:
Welcome back to the podcast. Today, I have the privilege of hosting Dr. Halee Fischer – Wright.. She’s the president and CEO of MGMA. She’s a nationally respected health care executive and physician leader whose work focuses on medical management, innovation and creating results and creating cultures of excellence. She began her career as a practicing physician, working for 19 years as a pediatrician and later opening her first successful medical practice in 1997. Moving on to serve in a variety of leadership positions with clinics, hospitals and systems. Later, as a management consultant, Dr. Fischer-Wright. worked with leading Fortune 500 companies from oil and gas to financial services companies to increase efficiency and develop new strategies to grow their market share. She’s long been focused on improving physician culture and performance of health practices and co-authored Tribal Leadership, a New York Times best seller focused on building business cultures of success. She’s going to be focusing on leadership and how that concept of leadership has more and the role of physicians and leadership. And so with that, I’m really excited to open up the microphone to Halee to join us today. So glad you made it.
Halee Fischer – Wright:
Oh, thank you, Saul. I appreciate the invitation.
Saul Marquez:
So, Halee, tell us a little bit more about your journey. Why did you decide to get into health care?
Halee Fischer – Wright:
Well, great question. I think I have both the answer. That is both. Just like everybody else and a little bit different. So what I would say is I am your classic oldest child. And so I think my driver, when I was a kid saying I want to be a doctor was that I wanted to help people. But, you know, when I was a kid, probably the most respected person in my world was the pediatrician. And my pediatrician, Dr. Aimer had been my mom’s pediatrician and was arguably probably one of the most respected doctors in Denver where I grew up. And I think he was just a great role model. He was kind. He was smart. He was caring. He was well respected. And I thought his job was the best job in the world. When I got a when I was in the I think a junior in high school, I got a little bit different view of the health care field. My grandfather suffered what would ultimately be his terminal stroke. And I had a very different experience, which was how he was cared for in the hospital. And I thought that there were things that could have been done better, communication better, better care of him, better decision making, which I realize is arrogant for from a 16 year old. But it’s what I thought at the time. And so I thought at first I was like, I want to be just like my pediatrician. And then when I was a teenager, it was, hey, I think that we can do this better. And then my last kind of I gotta go do this was when my dad was diagnosed with multiple sclerosis. And just seeing what it was like living with someone who was a he was forty four when he was diagnosed. He’s a vital alive person, be diagnosed with a chronic disease. And at that point in time, which was thirty years ago, really having nothing to offer him and how you work in the health care system, navigating chronic disease, that’s something that we’re terribly great at even today. So with those three different kind of prisons on health care, that’s what ultimately convinced me that I needed to pursue a career in health care.
Saul Marquez:
Wow, what a great story. And you do end up getting in those situations where despite your knowledge, despite everything that you can do, you can’t help. And that’s and that’s tough. You know, I appreciate you sharing that with us. You know, it’s not easy to care for for folks. So the concept of leadership is something that I think drives a lot of our listeners. You know, how can I do it better? And you’ve had such a diverse experience. Dr. Fischer – Wright. In both a frontline physician, a management consultant, and now leading the MGMA. What would you say is that topic that needs to be front and center in leaders minds today? And what’s the problem that usually gets in the way?
Halee Fischer – Wright:
So there isn’t just one problem. So if I stand back and I’m I’m objective and I strip out my personal opinion and strip out the mission of the organization that I proudly represent. And I just put on my management consultant hat. What I recognize is we’re focusing on the wrong question. So in the United States, we focus a lot on cost of care. And what I find is particularly getting involved in looking at different systems around the globe and looking at how other health care systems approach the challenges of delivering health care to a large population. What I recognize is this is my opinion, not my organization’s opinion, even a health care finance policy, not really a health care policy. So when we talk about as a nation. The United States, as we talk about health care, we’re talking about money. We’re not talking about healthier populations. We’re not talking about preventive care. We’re not talking. I mean, this is probably the most controversial thing that I’ll say the whole interview. We’re not talking about end of life and the fact that we spend 20 to 30 percent of our health care dollars in the last six weeks of a patient’s life. So we tend the issues as a kind of set at the top of the question are so much bigger and so much richer. And but we’re focusing on the wrong thing. So in a certain way, I think a way for us to approach it and what I’m pushing MGMA to do is to say leave behind everything you know and approach this as if you have a whiteboard knowing that you can’t eat the elephant all at once. Where can we take a bike that will actually create impact? And from an MTMA standpoint, I think as the United States, we tend to look at things on the top line. So what policy initiatives, what large health system, what large health insurer? I’m utterly convinced that if we start doing this small things that start where care is delivered in the medical practice, that we can change our health care delivery system. And so that’s what we’re focusing on.
Saul Marquez:
I love it. It’s a great call out. And look, I mean, you know, you really have to be candid with yourself and with the colleagues that you work with. If you’re going to actually make change. And so I’m glad, Halee, that you came and gave it to us as it is. And so I’d love to hear from you maybe an example of how this has been done and maybe you bring about, you know, somebody that was a guide in the process, how they helped. And if there’s a way to summarize the plan that was enacted, there’d be awesome, too.
Halee Fischer – Wright:
Yeah. So the answer is, let me start by saying my personal opinion is organizations that are committed to change have to be honest enough with themselves to say what we’re doing today, we know incredibly well we do it hopefully to the best of our ability. But if we’re actually going to create meaningful change, we either we have to do something different and we may not know what we don’t know. In health care, we hate seeing that as a physician. You know, you don’t want to say that in front of a patient. I mean. I was always comfortable saying, I don’t know, but I can send you to someone that does as a CEO to say I don’t know and I don’t know who to even reach out to. It’s not something you want to tell your board. So from that standpoint, we recognized we had to bring in innovation. But as I looked at other health care organizations, we’re talking about innovation. To me, that just meant writing a blank check with without any outcomes. And I’m a fan of Clay Christensen from Harvard and and really about discipline, entrepreneurship. That’s how I feel about discipline, innovation. So what we decided is, OK, we’re so good at doing what we’ve done for the last ninety three years, but we don’t know what the future is. And we’re comfortable in saying we don’t know what the future holds. In fact, I’ll even say to I don’t know what the future holds. However, they do know is that we can put in processes that allow us to be agile when the market shifts. So you asked me about what my processes is. It’s about discipline. So these are the four points. Discipline, focus, execution and outcomes. So we have a clear idea of where we want to go. It’s like saying I want to go to that island over there. So you getting your boat and you’re going and that’s the discipline is I need to sail to that island.
Saul Marquez:
You like sailing?
Halee Fischer – Wright:
The boat sailing is I do like sailing.
Saul Marquez:
And I say I’ve been more like I love the water. Kind of more power boating. Yeah. Oh, man. Sailing. Sailing is so involved.
Halee Fischer – Wright:
It is. And to me, it’s the skill involved. But that quiet and the is so beautiful. Yeah. So the metaphor of just taking that chip in that boat and trying to get to a place and what you recognize is there’s so many variables that are between you and where you want to go and you’re not going to get there in a straight line. There’s going to take that right. You’re going to go left. Is going to come up there. All these things when it’s the focus that keeps you moving towards that direction. So that focuses what? As barriers come up, you run out of money. You run out that you need different talent. You’re – let’s be honest, your initial assumption of how we’re going to get from point A to point B. Totally false. The you have the focus to say this is what we need to do and you recalibrate. So there’s no downside and saying this isn’t going to work. But the focus is on, say, not just, well, it’s not going to work. We’re gonna quit the focus and say what will work and how do we pursue it? That’s the that leads us to the third point, which is execution. And ultimately, for as much as we talk about all the things that we need to do in health care and I’ve got a Harvard Business Journal on my desk as we’re doing this interview and it talks about all the things you need to do to be great. Now, the reality is you actually have to do it and you have to follow through. That’s about execution. And I would actually say we’re so, so at execution because we’ve never stopped doing things. We just keep adding things. And so part of the discipline of execution is saying, what am I going to stop doing so I can start doing something else? And I am militant with our teams about this is your body of work. What are you going to quit doing that isn’t adding value to execute on what we’re going to do? And I’m pretty much a dictator about that point. And the last point is outcomes. And this is something in health care that I would say is our Achilles heel. We talk about that. We want to look at outcomes, but we actually are more invested in that process than the outcome. So when we talk about best practice, best practices process, I would actually. And so this is, I guess, the second most controversial thing I’ll say. Get rid of best practice, because I think what it does is level it down to mediocrity and instead focus on how do we get to outstanding outcomes. And as someone who’s sitting in a suburb of Denver today, how I get to outsing outcomes in my business, which is a 30 million dollar nonprofit health care association, is going to be very different than the hospital that is three miles south of me that is a $250 million business that has a different body of work. We’re both in health care. We have different things. And that parallel between my outcome is going to be different than theirs is very much parallel to physicians where because we know that 60 percent health care delivery is really social determinants of health. I mean, 60 percent of what we’re delivering is very regionally dependent. And so because health care is local, that outcome has to be able to shift from population to population. And third, controversial thing I’ll say, and it actually requires that patients participation and their say in what they want their outcome to be. So I’ll give you a great example on outcome. It’s easy for me to find that the outcome for MGMA is that we build our membership, build our audience and achieve a financial outcome. But in health care, if I’m going to look at when I was a physician, I would say I want to measure everybody’s blood pressure. But is that an outcome? Not really, because it’s not necessarily going to change people’s health. It’s a much different conversation. Just using my dad as an example to sit down and say, Mr. Fischer, you have high blood pressure, you have diabetes, your kinds of towards the neurologic terminal and of your disease. What outcome do you want? And my my dad would tell you, I want to be able to eat, because that’s one of the last things I enjoy doing, cause I can’t really do what I want to do. But I don’t want to die of a stroke. So he’s already identified. He wants to keep his blood pressure down. Then as a physician, I would say, OK, let’s agree to compromise on what you want to eat. Let’s focus on healthy foods. And this is where healthy foods look like. Let’s talk about how we manage your blood pressure so that and let’s talk about the signs of a stroke and those kinds of things. So what I’m doing is I’m tailoring my message of high blood, hypertension management, diabetes management, but I’m tailoring it to him. And what’s important to him towards his end of life. And that’s what I mean by outcomes. That’s why process needs to be led by what the outcome you want and the outcomes have to be meaningful to the patient. In our business, the outcomes of evening call to my staff. It’s not fair for me as this or it’s not reasonable for me as a CEO to say we need to make more money. What I need to communicate to the staff is why is that important? It improves our influence. It allows us to actually invest back in the organization, allows us to deliver more services to our membership. So the discipline, focus, execution on outcomes is kind of the formula that I use that I’ve found to work really well, regardless of what industry that I’m in.
Saul Marquez:
Love it. And the great thing about this, folks, it’s something that you two can think about employing and what you do. I love focus. And for me, focus drives the beginning of my day, my quarter, my year, and love how you’ve woven in these other themes of discipline, execution and outcomes. And then it’s just kind of like watch and repeat. Right.
Halee Fischer – Wright:
Yeah. And you’ll learn. And there’s a learning curve to all of this. And that’s why physicians in particular, we don’t like to hear the word failure at all. And I’ll tell you, I have failed every bit as much as I’ve succeeded. But my biggest successes came after right after typically epic failures. And I think because we’re typically high achievers, executives in general, not just physicians, we don’t want to fail. We don’t recognize that that is part of the recipe. And, you know, your goal, obviously, is to minimize those. But just to say my plan makes no sense. I’m just cleaning up my desk and the stuff I was looking at that I did in 2015. It was like, what was I thinking? I have four years life learning. Maturation experience that would lead me down a different path than in 2015. And I think that’s what you need to beat. As I mentioned, we bake in that things are going to change that. Agility allows you to have some grace and move on.
Saul Marquez:
What would your call to action b to the listeners?
Halee Fischer – Wright:
I would say go through not even a day, go through a morning, look at the work you’re doing and say, if I didn’t just kind of go through the motions, what is the outcome? I’m going to, I want to achieve. And if you actually go through that enlisted Daggett’s exercise, I have a staff go through what you realize is the stuff that you’re excited and passionate about is the stuff that you understand what the outcome is and why not to be silent cynic about it, but you understand why you’re doing it and that you’re in values alignment with it. And I think to have a happening place that has that, getting that club down to that level of clarity really engages the culture in a way unprecedented in health care.
Saul Marquez:
I love that message. Yeah. Clarity does drive focus. It does drive just inspiration. And tell us about one of your biggest setbacks. What did you learn from that?
Halee Fischer – Wright:
Ok, so it was funny. I was I saw that this was going to be one of the questions. And as I mentioned before, I have a I have a long list I could choose from, but I think any good. My standard position and that is so I’ve been I’ve been made a chief medical officer and I had been chief medical officer for about four days. So, you know, of course, I was excellent at it. And my boss, the CEO of the hospitals, had said to me, we have hospitals and we need our hospital service to do additionally X, Y and Z. Can you please speak to their medical director and get her invested? So no problem. So I sit down with this this woman who is an excellent physician. Just honestly, it really decent human being. And I’d speak to her like a business professional, because I’ve been a management consultant for seven years. I’ve been really successful. I’d run my practice. I was business person with practice, you know. So I spoke to her about business reasons and about money involved. Why was important? I needed her leadership and I thought we had this amazing conversation. I mean, I thought I thought I did an outstanding job. So the next day, my boss calls me into her office and says, tell me, how did the conversation go? And I said, oh, I think it went really well. I think we’re going to get exactly what we want. I think she’s really got it. And she said, Really? And so, yeah, she said, You sure about that? And I said, not now. Yeah. She quit. And I said, What? She said, yeah, she quit. Because as a physician, you were talking to her about money and what you needed to what the hospital’s agenda was for revenue. And that was not her agenda as a physician whatsoever. And there was no way she did go to the rest of the hospitals and talk to them about money. They wanted to talk about taking care of patients and having more time and enhance relationship. So you were speaking dollars and they were speaking relationship and patient care. And it was an epic failure. It actually it costs the organization time, which is money more than anything else. It was actually one of those true position kind of minded things where I was like, I got this. I’m such a leader in my own mind. And I recognize in retrospect, I listened to I did not listen to anything she said. I wasn’t watching her body language. I wasn’t I was just pursuing my own independent agenda. And it was a great and humbling lesson for me that even though I thought I had done the best job ever, I’d done actually irreparable harm in a certain way. And that I wasn’t what I had originally thought I was being the world’s best leader in having this conversation in reality, I wasn’t a leader at all. In fact, I was the opposite of a leader, if you will.
Saul Marquez:
Wow. You know, I’m just sitting here thinking about that. And this critical leader in the organization quits on you. Yes. And you’re just like, oh, my God, what am I going to do here now?
Halee Fischer – Wright:
Well, I am actually now having eight years since that conversation. One of the really important things that I pulled out of that.
Saul Marquez:
What’s the pearl?
Halee Fischer – Wright:
The pearl in this is that as health care administrators. So people like me, we speak business and business speaks the language of money. Physicians do not speak business. By and large, administrative physicians do, but by and large, physicians don’t. They speak the language of patient care relationship. So I was speaking to her in a language she couldn’t possibly understand and in all fairness. She didn’t understand what I was trying to say either. Even though probably our goals were similar because I was speaking a completely different language and have different values as a business person that she does as a physician. We couldn’t come to alignment, so. What I push physician leaders to do is to be very mindful that their role is to be in a certain way the translator between a purely business model and a purely patient model, and their level of success is to the degree that they can facilitate those relationships across those two independent language stakeholders.
Saul Marquez:
Love that. That’s a great way to put it. And if you’re thinking about this from the head of a health care executive or a physician that’s in a leadership role, I think Dr. Fischer – Wright’s insights here can be plugged into her model. Right. I mean, and then and then you add this translator, hat this this responsibility into your execution or. Yes. Or make it part of your discipline and rinse and repeat.
Halee Fischer – Wright:
Exactly. Exactly.
Saul Marquez:
Now, this is some really valuable work that you’ve done and stories that you’ve highlighted. How about the other side of the coin? You know, what’s been an example of something that you’re so proud of? That’s been a result of following this discipline.
Halee Fischer – Wright:
So what gets me up every morning is that where I experienced pure joy in my career path is is successfully transforming organizations. So when I was hired as a chief medical officer watching medical staff change and shifting that to a much more forward thinking, progressive, patient oriented, that changing the entire care model for the community that lived up there, that was actually probably one of my proudest moments. And basically, we had gone from I remember we had an executive team meeting and we would ask the question, would you come here for care? And people were incredibly uncomfortable with that question and no one would answer it. And that’s when I started. By the time I left, pretty much all of us were getting our care at the hospital. So that’s kind of put your money where your mouth is, where you actually going to go get seen. So that gives me a lot of pride. But honestly, with MGMA. So I’ve been here for over four years at the time I came in, I thought this was a turn around, which I’d done as a business consultant. And I was very, very competent at doing. It ends up and I think this is true of all associates, it’s not unique to MGMA. We’re all in the midst of a transformation because as we make a generational shift on our members, what our members want and the relationship of membership, it’s very different than what it was 20, 50 years ago. So it’s basically the transformation of MGMA. And we’re still transforming. We still have a lifetime worth of work. But over the last four years, I’m really proud of because I know I think we were on the pathway to becoming a relevant four or five years ago. And I think that we are relevant. And I can see a pathway where we will become a necessity. And I’m incredibly proud of that.
Saul Marquez:
I love that now. And, you know, and that’s definitely something to be proud of when you’re providing the resources and inspiration and just ideas to this group. You got to change. And one of my favorite quotes is a business that does not change is a business that is going to die.
Halee Fischer – Wright:
Yeah, it’s the evolutionary imperative. Adapt, migrate or die.
Saul Marquez:
Yeah. I mean, it’s that simple.
Halee Fischer – Wright:
It is that simple. And yet.
Saul Marquez:
But it’s not easy.
Halee Fischer – Wright:
That’s simple things are the hardest. You know, a lot of times, I mean, we navigate this, I think, in health care every single day. And it’s not unique to where I work today. In fact, where I was in Edinburgh, Scotland, and I work with someone about two weeks ago. And National Health Service is actually undergoing some of the same changes that we are cost issues over use, quality, etc. So these are once again not unique to the United States. But what we were talking about was all you need to do is X, it’s so clear. And yet getting to X will take countless dollars, countless efforts, countless energies, a generation of transformation as we age out certain positions and bring in new physicians, create new business models. So it’s simple, but it is arguably the most complex things that we have to do.
Saul Marquez:
That’s so true. And if you had to highlight one of the most exciting projects you’re working on today, Haylee, what is that?
Halee Fischer – Wright:
Oh, easy. So in the spirit of transforming MGMA are basically our golden brand. Our and our golden goose is our data, which is we provide physician compensation data for the nation and we are the gold standard. And we’ve been that pretty much forever for at least as long as I mean I think it’s been since 1909. So a while and what it used to be you just have a table so you’d say OK, internal medicine doctors in groups, this big dinner in Chicago, what is your compensation rate. What I’m really excited about is that we’re actually, looking at how do you visualize everybody? Every single entity in health care now has access to data. Data is like people would say we have data. Great. What no one is doing incredibly well is using that data to get to cost effective outcomes. So and I would say I was harsh. It’s not knowing. It’s very difficult to get to actually making that data information that is actionable. So what we’re doing is taking our is working on re visualizing our physician compensation so that it actually fits in to the rubrics of management operations and creating creating a visualization in such a way that it actually drives operations successfully because the basically the lifeblood of a practice. What people come to us is decreasing expense and increasing revenues so that they can continue to provide care. So we want to be able to take our data and translate it in such a way that it’s meaningful to day to day practice. And so that’s the project we’re working on.
Saul Marquez:
Love that. And you guys are mainly working with provider systems, I imagine.
Halee Fischer – Wright:
We’re actually we represent the diversity that is healthcare. So we work with small independent practices, one or two physicians, and then we work with the largest health systems in the country.
Saul Marquez:
Got it.
Halee Fischer – Wright:
So, yeah. So we actually are the diversity that’s health care today.
Saul Marquez:
I love that. Wow. Super exciting. So really, truly appreciate the thoughts that you’ve shared with us today. The process around discipline, focus, execution and outcomes. I’d love to conclude with your favorite book and then a closing thought that you leave the listeners here with today.
Halee Fischer – Wright:
So favorite book by far is The Alchemist by Paulo.
Saul Marquez:
Love that book.
Halee Fischer – Wright:
Love that book. I read it every year. I get something different out of it every year. It’s yeah, I really do. I was telling someone I purchased that originally. I was on a trip to Asia and I was in the Washington DC bookstore and I just happened to pick it up, not really knowing much about it. Honestly, I thought the cover was pretty and it kept. I was flying to Singapore. It kept me up the entire trip because it just was so evocative of humanity. I think the best of humanity. And I did think it was was poetry. So that’s my favorite book by far.
Saul Marquez:
I love it. Yeah, that’s one of my favorites. I can’t say I read it every year, but I’ve read it about three or four times. And folks, if you haven’t read The Alchemist, it’s one of those must reads. And every time I pick it up, too, it’s like I do get a different angle on it. So funny that you say that happens to you too.
Halee Fischer – Wright:
Yeah, I usually do that New Year’s Day to kind of start, start the new. Yeah.
Saul Marquez:
I like that. Ritual.
Halee Fischer – Wright:
It is my ritual. So closing thought I think I resisted the clickbait of of talking about physician burnout in this conversation. But what have the closing thought. I want to leave people with this. Every single personally listening to this has an opportunity to make an impact in a difference, which is why we went into health care, stripped down all the things that aren’t working and move directly into what actually is. What does work is that you have you whoever’s listening has an opportunity to make an impact. And I think that the more you can embrace that, the more we’ll be able to change healthcare for the better.
Saul Marquez:
Love it. It’s a great message. And folks take that to consideration in what you’re doing. You’re here to make an impact. So what would be the best place for listeners to continue the conversation with you or follow you?
Halee Fischer – Wright:
So I have a website and it is a it is an MGMA website, even though it is specific to me. It’s drhalee@drhalee.com and that’s spelled H A L E E. And so I have a website there and you can send emails to me and I’d be happy to respond.
Saul Marquez:
Outstanding. And folks will will place that link and email address inside of the show notes. So be sure to go to outcomesrocket.health for the full transcript and best ways to connect. Haylee, Dr. Fischer – Wright, I really, really, really appreciate the insights you’ve shared with us today.
Halee Fischer – Wright:
Thank you, Saul. And I appreciate once again. I appreciate your listeners giving us the time today.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resourses, inspiration and so much more.
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