Interview with Brazil RPCV Judy Pelham, FACHE, president and CEO, Trinity Health, Novi, Michigan
Interview with Judy Pelham, FACHE, president and CEO, Trinity Health, Novi, Michigan
Mar 1, 2002 - Hospital & Health Services Administration Author(s): Grazier, Kyle L
For more than 20 years, Judy Pelham has been a leader and recognized pioneer in developing programs to improve the health status of communities, particularly for the poor and underserved. From 1993 to 2000, she served as president and CEO of Mercy Health Services. At Mercy Health Services, Ms. Pelham championed the "intelligent network," designed to encourage partnerships and the development and sharing of best practices throughout the system. In May of 2000, Ms. Pelham began leading Trinity Health-the third largest Catholic health system in the United States. In addition, Ms. Pelham is chairperson of the Washington, D.C.-based Coalition for Nonprofit Health Care.
She also serves on a wide variety of national and regional boards, including Amgen and Catholic CEO Healthcare Connection.
Formerly, Ms. Pelham was president of the Daughters of Charity Health Services of Austin and Seton Medical Center in Austin, Texas. She also served as assistant vice president of The Brigham and Women's Hospital in Boston. In 1992, she received the American Hospital Association's Partnership for Action Grassroots Advocacy Award in recognition of her work in healthcare reform. Ms. Pelham holds a master's degree in public administration from Harvard University and a bachelor's degree from Smith College.
Dr. Grazier: Please tell us about the structure of Trinity Health.
Ms. Pelham: Trinity was formed from a merger of Mercy Health Services and Holy Cross Health Systems in May 2000. We are the third largest Catholic healthcare system and in the top 10 nonprofit healthcare systems in the country. We have 46 owned and managed acute care hospitals in seven states, from Maryland to California and from very small rural facilities to large sophisticated teaching organizations. We have managed care plans, housing for the elderly, and home care and long-term care services. Our sponsorship within the Catholic Church has changed to Catholic Health Ministries. This is a new vehicle created by both congregations that will eventually allow lay people to become sponsors in the name of the church.
This means the sponsors assume the responsibilities for the Catholic identity of the organization and assume limited reserved powers. Overseeing Trinity Health is a board of trustees of 12 people, four of whom are Sisters and the rest are lay people. I am one of the voting members of the board.
Dr. Grazier: You were CEO of Mercy Health Services prior to the merger. What attracted you to Mercy?
Ms. Pelham: I came to Mercy from Seton Medical Center, the Daughters of Charity Health System in Austin, Texas, where I had developed a regional integrated delivery system with a heart transplant program and a regional neonatal center. I developed their home care programs, outreach clinics for the poor, and a variety of other services including satellite hospitals. Mercy offered me the opportunity to take my Seton experience to a broader scale. They were trying to develop integrated networks in a broad array of communities and they had various service lines in home care, long- term care, and managed care.
But they were not integrated at the community level. So I took the opportunity to take Mercy into the next stage of its evolution.
Dr. Grazier: How challenging was that task?
Ms. Pelham: It was certainly a challenge because not only was Mercy operating on a much larger scope over multiple states, it also had a very rich heritage and had been a pioneering organization- Mercy was one of the first Catholic healthcare systems in 1976. But we were ready for the challenge. We were ready to be pioneers again in developing new ways as a healthcare system, improving operations, and increasing our focus on clinical matters. Most importantly, we had many very committed and talented people in the organization.
Dr. Grazier: Please tell us about the "intelligent network" program you initiated at Mercy.
Ms. Pelham: The way to add value to an organization is to leverage learning and best practices. Early healthcare systems were leveraging traditional staff functions such as purchasing, insurance, and debt and cash management. But they hadn't really moved into the core of the business-that is, healthcare. We expanded that theory with the intelligent network program. We brought together people from around the organization to share their clinical and managerial best practices, innovation, and reengineering efforts and to develop new competencies.
The program has evolved further. We focus on mission, value, culture, and our advocacy role by speaking out on behalf of the poor and underserved. We involve our member organizations in all the major decisions we make and in several of our goals. We are very clear on our goals and measures and we have very detailed implementation plans. One of our goals is to improve our performance to reach top-quartile benchmark levels on 15 clinical indicators we've identified. Another goal is to improve our operating income to get our long-term needs, reinvestment, and charity care in better shape. Another goal is to follow through on our initiatives involving revenue management, patient satisfaction, workforce, quality of life, and diversity.
Another goal is to manage our portfolio to examine the range of locations and services we offer. The intelligent network program is a mission-oriented process, not simply a business process.
The program has also served as a nice career-development tool for people. We have an extensive Intranet on which we have posted information, including key contacts at all our member organizations, best practices, disaster-preparedness information, and clinical courses. In addition, we posted self-assessment modules and we are working on posting learning modules by job category. We looked first at the learning opportunities available externally then developed our own programs and made them accessible, via the Intranet, to all employees in our member organizations. Using the Intranet, a nurse on the floor can brush up on the latest cancer treatments and a billing agent can check on the most recent Medicare coding for a particular diagnosis.
The human resources department staff just designed modules to assist staff in writing a job description, performing an evaluation, counseling an employee, and orienting new staff.
Dr. Grazier: How have these efforts been received by the caregivers, managers, and other staff in the organization?
Ms. Pelham: They are excited about the fact that they are redesigning activities and processes to find better ways to deliver care and save money. We save money on the administrative side so that we have more money to put in the patient care side. I am sure that they also appreciate that we are sensitive to the time and energy of the people at the member organizations, so we do a lot of our work by video and audio conference. We also use e-mail and our extensive Intranet to communicate and present information.
Dr. Grazier: From your Peace Corps days to your leadership of organizations whose mission is to serve the poor, you have oriented your career toward serving the underserved. What have you learned or observed from working with this population?
Ms. Pelham: I have stayed with nonprofit healthcare because of its mission commitment. Not everyone is in an equal situation in our society. In this society we regard healthcare as a right, but we don't provide the financial underpinning for it that other developed societies do. We don't have a governmental healthcare system or a tax-supported financing mechanism for healthcare other than Medicare and Medicaid. As a result, we have this huge population of people who are trying their best and who are working but don't have healthcare benefits because their employers do not provide insurance. From a humanitarian standpoint, it is important to reach out to the vulnerable.
Dr. Grazier: Speaking of vulnerable, many rural facilities are struggling. How does Trinity Health support its rural facilities?
Ms. Pelham: Not all of our rural facilities are profitable, but part of our mission is to provide access to care in rural areas. Generally we try to align our small rural hospitals with tertiary facilities that we have in the region so that they have good access to an array of services. This way they can take advantage of Trinity's cost-management arrangements for purchasing, insurance, physician practice management, sharing expertise, and best practices.
Dr. Grazier: You've been involved in complex mergers, nursing shortages, and financial challenges. What is it about the healthcare field that appeals to you?
Ms. Pelham: I believe this is fundamentally good and rewarding work, and it is worth getting up for every day. That translates into an optimism and enthusiasm for the field even when times are tough. I went into healthcare with a view that it was something that needed to be changed: There were things that didn't work well in the delivery, access to, and financing of healthcare. So it is a field that has a constant need for change and evolution, and that to me is very energizing.
Dr. Grazier: As a leader, how do you pass on that energized mindset to others in your organization?
Ms. Pelham: The more responsibility one has, the more one realizes that managers work with and through other people. It is critical to form teams of people who can work effectively toget\her because many problems are too complex for one person or one discipline to solve. So you need a cross section of skills, a cross section of styles, and an ability to pull the right people together to give a problem concentrated analysis. I believe in an open culture in which people share information and vigorously debate the pros and cons in an objective and respectful way to obtain the best solution for the organization.
It is also very important to eliminate a blame culture. We need to learn from mistakes and disasters. We need to ask: What are the lessons we learned? How can we do this better next time? I have found that having a blame-free culture frees people enormously to be honest about what went well and what didn't, and it encourages them to go forward. We also need to take the time to celebrate and praise. It is important for everyone to stop and recognize each other for a job well done, for something accomplished, or for a project that has succeeded before going on to the next thing. There will always be plenty of next things.
A simple thank you or a positive comment on a particularly good presentation or meeting restores people's energy and personally validates them.
Dr. Grazier: Are there people who influenced you along the way?
Ms. Pelham: Oh yes! I had wonderful mentors. One was a physician who taught me well about how to work as a team member with physicians and nurses. He gave me a lot of responsibility so I could try new things, then he gave me constructive feedback in private. He gave me enough room to make mistakes because that is one of the ways people learn. Another mentor was the Daughter of Charity Sister who hired me at Seton and who later named me to be her successor. She had an incredible charisma and an ability to get people to go far beyond what they thought they could accomplish. She also had an amazing ability to teach patience and timing, which was very tough for me as a go-getter, young executive who wanted to get it all done yesterday.
I learned that you can only push a project so far and if the timing isn't right, it isn't going to happen.
Dr. Grazier: Your mentors did a lot to prepare you for the challenges of leadership. Do you think the field is adequately preparing your future replacements and is the field providing you and other leaders with the material and guidance to develop these up- andcomers?
Ms. Pelham: Large systems have grown quickly into very sophisticated organizations, but we haven't always been quick with preparing the next generation of leaders well. Graduate programs have not kept up with the contemporary needs in the field, and they need to reexamine their curricula. As leaders, we need to expose potential managers to more sophisticated challenges and decisions because their experience now is not broad enough. There are many bright, capable people in this field. With some guidance and challenge, they can be trained to take on leadership positions.
Dr. Grazier: Given that view, what advice do you give to new careerists?
Ms. Pelham: First, choose your boss and organization carefully. Choose someone whose values are in concert with yours and someone whom you respect and from whom you can learn. Second, don't trap yourself in a functional niche too quickly. Go back and forth between line and staff and between functional areas because the broader the experience, the more you are grooming yourself for a more-- senior management or executive position. Third, do not stay with the same organization your whole career. Diversity of experience will provide a richer foundation.
Copyright American College of Healthcare Executives Mar/Apr 2002
