Michele Sutton (Host): Welcome to the Healthcare Executive Podcast from the American College of Healthcare Executives, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, visit ache.org. I'm Michele Sutton, President and CEO of North Oaks Health System in Hammond, Louisiana.

I'm here with Noel Cardenas, Senior Vice President and CEO of Memorial Hermann Southeast and Pearland Hospitals in Houston. He was recently installed as ACHE's chair, and I'm happy to be with him on today's episode. Thank you for joining me, Noel.

Noel Cárdenas: Well, thank you, Michelle. Thank you for this opportunity to speak with you this morning. I also want to congratulate you on a very successful year as our chair last year.

Host: Thank you. You have a very unique story about how you got into healthcare. It's truly inspiring. Can you tell us a little bit more about it?

Noel Cárdenas: You know, when you reflect back, it is kind of unique, a little bit different in most people's journeys into healthcare. So, it spans over 43 years. But what I really want to talk about, you know, and add is that I really am living out my passions and my why, you know. And I've got really three passions, and that's been healthcare, service to our nation and others, and of course, leadership. When I look back at where I started, it was in high school. I was part of a Health Occupation Students of America Program, and I started off my work working half day as a nursing assistant, working with a local orthopedic surgeon, and then did some medical transcription for him. I did that for a couple years and into my first couple years into college.

And then, it's kind of something that sparked that went back into some time when I was in high school where I got to listen to a Congressional Medal honoree, and he spoke about service to our country. And so, there was always a little bit of an interest in the military. And so, between my second and third years of college, I made the decision to join the ROTC program and finished my degree at Texas and was commissioned as a lieutenant. Then, I had to make a decision on what do I do next, because I was tracking towards going to medical school. And I had kind of a break in the ROTC program. A professor of military science talked me into transitioning and joining and going on active duty.

So, I submitted a packet and ended up in the Medical Service Corps as part of the Army Medicine, which was the administrative portion of Army Medicine. I started off my career as a medical logistician in the Army, did that for a few years. And then, about six years into my Army time, I ran across one of my mentors, and he pulled me aside and started talking to me about this great program that the Army had and where I could train and learn how to be a hospital administrator. So, I did that and earned my master's in healthcare administration from Baylor University through the Army Baylor program. And it kind of set me off on a different path in healthcare administration.

But one of the things in my military career was I had the opportunity to command at the company, battalion, and brigade level. And so, really, those assignments, they just did a lot for me from a leadership perspective. But I also developed as a hospital administrator in the Army, doing chief operating officer roles at an ambulatory surgery center, 90-bed hospital, then at the Department of Defense's largest medical center at Fort Sam Houston at Brooke Army Medical Center.

So, those were kind of my tracks in healthcare administration. But I also had some operational time. And I will go back and reflect that during my time at one of Congress—I can't remember the exact years—it was one of my mentors there who pulled me aside and said, "One of the things that you really need to do is make sure you balance your career." And so, between brick-and-mortar assignments and operational assignments, did some time, three deployments. One in Desert Shield, Desert Storm, and the other two were in Iraq. One of those was setting up 164-bed hospital north of Baghdad when we first started in our Operation Iraqi Freedom. And then, the second tour, I went back as a task force commander in 2008 to 2009.

So as I continued my path in developing as a healthcare administrator in the Army, my last assignment, I commanded the hospital at Fort Sill, Oklahoma. And so, that was back in 2013 to 2015. And around that time, I still had a little bit of time to serve. You know, I could do up to 30. But at that point, I kind of made the decision it was time for me to transition. So, I started looking at my options at that time.

Host: First, I need to say thank you for your service. Quite the distinguished career, and thank you, again, for your service to our country. So, what was it like for you to transition from the military to the civilian role, and what advice would you have for those planning to do it in the near future, to make that transition?

Noel Cárdenas: Yeah. Well, first, I'll say it's a tough decision to make, because you've been serving, and I loved everything I was doing. I loved being around soldiers, you know, the military had been part of my life for—the active part was just almost 28 years. But making that decision, when I was going to retire, I had to decide, do I go into the VA and work for the VA, or do I stay and continue to support Army medicine as a civilian?

But really, there was a deep passion inside of me that really wanted to transition and do something and serve a community. And really, I wanted to come back home to Texas. And be part of a community and be part of a hospital system. That's what I decided to do, was to transition to the private sector.

But really, I attributed my success and my transition to ACHE. And it was through the networking opportunities that I had, as well as the education sessions, but more so the networking. And I was very lucky in that I had served ACHE in multiple different support roles, and one of those roles was as the Army regent.

And during that time, I had the opportunity to interact with three former chairs. And I started talking about my transition. One of those chairs, the first was Major General Rubenstein, who had talked me through and was supportive of my transition in retiring from the military, but he also said, "We've got to set you up and, you know, you've got to network and meet some other leaders."

So then, he introduced me to Rich Cordova, who at the time was actually the ACHE chair. And Rich took an interest in me. One, we were both Hispanic, but he really loved the military and wanted to see the military succeed in their transition process. And so, Rich did a great job mentoring me and coaching me through the last couple of years as I was working through my transition.

And when he realized that I wanted to come back home to Texas, he introduced me to Chuck Stokes. Chuck was, at that time, the chief operating officer of the Memorial Hermann Health System here in Houston. Chuck and I had a great mentorship relationship. We did that for almost two years. And then, as I was getting ready to transition, then the talk came about opportunities and jobs. He handed off my resume to one of the leaders here at Memorial Hermann. And within weeks, I had an interview. Then, it landed the role as the chief operating officer at the Northeast Hospital, and did that for five years, and then into my current role as the CEO of Southeast and Pearland.

So really, it was the networking opportunities that really were instrumental in my transition and making me successful. But the other part of it too was once I joined the Memorial Hermann Health System, you know, I continued to take the education sessions that helped me with my transition at Congress. You know, those key things that I thought were so important, where I felt I wasn't as strong that I needed to be, mostly on the operational side. There were many things that I had down packed as far as leadership and emergency management and those types of things, but it was really the financial things. So, I leveraged those opportunities through ACHE.

And so, I can tell you, the best advice I could give to those transitioning from the military would, one, be patient, right? It is a process that takes time. I tell everybody that, you know, as I was transitioning, I was knocking on every door, sending emails, texts to numerous people, working with different executive search firms. And really, it goes back to that networking. But you got to use all those opportunities to reach out to others and be patient through that process. But really, more so, just leverage the opportunities that ACHE give you between the networking, the resume writing, the search firms that work with ACHE to help military.

And I will tell you the other piece of advice that I continue to give to those transitioning is don't be afraid to take a step back. And I reflect back on my career when I was transitioning. You know, I had been the chief operating officer at the largest Department of Defense facility. I had commanded and been the CEO of a hospital. But I took a step back and transitioned into a COO role in the private sector, which really gave me the opportunity to grow and help me as I was transitioning, really more so to learn the differences between Army medicine and providing care to that type of population, to being out here in a community and providing care in the private sector.

Host: Truly sage advice. Thank you for sharing and caring enough to help others. So, how has your personal journey shaped your leadership style?

Noel Cárdenas: You know, when I look at my leadership style now, and even when I go back to the military, it's grounded really in the foundation of my values. And, you know, it started with my parents. They gave me a really strong foundation of values. And then, the military, as I transitioned to the military and be became part of that culture, and there were seven Army values that were so important between personal courage, integrity, honor. You know, and I can tell you right behind me right here are my dog tags that I keep in my office. One of those was my identification tag, but the other has the seven Army values on it. And I keep it here in my office to remind me of the importance of those values in keeping me grounded. But as I look at leadership styles, you know, I go back to the military time that helped develop me as a leader through multiple roles.

But the good thing that the military provided me was the opportunity to see the good, the bad, and the ugly from different leadership styles. I had the opportunity to interact with many, many leaders, that I could really pick and choose from. I almost say I kind of had like a leadership style kit bag that I would learn from others and see what they were doing and how successful they were doing.

And also, those that were struggling and things that they did from a leadership style perspective that weren't good for an organization. So as I went through my career, I built on those, put those things into my kit bag. It helped me to develop. You know, I reflect back on one mentor that when I was going through my administrative fellowship, at that time, the chief executive officer, the commander of the hospital, he used to take time with me in the afternoons. We'd sit in his office, and he would talk to me about different things, things that I needed to know as a leader. But I always had a deep respect for his leadership style.

But one of the things that Colonel Ripple shared with me was, "Noel, as a leader, it's always important, especially if you're going to be in healthcare, you have got to see yourself through the eyes of the patient. And then, that will help you as you drive the culture and how you lead in your organization. But always keep in mind that the patient has to be at the forefront of everything that we do."

But when you look at leadership styles and the type of styles that I've brought into me, you know, I get this question asked often when I'm out giving sessions or teaching leadership classes here in the community or to some of the local groups. I get asked the question, "What is your leadership style?" And I actually have a slide up about leadership styles, but there's different styles. There's the servant, there's the authentic, there's the motivational, there's the transformational. And then, there's those type of styles that are like the autocratic, which I really never really been all that, you know, it's never really been a part of me. It's more so being about a servant and authentic leader. People have to be able to see what they get in a leader. And so, I've tried put all that together in my styles.

But when you look at sometimes and when you have to use different types of leadership styles, I reflect back in my times in Iraq where I had to put transformational leadership into action; motivational leadership when we had to build that hospital and keeping everybody energized and getting that hospital built so quickly. And then, the other part of it, about sharing with people that we were going to be there for a year, and how do you motivate people to let them know that you're going to be gone away from your families for an entire year? You've got to be able to find a way to motivate people. And then, I reflect also on the time when we dealt with the pandemic recently, and how did I adjust there. And between making sure people felt that we were going to be okay, that we were going to get through this, and even using some motivational tactics. I think of a time back when, you know, we were coming up on Easter. And on a Thursday evening, I thought, "Well, how can I motivate the people in the hospital?" So, I thought, "Well, how about dressing up as a bunny, right? Come in and dress up as a rabbit and pass out Easter eggs." So, I went home, told Christy about my idea. And before I knew it, she put a mask together for me, because we were all wearing masks at the time that had whiskers. And so, the next day, I came in, wore a bunny outfit, and went around passing out Easter eggs in the hospital. It really did a lot for the staff to help motivate them.

Host: I wish I could have seen that.

Noel Cárdenas: I actually have a picture. I'll have to send that to you sometime. But it really did a lot, right? So, it's really about building the types of styles that you want that are best for the organization and driving the culture.

But the other part of it that I'll say is ACHE's also been instrumental in that, because when I would attend Congress, I would always pick a leadership class, because I wanted to hear about some of the things that people were doing, especially leaders that were in the private sector and how they were leading. Because I knew there was a difference between how we led in the military and how you lead in the private sector. But again, there are still the foundational things. And most importantly, it's the values that are so important. And also, part of your leadership style needs to be is you've got to lead with a strong character and a moral compass.

Host: I couldn't agree more because when you think about it, patients are our purpose. And having a leadership style, you have to be flexible and adapt to the situation, and you've certainly done that. So while you were in the military, I know you shared that ACHE was your trusted partner. And I guess tell us a little bit more specifically how they supported your professional development while you were in the military and continue to do so today.

Noel Cárdenas: Yeah. So, I went back and thought about when I actually joined ACHE, and it's actually been 30 years now that I've been a member. And I didn't know anything about ACHE. When I was going through my master's program, I heard about all my colleagues talking about it. So, I asked, you know, several of them about what ACHE was all about. Before I knew it, I was being recruited. And so, you know, I quickly put in my application and realized just how important this would be for me. But I really go back to that first Congress when I attended back in 1998. My preceptor was supportive of me attending. He felt it was a part of my fellowship to attend Congress.

And so, I still remember sitting in that first opening session listening. And then, as I came out of that session and then interacting with so many of the members that were there, I was in a military uniform, there were so many coming up thanking me for my service. But it gave me the opportunity to share what we were doing in Army medicine, but it also gave me an opportunity to listen and hear from them about what was going on in the private sector throughout the many times I attended Congress.

But when you look at what ACHE's done for me, you think of networking, right? The networking piece is so important. You get to meet so many people. I've had connections now that going back 10, 20 years now, that I still stay connected with people that I met through ACHE.

And then, there's also the educational opportunities, right? Those sessions. My mom was an educator. And so, she used to always stress that education never stops. It continues through your life. It's a lifelong journey. And, you know, when you think of ACHE and lifelong learning, it is important to continue to do that.

So when I hear my mom's voice, it made me realize that and sitting through that first Congress, I was in the right place with the right organization that was going to help me to grow not only as a leader, but as a professional in what I was doing, and that was being part of healthcare.

Host: And that is one of our core values, is lifelong learning. Because you want that brain to constantly grow. You never want it to atrophy. So, I think that's key.

Noel Cárdenas: Yeah, absolutely. And, you know, when I would approach Congress, like I said earlier, I would always pick a leadership session because I knew that there were things that I still needed to learn as a leader. And so, I would listen in on some of those, take some key points away, and then find ways to put those in my kit bag, as I would say.

But the other part of it was is I would pick sessions where I knew my organization was struggling, or there was opportunities, or as well as some things in and around what my team could do better. And when I would come back from Congress, I'd bring the paperwork from those slides and the PowerPoints from those sessions, and I would share them with my team, or I would share them with my organization because there were always some really great key takeaways about some of the things that we could learn from what was going on in healthcare across the country and bringing those to Army Medicine.

Host: Okay. Well, I mentioned one of our key values. Another one is community. How is community essential to a healthcare leader?

Noel Cárdenas: So, you know, as I thought about this value, you know, it's been great that we've made this a part of ACHE and part of one of our core values. And it's also one of the values for Memorial Hermann. So, they're tied together both for part of my professional organization as well as what I do here at work.

But as you think as a healthcare leader, we need to ensure that we foster engagement, that we learn the richness of each of us and all of us is celebrated, and also the respect. And we've got to be able to create that respect within our organizations. I look across the makeup of both my hospitals, and I just see how I have so many people from different parts of the world, different parts of the country, even different parts of the state where people are different.

And you look at the different cultures, and you see how we bring all that together into our organization. And yet, there are differences, but there's so many things where we're similar. And it's really understanding those differences and respecting those. And then, how do you bring all that together and drive that within your organization and creating that culture of respect? But it's also understanding the needs of our community. And, you know, we're in profession where we're here to serve others. And there's no better higher calling than to be able to do that, you know?

And I reflect back on my time in the military, where I was able to serve our military members, and now I'm serving a community out here. And it's understanding what that community needs from us. And when you think of the challenges that we have going on right now in healthcare, everything from access to healthcare, the different disparities in healthcare, and then dealing with all the different comorbidities within the people living within our communities and what are we doing to help them to improve their health? Because those challenges are not going to go away, we've got to be able to find ways to better serve our community and get people healthier. And so as we look to the future, it's how do we bring all that together between the culture and what we're driving within our organizations and then what we're doing to serve the communities in getting them healthier.

Host: I get up every morning energized. I can't wait to get here as a leader because, for me, it's a calling. It's a sacred privilege to be able to help others when they need us the most. And when you think about community, for me, it's about ensuring that everybody has equal access to healthcare and has the same access to outcomes. And for me, that's a privilege and a gift, and I'm honored to be able to do that.

Noel Cárdenas: Similar to you, when I come to work every morning, I'm energized, excited for two reasons. One, it's the people I work with, and they excite me. I see the passion and what they do each and every day. As I round on patients, I hear the stories about how much our patients appreciate the nurses and the technicians and everybody that's a part of getting them healthier. And, you know, I love the teams that I work with at both my hospitals.

And the other part of it is the community, right? I get out in the community, and I hear the great stories about what my hospitals are doing for the people that live in our communities. And it's always great to hear those stories, right? Because it makes you realize that your calling and my passions and what I'm doing between healthcare and serving and leading just get to live that each and every day. And I think when you're doing that, you're doing the right thing, and just enjoy and love what you're doing.

Host: Okay. If I could make you narrow it down to one thing, what is the one thing you're most proud of that you have achieved in your career thus far?

Noel Cárdenas: For me, I think the thing I'm most proud of is that I'm living my passion. I'm living my why. When I go back and I reflect to when I started in healthcare over 43 years ago, and, you know, I still remember that one patient. I shared that story, and it's written out there about this little old lady that I took care of. And that connection that I made with her, it made me realize that I'm in a profession that I love to do. It was what I was meant to be and what I was meant to do.

And the other part of it was, is the second part, which is the service and giving back, and the opportunity to serve in the military and to be able to do that and continue to give back not only to my nation, but to those that they were serving, because being in healthcare, it allowed me to do both at the same time. And then, just the ability to lead, right? So when I think about that, that's what I'm most proud of. But it's always been about giving back. And I even think about what I'm doing now as the chair. You and I have talked about this, but this is kind of the pinnacle of our career, to be able to serve in this capacity as a chair of ACHE. But it's because it's the opportunity to give back to a professional organization that has done so much for me over the last 30 years to get me to where I'm at today and to live my passions and my purpose and my why.

Host: What advice would you have for emerging leaders?

Noel Cárdenas: As I think about that, you know, I go back to the quote that I shared with everybody during my presentation at Congress as well as what's in the ACHE profile. And it's a quote that's attributed to Abraham Lincoln, and that quote is, "The best way to predict your future is to create it."

And I think about my journey in healthcare and, you know, I go back to 1996 when my wife and I were having a discussion, and she asked me about what I wanted to do in my military career, and I outlined all the different roles that I shared with her. And she remembered all of those, and she shared with me several years ago. She said, "You did every single role that you set out to do," to include what I'm doing now, and that was to be a CEO in the civilian sector, in the private sector, in private sector healthcare.

So, I tell everybody the best thing to do is if you plan out your future, think of the different things that you want to do in your career. Live out your why, your purpose, and your passions. But also, you know, the best advice I could give is along that way is to also take the time to develop. Develop as a leader, be patient, and don't rush things. I see a lot of people trying to rush through different roles. And that's important, right? As you think of the roles that you take on, it's important that you, one, learn the role that you go into. Then, you grow into that role and really develop a really solid team that you're working with. And then, the third thing is master that role so that you really have it down pat. And once you have it mastered, enjoy that time. But then at some point, you have to decide, "Is it time for me to move on to that next opportunity?" But it's so key that you do that in your career, take on and learn, grow, and master those roles that you take on.

The other part of it is don't be afraid to take risk, right? There's times when you sometimes look at a role and say, "Can I do that?" You know? And you have to just think positive about yourself and have that energy, and you say, "Yes, I can do it."

And the other part is, like I did, don't be afraid to take a step back. I remember the best advice I got from somebody that was a recruiter. He said, "You know, you military guys, all you want to do is transition from the Army and become CEOs." He said, "Take a step back and take a lesser role so that you can grow." It was the best advice I ever received from anybody, and also the advice that I got from Chuck Stokes as I was transitioning, and then that's how I ended up here. So, again, that's the best advice.

But the other two things that I'll tell you as an emerging leader is, one, lead with character. Don't ever compromise your character. Keep your true north, and then maintain those values. And then, the second thing I'll say is leverage and support what ACHE can do for you. Because, you know, as you're growing and emerging as a leader, you're going to need the things that ACHE can provide to you between the networking and the educational opportunities. And then, the other part of it is you got to give back, right? And we're always looking for people in ACHE to serve. So when the opportunity is there in front of you, give back to ACHE.

Host: Well, you know, it has been the greatest privilege of my career to serve as ACHE's chair. What are your priorities during your term as chair?

Noel Cárdenas: First, I think it's important that we continue to grow our membership in ACHE. I take every opportunity to talk to everybody who's not a member that's in healthcare, and I share with them my journey and what ACHE's done for me.

I've had several young students that have come to see me, in college. They're going through their undergrad degrees and even those going through MHA. And I do ask the question, "Are you a member of ACHE?" And when they tell me they're not, I kind of share with them what ACHE can do for them.

And so, I think it's important that we tell that story and to continue to grow and bring in more people, both clinical and non-clinical, right? Because we're really growing our clinical presence in our membership, and I think important that we continue to grow that part of our membership.

The second is really growing the number of fellows. We have so many of our members out there that are qualified to transition and become fellows. I think we got to continue to encourage them to take the test and understand the importance of being board-certified in our field.

And I always share my story about when I finally was able to obtain board fellowship. And I tell everybody, I took the test once, didn't do well, and it was because I didn't put the full effort into it. But it made me really realize that I needed to do it. And so, the second time I passed it and became board-certified. So, that's going to be important that we continue to get people to understand that FACHE is the gold standard in our profession, and that board certification is something we need to do.

And then, third thing is we've got to support our chapters, and we got to continue to support them, help them to grow, continue to provide those opportunities, because they're out at the forefront for us and they're the ones that are having those continuous interactions with our members. And everything that they can do for our members, we need to continue to support them. I'm going to have a lot of opportunities to get out and visit with chapters throughout the year. I've already got the first two lined up. In the coming weeks, I'll be headed to Canada to speak to the chapter out there. And then, two days, later I'll be in North Carolina. So, I'm looking forward to those interactions with the chapters and talking to them and seeing what we can do to help continue to support them.

So really, those are the priorities that I've identified over the year. I know it's a fast year, but I'll be out there trying to do what I can to support ACHE.

Host: As we close, one final question. What gives you hope for the healthcare field and future leaders?

Noel Cárdenas: Well, what I'm really excited about is this group of leaders that are coming, this next generation. I know that, you know, some folks talk about how they're challenging and that they're different, but it's the differences really that are a plus. They're smarter, they're extremely bright. I see energy in them. I see that they're innovative. And so, I think we've got to find a way to really—you know, that energy that's in and around them as we bring them in, because as I tell many of them, I go, "You're going to be the ones taking care of me when I get older, so I need you to be out there and being a strong leader."

So, I'm really excited about them and what they're going to bring to healthcare because as we get into and the things that we're going to be dealing with, and we're already are dealing with how we're bringing AI into healthcare. And then, also, the different technology and how we're making those really fast advances in the technology and the use, because you and I see this each and every day in our hospitals and the technology that we're bringing in. But it's how we're going to leverage those things like AI and technology to help us to get out into the communities to talk about the things earlier that we talked about with the challenges in healthcare. How do we use that technology to improve the health of the communities that we're serving?

I know that I've got a ZIP code here in my service area where the life expectancy is 10 years less than those living in a different ZIP code in Houston. What do I need to do here to leverage AI and technology to help those communities to get better and get healthier?

I'm excited. I think there's a lot, but the other part of it is how ACHE's bringing all this in, and how we're using this, and we're teaching our leaders about AI and technology and so forth. I know we had a boot camp at Congress. It was packed full. And so, as we looked ahead, I know that ACHE's going to find ways to get our leaders smarter, brighter, and more energized to lead us into the future in healthcare.

Host: I couldn't agree more, because ACHE is the reason why healthcare leaders will be effective in the future. Thank you, Noel. Thank you for your service to our country. Thank you for your service and leadership to ACHE. For more information on ACHE's podcast, please visit healthcareexecutive.org. I'm Michelle Sutton, and thanks so much again for being part of Healthcare Executive podcast from the American College of Healthcare Executives.