Cheryl Pegus, MD, FACC (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 Cheryl Pegus. I'm a cardiologist, Chair and CEO of FlyteHealth, and I'm also the author of The Optimistic Leader's Guide to Healthcare: Turning Uncertainty into Opportunity, which has just been published by the ACHE. I'm joined today with Dr. Regina Benjamin, Founder and CEO of Bayou La Batre Clinic, and the 18th United States Surgeon General, and I am thrilled to be guest hosting with her today.

I got to pick the guest of my choice. And of course, I instantly settled on my wonderful colleague, Regina. I'm coming off this book publishing process, and one of the things I'm most proud of is Regina's endorsement on the back cover. I want to read it here, as I feel it perfectly captures who she is in her career.

This is what Regina has said: "I've cared for patients in small, underserved communities, and I've sat in boardrooms where decisions are made that shape access, prevention, and outcomes. We need more leaders who can bring clinical experience, public health perspectives, and business acumen into the rooms where decisions are made. It's the only way we can ensure that high-quality healthcare services exist where people live."

Regina, thank you so much for being here today. I'm going to maybe start with where it started for you.

Regina Benjamin, MD, MBA: Thank you, Cheryl. It was an honor to write the little blurb on your book, and your book has been wonderful, I have to say. You know, as you are my longtime colleague, my confidant, basically helping me with my career path, but most importantly, as my friend, I was honored to write that. So, thank you, and thank you for having me for this.

Host: Thank you. Thank you. I think, you know, our lives are a journey, our careers are part of it. And if we treat the career separate from our lives, we just miss out on having fulfilling lives. So, I know for you, like for me, we love what we do, and it just feels like the right thing every day when we get up.

But I want to talk about you today, and I want to talk about how you got started, the work you've been doing all the way through to the work today. So, expect that there is a lot I hope we can glean from your experiences and your just incredible expertise. So 1987, you went to Bayou La Batre, you joined a clinic. And in 1990, you opened your own clinic, and then you were the only doctor, the only doctor until April 2000 when you hired a second doctor.

And here's something you said during this experience. Your patient had problems the prescription pad alone could not take care of: housing, clean water, literacy—real public health issues. How did you then manage your clinic as a business and a needed community resource?

Regina Benjamin, MD, MBA: You know, like you said, I started at a federally qualified health center, which was not very far away. It was in the same area. And I went there as to fulfill my National Health Service scholarship program. So, I had to pay back my time in an underserved area, and it just so happened to be close to where I grew up. And so, I was home. In the two years I was there, I noticed that there were patients who were not coming into the clinic because they made too much money to qualify for Medicaid, and they didn't make enough to have health insurance, and they didn't want a handout. And so, those were slipping between the cracks, and I would meet people in town and that sort of thing.

So, I decided to open my own and people were coming. I had this little storefront, and patients were coming before I was able to even get the rooms ready, or my boyfriend was kind of a contractor, and he was trying to build the rooms and folks were bringing my babies with sawdust in the building. But I also saw something that happened was I had set up the little room for the lady receptionist, and everything else was clinical. I had no place. And pharmaceutical rep came and said: "Well, where is your business office? Where is your copy machine?" And I had never thought about a copy machine or the business side.

And that day, I decided, "Well, what am I going to do? And I looked online, and I saw Tulane had a executive MBA program, and I enrolled that day, and I got my MBA. And I got my MBA to find out a way to serve a community of people who couldn't really afford the healthcare but couldn't afford not to have it. So, I wanted to figure out how to deliver healthcare in an affordable way, in a quality way, and I'm still trying to figure that out. Maxed out my credit cards. I did all the things I needed, but it was well worth it. And I will say getting that MBA made a big difference.

You mentioned public health. The public health portion, I'm going to join—I grew up through the AMA as its resident, and I was inactive on the leadership of the AMA. And I served on our state licensing board and state medical association. We were also on the state committee of public health. So, I had been doing public health by being in these meetings all the time. We hired the state health officer in Alabama, unlike the governor in most states.

And so, I was living public health and this is what I saw and I see the—it's a shrimping town, and the water was, like, dirty. It was black. And we wanted to know how to clean up the water. The different agencies would not pay attention to it. So, I just got the shrimpers themselves. We put barrels out on the water. And when the shrimpers came in, the way they used to change their oil in their boats, is they would empty it in the water and put more oil in the boat. Just by putting those barrels, they started emptying it into the barrels, and the bayou started clearing up. It didn't take money. It didn't take anything. And the shrimpers wanted that too. It was just giving them a way. It was just simple things, and there were so many simple solutions of things that we found.

Host: What I love about that is a lot of healthcare doesn't require new technology, new treatments to be discovered. It requires us working together in a community to get that done. Truly what public health is. As we sit here today, what's improved over your time? Because you're still managing this clinic.

Regina Benjamin, MD, MBA: Even back then, being on the State Committee of Public Health and stuff, trying to get the agencies and stuff and arguing, trying to get them, you come up with simple solutions. Today, simple solutions still can help. It's those social drivers of health that improve our health outcomes so much better. If we pay attention to those things, social determinants, those are simple things that are hard to do because they are simple.

The things that change now is things are more complicated and it's harder to get services to rural communities. It's much more difficult and much more expensive, and many of these communities don't have the resources that's needed. Technology certainly helps tremendously in bringing services. We also have this distrust in public health that makes it even harder. For my patients, I find that I talk to them and talk to them about common sense, and they have common sense. You know, I'm not trying to convince them of different things that they need to do. But if I have them understand why they need to do certain things, why you need to basically eat healthy, why you need to do this, then they decide to do it. I encourage them, of course.

Host: I love the statement, having common sense in healthcare. I think a really important statement. You talk about how challenging it is to work providing healthcare services in a rural community, if you were advising a health system today on how do you keep a rural hospital open or a clinic open.

Regina Benjamin, MD, MBA: You know it's hard and you're seeing many of them closing now. But I'll go back first and just say why it's rewarding to practice in a rural community. The example I think of is during Katrina in our little town of Bayou La Batre. During Katrina, the town is 2500 people, 2000 lost their homes, and everyone was affected.

Our clinic was destroyed and we rebuilt it, and we rebuilt it from a different hurricane before too. And as we were rebuilding it, a fire occurred and it burned to the ground. And it was the day before New Year's, and it burned to the ground. And that next morning, I was out with the fire inspectors. This embers were burned, smoldering, and my patient sent me an envelope with five dollars in it by her granddaughter and a note that said, "To help rebuild a clinic." And I knew if she could find the five dollars, I was going to find the rest. When you're in a small community, you're part of that community, and they're part of you. And there's nothing more rewarding to be a part of that. So, it's very worthwhile for me to be in the small communities. And I think you can't buy that kind of feeling and that you're making a difference.

Host: Regina, I think one of the things that you're saying is that people who come from these communities are very well-suited to serve and provide healthcare in these communities. They understand the needs of the community. It is their community. And one of the things that I think we want to see in healthcare is that we attract people from rural communities to become healthcare professionals, be it doctors, nurses, NPs, because the likelihood of going back to your community is greater, and the resilience to want to stay and make it successful is even more.

Do you find that you spend time having to explain that to people not from those communities? The kind of, "Well, I don't know if I would go there," versus someone who's from those communities who say, "Yes, I only went to medical school because I want to go to my community."

Regina Benjamin, MD, MBA: Both exactly what you're saying. I also precept or have students come and do rotations with us. At our two medical schools in the state, they are required to do a family medicine or a rural rotation and expose the students who've never been to these communities. Many of them will have an experience where they never had it before. And even if they don't come back to the community or if they don't become a primary care, they know what the primary care doctors and the doctors in those communities need from them. And so, that experience helps them. Some of them are converted, and they want to come, but more likely you're going to see the ones who grew up in these small towns, understand them, they want to go back to that setting. And we have to invest in trying to encourage that pipeline, because I look at rural students as underserved like any others because they don't have the same opportunities. They don't have the same exposure to professionals like many people in a big city may have. So, purposely recruiting from these small towns and small communities and underserved communities particularly can pay off in the long run.

But I wanted to go back, you asked me, how could we advise a system? I've been on the boards of some large systems, Kaiser Permanente and Ascension. Those systems are two different type system. One is a fee-for-service, and the other is value-based care, and yet they both serve communities. I think it's important that those partner with small clinics, small practices in those small towns and bring some of those resources together. But technology also helps. I can now send to you a cardiologist and not have to send a patient 30, 40 miles away by doing a video conference or video call. And the technology helps, and it also helps me stay in touch with my colleagues. Those improve the lifestyle so the clinicians can stay in the areas, but it also helps these practices stay open. I could get into the financing and that sort of thing. That's a whole political football that we all have to watch and monitor and support trying to keep these rural hospitals and systems open.

Host: But I do think your point of everyone in that community is working together, they're not competing. The clinics aren't competing with the health systems, and the health systems have to see the clinics as almost a hub and spoke. They may be the hub, but the clinics are the spokes and ensuring that resources are available for them to be able to provide their services.

You know, the way hospitals are structured, and I think for rural hospitals, it is the building, and then it's the people. And then, it's the community, and then it's the connection to the community, and then it's the connection to the larger tertiary healthcare system. When we think of how do we ensure their success, it's also ensuring that we ensure the expertise is there in the community.

So, it's, yes, having students in school, be it MBAs, frankly, public health, medical school, either be from the community or have experiences in those communities because this is a you should see it to design what's occurring, not come from an ivory tower to design for the community. I think one takeaway from your comment is: how do we ensure that students and healthcare leaders are rotating through these communities? And are these communities or the local healthcare professional organization, be it the health system or a group of clinics, are they setting up those rotations to make them happen?

As you know, Alice Walton School of Medicine has opened, and they are only recruiting students from rural communities so that they can meet the needs just of Arkansas, but the other communities around them. It's a really important tenet, but also ensuring that others from other communities can come in to support. So, I do think, yes, that is one big piece. Two, the people who are there leading are really having the expertise to look at the financials and build out whether they can do VBC, whether they can do remote monitoring or telehealth, and really taking advantage of what exists today, for these communities.

We talk about clinics, but not also about the local pharmacy. You know, the other places that people can get care, the other places where services are available, and really making sure you understand the infrastructure before you say, "Oh, this solution I can just plop in there." And you have made sure that when you speak about a community, you know that community. That is the work. That is the pre-work, and you've done it.

Regina Benjamin, MD, MBA: I would also add the team, putting the team-based care together, because all the things you just described is putting those teams together, having the nurse practitioner, the physician, the clinician, the social worker all working together, and the value of community-based workers. The folks who are in the community and they're there, they know the individuals. They can come in and say, "Mrs. So-and-so didn't go to the grocery store today." That is valuable, more so than we can ever get from a 10-minute visit, so...

Host: Absolutely. I think it leads into my next question for you. As surgeon general, you built the first ever national prevention strategy, and you've always said we pay for sick care instead of prevention. Fifteen years later, that's probably still true. If you could focus on one change to get us to frankly look at prevention, what would that be?

Regina Benjamin, MD, MBA: You're right. We do have a sick-based system versus a prevention system. And it's probably not the thing you would think I would answer, but I think that if I had just to invest in one thing, it would be in education. Because if I can get a kid to finish high school, it matters.

The United States death rate of people with less than 12 years of education is two and a half times higher than those with a high school diploma. Just having that degree makes a difference. An additional four years of education is found to lower the five-year mortality, reduce the risk of heart disease and of diabetes by 10 percentage points just by getting an education. So, investing in education from the beginning could make a big difference in health outcomes.

Host: Do you see clinicians, healthcare leaders ensuring that a principle like educating your community, that they track, they follow, they engage in within their community? Should health system leaders ensure that they are part of that leadership? Is that being done?

Regina Benjamin, MD, MBA: It's not done enough. You know, you'll see a little bit here and there, bits and pieces. But I think we need to take that on as our responsibility. We'll say, "No, I'm here to give you a prescription." And that's good, but not enough. And so, we need to take that on as part of our responsibility in improving health of these communities.

Host: And there's a, you know, "How do you use data?" We collect, we ask people, "Did you complete, high school?" We ask them, "Did you complete graduate school? What's your highest degree?" We actually ask clinicians collect that information today. I don't know if we stratify out enough for those who have not. Are we ensuring that we have set them up to meet with a member of our team, be it a community health worker or others? Are we encouraging in that manner? To your point, simple things, but structural changes that you could put into place, particularly if you're tracking the data and you understand the overall ROI.

Regina Benjamin, MD, MBA: So, we started a Gulf States Health Policy Center to improve the health outcomes for the states that border the Gulf of Mexico, Alabama, Mississippi, Louisiana, Texas, and Florida. We had the poorest health outcomes and rankings of all the states. And it's not because we don't have good facilities. We have great medical schools. We have UAB, Tulane, all these great medical schools, yet our rankings are low, and it has to be something. And these are the social determinants or social drivers of health. And I had an NIH grant to look at those. And so, some of the things we were doing were teaching people how to read labels and cook healthy foods, how to get a GED.

We had GED classes, you know, twice a week, and those are the things that really are improving the health outcomes of the community. Walking, exercising, and having the patients themselves, once they go through these programs, they become the teachers. And so, it's almost like they continue it. The grant has run out, but they're still continuing to do it, which is great.

Host: I think it's where you absolutely need team-based care because our doctors who are treating acute problems, somebody else on their team should be helping with that. You know, we talk about team-based care. The reason that has not advanced where we're looking at determinants of health, we're ensuring, you know, someone isn't seeing a doctor when what they really need is help in learning how to take their blood pressure, they're seeing the appropriate person.

It's because our payment models have not structured themselves to allow a clinician to really bring that team in. Today, right, clinicians get paid for what they do, not what the rest of their team do who isn't licensed to bill. And I do think when we talk about rural health transformation and we talk about the needs in communities, payment models are just as important as being from that community, understanding that community, being able to track the data of that community.

Particularly for rural communities, it is probably up there in the top three that must be addressed. I think sometimes we try to address it across the entire country. If we picked rural communities and really focused on addressing there, we'd see a lot of these results that give us a lot of hope

Regina Benjamin, MD, MBA: Right. Totally agree

Host: So, I want to switch. I mean, healthcare overall, I'd say in 2026, we hear a lot about burnout, challenges in reimbursement. You mentioned, you know, in rural areas, health systems closing. One of the things that we're also seeing is really high CEO turnover in hospitals. Recent Becker's report, it is up to 32% this year compared to last. It's a very high number of people saying, "This is no longer a role that I want to be in." You mentioned, you know, you work with health systems. You talk to CEOs, you and I, of hospitals all the time. I'm less talking about why are they leaving, really trying to understand if they leave and when they leave, what does that mean for the health system? What does that mean for healthcare, the impact of having so much expertise leave at this time?

Regina Benjamin, MD, MBA: It means we really need to emphasize that pipeline. You know, just like we have a pipeline for students to go into healthcare or health careers, we need a pipeline for physicians to become leadership and management and get the business acumen and those sort of things to be prepared to be in those rooms. I find that the boards that I serve on, the companies are much more effective that have a physician on the board or at the table versus the ones who simply have a medical director come in and give a slide presentation and leave. But those who are there, the conversations are different, particularly in healthcare companies, just having that perspective.

The way we as physicians are taught is a lot different than the way a business degree, the MBA as told is a different perspective the way an engineer is taught. And maybe a CIO or information officer is they're looking at things differently. That physician's going to look at that clinical perspective and that patient perspective, and you need all of those. It's just like any other. You need that team. But we do have to build that pipeline and have physicians being prepared and, and groomed to go into, to management and leadership. And you bring that out in many places in the book, I think, , is really what I find most interesting in the book

Host: Thank you for that. I mean, I think physicians have not always been seen as being the CEO. I think they haven't seen themselves that way, and I don't think the healthcare industry has seen physicians as CEOs. To your point, there are new skill sets to be gained. But I think for almost every industry, the CEO doesn't know everything. The real importance and the training for a physician leader, for a physician CEO, is do you know how to assemble the team of skill sets that will lead to success? And can your board help you in doing that? You know, I tell people a lot of people focus on the CEO. When you see high hospital turnover like this, I think we also look at the boards and are we ensuring that boards have the right skill sets to not only help a CEO through the tough times of healthcare that frankly have been going on for a couple of years, but are ensuring that the feedback and the skill sets on the board are matching what we need today. And that really becomes how you structure it as a business. Is this business structured with the right skill sets at the leadership level and at the board level to be successful?

I think you've also mentioned training, and I do think what we consider continuing education has to be continuing education and understanding payment models, continuing education in understanding determinants of health, continuing education in not only how you look at your P&L, but how do you look at the data that helps drive that. And those are new skill sets for a physician, but I think even if you're an MBA, it's new skill sets to understand that you will have to meet HEDIS requirements and NCQA requirements. And we don't always say the MBA has to learn that, and that's not a tall hill to climb, but we always say it's harder for the clinical person to learn that.

It's frankly having the interest and leaned in approach to want to learn, to want to grow, to be humble enough to say, "I don't understand that." Many years ago, I worked at Aetna and Jack Rowe was CEO. And I remember Jack Rowe saying to me, "Hey, you've got to come to the finance prep meeting so when we're on analyst calls, you're not only following it. But when it's your turn, you know what to do." Holding my hand as a physician and bringing another physician along. Never saying, "Oh, you know, you don't have a business background." Saying more, "I expect that you will learn this."

I think when we raise the expectations for ongoing learning, that's where we really see what can happen. You know, you talked about the shrimpers. They had the same need. No one had approached them and said, "Here's another way to dump your oil, and we're going to partner with you to do it, knowing what your busy schedule is." That mindset, right, of being able to sit back and look holistically, I think it comes so naturally to you, Regina. Is that something you think you were born with? Did you grow it? How does that develop?

Regina Benjamin, MD, MBA: I think just being around mentors and watching others do that. I've had the luxury of being around them. But I want to follow up on what you're saying. The things that you just described also have to be intentional. They just don't happen. That change of mindset, that getting those physicians, pulling them along like Jack did with you, it has to be intentional.

I remember being on the Ascension board over the years, and we put in a leadership, a fellowship program, and the managers would pick different people to be leaders and go through that program and leadership development. And those folks who went through those programs were now somebody has told them that they're leaders. And now, their mindset starts to change, and they start to do things in their respective areas, and they're on that trajectory then because somebody picked them and said, "You're a leader." And that's that mindset that you're describing it has to be.

My mentors really, you know, I'm fortunate I was the second class of Morehouse School of Medicine. And so, I got exposed to a lot of folks. Dr. Louis Sullivan was my dean and taught me hematology. He became the secretary of HHS. Dr. Satcher was my community medicine professor, and he became surgeon general. And I used to sit next to this little older doctor—I mean, older person, he wasn't a doctor—and, you know, we'd be at all of these events and, because we're the first few classes, and it was Benjamin E. Mays. And so, I got to sit next to him to get his wisdom and all of these folks who had just done things. They were leaders in their own right, because they just saw things needed to be done, and they did them. And they just stood up and got it done. And to me, that's entrepreneurship, but we didn't know that's what it was.

Host: It's also having the exposure. And I do think, you know, it's risky to go start your own business as a clinic. It's risky to do something in healthcare as a physician where you're the only physician in the room. But it's also understanding with humility, I will learn this, to "Do I clearly understand my contribution and am I learning from the others in the room?"

I think in healthcare, one of the things that I do talk about in the book is that we sometimes are so unwilling to look at other industries and what they have accomplished that if we just studied that and brought it to healthcare, be it supply chain, be it, you know, the use of technology and the protections, we are so very focused on inventing ourselves. Because healthcare is so legislated, so regulated, we think there aren't other things to learn. But there is so much that we can easily pick up. I think it's finding the time as well to do that. I know your schedule and I know mine. You make the time. You invest in your own growth so you can accomplish the things that you need to do. You make those relationships where you will have to be, you know, not the smartest person in the room. You are the person in the room who wants to get it done. And success requires taking all of the skills from everybody else to make something get done in healthcare, in a community.

And I think one of the things that I try to always remember, you know, even now, I'm still learning. Everything I learned about how to lead in healthcare and do in healthcare, it's different when you're doing a startup company from when you're doing an established company. It's different when AI is introduced. And am I taking the time to ensure that I'm learning and listening? I love when, you know, my most junior person on my team, they say, you know, "Oh, we should get a chatbot for patients so they can get their questions answered."

And the next day, you know, she sends it to me and she's like, "Oh, I did this last night." And I'm like, "Okay. If you were looking to humble me, I'm humbled and grateful to be working with you." I do think that energy of let's be open to the people who are front line and bringing that in is also, I think, what adds to this. This mentoring is not just, I think, in our vertical, but it's really lateral.

Regina Benjamin, MD, MBA: It's like running a code. You have to learn when to lead and when to step back. If I'm running a patient that's coded, I'm not going to be the person necessarily to put in the IV. I need to let the expert put the IV in, because the nurse has done this so many times, or the person who puts the endotracheal tube to breathe them. Everybody has their role. And so, you have to know when to let them do their job and do their job well, and when to step up back. And sometimes as leaders, we develop people, but we don't always let them do their jobs, and that's constraining. It's really important that we think differently.

I had never seen a Black doctor before I went to college. And so, I never thought about being a doctor. I never thought about not being a doctor. It just never came. It wasn't in my thought process. But it didn't stop me. I was exposed to things in college and stuff that you create something that is filling a need.

If there's a need, it may not be a solution unless you create that solution. And sometimes sitting in a boardroom, the answers may not be there with you, but you have to pull on all the team together to come up with the right solution. And everybody contributing a little bit of each other, you come up with good solutions, and that's what you're describing.

Host: I mean, I think you know your point. I just want to make sure that I maybe repeat it. The exposure that is needed to ensure that you can realize your own full potential, it's ongoing. And if you don't see it and you want to do it, you may start down the path. But when you finally see others just like you doing it, it's an energy rush.

And I think, you know, if you see it, you can be it, continues to be something that whenever I see a young person who tells me, "Well, I did this because I saw this person do it, so I knew I could do it because they came just from where I came from." That continues to be so powerful.

You've had a lot of different experiences, rural clinics, obviously, boardrooms, surgeon general, and you definitely went in, I'm sure, with, "Here's what I know I want to do. Here's what I'm sure is the right answer to what I'm doing." But you've now had lived experiences. You've seen broader expertise. What today would you say you've changed your mind over after all these years?

Regina Benjamin, MD, MBA: Yeah, I've always gone in seeing what I can learn as well, because I love learning and also how I can do something better. You know, if we're doing it a certain way, you know, how can we do it better? If I go back to looking at the clinic, for example, and nonprofits and I, you know, serve on nonprofit boards too, I thought that I had to find all the answers myself, and I know now that I can't do them all by myself. I need others.

I also thought that, as a nonprofit, you just ask for donations, you beg, whatever. I realize now that in order for nonprofits particularly to survive, they have to have their own source of income or generate some sort of income. And the services and things we do, we can monetize some of those to keep the clinics or keep the nonprofits or keep the organizations self-sustaining because everybody's asking for donations, asking for things. So, the more you can be self-sustaining, the better the long-term viability of that organization.

And when you're looking at a clinic or something, you have to make some sort of a profit. The nuns used to tell us, "No margin, no mission." You have to keep the doors open or you can't do your mission. And so, it's important that you think about the responsibility of keeping that entity going, that it requires a business approach to keeping it going for the good of the community.

Host: When you think of today and your business acumen today in what you've learned firsthand, what you've studied, but frankly watching how other businesses run, what to you makes it seem like this is the thing that's really important? Because I do think—I mean, everyone manages their household budget. They truly understand how to get food on the table. They understand what's required in bringing money in to do that. Something changes when you sometimes go into a not-for-profit organization or a health clinic where there is—well, one not getting paid for doing this enough, even though you might have known that the payment was not enough. You knew that going in.

Regina Benjamin, MD, MBA: Some people also have the attitude that they're doing these folks a favor, and that's not the case. I had the fortune of getting to know and spend time with Peter Drucker before he died. And I was getting ready to run for an office at the AMA and stuff, and I asked him about management and stuff, and his advice to me was: if you want to be a good manager, have good manners. Basically, have good manners, treat your people well, and they will do well. And we oftentimes don't see that enough. You know, the people who are working either for us or under us, that we're not treating them with good manners. And when we do, they buy in, they feel valued, and that translates to the entire organization. And if we could just do that throughout, it would help.

Host: It is why your frontline people brings you great ideas on what to do, and then they go ahead and do it, because they feel they're an owner and they contribute and they matter. Ithink it also goes the other way, right? The transparency of letting them know what's actually going on in the business. Sometimes that's hidden in the C-suite and people don't know. When people know, they know what to do. They know they matter because you brought them in under the tent. And so, that two-way communication, something that II think is really important. You know, as you can say, "Oh, well, they won't understand, you know, the top—

Regina Benjamin, MD, MBA: I did that as early days in the clinic. You know, I wanted to protect them. You know, I didn't want my employees to know that I was having trouble meeting payroll. But then, I started bringing them in and letting them see that, and they understood. And they started helping and it was much better, because the receptionist would say, "I know she can pay her bill today." "She can't." And they'll say, "This one doesn't have any money, so don't charge her." But she knew the difference. And bringing them in, they became a part of it. And you're absolutely right.

The other thing I learned was I thought I had to do it all, and I was a Kellogg fellow, and we went to this Outward Bound in Colorado, climbing a mountain. They said we couldn't call back home. I'm like, "How's the clinic going to go for a week without me?" And what I learned is that I gave them, empowered my employees to do things that they knew the way I would do it, but they did it. And they may not have done it exactly like I did it, but they sometimes did it better. And, as I came back, it was so much better because they then had the power themselves to do things. And it changed everything, because I didn't have to do it by myself and valued their opinions and allowed them to make good decisions.

Host: And by the way, translates not just at work, but at home. My husband would say he was always shocked I trusted him to spend a full day when our kids were babies, that I would come home and they'd all be in one piece. He did just fine. Rules, when you eat, they eat. He did just great.

Regina Benjamin, MD, MBA: That's right. And also, the surgeon, a surgery professor told me that, you know, it's one thing you can teach somebody to cut, you know, to do surgery, but it's very hard to teach them and have them cut through other people's hands and align.

Host: Well said. Everyone contributes. Might not be the way you did, but did the team get it done? You've been quoted really just talking about making health joyful. I titled my book Optimism because I believe that you have to get up every day and not go, "Gosh, what's wrong?" It's, "What can I do? What will I contribute today?" Given all of our challenges, what are some practical ways to keep organizations optimistic, joyful, that you're frankly implementing or you're seeing implemented?

Regina Benjamin, MD, MBA: Well, I first started that, I called it the journey to joy that when I was trying to get the nation to be active and more healthy and moving and exercising and stuff. And so, I thought it should be joyful. And so, food should be tasteful. It shouldn't taste like wood. It should be enjoyable even if it's healthy. If you're exercising, it should be fun. You should dance. You should do things that you enjoy and not think of it as a drag and you will sustain it a lot better. And the reason you may want to do an exercise, not because you want to fit in a pair of jeans, but because you want to pick up your grandbaby or something and be able to carry. So, whatever that brings you joy is your motivation.

And the same thing in organizations, people have to enjoy coming to work. You can tell when you go to an organization and the people aren't happy. You can see that sometimes in certain airlines. One airline, the employees are happy and they're treating you well. The others, they don't want to be at work. But that really matters in your day-to-day life because you spend a lot of your time at work. And if the leaders in the organizations can spend more time having their employees and their leaders happy and enjoying what they're doing, it will be much more successful for everyone.

Host: Yeah, I do one simple thing. I recognize everyone's birthday. They're just all so surprised, you know? But it makes them feel seen.

Regina Benjamin, MD, MBA: You don't tell them how old they are, do you?

Host: I just did a birthdays. And that even if it's on a Tuesday, it's a great day to celebrate with it and make it personal. I think people, that touch of someone seeing you or remembering you is great. I think it's also the humor of ensuring that you're introducing it. Yeah, you've got revenue to think about, you're very focused on quality, reducing risk in healthcare. But, you know, fun things happen too. And I think that our brain, the endorphins, they respond to us making sure that we're in joyful environments.

Regina Benjamin, MD, MBA: People want to be valued. And it's like if you don't feel valued, you don't enjoy going to work. Even, I mean, anyone, everyone, the housekeeping, whatever, just saying that, you know, "You really kept this place clean. It's really nice," it makes them feel valued because we do value them. But people need to know that, and we should share that.

Host: When I was in training, I would always ensure I said good morning to the security guard, as you walked into the hospital, and then the person who, on our floor, the floor that I was working on, you know, would be the one to come in to transport patients. And I think just routine, right? I saw them every day. But I'll tell you the win of that was I would get access to the rooftop of the hospital for July 4th. I would get to go there. Many years later, I feel I can finally reveal that, the statute of limitations has gone through.

Regina, this has been wonderful. I want to end with maybe a quote from the first chapter of my book, The Optimistic Leader's Guide to Healthcare:

"I love working in healthcare. I truly believe it is the best job in the world. No other field I know offers the same combination of purpose, flexibility, and opportunity to change lives in such a direct and lasting way. My hope, continuing to draw more talented, mission-driven people into this extraordinary profession because we have the ability to transform the industry."

Regina, you represent the talented mission-driven leaders who have changed and continue to change lives. Thank you so much for joining me today.

Regina Benjamin, MD, MBA: Thank you, Cheryl.

Host: For more information on ACHE's podcast, please visit ache.org. I'm Cheryl Pegus. And thanks so much again for being part of the Healthcare Executive Podcast from the American College of Healthcare Executives.