Amanda Wilde (Host): Healthcare leaders are the powerful arbiters who determine direction, focus, values, and priorities for their organization. They have an immeasurable impact on financial sustainability, workplace culture, and patient care. We're talking about balancing all those elements and healthcare leadership with Dr. Norvell V. Coots, President and Chief Executive Officer, Holy Cross Health and the Maryland Region of Trinity Health. This is Your Best Life Podcast from Holy Cross Health. I'm Amanda Wilde. Welcome, Dr. Coots. It's such a pleasure to have you here.

Norvell V. Coots, M.D., MSS, FAAD: Thank you very much. I'm really looking forward to this today.

Host: Well, I think a good way to understand healthcare leadership is just through your biography. Can you talk a little bit about your professional background and also share what inspired you to pursue a career in healthcare leadership?

leadership

Norvell V. Coots, M.D., MSS, FAAD: I think, I'm a little bit atypical probablybecause, my background really is from the United States Army. So I did 36 years of a military career. I'm a Board Certified Dermatologist by training, but I started out in the Army as a medical logistician or a medical supply officer, and got out, went to medical school.

And came back in and then sort of worked my way up the leadership ladder. At some point in time, I got selected to go to a special school called Command and General Staff College. And I did that in resident. And, only a few doctors get selected for that because it's really a combat arms type of thing.

And so that is probably what set me off on the administrative track as opposed to the clinical track. Because after I did that, I never really returned to full time clinical practice. Although, I've always kind of continued to see patients. I see that as my grounding. But it took me into the administrative lanes and so I began to work my way up through leadership in hospitals and health centers.

Host: How do you balance that military background, that kind of leadership with civilian healthcare leadership?

Norvell V. Coots, M.D., MSS, FAAD: Well, you know, healthcare leadership is all the same. I mean, it's, a misperception to think that leading healthcare organizations in military is any different. I mean, a hospital is a hospital, a patient is a patient, human beings, the diseases are the same, you know, situations might be different.

You know, when I was the commander at Walter Reed Army Medical Center during a two theater war, the focus was on the combat casualties that were coming back, and so the routine health care, was sent out to the civilian sector so that we could make room in the hospital for the combat casualties coming back. But other than that, I mean, mothers deliver babies in military hospitals just like they do in the private sector. People have kids that need to see pediatricians. We see older retirees, so we have geriatric practices, and then, you know, aches and pains and scrapes and breaks and things like that, so it's all very much the same.

I think it's just sort of the mindset of a military health system being there to support the warfighter as opposed to a civilian health system really being there to support the broader community.

Host: But you're saying the logistics of that are really quite similar. So that doesn't change between military and civilian. What about the COVID pandemic? Did the pandemic change the landscape of health care?

Norvell V. Coots, M.D., MSS, FAAD: Yeah, it certainly did. I mean, it rewrote it. I think that, you know, we had been talking about the disruptors in healthcare that were coming and we thought that was going to be Berkshire Hathaway and, and CVS, Aetna, and Walgreens getting into primary care and things like that. It turns out that the pandemic was the great disruptor.

The pandemic showed us how broken our American health system had really become, and how it really wasn't transforming and moving forward. And it really, gave us the impetus to, develop new procedures and things like that. New equipment was brought in, just new tactics around healthcare.

But since the pandemic has ended, we've sort of lost some of that momentum and sort of drifted back kind of into the old ways that we were practicing. And I think that we've wasted all of the lessons that we learned during COVID in terms of speed to transformation.

Host: So what do you do to bring that back? That's more sense of urgency about change.

Norvell V. Coots, M.D., MSS, FAAD: Well, I think, change management. Change is a difficult thing, whether you're in the military or in the civilian sector. Leading change is not easy. People have a tendency to want to go back to what's comfortable for them, what their comfort zone is. COVID was definitely not our comfort zone, so people wanted to retreat back to the pre COVID practices as quickly as possible.

So what I as a leader have to do is to try to constantly focus on getting up over the horizon and developing the healthcare systems of the future and convince people that it is in their best interest to want to divest themselves of the old ways of doing things to move forward into a new reality.

We realized that our health systems were broken. We realized that we had access to care problems. We realized that we had financial problems, different relationships with payers and things like this. And really, we were practicing medicine in the health systems that we inherited and not that we created.

What COVID gave us was the opportunity to start to create the health systems that we've always wanted to have. And we were starting to head in that direction, and somehow or another, I think what happened was the post pandemic aftershocks when all the health systems started to go financially upside down.

And so the focus was, how do we continue to provide the health care? How do we continue to get the access to care? But how do we get the finances back? And when you put your head down and start to look at that, and you don't look up over the horizon. You don't look up into the future.

Host: Well, healthcare leaders have a complicated job of having to balance really competing interests in order to optimize the health of patients, but the health also of the institution, which you just touched on. So what strategies do you employ to foster a positive organizational culture that allows you to go forward with the changes you want to make?

Norvell V. Coots, M.D., MSS, FAAD: Well, I think, you know, communication is the key. Having a good relationship with all the different members of the staff, from the physicians to the nurses, to the technicians, to the people who are really important. Most important of the hospital system, the ones who meet the patient on a daily basis, your front desk folks, are critical.

But then your back office people are critical too, So, really communicating across all the domains, making sure that everyone understands what the mission is. We are a Catholic Healthcare, so we have, we're a very mission, vision, and values based organization, but to be articulate what the mission is and what the future is, to kind of set the conditions for what right looks like and for what success looks like and to be able to articulate that. That is how you motivate people to want to change, to want to see something different, to want to do something different as well. I think leading the team also means being a member of the team.

So being seen, going out and rounding, being there at huddles and different types of meetings that they have. For me as a dermatologist, I still get called to see patients with the interns and residents, that we have. Sometimes there'll be a, for lack of a better term, a funky rash on a patient.

So they're like, hey, let's get Dr. Coots down here. So I'm seen as still being an active member of the healthcare team, not just the exalted administrator sitting off in the high tower somewhere. So I think that, those are all the things that are, are very important. Information sharing is critical. So doing town halls and, you know, when I round, I talk to people about, you know, what our plans are and things like that. But I think also making people have a sense of ownership in the organization by empowering to the lowest level. So that you know our mission, vision, and values. You know what the vision is, where we're trying to go.

And it's okay. As long as it's morally correct, financially correct, you can make that decision and I'll back you up. Because you know where I want the organization to go and I trust you to be able to do those things within the parameters of our mission, vision, and values.

Host: So, communication and relationships are key among staff. How do you approach balancing financial sustainability with the delivery of high quality patient care?

Norvell V. Coots, M.D., MSS, FAAD: On a day-to-day basis, that is probably the biggest challenge that we have because nothing is set and nothing is fixed. There are things that we can't control. We can't control inflation, we can't control the supply chain. And certainly COVID taught us that because the supply chain at points was absolutely broken.

We cannot always control the supply of labor. And the pandemic taught us that, too. So, really, having to have a laser focus on each of those things, almost on a daily basis. Watching the number of patients who need access to care. Watching the number of surgeries we do on a daily basis, the number of deliveries that we do on a daily basis, what our staffing level is.

 If there's a big disease burden going around right now, like it is with all of the respiratory viruses, how many call outs do we have? How many nurses? How many techs? How many PAs are out? How do we maintain that? and then how do we negotiate for better rates from some of the suppliers and things like that to overcome the impact of inflation?

And then for us here in Maryland, we're in a rate set state. So I have a limit on my budget. I have a budget that I have to live in. There's nothing I can pass on to the patients like in other health systems or to other payers or things like that to say we've got to make up some ground and make up some difference.

So I have to live within those parameters and what can I shift around so that I can continue to provide the same high level quality of care, given the circumstances that I'm facing today, which may be different from tomorrow.

Host: Right, it's constantly changing, and that brings me to the innovations that we're always hearing about, technological adaptations and enhancing healthcare through things that are happening, all the, just things are developed all the time, so how do you prioritize bringing in those innovations and adopting new technologies?

Norvell V. Coots, M.D., MSS, FAAD: Well, we all want to stay up and stay abreast of the latest things. We all want to practice evidence based medicine. We all want to use the latest tools and equipment. Being able to prioritize part of the budget to say as soon as this piece of equipment starts to hit shelf life, we're going to go and get the next best thing to replace it with.

Like, for instance, robotics. Robots are now in everything. Robots are big in orthopedics. Robots are big in thoracic surgery and general surgery. And so, we want to prioritize getting the latest things, but, you know, you don't want to be the first to try the new, nor do you want to be the last, right?

You kind of want to make sure that this really is the right equipment, for the right patients, for the right reasons for your organization. You prioritize funding around that. You develop a proforma. You get a group of champions together around this new technology or this new equipment, and then you implement it.

And then you have to be prepared to fail fast. Okay. If this is not working, if this is not the right thing, then let's change tach, let's get rid of this and let's bring something else in that's new. One of the things that we're looking at right now is the implementation of more and more artificial intelligence, AI and healthcare.

What can it do? There's AI built into a lot of the equipment, so much of the equipment now is computerized and digitized and everything that the surgeon is as much an IT person as they are, as they are an actual operator. There's AI that's now built into our electronic health records.

There's AI now that can listen while you're doing your appointment with, you're visiting your doctor and the doctor is just looking at you, no longer taking notes, no longer typing at the computer because AI is listening and making a record of your visit so that the doctor is not distracted and can really focus on you full time.

And then there's AI now in radiology too, for basic plain film x-rays, the computer and AI enhanced programs can read it better than any radiologist ever could. There are still things that it takes a skilled radiologist to do special procedures that, that AI probably will never be able to do. But on those plain film reads, why not implement AI so that the radiologists can do the higher level work that's necessary. So these are some of the transitions that we're going through. These are some of the things that we're looking at. Of course, the world right now is trying to balance and create left and right limiters on AI because there's a fear that artificial intelligence will take over at some point in time and run amok.

I don't know that it'll really do that, especially some of the applications that we're using, but you know, you do have to make sure that you look at all of these new innovations from an ethical point of view as well. Like what's downstream? How will this impact the clinician? How will this impact the patient? How will this potentially impact society at large? So these are really big ideas that we have to look at beyond just access to care and providing you know, the best quality care to our patients when they come to us.

Host: You mentioned ethics, and as you said, the pandemic brought to light things that were not working within the healthcare systems that we have. In the face of healthcare disparities that have come to light, what initiatives has Holy Cross Health undertaken to promote equity?

Norvell V. Coots, M.D., MSS, FAAD: Well, because we're Catholic and because we fall under the Sisters of the Holy Cross, equity is a big part of our fiber. We have a thing in Catholic healthcare called subsidiarity, which means everybody's voice counts. Making sure that whatever we do is fair and equitable to everyone, regardless of their ability to pay, regardless of their educational level, regardless of their immigration status, whatever it is, whatever we do has to be fair and equitable, across all domains.

Health equity really means the right care for the right patient at the right time and for the right reason. So if you answer those four points, about health care, you will never go wrong and you will never provide inequitable care. So we're the largest provider of live births. Largest platform for that in the state of Maryland.

And we're number 10, in the United States. We deliver nearly 11,000 babies a year. So, between our two hospitals. So that's like a small village. So a lot of our equity work is around, maternal care, because you've heard a lot of stories about inequity when it comes to dealing with black and brown mothers.

So we're really doing a deep, deep dive into that, taking a look at that. We've done a lot of anti racism training, anti bias training, and anti bias training is good for any organization, and not just around health equity, but other organizations can benefit from that as well. We've implemented a special program called our Military and Veterans Health Program because the MilVet community, those retirees, their family members, people who are in the National Guard, people who are in the reserves, they're a special and very unique population and have very special needs as well.

So a lot of our equity work is making sure that we provide the right care for the right reasons at the right time for that population as well. So those are the lenses that we are looking through. And then finally, I think the thing we have to recognize is that a lot of healthcare is very race based, and unfortunately in the 1700s, 1800s, early 1900s to mid 1900s as healthcare continually developed, that race based direction, or those race based perceptions, in many cases, were wrong. And so we have combed through our procedures, we've combed through our policies, we've even looked at, some of the lab tests and things like that that seem to have a racial bias. And removed that and found that, you know, we've actually been testing people wrong for years for some of these things because we had a race based bias or a perception built into healthcare and we were all trained that, in medical school. I mean, I was trained that a patient in the emergency department, who's got pain; he doesn't necessarily need a lot of pain meds because, he can tolerate pain better. Whoever said that? That's ridiculous. I mean, human beings are human beings. I mean, we have perceptions about stoic Asians, who can take a lot of pain.

I worked for two years in Korea in the military and I will tell you that's not true. Everybody's a person and everybody has to be dealt with individual. So healthcare has to become more and more individualized and that gets to equity as well because it's giving that individual the opportunity to live their best life.

Host: As you said earlier, some things don't change, like babies being born or you just said human beings are human beings. And then we're talking about things like new technologies and transitions, improvements in equity. With all that in mind, what do you see as the future in healthcare at Holy Cross Health?

Norvell V. Coots, M.D., MSS, FAAD: Well, we are looking to create an Office of Innovation with someone who is dedicated to looking at all of our policies, to look at all of our procedures, to looking at all of our practices and see how they can be modernized. First and foremost, to make sure that everything remains evidence based and keeps up with medicine.

Changes in medicine are occurring faster and faster. Medical literature turns over not even every five years any longer, but even faster than that. So it's a full time job just to keep up with that. But how can we bring these new technologies? How can we implement artificial intelligence? How can we implement virtual reality or augmented reality into our care to give a patient a better experience and the best outcome that they can have? And so that is going to be our focus is really creating this Office of Innovation, to be the focal point for all of these futuristic changes.

Host: I think what this conversation highlights is that at the backbone of every organization is its leadership. Based on your experience, what advice would you give to aspiring healthcare leaders.

Norvell V. Coots, M.D., MSS, FAAD: First and foremost, everyone who comes into health care, there's some kind of spark that lit the flame for them. They have to do whatever they can do to keep that spark alive. Do not get disheartened. This is hard business. This is not easy. And especially in this, still in the post pandemic aftershocks, it is definitely the big leagues. It's not easy. The second thing is, I would say, never look at a job as potentially a bad job. There are jobs that people don't want to do. There are jobs that are hard. Take that job, put your thumbprint on it, put your fingerprint on it and make it yours and turn it around.

And people will notice you and say, wow, I gave Dan that job. That was a hard job. And he did it. He turned it around. Nobody else wanted to do that, but he stepped in. So be willing to do that. And then finally, I would say, recognize that there's a step wise progression. Sometimes you have, you move from one position to another and it's a lateral move.

But that's a good career move because every time you do something different, you learn something else that you can put in your kit bag as you continue to move up the ladder. Sometimes it's a stepwise move up, and sometimes you even take a step down periodically to do something special that may actually enhance your career.

So kind of be fluid, be mobile. Don't be too fixed and too rigid into having a certain timeline and a certain pathway that you think you have to follow. And then third, the next most important thing is get a mentor or mentors; people who are in the profession that are where you want to go and have them work with you and help to guide you and sometimes, you know, all they have to do is be a sounding board for you so you can bounce ideas off of them, but they have been where you are and they can help guide your career.

And then finally, what I tell everybody is I tell, I tell people never give up, just never give up. First and foremost, never give up on yourself. If you don't believe in yourself, why in the world would you ever expect anybody else to believe in you? The second thing is never give up on your dreams. Everything that we have in this world that we think defines us, our homes, our cars, our jobs, our clothes, our family, even our name can be taken away from us at some point in time.

The only thing that we truly own that can never be taken away, are our dreams. And we have an absolute responsibility to work as hard as we can to make those dreams come true. And then the third and final thing is, especially for us in health care, is never give up on the people that support you. Never give up on the people who depend on you. Never give up on those people who trust their health, their welfare, and often their very lives to you. If you never give up on them, they will never ever give up on you. So never give up.

Host: That's such an inspiring note to end on. Thank you, Dr. Coots.

Norvell V. Coots, M.D., MSS, FAAD: Thank you very much. I appreciate it.

Host: That was Dr. Norvell V. Coots, President and Chief Executive Officer, Holy Cross Health and the Maryland Region of Trinity Health. If you found this podcast helpful, please share it and check out our podcast library for more topics of interest.

Thanks for listening to Your Best Life Podcast from Holy Cross Health.