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Selwyn Vickers, MD, FACS (Host): Welcome everyone. This is our Checkup Podcast. And this podcast is uniquely different, entitled United by One Mission. Normally in this podcast, I take a topic and interview a guest of ours who really has focused their career and their activities on that topic. We're reversing that today. We're asking my colleague, Dr. Tony Jones, who's Professor of Anesthesia and President of our Practice Plan and Chief Physician Executive to interview me about my new role. That should be exciting and interesting. Not only for me, but hopefully for you and Dr. Jones. Tony, welcome.

Keith A. (Tony) Jones, M.D. (Guest): So Selwyn, this is a great opportunity for us to get together and chat a little bit about your new role.

Keith A. (Tony) Jones, M.D. (Guest): within the health system. So, I just have a few questions for you. So, why are we making this change, going from your role as Dean to both Dean and CEO?

Host: You know, Tony, thank you for sort of introducing this topic. And I'll say first, one, we started an evolution in process of physician leadership probably three to four years ago, maybe five years ago. And obviously it has impacted our institution in multiple ways. Your example of it as our first President of our Practice Plan who is a full-time physician, chief executive, we work that is we being Dr. Ferniany and Dr. Watson, and myself work towards trying to get to the optimal position where the full scope of the academic mission could be front and center to all of our leadership. And that alignment from key aspects of our mission would allow us to be our most effective and potent force for effecting healthcare desparities, improving outcomes of healthcare and taking care of the burden of disease our patients face.

So, moving the Dean to a position who has a strategic oversight of the healthcare enterprise is consistent with that organizing for success model that we had put in place. It was one where we wanted to have both the clinical and the research world be valued toward creating the best outcome for our patients, whether it's based on the research we do, or whether it's based on the clinical care, we immediately give.

I'll finally say, when we asked Paul Rothman, the CEO of Johns Hopkins Medicine, how do you deal with your research mission and your clinical mission? He promptly said we have one mission and all of those missions tie into that one mission, providing the best outcomes and care for our patients. So that in part is why we're making this transition and multiple layers to move forward.

Dr. Jones: Outstanding. So what other institutions have done this?

Host: So, you heard me mention Johns Hopkins. Vanderbilt has done it. Emory has done it to a degree. North Carolina has done it. UPENN, Michigan, all of those have a physician lead and physician leaders who are now overseeing both the clinical and have responsibility for the research mission.

Dr. Jones: Okay. So, how do you think that this new role that you're going to be taking, the dual role will enable us to have the kind of impact on healthcare throughout our state?

Host: You know, I think it will enhance the understanding of value of both enterprises across the full scope of our missions. To some degree, we were a bit siloed. Your role, for example, as now the President of our Practice Plan, brings an institutional perspective to our physician leaders versus a departmental focus. That's a big difference. Likewise, the role that I play, hopefully now will bring the perspective of not only the challenges and struggle of the critical enterprise right now with nursing staff, nursing shortages and labor costs, but also hope to bring the concept of how our academic leaders can create a learning health system model to effect a more efficient and productive and powerful health system. I think it's both the, the ability to hear the wins and the challenges that will bring a level of mutual respect and collaboration, and hopefully a more powerful entity.

Dr. Jones: Great. So, what do you think are going to be some of the, your initial priorities and when you step into the role?

Host: You know, I think it's doing a little bit of a resetting of what we want to achieve in the context of our alliance relationship. It's also resetting some expectations of the leader in this role. I am not Dr. Ferniany. Different. There will be very important people like yourself, leading critical parts of our organization. Don Bulgarelli, Reed Jones, Jason Alexander, who will be operational senior executives. So, I want to make sure that the team is highlighted. And not that Will didn't do that, but he was clearly a 30, 40 year operational leader himself. And so I one, want to make sure we create both the right expectations of both interactions and style with me.

I think second, I want us to basically prepare ourself for both short-term wins and longterm transformation. And part of that will be planning and access to a strategic plan that we will now need to work hard to get in place that will incorporate the full scope of our mission; both from our faculty to our research, to our clinical care and outcomes.

I think the other thing too, that is going to be important, I frequently hear, number one, how am I going to do this role? So, I think I'll have to work on communicating the team concept and even more regular basis. Secondly, I think I'm going to, in some ways to be more intentional as I engage with our chairs and our faculty, and then thirdly, I hear frequently as it relates to the alliance, tell me, what are we doing? Why are we doing? Who's doing? We're going to need really a robust communication plan toward the alliance, what its purpose is, what our intents are and what our opportunities and visions is. Those are going to be the early things we need to focus on.

Dr. Jones: What do you think about this role excites you the most?

Host: Well, I, like you, when you took your role as the first chair to do this at a full time, part of your taking that role was creating a paradigm for future leaders in the institution. Future chairs could aspire to do this and have an impact globally on our institution.

I, in a similar way, see this role as a, hopefully a paradigm shift for physician leaders within our organization to say, okay, this is something I might want to do. And yes, for the organization to look to physician leaders, this is who we want to do it. So, that excites me that we're, we're creating a paradigm that I think is probably in step where academic medicine is today.

And that I think is important for our talent and our growth. I think also, it's the ideas of many of the things that we know that can be mutually beneficial in transformation; we hopefully can break down some of those barriers and allow those really, I think the cross exchange and fertilization to benefit both of our worlds.

So, those are the things that excite me. I think the final thing is that I think, more and more, we have maybe the most compelling why of what we do of any academic medical center in the country. Where we sit, with the amount of research, talent, and infrastructure, we have in the burden of disease that we see and the trust that we've built. I think no other academic medical center has the opportunity we have. So, I'd like for us to be able to execute on that as well as attract some of the best and brightest minds across the country to be a part of that journey.

Dr. Jones: Fantastic, you know, Selwyn I'll just share with you that, you know, part of what excites me as an African-American physician leader in this organization as well, is how much you have articulated the value of commitment to health equity. How do you see your role in this role at both Dean and CEO as a, an opportunity for us to have a significant influence on health disparities and health equity across the state?

Host: Yeah I, I think it starts first and we have work to do, but it starts first Tony in leadership that is willing to own and embrace that. I think it also serves a great purpose that both you and I, as African-American physician leaders, a part of our senior team, I think represent a unique level of diversity for any AMC in the country. And yet that doesn't guarantee we're gonna, we're gonna move the needle on health equity, but it does speak to the fact that we, we have perspective and can have ownership of making sure we have that as a part of our focus.

I think that for America, the thing that we have to understand, that the tolerance that we've had toward health disparities is dangerous and for many of our citizens lethal, and we've seen it during our COVID outbreak. We've lived it during our chronic diseases over the last 30 years. But in reality, what we know for almost all of our data, when we improve access, reduce disparities, deal with the social determinants of health that create a part of the health disparities; when we address those things, we improve the care for all of our citizens. I think there's this view that if we deal with disparities we're only out there helping that disparate population that has an unmet set of needs that sometimes seem impossible to accomplish. But in fact, when we make the slow but important strides to remove those barriers for them to get the best health care, we improve health care for everybody. That becomes cost-effective, that becomes efficient and it creates both quality and value.

And we, we need that. Our health system obviously works well, but it is expensive, right. And there is a point in time we're going to grow beyond what we can afford.

Dr. Jones: Absolutely. Let me switch directions just slightly and let's talk a little bit about what this means for our employees. Clearly the patients are at the center of our goals and objectives and our mission. But in order to, to fully execute on that, we need employees that are fully engaged in the mission as well. How does this impact our employees?

Host: You know, I think it's a really important question. I think one of our risks is just not understanding the stress and the challenges that our staff have undergone doing this pandemic, which have been really immense across the country. I think all of us are hoping and praying that in our region, that we don't see another surge. And as our colleagues in New York and Michigan and Pennsylvania are feeling now, we're really desperately hoping that we don't see that here, not only for our citizens wellbeing, but for our employees' wellbeing. I think we have to continually have an active listening ear to our employees.

I think we also have to continually create an environment where we are the preferred place for them to work by not only the amount that we pay them, but the environment we create for them to work in. I think we have to strategically continually show appreciation for what they bring at all levels. And then I think we do have to continually put before them why we do what we do, why we ask them to be a part of our bigger team, why we are here and who we take care of. We sometimes can get really busy in our daily activities and miss the great mission that we have and taking care of the patients and the lives of our citizens in our state and in the deep south.

Dr. Jones: Thank you for those comments. I think that there are so many people are going to appreciate the fact that we are, we are in a period where we really have to focus on our employees because they, again, those will be the people that impact actual patient care. So, you know, I can imagine, cause I'm sort of thinking back to when I was initially stepping into the role as a department chair, and quite frankly, into the role I'm in now that you've brought up a few times; I would imagine that there's a little bit of an uncertainty. And what do you, what are you concerned about in terms of stepping into this role?

Host: You know, I think you're right. It's a new role for us. I think that it is, it's always a challenge to follow who I think an individual who's been a transformative CEO. I think Will's been a phenomenal leader for our institution. Really creating a paradigm of us being a national player as an academic health system. I think the uncertainties and some of the challenges I believe face us is just our healthcare environment has been disrupted so greatly by the pandemic. We can't, we're not back at normal business yet. We're still in a world fighting to deal with unexpected costs, pent up demand from cases and care that hasn't been delivered. And a cultural divide in our country that affects almost every part of what we do.

And we've seen it in our healthcare world. So, I worry that some of the problems we have won't be fixed overnight. Right. They're going to take time for, for us to get through them and design paradigms to get to a new normal. Some of the things that have occurred are good. Clearly we want to pay our nurses and our staff and our personnel and our hospital, a living wage and wages that are fair.

But obviously we want to create an environment of sustainability because that affects everybody. If we can't grow and keep our doors open it doesn't matter what we pay people, our institution's at risk, as well as their futures. And so, there are some, there's a lot of work to be done to get our sea legs back under us and to hopefully get beyond the pandemic's impact on our care models and our labor shortage.

Dr. Jones: Thank you, you know, another shift in a little bit more personal you know, you I'm sure like a lot of us, we didn't go to medical school thinking that our goals was to take on leadership roles, particularly at this level. So tell us a little about your journey in terms of going from medical student to physician. And to scientist and to ultimately to your, your your current role.

Host: Yeah. I would say that like you, and probably many of us of our generation are African-Americans we were products of educators. We were fortunate members or families who believed education was the great equalizer. And so we're, we are sort of birthed out of that generation. So, it's a different world now, often around entrepreneurship starting your own business, but we were taught to get the maximum you could in your education and an aspirational career, if you cared for people was being a physician.

And I'm sure those things drove you as they drove me. I think that probably as in your training at the Mayo clinic and particularly in my training at Hopkins, I was introduced to the value of being a leader. Right. And it was not separate from being a good surgeon or being a good scientist.

But it was encompassing those things. It was encompassing the aspect that you had to engage in and be a good educator and teacher of those around you. It was encompassing that you had to embrace discovery at some level, whether you were do it at the basic science, but clinical transformation or just the outcomes, but you had to be able to think about writing and putting forward the things that you've learned and you saw.

And then you had to think about the greater impact that you might have and you and I both know, both know it's a remarkable thing to wake up every day and have a, an unbelievably undeniable positive impact on a person's life. And in medicine, we daily have that. That's hard to trump to be able to do that.

And many people don't have that. But what I think we do know, even in medicine, a greater impact is to have the ability to lead at some level, whether it's a division, department or practice plan or health system in order to make life better, not only for the patient, but for those who take care of them. So, I would say my evolution was one to have a vision from my trainers and leaders that what you aspire to be is being a leader.

And I would say that coming to UAB, after initially saying I would stay at Johns Hopkins for 72 hours choosing to come to UAB. UAB gave me the opportunity to grow and lead like no other place. And from my initial view of the world, the ultimate job was to be a department chair. That's what I saw and what I realized and what I interacted with.

And I, and Minnesota gave me that opportunity to do that. And and that was very important and special. But I also saw there when I was recruited the role that a person at a Dean's level and how that person could impact an institution. And that, that also gave me a desire to both want to grow programs, recruit people, bill institutional opportunities at a higher level.

So, it's been largely driven by service and leading and growing an environment that enhances a better world for those around me, that sort of led me to this direction and hopefully will benefit our constituents as well as our physicians.

Dr. Jones: That's a great story. I know we're coming close to the end of our time. So, I just have one more question and just to have people get the chance to know you as a as a person, a little bit more, what are you passionate about? What do you care most about in terms of your personal life?

Host: Yeah, I, I think like many of us, are really I'm thankful for a wife who's really been fundamental to whatever I've done, both in my own professional and to our kids. So, I really thankful for them. And the resilience that they have exhibited through our moves, through my absence from often at work. I am also passionate about the legacy that we both live out from our forefathers and our families and what they went through.

I'm also passionate about the role that Birmingham can play in transforming the polarized political and racial divide in our country. I think we certainly have played a central piece in our past struggles. I am desirous and really hopeful that Birmingham can play a central role in bridging that divide.

I think we live out many of the ideas that Martin Luther King wrote about in his letter from a Birmingham Jail. And we have ownership of that. It was something written at the time to challenge and move Birmingham, but the world. But in many ways we are living out the dreams of that letter in Birmingham.

And we need to make sure both the world knows it, but also sees the example of how we do it. So those things really excite me. It's helping transform Birmingham, move the needle on disparities in our state and in our region. And the final thing is really making UAB an institution that has tremendous respect and destination for talent and patient care in our country to be really one where most people understand and believe and admire what we were able to accomplish and what we're able to do for our patients and the environment we provide for our faculty.

Dr. Jones: Selwyn, I want to thank you very much for your time. I'll just end this by saying that, you know, one of the definitions of a leader is a person who has followers. And I think through this podcast and quite frankly, through the work you've done, I think you have many people that are willing to climb that hill with you as followers. Thank you very much.

Host: Thank you, Tony. Thank you for the opportunity.