By Jeff Mortimer • Photos by Scott Galvin
At the helm of three hospitals, 40 health centers, a $1.69-billion annual budget and a workforce of 13,500, you might expect to find a highly-pressured executive with a commanding presence of power and authority. But in the whirlwind of daily activity — visible and behind the scenes — CEO Doug Strong is every bit the calm center of the storm.
On a gray, blustery Monday morning in March, Doug Strong, director and chief executive officer of the University of Michigan Hospitals and Health Centers, and a dozen or so members of his Senior Management Team are starting their week at Arbor Lakes, an office complex on the northeastern edge of Ann Arbor. This is where the nearly 500 employees of the Medical Center Information Technology operation work, designing, monitoring and supporting every computerized function of the Health System, which includes, among other things, every prescription and every test order from every doctor who practices here.
Visits to these locations have become a regular part of Strong’s and his team’s routine. It helps them know first-hand what happens in these workplaces, stay ahead of the curve on potential prospects and pitfalls, and try to sustain a human touch in an operation that employs 13,500 people — slightly less than the population of Traverse City, Michigan. About 20 percent of the Hospital and Health Center staff is off-site from the main medical campus.
Afterward, Strong is scheduled for a working lunch with his boss, Executive Vice President for Medical Affairs Robert Kelch, and a candidate for Medical School dean, then a two-hour meeting of the Health System Executive Group, followed by an hour-and-a-half one-on-one with Chief Operating Officer Tony Denton. He won’t get back to his office to check his e-mail, and whatever else has accumulated there, until 4:30 that afternoon.
Later in the week, he’ll chair a Senior Management Team retreat focused on goals and objectives, accreditation issues, customer service and referrals. He’ll preside at an Executive Director’s Forum where he’ll hear reports on the fiscal year 2008 budget plan. And he’ll spend an afternoon at the Ross School of Business, where Health System executives who have completed a six-month leadership program will report on projects as diverse as improving the psychiatry referral process and assisting faculty with research funding gaps.
Strong’s is not a schedule for the shy or sluggish. Eighty standing meetings a year appear on his calendar, many of which he chairs. Denton is one of 12 executives who report directly to him, and he meets semi-annually with each of the department chairs and selected physician leaders, and gives a talk almost every week “to any group in the organization that wants to listen to me.”
This doesn’t count his work outside the organization. He’s involved with the Michigan Hospital Association, the University Health System Consortium, the Greater Detroit Area Health Council, and the Association of American Medical Colleges’ Council of Teaching Hospitals and Health Systems. External work takes up about 20 percent of his time, but it enables him to contribute Michigan’s experience to the state and national scenes.
These are some of the ways Strong spends his time; these are some of the issues he has to know about, prioritize, and act upon.
Time to think and reflect
Strong needs a lot of input to do his job. He needs to know finance, personnel, facilities, the regulatory environment and medical practice, and he needs to know how social trends might affect them all. And, he needs to keep 13,500 people happy, engaged and feeling secure, even as he prepares for the vagaries of the future.
Figuring out priorities and policies that will turn all that potentially bewildering input into output is tricky business. It would be easy to get lost or overwhelmed. It would be easy to settle for keeping the lid on. But he sets his sights much higher than that. Strong says his most significant leadership quality is listening, and his most productive time is when he’s reading and thinking. Alone.
“I’ve always tried to reserve time each week for reading and reflection,” he says. “I don’t know what the measure of it is, maybe 10 or 20 percent of my work-time. Every day I scan or read The Ann Arbor News, The Wall Street Journal, and The New York Times. I read a lot of journals and magazines related to health care. It’s important to be aware of events going on around us so we can influence them — Michigan should be an influence in both the state and nation — but also to see what threats and opportunities there are.”
While he may not be able to precisely quantify his reading and thinking time, he knows exactly how it measures up otherwise. “I think what I do in that period of time has added the most value to the organizations I’ve been associated with,” he says. “It allows me to integrate things and frame them in ways that perhaps others have not.”
Thus does his solitary work inform his group dynamic: “I ask a lot of probing questions, and that’s the result of time to think.”
This is perfectly consistent with his demeanor. Quiet, soft-spoken, almost self-effacing, Strong couldn’t be farther from the flamboyant, commanding CEO stereotype. To a certain extent, it’s just the way he is, but he also sees it as a competitive edge.
“I spend more time listening than talking in most spheres of my life,” he says. “Part of being a CEO is taking in what you’re hearing from the organization. Part of it is thinking about that and imparting what you’ve thought about. I think it’s a fiction when people view a CEO as all-powerful. There’s a lot to be gained by presenting yourself as not being all-powerful, because it enables others to participate in leading the organization. Which, in fact, is what has to happen anyway. It’s never a one-person show.”
He’s serious about listening, and present where he is. He doesn’t carry a pager and, again belying the stereotype, isn’t welded to his cell phone and BlackBerry. “My style in meetings is to not be interruptive,” he says. “I attempt to be focused on what’s going on in front of me.”
Connecting the Parts
Strong earned an M.B.A. in health care administration from the Wharton School of the University of Pennsylvania, where he also held several positions at the School of Medicine. He joined the U-M in 1998 as associate vice president for health system finance and strategy, and became chief financial officer before assuming his current job. Before coming to Ann Arbor, he served as chief financial officer and associate dean of the Pritzker School of Medicine and the Biological Sciences Division at the University of Chicago, associate dean for administration and finance at the School of Medicine of the State University of New York at Stony Brook, and associate dean of planning and operations at the Saint Louis University School of Medicine.
“I’m a bit unusual for a hospital leader because of my background,” he says. “I’m steeped not in hospital administration, but rather in medical school administration. I’m a learner/listener normally, but in this context there’s a lot more reason for me to be listening because I have a lot more learning to do.”
Strong’s original career goal was to be an academic historian — he also holds a master’s in history from Penn — and his first foray into health care came when it became clear that the employment pickings were slim in the history arena, and he took a job doing survey research for the medical school there.
But his interests always seemed to be one jump ahead of his assignments. “I liked to think beyond the boundaries of my particular sphere, and I’ve been blessed to be able to engage in new questions and different opportunities over time,” he says. “I look at the whole of the organization, not just the segment I’m working on. I like to connect things. I’m an integrator.”
That quality is essential to wringing action from all those meetings. “The parts need to connect,” Strong says. “We need to see the various parts of an issue, such as patient safety, together in one room — from a nurse perspective, a physician perspective, a financial perspective, a regulatory perspective — and come to an agreement about the overall approach that we wish to take, then ideally delegate one person in the room to be responsible for carrying it forward.”
His administrative background may explain why he sees so many core congruencies between leading a health care system and leading any other kind of large, complex organization. “We all are driven by the connection of many processes,” he says, “and what we really need to do is quality work as efficiently as possible, which is common to most enterprises.”
Creating common ground
Coequal with communicating, listening, and facilitating implementation is what Strong identifies as the fourth aspect of leadership: creating a vision, a way of looking at where the organization wants to be at a future point in time, not in all its details, but in a form that can be explained and understood by the entire organization.
“What I learned in history translated very well to academic medical centers,” he says. “Critical thinking, quantitative analysis, reading and writing — are all useful in management, as were learning university values and the value of universities.”
That training is key to his rapport with physicians, which he counts as perhaps the strongest card in his hand.
“My ability to engage them in mutually beneficial and constructive ways has been important in my career,” he says, “and that comes from my ability to develop quantitative information so that physicians — at their heart, evidence-based scientific people — can deal with real data as they address real problems and move toward constructive resolution.
“Physicians work in academic medical centers because they believe in education, patient care and biomedical research. Because I share the value of those missions, there’s a common ground on which we can work together.”
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