A Physician Leader’s Journey: Strengthening Culture as a Catalyst for Growthv

Within the healthcare industry, effective organizational culture requires building trust, nurturing collaboration, and positioning leaders to drive strategic and impactful change. In this episode of Value-Based Care Insights, we sit down with Dr. Eric Velazquez, Professor of Medicine at Yale, alongside Doug McKinley, a clinical psychologist and leadership coach. Together, they explore the challenges and opportunities of strengthening the workplace culture in order to improve organizational effectiveness, financial performance, and overall patient care. Gain insights on the importance of vision alignment, a healthy culture, team collaboration, and the delicate balance between “steering the ship” and delegating responsibility.

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Transcript:

Daniel Marino:

Welcome to value-based care insights. I'm your host, Daniel Marino. I’m Really excited about today's episode. This is our one hundredth episode of value-based care insights.  Well, I'm really excited in celebration of our 100 episode to talk about a topic sort of bringing all of this together. And we're entitling this, the physicians the physician leaders journey. And as background. As we know. Leaders have a lot of challenges. particularly physician leaders have a lot of challenges, understanding how to align with goals, build effective management structures. Really setting the path for high performing organizations to really drive the performance, drive the care, drive all of the goals that that we need to accomplish in order to serve the needs of our communities and our patients.  

Well, today's guys, I couldn't be more excited to have with us today Dr. Eric Velazquez. Dr. Velasquez serves as a section chief for section of cardiovascular medicine for Yale School of Medicine. Doug McKinley, the other guest joining us today. Clinical psychologist Doug has worked in the field in within clinical and administrative leadership development for many years a wealth of knowledge. Very excited to have both of you join us today. Dr. Velazquez, Doug, welcome to the program. 

 

Eric Velazquez:

Thank you, Dan, and congratulations on your hundredth episode. I'm very honored to be part of this discussion today. 

 

Doug McKinley:

Yeah, woo, hoo! This is terrific.  

 

Daniel Marino:

Yeah. Well, thank you. Very excited, very excited. So, Eric, maybe we could start with you. Thinking back you. You've been in your role as the section chief in the section of cardiovascular medicine. Now for a few years, obviously moving into the organization. And you had some ideas in terms of what you wanted to accomplish. And thinking back, creating that vision, setting the alignment. What were a couple of things that that you did off the bat, or that in reflecting on that you thought was important in order to really start establishing that alignment of vision? 

 

Eric Velazquez:

Thanks, Dan, for that question. You know II first to just highlight. You know I was new to the institution and the institution that I was joining, and the organization that I was in a position to lead had been a bit rudderless for many years, and, you know, had actually had some traumatic episodes in in the in the distant past. And so II think we have to recognize that you know. The the context matters as a leader. And so I would say that you know what I felt was critical was to really evaluate the landscape. And those who you know we're hungry for my new leadership. Listen extensively, and gather information around what were the, you know, the most acute challenges and begin to prioritize. You know, with those on the ground about how to address those challenges.  

And so I think that was, you know, I would say, while a lot is made about the first 100 days, I think sometimes you have to, you know, what you do in those first 100 days is important, but it doesn't always have to be, you know, action oriented. I think it can be a very effective, and I think it was needed in, in, in my situation to be actively listening and actively gathering information instead of necessarily having specific initiatives or changes to personnel or or other things done. Which sometimes is what I think gets the most you know most you know credit in in that first 100 days construct, I would say, I would say that was one lesson that I would give people. Is that how you construct, how you know how you use those you know, First several months. You know, has to be contact specific. And in in my case I thought it was important to recognize that this that this organization needed someone to understand. You know the situation that we were in, and take the time to listen. 

 

Daniel Marino:

Well and listening, I think, was key. And as we talked about time and time again, sometimes, that's difficult for leaders, because they automatically, you know, our intention is to get into make change as quick as possible, and sometimes the biggest change we can make is just sitting back and listening. 

Doug, when you reflecting back, when you started to work with Eric, were there a couple of things that you can draw on that that thinking back was a big support to Eric in his new role as a within the organization, as a leader and even working with the team? 

 

Doug McKinley:

Yeah, actually, I thought of another thing, Eric. You were so kind, I mean he kind of inherited me. Because I was working with Eric's boss and that team at the time. And so in corporate we call it onboarding. So the suggestion from his leader was that I partnered with Eric to try to onboard him and get him in. That context is decisive, I think, is is a terrific line. Context is a big deal. And so just to support him through that. And he was very well, I wanna say this, Eric, you need to know this. You are very gracious and open. Some of the people that I get assigned to are not. And so my recommendation to leaders are when this, when this is available to you, is to seek that. And there was a big shift that happened. Go ahead, Dan. 

 

Daniel Marino:

I was gonna say. And a lot of times it's hard for new leaders because they don't want fail right? They want to come in and make a splash. All eyes are on them sometimes it's hard to be vulnerable and ask for help. 

 

Doug McKinley:

Yes, and I was working with Eric's new leader boss. So what does this mean? Where am I as the outside consult? Where are my Allegiances? Right? Is it safe? Is it safe for Eric to talk to me? And so my initial work with leaders is always to create a psychologically safe space, confidentiality and all that stuff, because you know, there's lots of stories out there right where these boundaries are violated. And, Eric, I don't know if you remember that time, but you were extremely gracious and open, and seem, you know, very coachable, and I don't know how to teach that. That was something you brought to the table.  

 

Eric Velazquez:

Well, thanks, thanks, Doug, I would just say that. You know we the the comment you made maybe, Dan, I think it was you made it, you know, make a splash, and that that was the that was really what I'm trying to convey is, you can make a splash in many different ways. And it. It depends on the context. And I think in in our, in my situation, when I entered my role. The splash that I want to create was of a of a new era. Where you know, it mattered to build, you know. Trust and collaboration with those who were leading. It mattered to be to be positioning folks to be listened to. And you know, and to gather information in a and build priorities and establish strategic initiatives that were not reactive. Which I think was really you know, in retrospect, I think. You know, obviously, was second nature, perhaps to myself, but wasn't necessarily to the organization that I inherited.  

 

Daniel Marino:

Yeah, no, that's a that's a good point. So, Eric, when you, when you think about what you did as brand new leader to this organization. I kind of think that there's 3 elements that are really important. Right? So you need to, you need to build an yourself, an effective team. You need to create trust. You need to introduce and create the tools that are gonna drive the success right, the performance success. But an important piece of that, and I would say, almost the underlying foundation is culture. You have to set the right culture with the right level of expectation. Thinking back what were some of the things that you accomplished to kind of set that culture direction, if you will, for the section with the team, with your leaders to help to kind of drive and achieve those visionary goals? 

 

Eric Velazquez:

Yeah, I mean. you know, we you, I think, as a leader, it is prominently, I think your key role to establish the culture of the organization and actually model that culture in your activities. And so you know, getting back to the points meant made earlier. II think you know that transformation is not something that happens overnight. It needs to be you know something that's, you know, thought through. But you know what II think worked on was, you know, again gathering information as much as possible from those who were in positions of leadership within the organization already. And then you know, probably key action oriented activities that I took on with the recognition that we needed to align the leaders of the future within the organization with the culture that I, you know that I felt was needed.  

 

Daniel Marino:

Well, I often heard you describe that when you, when you started, is kind of a divided house right? Bring the group together, or bring the team together to really set a direction.

 

Eric Velazquez:

I, you know I purposely was very interested in the culture of silos, and how you manage silos, and I think we were a very divided house. And you know, and there's value to silos. I think that you know, to build a lot of vertical expertise. But if that expertise can't communicate with other components of an organization, you know, the organization as a whole suffers. And so part of my really clear focus was to step, to identify. You know, a new leadership team within the organization that recognizes the value of not breaking down silos, but kind of developing communication paths between those levels of expertise within the organization. And you know, and developing a increasing trust among everyone that we weren't going to take their piece of cheese away. That we're going to actually work to. Hopefully, you know, build more opportunities for them in their roles, but they had to be. They had to kind of buy in that we were stronger together, and as individuals, and I think that was was not the case previously.  

 

Daniel Marino:

If you're just tuning in, I'm Daniel Marino you're listening to value based care insights. I'm here talking today to Dr. Velazquez, Dr. Doug McKinley. This is our hundredth episode very excited. Our topic is a physician's, a physician leader's journey enhancing the culture and the change agent for growth. 

Doug, let me let me build on one of the things that that Eric just mentioned. Building the team was going to be critical right? And you mentioned that you helped him build his team really around the cabinet, right? Thinking back what were a couple of those key concepts, or maybe programs or things that you introduce to help establish the leadership team around Eric. 

 

Doug McKinley:

Hmm. I don't remember that. But the specific thing. I I'd like to just say when you when you've described this, Dan, you know. Of course you build a team. Of course you've set culture. I haven't found that to be a natural first move for very many physician leaders, let alone any leader. So I think Eric was unique in that. He was open to that. So my, my recollection, Eric, is that we just kept talking about that and said, What is it? What is it? Air quotes that we have to create. I think the tendency for physicians just to be quite frank, is to do it alone. It heroic leadership has been really, it's it's traced, and it's been marked. Our past history is marked with heroic leadership. And I'm not making that as a positive. I'm saying, that's a that's an unfortunate reality. And so in heroic culture, in heroic leadership, culture environments, people have to swoop in and save the day instead of building a really healthy, safe space to for all people to contribute. And it's not being called inclusive leadership. So I would say it was just that vulnerability and trust between Erica and I, where he was reading books. I was reading books. We started reading a couple of books together, and we Co- Created the ideas and the vision. A Eric would get on his whiteboard, and he would just. You've seen him do this day, and he would just draw these things that made no sense to me or him, but he just kept drawing and drawing, and he finally was able to articulate a grand vision, and the ecosystem through which we were gonna support that had to be established. So I think it's really strategic conversations would be the only way I can explain.  

 

Eric Velazquez: 

I'm just gonna follow with one thing, cause I think Doug's being too humble. II do think that one of the things that I would say to Doug was critical is you know. Sometimes, you know. There you it depends on the individual, and I'm you know it depends on the on the situation for each individual. But you know I think I was, Doug drove me to recognize that I wanted to accelerate some of the ideas that I, you know, was positioning, and that to do that effectively, and I had to, you know, put myself out there by defining those areas, or and we've I've called them domains critical domains that required, you know, senior leadership, and to choose those individuals. you know, frankly based on character traits, that we've talked about already. And the kind of a kind of culture that we wanted to create and that would allow me to take this, and I you know we were joking before.  

You know, II see this as an aircraft carrier. We you know, this is a massive organization. With a lot of a lot of technical expertise, amazing faculty and staff. But not everyone want what you know. It was rudderless in a way, it wasn't directed, and I think to move it and move it faster in the right direction. I had to can move things around. And my tendency. And I think this is where we talk about areas of discomfort. My tendency is that everyone stays on the carrier when it's making a redirection, you know. That's my goal. III would like to make people happy. That's probably my one. I don't know if it's a weakness, but it is it is a reality that that that Doug has helped me understand about my own my own self. But some people are not gonna stay on. That's okay. And that, you know, I think as long as they understand the direction we need to go into date, those are decisions people can make for themselves. So I would say that you know very important was the need to kind of say, Okay, we've done We've done. Now, we have to kind of start, you know, accelerating. And I can't do it alone.  

 

Daniel Marino:

I  was going to ask that question. How difficult was it for you in the early days, for you to, you know, using your analogy to want to steer the ship versus delegating some responsibility to others to help you steer the ship? 

 

Eric Velazquez:

Hmm, I think it is hard, because you, you know, particularly in my situation, I wasn't part of the organization previously, so I was, you know, while I knew a lot of individuals who were collaborators and colleagues from afar. In my, from my, you know, when I was in a different institution. I was, assessing. You know, actually, you know, assessing whether people's skill sets and focus and their character were ones that were gonna mesh well and was where we wanted to go and be able to lead people the way I wanted them to lead be led into the future. And so I think my natural tendency was it be to be cautious because these were roles that were going to upset others who may have been, you know, may have had those responsibilities in the past, but I'm very, very pleased with where we ended. And we're still in the midst of that, you know process. But Doug, you know that relationship. That ability to discuss the strategic priorities and for him to understand and give me the, you know, kind of an awareness side, because it helped me get to the awareness that you know. The next phase of this was to, you know really start actively redirecting this aircraft carrier and moving it faster in a direction I needed to go and that was really something I needed to do with. You know. I could be captain of that carrier. But I but I needed people. you know, Manning the gunships and manning the you know, the nuclear reactor downstairs, you know, and all that. I mean that that's my visual for this, 

 

Daniel Marino:

And there's only so much time in a day. It it's hard you just have to be able to delegate,  

 

Eric Valezquez:

And that's not natural for folks who are, you know, I think that's pointing to a lot of people would think they just need to get it done on them that that's their job. They just need to get it done, and you know and just do it themselves. But the reality is, I think we moved much faster and actually you know we've accomplished much more.  

 

Daniel Marino:

Right? So, Doug, just kind of building on what Eric said. II think this is such an interesting point. I'm sure. You see that quite a bit right? Where leaders want to take on  they want to do it right. They want to drive it. They feel passionate about their work. And you know, engaging the team is just so critical. 

  

Doug McKinley:

Yeah, it's that's why I call heroic leadership. I think what we did early on with Eric. I don't know if you remember this, and I hope you don't mind me sharing this, but we, Eric's values, and how he his particular leadership vision is unique to him, and we had to be clear. And we came up with these 2 words that ended up, We didn't publicize them, you know. We didn't tell anybody this, but he really valued compassionate conviction. He had this intensity to him, and tenacity and forward action, but it had to be held with compassion.  

 

Daniel Marino:

Compassionate conviction, that’s great. 

 

Doug McKinley:

I know I wanted to put on a card we chose not to. We went with other phrases. But that's the kind of team he needed to surround him that understood those values. And there were other people, that were wanted positions right like in every organization. There's people vying for leadership positions. But we knew it had to be people that could get behind, not only the mission of the section and the department. But the way in which Eric wanted to lead and needs to lead that's who he is. Leadership is more about who we are than what we do. It's has to come from that.  

 

Daniel Marino:

So yeah, that’s such a great point. Eric. Any pieces of advice? We we've a lot of leaders who tune in a lot of physician leaders administrative leaders who tune in thinking back are there, are, are there pieces of advice that you can provide to some of our listeners? Around maybe if if their new leaders are struggling with kind of building the leadership teams any piece of advice you might want to share? 

 

Eric Velazquez:

Yeah, a few. Let me yeah, and see if I can communicate this effectively. II think you have to give yourself time to reflect. I think if you're just go, go go all the time, and you don't give a chance to you know, reflect on where we are, and to kind of ensure that you've communicated effectively and over communicated or down. You know you, you know II kind of believe in a matrix organization. So I just what I'm creating. But I think make sure that all the individuals that are in a position to, you know, put that culture into action. know what they're doing. And I think we've done that you know, we've dedicated efforts to enhance engagement and communication. We've run a a few retreats. I think our, The challenge for that really was a pandemic that no one expected and so move. Really, you know, I got there, and in the pandemic happened so that you know those were were realities. The other thing is, you know, you have to delegate to the people that you want to position your yourself to lead out. You know your vision. But you need to meet. Make sure that they feel a supported, and that you make them accountable to the organization part, but to the organization, and I think that that's important. That's it's process, you know. I think people, many people are have limited experience in in leadership. And we're all kind of, you know, a, every situation, every context is different. One thing that I think. Doug certainly reminded me, and I think III attribute this to him. I think I'm a cardiologist. I think we're much, very action oriented. We're results and deliverables related oriented, and sometimes we don't. We don't take the time to celebrate, you know, successes, even small ones, and I think reminded me to that that everyone needed a data boy occasionally, and we needed to all. And I, you know, we needed as a leadership group to recognize when we had made some progress, I think and and celebrate. That was important.  

 

Daniel Marino:

And going through what you described. It's tough, right? It's not an easy road celebrating even the small successes, I think, are really important, Doug, let me turn to you any pieces of advice you give some of the, you know, to our listeners any new anything to new leaders, or even the more experienced leaders. 

 

Doug McKinley:

Yeah, be like, Eric, I'm not being. I'm being a little coy, but be humble. Have convictions like, be clear about what matters to the organization. Align that, align your values to the organization, the your leader, and then just build a team that you can do life with right it. It's a hard, it's hard work and doing it alone is just really a terrible idea. Nobody wants to follow a leader that's leading alone, and so be a leader that people want to follow. 

Be contagious, be. you know everybody wants to say inspiring. But I think inspiration comes from conviction. Right? You're clear. You know who you are. You know why you're leading what you're leading, and it's a compelling narrative. So be a part of a compelling narrative,  

 

Daniel Marino:

And I love that term. Doug. Compassion conviction. I think I think that's great. Gentlemen, congratulations to both of you. It's been really exciting to hear your story, and a special congratulations to you, Eric, on what you've been able to accomplish. Just really excited for you all. Thanks again for joining today. Great discussion really appreciate it, and a special thanks to our listeners. Without you all tuning in, we've never would have been able to accomplish. Our one hundredth episode, so special thanks to all of you, until our next insight. I am Daniel Moreno, bringing you 30 min of value to your day. Take care. 

 

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners