Inspiring Leadership: Dr. Melinda Estes

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Inspiring Leadership: Dr. Melinda Estes

Given all that is happening in health care, it is more important than ever for physicians to voice their opinions, whether conversations are taking place within politics, health care organizations, or communities. Metro Med is asking some physician leaders within our community how others can follow in their footsteps and become inspiring leaders.

Today’s conversation is with Dr. Melinda Estes, who took over as president and chief executive officer of Saint Luke’s Health System in September 2011. Board certified in neurology and neuropathology, Estes also holds an M.B.A. from Case Western Reserve University.

Prior to joining Saint Luke’s, she served as president and chief executive officer of Fletcher Allen Health Care in Burlington, Vt.

Estes’s other executive positions have included serving as: chief executive officer and chair of the Board of Governors of Cleveland Clinic Florida; executive director of business development at The Cleveland Clinic Foundation; chief medical officer at the Cleveland Clinic Florida; and executive vice president and chief of staff for the MetroHealth System in Cleveland.

Why is it important for Saint Luke’s Health System to have good physician leaders?

I believe all physicians are leaders – you are leaders for your patients, you are leaders in your practice, you are leaders when you participate in your societies. But I think that taking that step to take on administrative roles is important because physicians, along with nurses and allied health professionals, are really the line workers of health care. We are the ones who understand the inner-workings of delivering care and doing that in a clinically effective and high-quality way. That is particularly true for Saint Luke’s because we are a large, diverse health system with multiple settings of care, and we have physicians working in all those settings of care, and we really need them to step up and be leaders so that strategies of the organization can move forward

Some critics of medical education argue that it does not focus enough on the management side of health care. In your view, what is it about the current medical education system that holds doctors back from being ready for administrative roles? Or, on the flip side, is there anything in your medical training that helped you become an administrator?

One of the most popular tracks in medical education is the MD/MBA track. When I got my MBA back in 1995, I was the only physician in my class and very few physicians were pursuing any kind of business education, but today it is not uncommon to see that combo. Today, people talk about medical knowledge turning over every seven years as opposed to just a few years ago it was every 20 years. So, if you think about that, just the demand to keep up with the change in knowledge, I think makes it very difficult for physicians often to wear two hats.

How does Saint Luke’s provide opportunities for aspiring physician leaders?

At Saint Luke’s, we are very interested in identifying young and mid-career physicians who have an interest and potential to take on more formal roles. You consciously have to reach out and identify people and ask them to participate on a committee.

I have found it to be very appealing to physicians to serve on something that has a finite life span. For instance, our strategic planning process is going on now, and we have a steering committee, which will have, by the time all is said and done, six or eight meetings, and we had many physicians on that committee.

(By serving on committees,) you learn a whole host of things, plus you have an opportunity to see how that work fits into the larger and broader picture of the organization, which was really important for me. Every one of those committees (she served on early in her career) had a different chair – they had a different style. Some people would come in, and the chair would do all the talking. Other people did brainstorming. I don’t think we are born with a leadership style – you have to develop it.

There is a school of thought that with more and more employed physicians, with more mega health systems, that financial pressures might tilt the focus more toward the bottom line as opposed to medical care. How can you keep the medical voice through physician leaders to make sure discussions don’t go too far toward the bottom line as opposed to best practices medically?

I really do believe that in these times of turmoil, that if we focus on why we went in to health care, which was to take the absolute best care of patients that we possibly can, that everything else will fall into place.

On the other hand, those people who are involved in clinical care – physicians, in particular – do need to understand, and be realistic, and be helpful to us as we look at the need to generate a margin. What we put on the bottom line enables us to reinvest, and reinvesting gives our clinical providers facilities, it gives them technology, it’s programmatic, it helps us take better care of patients, so it really is a continuous circle.

Part of health care today is keeping people out of the hospital. As far as promoting wellness, a) is that useful for physicians? And b) how do they make the time?

We all understand the post-acute continuum of care. What we have less experience and a little more difficulty thinking about is this continuum that happens before you get to the hospital. So whether it’s the doctor’s office, whether it’s the fitness center, whether it’s the employer sponsored – wear your Fitbit and we are having a contest – whether it’s get out and play for kids for 30 minutes a day – we haven’t been trained to think that is health care, and we are being asked today to think that is health care.

Having said that, if you think about what physicians do: they listen to the patient’s complaint, they confirm with a physical exam what’s going on, they come up with a differential diagnosis, and then get some tests, they treat, and then they measure that. And when you think about it, a planning process does just that. So I think they are really uniquely qualified to be able to insert themselves into a planning process.

The time question is a tough one. All of us know that sometimes it’s the busiest people who seem to do the most. I think it’s a matter of saying this important to me, and I will make the time to do it.

Nowadays, physician leadership also means collaborating. How can the medical community do a better job of encouraging more collaboration among physicians?

Where you see that playing out is in medical education with teaching with dummies and computers, and what medical schools are doing is instead of educating physicians separately, nurses separately, laboratory people separately, EMT’s separately, they are bringing that team around the bedside and educating them together in a medical setting.

So medical schools are not as resistant to change as some people might think?

The very best and brightest medical students know what is going on in the world and want to train in an environment that allows them to adapt to that. We see it at Saint Luke’s, and we see it across the country. When the Millennial (Generation) physician comes out of training, they expect to be employed, many want to work 8 to 5 and take call, if at all, once a month. They expect to balance their family. They expect to work in a team with hospitalists and nurse practitioners and physician’s assistants. Those doctors want something very different than the physician who is just 15 years ahead of them.

Do we have enough physician leaders today? If not, what can we do to build the ranks?

If you look around the country, for my job, to lead a hospital, everybody wants a physician, and that is where we clearly do not have enough physician leadership – in the physicians who really have said, “I am going to have an administrative career.” That requires a real different mindset to say, “Maybe I’ll start out as a vice president for medical affairs, and then I’ll move into being a chief quality officer, and then I’ll move into being a chief physician executive, and then potentially I’ll be a CEO.” I was sort of fortunate. I started down the path before anyone knew it was a path.

Being a physician and an administrator is sort of left brain, right brain thing. How does a physician learn to use both sides of the brain?

We talk an awful lot about the science of medicine, and we should, but medicine is an art as well. And you look at the number of physicians who are musicians, (it’s) a high percentage, the number of physicians who are artists. There is an awful lot of right brain that goes into that really good physician who can tap into that creative side.

What we are trying to do at Saint Luke’s is actually beginning to structure a leadership course for our physicians to say – if you have an interest, come and spend some time one Saturday morning a month – (to learn) what’s a balance sheet, what’s the P & L, what does branding mean, what are crucial conversations. And then, pretty quickly, there are people who raise their hand and say, “I’d kind of like to do some more of this.”

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Connect &
Collaborate

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Events

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Practice
Opportunities

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For Retired
Physicians

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2015-09-01T17:57:33+00:00November 12th, 2014|Leadership|

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