When it comes to budgeting and prioritization, there’s a tendency in healthcare to make decisions based on available funds.
Deborah Proctor was never a fan of that method.
Because while it might make sense from a fiscal standpoint, it’s not the best approach for ensuring patient needs are met. “To me, it’s backwards,” she said in a Keynote Interview with Bill Russell.
Deborah Proctor
Proctor, who spent more than a decade as CEO of St. Joseph Health (now Providence), believes that it starts with establishing a mission and identifying desired outcomes. “What are the things we need to do next year? What do we invest in to achieve those goals? And then, we’d go out and find the money.”
Of course, doing so required a solid foundation and strong culture, which she worked hard to cultivate at St. Joseph. During the interview, Proctor opened up about the keys to creating a mission-driven culture, and the hard stance leaders must be prepared to take.
Despite where she ended up, Proctor had no aspirations in her early career of becoming a CEO. In fact, it was a conversation with one of the Catholic sisters that convinced her to put a hat in the ring when the position opened at St. Joseph’s. “I didn’t know that I could do the job,” she said. Fortunately, she had support from colleagues, along with a keen interest in “how organizations work, what makes them tick, and how to accomplish things through the culture of an organization.”
When Proctor stepped into the role, however, she quickly learned that culture was lacking at St. Joseph, which operated more like several individual entities than a system. Her strategy, therefore, was to “operate with a local focus while trying to collaboration on certain efforts.”
In the meantime, the culture – or lack thereof – needed to be addressed. Part of that was recognizing that “culture isn’t an add-on,” but rather, the base on which other components sit. “It’s everything,” and therefore, understanding it is vital.
But that’s just the beginning. “I believe strongly that you have to have a clear mission. You have to have an energizing vision statement. You have to have underlying values,” Proctor said. “Culture allows you to achieve all that. It's the way we get things done.”
When Proctor arrived at St. Joseph, the value statement was “foggy.” And so, she gathered a group including management, physicians, board members, and sponsors to gain clarity on how the organization would define and measure value.
That meeting – a three-day, intensive retreat – produced three core pillars: perfect patient care, which meant “making sure that patients received perfect care 100 percent of the time”; community health (ranking in the top percentage of healthy communities in the country); and sacred encounters, which takes customer service a step further.
The idea was to cultivate a true set of values – not some words that merely hang on the wall. “Those don’t mean anything,” she said. “Culture is taking that mission and those values and putting it to work and figuring out how do we successfully get the results that we intended.”
The situation in which Proctor found herself at the beginning of her tenure (leading 16 seemingly separate organizations) isn’t unusual, particularly as mergers and acquisitions continue to climb. Still, it’s not an easy situation to navigate.
“In the past, the hospital had put their individual budgets together and said, ‘this is what we need,’ and we would roll that up and see what it added up to,” she recalled. “I was trying to create an organization that moved collectively toward a set of outcomes.”
One of her first moves was to involve all of her direct report CEOs in the prioritization process. That way, “CEOs couldn’t just argue for their organizations,” she said. “We had a system by which we put everything on the table that everything that had been asked for, and prioritized those according to what we had to achieve through our outcomes.”
It came down to a simple premise: Is this the right thing for us to do? “There’s a limit to what we can spend,” Proctor said. By leveraging the pillars of mission, vision, value, and outcomes, leaders can make more informed choices that cater to the most pressing needs. “Without having those in place, you’re making random decisions. There just has to be real clarity about what drivers lead to a set of outcomes.”
Creating this type of culture, of course, doesn’t come easily. For leaders, it means being willing to take a hard stance – and take accountability. “The leader has to be the final word,” she noted. “You can prioritize collectively, but at some point, there are tough decisions to make. It’s my decision, and I’ll take the accolades or the punishment at the end of the day.”
That “courageous leadership,” Proctor believes, is what separates good from great, and is what the industry needs to tackle the challenges of today and tomorrow.
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