Discuss how you met and dealt with the leadership challenge, and discuss the outcome or resolution of the challenge

Interests

Facilitating and providing quality health care; mentoring exceptional leaders and managers; and developing innovative and creative answers to challenges, issues, and problems.

Biographical Sketch

Don Bradshaw is the senior vice president and operations manager for SAIC’s Health Solutions Business Unit’s Defense Health Operations (DHO).

DHO is the customer-facing organization for the support that SAIC provides to the Department of Defense’s Health Affairs and TRICARE Management Agency (TMA), the Department of Veterans Affairs, and the medical elements of the Army, Navy, Air Force, and Coast Guard. SAIC has more than 1,000 personnel supporting these organizations, including staff at every military treatment facility in the United States and abroad. The team’s skills and expertise center on health information technology, including full life cycle systems integration support and services, health domain expertise, supply chain management and medical logistics, workforce support services (counseling, nurse advice line, and employee assistance programs), and health administrative services (coding, claims auditing, appointing, referral management, enrollments, and third-party collections).

Bradshaw, who is a retired Brigadier General in the U.S. Army and board-certified in family medicine and medical management, manages the DHO team and also provides executive-level support on the company’s health and medical initiatives.

Prior to joining SAIC, Bradshaw was a senior partner at Martin, Blanck and Associates, a leading health services consulting practice focused on federal health sector programs and services. In addition, his military service spanned more than 30 years, which included commander- and director-level experience across the entire military health organization:

From 2005–2009, Bradshaw was the Commanding General of the Southeast Regional Medical Command, a healthcare system with five hospitals and six clinics in seven states and Puerto Rico, serving more than 750,000 patients and generating annual revenues exceeding $1 billion. Simultaneously, he was the Commanding General at Eisenhower Army Medical Center, a teaching, referral hospital in Georgia with four satellite clinics in three states and annual revenues exceeding $225 million.

From 2003–2005, Bradshaw was the Commander (Chief Executive Officer) of the Fort Benning Hospital and Health System, which had clinics in three states, 80,000 patients, a graduate medical education program, and annual revenues exceeding $120 million.

From 2001–2003, Bradshaw was the Medical Director and then Lead Agent of the military’s TRICARE Central Region, where he managed the tri-service Military Healthcare System’s integration with the TRICARE Managed Care Support Contractor, including management and operational oversight for purchased services totaling $2.3 billion supporting 1.1 million patients with 26 military hospitals and major clinics in 16 states.

In addition to his military service, Bradshaw earned his medical degree (Doctor of Medicine) from the Uniformed Services University of the Health Sciences in Bethesda, Maryland; his master’s degree in Public Health from the University of Washington; and a bachelor’s degree in Chemistry from Wheaton College. He is a fellow of the American Academy of Family Physicians, the American College of Healthcare Executives, and the American College of Physician Executives. He has also served as the senior advisor of the Central Savannah River Area Wounded Warrior Mentorship Program and as a member of the board of directors at the Christian Medical and Dental Associations of Central Savannah River Area. His office is located in Falls Church, Virginia, at SAIC’s Skyline facility.

What Is Your Leadership Style?

My leadership is cooperative and collegial in the development of vision, mission, priorities, and resourcing. I understand that ultimate responsibility rests with me, even as I delegate authority and roles to subordinates. I then allow those subordinates freedom of action within mutually agreed-to boundaries. I ensure accountability and encourage a freedom to innovate. I underwrite well-thought-out risks and accept that not every idea or plan will be completely successful. Subordinates are expected to lead and manage their responsibilities as part of the organizational team. Simultaneously, they should be learning and growing to expand their knowledge, skills, attributes, and attitudes. They must also grow their subordinates to ensure future leaders and managers throughout the organization. I believe healthcare organizations must learn and grow while remaining focused on the patient and the highest quality care.

What Are Your Three Biggest Leadership Challenges?

Effectively communicating with all levels of the organization

Developing “middle managers” to lead, manage, understand accountability, and develop others

Encouraging innovation and creativity balanced with standardization and consistency throughout the organization

What Are Your Three Most Important Leadership Improvement Areas?

Communication, communication, communication

Balancing accountability with subordinates’ authority and freedom of action

Counseling marginal or poor performers

Organizational Background

SAIC is a Fortune 500 scientific, engineering, and technology applications company that uses its deep domain knowledge to solve problems of vital importance to the nation and the world in national security, energy and the environment, health, and cybersecurity. The company’s approximately 41,000 employees serve customers in the U.S. Department of Defense, the intelligence community, the U.S. Department of Homeland Security, other U.S. government civil agencies, and selected commercial markets. Headquartered in McLean, Virginia, SAIC had annual revenues of approximately $10.6 billion for its fiscal year ended January 31, 2012. For more information, visit www.saic.com.

Leadership in Practice: Bradshaw Case 1

Implementing an Information System: Electronic Health Record

Describe the leadership challenge of your case.

Our task was to implement an outpatient electronic health record (EHR) within our health system, which consisted of multiple, geographically separated clinics and a community hospital. We were part of a vertically integrated, staff-model, worldwide healthcare system; the EHR was developed by our parent organization, and the training package was centrally contracted. Because we were early in the process of implementing the EHR, important leadership roles were to capture strengths, weaknesses, and lessons learned concerning the EHR system. The greatest challenge was to use the EHR implementation to evaluate the entire care process and not just take our present processes of information flow, patient flow, and staff communication to the electronic record, but improve the efficiency, effectiveness, and efficacy of the care processes utilized.

Discuss how you met and dealt with the leadership challenge, and discuss the outcome or resolution of the challenge.

We addressed this challenge in several areas by utilizing a situational assessment that included an analysis of the following areas:

Equipment and infrastructure (e.g., computers, printers, bandwidth, classrooms).

Patient flow. After this analysis, we reengineered patient flow while determining the scope of practice and duties of providers and staff; we then modeled changes caused by or necessary to support EHR implementation.

Staffing implications for EHR implementation (not only the trainers and information management/information technology staff, but also additional support staff in clinics, appointment and admissions sections, shifting duties among present staff, dealing with labor unions, and other relevant issues).

Implications for reimbursement/compensation caused by decreased patient care during implementation (salary versus workload-driven compensation models).

Adequacy of the centrally contracted trainers compared to our organization’s needs: If additional local trainers are required, how do we find, hire, and train those local trainers?

In essence, moving to an EHR across the entire system required changing our existing models of delivering care. Leadership issues in change management included the following points:

Developing a vision, message, and communication plan for the EHR implementation.

Identifying champions (physicians, nurses, support staff) for each area of the system.

Identifying early adopters who would stimulate change and “anchors” who were resistant to change.

Determining the appropriate implementation model (rapid change for the entire organization over several weeks versus clinic-by-clinic implementation over several months).

Determining the appropriate training model (large groups with individual follow-up versus one-on-one, over-the-shoulder, on-the-job training), structure (in groups by function versus by clinical team), and time lines. Because central contractors were deemed adequate only for the initial training, we needed additional trainers for maintenance training.

Leadership imperatives for the implementation of the EHR included the following needs:

Ensuring synchronization of equipment, training, and staffing

Ensuring adequate training, both initially and then over the long term (refresher, new employees, and revisions); scheduling; and the ability to modify training and scheduling based on individual needs and unexpected events (e.g., staff or trainer illness, system downtime, local surge in illness or demands)

Creating incentives for using the EHR system and publishing results

Developing a system to ensure rapid response to questions, suggestions, and needs

Celebrating success

The results of the EHR implementation were successful. Over a 9-month period, an implementation plan was developed, training was completed, and the necessary changes were implemented with a marked improvement in effectiveness and efficiency of care. After implementation, more than 95{b347ee882963fc078925bef44838eb079b614d3dde11dc0714b595823c2ade58} of patients had records available at clinic visits (baseline was less than 70{b347ee882963fc078925bef44838eb079b614d3dde11dc0714b595823c2ade58}), documentation vastly improved in legibility, records were linked to electronic prescriptions with improved safety, and health promotion and preventive measures were facilitated through systematic reminders and ease of tracking. Additionally, improved staff satisfaction with their new or changed roles, due to reengineering, was realized.

Over the 4 months of initial implementation, we did see 15{b347ee882963fc078925bef44838eb079b614d3dde11dc0714b595823c2ade58} less productivity (e.g., more training time, slower patient flow, longer visits required, patient education) in outpatient clinics. Implementing a single EHR for primary care and specialty clinics was challenging: The EHR was developed for primary care, so specialty care applications for drawing, scanning, and other needs had to be developed. Also, EHR continues to be a challenge owing to issues related to ongoing training, accuracy of coding, and some provider dissatisfaction with movement through the electronic record (multiple screens, slow response, and multiple logins).

Leadership in Practice: Bradshaw Case 2

Ineffective Subordinate Leader

Describe the leadership challenge of your case.

The chief medical officer (CMO; also called the chief of medical staff) at the hospital was a nice guy, well liked by staff, but ineffective. He had limited experience in critical areas such as credentials, risk management, and project management. He could not manage the medical staff effectively.

Discuss how you met and dealt with the leadership challenge, and discuss the outcome or resolution of the challenge.

First, I had to determine how much of a knowledge deficit the chief of the medical staff had, how much was attitude, how much was personality, and if he was willing to learn and grow.

Second, I had to determine critical areas that could not wait on his growth because they might lead to loss of workload (and the corresponding funding), loss of accreditation, or loss of key medical staff members. I then had to determine possible short-term solutions for these critical deficit areas for the CMO.

Third, I had to determine which options were available to lead him:

Could I move him or relieve him of his duties?

Could I develop him without destroying his capabilities to lead medical staff over the long term?

Could I work with him at all? (Was the relationship open to and capable of sustaining counseling, growth, accountability, and open communication?) If not, could someone else provide the mentoring?

Fourth, I had to develop a plan to stimulate his growth, including setting appropriate time lines and goals. At this point, I counseled him, identifying what he was accountable for in this process.

To implement the plan for his growth and improvement, the following occurred:

The CMO’s skills were assessed through a variety of tools (he had already taken several assessments including a 360-degree management-style evaluation tool) and interviews.

New chairs of several critical committees were temporarily appointed, with the announcement that the CMO was assuming specific other duties for the 6-month period that would prevent him from providing focused leadership during this time frame.

A plan for the CMO’s development was created, including specific readings, courses, and time spent “shadowing” various experts (e.g., the credentials staff); specific targets for improvement were set.

I counseled the CMO initially every week and then every 2 weeks, identifying specific written and verbal projects for him to complete and provide to me and the medical staff.

The results of the CMO improvement program were generally successful. This executive did complete his time as CMO; we did have a Joint Commission survey and achieved full accreditation with commendation. Other staff members developed their leadership skills as they chaired committees and led specific projects. The CMO was placed back into a full-time clinical role with minimal administrative duties and remained a productive member of the organization. However, his leadership void did result in some distress and power shifts with the COO and senior nurse executive, which required additional time from me to monitor, listen, and occasionally “referee” disagreements. Looking back on this situation, once the CMO’s assessments were completed and it was clear his greatest lack was an ability to hold others accountable, I should have moved this individual back to a clinical position without leadership responsibilities earlier.

Leadership in Practice: Bradshaw Case 3

Values and Vision Conflicts

Describe the leadership challenge of your case.

As the CEO of a hospital within a larger system, you are faced with your higher leadership developing a plan to reorganize the reporting and accountability system within the entire organization that includes the hospital you lead. The goals of the reorganization are to streamline reporting, improve clarity of responsibilities, cut down on leaders with multiple supervisors, and hold leadership at all levels accountable for performance. You feel certain that the proposed plan will actually increase the complexity, decrease clarity, fail to decrease multiple chains of supervision, and decrease accountability. You have expressed your beliefs to leadership, but they appear not to listen, and they proceed with the proposed actions. It appears much of the weight behind their decision is political (limit loss of jobs in any one area, market it as better focus on prevention and community health, and continue to build up headquarters’ centralization of control).

You are the spokesperson who must tell your hospital staff, your patients, and your community about the reorganization. As senior leader, you are charged with communicating why they should support this reorganization, why they should not be concerned for their jobs, why this change is good and meets the stated goals, and how the reorganization will be implemented at your hospital.

The following are leadership issues at the local level:

Do you readdress your concerns with higher leadership?

Do you discuss your concerns with other hospital CEOs (your peers) within the organization? If so, for what purpose or what action?

Do you support the “party line” when marketing this reorganization internally and externally?

Do you resign?

Do you start a job search?

Additionally, the following are topics for discussion based on the reorganization plan:

Loyalty to the larger organization when it conflicts with your perception of loyalty to your own staff and organization.

Communication within the larger organization and specifically your communication, impact, and participation in decision making.

Your personal integrity and reputation: How do you maintain them in various situations?

Your standing within the bigger organization: Should you consider the decision to go ahead with the reorganization to indicate a failure of alignment of your goals, leadership style, and purpose with those of your employer, and begin a job search for a company with better alignment?

Means to additional information or other (peer) input and advice without appearing disloyal, not a team player, or overly opinionated.

Ways to transmit the higher organizational level’s messages to your staff, community, and political leaders.

Discuss how you met and dealt with the leadership challenge, and discuss the outcome or resolution of the challenge.

First verify all of your concerns. Do you understand the plan? Then go to your mentors or people you trust (preferably outside the organization); discuss your concerns to get a broader understanding and additional opinions about them, and to have others challenge your concerns. If your concerns are validated, readdress them with higher-level leadership in a nonconfrontational manner to better understand their decision-making process, develop better communication, and develop a fuller understanding of the issues.

Then you have one of several choices:

Support the plan and implement it to the best of your ability.

Find other CEOs (if any) who agree with you and go as a group to higher leadership. Be prepared to present your own plan and alternatives, not just negatives or complaints.

Take this rejection of your position as an indicator that this organization may not be a good long-term fit for you and begin a job search. (Continue to do your best so you leave with a positive reputation.)

You should always strive to develop ways to improve your communication with higher levels of leadership and provide your input early in change processes. An absolute imperative is that you do not complain to your staff or community leaders about upper management’s decisions.

 

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