The Importance of Authentic Leadership with Cindy Hundorfean

Podcast Transcript

Brian Bolwell, MD: Welcome to Beyond Leadership at the intersection of leadership and everything else. In this Cleveland Clinic podcast, we will commingle with extraordinary thinkers and explore the impact of their ideas and experiences on leadership and management.

Today I'm thrilled to introduce you to a wonderful colleague and friend Cindy Hundorfean. She is the CEO and president of Allegheny Health Network, a 12 hospital, $3.6 billion healthcare system based in Pittsburgh, Pennsylvania. Since she's joined the network in 2016, Cindy's extraordinary efforts to transform AHN have been recognized both regionally and nationally. And in 2019, she was selected by Modern Healthcare Magazine as one of the nation's top 25 women leaders. A very impressive accomplishment. Cindy, welcome.

Cynthia Hundorfean, EMBA: Thank you, Brian. It's great to be here. Nice to talk to all of you.

Brian Bolwell, MD: So Cindy, when you joined Allegheny in 2016, what were some of the challenges and how have you addressed them? And after we talk about that, I'd like to hear about how you became a leader in the first place. Cynthia Hundorfean, EMBA: Oh, sure. Thank you. So when I arrived here at the beginning of 2016, it was a system that had gone through bankruptcy and it was really still reeling from going through that. A lot of the providers had left the system and gone to one of the major competitors UPMC. So, the system was really floundering and what they really needed from both the physician and the nursing perspective was a leader that was going to really help guide them back to where they were before. And as we all know, or the people who do know about Allegheny General back in the heyday, it was a really, really great institution.

So it was hard because the clinicians really had no trust in the leadership because they had led them down this road of bankruptcy. So I had to be able to convince them over the next 12 to 24 months, why they should trust me and the leadership team that I put together and really help us get back to where we wanted to be. So it was a real challenge, but probably one of the best decisions I ever made really, as far as coming here because they needed somebody that was going to believe in them. And we've been really successful since 2016, as far as returning to profitability and kind of putting our name back on the map, so to speak.

Brian Bolwell, MD: So you talked about trust and almost every leadership book that's ever been written talks about the importance of trust. One of my favorite books is from Stephen Covey that talks about the speed of trust. How if trust is present, everything is simpler, everything is quicker and actually more fun. How do you generate it? Or how did you generate it?

Cynthia Hundorfean, EMBA: You know, Brian, that's a really good question. And I think that you do that by leading by example. And you all know, and anybody who's listening to this, that the administrative leadership at the clinic was absolutely wonderful. And I spent my entire career at the clinic and I learned everything that I knew from the clinic. And I knew from working with clinicians all those years, that unless they trust you, you're not going to get anything done. You're not going to move. So you got to be good for your work. If they called you and asked you to do something, you did it, or you gave them a reason why you couldn't do it, but the follow through was absolutely essential.

I really haven't told this story to anybody, but I remember that when I ended up taking this job at the beginning of 2016, one of the physician leaders at Allegheny General, who was the person who was probably the hardest person on me during the interviews said, "Why should I trust you?" And I handed him the phone directory of the Cleveland Clinic. Then I said, "Call anybody you want," and that was it. And he actually did. He called I think 10 physicians. And they all said, "No, you can trust her. You can trust her." So that goes right back to your question, why it's so important. Because you can't get people to go with you on your journey unless they trust you.

Brian Bolwell, MD: Yeah. It's just essential. And you mentioned follow through and keeping your word. I think that it's so important not to let things dangle. And if somebody asks you a question or somebody asks you to do something, even if you can't do it, you can acknowledge that you are aware of it and you're going to do your best to come up with an answer down the road.

Cynthia Hundorfean, EMBA: You're absolutely right. And that has been critical for me in my new leadership position at AHN, to surround myself with leaders who think and feel the same way. And that's the cardinal sin in my book. When people ask you to do something or ask you for your help, if you either don't respond or don't follow through, that's not acceptable. So that builds trust. Going back to trust. Because people then will continue to call you and then you start to know what's going right and what's going wrong. And they don't hesitate to call you because they know that you're going to come through for them. And it's a two way street going both ways.

Brian Bolwell, MD: You had to pick a leadership team. How did you do that?

Cynthia Hundorfean, EMBA: It was hard in the beginning because I came to AHN. The idea first was to do the financial turnaround, which I had never done. We had a brand new CFO. He had started, I think four weeks before me. He was outstanding, but he was from another state. So he didn't know much about AHN or Highmark either. And I think we had 28 or 29 people on the leadership team at AHN. And it took me a couple of months to really get to know who they were and what they did. And it didn't take me a long time to find out that it's probably not the group that I needed to do... The way forward. Because they didn't value where the physicians wanted to go.

Every time I would ask a question, I would say to them, "So what do the doctors think?" Or, "What are the nurses think?" And they couldn't answer that question. So I knew that I needed to get people who understood that in order to move the system quickly and turn it around, that we needed to have partners on the team that appreciated the fact that you can't do anything unless the clinicians are on board, and in effect, helping lead the turnaround. So what we did was we switched out a lot of the leadership team with clinicians within the system, and really put them in charge of the major decision making for the system. And automatically things started to turn around because it was them making decisions and then them talking to their colleagues about why we needed to do that. And the trust just came back very quickly. So it went faster actually than what we even had anticipated and at the end of the day, it was the right thing to do.

Brian Bolwell, MD: How do you delegate to these folks?

Cynthia Hundorfean, EMBA: I don't even really have to. They just take it. We have a meeting every morning at 7:00 or 7:30 with about 45 of us. We all talk about what's going to go on for the day. And they're jumping to take responsibility for it because they get enjoyment out of just being able to make decisions. And they don't have to ask, "Can I do this?" When we all as a group agree every morning, okay, this is going to happen, this person's taking it, it just happens. And one of the things I was very intentional about when I came here was making sure that the clinicians, when they were going to go in a direction and they agreed together collectively this is what we want to do, that they didn't have to ask permission. They were just going to go.

And I think it took them about a year to get used to the fact that they didn't have to do that because they would stall after they thought of something, waiting for someone to say, "Okay, yeah. You can do this." And I kept saying to them, "You don't need to wait, just go." And then they started going. And it's been fun because you know what I do? I play catch-up with them sometimes because they're going so fast. But that's okay. It brings a great deal of enthusiasm and enjoyment, and it's just fun watching them. And I tell them all the time, "Okay, we may make mistakes because we're moving fast, but that's okay because we'll just change it together." So it's been a much different dynamic than what I had really even anticipated. The ability to work with Highmark as the payer has been a dynamic that I never thought I would enjoy as much as I did, because I didn't know enough about it. But that has brought a whole new world to me that I really, really appreciate at this point.

Brian Bolwell, MD: Say more about that.

Cynthia Hundorfean, EMBA: So Highmark, which is a huge insurer, a Blue Cross Blue Shield company, fourth largest in the nation, bought Allegheny Health Network. Actually, it was West Penn Allegheny Health System at the time back in 2013, with the idea of improving quality, but reducing cost. And when we really got our act at AHN, our physicians were able to start participating... Everything that the payer was doing as far as designing products that were going to go out in the market, reducing cost. Because we were one system from a financial perspective, it was easier for us to do it because we were doing it all together. And that was a whole side of the house that formerly, the doctors knew about Highmark and knew what they did, but they didn't really understand it.

But once they started sitting at the table and helping them determine what was going to go out into the market and designing the products and reducing cost and doing it all together as a group, they all got on board, which really benefited Highmark in a big way too. So we've just moved forward. We call it blended health now. So everything we do, we do together with Highmark, and it's really invisible where kind of Highmark starts and AHN starts and stops. We're all together in the same space, all of our meetings together, and in the meetings that we have, the AHN physicians are sitting at the table. So it's one big happy family, so to speak.

Brian Bolwell, MD: How has that translated into results?

Cynthia Hundorfean, EMBA: It's been amazing. So we've put products out in the market which we would call network products that really are products that we are able to perform really, really well at Allegheny Health Network, because we've been able to take a lot of the cost out of the care that we're providing. Because Highmark has, as you would have well imagined being a big insurer, a ton of people who are very knowledgeable about the cost of care. And when we've been able to utilize them at Allegheny Health Network to help us and show us where we are high or where we could make improvements, information that we wouldn't have had if we weren't with Highmark, has been very beneficial. So now we can actually gain patients by the fact that we can reduce our cost legitimately because we've focused on the right areas.

You could look at the results of what we had over the past few years. We turned a profitability in end of 2017, and really have been profitable ever since with the exception of COVID, which hit everybody. But, we returned to profitability two months ago at AHN. So, we're on the right trajectory at this point.

Brian Bolwell, MD: So, can you give our listeners a couple of examples of how you reduced cost?

Cynthia Hundorfean, EMBA: So, we put the doctors in... Well, you'll love this. So, we said to the doctors, we get about 30 doctors, and it was actually led by Sri Chalikonda, MD, who was formerly at the clinic. And we said to them, "So, if you could redo what you do and take out anything that you don't think needs to be done for patients, but you've always done it this way, just because it's what you've always done. What would you do differently?" And as long as they understood that it wasn't going to harm them financially, they may list as long as, serious, I mean, 30 feet long. So, we took those ideas, and then we just kept going through them, going through them, going through them. And in fact, we actually ended up implementing a lot of those through the products and it reduced the cost.

We just stopped doing them. And how do you do that? You lock it down in Epic. So, they just can't do it anymore. But, it wasn't me saying to them, "You need to stop doing this, because you don't need to do it." Because, how can I do that? I'm not a clinician. But, if their colleagues are saying, "You know what, guys? We don't need to do this anymore." It was fine, because they all believed it, but they just didn't really do it. Because, remember the fee-for-service world, "The more you do, the more you pay." Well, that's not our world. We don't live that way.

Brian Bolwell, MD: That's a wonderful story. So, the engagement of clinicians with the administrative leadership, is something that you've always excelled at and yet, is not common Cindy, it just isn't-

Cynthia Hundorfean, EMBA: I agree.

Brian Bolwell, MD: What's your personal secret sauce?

Cynthia Hundorfean, EMBA: The secret sauce, is you can't do it without the clinicians. That's it, end of story. And when people ask David Holmberg, who's the CEO of Highmark Health, our parent company, "What has made AHN, be successful over the past five years?" His immediate answer is, "We put clinicians in leadership positions, so they can help us get there. And they're helping us make the decisions." And I don't know that before then, they would have thought that, but that's true. That we don't do anything without having the clinicians at the table. And that's both nurses and physicians, anybody who's seeing patients.

And we don't just talk about it, we actually do it. We've got $100 to spend, it's the clinicians who are going to decide how we're going to spend them. And I explain to them all the time, my role is to help you do what you want to do once you've decided, just to make it easy. That's what I do. I'm not going to make the decisions. Now, I can make decisions if they don't, but I don't have to do that very often. I guide the ship, so to speak, but they make the decisions.

Brian Bolwell, MD: Well, that's a winning formula clearly. And it sounds, it also must foster engagement.

Cynthia Hundorfean, EMBA: It does, it does. I'm not embarrassed to say, that the physicians here, if you were to ask them, if they like working here, they'd probably say I love working here. Because, there's nothing that prevents them from doing what they want to do. The ones that we don't tolerate, are the ones who don't want to work and you're always going to have people like that. But, the good thing, is that the other physicians, because they have a feeling of, I don't want to say control, because that's probably the wrong word, but they're responsible for what goes on during a day. And no one's telling them what to do. They're the ones that call their colleagues out and say, "You know what? Maybe, you should go someplace else." It's not me, it's not somebody else. It's just, they now own the system. It's probably the best way to put it.

Brian Bolwell, MD: Cindy, yesterday I had a conversation with somebody about different parts of leadership. And one topic that came up was authenticity. I've always kind of prided myself as being authentic. And I think that that has served me well. Although sometimes, it makes me weird and different, but I'm okay with that. Your authenticity always rings through as well. How do you do that? Is there any downside to being as plain speaking and straight and authentic as you are?

Cynthia Hundorfean, EMBA: I don't know, Brian, that's a very good question. I will tell you that, I don't know any other way to be than that. And I remember the first month I was here, I was at Allegheny General Hospital, in front of the staff. There's probably four or 500 physicians there, and it was horrifying. Because, it was the first time that I had actually talked to the staff in one big collective group. And they were so hard on me. "What are you going to do? What are you going to do to turn this system around?" And I understood where they were coming from, because they were still so hurt by everything that had happened. And finally, I just said to them, "Stop putting it on me. What are you going to do to fix this?" And I remember them acting out after that.

And I said, "Don't ever ask me a question, if you don't want to hear the truth, because I don't know what else to do other than to tell you how I'm feeling and it may be wrong, but it's just the way I am and you're going to get used to it. And if I tell you I'll do it, I'll do it. But, if I don't know the answer, I'm not going to pretend like I do, but we'll figure it out." And I don't know how you do that, other than to tell you this. Absolutely, so critical and important when you're a leader that you are like that, because people can see through that as you know, right away.

And I've always appreciated that quality in you too. If I ask you a question, you're going to tell me the truth. You may not like the answer, but you're going to tell me the truth. And people who are like that, gravitate to other people that are like that. I have done that throughout this organization too. I go to the people who I know are going to say, "Yes, or no. Or, this is why, or this is why not." So, I don't know. It's just a trait that I like and appreciate. And I think other people do too.

Brian Bolwell, MD: Yeah, I agree with that. I think, that it does tend to attract like-minded individuals.

Cynthia Hundorfean, EMBA: Mm-hmm (affirmative).

Brian Bolwell, MD: And I think the one key to it is, having the security, the inner security, to be honest and vulnerable. A lot of times when you're honest, you're exposing yourself to risk and feeling vulnerable. In the story you just told, you said that, it was a horrifying experience to get in front of all these docs the first time. And just to be able to verbalize that honestly, is I think, so essential to authenticity and not everybody can do it.

Cynthia Hundorfean, EMBA: It's hard. And it does take confidence in yourself. I think people underestimate the amount of knowledge that they get from the Cleveland Clinic. I mean, I spent my entire career as you know, at the clinic and I am so indebted to everything I've ever learned, because I got it all from the clinic. And I still love the clinic so much. I mean, I consider it truly my home, and it's okay to say, "I don't know." I think people appreciate that. They're like, "She's honest. She doesn't know." There's nothing wrong with that. As long as you do something about it afterwards. And learn.

Brian Bolwell, MD: Well, I don't know, is one of my favorite phrases Cindy, I say it all the time and I actually wrote an op-ed about it. And I think, it's engaging to your team. Number one, it eases tension. Number two, people always want to help. And so, "If he doesn't know, let me try to help him out." And again, the honesty and the transparency, I think just helps build trust. I think saying, "I don't know," is a very useful tool that unfortunately, is highly under utilized.

Cynthia Hundorfean, EMBA: I couldn't agree with you more. In fact, we had this conversation yesterday with a leadership team meeting and I asked a couple of questions and somebody answered it and I knew it wasn't the right answer. And I said to him, "Why don't you just say, "I don't know." And then, just go find out." And we laughed about it, but I guarantee you, that person hopefully learned from that, and won't do that again. Because, I don't want answers just for the sake of answers, it needs to be true.

Brian Bolwell, MD: So, how did your journey start? I remember when I started at the clinic a long time ago, I was clueless about so, so many things. And I remember how you went out of your way to help me. And I have no idea why you did, because I was a very young, naive, bone marrow transplant physician. You were in charge of surgical ops, I think at the time. And so, I was doing bone marrow harvest and I was in the operating room and I probably was messing up all over the place. And you helped me out. Did you start in surgical operations? Is that how you start?

Cynthia Hundorfean, EMBA: No, I actually started as a clerical supervisor, which is no longer a title at the clinic, I'm sure. For ENT, otolaryngology and communicative disorders, that was the name of it at the time, in 1981. And it was really a supervisory position over a clerical staff. And I just started to take on more and more responsibility and move to other specialties, as far as leading them and the job titles changed. But, I got so much joy out of the working with different groups and learning the specialties and learning from different physician leaders. And I just had I guess, a thirst for knowledge. And then, I ended up working with Joe Hahn and spent many, many, many years working with him and learning from him and how he treated people and acknowledged people. I mean, he knew everybody at the clinic and everybody's voice was just as important as the next person.

And I've told him often, that a lot of, I think the qualities that I have, I think I learned a lot of them from my dad, because he was very similar to me, but a lot from Joe too, because I watched how he treated people. And I remember one time he said to me, that he learned more about what was going on at the clinic, from the people who were in a parking garage and attending to patients, than people on the leadership teams, because they weren't afraid to tell you what was really important to the patients. Then he said, "If you don't have that relationship, how are you ever going to find out?" And that stuck with me, and I believe that to be true. So, I've tried to do the same thing. So, anyway, so I just kept progressing through the clinic and just kept taking it on more and more and more.

And I loved every minute of it. And it was very hard to leave, because I truly thought I was going to retire from the clinic, but this opportunity came up and I talked to several people about it. And I remember at the end, when I made my decision, I thought to myself, "If you were ever going to take everything that you learned from the clinic and apply it to a system that really truly need your help and the physicians need to be propped back up and made to feel important, this is the one." And so, I did, and it was the right decision for me.

Brian Bolwell, MD: So, for our listeners, Joe Hahn was...

Cynthia Hundorfean, EMBA:... the right decision for me.

Brian Bolwell, MD: For our listeners, Dr. Hahn was the Chairman of Surgery for many years at the Cleveland Clinic and later became Chief of Staff and certainly was one of my mentors as well. And I'd like you to comment a little more on a couple of things about him. One thing about Joe that I really think is important was his sense of optimism. He was always convinced that we'd get through the tough times and he was invariably correct and he would hit a very steady hand through turbulent waters in part because of that optimism. The second thing about Joe is his resilience. I've talked repeatedly on this podcast about my personal ups and downs professionally and when things don't go your way, sticking to it and having resilience, usually there's another door down the road that opens, and maybe there's a lot of other doors that open, but those are two things that always stuck with me. How about you? Do those resonate with you?

Cynthia Hundorfean, EMBA: They did. He was always so optimistic, looking to the future, what's going to be next for us and leading us there. And I still talk to him quite frequently, and it's funny, Brian, because I'll talk to him sometimes in the evening when I get home from work and he'll just call to check in and he'll say, "How was your day?" And if I say anything other than, "It was great," he'll say, "Okay, tell me something good that happened today." And sometimes it's hard for me to think of something, but it goes right back to what you said, he's full of life and he was truly someone that I learned from, I watched and especially I would do walks with him throughout the hospital and how people reacted to him and talked to him. And he always smiled and people could trust him and he was truly a mentor to me throughout a large part of my career. And the thing is it doesn't stop with him. If he's your friend and he believes in you, that's for life, it doesn't just stop. He's proved that since I've left. He's a great guy, a really great guy.

Brian Bolwell, MD: And what about resilience? How do you handle setbacks or derailments or whatever?

Cynthia Hundorfean, EMBA: We have them a lot. I think everybody has them a lot, and if they don't they're just not admitting to the fact that they have them. For us, it's happened before in big, big ways. The smaller setbacks aren't that big of a deal here because they've had the really major ones. People here have a little bit of a different attitude, Brian. I would say that they're, this is sad to say, but sometimes used to disappointment. They've been really encouraged and invigorated over the past four or five years that we just haven't really seen that. But when things do happen and we have setbacks, they just assume at this point that it'll work right back or we'll figure it out. And they think that because it's their colleagues who are actually making the decisions and if they don't like something, they just go and talk to one of the people on their team and they don't need to come back up to me to say, "Can we do this?"

We do have setbacks, the Coronavirus was something that obviously wasn't anticipated by any of us, but the fact that we could count on Highmark as an organization to help us through that was critically important. And I don't know how we would have fared without them, but they jumped in as if we were one big family. And David Holmberg, who is the CEO, when we were doing vaccinations, we've done I think 368,000 vaccinations to this point with so many events, it's crazy, but he was at the front of the line for every single one of these, greeting every person that walked through the line for every single event.

And if that wasn't something to look at and be proud of. Yeah, it was a setback, it was hard, nobody was expecting it, but I think you just make the best out of and think, how can we take the situation and make it into something that's a win, so to speak, for our systems so that people look at us and say, "You were resilient, you did what you were supposed to do, you came through for us?" And we try to do that every time.

Brian Bolwell, MD: During the COVID pandemic I was still running the cancer center at the time and my job changed. I became much more of a presence to be there to be present to walk the halls as well as a communicator. I think that I had to communicate, I did communicate daily to everybody who was on our team about the Coronavirus, about what was going on locally, nationally, within the organization and as well as my own personal life. And that I think helped bond the cancer center together in a way that was pretty remarkable. Did you do anything different with respect to communication?

Cynthia Hundorfean, EMBA: We did something very similar. We were not only reaching out to all the employees in the system, but we were very visible in the hospital's during those times. And it was sad and it lasted for a very long time, but we felt the need to be really, really connected to the people who were providing the frontline care because they were just taking hits day after day after day. And everybody was suffering from it and we did the same thing, we just communicated, probably overly communicated sometimes, but just to tell them that, "We know what you're going, what can we do to help you?" That was our message. "What can we do? What can we do tomorrow to help you more than what we did today?"

And they were very vocal and they were really concerned, much of the time, about the protective gear that they were wearing. Is it enough? Can we do something differently and Highmark, to David's credit, jumped in and worked with several of the manufacturers in Pittsburgh to design different and better equipment so then the caregivers felt a part of it. I don't know, it always comes back around when we talk about this to including everyone in the decisions and not pretending like you're the only person in the world who's going to make the decision that's best for everybody that's working with you. We learned a lot of lessons and I think if we go around again in something similar to this, I don't know that we would change it that much from what we did during the pandemic.

Brian Bolwell, MD: Cindy, one thing we've talked about on these podcasts is leadership development and self-insight, and for me, when I first got my initial 360, many years ago, that was very illuminating and changed me because so much of it was negative about my style of leadership that I decided to read a lot about the topic and change and evolve and get better. Have you had any formal leadership development? Have you used executive coaches, have you had 360s and if so, what have you learned and how has it helped you going forward?

Cynthia Hundorfean, EMBA: That's a really good question, Brian. I have, and I would say that I probably hadn't had that much before I came here and I would also tell you, and it's not something I really wanted to do. Because I thought, okay, I know what I'm doing. I'm giving people the ability to make decisions. What wouldn't they like about that? But as we both know, there's always things that you can do better and do differently with the people that are... It was hard for me to admit, okay, there's things that you probably should change. I did do that and I never had a coach, but I did work with people that worked right around me to say, "Okay, this is the results I got, what do you think?" And they confirmed, "Okay, here's some areas that you could work on that would make it even better to work together as a team," and I've tried very hard over the past couple of years to address that.

I think one of my issues is that I go so fast that I just assume that everybody's right there with me and that's not always true. I've had to modify how I work around several of the leaders to bring them with me instead of just running ahead of them all the time. And there's other things, too.And I do much more frequent check-ins with the leadership team to say, "Okay, tell me what's going on. What can I do to help you," than I did before. I assumed they would just tell me if they needed something, that's not necessarily true. The answer is yes, it's important. I think it's sometimes hard for people like us because we think that we're doing a really great job, but if you don't do that, you're probably missing some things.

Brian Bolwell, MD: Yeah. I think it's, certainly for me, probably because of the list of what I was doing bad was so long, it was really important because I had a huge amount to work on. One of my favorite phrases is to say, "I've got a PhD in making mistakes," which has a highly accurate story. One of the things, you mentioned your team and sometimes they're not going as fast as you are and I find that to be true as well. And it leads to a topic that's not commonly talked about in leadership and that's forgiveness, both for other people, as well as for yourself. I think that invariably people make mistakes and sometimes they let you down and certainly you let other people down.

Cynthia Hundorfean, EMBA: Right, right.

Brian Bolwell, MD: And if they're good people, and they're the sort of people that we talked about earlier, who you want to be on your team, forgiveness sometimes is hard and it's not the same as accountability because accountability is extremely important.

Cynthia Hundorfean, EMBA: Right.

Brian Bolwell, MD: But again, if you exhibit forgiveness I think it strengthens engagement and it actually makes people even try harder down the road. And it's equally important to not be so hard on yourself all the time. I think that sometimes high performers, certainly not all of them, some people I think, think they're always great, but people who have an ability to self-reflect sometimes can get pretty down on themselves and having self-resilience and being able to cut yourself a break, I think these are important things. What do you think about forgiveness?

Cynthia Hundorfean, EMBA: I think you're absolutely right and I've always held to the belief that I am willing to work with anybody who is not performing at the level that I think they should be. As long as they're trying and they're putting a lot of effort forward, I'll be the first one that will sit down with them and spend as much time as I need to, to get them where they need to be. As long as their heart's in the right place then I know that at the end of the day that effort's going to be worth it. But I'm also the first person, as people at the clinic would attest to, that if you're not trying and you don't really care, you're probably going to be gone by tomorrow. I've just never tolerated that and I don't hear it, and people know it. So the people that are here are good and there are a lot of people who are far ahead of others, but that's okay because the people who are behind them want to learn. And I think that's fine.

And as far as giving yourself a break, probably the hardest thing for me. I was on a panel for modern healthcare last week and one of the questions that was posed to me was, "So what do you do for yourself?" I said, "Not a lot. Probably not enough, because I work all day long and then I go to bed and I get up and I do it all over again." But I've got a wonderful family. Other than that, I don't really concentrate on that. And I don't know if that's our generation, Brian, but I think I'm hopeful that the people that are behind us will think about it differently and take the time to really take care of themselves too, because I think it's so important. I don't begrudge people that are doing it, it's just that I haven't really learned how to do it well for myself.

Brian Bolwell, MD: It's interesting to wonder if it's generational or not. I don't know, but certainly a lot of people that are in leadership positions are certainly quite driven to achieve results and succeed, actually, I know that's true of me. But I think that in addition to spend time away from the job, I just think that sometimes if you make a mistake or a meeting didn't go quite as well as you planned, as long as you reflect on it and resolve to get better, that's probably the best you can do.

Cynthia Hundorfean, EMBA: I agree. I agree.

Brian Bolwell, MD: And then you just got to go from there. The other point you just raised though is how do you build a team? And you mentioned people who care, they got to care about what they do, and there's a wonderful book by an author named Duckworth called Grit: The Power of Passion and Perseverance. And passion is so important. People who care who really get the mission, we're taking care of really sick human beings and what we do is very important. How do you find passion in people? How do you recruit for it?

Cynthia Hundorfean, EMBA: Because I always ask them, Brian, what's the most important thing in the world if you're in healthcare? And if their answer isn't the patients or close to the patients, they're probably not the right people because I tell my team all the time, we're making decisions along with the clinicians at the table. Is this decision that we're making, how's it going to impact the patients? And if it doesn't in a positive way, maybe it's not the right decision. And I think that when people say, "My career," or "Advancement," or "Knowledge," I'm really looking for people that want to be involved in making life for our patients better. And by the way, almost as importantly, making life for clinicians better. Because if our clinicians aren't feeling the fact that they're being supported and valued, then it's not going to make for good patient care or good patient experience. It's equally as important.

And I've put a lot of time into talking about clinician wellness and a lot of efforts around what we can do around that. We've got a full on campaign and group that work on this continuously and just keep... In fact, I'm going to be talking about that this afternoon at one of my meetings, about the results that we've had over the past year, because the clinicians have formed this group. And I said all along, "We're not going to do this unless we're going to listen to what they have to say and actually do something about it." And so happy clinicians equal happy patients. Patients are the most important thing, so when I'm looking for leaders, I'm looking for answers that don't exactly match that, but are going in that direction. Does that make sense?

Brian Bolwell, MD: Yeah, it makes total sense. I try to recruit for it, too. I just think it's vital. I think that and emotional intelligence, I think an ability to walk in other people's shoes is very important and I think you can actually probe for that when you're interviewing people.

Cynthia Hundorfean, EMBA: Yeah. I absolutely think that you can, too. It's funny, I was on a panel, a different panel last week, and I talked about the importance of emotional intelligence. And it's going to be even more important going forward because the people that we had working before in our offices, let's say our back office functions, who a large part of those are at home and you need to understand what it is that is important to them now, not before. It is different. You really have to be thinking about that all the time. I think that that's going to be one of those things, Brian, that maybe we didn't appreciate as much as we probably should have before, but we're going to have to really be in touch with that now and look for those who have that. I agree.

Brian Bolwell, MD: What's healthcare going to look like in five years?

Cynthia Hundorfean, EMBA: I think it'll be more consolidated. I think that value based care is going to move forward at a fast rate. I think fee for service is going to continue to decrease whether we want it to or not. I think that there'll be more primary care. I think there'll be more people taking care of patients in their homes. I think that everything is going to move to the least expensive place where we can provide the best quality care for patients, and that's not necessarily going to be in the hospitals.

We're trying very hard to move as fast as we can to areas where it's close to where the patients are living so they don't have to move and we're doing it at reduced cost. But the quality and the patient experience are really still always top of mind for both us and for Highmark. It has to be, from a membership perspective, and for us, from a patient perspective. It's going to look different. I think that Cleveland Clinic, it's so amazingly good as we all know, but the clinic will have to make changes, too. But they recognize that.

Brian Bolwell, MD: As we wrap up, Cindy, do you have any words of advice for aspiring leaders, either in healthcare or in any industry?

Cynthia Hundorfean, EMBA: Be passionate about what you're doing and if you're not passionate about what you're doing, go do something else. Because if you're not passionate, you're not going to do it well. That's my words of advice.

Brian Bolwell, MD: Well, I think that's great advice, actually. I heard exactly the same advice yesterday from another individual talking about, find something that gives you joy.

Cynthia Hundorfean, EMBA: That's right.

Brian Bolwell, MD: And hopefully that's your current position wherever you are and certainly if you're in healthcare, hopefully that's doing what we do in healthcare. But finding your passion I think is a big, big deal. Cindy, thank you so much.

Cynthia Hundorfean, EMBA: Thank you Brian.

Brian Bolwell, MD: To our listens, we welcome any topic ideas you may have for future episodes, comments and questions about this, or any past episodes. You can let us know by emailing us at executiveeducation@ccf.org. Thank you very much and have a nice day.