Key Takeaways
- Leverage administrative fellowships as a strategic career accelerator to gain early access to C-suite mentorship and lead high-impact operational projects.
In a recent episode of the Fellowship Review through the American Journal of Health Care Strategy, host Vrushangi Shah, MHA sat down with Madeline Cremin, MHA, a seasoned Program Manager at Mayo Clinic. What makes Madeline's journey so compelling is how she transitioned from her graduate school days at the University of Missouri-Columbia into a coveted hospital administrative fellowship at Nicklaus Children's Health System in Miami—and then on to a leadership role at one of the nation's top integrated healthcare systems, the Mayo Clinic. This conversation unveiled a trove of insights into the admin fellowship application process, the importance of mentorship, and adapting to new professional cultures and settings in healthcare management.
Below is a closer look at how she navigated these milestones, the lessons she learned, and the advice she offers to those aspiring to follow a similar path in healthcare administration fellowships.
Madeline grew up in Chicago and eventually chose the University of Missouri (often referred to as "Mizzou") for her undergraduate and graduate studies. She began her academic journey in Health Sciences, later pursuing a Master of Health Care Administration (MHA). These years proved to be critical, as she dove into hands-on experiences that introduced her to the complexity of healthcare administration and the healthcare continuum.
One of her earliest roles was as a Care Transition Resource Specialist at MU Health Care, which gave her a foundational understanding of hospital functions, electronic health records, and institutional policies. However, it was her administrative internship—supported by MU Health Care—that truly allowed Madeline to test the waters of hospital administration and gain exposure to operational program development.
From this internship alone, she gained a taste for large-scale process improvement and strategic planning. The exposure to ambulatory care—often touted as the future of healthcare—reinforced her desire to play a larger role in health system operations and pursue an MHA fellowship.
While wrapping up her graduate program, Madeline wrestled with the question many MHA graduates face: Should she enter consulting, pursue a direct hospital operations role, or apply for administrative fellowships? She was drawn to the fellowship route by stories from peers and mentors who described it as a rare opportunity to interact with senior leadership, gain holistic organizational insights, and steer high-impact projects in healthcare management.
She also added that if she didn't secure a fellowship, she was open to exploring other options. However, once she fully committed to the application process, she realized just how rigorous—and rewarding—it could be. This led her to research what is an administrative fellowship and how it could benefit her career in healthcare administration.
Madeline's organizational strategy was one of the key elements of her success in landing a healthcare administration fellowship at Nicklaus Children's Health System. She applied to roughly 10 to 15 fellowships, creating an Excel spreadsheet to keep track of deadlines, application requirements, and follow-up tasks such as reaching out to fellows on LinkedIn or attending informational webinars about top administrative fellowship programs.
Ultimately, her preparation paid off. She secured interviews and found Nicklaus Children's particularly appealing after visiting in person. She described how important it was for her to feel the culture firsthand, meet key leaders, and see the environment. It helped that the children's hospital exuded a sense of warmth, positivity, and mission-focused care, with a strong emphasis on community health and health equity.
Nicklaus Children's fellowship was (and still is) a one-year program, though the structure has evolved slightly since Madeline's time. When she was there, she was the sole fellow, shouldering all major projects that came through. Since then, the program has expanded to include two fellows who share responsibilities—a change Madeline sees as positive for healthcare admin fellowships.
The fellowship was rotation-based with a heavy focus on projects, aligning closely with the typical administrative fellow job description. Early rotations allowed Madeline to orient herself, meet department heads, and explore service lines. Eventually, larger initiatives took center stage, where she found herself employing process improvement and organizational development tactics across the system, gaining valuable experience in project management and change management.
Nicklaus Children's offered Madeline ample face time with C-suite executives, including the CEO and COO, as well as a Vice President of Quality who provided close mentorship. Yet, the structure was flexible. She was encouraged to seek out additional mentors on her own, which is a common feature in many healthcare administration fellowships.
One especially memorable project tackled hand hygiene compliance. What began as a straightforward quality initiative soon turned into a systemwide overhaul, showcasing the importance of operational excellence in healthcare:
It was a microcosm of what administrative fellows do best: bridging clinical imperatives with operational realities, aligning departments with quality goals, and carefully managing cultural change so that improvements stick. This project also gave Madeline insight into value-based care and population health initiatives.
Another significant facet of Madeline's fellowship was relocating to Miami, which stood in stark contrast to her Midwestern upbringing. Though she had visited South Florida before, she quickly realized that "visiting" is different from "living."
She quickly learned that adapting to a new city is about embracing cultural differences, learning basic language skills (in this case, Spanish) to better connect with colleagues, and finding joy in local traditions—from food to community festivals. This experience proved valuable in understanding diverse patient populations and the importance of cultural competence in healthcare management.
After completing her fellowship, Madeline leveraged her expanded network and newfound confidence to transition to Mayo Clinic as a Program Manager for General Internal Medicine. She credits both her academic background and fellowship experiences—especially the cultivation of relationships—as pivotal to this jump into a role focused on medical group operations and clinical service lines.
This transition showcased how administrative fellowships can serve as a talent pipeline for integrated healthcare systems, preparing fellows for roles in performance improvement and practice integration.
Having weathered the highs and lows of fellowship applications, cross-country moves, and high-stakes projects, Madeline offered some final words of wisdom for those considering healthcare admin fellowships or healthcare administration fellowships in 2024:
Madeline Cremin's story underscores the transformative power of an administrative fellowship, not just for acquiring technical skills, but also for shaping one's broader approach to leadership, relationship-building, and cultural adaptability in healthcare administration. From her initial administrative internship at MU Health Care to her year-long fellowship at Nicklaus Children's Hospital, she gleaned lessons in process improvement, data-driven decision-making, and patient-centered care—all under the guidance of experienced healthcare executives.
Today, as a Program Manager of Clinical Operations at Mayo Clinic, Madeline continues to apply those lessons, crediting her fellowship with accelerating her professional growth in ways she never imagined. Her journey serves as a testament to the depth and breadth of opportunity that a well-structured hospital administrative fellowship can provide.
For aspiring health administrators, her path offers a clear message:
Above all, Madeline's trajectory illustrates how a healthcare administration fellowship can be the perfect launchpad for those aiming to make an impact in the ever-evolving world of healthcare leadership, preparing them for roles that require a deep understanding of strategic planning, business planning, and the overall healthcare management landscape.
<p>in terms of advice for others to really keep your doors open and seek a bunch of mentors I don't think it needs to just be one person or you know one title per se I think it really can be anyone um just depending on your personal preferences and maybe areas that you want to dive into deeper [Music] hi everyone it's rangi Shaw with the fellowship review through the American Journal of healthc care strategy today I'm thrilled to be joined by someone that I had the pleasure of working with during the ecag conference mateline thank you so much for being on the show today thank you for having me it is a pleasure to be here yeah so let's just get right into it why don't you go ahead and tell tell our listeners a little bit about where you're from your educational achievements and kind of a high level overview about you let's do it all right so my name is mateline keman I grew up in Chicago um I went to the University of Missouri for my undergrad where I studied Health Sciences and then I went on into my master of healthcare administration program during my time at missou I had the opportunity to kind of get you know dive into healthcare for the first time through various internships project Project work and then ultimately you know the course work in my master's program um at the tail end of my master's program I was accepted into a fellowship position which you know we'll dive into in more detail today um but this was at Nicholas Children's Health System in Miami Florida um where I spent a year there doing um a bunch of project work you know working with executive leadership getting kind of that real world application of um everything that we were learning in school so um it was a great experience where then I um ended up networking and transitioning to Mayo Clinic where I'm am now uh serving as a program manager for General Internal Medicine that is so exciting um and of course we'll chat a lot about your fellowship experience um because this is the fellowship review but I do want to highlight a little bit more about your grad school experience you know um getting Masters at missou and specifically the administrative internship that you did at missou um what was that experience like any projects during that time that you would like to highlight and any memorable times from that internship experience yes that was a great experience so I you know had an experience before that where I first was introduced into the hospital setting so I was working as a care transition resource specialist at mu Healthcare so that luckily gave me a little little bit more background into the organ organization itself um and you know learn things for the first time like health records various policies and um again just applying that knowledge but really my administrative internship was I mean I think back to it and just the experience I was able to gain from it was invaluable into you know going into the fellowship and even applying things I learned today um but I had the opportunity to work under the senior director of ambulatory services and she oversaw 60 plus clinics at mu Healthcare and during this time um I remember I came on and the project that is was starting out was smaller but then it just ballooned into this whole reorganization of the revenue cycle prior authorization process so again it was like this huge undertaking where you know I thought is coming in to make this small change and it just became this huge project um for the organization and so that experience was one beneficial to get into the understanding of you know Hospital versus physician billing and revenue cycle and what is a prior authorization and you know all of the various policies that go into billing and again contributing to that complexity of the Health Care system and so that was probably my favorite project just because it kept going we had the opportunity to work with a bunch of leaders and then really just rethink that entire process but for all outpatient clinics so it was yeah it was a great experience nonetheless yeah no it definitely sounds like it in like ambulatory spaces across Health Systems in the US definitely growing kind of a lot of people say you know ambulatory is the future so how cool that you got to do such an extensive project so early on in your career and I think you know one thing I'll like I I'd like to draw attention to about something that you said is when you came into the project it was kind of small maybe the scope wasn't that big and then you said it ballooned into something so much bigger and I feel like there's that tends to happen in healthcare because there's so much work that needs to be done you may come on a small project and slowly it kind of becomes bigger and bigger and and you get to learn a lot so thank you for sharing that um you know and I kind of want to also dig a little bit deeper into Fellowship so I always tell my guests you know when you get a master's of Health admin or a similar degree you have a lot of different avenues that you can go you can join Health Tech you could go the payer route you could join Consulting of course you could do Fellowship so when you look back on your journey as a grad student what specifically Drew you to picking the fellow Fellowship route and pursuing that as opposed to other avenues you could have taken yeah that's a great question I think a lot of it was you know just hearing from peers who explored the fellowship route and those who didn't who also talked highly of the fellowship position um when I was considering applying I really thought about what experience is going to you know prepare me to keep growing in the future and I think a lot of you know experience you're going to keep growing um but really I saw the fellowship as this opportunity to catapult yourself almost into like that 40 years from now and then you know obviously you come back and you're not fully there but it's that insight into senior leadership and being a part a part of you know this strategic decision-making processes and you know understanding Hospital operations as a whole not necessarily just one Department that you might um see yourself in if you go another route other than a fellowship and so I think when I was you know thinking back when I was in grad school it was just like okay I'm hearing all of these amazing things I know it's a challenge and you know you have to it's hard work to get one but why not if I apply and get one you know great but if I don't then of course I'd be open to exploring those other opportunities yeah absolutely and and I think that's a really great way of putting it this idea that you get kind of a firsthand view of Hospital operation strategy and just everything that goes into running a health system um and you know you kind of built a perfect segue into my next question for you which is the fellowship um application Journey can be difficult it's hard work so what was that like for you you know um how did you go about picking the number of sites that you were going to apply to um you know how did you stay organized and then finally what do you feel you did that helped you get the interviews you know so just overall what was that entire cycle from the start of the application all the way through interview season like for you it was competitive I'll say that but in a great way I think it really challenges you to be conscious of what you're doing where you're applying um the effort that you're putting into it and so and you know again I had a bunch of peers who were excellent resources um mentors who you know went through the same process who were able to give me advice um and so ultimately I think I applied to about maybe like 10 to 15 fellowships I can't remember the exact number um but you know I took a lot of the advice from my peers um a lot of their recommendations for staying organized you know I created an Excel sheet of okay when is this due date when um um you know have you reached out to the fellow on LinkedIn yet have you you know just creating all of this checklist for each organization um so I got a little bit crazy with it but it you kind of have to just to stay organized because it becomes so tedious for each organization because you know there's the webinars that you need to join and the phone calls that you need to make and the applications themselves and um you know really making sure that you're putting 100% into every organization that you apply to is key um so it was a tedious process but looking back I wouldn't have changed anything obviously because I was able to land a fellowship which is a blessing in itself yeah absolutely no I love that and I think you know I feel like 10 to 15 is what I've been hearing a lot from a lot of the people that I've interviewed and that seems to be kind of the range that most people go to but of course there is that people will only apply to a couple or some people will go into the 20s so I do want to call out like being intentional with where you apply is very important because like you said it's a competitive and difficult process um and of course you landed at Nicholas children's which is so exciting um you know when you look back at your final round interview with them and what that was like was there something that really stuck out to you where you know you knew you were going to accept the offer and you felt what was it that called you to say yes to Nicholas children's it was exactly that it was the final round interview it was being there in person meeting with people face to face walking and you know getting a tour of the hospital um and so Nicholas children's is a children's hospital and so seeing the culture and environment there you feel the warmth and positivity that Children's Hospitals can bring just you know trying to provide that warm environment for you know the children that they're serving so I truly think it was that on-site visit where you know I had the opportunity to meet and network with different individuals that ultimately led to me falling in love and you know accepting yeah yeah I love that falling in love and and I think you know uh seeing things in person and interacting with people in person especially at something like a final round can be gamechanging cuz you can actually get a feel for you know the people The Vibes and just the environment that you could po potentially be in so I appreciate you sharing that um for people who are interested in the Nicholas children's um administrative Fellowship can you just give like a high level overview so is it one year is it two-year Project based rotation based and also do you have a co- fellow kind of what's the setup of the fellowship like sure so I'm gonna answer that a little bit differently probably than the average person so when I was in the fellowship it was a one-year program with one fellow so you were the only fellow um which has its perks of again being the only fellow any projects that come up your you know folks turn to you first um today it is still a one-year Fellowship however there are two fellows um which I think is a great thing because having that co-partner who's in that same position as you um can really be valuable especially while going through this transition from you know grad school into the real world environment um but aside from that I think everything else is the same so it is a rotation based I mean it's kind of a mix between rotation and projects um and it's really I think this Nicholas Fellowship from after talking to other people I think it differentiates itself in that it's really dependent on the fellow themselves for the rotations that they want to do how long they want to be in those rotations in the project work that they join um and so you kind of do rotations and projects all at the same time just based on you know your schedule I think you kind of start off doing more rotations just while you're getting you know making this transition getting used to the um work environment and just again learning the organization and then again the project Works takes off and then you know that becomes the majority of the fellowship towards the end of it yeah absolutely I love that a good mix of rotations and um projects and then also I think I agree with you completely having a co- fellow one or even more than one it's so helpful right because it takes away that like loneliness or isolation because you know the fellowship is such a unique experience that um having a partner especially during Fellowship recruitment can be like a GameChanger oh my gosh that would help so much yes exactly and I I think obviously you did it alone but I'm sure that whoever came after you was thankful that they had a part um to navigate that very competitive process I think even from an organization standpoint right it's about recruiting the right the right fellow for the next year so I completely understand that um and you know another reason why people tend to pursue fellowships as their mentorship structure and so could you maybe also give a little bit of insight into do you have a traditional preceptor in this fellowship or did you feel that you were able to kind of build mentors throughout the health system you it's both again so you have the traditional mentors in terms of those executive leaders you have one-on ones with the CEO and the COO um who really serve as that traditional you know standing meetings who give you you know advice on what to do and um have those check-in points but again it's up to you to also seek out other mentorship that maybe aren't presented to you in that traditional format and so um yeah the opportunity to kind of identify a few others which you know once that door opens other Project work opens up and um yeah I would just say for you know in terms of advice for others to really keep your doors open and seek a bunch of mentors I don't think it needs to just be one person or you know one title per se I think it really can be anyone um just depending on your personal preferences and maybe areas that you want dive into deeper yeah absolutely um and any Fellowship projects or any rotations that you did that really stuck out to give our listeners an example of you know what that project experience or rotation experience was like H so I I mean there was a bunch um I think back to one that I didn't realize how I don't know how much experience I gained from it in the moment until afterwards you know and reflecting back but I had the opportunity to work with the VP um in quality and the um infectious prevention um and disease team at Nicholas children's to really um improve the hand hygiene compliance at nichlas Children's and so with that it came kind of you know this whole process Improvement project from you know looking at how we're measuring hand hygiene compliance all the way to rolling out a different hand hygiene product to then also you know it was it's again it just ballooned into this whole project so essentially you know we knew hand hygiene was low but at the time we were the way that we were collecting data was on a clipboard where you would go it floor to floor and you know you'd have someone be just marking if they were you know being compliant with hand hygiene after seeing a patient again that mixes the data a little bit since if someone sees a clipboard immediately their thoughts are like what is going on it's not natural uh this feels weird and so to address that we worked with an external um company called intelligent observation and this was something that goes on your badge or little um sensor and it tracks if you're hand hygiene you know compliant with hand hygiene so essentially if if you're close enough to a hand sanitizer machine for the amount of time or washing your hands for a certain amount of time time it tracks that and so you know that was really how we addressed that issue and then you know the second portion of that was okay once you have all of this data how do you apply it how do you work with the different department leaders to actually address hand hygiene which becomes a lot easier when you can track it down to the individual but you know again that each project comes with so many different learning opportunities you know in terms of working with external Partners to rolling something out that seemed as a little controversial to um you know the staff who was on the floor and you know directly affected by this um so I think back to that project a lot just in terms of you know all of the different layers that that one project had um but again it was you know one of my favorite things of process Improvement and so I think when you're able to actually see the results of the project and like provide more data to it is like Geeks me out yeah yeah data is incredibly important so thank you for sharing that and you know um this episode's been so fun because I feel like I learned a lot about um your experiences that Nicholas even though I met you while we were still fellows I don't know that at that time we got to kind of dig deep into you know your experience so I really appreciated you sharing all this um kind of the last two questions that I always like to take this um my guests on are related to living um in the city and the state where the hospital is located and then also just like you know general advice so kind of starting with that first question you know often times with fellowships people um move cross country you know completely brand new state brand new city um and of course you being from Chicago having gone to school in Missouri Florida was quite the move and so what do you want to share to our listeners about living in Miami and kind of what that experience was like and what should they anticipate good question so you're absolutely right I think it's so different visiting vers living somewhere um before the fellowship I had the opportunity to visit Miami you know in short stays but again that is so different from actually living there um when I was applying to fellowships you know I really had the dream of going somewhere warm being by the ocean you know I grew up in the midwest I was ready to you know try something different in so many different ways but um living being one of them and so I was just excited by the opportunity to go to South Florida um South Florida is a and people would tell me this before coming and I was like okay yeah you know I know it's different and everyone's like no but it's truly like a different world like it's not anywhere else like you know in the US I was like yeah sure you know everyone probably says that and it's true I think um the culture is so different um you know there's a lot of Spanish-speaking individuals and um you know Cuban restaurants and Cuban coffee became like my go-to um if you've ever had Cuban coffee you would know what I'm talking about but it was it was a positive learning experience just learning different cultures and being immersed in it yeah no that's good that's I no I love that um and you know kind of the final question um you know when you look back at your fellowship cycle I'm sure there were times where you were like oh this is really difficult I'm sure there were highs and lows where you got interview offers but you also got rejections ultimately though you were able to land a fellowship right so what general advice do you think you'd want to give someone who's interested in going through the fellowship cycle um what's something like key takeaways from your own application process where you're like you know I this is advice that I want to pass on to everyone everyone must know this yeah I again I think it's probably pretty generic but something that wasn't top mind when I was going through it you know I really saw the fellowship experience of like okay getting that experience doing a bunch of different projects and learning as much as I can and I think if I were to redo my fellowship I would focus more on building those deeper relationships with the mentors and leaders throughout the organization I think I gained a lot from those formal projects but I think a lot of those invaluable insights came from those you know one-on-one conversations um with Executives and so I think I just advise those future fellows to really you know take every opportunity to ask questions and seek feedback and really learn from those around them and you know be a sponge that was the big biggest advice I got and you know tried to implement it's it's hard when there's so much to absorb but um yeah yeah no I love that advice I think um overall I also share with a lot of people like focus on their relationships of course focus on your projects but you know an added like layer that I would say is also focusing on shadowing experiences and getting kind of on the floor trying to see if you can go watch a surgery or go follow you know um someone in the cafeteria for a day there I feel like there are so many things fellows have access to so if you have a wish list of things you want to see you definitely should um you know ask your preceptor and find a way to get that experience um so no I appreciate your advice it very helpful and you know those are kind of all the formal questions I had but really appreciated reconnecting with you and kind of you sharing your journey because of course you know you have such a unique Journey you've moved around quite a bit um have experienced Health Systems in three different states at least and so I think it's good to bring that perspective up forward and also I appreciate having a children's hospital um you know someone from a children's hospital come on board because there are less Children's Hospital fellowships than there are just the regular adult hospital so we have to bring the children's hospitals to light yes Advocate the children's hospitals I love that no but thank you this has been a great opport Unity it's always great to see you it's been a long time so we need to connect outside of this as well but um no thank you you've been amazing</p>
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