Leadership & Culture in Transformation at Inova Health

<p>I always consider leadership a continuous learning cycle. So don't stop learning, right? Put yourself in the spaces and the positions and in front of the people that you can learn from. Whether that is, you know, books, taking formal classes or mentorship, it matters, right? [Music] Hello everyone. This is Cole from the American Journal of Healthcare Strategy. Joined by a wonderful guest today with so many years of excellent experience in some very intriguing areas.</p> <p>Currently working in the DMV area right now uh not too far from us here in Philly. Was really excited that we connected. Mara, can you please introduce yourself and your current role? Sure. Thank you, Cole, for having me on today. My name is Mara Bouer and I am the chief of staff and vice president for executive administration at Anova Health System. Again, thank you for coming on.</p> <p>The first question I have is, can you tell us a little bit about Anova and a little bit about why you love working there? Absolutely. So, Anova is the premier health care system in the Northern Virginia um DMV region and um we have the opportunity of having 25,000 team members uh who care for more than a million two million um patients a year. Um and that's across a network of hospitals, acute care centers as well as ambulatory sites and physician practices.</p> <p>Um uh ambulatory surgery centers and we really pride oursel in our mission which you know really allows us to provide um you know the best care to all patients, every patient we have the opportunity to serve in our community. So, we're really proud of the work that we get to do here every day.</p> <p>Um, at Anova, I've uh talked with you and some of the other uh individuals at your organization, some of the interns and fellows, and and I really do see what you're saying kind of firsthand and speaking with them. It's a wonderful organization, and I'm really happy to to discuss the work that they're doing. Uh, one of the things that's really great, I think, is is you've done really well with your career.</p> <p>you it looks like in 2009 you started as a project manager at Cleveland Clinic and then of course about uh you know 12 years later or so you're you're here at the the chief of staff and so I think that you've done really well you've gotten a bachelor's an MBA and now of course a DHA I have to ask about the DHA it's from MUSC which is one of the best DHA programs in the country I think one of the first actually in the country as well what caused you to get that how did that come about and then how does it work with being a senior leader Sure.</p> <p>You know, I had been in operations within healthc care for a while once I decided to do my DHA and it really was for me a personal passion to learn a little bit more and upskill myself as a leader. Um, so I looked into it and you know I had the opportunity to research what were some of the different doctoral programs that would lend itself to really that um that next level of learning that I was looking for. I looked at PhD programs.</p> <p>I looked at the doctoral program for the healthcare administration. I looked into public health. All of those things. And really the DHA program at MUSC just really aligned more with the goals that I was looking for. I was not necessarily looking to go into academia full-time. I was looking to upskill what I was currently doing in the healthc care setting.</p> <p>And so it allowed um it it presented essentially a practical um uh degree that would allow me to apply my learnings directly to the work that I was doing every day. And so it was the optimal one for me. And the design of the program also was um set up in a way that encouraged working professionals to uh continue to develop themselves. and that again I didn't see myself fully leaving the workforce to go focus on school again.</p> <p>I wanted to be able to do both and they really catered to that in a in a in a great way.</p> <p>I think the other aspect was that you know having attended uh Case Western's weatherhead um MBA program there is a huge focus in that program around organizational behavior and development and that really um I I think jumpstarted my passion around leadership development organizational behavior organizational development and so I wanted something a little bit deeper in terms of what does leadership look like um within a healthcare organization and how do I become an as an an expert so to speak in that space and so those were some of the decisions that really um those were some of the inputs that essentially led to my final decision.</p> <p>When did you graduate and when did you start the the program? So I started the program in 2018 and I graduated in 2021. And so if you kind of look at that timeline, much of my program happened over the course of a raging pandemic. Um, and again, the structure of the program lent itself to that flexibility that allowed us to continue our learning.</p> <p>Um, and even in the midst of all of what was happening between 2020 and 2021, by the time I um graduated, it still allowed us to remain plugged in and focused and and allowed me to graduate within that time period. And it looks like uh during the program is when you got your job at Anova. Yes. So, I started the program. I was still at the Cleveland Clinic when I started the program. um in the midst of being in the program is when I transitioned over to Wenova in 2019.</p> <p>That must have been an interesting time period for you doing doing all of that, right? Because you you'd been at Cleveland Clinic for almost 10 years. Yeah. You'd been a director of ambulatory operations, a senior director? What What caused you to leave? Were you nervous at all leaving an organization you'd been with for so long and had been able to consistently move up in? I think anytime you have such a major transition in your career, there's going to be some level of anxiety with that.</p> <p>And Cleveland Clinic had been such an amazing organization for me over the past 10 years. I had grown significantly and had the opportunity to lead some really amazing uh teams and sites of care. Um, uh, I was the the decision to come to Anova was because there was an amazing leader that had been at the Cleveland Clinic who came over to Anova who kind of tapped me on the shoulders and said, "Hey, I'm looking for someone with your expertise and skill set.</p> <p>I'd love it if you come to Anova." In in terms of making that decision, there's a lot that goes into, okay, how do I pick up my life and move across states, right? especially when I've got a good thing going. And by the way, I'm working on a doctorate at the same time. But I think that, you know, this is where great leadership matters, right? Because I think it depends on who's asking, what is the opportunity and how does it fit into your personal goals, so to speak.</p> <p>Um, and um, it all of the pieces just fit perfectly together in terms of making that decision. But again, it is very very much so dependent on who's asking. And I think that I had an amazing leader who was tapping me on the shoulder that I thought that I already looked up to, who demonstrated all the values that I I valued and um was embarking on an amazing journey at a new organization that I had an opportunity to meaningfully impact alongside him.</p> <p>And so that it it it was a no-brainer at that point for me. And that makes sense too based on what I know we're about to discuss which is the situation at the time and what you have done.</p> <p>It really does make a lot of sense but I think it it goes again to you had intentionality in the decision-m of your career right I mean it's it's tough because you don't want to pigeon hole yourself and and let the wind and sometimes you want to let the wind take you wherever it goes so that you can find what you want to do but at the same time you did focus on some things that were very important to you when it comes to leadership.</p> <p>Can you share a little bit about the traits, the qualities or the culture that made you say this is the right move? Yeah, you know, that's I think that's really important because, you know, we tend to think of our career growth as a linear thing. What comes next, right? What's vertical, so to speak. And I I tend to describe my career path as more squiggly than linear um on any given day. And I I I I used to, you know, try to answer the question of what happens in the next five years for you.</p> <p>That's almost an impossible question to answer these days. But I always say remain open and look for those things that really align with who you are as a leader, what impact you want to make and um and and what value it allows you to bring to the organization.</p> <p>And for me, what I looked for in a leader was one that really um demonstrated um empathy, one that demonstrated um um participating as one team um collaboration, who also was very much so of um you know, I don't hear this term as much these days, but a servant leader, right? um someone who um recognized my work but recognized me as a person, right? And recognized that that made a difference. And those are some of the things that I saw in Stephven Jones.</p> <p>Um so when he asked me, it was a no-brainer for me, right? I I was pretty deep into the organization and I had no idea Stephven Jones knew who I was, right? So, it was really interesting to me that I remember I will never forget my very first interaction with him coming into ambulatory operations. We're having a a a a big kind of division meeting, so to speak. And he comes up to me and introduces himself and says, "Here, I I hear that you're one of our newest directors.</p> <p>Welcome to the organization." And after that, I mean, how many other leaders would he have met during that time for him to even remember who I was, right? But that tells you about that leader in particular and it it I think signals what then you can expect from what that working relationship looks like. Um and so if those are things that matter to you, those are the things that you then look for in the person that you work for or the culture that you choose to join.</p> <p>So I think those are look for those signals that align with the things that matter most to you. And thank you for sharing that too because sometimes when we talk about this advice, we gear it towards those who are early careerists or what we like to call emerging leaders, right? Those who maybe are getting their first associate director or program manager position, but this applies to people in the seauite as well, right?</p> <p>And absolutely when people in the seauite go to jobs that they really align with, we know that they're happier. We know that they do better at their jobs and then everyone else under them of course is a lot happier. Absolutely. What was the situation at the uh Anova Health System when you started? They've been going through a lot of transformation. What did the timeline look like when you joined and and what was your role kind of evolving into? Sure. I joined about a year after um Dr.</p> <p>Jones joined the organization and anytime you have new leadership within an organization, there's bound to be transformation, right? And so um I joined at a time that there was um a new leader um and not just Dr. Jones, but the entire cabinet was practically new at the time and still shaping and still, you know, coming on board. And so it was definitely a a new day for the organization, so to speak, right? We um we had a new mission, a new vision, new values.</p> <p>Um and um all of these things were we were in the midst of embedding that within the organization. there was already so much great work happening here. Um Anova was already providing excellent care here. So that that wasn't what needed to be transformed, right? And and I think that anytime you have new leadership, there's going to be some expectation that there is going to be a new lens by which to look through and that might shape and shift things a little bit differently than than used to.</p> <p>Um so that really embarked I would call what we call our transformation journey which we have called our drive to excellence and it's been you know we're six years into it and we're like you know what we look back we've achieved so much of the things that we we said we wanted to do at the start so what's the next thing right how do we continue to level up as an organization so to speak I love the name drive for excellence I think that's important was that a did that take some decision-making did the the the seauite get together to come up with that because I feel like when you're naming something that everybody in your organization also patients of the community are going to hear about that's important it shows people what you're you're gearing towards how did you come up with that how collaborative has the process been in in planning and whatnot yeah naming it matters because naming it makes it real right and so yes it was our seauite but we also had um many voices across the system that really put voice to first of all what are we trying to achieve here right so in the in in in in in shaping our mission vi vision and values we had a cultural integration council that was made of leaders and team members from across the organization that really helped answer some questions to say we really um look at Anova being you know a a a healthcare organization that provided world class care.</p> <p>What does that really look like? What do we need to do, you know, differently that allows us to get there? And that starts to shape that. And when you started looking at all of the characteristics and all of the attributes that we're putting down on paper, we're like, we're trying to get to excellence here. So, isn't that the journey that we're on?</p> <p>So, that it I think the naming essentially naturally shaped once we really started putting pen to paper in terms of what what we were really trying to do. And so it it has taken shape and it it it did involve a few voices across the organization to help inform that.</p> <p>I wanted to bring that out specifically because even small things that some people might just push aside there's this focus there's this effort of people who are really intelligent and really devoted like yourself being put on that and and a lot of it what we're going to discuss too is about being given the space to do that kind of thing. And so what I wanted to ask is you've done a tremendous amount of change in the organization.</p> <p>Are there any big ones that really stick out to you that you look back on and you're especially proud of? You know, I I'm proud of the entire journey that we have been on. And if you consider the fact that, you know, our journey kicked off right before we were hit with a pandemic. Um, I think that the organization as a whole, we're incredibly proud of where we are.</p> <p>And what I mean by that is one of the things that we set out to do was you know there were kind of these three tenets so to speak that we considered to be a part of our transformation. One was systemness um whether or not you want to call that a real word or not we knew exactly what we meant by that. So systemness, seamlessness and stewardship. And we said in everything that we're trying to achieve here, these three tenants need to need to be essentially our guiding principles so to speak.</p> <p>And so what did that actually look like? One of them, let's just talk about systemness, was that, you know, Anova was a great health system that essentially operated more like a loose federated system of individual um um sites of care that happened to have the same name but may not have necessarily um operated in a sense that felt connected. Right? So in systemness, we said, how do we truly look and feel and play as a system, right? What does that look like?</p> <p>Well, interestingly enough, I I mentioned that, you know, the the pandemic, you know, kind of hit in the midst of us really kicking off our transformation journey. And, you know, some would say, well, you know, that's a major interruption to your transformation. For us, we found that it accelerated it more than anything else. So all of a sudden we now have a system command center.</p> <p>We have our teams from all over the system coming together to figure out these big hairy challenges for the organization to ensure that we were still providing care seamlessly um for our patients and taking care of our team members along the way. And in so so in so many ways it accelerated our process in being able to do that. And today I can say that we feel more like a system than we've ever have before.</p> <p>You know one one thing that came out of that for instance we have a transfer center a system transfer center. Whereas before our transformation, you know, it was a bit of, you know, if a patient showed up to one of the hospitals that whether that hospital was full or not, you know, we would that's where the patient would be seen and there was no kind of thinking across the fact that we have a network that we could leverage here.</p> <p>From a transfer standpoint, it is getting um the patients to the right care at the right time with the right providers, no matter where that is in our system. And the way our sites of care collaborate to do that well right now allows us to provide even better care for our patients. And we were already providing top care for our patients, right? And so now it's allowed us to do that at an at an even better scale.</p> <p>I know a lot of people listening probably love hearing that and they think it's a great idea right that co could have been used to to advance things and I think it it did for I think everyone experienced some kind of benefit or advancement technologically at least but uh you know looking at inov health systems financials we see the contraction during the 2022 report because of covid we've seen a great recovery in the reports and other health systems have really struggled but they've struggled especially in the leadership area when it comes to staffing.</p> <p>You know, we've had a really tough time getting staff at a lot of institutions. Press gaining scores at a lot of places have just been down since the pandemic and have not recovered. People are still struggling with remote work, in-person work, you know, offices without enough space. So, a lot of organizations are are struggling with their people management. They're having to do layoffs. Whereas at a Nova Health System, it seems like they're kind of almost going the other way.</p> <p>And I appreciate kind of what you're alluding to that during COVID it was kind of a pivotal pivotal time and you didn't pass it by instead you you really grabbed a hold of it but that can it's still a scary time for the employees. So, do you have any anything that you think leadership or yourself did to try to reassure and help employees to to keep seeing things positively and help as you're going through systems also become kind of a a team and and build that new culture? Yeah.</p> <p>Well, that's just it right there, right? Because I can list off a thousand technical things that we did, right? But we never stopped working on our culture. As a matter of fact, when times got the hardest, that's when we leaned in further to the culture. And part of that, you know, one of the things that we did during the pandemic, and we continue to surface it today or at all times, it's just a part of who we are is we focused a lot on purpose and joy. Right?</p> <p>At times when things feel the toughest for our teams, we leaned on really um reminding them or at least creating the space for them to remember and reflect on why am I in this thing called healthc care to start with? Why did I ever want to do this? But also what does kind of creating the space for joy at work look like? Right? And we have intentional you know we share those stories at our leadership forums.</p> <p>We r we have our leaders who are rounding across the organization recognizing our teams for their teamwork and the culture building that they are doing. We recognize them for the amazing care that they're providing our patients and we just continue to tell their stories and elevate them. But there is something about our focus on purpose and joy that has just been so integral to our culture and and what that looks like.</p> <p>I think also, you know, I talked about some of those tenants of our um of our transformation earlier. Stewardship is something that is a one of those core tenants. And so with us from a financial management standpoint, I think that it's it's especially um part of our routine way of how we manage our operations on a day-to-day basis. Margin improvement is something that every one of our leaders look at on a regular basis.</p> <p>our our um operators um have um um management action plans that they build out during the budget cycle that says, "Yes, I know this is what our budget is, but also we think these are some of the other things that we could be doing to be even more efficient and effective in in in how we manage our areas. So that's one thing from just kind of the financial management standpoint, but we never stop working on our culture.</p> <p>Whether that is to help continue developing our leaders to equip them as they are working with our frontline teams or it is telling the stories of our frontline teams to recognize the amazing work they are doing. Um so that's that's been some of it for us. We culture matters. It sounds like you you mentioned margin improvement. I'm sure some of the people listening to to this might hear that word and go ah you know, they don't want to hear about margin improvement because it's it's it's a lot.</p> <p>It's kind of anxietyinducing. Sometimes people think about in efficiency people coming in and eliminating roles. However, from the way you're saying it, it doesn't sound like there's as much fear or angst in your organization surrounding that margin improvement. Looking at a graph of just the public reports, it's almost as if a a catapult has been released to to, you know, bring you guys further into kind of a new next generation of of uh Innova, which is awesome.</p> <p>But I kind of ask, is there any tips you have on how to sustain some of these things? Because we've seen systems over time, they've done tremendous, you know, they'll have a year where they'll they'll do great, they'll have windfalls, they'll do awesome, and then as people leave and people move around, it it kind of falls apart. You've been there for a while, though, and I know we talked about a bit last time on how you're changing this from uh from being just words to really solid actions.</p> <p>Any advice on how you can get these actions to be sustained over the next 10 years? Yeah. So f so first of all the credit goes to our amazing leaders at the right. So first of all getting the right people matters right. Um having the right people to lead this work matters. That's I think one thing.</p> <p>I think the other thing is that we've been intentional about creating what I like to call our operating rhythm right which is what are the sustained spaces that we create to have these critical discussions. Right? We have operating reviews with um you know our system leadership teams. We have executive leadership team meetings where we really you know um discuss and have discourse through some of the things that are most impacting our teams and the organization altogether.</p> <p>We have regular cabinet meetings with our CEO to understand some of the major decisions we have to make as an organization. But having those and I all of this is organizational development, right? How do you make sure that you have the right forums and spaces and conversations that happen on a re routine basis? You have a built-in cadence of conversation and hold each other accountable to some of the things that we have committed to as a leadership team.</p> <p>And so I think that really goes a long way in terms of sustainability because our leaders know that this is a part of how we manage our work, our operations. And if we're going to continue to be able to do that in a way that is sustainable for our patients and our team members, we have to continue to have that discussion. So transparency matters.</p> <p>if it's a hard thing to talk about, let's talk about it because, you know, if we don't, we might miss an opportunity to truly come up with the right solutions. So th that's just some of the things that we're doing. That is awesome. I I this uh advice for both emerging leaders, but also executives, very very impressive. If I could just ask one last piece of advice, are there any tips on how to become a great leader? If somebody's listening to you and they're saying, "I want to be just like Mara.</p> <p>I want to be this, you know, eloquent, wellspoken, intelligent person, but I don't feel like I'm there yet." I know I felt that way a lot. Uh even now, I continue to feel that way, and it's hard. So, any advice on how for these younger leaders, they can really elevate themselves and get that voice. Well, I always consider leadership a continuous learning cycle. So, don't stop learning, right?</p> <p>put yourself in the spaces and the positions and in front of the people that you can learn from whether that is you know books taking formal classes or mentorship it matters right um I I also think and let me go a little deeper on the mentorship aspect um because a lot of us learn how to lead from other great leaders or just from other leaders so I think it's really important to decide what kind of leader do I want to be And where are there um leaders who demonstrate pieces and parts of those attributes that I might learn from?</p> <p>Um where do I um you know have the opportunity to develop myself further? Do I ask for feedback? Right? Do I uh create a space where I am vulnerable enough to know that I still have opportunity to learn? That doesn't stop no matter what level you get to in the organization.</p> <p>if it does then you know then you can slip into um you know the wrong side of leadership right and so I think it's really determining what kind of leader do I want to be what kind of leader does my organization need and how do I really surround myself um with the right people tools um development um uh uh resources that that helps shape me to become that person so I think I think we're all on this continuous learning journey together. I love that.</p> <p>Don't feel bad about being on the journey, but try to surround yourself with the right resources. Very important advice. Thank you so much for speaking with me. I enjoyed our conversation. Uh, you know, when we were talking last time, I really enjoyed being able to bring you on the podcast. I think the organization is wonderful. I'm also really excited to see what you do next. You still have a lot of time left in your career. I don't know what you're going to do next, but I'm very excited to see.</p> <p>I'm sure that there's going to be uh a lot of great things in your future as well.</p>