In the mid-1940s, two patients with similar illnesses were admitted to a hospital in Oakland, Calif. One patient was white, the other black. Attending medical staff asked Henry Kaiser, the founder of the hospital, whether the two patients should be segregated.
As the story is told today, Kaiser asked his staff whether there was any medical reason—any reason at all besides race—why the patients should be cared for in separate rooms. The staff replied no. And it was then that the decision was made that Kaiser Foundation Hospitals would not segregate patients based on race.
Bernard Tyson, another of this year's Top 25, tells this story as an example of Kaiser Permanente's commitment to diversity, a commitment that started long ago and is ingrained in the organization.
Tyson would know. He started working at Kaiser Permanente in 1981 as an administrative analyst. Today, he's executive vice president of health plan and hospital operations for the managed-care giant, where he oversees all eight regions, a budget of $30 billion, 35 hospitals and 150,000 employees. Tyson reports directly to the CEO and has led the $27 billion capital improvement plan for the organization. He's also board chairman of health plans for the Mid-Atlantic States and Georgia regions.
As an industry, Tyson says healthcare has made “significant progress” in terms of diversity.
Tyson has stuck with Kaiser Permanente throughout the years because he says he's an advocate for “the Kaiser way.”
“I believe in what we are trying to do,” Tyson says. “I've worked in all parts of the organization—in programs, in different regions. I see an organization that is genuinely committed to doing the right thing.”
Like other top executives interviewed for this article, Tyson says his focus now is on improving the quality of care.
At Kaiser Permanente, Tyson is working on a three-year plan to deliver superior quality of care. This includes full implementation of KP HealthConnect, the system's electronic health-record system, along with bar-coding, cross-checking medications and physician orders and rapid-response teams.
“I want to demonstrate that walking into a hospital is as or more safe than getting on an airplane,” Tyson says.
This initiative includes transparency about “near misses”—medical errors that almost happened but didn't. The plan is to foster a more open and transparent culture where people aren't afraid to report these almost-mistakes to their supervisors, he says. Near misses can create opportunities for learning that in turn will help build better quality, Tyson says.
“It's a work in progress,” he says. “It's a balance between holding people accountable but at the same time creating an environment of an open atmosphere where people can speak the truth.”
Quality, and a deep desire to help people achieve better outcomes, is what drew many of this year's winners into healthcare in the first place.
Paula Autry, another Top 25 executive, grew up watching her older sister struggle with neurofibromatosis, a serious genetic disorder of the nervous system. “Hospitals and the healthcare setting was a second home,” she says.
As a young girl in Baton Rouge, La., Autry witnessed many of the problems in the healthcare system. When her sister was 12, she had spinal surgery to help correct her condition. The surgery left her paralyzed from the waist down. Autry was 10 years old at the time. Her sister died at age 39 from a complication brought on by a medical error.
“From a young age, I saw the disconnect,” Autry says. “I really saw a lot of inefficiencies in patient care.”
She also watched her mother, a physics teacher, stick close to her sister during her hospital stays and doctor visits because of prevalent medical errors. It was a lesson in the importance of having a patient advocate.
“I understand that it is so important for nurses to be an advocate for their patients,” Autry says.
Today, as president of Mount Carmel East Hospital in Columbus, Ohio, a Trinity Health facility, Autry has made quality a priority for the organization, focused on improving the patient-care experience and identifying areas for improvement, such as eliminating hospital-acquired infections.
Bluford of Truman Medical Centers agrees that quality can drive an organization's success. “We've changed our mindset from cash being king to quality being king,” he says. “That gives you some different values.”
Today, Bluford kicks off all his board meetings with a discussion about quality initiatives. He learned how to run efficient and effective board meetings from his mentors at Cook County Hospital in Chicago, where he worked as a night and weekend administrator in the 1970s.
What he observed was “a participatory process with a very firm decision made from the top,” Bluford says. He adopted that leadership style as his own, and it's the one he stays true to today.
Early experience with the healthcare system also can influence views on the uninsured crisis.
Ruth Brinkley, president and CEO of Carondelet Health Network in Tucson, Ariz., also a member of the Top 25 this year, says growing up in rural Georgia without health insurance or a primary-care physician helped formulate her view of the healthcare system.
“If you have always had healthcare, you have a different perspective,” Brinkley says.
Brinkley witnessed people in her rural community—black and white—die early or become disabled because of untreated chronic medical conditions, such as hypertension. This helped propel her to the field of nursing and, later, into healthcare management.
Brinkley says her grandmother wanted her to choose a career in nursing, and her grandparents, who raised her, emphasized the importance of education as a path to success.