NICHOLAS TEJEDA, 35, is the chief executive officer of Tenet California’s 73-bed Doctors Hospital of Manteca and the immediate past president of the National Forum of Latino Healthcare Executives. Tejeda discusses the challenges of becoming a hospital CEO at a relatively young age, advice for seasoned employees who are welcoming a younger leader, and diversity in the C-suite. / Interviewed by Marty Stempniak

Why will every hospital need to consider hiring younger individuals for C-level positions in the coming years?

TEJEDA: A recent survey from B. E. Smith indicates that 75 percent of health care leaders plan to retire in the next 10 years, and even more plan to change jobs within the next five. If you are at a hospital conference with that statistic in mind, go into the hallway and find four CEOs. Three are going to be retired by 2020. You have to have a plan for replacement, and there are simply not enough people who are 55 or 60 ready to step in. You have to look at a younger generation.

Do you think most hospitals are prepared for that?

TEJEDA: Like a lot of things, it depends. Culturally, hospitals are always looking for the best person to help the organization meet its objectives. What they need specifically will depend on the type of hospital. Is it rural? Is it community? Is it academic? Is it a public institution? What was the previous CEO like? What are the gaps they’re trying to fill? If a hospital is looking for energy, enthusiasm, creativity, someone with a hunger to prove him- or herself, clearly, a young CEO fits. If they’re looking for a leader who can help stem the tide of bankruptcy, clearly, they’re not going to go for, nor should they look for, a young, new CEO without experience. So, the question then becomes: What about the middle? What about those hospitals where you could make an argument for the experienced CEO, or the lesser experienced or new, young CEO? That’s going to depend on the specific nature of the medical staff, of the governing board and of the other members of the executive leadership team in place.

What was it like for you when you became a CEO?

TEJEDA: After coming here, I became interested in the topic of being a younger leader. I took the opportunity to talk to people who worked with and for me at previous hospitals where I was a young leader. I’ve since done the same thing at this hospital, and I’ve asked about their reactions to having a young leader or a young CEO. Some of the words they used were quite surprising to me. Anger. Cynicism. Frustration. Insulted. That’s how they perceived not me, but having a young leader. It’s for logical reasons that I probably will think to myself, too, in 20 years, when I see a new young leader come into place, that he or she is eager to use the hospital as a rung on a ladder. I will believe that the young leader is going to have a chip on his or her shoulder with something to prove, and micromanage accordingly. If I’m a member of the medical staff, I’m doubting if this new leader will be able to command the respect of the physicians and the medical staff, and I’m doubting if this person is going to be able to effect change that may improve my practice. That being said, once you meet people and they get to know you, things naturally get better.

Any anecdotes from your early days?

TEJEDA: The first time I became a leader of anything was in 2008. One of my departments was the laboratory at a large hospital. The day before the lab director was going to start reporting to me, I heard through the grapevine that he was planning to refuse. ‘I will not. It’s a disrespect to me. I’m used to reporting to the COO. I’m not going to report to anybody other than that.’ This is an individual with 30 years of experience in leading a laboratory. He would be the first director in that hospital not to report directly to the COO. By the way, he was not given a reason for the reporting change. Given all those facts, I completely understand why he would be upset. He didn’t know me at all. It was nothing personal. Nonetheless, the next day, he was going to start reporting to me. That night, I tried to figure out what to do. What will I say to him during our one-on-one meeting? What if I fail in that message and he quits? What does that say about me? What if he stays and resists? Should I advocate for his departure? He came in the next day and I shared with him what I’ve shared with a lot of people I’ve worked with: I should have been a little more proactive in communicating why he was going to be reporting to me, who I was and where I came from, so that he would have had some level of justification for reporting to me. But most importantly, communicate to him that I could work all of my life and I would never run a laboratory as well as he could. That’s not my job. My job is simply to understand the metrics that indicate we are successful, to understand the resources that he needs to be even more successful, to get him those resources when he needs them, and then measure the success of those new resources. It ended up being one of the best work relationships that I’ve ever had. He taught me so much, without having to teach me explicitly.

What are some other mistakes made by youthful CEOs?

TEJEDA: Young CEOs can have chips on their shoulders and try to prove they belong, which means being overly aggressive, falsely or truly overconfident in their abilities, and not willing to acknowledge when they make mistakes. By acknowledging a mistake publicly, it has a side benefit of showing humility. Young leaders often don’t integrate and build upon the past as much as they should. You have to respect the hard work and effort of those who came before you. By publicly demonstrating respect for what others have tried to do and are still doing, people will see that you’re comfortable not necessarily saying ‘this is my shop’ immediately. There are lots of other mistakes I’ve made and, hopefully, others can avoid. Sometimes, you enter a scenario in which you’re intimidated. You sit at a table and you don’t know an answer. The first time I sat down at a table and talked about capitation and risk-adjustment factors as a CEO, I had two choices. I could nod and pretend that I knew what everyone was talking about and make a bad decision, or I could ask, ‘Hey, what’s a risk-adjustment factor?’ What do you do in that scenario? Do you play a game and risk making a bad decision, or do you have the confidence and comfort that you are a leader and you need to have the right answer and you’re going to ask a dumb question? The first few times I went through that, I didn’t ask the dumb question, and I made bad decisions. I still probably do that today, but I do it less because I acknowledge the fact that there are some things I don’t know yet, and that comes with time.

What can older workers do to smooth the transition?

TEJEDA: Fundamentally, treat the leader as they would treat any other new leader. Give them a shot. A survey I read indicates that seven out of 10 more experienced employees are dismissive of younger workers’ abilities. That means the three out of the 10 who aren’t dismissive can take the ideas they’ve had for a long time, leverage the energy and enthusiasm of the young leader, and try to put those plans into place. Everybody will win.


THE TEJEDA FILE

Background:

Before becoming CEO, Tejeda was COO of Tenet’s Twin Cities Community Hospital, VP of St. Mary’s Regional Medical Center and client account manager with KeyCentrix.

Any hobbies?

Not as many as I should have, but the three things that I probably do the most are spend time with family, go on random drives with the family, and watch University of Kansas basketball.

Biggest influence?

My family and, specifically, my father. I grew up in health care. My father is a pharmacist. We owned our own pharmacy in Wichita, Kan., and he set the tone early on. He always told me, ‘You have to remember that patients never want to be here. They’re sick, so if you can have them leave with smiles on their faces, think of what you have won.’ That’s always stuck with me and it’s something I try to carry through here today.