Nancy Schlichting is the 2014 recipient of the TRUST Award from the Health Research & Educational Trust, an AHA affiliate. The award will be presented to Schlichting on July 20 during the Health Forum/AHA Leadership Summit in San Diego.

Leadership at Henry Ford Health System and in Detroit

Maulik Joshi: During your tenure as CEO, what do you consider to be the organization's top accomplishments?

Nancy Schlichting: It is such a wonderful health system and has so many great assets. Our growth in a declining marketplace is something I'm particularly proud of and I think has been a great accomplishment for the entire system. We have basically doubled our size in about a 10-year period in terms of revenue and staff. We invested about $350 million into the campus at Henry Ford Hospital downtown. It has been transformational in virtually every aspect of our performance. Again, in a community that has declined by about 30 percent in population in a 10-year period, Henry Ford Hospital has grown substantially. That's really good news for us as a system, and I think very good news for the community.

The construction of Henry Ford West Bloomfield Hospital — a very creative concept, as we built a new vision for a health and well-being community center — has been an important part of our organization's success. Bringing new concepts to culinary wellness, patient safety and a variety of initiatives has been a model for our industry and really enhanced our system as a whole.

Finally, a major accomplishment was our system's journey of improvement as we pursued the Baldrige framework and eventually were awarded the top honor. [Editor's note: Henry Ford Health System received the Malcolm Baldrige National Quality Award in 2011]. I think it is the culmination of all of our work and cuts across every element of performance. We achieved that as a system and were the largest, most complex health care organization ever to receive the award. It says a lot about the commitment of our more than 30,000 stakeholders internally, including our employees, doctors and volunteers — everybody who works on behalf of the health system.

Joshi: How were you able to prioritize some of these great initiatives?

Schlichting: We stayed focused on the fundamentals. At Henry Ford we have seven pillars of performance: our people, quality and patient safety, service, growth, research and education, community, and financial. Our people are first for a reason; finance is last for a reason. We believe if we do the first six well, we will be OK financially. Organizations cannot accomplish a great deal if they're not doing the fundamentals well. We've made tremendous strides over the last decade or so on quality and patient safety and the levels of service that we provide. We opened a new hospital that was at the 99th percentile of patient satisfaction in the first year, which is pretty unfathomable. These great strides and others like them have driven us.

We also have invested in Detroit. That was not the corporate strategy when I came to Henry Ford. At that time, it was thought that expansion and investment in suburban markets was the only way to survive. My belief was that we had to invest in Detroit. We had to make our flagship hospital absolutely superb, because we had to attract patients from outside the Detroit market to succeed. I think that investment in Detroit was incredibly important and would not have been intuitive for a lot of people.

Leadership in our community also has helped us to prioritize what we do. Again, Detroit needs leadership, and we have been here during a time when the city government completely lacked leadership. So the business community needed to step up. But frankly, a lot of people in the business community were highly skeptical of whether Detroit could come back. Our decision to be leaders in the community and try to counter the naysayers was important.

Joshi: Going back to the Baldrige Award, what are some of the highlights and, since then, how do you continue that journey?

Schlichting: The Baldrige journey for us was about becoming a better organization. We wanted all of our metrics to be better. We wanted to be a better system and create more effective integration across the organization. We're still on that journey. Receiving the award doesn't mean you're perfect by any stretch. But we made substantial progress through our Baldrige journey.

It also caused us to have real transparency around our performance. We applied five times before we won. In that process, we received really valuable feedback. The first year, the feedback was dreadful; it was depressing. But it made us see some of the issues we had to work on if we were to improve performance. I think transparency in our culture was enhanced through the Baldrige process.

The lasting effect is that we don't want to give it up. Even though you can't apply for a number of years when you're a recipient, we plan to apply again [in 2016]. At a minimum, we're going to obtain more feedback and learn more about whether we've made additional progress. And it will give us another stake in the ground of what we have to work toward.

Applied Research for Improving Health Care

Joshi: The TRUST Award honors individuals who apply research and education into practice. What are the keys to applying research well?

Schlichting: I worked at the front line and was a chief operating officer for 20 years at different hospitals and systems. I like to make things work. I am continually evaluating what needs to be done to make things better: How do you organize yourself to get it done? It's not enough to talk about it. You must have structures and organization to get things accomplished. And that's what we do.

The reporting relationships are very important in the organization. For example, the CEO of our medical group oversees our Center for Health Services Research activities and our population health work. When he has David Nerenz [at the Center for Health Services Research] sitting at the table with the chairs, instead of at some institute away from the action, they continuously look for ways of integrating the work. The same is true with the Institute for Minority Health, which reports to Kimberlydawn Wisdom, M.D. She's constantly looking at ways to integrate it into our community-based work or wellness work across the system — how we can make and shape it differently. It's not just research — it's application.

Our bias in our academic research work has always been taking it quickly from bench to bedside. We're not a traditional university setting. It gives us a lot more latitude. We don't measure our success based on how many papers we write, although that's important. We measure our success based on what gets done. Our COO has the Henry Ford Innovation Institute reporting to him. He's made it incredibly focused not only on innovation of clinical work but on innovation in business process and application. We invite a lot of partners to come in and help us — from industry, from other universities, from all walks of life — to help inform and change our thinking on various things. We're also evaluating our international work in terms of business process and how we innovate and drive strategy that can build scale and impact.

Advice for Health Care Leaders

Joshi: As organizations and leaders are moving toward the future health care system, what is your advice?

Schlichting: I believe my fundamental role as CEO is to create a great environment so our people can reach their full potential and our patients can reach their full potential. To do that, you have to be good at breaking down organizational barriers, constantly looking for ways to bring unusual suspects together. That's where creativity originates.

Saying "yes" to innovation and new ideas is so important. A lot of administrators think their job is to say "no." I completely lost control of this organization a long time ago, and I'm so happy about that. I am constantly amazed and unable to keep up with the amount of new thinking and new initiatives.

The final thing is to do the right thing. We make things awfully complicated in health care, trying to sort of game the system all the time. When you step back and really think of what we're here for, what we're trying to do, it's not always easiest to do the right thing and it's not always the most profitable in the short run. But I think when you do the right thing, at the end of the day, you gain trust. You have the trust of your people and you get the trust of your patients and your community, who are always skeptical of the corporatization of American medicine. It's pretty cool when you can talk from your heart about why you're doing what you're doing and your commitment to making sure it is the right thing.

For more information on the 2014 HRET TRUST Award, visit www.hret.org/trust.

Maulik Joshi, Dr.P.H., is the president of HRET and senior vice president for research at the American Hospital Association. He is also a member of Speakers Express.