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With a background in psychology and religious studies, Rusty Holman, M.D. (Fellows class of 2015) is a lifelong student of the nature of people – how beliefs, behaviors and human needs all work together in organizations and impact people’s personal experiences. His passion for developing leaders and proven expertise in shaping organization culture defines some of his most crucial achievements over more than 25 years as a physician executive, author and speaker.
Rusty’s leadership has been integral to three health system mergers and ownership changes involving academic, non-profit, venture capital, private equity and publicly traded entities. He is a Past-President of the Society of Hospital Medicine, a founder of the SHM Leadership Academies, a Master in Hospital Medicine and was voted a Top 50 Physician Executive by Modern Healthcare. Most recently, as Chief Medical Officer of LifePoint Health, Rusty created a national quality program that was awarded the John M. Eisenberg Patient Safety and Quality Award, a recognition co-sponsored by the National Quality Forum and the Joint Commission.
What inspired you to go into healthcare? Tell us a little bit about your career journey and the path you took to become an executive and now an entrepreneur.
My career path was a matter of convergence; I enjoyed both the humanities as well as science. I was drawn to problem-solving and I loved to teach. Roll those together and healthcare was a natural fit. I trained as a physician with the intent of a lifetime of clinical practice, and along the way I discovered an aptitude for managing others and solving problems at a system level. I assumed incremental leadership roles within a large nonprofit health system and university teaching program, then moved to a small venture-backed company that employed and managed physician groups. From there I stepped into an executive role for a national, publicly traded health system. With each successive move I enjoyed the expanding scope and reach of the work I was doing. Having worked in just about every ownership structure possible, it became time for me to break out into the world of entrepreneurship!
How did your training and work as a physician inform your work as an executive?
In my training I noticed many things that did not sit right, in both the formal and informal curriculum. Medical education lacks any significant interpersonal and organizational training such as effective communication, teamwork, conflict management or building culture; and yet we as physicians are looked to as leaders. Furthermore, the informal curriculum socialized us to become rugged individualists rather than team members, and there was often an environment of disrespect towards and from others that did little to help us build relationships across disciplines.
In my practice as a hospitalist – specializing in the care of hospitalized patients – I was able to directly experience the broken processes and systems of care that lead directly to patient safety and quality shortfalls, workforce alienation and burnout, economic waste, and massive gaps in health equity. I eventually transitioned from patient care activities to leadership roles that would let me positively impact not just 1 patient at a time but 100, 1,000 or 10,000 at a time.
After a long career in executive leadership for some of the biggest health systems in the country, you recently launched 1821Health. Why did you decide to start this company?
The decision to begin my own company was born out of 3 things. First, I am certain that the pathway to reforming our healthcare industry must be grounded in effective, compelling leadership. How else will we confront the ongoing chaos, crises, financial challenges, quality imperatives and workforce sustainability? Second, the way we have traditionally thought of a “leader” must change – quickly. I believe that EVERYONE in healthcare is a leader, regardless of title, and we need to start treating them that way. And finally, 1821Health sets out to develop leadership skills in accordance with adult learning principles rather than the status quo of traditional development programs. Case in point, why are we drowning people in 8-hour training workshops and conferences when the adult attention span is 20 minutes? These are issues I’m addressing with 1821Health.
The healthcare workforce is facing a crisis, with no end in sight. Clinicians are leaving the profession and stress is at an all-time high. How do you look at this problem and what can we do to solve it?
Clinicians and many others are seeking less stressful and less harmful positions in healthcare, or they are quitting the industry altogether. Clinicians especially feel a loss of control and autonomy at work, while simultaneously feeling a deep sense of personal responsibility for outcomes. This is a recipe for disaster. Couple that scenario with other potentially undesirable factors like a toxic workplace culture, pervasive broken processes and bureaucracy, or a having a bad manager (people more often quit their boss rather than quit a job), and the reasons for departing just pile up.
Part of the solution lies in deliberately investing in our workforce to acquire new skills – leadership skills – and start reforming healthcare from the inside out. Those closest to the work are in the best position to solve problems and improve the work environment, and to do so they must be empowered by acquiring new abilities.
How did the Fellows program influence your career? (Did you make any specific meaningful connections, create partnerships, find resources/talent, think about healthcare in a new way, etc.)
One of the most profound benefits of the Fellows program is having immersed myself in the spirit of continuously challenging the status quo in healthcare. The diversity of faculty and other Fellows engendered a learning environment that constantly raised my awareness and opened my mind to new ways of thinking. Our topics were a convergence of policy, finance, public health, payer entities, provider systems, innovation, unique partnerships and other subjects that highlighted the amazing complexity in which we work and the imperative to creatively envision new solutions. It was a gift to be able to do all of this in a protected environment, out of the fray of the mad crush of business, and allow room for this higher level thinking and reflection to take place. In many ways, the Fellows program was an inspiration for starting 1821Health as a way to meaningfully contribute to overcoming the systemic difficulties in our industry.
What is the best piece of advice you’ve ever received?
Leland Kaiser, a healthcare visionary and futurist, once told me “there are no problems, only preferences.” It fundamentally changed the way I saw the world. My lousy sleep wasn’t a problem, it was because I preferred to bring my laptop into bed with me. Patient safety gaps weren’t a problem, it was because we preferred to tolerate behaviors that undermine a culture of safety. Having 30-40 million uninsured Americans wasn’t a problem, it was because we preferred to sustain a system that limits access and equity.
Tell me something about yourself that isn’t on your resume.
I make a killer pesto. Before I can even mix it into the pasta my kids shove me out of the way to line up and plunge their handfuls of crusty bread. You’d think they hadn’t eaten in days.
Are there books you would recommend for people interested in learning more about inclusivity in the workplace?
Absolutely, and both of these are must-reads for anyone interested in leadership. Inclusion is a mindset that everyone who works here is valued and respected, and that everyone’s contributions are vital for our success. “Radical Inclusion” by Martin Dempsey and Ori Brafman advocates for inclusion as the way to build trust, and elegantly describes how to gain more power by giving up one’s quest for tighter control. The other is “The Leadership Secrets of Colin Powell” by Oren Harari. Powell’s leadership style was to unapologetically give deference to those on the front line and closest to the work, that people are always far more important than plans, and that challenging the status quo – and the experts that perpetuate the state of affairs – is to be encouraged and rewarded.