When Stephen Mansfield was hired on as president and CEO of Methodist Health System in the fall of 2006, there wasn’t any drama around it.
The former CEO was simply retiring and things were running like clockwork. But with that retirement, the board saw an opportunity. The hospital’s financial performance was starting to deteriorate, primarily because of the amount of charity care and uncompensated care it had to provide — a common problem for hospitals as an increasing number of people lack health insurance.
“My feeling was, and the message was, that we need to grow,” Mansfield says. “If we’re going to be able to sustain the mission of this company and provide care to the poor who are unable to pay for their care, we’ve got grow in some new areas that can generate income to offset that.”
His first 90 days on the job were spent in conjunction with the outgoing CEO, so he did one-on-one interviews with the board, senior leadership, community leaders and about 80 medical staff members, all in an effort to understand the organization well.
By January, Mansfield was in a position to stand before the board and the entire medical staff and provide his assessment and early thoughts as to how and why the company should grow from where it was — about $460 million in net patient revenue — to $1 billion in net patient revenue by fiscal 2011.
The results in his first four years are impressive: $890 million last fiscal year and nearly doubling the net patient revenues. Additionally, the system has grown from two hospitals in 2006 to seven today.
“It’s been a pretty aggressive growth trajectory,” he says. “I don’t know many other health systems that have doubled in size over the last four years. We’re very fortunate.”
Here’s how Mansfield used two key strategies — planning and careful hiring — to hit his growth goals.
Create a plan
Mansfield simply loves strategic planning, and it’s the first thing he went into following his address to the company in January 2007. He knew that if Methodist was going to grow, it couldn’t just meander its way through it.
“Next to the right people, strategic planning is one of the most important functions you can do,” he says.
Mansfield essentially creates a four-year plan every three years, which allows for a year overlap on each plan. For example, he began creating Methodist’s 2012-2014 plan in February 2010, while still in the middle of the 2009-2011 plan.
He starts with an off-site, one and a half day conference with the board, leadership team and medical staff leadership. One of the keys to strategic planning is getting an outside perspective, so he brought in well-known, industry experts to speak about where they saw health care going.
“Have thought leaders from your industry come and talk to your leadership,” he says. “We tend to get myopic in our focus on our own organization and our own market, and we think that’s the way the world’s running, but, in fact, there may be trends occurring outside of your market that you need to take into account for your market. …
“You may not agree with all of them, and some may not work for your market or your company, but it’s helpful to expand our horizon of thinking at the beginning of a strategic planning process. Then you take it from broad to narrow and make it work for your organization and your service area or market.”
After that, he says to come back with your senior team and synthesize the thought from that session at a high level and put it into a document.
“Whoever’s going to be tasked with the primary responsibility for delivering on your plan needs to be involved in your planning process so they feel ownership in that plan,” he says.
Over the months that followed, the senior team members discussed and refined it, and in September, they presented it to the planning committee.
“We had a lot of people involved in it, because we wanted to have buy-in from the medical staff,” he says. “I didn’t want it to be Steve Mansfield’s strategic plan — I wanted it to be our medical staff’s plan, our board’s plan, our community’s plan, our employees’ plan, our management structure’s plan.”
A year after the initial conference — and still a year before the plan starts — is when he starts the budgeting process for that three-year plan. They create a planning calendar, which he calls a racetrack, that has the key things that have to happen during that time period for the plan to be successful.
“As much value as I place on planning, I don’t think it’s the final plan that’s so important as it is the process of creating the plan,” Mansfield says. “Then the real differentiator is not necessarily the plan but how well you execute on it.”
He says companies get caught up in creating a plan but they don’t involve key stakeholders and then they don’t track their progress or see how they’re doing against the plan.
“Those things are so important to making sure the plan has the impact on the organization that you want it to,” he says. “I tell people all the time, as proud as we are of our strategic plan, reality is, if you compared our strategic plan to our two top competitors’ strategic plan, there’s probably about an 80 percent overlap. So what’s the differentiator? The differentiator is who can execute the plan better.”
Once the plan actually begins, he meets every other week with his senior executive group to review key data. In one meeting a month, the key metrics of the plan are reviewed by the planning department, and the team receives feedback on how they’re doing on accomplishing and delivering on the plan. The hospitals are given updates on the things they’re measured on once a month. If anything is off, he and his team try to find out why.
“Missing a goal is not the cardinal sin,” he says. “Missing the goal and not having discussed it and asked for help along the way is.”
Lastly, to make sure people are staying on track, he also stops by people’s offices — not call them to his — to casually talk with them about how things are going.
“There’s no substitute for periodically sitting down with the key members of your team and saying, ‘How’s it going? How are things working? Do you feel like you’re getting things done that you need done? Is there anything I can do to help you? Oh, by the way, I saw that you did such and such, and that’s awesome,’” he says. “We get, as CEOs, so busy sometimes that we don’t just take the time to sit down with the key members of our team and just spend a little bit of time refreshing on the priorities and making sure that we’re acknowledging the successes. We have a propensity to assume success and sometimes to withhold encouragement, and that’s not good.”
Hire the right people
When Mansfield came into his position, he was new to the area, having just moved from Arkansas, so he recognized his weakness — not knowing the market. He needed to hire a development officer who knew people, knew the area well, could look for growth opportunities and had the relational acumen to facilitate complex transactions. He hired someone in, and that person made a lot of connections for Mansfield very early in his tenure.
“You plant a lot of seeds and not a lot of them grow, but we planted a lot of seeds in those early weeks and months and a lot of them did grow,” he says.
That person got a group of physicians in McKinney, Texas, to agree to do a joint-venture hospital there. Shortly after that, he brought another group of physicians in the community on board that was already assembled and looking for a partner to do a joint-venture hospital. The city of Richardson also approached Methodist about merging its hospital into their system. On top of all those efforts, they also opened two other hospitals.
The system was also facing a physician shortage, so Mansfield got the board to agree to an aggressive employment recruitment strategy, so hiring was a major part of his position when he started.
But hiring can be tricky, so Mansfield was very particular in his process and says that’s the way you have to do it if you want to be successful. To start, he first looks at if there’s anyone he knows that could do the job well.
“The best way to make sure you make a good hire is when you hire someone you already know will fit in that job if you can just convince them to take it,” he says.
That was the case with the development officer, as well as with the CEO for one of the hospitals, the new system COO and the human resources executive. Despite knowing these people, though, he knew it couldn’t be all up to him.
“Even if it’s someone I think will work, they’re not going to be effective if they can’t work with the rest of our team,” he says.
So despite having a front runner for a position, he still did searches and put each candidate through a hiring process that makes them interview with teams of board members, medical staff, employees, senior executives and middle management.
“It helps to do a team interview,” Mansfield says. “I’m not sure if it helps you so much with your selection process as it helps you with that person’s assimilation … to have key people who would have to help that person be successful involved in the selection process.”
He says to ask behavioral-based questions, such as what have they done, what’s the worst decision they’ve made and what they did about it, instead of what’s their management philosophy.
“Those kinds of questions you can get a little bit deeper than ‘What’s your management philosophy.’” he says. “Don’t ever ask that question.”
All together, a candidate can meet with about 120 to 150 people in his or her interview process.
“It’s a scheduling nightmare trying to get that many people together, and it exhausts our candidate,” he says. “If that candidate is still perky at the end of a day and a half of being asked the same question that many times, they can probably handle a typical day at Methodist.”
With that many different people scoring a candidate, it’s easier to get buy-in for whomever you ultimately hire.
“Through that process, we select a person — it’s not just Steve Mansfield’s person, it’s all 150’s person,” he says. “We’ve all got a vested interest in that individual being successful and quickly assimilating to our team.”
Beyond sheer numbers in interviewers, there are other keys to hiring. He also suggests, especially for senior executives, for you and your spouse to spend time with them and their spouse in a dinner setting to see how they interact together, what kind of support they have in their life and how they are in social settings.
He also makes it a point to look for diversity and likes to have at least one of the final four candidates come from a racial or gender minority.
“That doesn’t mean we select the diverse candidate,” he says, “But if you’re not seeing them, you certainly can’t select them.”
After that, Mansfield likes to get an off-the-record perspective on that person by speaking to someone he may know that might have worked with that person. And then the final step is to use an outside company to complete a psychological profile of that person, which is what he calls Myers-Briggs on steroids.
It’s a long process, but he’s successfully recruited more than 100 physicians that have helped Methodist grow.
“Despite all of that, I think the interview process is still just a little better than a coin toss,” he says. “It’s like getting married. No matter how long you date, when you get married, you find out some things you just didn’t know. Usually those are mostly pleasant things, but that’s just the nature of it.”
How to reach: Methodist Health System, (877) 637-4297 or www.methodisthealthsystem.org
The Mansfield file
Mansfield on leading change: To change anything — to change a habit or change culture or change anything that’s indelibly embedded as culture — you have to start with making the compelling case for why. Why change? If we’re successful, if we’re delivering on our mission, if we’re happy, then why change?
Changing a culture is like breaking a horse — you’re going to get bumped off, but you have to be willing to get back on and keep getting back on until you get the change from the culture that you need to be successful.
Mansfield on your career choices: Work for an organization whose espoused and practice mission matches well to your own value system and life priorities. I feel very fortunate to have had almost a four-decade career, and I have never been in an organization where I felt like I had to compromise my value system in order to be effective in the role that I had. I think that’s very important as you’re contemplating where you’re going to spend your career, to make sure you’re working with a company whose goals and value systems and mission and vision statements you can embrace and support from a personal standpoint.
Mansfield on setting personal goals: I’m still amazed by the number of people who don’t do it, but it’s so important for human beings to have the discipline to periodically create and update your own personal goals. Not just your goals related to work, but your goals related to community and faith and health and all of those variables that make us multidimensional creations. Human beings have the capacity to accomplish so much more than we do.
One of the delimiting factors is we don’t create a road map that’s trying to take us to a better place as individuals. If you don’t really care where you’re going — it doesn’t matter — one road’s just as good as the other, but if you’re intentional about what you want to accomplish with your life across its many dimensions, I think that there’s strength and power in that acknowledgment. The Bible says that as a man thinketh in his heart, so is he. What does that mean? I think that means we can accomplish a whole lot if we establish an expectation of ourselves to do so.