Pittsburgh’s health care landscape has been anything but boring, and for Robert Rogalski, that statement holds very true. The health care lawyer turned health system CEO has been surrounded by industry change and talk of mergers and acquisitions ever since returning to the area in 2009.
Rogalski’s entrance into the CEO role at Excela Health was rather nontraditional. The former counsel for University of Pittsburgh Medical Center and West Penn Allegheny Health System was asked to join the board of directors at Excela, a 4,800-employee, $500 million health system. Just a few months later, he stepped in as interim CEO and took the job permanently in 2010.
Five years earlier, Excela had undergone a merger of four hospitals — Latrobe, Westmoreland, Fricke, and Mercy Jeanette. Mercy Jeanette has since closed, but the other three remain open, and it has been up to Rogalski to continue the long process of unifying those cultures into one.
“We had difficulty fitting together the cultures of Latrobe Hospital and Westmoreland Hospital and I think the biggest challenge is trying to find common ground to build upon to develop a common culture for the new entity,” Rogalski says. “Like any merger there tends to be a little bit of push and pull in terms of which culture is going to succeed in a merger.”
Unlike many mergers or acquisitions where the incoming company adapts to the culture of the acquiring business, Rogalski and Excela didn’t want to force one particular culture upon the new entity and instead are looking to form a culture made up of best practices.
“What we found here is that there was a sense of lost in terms of the culture and what we’ve attempted to do through a series of planning exercises is we’ve tried to define a new culture for the system rather than adopt one culture or the other,” Rogalski says.
Here is how Rogalski has helped bring together three systems and form a common culture for future success.
Evaluate the culture
With Rogalski at the helm and a new board also in place, the first task at hand was to get together and evaluate the type of culture they wanted to set up for the new entity.
“As a board exercise, we sat down and tried to establish the culture that we would like to see,” Rogalski says. “When we studied it and spent time at the board establishing it, it really came down to a lot of fundamentals that included patient convenience, quality of care, and patient experience. At the center of it was, ‘How do you design systems that are the most patient-friendly?’
“A lot of times what you run into in our industry is systems that have been established for provider convenience, whether that’s physician convenience or nursing convenience or otherwise, sometimes aren’t established on the platforms that they should be.”
Rogalski and his team spent a great deal of time evaluating how patient-friendly Excela was and whether it was maximizing the patient experience and where the gaps were.
“We were trying to lead both cultures to that end and to get a lot of the decision-making focused on our basic pillars,” he says. “We then needed to wire our culture into our hiring decisions, retention issues and awarding of employee promotions based on how well they adhere to those values. Those are the things we are working on now.”
Another focal point that had to be addressed was the fact that these hospitals used to be competitors and now they were on the same team. Excela had to make sure processes didn’t involve competition.
“I think historical competition that existed between these two hospitals had fostered some level of mistrust,” Rogalski says. “When you’ve competed with someone for a while and then all of a sudden you’re put on the same team, unless you eliminate the competition between the two entities, there is always going to be some type of element there that isn’t necessarily constructive.
“We did have to look at where some of our practices were allocated, and we’re doing that analysis now. We had to look at where they wanted certain services to be rendered and that type of decision-making was very good and helpful in terms of being able to eliminate intramural competition in the future.”
The historical competition of the hospitals was another reason that Excela wanted to blend cultures rather than choose one in particular.
“In certain circumstances you can be more prescriptive about the culture,” he says. “But even in those situations I think the blending of cultures is important. One of the things we wanted to hold on to were the valuable attributes of both organizations. Both were hospitals that were very successful in the past, so making one culture subservient to another wasn’t the right prescription for our situation.
“The right prescription for us was trying to define what we wanted to grow into and invite both organizations to matriculate to a new culture.”
When evaluating such an in-depth process with many different things to consider in every decision, it is helpful to form a plan to follow and have people that will help you achieve it.
“You have to have a template with your mission and your vision and your values system that’s listed,” Rogalski says. “I think you have to spend a lot of time in strategic planning in terms of evaluating the value system for your organization. Once you have that definition developed, I think the key is doing the gap analysis. Go through on a unit-by-unit basis and see where you think the shortcomings are.
“You also have to evaluate each of your leaders and that takes a long, long time. You have to attract the type of people to your institution who have some innate attributes to be selfless and attributes designed to put their own convenience to the backburner.”
Communicate your plans
Rogalski’s predecessors made some very good decisions in regard to the merger, but they were difficult decisions that involved rearranging of services. What Rogalski had to do was to take charge of communicating the new plans moving forward.
“With the reshuffling of some of the services, there was some sense of loss,” he says. “Among the things that I had to deal with when I got in the chair was some dissatisfaction among community members and others about those types of decisions. So we had to try to get everyone to agree that those decisions made a lot of sense, and we tried to explain the reasons why they made sense.”
Communication has been Rogalski’s biggest focus in recent months. Meeting with community leaders and explaining why certain decisions are being made has been a key effort.
“What gets people into trouble a lot of times isn’t necessarily the ultimate decision, but the way it’s communicated,” he says. “There needs to be communication before decisions are implemented. We’re certainly not perfect at this even as we sit here today. In the interest of time we have pushed some things through where we could have communicated better.
“When you’re dealing with a merger you have to spend a lot of time matching up your mission, vision and values. Try to evaluate your culture and make sure that if you have gaps between the two entities that you try to close those down from an early time period.”
Communicating to get buy-in for Excela’s new culture was the next step in the process, and it presented some difficulties.
“As a not-for-profit hospital we have some obligation to the community, but ultimately to make the organization operate efficiently, you have to make certain decisions,” Rogalski says. “You hope to, as leaders, get enough consensus built around a decision so that people agree it’s important to do.
“We built some collaborative structures in place for our physician leadership. We’d established a number of leadership committees, so we are involving the physicians in strategic discussions and more importantly, we are getting feedback from the physicians, which help us guide our decision-making process. We also have a very active and engaged board who helps push us on our decision-making as well.”
Even when buy-in for a decision is gained and that new direction is implemented, certain decisions are going to impact people differently.
“Ultimately, once the decision is made, I don’t think you can harbor dissent at that point in time; people either agree and get on board with it, or you just have to get past it,” Rogalski says. “If that means they’re no longer going to be employed by the organization then that’s fine … we’ll just pursue our interests at that point in time. You can’t satisfy everybody.”
In a process that’s as critical to the organization’s overall success as a new culture, you have to make sure your employees have input on how things should operate.
“The communication is important, but even more so, if you have a strong core of physician leaders who take the time to become educated on why it’s important for a health system to run efficiently, how they should run efficiently and who can assist you in telling their colleagues why it’s important to put their individual convenience to the side for the benefit of the system is critical,” he says.
“We have to prove to them and build trust and it takes a little bit of time for us to do that. We’re trying to develop a level of engagement where we get feedback from the employees and try and respond to their concerns and explain why we’re undertaking certain decisions.”
Don’t get discouraged
In a process where every decision has a big impact on the organization, it is easy to become discouraged or for employee morale to drop. You have to stay positive and do what’s necessary to keep morale up.
“The most difficult part is we’ve been required to make decisions that are difficult and politically difficult,” Rogalski says. “When you make those types of decisions, it’s very difficult to get buy-in for what you’re trying to build from a cultural standpoint.
“When you make decisions like that that are difficult for any community and difficult for any workforce, it takes a while for the employees to develop trust in the organization. How’s it going to be different? How’s my daily life going to be? Those sorts of things make it more difficult for us to build morale.”
Getting morale where it needs to be to buy in to a cultural transformation is one of the biggest challenges for a CEO to face; you just have to continue to build trust.
“Employees are smart,” Rogalski says. “They’re not going to listen to what you say; they’re going to watch the actions. I think communication is important, but it’s only as important if you follow through on what you say you’re going to do. They’re going to want to see you live your values and set the example for your values through working hard and trying to be selfless. If they see you doing that, they’ll be more likely to agree that these values are something that you’re serious about and that you think are important for the organization because it’s the right thing to do.”
Boosting morale in a transition such as this is vital and it helps to celebrate the little victories and recognize the employees who get you there. You also have to realize that culture is an on-going process.
“We’ve tried to take all this on with some humility in terms of our understanding that there has got to be a better way to do things,” he says. “We never approach our successes as though we’ve reached the end point, but we do celebrate our successes. You have to celebrate the success of the people who bring you the results.
“Ultimately, I don’t admit patients, I don’t care for patients, and I wouldn’t have the slightest ability to do either thing, so we need the nursing staff, physicians, and the other employees to develop our successes for us and when they do that they’re the ones that deserve the credit for it. The biggest takeaway is knowing that you’re never really finished with a task like that.”
HOW TO REACH: Excela Health, (877) 771-1234 or www.excelahealth.org
- Understand what kind of culture your organization needs.
- Communicate the changes that will make the culture work.
- Don’t let the process discourage you and try to keep morale high.
The Rogalski File
Born: Kittanning, Pa.
Education: Graduated from Saint Vincent College of Latrobe and received a juris doctorate from the University of Pittsburgh School of Law
What was your very first job, and what did you learn from that experience?
One of my first jobs after graduating college was as a newspaper reporter. It taught me that there is enormous power in public perception.
What is the best business advice you’ve ever received?
It came from my mentor Jim Cooper. Jim was the CEO at Medcenter One. He used to say that it’s not necessarily the decisions that you make that will be your doing or undoing; it’s how you communicate them.
If you weren’t the CEO of Excela, what’s a job you’ve always wanted to do?
If I wasn’t the CEO of Excela, I’ve always enjoyed being in health care, so I wouldn’t mind being back practicing health care law.
What are you looking forward to in the health care industry?
I’m excited about the transformation that we’re doing in health care in terms of trying to control costs and create as efficient a system as possible. We’re using a lot of the lean tools and that part is exciting to me.
Who are leaders that you admire?
The biographies of the presidents have always been interesting to me. I have a lot of admiration for Harry Truman. I was impressed with him and the decisions he had to make in some of the darkest hours of World War II and the beginning of the Cold War. I think he was thrust into a very difficult situation and acquitted himself about as well as anybody could be expected to.