How Stephen Mooney transformed the back office operations of Tenet Healthcare into Conifer Health Solutions

Cost center managers tend to lay low during times of change, but not Stephen Mooney. The latent entrepreneur in 2008 proposed the idea of splitting off the patient financial services division of Tenet Healthcare into a stand-alone company to take advantage of an opportunity he saw in the marketplace and to capitalize on the strong relationships already in place with Tenet’s network of hospitals.

To understand what Mooney faced getting this idea off the ground, consider Tenet’s situation:  The organization was in the midst of selling more than half of its 110 hospitals when he floated his idea by Tenet’s CEO. That meant significant change, and during a time when organizations typically are hesitant to champion new start-up initiatives.

“My idea didn’t have a lot of fans at first, but it did get our executives thinking about the future instead of our current dilemma,” says Mooney, who serves as president and CEO of Conifer Health Solutions LLC, a subsidiary of Fortune 100 company Tenet Healthcare.

Mooney was convinced that health care organizations would jump at the chance to boost revenue cycle performance and focus on patient care instead of billing and collections. So Mooney sold his vision to everyone he encountered, turning a $200 million cost center into an outsourcing success story, adding some 7,000 employees and 600 clients in just five years. Here’s how he did it.

 

Build a strong foundation

Providing revenue management to non-Tenet hospitals and health systems would require a hefty investment in technology, a cultural shift as well as the development of a sales and marketing arm. Still, Tenet execs were intrigued by the idea and pledged their support if Mooney could find some way to fund his revolutionary venture.

“My initial forecast had us losing money for the first two years,” he says. “Under the circumstances, the company couldn’t afford to lose a single dime. And since venture funding wasn’t an option, I had to find the cash in our operating budget.”

With the executive team behind him, Mooney set out to achieve buy-in from other constituents. He alleviated any concerns by sharing his vision and offering each group a customized slate of benefits. Servant leadership and creating vested partnerships was his goal.

For example, he grandfathered existing rates during the initial transition period. And, he lowered the cost of processing rudimentary transactions by offshoring selective technology and call center services, using the savings to build a robust technology platform.

“We’re not a tech company, we’re a tech-enabled company,” Mooney says. “I needed to enhance our IT platform so we could drive more volume through our machine and offer our clients greater efficiency and value.”

Next, he approached Tenet’s suppliers and asked them to partner with the company. Could they make near-term concessions by thinking long term?

“I shared my business plan with our suppliers,” he says. “I wanted them to see that they had the opportunity to grow with us if they were willing to reduce their fees. Plus, you need to establish strategic alliances from the outset because you’ll need them to manage growth.”

Tenet’s suppliers recognized the opportunity and jumped on board. But after several years of change, Mooney knew his larger task would be with his own team members.

“Getting this thing off the ground would take a lot of work, so I absolutely needed our employees’ support,” Mooney says. “You need to make sure that everyone’s behind you before you start approaching customers.”

Mooney emphasized the benefits of growth to garner support from workers. Having the opportunity to control their own destiny and career opportunities were his main selling points.

“I had to explain my vision to employees, get them engaged and help them understand that short-term sacrifices would yield long-term gains for them and also add tremendous value to our external clients,” he says.

Mooney credits his team’s enthusiasm and willingness to embrace change with Conifer Health’s early financial success.

“We were supposed to lose money in the first year and to everyone’s surprise, we actually broke even,” he says. “I credit employee engagement for allowing us to achieve a budget-neutral position in our very first year.”

 

Hit a home run

Convincing a prospect to relinquish operational control of vital functions like billing and patient communications isn’t easy.

Mooney and his sales team made ends meet by selling point solutions while devising a strategy to close their first major end-to-end outsourcing deal.

“We bought time in the first year by hitting a few singles and doubles, but we needed to land a big fish to prove our concept,” Mooney says.

“Our executives were wondering if this was going to work, but health care organizations were wary of turning over their entire business office to an outsider from Mars.”

The sales team set its sights on landing a major deal with a member of a faith-based, not-for-profit system. Mooney knew that signing a member of this prestigious fraternity would encourage others to follow. But he and his team would have to sway a host of skeptical attorneys, consultants and stakeholders to ink their illusive inaugural deal. They emphasized their industry experience, their servant leadership model, and cultural alignment.

The looming impact of the Affordable Care Act finally proved to be the tipping point, as Conifer Health signed a number of major deals including a long-term agreement with Catholic Health Initiatives (CHI) to provide revenue cycle services for 56 hospitals across the nation.

“Even CHI’s consultants agreed that their current model was unsustainable given the changes under health care reform,” Mooney says. “The market was aligning with partners and we finally convinced our prospects that they couldn’t wait to act.

“All I can say is don’t give up,” he says. “Our first deal died more than once, but I remained involved, and we continued to push the benefits that mattered to our prospects like improving the patient experience and the revenue cycle until the timing was right.”

 

Close service gaps and accelerate growth

Mooney worried that Conifer Health might lose its competitive edge given the massive changes imposed by health care reform. He hired experienced leaders, invested $200 million in the firm’s technical infrastructure and paid another visit to Tenet’s CEO where he presented a plan to leapfrog Conifer Health past its competitors.

“The market was in a state of flux due to health care reform,” he says. “Clients wanted turnkey solutions, and we needed to close a few service gaps to help them transition from a fee-for-service to a fee-for-value environment. The question became, ‘Should we build or buy these capabilities?’”

Mooney proposed a series of strategic acquisitions, and this time he not only garnered support, but funding from Tenet’s executive team and board.

In recent months, Conifer Health has added new services like clinical integration, population health management and financial risk management to its arsenal as well as data modeling and analytics. In the process, the firm has acquired a host of new clients and employees.

While acquisitions can boost revenues and a firm’s capabilities overnight, assimilating an outside organization can be tricky. Depending on whose research you believe, mergers have a failure rate of anywhere between 50 and 85 percent primarily due to a lack of cultural compatibility and the hasty departure of key employees who possess critical institutional knowledge.

Mooney has been successful in assimilating acquisitions by getting Conifer Health’s acquired companies to embrace his unique philosophy and vision for the company.

“We try to retain or find other opportunities within Conifer Health for everyone we acquire,” he says. “If we do lay someone off, we give them severance and outplacement assistance because everyone deserves the right to leave with dignity.”

He’s created new business units within Conifer Health to help him retain key leaders and staff from an acquired firm. He’s also bolstered retention by allowing employees to telecommute as Conifer Health expanded its footprint to more than 40 states.

“The key is empowering people to make decisions so they can serve the client,” Mooney says. “We’ve expanded what we offer our clients, and they’ve embraced them because they add value to their mission and their communities. I keep our staff engaged by relaying our success stories. That’s critical feedback as it validates the work they provide our client every day.”


Takeaways:

  • Build a strong foundation before you approach customers.
  • Prove your concept by hitting a home run.
  • Close service gaps and accelerate growth. 

 

The Mooney File:

NAME: Stephen Mooney
TITLE: President and CEO
COMPANY: Conifer Health Solutions LLC 

Birthplace: Margate, N.J. 

Education: Bachelor’s degree in accounting from Stockton State College in New Jersey and a master’s degree in business administration with an emphasis in accounting from Pepperdine University. 

What was your first job and what did you learn from it? I restocked the ice cream vendor on the boardwalk of the Jersey Shore. I learned that every person is important because the business couldn’t operate without a runner. Plus, it taught me responsibility because I couldn’t take a day off unless I found someone to take my place. 

What’s the best advice you ever received? Put people first because it increases their engagement. In turn, they’ll take care of your customers and the bottom line. For example, we let people go home when an ice storm is approaching and they make up for it the next day. They respond because we trust them to do the right thing. 

Who do you admire most in business and why? Jack Welch, former chairman and CEO of General Electric, because he was incredibly focused and a great developer of people and leaders. 

What is your definition of business success? Your business is successful when it’s turning on all cylinders, and it’s sustainable. In other words, you could walk away, and it would just keep going. We’re not there yet because we’re only a five-year-old company, but I believe that we’re on the path to sustainability.

 

Conifer Health Solutions Social Media Links:

Twitter: @coniferhealth
LinkedIn: http://www.linkedin.com/company/conifer-health-solutions

 

How to reach: Conifer Health Solutions LLC (877) 266-4337 or www.coniferhealth.com

 

Tenet Healthcare to buy Vanguard Health for $4.3 billion

DALLAS, Mon Jun 24, 2013 — U.S. hospital operator Tenet Healthcare Corp. will buy smaller rival Vanguard Health Systems Inc. for $4.3 billion including debt to expand into new geographies.

The offer of $21 per share represents a premium of 70 percent to Vanguard’s Friday close. Vanguard shares were up 66 percent at $20.51 in thin trading before the bell.

The companies said the deal includes the assumption of $2.5 billion of debt.

Tenet said it expects the deal to add to earnings in the first year and estimates annual savings of $100 million to $200 million.

“This acquisition will take Tenet into new geographic markets, expand the breadth of our service offerings, diversify our earnings sources and increase the benefits we expect to realize under healthcare reform,” Tenet CEO Trevor Fetter said in a statement on Monday.

Tenet has hospitals in California, Texas, several states in the U.S. Southeast and in Pennsylvania.

Vanguard owns and operates 28 acute care and specialty hospitals in the U.S. Midwest, South and Massachusetts.

U.S. hospital stocks have rallied this year as investors expect the companies to benefit from President Barack Obama’s healthcare reform that will expand insurance coverage to more Americans. The reform has also spurred consolidation in the sector.

Tenet has secured fully committed financing from Bank of America Merrill Lynch.

Trevor Fetter retooled Tenet Healthcare to counteract a growth slump

During the first four years of his now decade-long stint at the helm of Tenet Healthcare Corp., Trevor Fetter spent a lot of time putting out fires. The company was embroiled in a couple of delicate litigation issues left over from its previous regime, and those cases drained the newly appointed CEO’s energy and focus.

Unfortunately, the legal entanglements left Fetter with little time to address a significant problem that had begun to affect both his company and the health care industry at large: a long-term growth slump that began in 2003 and persists to this day.

“From 2003 to 2006, I was focused most intensely on fighting fires and resolving legacy problems,” Fetter says. “But you could see the early signs of the slowing of growth in our industry around the beginning of 2003.”

The slowdown was largely being driven by a conscious initiative of employers and insurance companies to reverse the tide of ballooning health care costs. Companies were beginning to shift a portion of the health care costs they had traditionally borne onto their employees by increasing out-of-pocket payments such as co-pays and deductibles.

“Behind the scenes, employers’ HR departments were fixated on the percentage of total health care costs being borne by the company versus the employee,” Fetter says. “They were trying to move it from, say, an 80-20 ratio to a 70-30 ratio. And that made a big difference in the take-home pay of employees across American industry.”

It also started to make a dent in the revenue of companies such as Tenet, which owns and operates 49 hospitals and about 100 outpatient centers in 11 states and generated $9.58 billion in revenue in its most recent fiscal year.

“That and other factors have resulted in a prolonged reduction in the growth rate for our industry,” Fetter says. “And if that weren’t enough, when the recession came along in 2008, the suppression of growth expanded, and it has persisted. So our big challenge over the past few years has been how to overcome these pressures against growth.”

Tenet has faced that challenge by launching a handful of initiatives that, taken as a whole, have transformed the company into an innovator and a model for a more sustainable way to deliver health care services in the coming decades.

React to shifts

The first of these new programs, kicked off in 2007 and was dubbed the Target Growth Initiative. The program’s goal was to revise the Tenet hospitals’ menu of services to better fit the changing demographics of their communities, thus making them more competitive in their markets.

“What we did was to deconstruct our hospitals and look at them as a collection of service lines within a fiscal infrastructure,” Fetter says. “When you look at a hospital that way, you realize that some of the services you’re providing to the community are in a permanent state of decline, generally fueled by demographic trends.”

As an example, Fetter cites a hospital serving an aging community. In that type of market, the demand for maternity services will naturally decrease while the demand for cardiac services will naturally rise.

Tenet’s Target Growth Initiative enabled it to get out in front of these types of trends by investing more in service lines for which the demand was growing, even though that often came at the expense of cutting service lines for which the demand was shrinking.

“An example of this was at one of our hospitals in Los Angeles where they needed more space for operating rooms and equipment related to treating cardiac disease, while they had excess capacity for maternity and obstetrics,” Fetter says. “Another factor we had to consider is that in Los Angeles it takes forever to get permission to change a physical facility. It’s very difficult and very expensive.”

Tenet’s leaders also realized that there were competing hospitals nearby that had large, established maternity and obstetrics departments. So the company solved the puzzle by shutting down its maternity services at the Los Angeles hospital and using the freed-up space and resources to expand its cardiology capabilities.

“We repurposed those facilities to satisfy the need of the growing cardiology business,” Fetter says. “A change like that can make a huge difference if, for example, someone is having a heart attack. It might shorten their ambulance ride by 10 to 15 minutes. That can make a real difference in saving lives.”

The role of legal counsel in achieving business success

James deGlee, Senior Managing Counsel, Florida Region, Tenet Healthcare Corporation

As many industries experience increased regulation and undergo fundamental changes in a difficult economic climate, companies require lawyers with a niche in key areas of service, such as health care, real estate, regulations, mergers and acquisitions, etc.

Even with specialized expertise, constant changes in a volatile economy can lead to many sleepless nights for those responsible for the legal affairs of large companies. This is especially true in health care.

“We are seeing major consolidation in the health care industry at all levels, which requires a lot of careful legal work,” says James deGlee, senior managing counsel for the Florida Region of Tenet Healthcare Corporation. “We need to be proactive and provide our clients with concise guidance on new developments in payment systems and regulatory areas, and at the same time provide the day-to-day legal services required for our facilities from an operational perspective.”

Smart Business spoke with deGlee about how having the right expertise to competently and expertly address legal issues can influence business success.

What is the role of legal counsel in achieving business success?

In the landscape of today’s competitive marketplace, it’s becoming critical to integrate legal expertise within all constituencies of an organization. It’s impossible to put legal function in a silo and expect business success. Progressive companies are closely integrating legal strategy into business operations to open communication, join forces with shared goals and work proactively to maintain a competitive advantage. This is especially true in health care, where the legal test is often whether a proposed transaction is ‘commercially reasonable’ or a payment is ‘consistent with fair market value.’ You simply cannot provide good legal advice without understanding the business details.

Even though we are an in-house legal department for the Tenet Florida region, we consider our 10 hospitals and their administrators our ‘clients’ and we treat them that way. It’s our responsibility to bridge Tenet’s overall goals with each individual hospital’s goals, and that can be a challenge. We must listen to both our corporate leadership and hospital clients to find legal and compliant ways to strategically accomplish positive business outcomes. As legal advisers, we can influence the organization’s success by developing our legal strategy around supporting the best, most efficient ways to operate hospitals and deliver quality care to the community.

How do you influence your organization’s ability to achieve its strategic goals?

Tenet has adopted a corporate culture of compliance, which has influenced our legal strategy. First, the ‘legal’ hurdle is generally a low barrier and should not be the standard to gauge acceptable behavior. The first question shouldn’t be ‘Is this legal?’ Rather, the organization should ask: ‘Is this ethical business conduct in the best interest of our patients and consistent with company values?’ Just because something may be legal, it might not be the best or right thing to do. We also refrain from ‘risk of enforcement’ analysis or advice. For example, if the speed limit is 55, lawyers shouldn’t engage in discussions about whether their clients risk a ticket if they go 60 or 65.

Our challenge is always finding a way to legally accomplish our clients’ business goals. I believe it’s important to consider workable solutions and analyze alternative courses before you simply reject an idea on legal grounds. The easy answer to many clients’ questions is to simply say, ‘no, that’s not legal.’ When the client doesn’t take action and your decision is never tested or challenged, ‘no’ does little to benefit the company. The right course is to carefully consider the goals and give the client legally compliant ways to accomplish them. You need to have a good understanding of the industry and work closely with your business leaders to give that advice.

What is your strategy for building relationships between legal and business leaders within the organization?

Relationship building is key. Professional business relationships cultivate mutual trust, and with mutual trust, the client is more likely to provide the facts and information required for the legal team to build an effective strategy. Without full disclosure of facts and the answers to the important questions, a legal team will not have the insight and basis to deliver the best legal advice on important business decisions. Building trust with an organization’s senior leaders is often a challenge because each may have preconceived beliefs or past experiences that either positively or negatively influence their openness to legal involvement in business matters.

To build professional relationships, you have to listen. Active listening builds trust and mutual understanding. To really know what a client or business leader is trying to accomplish, you need to do a lot of inquiry to get a better picture of their situation and their needs. Pay attention, listen to cues and be engaged in what they are telling you. Really listening to people encourages them feel more comfortable. Building strong communication patterns and mutual trust fosters respect, which is the foundation of any professional relationship. With strong relationships, business leaders will be more likely to partner with legal teams and the resulting cooperation is invaluable to achieving shared goals.

How do you perceive the role of general counsel evolving within large organizations?

Consolidation is a big trend, and with more mergers and acquisitions, we will likely see large organizations becoming even bigger. Their need for in-house legal counsel may grow, along with the legal team’s job responsibilities. Forward-thinking companies are involving legal counsel in business strategy, which brings the legal department more accountability and responsibility for outcomes and the bottom line. Large organizations of the future will be looking for legal experts with a solid knowledge of the close interworking between law and business, as well as experience working within large system-based law departments.

James deGlee is the senior managing counsel for the Florida Region of Tenet Healthcare Corporation.

How to create a culture of compliance and ethics in the workplace

Debbie Wheeler, Regional Compliance Director, Tenet Florida

Do the right thing. This may seem like a simple task, but there are many circumstances in the workplace that challenge employees’ ability to act within their organization’s core mission and values. With a strong ethics program, employees can better grasp expectations and understand their individual role in making the culture of compliance thrive within the organization as a whole.

“The law is the minimum standard,” says Debbie Wheeler, regional compliance director, Tenet Florida. “To help employees make the right decisions that properly reflect the organization, employers need to take a step further by developing, communicating and enforcing clear standards of conduct.”

Wheeler discusses with Smart Business why ethics in the workplace is critical, and offers suggestions for building a strong employer-driven compliance program.

What are the benefits of managing ethics in the workplace?

A strong ethics program aligns the organization and its employees. It provides a solid foundation from which an organization can build a consistent culture of ethical decision-making, transparency and accountability. I always say that the law is the minimum standard; what goes beyond that in our daily decision-making of ‘right’ versus ‘wrong’ is guided by integrity and ethics. Employers can play an important role in helping employees make more ethical decisions in the workplace by routinely communicating and enforcing a standard of conduct. This serves as a guide for employees to understand their organization’s specific expectations for communication, decision-making and actions in their work. When employees feel that their own standards and values align with their employers, they are generally more positive about their work and even more productive.

What is a code of conduct and why is it important?

A code of conduct can be viewed as a guide or reference for employees, as it provides a resource to influence ethical decision-making and behavior. The code of conduct also reaffirms the values of the organization, which often include integrity, transparency, honesty and respect. For example, the code may communicate that employees are expected to: make decisions that support the organization’s values; be responsible for their decisions and doing the right thing; raise issues that are inconsistent with their workplace values; seek appropriate help when the right decision is not clear; and have the tools to effectively solve problems.

It’s important to have a code or standard of conduct, but it’s even more important to enforce it and offer consistent support and resources for employees who may need help with the ethical decision-making process. At Tenet, our Standards of Conduct provide employees with an Ethical Decisions Guide. The guide is a step-by-step algorithm that can assist individuals with making decisions when the right one is not obvious or clear. In addition, Tenet has created the culture of open communication and trust, where employees understand how to go through the proper channels to discuss and report their concerns. One of these channels is the Ethics Action Line (EAL), which is available 24 hours a day. Employees know that they can call this line and anonymously talk to a qualified professional who can help address their problems and offer a suggested process to reach a resolution. Employees are also encouraged to go to their supervisors and express ethical issues without fear of retaliation. We have taken every effort to open communication within all organizational levels while ensuring that employees feel protected. I recommend that organizations promote their code of conduct and ethics program by fostering a high level of trust between employees, management and administration.

How to identify and achieve a clear vision for business planning and success

Ana Mederos, CEO, Palmetto General Hospital, Tenet Healthcare Corporation

A leader looks to the past, the present and the future in order to establish and shape an inspiring vision. This vision paves the way for how the organization will motivate its employees to develop and execute its business plan.

“It’s integral to involve the people in your organization right in the thick of it — build teams and encourage contribution,” says Ana Mederos, the CEO of Palmetto General Hospital, which is a part of Tenet Healthcare Corporation. “To achieve your vision, you have to have a work force behind you that is motivated, engaged and commitment to shared goals.”

Smart Business spoke with Mederos about how to identify and achieve a clear vision for business planning and success.

How can business leaders create inspiring visions for their organizations?

In my experience, it takes a team of many individuals to create and achieve a shared vision for an organization. Together, this team must consistently answer these key questions: Who are we? What have we accomplished? What are our strengths? What is our realistic potential?

These are powerful questions that pave the way for determining where an organization is and where it can go.

How does a vision influence the development and implementation of a business plan?

Like a road map, an organization’s vision creates a beginning point and a final destination; the business plan creates the exact path to get there. The business plan sets the goals and objectives and the strategies and tactics to achieve them. I compare this process to putting together a winning Super Bowl team. If your vision is to win the Super Bowl, how do you get there? You have to recruit the very best managers, coaches and football players that share the same passion and desire to be the best. Leadership identifies the best players and then invests in training those with drive and potential.

As a hospital, we have the vision to be the preferred place for health care in our local community. We want people to think of Palmetto General Hospital first, especially for heart care and open heart surgery. For example, just a few years ago our goal was to develop a leading cardiovascular open heart surgery program. To create our program and bring it to the level that we envisioned it to be, we had to recruit cardiothoracic surgeons and entire medical and nursing teams that had the right experience and commitment to quality. Throughout the hospital, we’ve created a team of medical staff leaders, administrative staff, directors and employees that embrace this vision and fit the direction in which our hospital is moving.

How to maintain a family-centered service while advancing into the future

Jay Miranda, CEO, Coral Gables Hospital, Tenet Healthcare Corp.

Jay Miranda, CEO, Coral Gables Hospital, Tenet Healthcare Corp.

When one thinks of a boutique, a hospital is not usually the first thing that comes to mind; however, it’s a trend that makes sense.

A boutique hospital is small, specialized and dedicated to delivering highly personalized health care services. And, this is exactly what you will find at Coral Gables Hospital.

“A boutique-like influence is imbedded in the culture and mission of an organization and its employees,” says Jay Miranda, the CEO of Coral Gables Hospital, which is a part of Tenet Healthcare Corporation. “It’s integral for a small hospital to advance with top-notch technologies yet remain small in size, which allows it to focus on what’s most important: patients and their families.”

Smart Business spoke to Miranda about the small hospital trend, and how to maintain the culture of a family-centered service while advancing into the future.

Describe the boutique or smaller hospital trend.

Many South Florida communities, and Coral Gables in particular, have been recognized for exemplifying a particular type of style and living by creating a small town feel within a larger city. This feeling of community and identification with it creates a pleasing environment. As part of the local community, a smaller hospital strives to emulate this theme and bring this same feeling of comfort and familiarity into the health care environment.

The boutique hospital trend is growing because communities are becoming more educated and selective when it comes to their health care; they want very high quality care delivered with service excellence. It is generally smaller in size, distinguished by specialized service lines, and can offer high-quality health care within a more intimate, family-centered setting.

What are the advantages of maintaining a smaller, more family-centered health care delivery organization?

A smaller hospital often strives to put the patient first. It often has the resources to treat each patient and his or her family with respect and understanding in a family atmosphere. In a larger facility, patients and their families can get lost in a mass of ‘bricks and mortar,’ and because of the larger number of employees and organizational loopholes, it can be difficult for patients to get the special attention that they may need. With strategic planning, smaller hospitals can deliver a high degree of attention to patients, yet still maintain the same level of clinical equipment and diagnostics as a larger facility.

A smaller organization may also have more control over selecting employees that have a passion for quality service and who reflect the cultures of the community they serve. For example, at Coral Gables Hospital the majority of our staff is bilingual in English and Spanish. Our employees can relate to our diverse patients and cater to their needs. We look only for employees that exemplify the same feeling of compassion, warmth and service that our hospital is known to provide.

How can a company maintain the influence of a small, specialized company while continuing to develop and expand into the future?

Just because a hospital or ‘boutique’ organization is small in size, it is not necessarily short on resources. From a service line perspective, many smaller hospitals advance technologically and expand specialized services based on community needs. One example of this at Coral Gables Hospital is our stroke program. Many of our patients were coming to our emergency room experiencing signs and symptoms of a stroke. We knew we had to expand this level of service to meet the needs of our patients so we went through the proper processes and recruited neurologists to establish our hospital’s stroke program.

Every hospital — despite its size — must continue to upgrade its facility; continue to seek the most qualified employees that fit the organization’s cultural environment; and continue to recruit experienced physicians that can appreciate practicing family-centered medicine.

What are the challenges of running a specialized health care delivery organization and how have you overcome these challenges?

The challenges one faces today are challenges within the complex health care industry as a whole. A hospital is merely one piece of a much larger structure that is constantly evolving and changing. We have to adapt with the ever-changing industry, but as a small hospital, our No. 1 priority will always be maintaining our family atmosphere and patient-centered culture. Every day, it’s the patients who experience health care and it’s a hospital’s job to simplify the process for them and make it as comfortable as possible.

While the challenges are great, there are also many rewards, such as helping people and being a positive influence in the local community. When each staff member walks out of a hospital, he or she feels an intrinsic reward knowing that he or she has had a positive impact on a human being’s life. In patients’ most important critical, vulnerable and often anxiety-driven moments, they are helping them to feel secure that they are receiving the best care possible. This motivates them to achieve the most positive outcomes possible with each patient.

What strategic advice would you give other smaller, boutique-like companies on advancing into the future while staying true to their very consumer-oriented environment?

In a small hospital, building a family-like culture starts from the top, down through interactions between administration and management, physicians and nurses, and, most importantly, patients. This is the true challenge. Machines don’t talk to or touch people; people touch people. Purchasing equipment is something you to do to advance and support the medical professionals in their ability to deliver the best patient care, but the culture is created through the relationships fostered each day. For any boutique business, building relationships is key.

Jay Miranda is the CEO of Coral Gables Hospital, which is a part of Tenet Healthcare Corporation.

How to build an effective leadership team for mission-driven achievement

What defines an effective leader? John Quincy Adams once said, “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”

Behind every organization’s successes, you will find effective leaders guiding all company levels toward accomplishing a single mission. To continue to grow and achieve, it is critical for organizations to support their leaders, as well as identify and inspire their leaders of tomorrow.

“Leaders get the big picture and understand how to guide the organization to strategically achieve success,” says Ralph Aleman, CEO of Hialeah Hospital, a part of Tenet Healthcare Corporation. “Good leaders also have a positive long-term influence; they leave a legacy of leadership skills in others.”

Smart Business spoke to Aleman about how identifying leaders within an organization and then giving them the tools to succeed is an investment in human capital that every business should consider.

How is effective leadership critical in business success?

Effective leadership creates and fosters the mission of an organization. With leadership, an organization can focus its resources and human capital to reach strategic goals and objectives. Leaders know where they are going; they have a clear vision and constantly communicate this direction. Leaders set the tone for success by developing strategies, taking action and inspiring others to achieve specific goals. Good leaders also have a long-term positive impact by instilling a legacy of leadership skills in others. The old saying, ‘it all starts at the top,’ has real meaning. If top organizational leaders invest in the people under them, these individuals will learn how to invest in the people under them and so forth.

In your opinion, what are the attributes of an effective leader?

There are many attributes of effective and successful leaders. In my experience, leaders create a vision for the enterprise and have the communication skills to clearly articulate that vision at all organizational levels. Furthermore, gifted leaders clearly and openly communicate their goals and expectations in a way that engages employees and fosters their commitment to get the work done. Motivating employees at all levels takes skill and talent. Being honest and having integrity is a must, and this includes following through with professional commitments and promises, which builds trust and respect. Being a good, objective listener is also very important. Finally, leaders need to be role models for everyone within their organizations, their communities, and beyond. I strongly believe, and tell everyone who works with me, that I would not ask someone to do something that I would not do myself.