Lessons in Orthopaedic Leadership: An AOA Podcast
Lessons in Orthopaedic Leadership: An AOA Podcast
Out of the OR, Into the C-Suite: Laura Forese, MD, MPH
Laura Forese, MD, MPH, joins the AOA Lessons in Orthopaedic Leadership to discuss what orthopaedic leadership looks like from the C-Suite.
Episode Highlights:
- Personal Leadership Journey: Dr. Forese shares her own road to the C-Suite
- Building a Team: Having the courage to get it right
- The Best Fit: Advice for those looking at advanced degrees
- Sponsors, Mentors, Support: What helps along the way and how to approach building those relationships.
- Credibility: What makes a leader truly credible
About Dr. Forese: Dr. Forese is the Executive Vice President and Chief Operating Officer of NewYork-Presbyterian, one of the nation’s most comprehensive, integrated academic healthcare systems. The only hospital in the country affiliated with two top-ranked medical schools, Columbia University Vagelos College of Physicians & Surgeons and Weill Cornell Medicine, NewYork-Presbyterian Hospital is consistently recognized as a top 10 hospital in the nation and the #1 hospital in New York by U.S. News and World Report, as well as a best place to work by Forbes, Fortune, and Glassdoor.
Dr. Forese has ultimate operational responsibility for the NewYork-Presbyterian enterprise, including 10 hospital campuses, 200 primary and specialty care clinics and medical groups, more than 45,000 employees and affiliated physicians, and more than $9 billion in revenue. Her transparent and reassuring leadership as COO, including providing near daily video reports to the NYP workforce during the COVID-19 emergency, has been an important element of NYP’s efficacy in confronting the pandemic.
Under Dr. Forese’s leadership, NewYork-Presbyterian launched an innovative suite of digital health services called NYP OnDemand, implemented groundbreaking employee programs for paid parental leave and respite care, and achieved significant gains in patient satisfaction scores as well as employee engagement and front-line empowerment by focusing on building a culture of respect. As President of the NewYork-Presbyterian Regional Hospital Network, Dr. Forese expanded the organization’s presence in Westchester County, Queens and Brooklyn, bringing high-quality community hospitals into the network, and she established the NewYork-Presbyterian Medical Groups to expand NewYork-Presbyterian’s primary and specialty care throughout the region. Among Dr. Forese’s top priorities and accomplishments is the regionalization and standardization of financial, operational, and clinical practices across the enterprise so that every patient receives the same exceptional standard of care no matter where they go in the NewYork-Presbyterian system.
Active in multiple healthcare and civic organizations, Dr. Forese chairs the hospital board of the NIH Clinical Research Hospital in Bethesda, MD; she is also a Trustee of Princeton University, a board member of the Mother Cabrini Health Foundation and of LiveOnNY, and previously served on the board of a healthcare related public company. She has been named among the 100 most influential people in healthcare nationally, the top 25 women leaders, and the 50 most influential physician executives each by Modern Healthcare magazine. Dr. Forese has also been named among the 50 most powerful women in New York by Crain’s Business, and has been honored as Mother of the Year by the American Cancer Society.
An orthopedic surgeon, Dr. Forese graduated summa cum laude and Phi Beta Kappa from Princeton University and Alpha Omega Alpha from Columbia College of Physicians & Surgeons, and she holds a management degree from Columbia’s Mailman School of Public Health. She is married to Dr. Robert Downey, a thoracic surgeon and they have 3 adult children.
Good evening, my name is Charles Goldfarb, I'm joined by my co host, Alexander Aleem. For this edition of lessons in orthopedic leadership, we are so pleased today to be joined by Laura Forese, the Executive Vice President and Chief Operating Officer of New York Presbyterian Hospital. It, interestingly, is the only hospital in the country affiliated with two top ranked medical schools that is Columbia, and Weill Cornell. And recognized, especially in New York, but certainly nationally and internationally as a great place to work. And so I'm going to stop there with the introduction, because I think we're going to get back into some of Laura's many interesting career path choices. Welcome
Laura Forese, MD, MPH:Thank you. It's really good to be with both of you.
Alexander Aleem, MD (Host):Laura, welcome. I think one of the other interesting aspects is you are a pediatric orthopedic surgeon by training. And that was the early part of your career, and then made the very interesting transition into hospital administration, which is maybe not a pathway that a lot of surgeons kind of think is a natural leadership pathway to take. So maybe just kind of top view, and then we can break down some of your experiences through that. Why do you think surgeons should look at this as a possible leadership role to take because I don't think, at least personally, it's something that I've really kind of considered given the makeup of the physicians and hospital leadership that I've seen throughout my training?
Laura Forese, MD, MPH:Well, Alex, it's true that there, it's not as though every hospital leadership role is filled by surgeons, but there are a number of us. And I would suggest that there are a few things that as surgeons, really are incredibly helpful as you're going into leadership roles. So the first is surgeons are super comfortable being the leader of a team, right? No surgeon ever thinks that she can go into an operating room and be the only person in there. So it's a team, it's a multidisciplinary team. The surgeon also needs to be very comfortable, as the captain of the ship, or the person who is the quarterback laying out the place, but clearly has to be telling everybody else what the plan is. So you're comfortable doing that every time you walk into an operating room, as the surgeon. Same is true. When you're leading a team, you need to make sure that people understand what the plan is, you need to make sure people understand who's going to make what decisions, all of those things come, I believe very naturally to surgeons. And then finally, I would point out that surgeons have to be very comfortable making decisions under uncertainty. So if you just stand there, nothing's going to happen, patients aren't going to get better. It's like somebody that they just got to die. So it's the idea that you can't wait until you absolutely perfect information to make that next move. That's critical for leaders. And I find that that comes very naturally to surgeons.
Charles Goldfarb, MD, FAOA (Host):That is so interesting and so true. But again, it just it doesn't always feel natural. So talk us through how you came to the decision to exit orthopedic surgery. Because let's let's be honest, one of the reasons we don't see perhaps as many surgeon and orthopedic surgeon, hospital leaders is that it's a long pathway. And it's a long pathway, many or if not most of us are really happy with our job. And so, though most of us think okay, leadership means helping to run a department running a department, etc. So what was your thought process about the transition? And how did you choose to go into hospital leadership because your team is huge. You have 10 hospital campuses, 200 primary and specialty care clinics and medical groups, more than 45,000 employees and affiliated physicians. And yeah, around 9 billion in revenue. So you have a little bit on your plate for oversight. So unbelievable responsibility, but how did you make the decision to pivot?
Laura Forese, MD, MPH:Now let me go way back to residency. I had a great chair. And as I was taking my first faculty job out of residency, he actually suggested that I go back and get a management degree when I was first starting as an attending. Great suggestion, although not everybody needs a management degree to do these kinds of leadership roles. But he said to me, I think you like these kinds of opportunities had some of that experience as a, as a resident working in teams having some leadership roles. And I'll come back to that overtime this idea of leadership roles, formal and informal, because that's really important throughout one's career. So I had my first attending a job and I went to an executive pro grant to get a management degree. And then I started to use it. And I was practicing surgery, but I was volunteering for some opportunities. And I was being volunteered for some things. And it was through those experiences. Again, I was a practicing pediatric orthopedic surgeon, and I got other experiences. And then I started to realize that, you know, I can have impact in other ways. Now, I gotta be careful about you're building a practice, you're doing all of those things, but I was able to do some of that juggle, I also let it be known that I wanted other experiences. So my chair was providing some opportunities for me. And then I started to have some success in doing certain team based roles or other types of things. And I realized that I liked it. So it was those things together, I was in the department of orthopedic surgery at Columbia for 10 years, before I left, so I didn't take that lightly that I was leaving a career. But I also realized for myself that I could have to have greater impact. And as I moved to the hospital, I'd already had some informal roles, where I could test the waters. So that's an important piece that when people ask me about switching or leaving clinical medicine, you don't do that all at once. That's not typical. And I would certainly not advise that. But you're testing things out. Do you like those kinds of roles, it's not for everybody, are you good at it, but you can learn and you can continue to grow. But for some people, it's just not something that they enjoy. And they don't have a talent there. So why go in that direction, you've already got a very successful clinical career and clinical pathway. But for others, there comes a point where you see these opportunities, and then you can run with it. And that's what happened for me, I had done what I thought I was going to be able to do as the vice chair in that department, and was ambitious about doing other things and making a difference. So I moved into our hospital, I moved from the University Department of orthopedic surgery into a hospital role. Now, I started in a quite a junior role, I've had seven or eight different jobs in the last 20 years. And it's really a business career. Now, of course, I didn't just medicine, and it's making a hospital and health care system run for surgeons like yourself and for for others who are going to practice there. But it really is moving and gaining new skills and new different types of roles. So that's how I made that transition.
Alexander Aleem, MD (Host):That's incredibly fascinating. A lot of people in my shoes kind of starting out five years into practice, when they're looking at that management kind of role. A lot of us think about an MBA versus sort of more particular management degree. What advice would you give to surgeons looking at trying to get some sort of advanced degree as you said, it's not for everybody. But the MBA seems to be a hot ticket right now, what what would you suggest in terms of looking at specifics if you are looking for some advanced education?
Laura Forese, MD, MPH:Very interesting question. And my thoughts have evolved over time. First of all, it is not a prerequisite for a leadership role in a hospital or healthcare system, or even outside of one of those types of jobs, right, there are a lot of jobs that physicians can move into outside of pure clinical or research roles. So it's not a prerequisite. It does sometimes open a door. But what it won't do is guarantee you something so a lot of people come to me and say I want to change I want to move into this areas. So I'm going to get a degree and then everything will be right there. For me. It doesn't work that way. It's far more important, what you've done, what skills you've developed, how you've demonstrated as what experiences you've had are more important than a degree. So get a balance that. The other thing about a degree. Now my degree is through our management team within our management program within our School of Public Health. MBA is another one MPa, mph. Again, they're all varieties of management programs. Do you think it's important to acknowledge that good programs take time if it's a program that you can just toss off and do in a couple of hours, it's not a good enough program, and it will also cost some money and your time. So putting all those pieces together. You have to weigh all of those out for a lot of people they like to go school, I'd love to go to school. And even thinking that it might not have been something that I wouldn't necessarily use, I had no sense that it was necessarily going to open any doors for me, I was excited about going to school and getting some more education. Again, that's not for everyone. So you have to put all of those pieces into the mix. Now over time. For me, that was 20 some years ago, today, it is far more common to see people come out with MD MBA degrees, or there are a lot more executive programs, that's a program that I did it was every other weekend or one long weekend, once a month, for several years, those are much more common than they used to be. So looking at all of those, if you like the idea of getting more education, if you can fit it into the rest of your life, because let's face it, people are busy. I'm a fan. But know that it's not a guarantee of of anything. The other thing that, again, is important to way, it's probably easier to fit the time in to get a MD MBA. But there's also this notion that I gained a lot from working while I was going back to school. And what I mean by that was I could then use some of the things we were talking about, right some of the courses around people skills, I had my own team, I had my office, I had the ability to use some of those things in practice, you don't have that when you're going to school full time, or you're in the middle of two degrees. So again, all of these things are important to way, there's no one way to do this. And I advise everybody think about how it fits into your life and your interests.
Charles Goldfarb, MD, FAOA (Host):Thank you. Alright, so I love this. But I want to make sure it's crystal clear both for me and for our audience. You are a practicing pediatric orthopedic surgeon, and you interacted with hospital leadership, you volunteered and likely were volunteered. And presumably, it's one of those things where you did a good job and more opportunities came your way. But at some point, it sounds like you made a decision. And you made a clean break from orthopaedics couple of questions around that first, couldn't be easy, because you had invested, you know, a significant number of years into getting where you are not that it was wasted and moving on, but it's just different. And second of all, you had to have really supportive, positive mentors, friends, family, obviously, but talk a little bit about who helped you make this decision. And it's clearly has been the right one, I think, just talk through those issues, please.
Laura Forese, MD, MPH:Sure. So let me start with this idea of giving up a clinical practice. And it's true, it's a long road. But I ended up not thinking about it that way. I ended up playing like everything that I did got me to this place. And I'm ready to leave. It didn't happen overnight. But I was ready to take the next step. And I thought long and hard about what I was doing. And I feel great about having put all that time in because I think it has made me better at my job that I could say, Look, I understand what that was like to be it's two in the morning. And the trades are not exactly what I needed to have and what's going on back there. I felt like those were important years that I put in, I learned a lot. And I felt like I contributed there. For me what was happening was, I thought that I could contribute more. And I keep using this word impact that I could affect more people in a different type of job, which, in orthopedics, I had run my course there, I was going to continue to be, I think, an excellent orthopedic surgeon taking care of kids and families in the life. But I wasn't going to be able to advance and I wasn't going to be able to move into something wasn't going to be a chair. I didn't have a research career. That was for me kind of a decision point. But Chuck, you hit on something that was really important was I thought a lot about it. And I had an incredibly supportive work environment. I had a lot of people who were sponsors. My chair was just a fantastic thing was held IQ and he's on sadly gone but he was just incredible. My first chair and then my second chair that I worked for for many years was Louie biryani, who was just outstanding and so supportive, and how can I help you and how can I find other roles? Now, of course, I'll say that they both benefited from someone in the department who was connecting the dots and could do other things. So it's not like it was completely altruistic. But I have been very fortunate to have had great sponsors and mentors and sponsors, people who, who paved the way. And then when I moved to the hospital, I had the same thing. And, and that was was helpful, too. But I also had a very supportive family situation, my husband's a surgeon. And so we met when we were residents, medical student and resident, and so incredibly supportive, understood, but also said to me, Look, at some point, if you really want to pursue this track, you have to start making some decisions. And that's really what happened for me. So I went to big job in that first job, but I'd already been testing the water in things. One of the things again, I want to just go back and emphasize this for people, it comes up a lot. Don't leave your clinical practice fully, until you know that you're okay with that. Meaning, if your first management job or this leadership role doesn't work out, because this is business, and a lot of times people are reorganized out of jobs, not like medicine, a lot of times there are just complete reorganizations in hospitals, healthcare systems, someone, some system gets taken over the just the roles change, got to know that you may very well be looking for another job, another organization, I'd be comfortable with that. So again, it's all of those kinds of things. I was very fortunate, incredibly supportive, husband and family and, and then great people at work. So I recognize how lucky I was. That's why it's good to talk to people, when you're thinking about these kinds of things. You can bounce things off of people who can give you that are you sure have you thought about all of these things. That's why it's critical to be doing this and not ever to make that kind of snap decision. put too much into a career to, to not really think some of these things through.
Alexander Aleem, MD (Host):I'd love to talk a little bit more about the last point your sponsorship experience and something within our own institution that I think even the generation of surgeons a few years younger than me thinks a lot more about than I did when I was coming out into practice. Alright, did residency, did medical school fellowship done? Alright, I'm ready. And then you kind of realize about your two and you're like, I have no idea what I'm doing. Obviously, you've been on both sides of that now. And you've had a great support network with your sponsors. And on the other side being a sponsor for for people. What are some tips for people looking for their sponsors? How do you find the right person? Because I think sometimes you kind of think, okay, naturally, I'm just gonna go to this person, because they're in my division or my department, they may not have all the answers, they may not be the right person. So what were some of the key successes for you, as you found those really helpful sponsors?
Laura Forese, MD, MPH:A couple things. First, if you're interested in these opportunities, things that are outside the path, let's just say leadership roles in general, you need exposure. And the first thing has to be that you have to let people know that you're interested in those things. So you got to be out there. This is the classic networking concept. I'm always saying to people, there may not be something today that someone can help you with. But she or he's not going to know that you're interested, if you don't go out there now. And let people know, ask someone if you can grab 15 minutes 15 or 20 minutes, is something that everybody can fit in. And when you tell them that you're asking for 15 or 20 minutes, you're also signaling to that busy person that you're trying to get with that I understand. And I'm going to ask you a few things. And I want to tell you a little bit about myself. So you're sort of packaging yourself. And it could be certainly it's people within your department. But it's people who are in adjacent departments that maybe you've seen, but they don't really know you. Maybe it's people in your hospital leadership line. Maybe it's just saying I'd like to learn a little bit more, do you have a suggestion of someone else I can talk to? And some of it is, hey, I know about people in other institutions who've done some of this. Do we have any of those kinds of programs, it just kind of builds from there, let's it could be someone outside of the hospital system. If you're in a academic medical center. It could be the university but not necessarily the medical school, it could be somewhere else again, it's all of those different kinds of things. And if anyone ever offers to connect you to someone, your answer is always yes. Because you have 15 minutes that you can squeeze in. And so it's those kinds of things. It's also about word of mouth, right? You're talking to this person who says, oh, yeah, you should go talk to so and so. Who runs our Perry op, and she's done this or he knows this person. What about the business school? What about this other organization? What about the people who are doing our supply chain, the orthopaedics, my goodness, talk about every hospital system. orthopods are people that we are thinking about in terms of devices, who's the person in your hospital system who's thinking about device cost, about standardization about how we're teaching everyone, there are just so many different ways that you can use something that you already have to connect to other people. And then you get to see, this person is willing to sponsor me to help me with what I'm interested in, because they're also looking for how it's going to help them or help the organization. It's really this two way street.
Charles Goldfarb, MD, FAOA (Host):This is so interesting, I want to pivot slightly to the idea of leadership principles that have served you well, because, again, you've managed a large clinical enterprise. And I think I've heard you say in the past, and I'm going to, I'm going to use a term that our nurse, clinical manager loved to use, which was, you want to make sure you have the right people on the bus, in in the right seats on that bus. So if that kind of resonates? Can you talk about that and how you conceive of those ideas,
Laura Forese, MD, MPH:I know that early in my career, I was absolutely sure that the path to success was going to be for me to work harder. And that that was going to be the secret. And over time, I realized that yes, hard work is critical and important to do. But that's not the secret to success, the secret to success is having great people on your team, and figuring out what their jobs should be. And sometimes it's moving people around to take advantage of that. It's always thinking about the chemistry of the team, because five of the best basketball players in the world do not make the best basketball team in the world. So making sure that you have complementary skills, it's making sure that when some people are not right, for the team that they exit, it's better for the team, most likely better for them too. So having that courage of of making decisions about adding to the team, and then subtracting, all of those are so critical. So it's really about getting that team to work. And let me go back again to something I said at the beginning, which is, you're the leader of that team. So you got to set up some of those principles. You know, here's the norms about how we're going to act. And here's what we expect. And here's how we make decisions. All of those things are so critical. So think about it, you're the person who's setting up everybody, everybody in that bus, you got to get a big responsibility. To me, that's the most important thing in in leadership.
Alexander Aleem, MD (Host):Some other leadership ideas you talked about. One of them was, you know, owning up to mistakes, like you said, in your previous comments, you find the right you think you find the right person, and then you realize them, maybe they're not the right person. You have to tell them bad news. But how hard is that to then get up in front of people? And they Yep, that was that was my fault. And we see this countless times in public life, people really miss handling that either not owning up to a mistake or almost owning up to it too much, and then bringing it up over and over again. So what are some lessons you've learned from just how to come across owning up your mistakes and still have your accountability and maintain your leadership credibility?
Laura Forese, MD, MPH:I think for leaders, that's one of the hardest things because nobody likes to be seen as vulnerable. But over time, what you realize is, that's what makes you human. And everyone's gonna make mistakes. Now that you're trying never to make a mistake. But when you do make a mistake, it's been course correcting. And if it's something where you need to explain, you explain, here's why we're changing. And then you move on, you don't go back and revisit that over and over again, because then of course, you've lost everyone's confidence. And if it's something where you need to apologize, it's different than explaining that. We did pass a, we now realize that that doesn't make sense anymore. We are changing. I'll say that was a mistake if we'd only known but we didn't. Now we're on B. Here's why. Now we're on B or moving on. If you've made a mistake, that something you need to apologize for. It's better to get that out. I'm sorry, I did that. I regret I did that. I shouldn't have done that. And now moving on. I can't go back on that over and over again. But I think that there are times in which I have very publicly said, I made a mistake. I regret having done that. I'm not going to do that again. And then it was moving on to people remember that they don't remember what the issue was, but it was like oh, she said I'm sorry about that. And then it was now we're moving on. Because if you just keep going back, you've lost your team. Your focus backwards as opposed to focus forwards. And why is anybody going to follow you?
Charles Goldfarb, MD, FAOA (Host):I really liked that it really resonates. And certainly, we hear so much about leaders, you're human, and we're all going to make mistakes and owning them really does, hopefully make people appreciate all that you bring maybe a couple more questions. And again, we're so grateful for your time, agree or disagree with this statement. Great leaders are born not made.
Laura Forese, MD, MPH:disagree, disagree. Great leaders are people who continue to work on it. Leadership is a skill like everything else. I don't know what that means you're born a leader, you're born. I think some people enjoy it more. Some people work harder at it. That's a skill like anything else. And I believe that truly great leaders say I can always get better.
Alexander Aleem, MD (Host):Similar kind of question, agree or disagree. It's not what you say. But what you do that is key.
Laura Forese, MD, MPH:Agree 1,000%. It's helpful, if what you say also fits, but everybody's watching. Think here's my best illustration of that we a number of politicians in this last couple of years, who were saying one thing, and then did something else. What do you think people remember, they remember what they did, because that resonated with people. Now, of course, it's best if you can say the right thing, and then follow through on that. Actions speak much louder than words,
Charles Goldfarb, MD, FAOA (Host):as we wind down, I would leave it to you to help us bring this to a close whether you want to share another leadership principle or two that is important for our audience to hear, or perhaps some words of wisdom to younger potential leaders. We've heard a lot about your path. But any any final thoughts you'd like to share with our listeners?
Laura Forese, MD, MPH:I'll frame it that I said before leadership is a skill. And this idea that you're constantly watching. So you can be watching leaders in your career in your personal life. I was just talking about politician, he can be watching a lot of people and saying, what would I do? If I were in that situation? They've lots of opportunities to imagine that and sort of test that out without it being high stakes, what would I do if I were the chair of this department or the CEO of that hospital or the governor of my state. And as you're thinking about that, make sure it's fitting with your own values, right? So because you're going to live with some of those, when you do get into these leadership situations, and you do make decisions and you have roles, you're going to have to think about, well, I feel good about this. Afterwards, we talked about mistakes, there's nothing, there's no shame in a mistake if you made it for the right reasons. So lots of opportunities to reflect on this before you're actually in one of those roles. And then just finally, one thing that I believe is really important is to get feedback. And that can be very hard to do. It's hard and early in career for a different set of reasons. It's hard later in career for other reasons. But getting feedback is what helps you get better, it can be very, very uncomfortable. But that's part of what good leaders do. So don't be afraid of that. You've always as I said, skill, you can always get better. So I'm delighted with the idea that we're talking about these kinds of things for people's careers, because they don't just happen sometimes people look at leaders and just think, oh, everything just happened. And now I'm I'd like that. That's not how it is. It's it's complicated. And there's lots to learn. And it's definitely worth it. Looking for those opportunities, informal. And then, at some point, perhaps formal leadership roles.
Charles Goldfarb, MD, FAOA (Host):Alright, well, first of all, congratulations on all that you've accomplished. Secondly, thank you so much for joining us on lessons on orthopedic leadership. And I know Alexander and I both learned a lot and enjoyed the conversation tremendously. So thank you.
Alexander Aleem, MD (Host):Yeah, it's, it's an honor to have you and so many great pearls about leadership in the last, you know, 30 or so minutes that we've learned. I'm going to really think about a lot of these things in, think about my trajectory, and we'll see we'll see how things go. But really appreciate your time and really appreciate you joining us on the podcast.
Laura Forese, MD, MPH:Thank you very much for having me. I'm really flattered to have been asked and wish you both and all of your listeners good success.