How To Lead 106,000 People Without Losing Yourself with Dr. John D'Angelo

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2:31Morra Aarons-Mele: When you're in charge of a huge hospital system with 106 ,000 employees, how do you possibly take time for yourself, find time to think, maintain your energy, find people who you can be vulnerable with, manage your own emotions? Well, today we have Dr. John D 'Angelo. He is the CEO of Northwell Health. He is an emergency room doctor by training who has gained increasingly visible and responsible roles in this huge medical organization over the past 25 years. And Dr. D 'Angelo identifies as an anxious achiever, but he, like so many of you, has done the work, has the self-understanding to know how his anxiety is powered also by curiosity, by purpose and servant leadership where he is in this to help people and also a need to always prove himself.

3:34Morra Aarons-Mele: It's an incredible mix that he's made work for him after many years. And I love how open and candid and insightful his conversation is on everything to how does a CEO manage his schedule and his time to going through big job transitions when you feel a little bit of the, really, you're asking me to do this, but you're so inspired and motivated that you do it anyway and learn along the way. It's a great conversation with Dr. John D 'Angelo, who's the CEO of Northwell Health.

4:08Morra Aarons-Mele: Hello, Dr. D 'Angelo. How are you? Glad to be here. You can call me John. Thanks for the opportunity. Of course. I'm always excited to interview CEOs who are in the CEO seat, who are living it day in, day out, which you certainly are. I'm going to start with a question that I like to start with, which is what does leadership mean to you? What's your personal definition of leadership? For me, I think the more successful leaders and what I aspire to is those that lead through purpose. And I guess that's why healthcare is where I landed. So for me, the great leaders are those who, if you think back of who's like great movement, especially great social movements, they usually do so through a lend of purpose and commitment, rather than compliance.

5:04And, you know, I'm your boss. I have a paycheck over you. So for me, it's always been about servant leadership. It's been about purpose driven leadership commitment, which kind of ties into being a doctor and going into medicine. I didn't intend on being a leader. I intended on being a doctor at the bedside. And then one thing led to another. But but still, it comes down to that simple fact and that simple kind of attribute that I think, especially in health care, drives success and leadership. And what I tell our teams are the two simple rules that I've held with me from day one. I've heard somebody else say this.

5:38I'll say I shamelessly stole this like 30 years ago in residency when I heard somebody say this at a conference. It was rule number one, do what's best for the patient. Rule number two, do what's best for the people that take care of the patients. And to me, that's always been kind of my marching orders internally, whether it was leading at the bedside, taking care of an individual patient at a time of crisis or need, or whether it's now leading an organization of 106 ,000 team members that treat millions and millions of people a year, it's the same two guiding principles.

6:08Morra Aarons-Mele: When you find yourself in a moment of stress or overwhelm or chaos, how do you come back to that? I joke with others that that's why they picked an emergency medicine doctor to be CEO because if you're a good emergency medicine physician, you are very comfortable over time. You have to be, or you wouldn't survive in the specialty. Navigating uncertainty, understanding when you need to be decisive and act, maybe when you don't have all the data you would like. And you also get very good at understanding when you don't act and you let things play out a little bit and you monitor. If you really take that emergency medicine mindset, that you don't usually fail big.

6:58You're really trying to avoid failing big, especially when you're navigating uncertainty. You know when you need to act, you act, but you pay so close attention to the outcomes and the incremental changes based on that action. And then you're quick to pivot to still set you on the right course of where you're trying to go, which is minute by minute sometimes in a critical situation at the bedside. But that ability to be kind of open to the action and then the reaction and then be responsive to that to get to the end point that you're trying to get to, I think is something that really good seasoned emergency medicine docs are very good at.

7:39In addition to the multitasking and all the other things that we do. But to me, that's what is required of leadership in healthcare today because it's a really dynamic time in the industry. But anyway, so to me, that's the essence of it in kind of a nutshell.

7:56Morra Aarons-Mele: I never thought about that. But sure, I mean, I would imagine that when you're an ER doctor, you literally show up every day. You have no idea what's going to happen, right? Every day is different. Every patient's different. And you're dealing with stuff that some would say is low acuity. They didn't need to be there. But to that parent with a kid with 104 fever, it's a real scary situation for them. And it could be meningitis. Most likely, it's an ear infection. and retrospectively, we should say they should have been there and should not have been there. But being able to manage, you know, things that to everybody there, it is potentially one of the scariest moments of their life.

8:30And then you also have to be the objective one because you can't be at the bedside of 20 people simultaneously of really being good at multitasking and leading multiple teams and triaging not only the level of acuity of patients, but triaging your time and attention and being able to bounce from one thing to a next, uh, and not lose sight of the other thing you just made a decision on. So, so, um, it really is the ultimate arena in my mind for, uh, for fine tuning that, that skillset.

9:04Morra Aarons-Mele: Do you think that, um, the fact that you went into emergency medicine, that you liked it, I guess, do you have a different relationship with sort of worry and the what ifs. I would imagine many people might find the thought of being in charge of an operation where it could be everything from life or death to one of the worst days of people's lives ever could create a lot of, oh my God, what ifs? Did I make the right call? Did I do this right? How do I not get stuck in rumination? Like all of that. Yeah, there's a lot to unpack there. You definitely have to get, But so at the bedside, you have to get used to that.

9:47And in emergency medicine, you have to have a little bit of a thick skin. Because like I said, the retroscope is always 20-20. There's always going to be some case where, not that there's a bad outcome, but maybe you took an hour or two and you thought it was cardiac and it wound up being a GI-related thing. And then some cardiologists will come in two hours later and go, well, of course it was GI. I'm like, all right, now you have the EKG and the test results. And you didn't have the person coming and clutching their chest. But okay. So you get a little bit of you, you laugh about it, you get a little thick skinned, but you're dealing with everything in such an undifferentiated way.

10:16And to your point, every day is different. So you get good at managing the intensity of that. But what you also have to watch out for, and I can tell you a personal story that just reminded me of this recently, but you also sometimes then get a little bit desensitized to the intensity, but also to the weight of the moment for the person on the other side of that experience because it's just another day. Right. And so you got it. You got it. A. It's it. There are some people that really don't do well because they don't take good care of themselves personally, despite the high intensity stress environment they're in.

10:56There are some people that can disassociate from that. And that could be good at managing the task at hand. But sometimes then you lose sight of, again, the perspective of the other person. So it's a balancing act. um and I think of a few stories you know we were we were on vacation for my my I'll keep this really short but my go for it my my 18 year old when she turned 16 uh I have six kids and we got out of the whole sweet 16 things where every every one of our kids we successfully convinced them to take a trip instead um and we were on a cruise and we were over in Italy and we we took a little speed boat from Naples over to Capri and I booked four hours of kayaking and I'm very like process and time and And I'm at the beach and I'm getting the paddles and my wife and daughters are just, you know, admiring the beach while I'm carrying all the equipment.

11:45And all of a sudden I hear my wife screaming my name and I'm thinking to myself, great, there's a shark or something. We're not going to the water. And I turn around and they're dragging this lifeless body out of the water. And somebody had either drowned or had a cardiac arrest or something I didn't know. So I go into doctor mode. I go over there. I take control. I start resuscitating this guy. I have all these Italians screaming at me in Italian. I don't speak Italian. and I'm just trying to, you know, 911, somebody get an AD, and I didn't think the guy was going to survive, but after like 10, 15 minutes, I get a pulse back.

12:15He starts breathing again, doesn't gain consciousness. The ambulance arrives right at that time. We put it on the monitor. They pick him up. They scoop him off. As soon as that's over, I turn around and go, all right, let's go. It's time to go. We missed 15 minutes already. Like, to me, it was not a big deal, and then I saw the faces of not only the beach but my kids, my wife, everybody shaking, and to them, and especially to that guy, that was a big deal. To me, it was no big deal. And I'm not telling you the story to like to to. But it was a story that reminded me and helps me remind the staff that what we do is so incredible that you can't forget that.

12:51So anyway, gosh, that that is that's such a fascinating story on so many levels.

13:00Morra Aarons-Mele: but have you ever thought about the fact not to get all like armchair psychology on you but like those feelings are you totally separate from emotion in a situation like that are you just in sort of like doing mode and well in the mode you're in doing mode you're in action mode you're in you know you know what you got and sometimes it's tense I mean I can tell you there are times when you're in that ed and you have a you know a very sick you know baby or um and it's it's intense and you've got to maintain your composure because you have to, but there's plenty of times in those situations where then you, then you take a breath or you go back or you cry a little bit.

13:39Yeah. All those sorts of things. But, but you have to, in the moment, compartmentalize what you have to do because that's your responsibility to be there and do it. But that's where when you hear about burnout in the clinical staff and building resiliency, we got to be conscious of that because a lot of people went into medicine. I'll put the medicine hat on your audiences more than medicine, but a lot of people, doctors, nurses went in for purpose, for mastery of the skills that they had a lot of pride in mastering. And unfortunately, because it's such a demanding arena right now, and there's a financial system that's flawed and there's over-regulation, and there's all these requirements and documentation, there's so much administrative burden that the combination of administrative burning and financial constraints, I feel like the frontline teams from outside of the bedside, once they walk out of the exam room, what they're hearing about is their productivity and the financial constraints and doing more with less.

14:40And how do we make cuts here and there? Because the health systems aren't trying to be the bad guys, but they're trying to survive on very thin margins so we can be here to serve the communities and patients, but the frontline teams are constantly on this hamster wheel of doing more with less. And it creates that burnout and that, that the chips away at the resiliency over time. So, so there's a lot that goes into that. So there's, it's, it's again, getting people back to purpose. It's keeping the patient at the center. It's making sure you're doing everything you can for the team. And you're reminding them regularly that what they do really matters and it's impactful.

15:16So you bring them back that pride a little bit and that purpose. And then you have to do things. And I spending a lot of time focusing on my, let's say, by introducing myself to the organization. I'm in the seat about eight months through some personal journey, personal stories. But and Northwell is great at this. We just ranked by somebody the third healthiest company to work for. We do a lot for our team members in the wellness and their own personal health space. but I want to raise that even further because the message I try to relay and, and live. So they see it is, you know, if, if we're not taking care of ourselves and we're not making sure we're our best selves at home and personally and taking care of ourselves, we're not going to be our best selves at work.

16:00And what we do is incredibly hard. So we want to do everything in our power to make sure, you know, you're striking that right balance in your own personal wellness and that sort of thing. So, so it's, and it gets back again to the beginning of that servant leadership, take care of the team members. So it's a big part of who we are and a big part of kind of my agenda as CEO, especially in such a difficult industry.

16:25Morra Aarons-Mele: Because I think what I hear you saying is that, and I hear this in many, many industries, even when it's not a life or death situation, is that people are there to do their craft. They are highly trained professionals who are very skilled and really just want to do what they want to do. you know that's what they show up for and then there's so much work beneath the work that right is really draining and so i think what i hear you saying is it's not it's not the very sick patient in the ed that is the emotional drain on a lot of these people it's every it's a system that somehow is failing and draining them yeah right right it's i send 10 minutes of patient but then 20 minutes on the computer for every patient and i can't keep up because there's eight patients waiting to be seen and people getting angry because they're waiting.

17:12But if I don't spend 20 minutes documenting all these things that have to be documented, we're not going to get paid or it's going to be a quality thing that I did, but I don't get credit for. And then we have all these things that people have to worry about. And then they spend two hours after their shift, spending two hours at home or at the office, finishing up all their charts and the administrative task. And it's, it's taken that joy out of it. And that ability to actually be in that intense moment, and then take a breath and reboot before the next one because in between you're not, you're frantically trying to get all this other stuff done.

17:44So anyway, so it's something we have to solve for. And I think the pivot point we're in in the world, you know, how we leverage technology and there's ways we need to tackle that. And I'm very focused on that, but it's an exciting time that I think we could start to get ahead of this.

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19:39Morra Aarons-Mele: We were talking about money and emotions. Money is way more than dollars and cents. It's emotional, right? And I'm trying to teach my kids to have healthier emotions around money than I did. But I'm getting better every year. And part of it is that I use Monarch. Monarch simplifies, identifies, and helps me have a plan for my money. Monarch is like having a financial advisor in your pocket. It has easy to read diagrams that help me visualize exactly where my money goes each month. And it has investment views so I can compare my portfolio, say, to how the S &P is doing. All kinds of great tools that help me, frankly, take some of the emotions out of money and make it more practical and working for me.

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21:14Morra Aarons-Mele: It's called the abyss. You've all seen the visualization from Anthropic, right? It's a big blue blob of what jobs AI could wipe out, including finance, management, computer science, legal. But there's good news. Mark is a renowned serial entrepreneur, investor in Silicon Valley. And in this fast-paced 170-page book, he gives you his whole playbook. And here's the thing. It can be a time you don't want to get out of bed in the morning. But Mark writes about how he's found value in the abyss. And I think you anxious achievers will know. And it offers a framework for rapidly developing and more importantly, discerning between ideas that can generate once your curiosity is activated in the abyss.

21:59Morra Aarons-Mele: And because Mark believes this is such a moment of opportunity, he has a special offer for our listeners. If you buy one copy of Life at the Speed of Play, Mark will pay for a second copy to send you. Mark personally will pay for it. Purchase one copy at getmarksbook.com slash anxious. That's Mark with a K. Getmarksbook.com slash anxious. And Mark will send you two. I have so many people who just are craving a good day's work in a way. I don't know if that resonates with you, you know. Oh, yeah. For me, it would be a day where I could just sit and write, right? And like sort of do my craft without all the BS.

22:38Morra Aarons-Mele: Yes. And I think that that feeling is so visceral for so many people. I just want to roll up my sleeves and do a good day's work. Yeah. Yeah. Yeah. And you got to create the right environment so they can. Yeah. And sometimes it's simple things. I'll give you a little example. I'm talking with my senior executive team and I was a market president. I ran one of our largest markets, not one of our largest market the last four years. I had 24 ,000 employees. Yeah. So I had most of Nassau County in Queens. I was in charge of the P &L and the operations for that$8 billion portfolio of 24 ,000 employees to forth.

23:15Northwell's big. So I had our biggest market. But myself and the other market presidents and the corporate leadership, you felt like you almost had like a ball. With all due respect to it was just the way we operate, but you're in meetings all the time. And you're like, even though my market, I was closest to the corporate headquarters, is I had such a hard time getting out to my hospitals, to my ambulatory sites, because you were just always in these, you know, there's a million things going on. So we've been talking about simple things. How do we make sure the corporate meetings are only on these two days so everybody knows they have these days to get out and engage with their teams?

23:49Why do we have these hour-long meetings? Why every meeting should start at 15 minutes after the hour and they should go no longer than 35 or max 45 minutes. So I'm baking in 15 minutes to 30 minutes between every meeting and the simple stuff. circulate the stuff ahead of time. What are we deciding on? We're not having a meeting, just have a, you know, put a feather in your cap and you report it out something nice. Like, what's the objective of the meeting and the action we're going to take as a result of decisions we're making at the meeting. So just even being structured around that gives people time.

24:18Like even with my team, like how do I structure my time, which has been one of the challenges of transitioning into the role. The role is great, but transitioning that I have four hours a week that I can just sit back and think strategically about the bigger organization and not be running from one thing to another. How do you protect that time?

24:34Morra Aarons-Mele: That's such an interesting question. We're still figuring it out, but you have to. You have to. I've talked with other CEOs around the country. I was just at a great, you know, I was with 40 of the bigger healthcare systems in the country, and there's some of them, and I don't know what I'm saying, these would all apply to me. One said, my team knows from noon on Friday to noon on Sunday, I don't look at it, I don't respond to emails. They'll get a response. They still call, and I don't respond to calls unless it's an emergency. Call me. Others were like, I only do two nights out a week. And I'm like, really?

24:58I'm out every night of the week. I only do. So they all have different rules. And some of it's that it's just structure. Like I think of I can't. And I like to say yes to everybody. But with 106 ,000 employees and 13 million people in the geography we serve and the big geographic footprint, I can't meet with one to ones with all the same people I used to have one to ones with. So how do I triage these things to other people on the team? And how do I, you know, I think about my time, like 30, 40 % of my time should be doing things that are strategic for the big picture of the organization, 20, 30 % of that time catalyzing that.

25:36So being out in front of the staff, the board, you know, getting people motivated behind that strategy. And I'm an operator by heart, but I can only spend 15 % or so of my time in the operations. And if I am, I'm coming in to dip in and kind of level set something or write something I think is going in the wrong direction, get out. And so just how I think about structuring my calendar, my team, my emails, who manages my emails, triage and emails. It sounds silly. No, it's everything. It's so burdensome. So it's that administrative burden of our frontline staff. I got to figure out the administrative burden on myself and how I best have my team manage that so that I can be my best.

26:16So anyway, so it's like everything else. It's finding that right balance. It's not doing what I did every other promotion in my career up until 2015 or so. I put on 20 or 30 pounds and I wouldn't take care of myself. And I'm on the phone and I'm not my best self at home. And then in 2015, after another big step in my progression of leadership, my wife called me out on it and she was right. And I wasn't my best self personally or at home. And we went on a journey together and I dropped like 65 pounds. We've been in a healthy lifestyle since. We've maintained it. Wow. And that's a good example for our kids.

26:51Yep. I'm on the lacrosse fields on the weekends. I balance that time. So but that balance may be a better leader, I think. So. So anyway, I forgot where I was going with all that. But to me, that's what it's all about.

27:04Morra Aarons-Mele: Let's talk about energy. So how do you I would imagine? Well, first of all, you became an emergency room physician. So I have to imagine you're kind of a go getter. Like naturally, you're you're probably you know, you don't you're not the kind of person like me. I don't slow down. Sit in their office and be alone all day. Do you consider yourself more extroverted or introverted or both? I've heard this term, what is it they say? An extrovert, an extrovert, an introvert. I find myself, I remember the Myers-Briggs thing I was, but I find myself to be an extrovert, but I got to work on that because I had humble beginnings.

27:42I had to get more and more used to, and in this role especially, like let's say you know I'm interacting with titans of industry or billionaires that are on our board and I'm the kid from the Bronx that's the son of a union electrician to me I I just always had this almost like insecurity or anxiety about like I'm gonna sound dumb or I'm not as articulate or I'm not and you know so you have to work it's not just an extrovert like I can walk into any room and just you know talk with it and it took time for me to get comfortable and to realize everyone's just, they're all people. And you also bring a lot to the table.

28:20So you can, you know, don't feel intimidated by those kinds of interactions. But that wasn't just natural to me, I guess, to answer your question. So, but in the moment of doing work, I've always found, maybe it was more my work ethic than, and my energy around that, than it was more of an extrovert kind of nature. It was more of just this, almost like the name of this is like the Anxious Achiever podcast. And it's funny, my wife would always make fun of me because every time I took on a new job, whether it was my first day working in an emergency department, like when I was coming out of residency, whether it was, all right, now they want me to run all of emergency medicine for the health system.

28:59I would say this out loud to her often. I hope I don't get fired. Or I had this anxiety about not performing. And it was a healthy anxiety because that anxiety kept me kind of trying to stay ahead. And it led to me kind of overperforming. It was always an overachiever in that regard. But it was the anxiety of like every time it was like they would say, we want you to do this. I'm like, me? When Michael Dowling sat me down in a diner two or three years ago and said, did you ever think about throwing your hat in the ring for my job? I'm like, no. You know, like it's never. We're, so, but that anxious achiever kind of title kind of describes me a little bit in a way.

29:38So many. And I don't want to let people down. Yeah.

29:40Morra Aarons-Mele: So many successful people, you know, and I think it's, I think what's really wonderful about it is it can be a very endearing trait to other people. Right. Because we, so many of us are, we see it in each other and we, we, we want, we want to support you. You know, we want to, we want to have you see that, yes, you should throw your hat in the ring in a way, you know. How do you manage that feeling, the imposter feelings? I mean, you know, I was looking through your career, and you have an unbelievable through line. You were a physician, and then you became a manager, and then they started throwing bigger and bigger situations at you.

30:20Morra Aarons-Mele: I would imagine, like, at each transition, there's a different moment maybe of, like, vulnerability or consideration. Yeah. Um, how do you, do you have a process for that? Or you just sort of say like, all right, I'm here. Let's figure this out. It's kind of both. I very rarely, I don't think I, I very rarely have ever said no to anything. So if it's a need that someone says, we need you to do this, whether it was a big system project, whatever I'm in. Um, and I've always been someone that also, whether I was being asked or not, like to lean in where I thought I could have an impact. So it wasn't just showing up for my three 12-hour shifts a week as an ED doc.

31:00I was like, all right, we have not great relationships with all the EMS providers around the hospital. Let me get involved with that. Let me, you know, the hospital leadership, I want to take on a little bit of a response. Or we need somebody to help us think about emergency preparedness and all the, both the state and federal requirements. But truly, how are we going to be prepared for the major mass casualty or a pandemic flu or whatever it is? I've always been someone that's, that's leaned in where a, I thought I had the right skill set, the operational mind and the, uh, and I can make an impact.

31:30Uh, even if it was, it wasn't something I was getting paid for or a title, just, I always had that energy of wanting to contribute that led to larger and larger things. But then when they asked me to do things like, oh, we want you to run all of emergency medicine. And I was like me, or I want you to be, I had to, you always just have to take a breath and say, well, they asked me for a reason. they see something in me and you just have to take a breath to convince yourself. Like it was even in the process of thinking about CEO and Michael Dowling asked me if I would consider throwing my hat in the ring through the process when we had a very long process of selection.

32:02And, you know, um, they, they brought in a consultant firm plus a search firm and it was a committee of the board and it was a long process. And I, through that process by the end of the, the process by the, I would say two thirds through the ways that interview through the work and the mental work and the reflection and reading books about, you know, what traits of best CEOs. And I'm like, Oh, that's, that's, that sounds like me. I actually became convinced by the end, I'm the right guy. And I'm, I've got the right skill set, the right organizational knowledge, the right, you know, I'm the guy for the moment, but it takes me a long way to get there mentally because, and then that gets me more energy because I think about the impact I could have.

32:45It's about, It's about chasing impact. It's never been about chasing titles for me. But - Sounds like it's about curiosity too. Like, huh, there's a problem.

32:54Morra Aarons-Mele: Would you say that you're motivated by challenge, fixing stuff? Oh, absolutely. Yeah, the ultimate, I'll tell you, the real inflection point of my career. I was really good at emergency medicine and that's why all my roles expanding across the health system were somewhat tied to emergency medicine throughout my career. Even if it was big clinical projects or whatever they still had an emergency medicine attachment all the it was covid that which also has an emergency medicine tie but covid changed the game internally i remember michael dallen coming to me after the first just say who michael dalling is because probably i'm sorry he was a former ceo of 23 years uh who i succeeded and uh after the first wave john you were like the vip of that and it wasn't like i had a formal position initially but ultimately i wound up becoming the operations chief running all the operations of surge unit staffing uh testing you know all the dynamics of managing the pandemic.

33:47And we had major operators, these market presidents, I wasn't one of them at that point. And it was like the entire organization was, you know, not everybody did amazing work. But I was like, kind of ended up being the default ringleader. And, and just because just like in that code at the bedside, we don't have time to think I was the right guy at the moment. And I was treating it no differently. Like, all right, here's all the 1000 challenges of this day and we're going to do this here and do that there. And, and I also, anyway, so leading through the pandemic was the point of my career that everything came together and, um, Northwell did exceptionally well in managing, I think the hardest hit area of the country.

34:31Yeah. Right.

34:32Morra Aarons-Mele: You're in the New York Metro region, we should just say. The New York Metro region and all the numbers people see about New York just multiplying by five or 10 because all the numbers are way off because for the first three or four weeks of the pandemic, there was no testing still in the country. Like we were able to start doing maybe 100 tests a day, three weeks in, four weeks in. So the numbers don't reflect the magnitude of things. But just to give you the sense, like we have in the worst flu season, we'll go up to 3 ,200 patients in all of our hospitals of the hospital portfolio we had at the time.

35:02We were up to 5 ,100 patients and where 20 % of critical care, like 70 % of them were in critical care situations. So we were, we, we, we, and all the other things that go along with our, so, but managing through the pandemic really showcased without it being my intention. I didn't feel like I was interviewing for anything, but I was a big part of how we did that. And it was on the heels of that, that they were like, everything you just did, we need to do that going forward. They created a whole new arm of the organization. They wanted me to run around optimizing kind of our system assets and operations.

35:36And then that led to three months later, we want you to run the central market. And one thing just constantly led to the other because I think the pandemic put just my operational mindset, but that high, that ability to build the plane while flying it, navigating uncertainty, to be thinking couple steps ahead of what was going to come and mitigating things before they even happened. All those things were part of that error for me. And I think that's what ultimately led to where I am today.

36:06Morra Aarons-Mele: That's such a cool thing. And I think listeners of my show will really appreciate that because, you know, when you say I'm an anxious achiever, sometimes we think that anxiety makes us stuck, right? Like we're stuck and we're like the, oh God, what if this happens? I can't possibly move forward. But I find on the contrary that when you're sort of motivated by that hunger and that drive, but also by challenge and solving problems, you're really good in a crisis. Like you are absolutely able to make decisions without that sense of like trepidation or like wavering. You don't become paralyzed in the moment.

36:41Morra Aarons-Mele: You don't. You don't. And it's a real misconception, but it's a really important leadership skill, especially for the world we live in. It's like I don't think anything's – well, let me ask you. I'm sure your life is different as a leader now that we're not in a pandemic. Is it easier day to day? I think the magnitude of the role I'm in now and I've been in since the pandemic, it's different than the pandemic. It's not, I don't know if I would say it's easier just because I would say we're in a little bit of a perfect storm as an industry as well, which I know is not, this isn't like, you know, we won't have a big healthcare talk, but there is a perfect storm in the industry.

37:21So I think we're in somewhat of the early stages of - What is that perfect storm? It is a combination of the affordability crisis that we're facing in healthcare today, which is accurate, but it's because of a flawed financial structure. And I think people are going to attack that the wrong way, and it's going to hurt access and quality and outcomes if we don't do it the right way. So I'm trying to, with other healthcare leaders, lead the right way to affordability. So it's the financial flaws of the structure, the affordability crisis. It's the demographic shifts, the aging population, increasing demand, the epidemic of chronic disease.

37:56At the same time, we have workforce shortages that are only getting larger and larger. So we're predicting like four to six hundred thousand fewer nurses in this country we're going to need over the next five to seven years, 80 to 100 ,000 fewer doctors than we're really going to need to meet that demand. So we have workforce and capacity constraints. Again, an epidemic of chronic disease, which really is the biggest driver of health care costs and outcomes. Yes. and an aging demographic, so more demand and less people to take care of them. So it is a tidal wave that's coming and there's a way forward.

38:32But I kind of, again, going back to that's why they picked an ED doc to be in the seat. We got to figure out the right way forward so it doesn't impact health. And so that's what excites me is being able to deliver that better future and be innovative in the process. It's not the model of healthcare delivery today. That's going to get us there.

38:50Morra Aarons-Mele: No. But that's a whole other podcast. That is a whole other. I would be way above my pay grade. Well, so let me ask you a question that is at my pay grade. This episode is brought to you by Vinted, a secondhand marketplace app. You know, I love clothes. And I love when the seasons change to spend a good amount of time, you know, moving out, reviewing my summer stuff, bringing in my fall stuff. I live in New England, so I love a great sweater. I love a great tweed blazer. And now I have a way with Vinted that I can sell clothes I no longer want, but I know someone else will love and buy some new clothes.

39:26Morra Aarons-Mele: It really solves a problem for me, which is running out of closet space and also feeling guilty about buying new clothes. And it's really, really fun. The other thing is that there's no selling fees. So you keep everything you earn. And when you have that extra money, you could buy some new clothes. Not to mention a less cluttered closet is an awesome feeling. Let's face it, especially when the weather is getting colder. Listing items on Vinted is quick and simple. And once an item sells, Vinted creates the prepaid shipping ladle just for you. So if you're ready to clean out your closet and make some extra money, download the Vinted app for free and start listing.

40:04Morra Aarons-Mele: With no seller fees, you keep every dollar you earn. That's right. Download the Vinted app for free. Start selling with no seller fees, keep what you earn, and have some fun giving your old clothes a new wonderful home and maybe bringing in some new clothes with that extra money. You know, I love mushrooms. I am fascinated by them. One of my favorite things to do is in New Hampshire to go on mushroom exploring walks with a renowned naturalist Riley McHugh. Riley has taught me to put on my seeing eyes. And when I do, I see purple mushrooms and red mushrooms, big mushrooms, gross mushrooms, cute mushrooms.

40:46Morra Aarons-Mele: And I was thinking about the holidays upcoming and, you know, how we use mushrooms as a decorative theme. Think about it. You probably have a mushroom ornament or a little mushroom figure that you may put out sometime in the fall or holidays. Mushrooms. If I had an online store, Or I would sell all manner of decorative mushrooms. I know it sounds silly. And I would do it on Shopify. Shopify is the platform for a record-breaking, reliable holiday selling season at every stage. There's a reason why so many businesses thrive on Shopify. You can easily sell everywhere people shop, online, in person, across social media, even in AI chats.

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42:14Morra Aarons-Mele: But I'm getting better every year. And part of it is that I use Monarch. Monarch simplifies, identifies, and helps me have a plan for my money. Monarch is like having a financial advisor. in your pocket. It has easy to read diagrams that help me visualize exactly where my money goes each month. And it has investment views so I can compare my portfolio, say, to how the S &P is doing. All kinds of great tools that help me frankly take some of the emotions out of money and make it more practical and working for me. Most apps only tell you what you've already spent, but Monarch helps set goals, map out big purchases, and see if you're actually on track before it's too late to adjust.

43:01Morra Aarons-Mele: You can write your own money story with Monarch. Use the code achiever at monarch.com and get your first year of Monarch Core at half off just$50. That's$50 off your first year at monarch.com with code achiever. If I asked you what mentally healthy leadership is to you, what would you say? Yeah, I think it's that balance of getting back to making sure I truly I was in this next generation kind of CEO kind of coaching things. And although I took opportunities in the couple year process. And I was so thankful to hear from so many other CEOs around different industries, who also focused on their own wellness.

43:47And so I think it's, It's that personal balance is really important. Be your best self for yourself, for your family. You'll be your best self at work. So that's one piece of the equation. The other piece of the equation is being anchored in and impact and purpose. To me, that's very important. I wouldn't do this job if it wasn't that.

44:08Morra Aarons-Mele: Would you say that's being values aligned as a leader, like knowing what your values are? Values have to be aligned. You have to stay grounded. And it's not about you. It's not about the title. It's not about your own stature. It's about you have to be willing to and embrace the responsibility, the weight. It really is a lot of weight. I have not only, again, we treat upwards of 5 million patients a year. 5 million? That rely on our services. But I have 106 ,000 team members, and they and their families depend also on, you know, so that's a big weight. You got to be willing to carry that weight, but you carry it kind of willingly because, again, you have to be someone that gets excited about the fact that you can drive a better future, that you can have that impact.

44:55You're given that opportunity to have that amount of influence to make this a better place. So that's got to be part of the motivation, that servant leadership. If it's not, I don't think these jobs aren't worth killing yourself for if you're not motivated by it. It's not worth it. They're good. It's not worth it. No. So, but anyway, so to me, that's what it kind of, how it all kind of comes together.

45:22Morra Aarons-Mele: What do you understand about your own, taking care of your own energy now? Yeah. How do you do that? Again, going back to that now 10, 11 year commitment of making sure I still get my exercise in, I'm still eating appropriately. I'm still focusing on my sleep, my mental well-being, that I'm not, you know, I'm very proud when I tell the staff, I just went on vacation with my wife for our 31st anniversary. I've been, you know, CEO by day, Jerry Maguire by weekends because my daughter's in her lacrosse recruiting year. So every weekend since September through February, we're at some college or some, you know, lacrosse thing up and down the East Coast.

46:01But I proudly, A, do those things and strike that balance and then talk about it because it gives my team, my executives that I want them to, you know, no one should have their PTO bank, you know, over the limit because they haven't taken a vacation for two years. So it's that balance that I not only need for myself to be successful, but it's a balance that if I am intentional about it and people look to everything the CEO does and says and hang on every word you say, which is tough to get used to, that part of it. Uh, that's my chicken soup analogy. I can tell you, but, uh, it's, um, if I can live that, I'm also doing my job of making sure the 106 ,000 people are, uh, at least they're seeing me do it.

46:52Hopefully that models. And then the organization gets behind things that we're thinking about wellness challenges and all the other things that we're, we, we focus on with our employees, but it just raises that game, especially if I'm living. And I'm not just saying it and then they see me and I'm at 5 a.m. and I'm home at 11 o 'clock every night and Saturdays I do this and Sundays I do this. And I'm not relaying what I do for myself and my family. It almost feels like they're not working as hard as me. So it's just you got to create that right outward balance.

47:21Morra Aarons-Mele: It's a terrible feeling when you feel like you're in competition or you're being judged against someone, a leader, someone on your team. We've all felt that way. and it's a terrible feeling it doesn't work yeah you can't you can't leave people to feel guilty about you know just and that's where you know i always tell like oh i have this with my kids go it's fine the work's not going anywhere like as long as we're all still committed to the results that we're committed we're committing to here's the strategy here's the things we need to achieve here's our goals and all these different lanes uh quality operations patient experience team member, all the different lanes we're responsible for.

48:03And we have, we're going to be operationally really strong. We're going to be very strategic, short and long-term. We're going to set goals. We're going to set milestones towards our goals. We're going to be really comfortable with transparency and accountability. And we're going to be relentlessly collaborative. We're one team. We're going to speak with one voice. We're going to go out, you know, and as long as everybody's actually working within those kind of a couple working, it's not like we're just sitting with our feet up saying we all have to be healthy and let's, you know, we work hard, but we also have to take care of ourselves and put the same amount of tension into that.

48:37And, and that's what I learned 10 or 11 years ago. My job wasn't getting smaller. I was running 21 emergency departments, a joint venture. We just started that crew to like 70 urgent care centers. I was, I was overseeing medically a UGMS fleet, a new aviation program, and then asked to do other system level things. My job wasn't small. Right. But I like it was an aha moment. I've been able to do that and be a better father and a better husband and a better version of myself where I felt better about myself, not just mentally, but physically and everything else. And and when I was doing that, actually, this became easier.

49:15And it just it just you got to figure out how to make it all work.

49:18Morra Aarons-Mele: It's almost like you figured out how to build capacity for yourself. Right. Like in the sort of energetic way. Right, yeah. Like healthy. You build capacity. It's also by eliminating the things that aren't adding value. And that's how you get comfortable with, you know, the team and delegation. And there's all sorts of things that you got to go through depending on the scale of what you're leading. It's really interesting. I don't know if you're into psychological safety as a leadership concept. Is that something that you guys talk about and think about? We do talk about it a lot, yep. You know, obviously a big center of psychological safety is mistakes.

49:52Morra Aarons-Mele: And failing. Right. You have high stakes mistakes, I would imagine. How, now that you're the boss, like how do you think about creating psychological safety at scale, especially when the stakes are very high? I mean, you are an ED doctor, so you know the cost. Yeah. That's one of the, I mean, I've been in the organization 25 years. And a lot of people would look at that as stagnation, I guess, with an organization. But Northwell, it's not uncommon. It really is a sign of growth. And there's so many leaders that were nurses or physical therapists or in PT, you know, I said PT already, but in all different areas that are now chief operating offices and market, clinicians and non-clinicians that started in various arms of the organization and have excelled because Northwell is the kind of place that, A, we all subscribe to the mission, the purpose, the culture.

50:44B, it identifies talent and invests in talent. And we have half the turnover. We have low vacancy rates of all of our peers and nationally because there is that secret sauce of culture and so forth. I forgot what your question was.

51:00Morra Aarons-Mele: It was about mistakes and psychological safety. Right. But that's one of the things I've always loved about this organization, too, is we've created that culture. And it's not just about mistakes. Yes, there will be mistakes. And there's going to be really bad outcomes despite the best practices being applied, which are also very emotionally taxing. So whether it's a mistake that led to a bad outcome or whether it's a bad outcome that was just naturally going to happen, but you had to manage it. And it's emotional. You know, we have these code lavenders. You have a kid that passes away and it's a terrible situation.

51:31Code lavender is called and a team with some psychologists and other teams, but a support team is going to work with that team. Oh, my God. Time outs in our OR. Anybody. It could be the OR tech and our surgeons. Everybody's into this. Something's not right. Say something. Time out. You can be the, I don't think this way, but technically the lowest like role in the room. And it could be our top neurosurgeon. But if you see something that looks wrong, we want you and we are empowering you. And no one's ever going to reprimand you. You say time out. Wait, is that the right count of this? Or, you know, doctor, I'm sorry, but I did see your hand hit the underside of the table.

52:09We're going to have to re-scrub. We want that culture. And we have that culture.

52:16So, yeah, mistakes happen. Things happen. I was at a white coat ceremony for our medical students. It's like the ceremony when they get their white coat for the first time in their first year. And I was asked to be a keynote. And I was trying to think. The whole concept was humanism. and that, and anyway, so I was telling them a story where I suffered. You could say it was a mistake. Some will say it was inevitable, but either way, there was a really bad outcome that really hit me emotionally. And the thing that I wanted to relate to them was, yes, I was a little afraid that did I mess up, you know, or just overall, but the medical director of the hospital, the team came around me.

52:57I was first time in the only time in my life someone sent me flowers, which was the medical director of the hospital. So that ability. It's okay. Anyway, that ability to show each other grace in those moments is also important. And I think North Wales does a great job with that. So I think that's where that psychological safety comes in is that one, that team kind of sport of what health care is. and we have to give ourselves grace because we always say medicine's an art, it's not as exact science and people are built differently. There's not a one way things present themselves. There's a reason why things are missed because there's all these atypical cases that I can give you hundreds of them that this is what the textbook says and then this person came in with this and just out of a whim, I said, let's just do an EKG and they're having a huge heart attack.

53:50I'm like, what? They didn't even have anything that the book told me. So it happens. And, you know, it's just it's the nature of medicine. So you got to be prepared for how you deal with bad outcomes. And that includes the impact it could have on your staff. And you got to have mechanisms to, you know, learn when there's a mistake and make sure it doesn't happen again. If it's a malicious thing somebody did, you got to have the leadership courage. So then that's not a person who fits in our culture. But 99.99 % of the time, it's not through any ill intent. It's just the nature of the work. And you got to learn from it.

54:35And you got to make sure it doesn't happen again. You got to put the right structures around to make sure it doesn't happen again. But you got to do so with grace. And I think that's important.

54:42Morra Aarons-Mele: Yeah. Grace is so important, especially these days. My last question for you is really about who you surround yourself with in this new chapter. You know, who does, there's always a saying, right? It's lonely at the top, heavy is the head that wears the crown. What have you learned as you've gotten more senior about who you need to surround yourself with for comfort, for learning, for real talk? You know, like how do you think about that? it's really important and I had to figure this out and I believe I figured out the perfect solution but you got to figure out who is that inner circle that you can just again be yourself and say I don't know what to do here what do you think or or this is what I want to do tell me what you think and you got to have people that feel comfortable with that and depending on the altitude of your position like what I had to get used to is I've developed also amazing relationships across this organization again I think relationships are the cash this organization.

55:42That's the currency that helps you get things done because we all really do like each other. And it wasn't uncommon for me during my whole tenure to call up, you know, the different chairs of different departments or whoever and say, hey, I'm having this problem. Can you help with this? But when, especially in the CEO role, everybody pays attention to everything.

55:59Morra Aarons-Mele: That's right. And I had to get some coaching on this, your body language during the meeting, what you say. This is that chicken soup analogy. I was reading a book where the CEO of the new whatever company. I forgot what book it said. And he's doing his tour and he goes to the cafeteria, they have a chicken soup. He goes, oh, I love chicken soup. And then six months later, one of his senior executives go, can you do us a favor? Can you go down and tell them it's okay to make something other than chicken soup? We've been eating it for six months. And people hang on every word you say. And I've gotten caught that way a few times.

56:26Like I'm saying, well, maybe we should think about this. Next thing you know, people are executing on, John said, we got to do this. I'm like, no, I didn't say that. I was just thinking. So you just got to have that appreciation of the weight of your words and your body language and what you represent to the organization, which also means, to your point, you need to have that core group, whether it's some people on the board that you really kind of know they have a skill set, a level of trust with you and you with them that you can say, hey, I'm not an expert in PE, but there's this, what sounds like a great opportunity, but this is your level of expertise.

57:04And you don't want the, you gotta have that level of trust with people with the right expertise. And then for me, it was historically, the model here was we grew one hospital over time. So my predecessor and the other senior executives, it's interesting, the CEO just wasn't the only transition. When he retired, about eight or nine of the other very senior executives all retired within the same two, three months because they've all been with him from the beginning. So I had to put in place a CEO, a chief operating officer, a chief medical, a chief nursing officer, a chief strategy officer, a head of our foundations, a head of our business development, ahead of our, so there was a lot of moving parts.

57:39So it was getting my team. But the model for my predecessor was there was a very smart, we have this pipelines of administrative talents. It was a very high potential, but mid-career administrative talent type person that was like the, we didn't call it this, but like the chief of staff type role. That wasn't going to work with me. So I have Now, not just one person. And also right before I came in, we just took on the biggest merger of our history. We always grew one hospital at a time, but we seven hospitals and another 15, 16 ,000 employees in bigger geography, upstate New York and Connecticut.

58:18Our first time at hospitals in Connecticut all happened right before the transition. So I'm navigating this biggest merger of our history, replacing most of the senior C-suite executive team. And we are at the starting gate of a total digital transformation. The largest in Epic is one of the big electronic records. Largest in their history. We just went 46 ,000 users just went live in our second wave two weekends ago. So we have this big digital transformation going on. I forgot where I was going with all that. So you got all that going on. I just couldn't rely on just me alone with, you know, so I brought in someone who was a former very high level executive, not from health care, but also someone I'd known since I was a kid and I trust.

59:03So that person is my chief of staff and there's a team below him. It's a team. It's not just one person anymore. But having that person who I trust with my life in and out of work and has an executive mindset and ran a two or three billion dollar P &L with a lot of the same kind of shared services, HR dealt with, you know, labor unions, all the other stuff, but is not in health care, too. It was a nice, nice ingredient. and then also the people that I put on these teams. My chief operating host are people that I, again, I have a good core team that I can close the doors and be as vulnerable as I need to be to make sure we're doing the right thing for the organization.

59:44So it's that balance. You've got to create that structure for yourself.

59:49Morra Aarons-Mele: I hear you saying it's very individual, right? Everyone's got their own recipe, right, for their energy, for their time, for their schedule, for their staff, for their resourcing. It's like everybody, but it's worth investing and understanding what you need. Yeah. Yeah. It's treating the soft stuff as the hard stuff. You got to get that stuff right. Yeah. Because otherwise you're not going to be as effective as you could be. Yeah. Thank you so much, John. This was just great. This is great. Yeah. I really appreciate it. Best of luck to you and the podcast. And I look forward to seeing some of your other work.

1:00:22Thank you. Thank you.

1:00:27Morra Aarons-Mele: That's it for this week's show. If you like the show, follow us and tell your friends. And please leave us a review. It really helps the anxious achiever get found by people just waiting for our content. I'm your host, Maura Aarons-Mele. Lots more to come in the next episode.

1:00:59you