Ambition and Leadership: Remarks to the Graduating Class of AHIP Fellows

This article is an abbreviated adaptation of remarks I delivered to the 2024 graduating class of AHIP ELP Fellows as the Edward F.X. Hughes Honorary Commencement Speaker. I focus on the qualities, attitudes, and values needed to create meaningful change in healthcare.

My brief remarks today are going to focus on two topics about which we rarely speak explicitly but are important and meaningful: ambition and leadership.?

Each and every one of you has been identified as a star and future leader by your organization. ?

Because someone saw you as having tremendous potential and capability.

Because someone believed that access to didactics, mentorship, and a cohort of like-minded individuals would accelerate your development.

And I have no doubt that each and every one of you—coming into and out of this fellowship— is on a path toward achieving greater influence in your respective organizations.

You have my warm congratulations. ?

You and your families have much to be proud of and to look forward to in the days and years ahead.

As you grow in your career, I’d like to offer you this simple message: never forget what brought you to work in healthcare in the first place.

I suspect that most of you—when you got started in this industry—had a simple desire to help people.

To enrich the lives of others through healthcare.

And while each of you probably still feels that way…

Let’s be honest: We start to have some other feelings as we progress in our careers.

Our moral compass becomes a little less reliable.

Sometimes it’s hard to see true north.

Our passion for patients and people makes way for ambition. ?

Our desire to improve health and healthcare gets replaced by a desire to become maximally conventionally successful.

Promotions, bonuses, stock grants, and stock prices become our measure of personal success.

Our relative organizational standing becomes our measure of self-worth.

And, as we sacrifice more and more of ourselves—we get distracted—maybe even consumed—by the quest to climb higher and higher up the corporate ladder.

Losing sight of what brought us to work in healthcare in the first place.

I see it happen every day and, I can honestly tell you, it is more common than uncommon.

What’s more, it very much influences the behaviors of our industry and the companies in which we operate.

Ask top leaders in our industry what they do—most will give you some corporate pablum about affordability, access, and quality.?

It all sounds good. ?

And they—we!—say it with a straight face.

But could it be that in the quest for personal success, we have gaslighted ourselves into believing that we are better than we are?

We get used to repeating--rather than challenging--the conventional corporate lines that we came here to change!?

Access delays, inelegant utilization management, and the tremendous confusion created by the processes we preside over have contributed to the Frankenstein nature of our healthcare system. ?

To make ourselves feel better, we launch feel-good, sub-scale pilot projects—on the social determinants of health and health equity.

And in doing so, we distract attention away from the fact that much of what we do actually makes the experience of healthcare worse—not better—for the patients we serve.

And yet, many of us look at each other with straight faces and say that we are the stewards of affordability, access, and quality.

And that we are “patient-centered.”

And that we are focused on “the whole person.”

And on and on with the jargon.

Oh the jargon.

I believe all of this arises from one moment.

Just one. ?

The moment when we lose focus on the thing that mattered most to of us at the beginning of our careers—the thing that should guide everything we do—which is to truly, undeniably make things better for patients.

Not just a little better. But a lot better.

So, I urge you, graduates of this AHIP Fellowship, even as you maintain your ambition (I’m not unrealistic about this very basic human need), fight hard—against the system in which you’ll operate and, indeed, against yourselves—to never lose your clarity and never lose sight of why you are doing what you do and why you do it.

And help your teams and companies do the same.?

Because unless we have a clear, undistracted view of our purpose—and an unvarnished view of our own warts and blemishes—we stand little chance of actually making any of it better.?

Which brings me to what may be the most overlooked part of the entire healthcare system: leadership.

If you haven’t figured it out yet, corporate leadership is easy.

Real leadership is hard.

Let me repeat that.

Corporate leadership is easy.

Real leadership is hard.

Corporate leadership is about learning the rules of a company’s culture and living and succeeding within those rules. ?

It’s about knowing with whom to align and making sure you’re aligned with them. ?

It’s the hidden curriculum of everything you’ve experienced since joining this industry. ??

And, if you’re here, no doubt you are quite adept at this kind of corporate leadership.?

As you prepare for the next phase of your career, however, I would ask you—outlandish as it sounds—to quit comparing yourselves and your leadership to leaders in managed care.?

Because I would submit to you that you’ve likely mastered that—and will continue to be excellent at it.

Instead, I ask you to compare yourself and your actions to leaders like Rosa Parks, Mahatma Gandhi, and Martin Luther King.

Rosa Parks, Mahatma Gandhi, and Martin Luther King?

What the heck is this guy talking about? you’re probably asking right now.

And you wouldn’t be wrong to ask that question.

But, yes, I would ask you to compare yourself to Rosa Parks, Mahatma Gandhi, and Martin Luther King. And here’s why:?

Each of them challenged conventional wisdom.

Each of them quit normalizing abnormal things in their societies-two of them in our society.

Each of them stood up to orthodoxy—often times at a personal cost to themselves.

Each of them was absolutely relentless in the face of obstacles and challenges and bigger societal forces that seemed insurmountable.

And yet: they changed the world.

And I would submit that it’s that type of leadership that we need more than ever within the organizations that preside over the structure and delivery of healthcare in this country.?

Why?

Because the other option—the conventional model of leadership--got us where we are.

To a place where our industry isn’t trusted.

To a place where more people than not believe that we are the reason healthcare costs are high.

To a place where we don’t reliably show up when people need us most and the way we show up isn’t the way they need us to show up.

While it’s a little preposterous to compare work in the healthcare industry with the civil rights and Indian independence movements, conventional corporate wisdom says we should just go along and get along.

But my heroes—people like Rosa Parks, Mahatma Gandhi, and Martin Luther King- were relentless in the pursuit of their convictions. I draw inspiration every day from them and many others who refuse to just accept things as they are—-and I try to follow their example.

You should too.?

We live in a messed up industry. ?

Let’s admit it!

We have so many things to fix. ?

And it’s going to take non-traditional means and methods to fix them.

So please, please, please: as you progress in your careers—develop a fighter’s mindset.

Remember why you got in this fight to begin with - to improve the lives of patients.

Because the easy thing to do.

The thing everyone before you and me did is what got us here in the first place.

And we need your leadership—-more than ever before—to help American healthcare truly rise to its full potential.

I wish you all the best.