Profile in Business
Hospital CEO’s Career Is a Study in DeterminationWhen Craig Melin embarked on his pursuit of a doctoral degree from the Dartmouth Institution for Health Policy and Clinical Practice, he figured it would be a two- or three-year journey.
Almost five years after he started, Melin, president and CEO of Cooley Dickinson Hospital in Northampton, still has a ways to go, but there is light, he said, at the end of the proverbial tunnel.
Work on his dissertation has been slowed, and made both more challenging and intriguing in many respects, by the lengthy recession and its ongoing impact within the broad health care community, he explained, and especially hospital administration, which is at the heart of his work.
“There were two factors, both of which had to do with the health care environment, that slowed things up,” he explained. “One was that this environment became so treacherous that two of the hospitals that I wanted to visit were going through such economic upheaval that, at the times I wanted to visit, they were going through reductions in force.
“And to interview people about all the wonderful things they’d done and how great their outcomes were, at a time when the staff was going through the angst of feeling that they had failed and that the world doesn’t work … well, the timing just wasn’t right,” he continued, adding quickly that the second delaying factor was that he was dealing with these same issues, including workforce reductions, at CDH — work that absorbed early-morning and evening hours he would otherwise have devoted to his studies.
When asked about the specific thrust of his doctoral work, Melin said it centers on “how to transform the quality of care in community hospitals.” He then caught himself and made a key adjustment. “It’s actually ‘how to lead the transformation of the quality of care in community hospitals.’ It’s from a leader’s perspective.”
That’s an important distinction, and in many ways, Melin isn’t simply studying this concept, he’s living it. It has become much more than the title of a dissertation — it has become a life’s work.
Indeed, when Melin arrived at Cooley Dickinson in 1988, soon to commence work that would pull the hospital from the brink of financial collapse, he figured the stay would be no longer than five years. Close to a quarter-century later, he is still at the helm, primarily because he believes this is where he can make the most significant impact with regard to that ‘big picture’ that is modern health care administration.
His goal, almost since the day he arrived and especially over the past decade or so, has been to make CDH what he called a “model community hospital.” And to do that, he decided he needed to take his base of knowledge to a much higher level. “I understood that I needed to be an expert in that field, not simply know about it, and that’s why I decided to pursue my doctorate.”
This pursuit has been a learning experience on a host of levels, one that has brought new perspectives on the ongoing work at Cooley Dickinson and lessons in how to do it better.
For this, the latest installment of its Profiles In Business series, BusinessWest talked with Melin at length about the process of putting Ph.D. after his name, and about what is certainly much more than a research topic; it’s what he hopes will become a blueprint for more effective hospital administration.
Regarding the timeline for his dissertation, Melin said most all of the course work, research, site visits to four of the top-performing community hospitals in the country (which he couldn’t disclose at this time), transcription of dozens of interviews, and coding of most results is now all behind him.
What remains, essentially, is completion of his analysis and the writing, which he has started, both on his home computer and in his mind. He said he anticipates being finished by this June, but followed that statement with a qualifying ‘but…’
While acknowledging that it is quite difficult to sum up what he has learned and what his dissertation will say quickly or in simple terms, Melin said much of his doctoral work comes down to five steps, not necessarily sequential, that he has identified and that he believes form a framework that can be followed by virtually any community hospital as it goes about working to transform quality of care.
“The first involves how the leader got the attention of his or her organization regarding the gap between where they are and where they need to be,” he explained. “And the second, after you’ve recognized, for example, that more people are dying in health care than should be or people are harmed in health care organizations more than is necessary, the next question is how to get people’s intentions to change. So you go from attention to intention.”
In other words, he said, the employees of the hospital, not merely the administrators, take ownership of that aforementioned gap.
“The third piece concerns how we translate that ‘intention’ into the work that people actually do,” he continued. “So it’s one thing to believe that we need to do a better job of eliminating infections in a hospital, it’s another question to look at whether we can figure how to test every patient who comes in and disinfect rooms in a very different way. It has to be the work of the people on the front lines, not the managers and directors.”
The fourth step involves how to hold people within an organization accountable for the change in their work and the results that are expected, he went on, adding that this step is necessary to ensure that the changes that everyone agreed to make are actually happening.
As for the fifth … “you can do all of this and still fail as a leader if, as an organization, you don’t provide all the system supports to help people change their work, know how they’re doing, and so on,” he told BusinessWest. “Whether it’s IT support, or, for the front-line staff, whether the group has time to sit down and think, rather than just do, whether they have a facilitator and outside resources to look at what others are doing and what can be copied and adjusted for us … the system supports are central to success. You’ll see systems that will do the first four things and then fall apart, because they’re expecting everyone to change the work they do, but not give them any time to think about how they would do it.”
The dissertation will go into several hundred pages worth of elaborate detail on these five steps, and essentially take a retrospective look at how those four chosen hospitals, each with outstanding outcomes, navigated them.
Meanwhile, the experience of doing the research and those interviews has provided invaluable opportunities to look prospectively at how CDH may be able to take what those hospitals have done and are doing and apply them to its quality-improvement efforts (more on that later).
How Melin arrived at this place in both his professional career and education is an intriguing story that really begins to take shape at the Massachusetts Institute of Technology, where Melin earned a bachelor’s degree in Mathematics and for a long time thought he would wind up teaching that subject at some level.
Adding Things Up
“But I sort of adjusted to more practical uses for math,” he said, adding that his search led him to actuarial work with some insurance companies and, eventually, a summer job with the Mass. Rate Setting Commission, where he worked for a group redesigning the payment system for hospitals and nursing.
“Through that, I came to the conclusion personally that the data suggested that health care organizations were not well-managed,” he said, “and that this represented an opportunity for me.”
So he enrolled in Harvard Business School with the mindset of pursuing a career in health care management. While there, the School of Public Health created a new program called Health Policy and Management and invited the 800 first-year students at Harvard Business to consider a course of study that would essentially combine management and health care. Melin said he was the only one who did.
Fast-forwarding a little, he said he would go on to earn master’s degrees in business and health policy as well as management. He would put them to work first at Beth Israel Hospital in Boston, which he would eventually serve as associate director; National Jewish Hospital in Denver, where he would become both vice president of Planning and director of Hospital and Clinical Services; the Cambridge Research Institute; and University Hospital (now Boston University Medical Center), which he would serve as vice president of External Affairs.
His career then approached what could only be described as a crossroads.
“I was contacted by a search firm to look at the possibility of a teaching hospital in another state and also Cooley Dickinson Hospital,” he explained. “I didn’t really know Cooley Dickinson or Northampton, and I was at a career stage where I was considering two paths to reach my ultimate goal, to be CEO of a major teaching hospital; one was to be the CEO of a community hospital first, and the other was to be the number-two person at a teaching hospital.
“There was something about Cooley Dickinson and the community that attracted me, and so I came here,” he continued. “I thought it would be five years, but once here, that attitude changed, because underlying all that was wanting to change the health care field, not just where I was working. I soon got the sense, from all that we were able to do, that you could develop a model community hospital that others could learn from, and change the field.”
Melin told BusinessWest that recruiters have contacted him countless times over the past 23 years to gauge his interest in other administrative positions, some at facilities several times the size of CDH.
They still call, or e-mail (the more common method of making such inquiries these days), but he said he hasn’t seen or heard anything that would take him away from CDH. When asked to elaborate on why, he said, in essence, that there is still considerable work to be done with regard to making Cooley Dickinson into that model community hospital. In short, he hasn’t finished what he started.
Which brings him back once again to his Ph.D. and that prospective work he’s doing with taking lessons from his site visits back to CDH. He said those visits have generated tremendous learning experiences and provided plenty of insight into the work he’s doing in Northampton — and how he might do it better.
“I’ve got a framework for how I think and how I lead,” he explained. “The experience of seeing other places has given me guidance on how to adjust that framework, because it’s always going to be different based on context. There’s a concept called realist evaluation that says that you need to look at the mechanisms of change in the context in which they occur, and then look at the outcomes.
“And where the process I’m talking about has five steps,” he continued, “we’re looking at five different mechanisms of change, but the question becomes, ‘how do you adjust them in different contexts, and what outcomes do you get?’
“Basically, it comes down to what works where, when, and why,” he went on, adding, once again, that his site visits have provided myriad talking points for his dissertation and plenty to think about at CDH. “Cooley Dickinson has a completely different context than those other places, and our outcomes will be different, but we can still ask the question, ‘how can we make that framework successful in our community?’”
And while his site visits have involved lengthy visits to CEOs’ offices, they’ve also included talks with physicians and quality-improvement staff and lengthy stints on the front lines, said Melin, adding that with each group came a unique perspective on the steps taken and, more importantly, why they were successful.
“This was a real learning experience for someone who’s a CEO,” he told BusinessWest. “When I talk to the CEO about what he or she has done to lead change, and then I talk to the front-line staff, they’ve experienced the change, too, and they know why it is they made the changes, but they might not be the same reasons as the leader thought.
“And as someone who’s in a leadership position, this was a great opportunity to see first-hand somewhere else that there is that disconnect,” he continued. “That doesn’t mean that what the leader did wasn’t really effective, because in each of these places it obviously was, but it wasn’t necessarily what they thought they did that caused the success at the front lines; it was something that happened within their organization because of the transitions they set in place.”
Degree of Progress
When asked what he does in his spare time, Melin smiled and said that, at this time in his life, there simply isn’t much of that precious commodity.
Indeed, between his work molding CDH into a model community hospital and work on his Ph.D., most everything else has been put on hold. He still finds time to visit the Connecticut shore with his wife, who operates a unique bed-and-breakfast in Northampton that features extended-stay programs. There will be more time for the beach when his doctoral work is completed, obviously, a day Melin is looking forward to seeing.
But while that work will eventually end, the more important assignment of applying what’s learned won’t. That’s because hospitals must seek to continuously improve, he said, adding that this is the real framework for a model community hospital.
George O’Brien can be reached at [email protected]