Ep 62: A Leadership Legacy

with Marna Borgstrom

February 9, 2022

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Marna Borgstrom
CEO, Yale New Haven Health and Yale New Haven Hospital

Marna Borgstrom began her career at Yale New Haven Hospital more than 40 years ago. Her varied roles have taken her from a post-graduate fellowship, to various staff and management roles, to her promotion in 1994 to the position of Executive Vice President and Chief Operating Officer at Yale New Haven Hospital. In 2005, she assumed the position of CEO of Yale New Haven Hospital and President & CEO of Yale New Haven Health and now serves as the CEO of both organizations. Ms. Borgstrom chairs the boards of the Healthcare Institute and the Coalition to Protect America’s Healthcare and is the past chair of Vizient, a Dallas, Texas-based health care company. She serves on several other boards including the Connecticut Hospital Association and New Haven Promise. Ms. Borgstrom has been the recipient of several awards recognizing her advocacy and community involvement including the AHA Grassroots Champion Award, the Anti-Defamation League Torch of Liberty Award, The Greater New Haven Chamber of Commerce Community Leadership Award and Business New Haven Business Person of the Year. She was awarded an honorary Doctor of Humane Letters by Quinnipiac University and Sacred Heart University and a Doctor of Business Administration by the University of New Haven. Ms. Borgstrom received her undergraduate degree from Stanford University and was awarded a Master’s of Public Health by Yale School of Public Health. She and her husband, Eric, have two grown sons.

 

My vision for healthcare includes figuring out a system of care that works for the individual. People need advocacy and continuity.

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[00:00:18] Joanne Conroy, M.D.: Welcome to Her Story. My name is Joanne Conroy and I’m President and CEO of Dartmouth Hitchcock and Dartmouth Hitchcock-Health. And it’s my pleasure today to have Marna Borgstrom, who’s CEO of Yale New Haven Health. Her Story is an opportunity for us to have conversations with women leaders so other women can envision leadership possibilities in their own career. And Marta is a good friend, as well as a incredibly well-respected colleague by her peers across the country. So Marna, thank you so much for making the time to be with us today.

[00:00:56] Marna Borgstrom: Thank you, Joanne. And, given your accomplishments, I’m honored to be asked to do this.

[00:01:01] Joanne Conroy, M.D.: Well, Marna, you have a very interesting career at Yale New Haven. And just to kind of level set it for our audience, talk about kind of the years you’ve spent at Yale New Haven. It’s not usual for a woman leader to actually be able to ascend to leadership within an organization and never actually hiring a moving truck. So talk a little bit about that.

[00:01:29] Marna Borgstrom: I jokingly, but not jokingly sometimes say to people, I just obviously didn’t interview well for other jobs. And so, I didn’t get pulled any place, but you know, if I go back, when I finished my undergraduate and had a degree in human biology, which qualified me to do absolutely nothing, I worked as a unit secretary on a pediatric unit at Stanford University Hospital so that I could pay my rent. And then I worked with some undergraduate friends who were in business school to do a risk management study. And I got to know my first mentor, who at that time was the 32 year old president of Stanford Hospital, if you can imagine, back in the day. And it was from that experience and being on the floor, but also doing this risk management study and learning about healthcare at the time that I decided that I wanted to go into this field. And I went to graduate school. I came back to Connecticut to go to Yale and married my husband in 1978. And he’s from the west coast, promised him we would stay here for two years in 1978. And that is one of hopefully not too many promises that I did not keep. But you know, I’ve done a little bit of everything. I started as an administrative fellow. I’ve done staff work. I’ve done operations. I’ve done some new business deals and I think the common thing is I’ve liked everything I’ve done. I never said no when somebody gave me a new opportunity, even if I had no idea how to structure an acquisition of an ambulatory surgery center and two radiology practices back in the nineties, which I had no idea how to do. And I lived for the opportunity of the time. I didn’t say, I have to be here in a certain period of time and I want to be the CEO. I kind of lived for what the opportunities were. And I think in retrospect, I think that that helped me both grow, but also enjoy the growth process.

[00:03:27] Joanne Conroy, M.D.: What was the favorite job that you’ve had, aside from being CEO because there’s something great about being the boss. But there are some jobs that you hate to leave because you either enjoy the team or you enjoy the work.

[00:03:44] Marna Borgstrom: You know, that’s a hard question because I really have enjoyed everything. But I think it was when I had a hybrid job where I had a fairly good operating span of control, but I was also doing strategy at that point and had an opportunity to acquire a very large independent ambulatory surgery center and two private radiology practices, and thread that needle of letting them stay somewhat independent, but integrating them with the full-time faculty in some respects. And I think that what I liked about it was there was the operational piece, which kept me grounded on what it takes, to sort of keep the trains running. But I was learning a ton as I was learning how to value a business, how to do negotiations with people who were far more sophisticated than I, and I just loved the diversity of it. And it was a pretty busy time, but it was really fun.

[00:04:44] Joanne Conroy, M.D.: Let’s follow up a little bit on the question about strategy, because when people sometimes think about the job they want, sometimes it’s in operations and sometimes it’s strategic. You’re right. It’s great when you can actually marry them both. Talk about the difference between the two for young leaders. What should they think about having mastery around first? It’s kind of hard to imagine people could think about strategy without understanding operations, but talk a little bit about that because your job now is a lot about strategy and HR, but it’s a lot about strategy.

[00:05:18] Marna Borgstrom: It is, but it’s also about operations. I mean, I firmly believe, and you may disagree, that when we’re sitting around the table with other CEOs talking about the challenges we have right now and strategy, I would bet a fair amount of money that we all have fairly similar strategies, overarching strategies. The holy grail is execution and execution is a lot about understanding operations in my humble opinion. And when I had done strategy, moved into operations, still had a foot in both camps, and, unknown to me at that time, my predecessor was thinking about his retirement timeframe much sooner than I thought he was going to, he had somebody who was kind of an advisor coach for him who knew me pretty well. And he said, when Joe was trying to figure out if he was going to put me completely in operations or completely in strategy as he was choosing that next course, Jordan said to him, I can find you a strategist like that. I cannot find you a good operations person like that. They’re much harder to find because it requires a combination of intellect and interpersonal skills and intuition. And so that’s when they moved me fully into operations before I took this role. So, I don’t know that I would advise anybody that there’s a perfect order in which to do it. I think some of it is opportunistic, but I do think to your point, you need to have both because you can’t be a good operator. If you’re not strategic. I mean, operations, is not just keeping the trains running. It’s advancing, its innovation. But you can’t be, I don’t think, a great strategist if you don’t know what this business is about and what it takes to make it work.

[00:07:14] Joanne Conroy, M.D.: Yeah. Yeah. It’s interesting. There’s also a conversation about visionary leadership. And, at some point, I think it’s easy sometimes to be a visionary because you’re not accountable necessarily for what happens, especially if you’re a futurist. But you do have to have some level of vision about where you want the organization to go. How do you develop that?

[00:07:38] Marna Borgstrom: Boy, that is a really good question. Sort of that mission, vision, vision values triad comes to mind because it all plays together. Why are we in this field? That’s kind of mission. What are we trying to do here? What guides what we do? I mean, all of us, I think, have very similar values, but they’re a lot more about respect, compassion, accountability. But then vision comes, I think, from how you get from having those values and knowing what you need to do, but figuring out what the best path is for an individual organization. I mean, we’ve talked in the past, that’s kind of a blah answer, but healthcare is different locally in every geography in every state. And in large states, what’s gonna work in Northern California isn’t going to work in Southern California. And I think that’s the art of creating a vision, is knowing what you need to do and what will also work in the geographies that you’re able to be leading and serving. And I think the hardest part of vision and the piece that I would ding myself on a lot is being innovative because I don’t consider myself a very innovative person. I’m more an incrementalist, but if I have a vision for healthcare, it would be, we have to figure out how to make a system of care work for the individual. The way we’re paid and the way we’re organized, we unintentionally do terrible things to people because we treat the issue at hand and then we hope that somebody is going to connect the dots for people. And people need advocacy and continuity, and that’s what our, my underlying vision is for everything that we do.

[00:09:37] Joanne Conroy, M.D.: Yeah. I think a lot of us had said, if we had a blank piece of paper and could envision delivery of healthcare differently, we would draw something very different than we have today. But we’ve also talked about how difficult it is to change our payment systems, our delivery systems, our GME systems, our training systems. It’s just, it’s almost almost difficult to kind of conceive of what that would look like.

[00:10:06] Marna Borgstrom: If we change the payment system, I think it would be easier to change that delivery system. I mean, I think that we’ve got a lot of that quite backwards right now.

[00:10:15] Joanne Conroy, M.D.: Yeah. Yeah. A lot of young women leaders ask about advanced degrees and you said you went back to get an advanced degree. Was it an MHA or an MBA? And how do you make that decision between the two degrees?

[00:10:31] Marna Borgstrom: I have an answer for now and an answer when I did it. When I did it, I was just naive and stupid. And I selected an MHA program because I had missed the deadline to apply and I look at these people now who are coming in and they’re so much more intentional and thoughtful about it. But, I think the degree was helpful in orienting me to specific concepts. But what I do and what I’ve learned to do, I’ve learned to do by doing it, by watching others, because I think you can’t teach management in leadership. You can teach skills, but that is really an experience that I think all of us have had in different ways. Today, I think it would be more unusual than not for us to hire somebody who does not have, it may be a clinical degree, and/or an MBA, because I think that the business discipline is much more rigorous now than it was when I was growing up.

[00:11:38] Joanne Conroy, M.D.: We often talk to our interviewees about being an accidental or an intentional leader. So what category do you think you fall into?

[00:11:48] Marna Borgstrom: Accidental. No question about it. When my predecessor told me at 59 that he was going to retire and he said, “you’ve been the insurance policy for this board. Do you want it?” And I had to think about it for a minute because I wasn’t sure. I had never said that’s the job I have to have. But when you’re faced with that opportunity, I quickly realized that I was the only person who’s in control of my career. And that’s true for anybody who listens and watches this. Nobody else is in control of your career but you. And I had a vision for where I thought this system should go. I loved and was very loyal to my predecessor, but I would have done some things very differently. And I recognized that if I didn’t put my hat in the ring and they brought in somebody else, I would likely have to be looking for a job because that person would create a new team. So, I started looking at the same time I threw my hat in the ring. Spencer Stuart came in. They did a national search. The President of the university at the time said this has to be a physician, which, as you know, I am not. But, once I really started to think about it and was able to articulate my hopes, my vision, my desires, it was pretty exciting. And so then I became much more intentional about what I did in this role.

[00:13:18] Joanne Conroy, M.D.: Yeah. How did your life change once you moved into the role?

[00:13:25] Marna Borgstrom: Well, I was terrified, first of all, because I sat in the one of the other seats around the board table. And the very first time I sat where the CEO sits in the health system board meeting, I thought that there was not enough antiperspirant to get me through that meeting. I was terrified, absolutely terrified. My life changed in pretty unexpected ways. There were the intangibles. Growing up in an organization, being promoted, there were a lot of people who kind of, I know, didn’t whisper very quietly saying, well, she’s know the name of my predecessor or, she’s…and. I think there was some gender bias against having a woman leader. And I think there was an expectation of what leadership looke like based on the people who had preceded me. And I didn’t look like that. I didn’t act like that. The way it changed is people who I had thought were pretty friendly were all of a sudden much more wary of me, which is hard to do. And I also came in at a time when my predecessor left in part because things were very difficult at the time, difficult relationship with the university. We were making an operating margin of about three quarters of a percent. We had a corporate campaign going on. We had a major building project that was dead in the water politically because of the corporate union campaign issues. It was really, really tough. And my life changed because the pressure that was put on me, people thought I would be an easier mark than my predecessor and they could do it. So, I made a lot of mistakes in those first year and a half, but I also found my grit and found that I was a lot tougher and stronger than I thought I would be. And so when I came through, what was an experience I would never want anybody to have is their initiation into this role. I knew one thing and that was, I could survive almost anything and that nobody could ever define me again the way they wanted to define me, because I moved to control the narrative from being controlled by. it

[00:15:35] Joanne Conroy, M.D.: Yeah. Yeah, that’s great. That’s a great lesson for a lot of our young listeners. Now you have been an advocate for women and men in leadership, but specifically women in leadership in your organization. Do you want to talk about the investments you’ve made really over the last, what, seven to ten years in really creating paths for women at Yale New Haven Health.

[00:16:00] Marna Borgstrom: I feel that a diverse leadership team, like many of us I think feel, is critical to success because you can’t have everybody look the same or bring the same points of view. And, we have been still largely a white male culture. And one of the things that a member of my board told me several years into this role was that I should be spending 20 to 25% of my time on talent development. And I thought, well, that’s absurd. How am I going to spend that much time? I will tell you that I spent every bit of 25% and more now. And part of that is helping to build the tools, the skills, the opportunities for people to grow in leadership. And part of it is also getting into that sponsorship advocacy, as well as mentorship, making sure that we don’t unintentionally let tradition dictate how people move forward. So specific to your question, around the time that Sheryl Sandberg published “Lean In”, a woman who worked with me, Gayle Capozzalo, was our senior strategy person who is a force of nature still, came to me and said, we need to do more for women at the frontline levels in the organization, at the department head and manager level, and we should create a leadership development opportunity for these women. And let’s call it Lean In, and let’s have them read Sheryl’s book. Let’s talk about it. And like any good CEO representing 28 or 29,000 people, I said, well, Gayle, we can’t do that just for women because, what are the men going to say? What are people who are Latino going to say, what, you know, I’m thinking of everybody else. And Gayle basically said to me, now Marna, that’s really nice and important, but we’re going to do this.

[00:17:58] Joanne Conroy, M.D.: Yeah, she would.

[00:17:59] Marna Borgstrom: she would. Yeah. And so we did it, and that was about seven years ago, I think. And it is still alive and well. We’ve probably taken 300 plus women leaders through Lean In. It has a didactic component, so there’s work to be done about how we think about leadership, how we grow and develop. And there’s also the sort of social ally building component of it so that they have a little bit of a budget, so they’ll go out to dinner or breakfast. A lot of alcohol involved in some of these groups, but you know, it’s also building relationships. And now the testimonies of people, and a lot of physicians who didn’t know how to get into leadership have been through this now, people talk about how it changed them and how they think about the opportunity to grow and it is downright inspiring. And we’re looking right now because I think it’s not an exaggeration to say that at least a third or more of the people who have been through have been promoted at least one level. And I can tell you names on one hand of people who have now grown three levels in the organization. There are things that work. But here’s the other interesting thing is, two years ago we were talking about the learnings from Lean In and all of the guys, men of color, as well as others, were sitting around the table going, well, I didn’t know people felt that way. I didn’t know they thought we talked over them. I didn’t know, whatever it was. And so, we said, well, duh, how do you change the culture if it’s just women talking about it? We have to share this. It has to be more broadly understood and discussed. So we started Lean In for men. And now there’s a cross-fertilization. And I would say that it’s just remarkable to me, some of our male leaders who said, gee, I never walked into a room and wondered why all the women were sitting in the seats at the perimeter of the room while the men would go in and put their stuff down and sit at the table. Or gee, I never knew that somebody thought that they made the comment first and then I credited a man with making the smart comment. And it was little things like that that I think just creates some self-awareness among all of us. That’s good for the culture and good for developing women.

[00:20:31] Joanne Conroy, M.D.: Yeah. Yeah. Well, I know it’s made a huge impact on not only women at Yale New Haven Health, but a number of our women leaders up here have actually copied it and developed some Lean In circles. And you’re right. The sense of community is really powerful even through the pandemic. Even if they have to do their meetings virtually they all show up and they really appreciate that support and fellowship that it creates.

[00:21:00] Marna Borgstrom: Well, I had two of your great women, Maria Patton and Stacy Herman, who I’ve had the privilege of working with, who I think carried some of the best of what we’ve talked about and really enabled growth with you at Dartmouth Hitchcock that’s been remarkable.

[00:21:16] Joanne Conroy, M.D.: Yeah. Yeah. They’re very impressive. So thank you for your mentorship of them. Now, all good things come to an end and we understand that you’re retiring from Yale New Haven Health. How does that feel? And what’s the next chapter, because you’re not really retired.

[00:21:34] Marna Borgstrom: No, it’s really weird. So next month I turned 68, not that numbers or anything, but you know, and I’ve been doing this for 43 years here and one of the byproducts of hopefully good and successful talent development is that you get people who become more self-confident and they want to leave. And if they don’t see the opportunity to grow in the organization, they look elsewhere and you and I both know that there’s a lot of turnover, and for women, particularly, who are watching this, there are a lot of good jobs available and this is really an interesting and challenging environment. And my feeling was that it would be selfish to have developed these people and I’m a big proponent of internal succession because I think there are objective data that say that, on balance, internal successors are more successful, faster than people recruited from the outside. And so I really felt that there was a generosity that I needed to display, to say to these people it’s been worth the investment that you’ve had at Yale New Haven Health. And so we turned over the President of the Academic Medical Center, which is 1,540 beds, and the health system CEO role when I leave, and human resources, Chief Human Resources Officer, so a relatively large amount of senior change in a short period of time. All internal successors. And none of them look like the other. You have a woman, you have an African-American man and you have a Caucasian male, and very different backgrounds. And then you round out the rest of the team. And so, I guess part of this is saying it’s bittersweet because I could work forever. My late father, who died last year at 98, retired for the final time when he was 90. So I hope the genes are on my side and I will be working for a long time, but I also look forward to not getting up at 5:10 every morning. Why 5:10? I don’t know, to exercise before I can come in and do this. So. I’m going to do a little bit of board work, but frankly, sitting on corporate boards is not what motivates me. I’ve been looking into some of the certificate programs, one at Columbia, to become a coach officially or a formal, not to make money, but to sort of build out the skillset because I know one of my own children has really struggled with trying to figure out where he needs to be, what he would be happy doing. And so I’d like to do some of that. And then I’m looking forward to working as a volunteer for some of the key not for profits that I have been philanthropically invested in who need a lot of support and can’t afford people like me. And I don’t need the money, so I can, as I said to them, for as long as I have any value, use me. So I think I will probably be busy. But I’m going to have a great garden this coming next summer. I’m positive of that. And I’m going to take some bucket list trips that I haven’t taken because I kept saying, oh, I can’t go because that’s my annual board meeting or I can’t go because…all that. So it’s a poupurri Joanne.

[00:24:54] Joanne Conroy, M.D.: Yeah. So a couple things. When we started the conversation, you did mention that 35 year old president of Stanford Hospital. And you know what? We know that we’ve had a lot of senior leaders that have stayed in leadership roles for a long time. So young women that are listening to this need to appreciate that there’s going to be a turnover. We’re starting to see it right now, where people are starting to step down from their positions to really allow other people to lead. And it is a tough time, but women need to know that there’s a lot of opportunity out there. The second thing is, I totally agree that when you actually have great leadership development programs within your own organization, internal promotions just validate it for everybody that they can move up in the organization. But you know, it’s, people will miss you because you are Yale new Haven Health. You’ve created the health system. It was only one hospital when you started and it’s a force across Connecticut and in the New York metropolitan area. So what is the top place on your bucket list?

[00:26:10] Marna Borgstrom: I want to go hiking and fly fishing in New Zealand.

[00:26:13] Joanne Conroy, M.D.: Oh yeah, you said you love fly fishing.

[00:26:17] Marna Borgstrom: Yeah. Yeah. So, that’s one. And then I have a Russian cardiologist friend who I’ve been working with professionally for a number of years, and I want to spend some time in St. Petersburg with her. I’ve never been to Petersburg, but I understand it is a magical place. So those are probably my top two.

[00:26:36] Joanne Conroy, M.D.: And what are the not-for-profits that you are so supportive of? I think you’re right. For them to actually hire people with your level of just expertise in the organizations would be undoable for many of them.

[00:26:52] Marna Borgstrom: Yeah. So there’s one in particular called ConnCAT, which is the Connecticut Arts and Technology Institute. And basically it was built and modeled after a project done by a guy whose first name I’m forgetting Strickland in Pittsburgh. And it focused on trying to give job skills, education and training to adults who either hadn’t finished high school, may have been incarcerated, but sort of find themselves wanting to get back into the workforce, into society, but don’t have the skills, don’t have the wherewithal necessarily to get the kind of education training. And so ConnCAT is kind of a work study program that has been built up over time. And I hope we can replicate it. But part of where they built their programs is they came to us early on and said, what do you need that you can’t fin? Well, coders. How do you teach people to code? Phlebotomists. They now have a culinary arts program and we have a lot of people eat a lot of food. So, you think about those things and, there’s an element of philanthropy, there’s an element of strategy. And there’s just advocating for organizations and people like this in the community. And I will tell you I’ve been so inspired. By the leaders of ConnCAT and the people I’ve met who have graduated from ConnCAT and found a place in the workforce in ways they never thought they would given, in many cases, poor choices they made earlier. So that’s been a favorite philanthropy of my husband’s and mine and is one group that I would like to work with.

[00:28:42] Joanne Conroy, M.D.: Yeah. Yeah. Well, I didn’t expect you to be golfing five days a week in retirement. And, you know what, I think you live and you value. Something that I’m not sure leaders appreciate is the importance of philanthropy and philanthropy as a leader. It’s interesting. The best advice I got was from my chairman of anesthesia at MUFC, who taught me the value of philanthropy. I actually didn’t get it from my parents. But it is really important as a leader. And so I wouldn’t expect you to do anything else except continue to give back to the community as you’ve been doing for the last 40 years.

[00:29:25] Marna Borgstrom: Now, One of the things that you said, which is really interesting. So I have done financially better than I ever thought I would do in anything in my life.And I don’t need a lot of money. I’m not a big clothes and jewelry person. As a matter of fact, I’ve started giving away my clothes already now, which is kind of fun. But when I was doing some personal financial planning, one of the things that my husband and I decided to do was to create a very small foundation and have our sons be responsible for it. So it’s a certain amount of money that they will oversee, but it’s not to go to them. It’s to learn how to make, how to research, and how to understand and make those kinds of philanthropic decisions because I had the same experience you did, joanne. I didn’t understand it. I didn’t understand the power of philanthropy.

[00:30:13] Joanne Conroy, M.D.: It is very powerful. It changes the landscapes of our communities, our cities and it’s incredibly powerful. And it’s a leadership skill that people need to have to appreciate it and integrate it into their lives. It’s been a pleasure Marna. It’s always great to talk to you. You’re an inspiration, not only to the women of Connecticut and New England, but really women leaders across the United States who aspire to lead health systems. So thank you so much.

[00:30:46] Marna Borgstrom: Well, thank you, Joanne. And coming from a person who was just beautifully honored by Leapfrog, that means a lot because I have watched your career and you are amazing and doing amazing things at Dartmouth Hitchcock.

[00:30:59] Joanne Conroy, M.D.: Well, thanks Marna. Thank you. And to our audience, thank you so much for joining us and have a wonderful day.

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