Ep. 87: A Voice at the Table

[00:00:00] Nancy Howell Agee: It is a pleasure to be here today with my dear friend and wonderful, trusted colleague, Mindy Estes. I’d like to introduce you briefly by commenting on what you’re currently doing and a little bit of your background, and we’ll get right into it. Dr. Melinda Estes. Mindy is a physician. She is president and CEO of St. Luke’s health system headquartered in Kansas City, Missouri. Mindy is champion I know of forwarding healthcare of innovation, healthcare and in particular of strengthening physician engage. In 2020, Mindy served as the chair of the American Hospital Association’s Board of Trustees. And so we’ll get right to it. I would love to hear your story and I’m gonna ask you a very pointed question, and that is, you have shared with me that your father was a big influence on your career, so I hope. Describe your journey. You’ll talk a bit about what it meant to have a father as such an influential person in your life.

[00:01:07] Melinda L. Estes, M.D.: I’m happy to. Thanks Nancy for doing this. I grew up in a household where I was told from the time I was little, anything was possible. And my mom was a pharmaceutical chemist at a time, when women did not pursue science education, but my dad was a social psychologist and career military officer, and I think, that really influenced me from a very early age because it was a life in service to others and dedicating. Yourself to something that was greater than you. And that was something my father emphasized always from the very beginning. He was a scholar. He was a great father, but above all he was a patriot. And I think as I have. Pursued my professional career and I was very fortunate to have my dad with me until he was 93. He never believed as a veteran of three wars that he would see 93. But I know he was very proud of the notion that it stuck that you do something greater than yourself.

[00:02:09] Nancy Howell Agee: Great story. I know too that you have juggled a professional career as well as marriage and mom to two children, two daughters. I know you as a trusted colleague and a as a dear friend, as a mentor, as an innovator, and I know you’re passionate about healthcare. Can you talk to us about what it was like to juggle all those different priorities as you moved along your career?

[00:02:37] Melinda L. Estes, M.D.: So one of the things I learned then that has stuck with me my entire career is the value of colleagues and the value of colleagues who are going through the same things that you go through, who get it, and you and I both know we’ve had many conversations. Is where we get it. And it’s very helpful to have colleagues who understand what you’re going through. I was very fortunate my husband, Holly, successful neurologist understood that, this was a partnership and it was a full partnership. And we would, I remember every day negotiate who came home first. And I think it I think it worked pretty well, but, I was always looking for a way, to lead and to learn. And what happened is, as so often happens I was given assignments mostly by the older men at the Cleveland Clinic that, seemed to reflect of my sensibilities and my gender and what things I might know about. For instance, I started my administrative career on the childcare committee. I was on the library committee. I, that was my first chairmanship, was the library committee, and then I was on the redecorate, the foundation house

[00:03:44] Nancy Howell Agee: Oh,

[00:03:45] Melinda L. Estes, M.D.: which I actually think had they really known that was a mistake putting this woman on that committee. That’s not one of my, one of my strong suits. But, I learned over time that you, you know, to be to. In the mix, you have to sit at the table and even if the table is a small table, you need to you can learn from that. And you can learn to know how you build consensus, how you move a group forward, what it looks like for somebody who really chairs a good meeting and what it looks like when somebody.

[00:04:20] Nancy Howell Agee: So Mindy, you are a board certified neurologist, a neuropathologist with special training in pediatric neuropathology. I would say that makes you wicked smart. and you were a practicing physician doing a lot of administrative things, but but all in the medical world and somehow your path moved towards. Healthcare administration and I just wanna comment that about 60 to 65% of the people employed in our field are women but only about 30% of the C-suite, and that’s all the Cs, whether it’s the cfo, the coo, the C, the cmo, the cao, the Chief Human Resources Officer. When you put all that together, only 30% are women. Women CEOs are still unicorns. And can you talk about, first of all, your journey from being a practicing physician to moving out, into into the administration of a hospital or health system? And then let’s talk a little bit about how we can encourage more women to get into the administrative roles that I think would be so important.

[00:05:33] Melinda L. Estes, M.D.: I think no career is a linear journey, and I think a lot of times we see it that way. And women in particular, I think we have to look for the opportunities that are presented to us. And, sometimes an opportunity comes forward and women look and say, Gosh, I don’t meet a hundred percent of those criteria, so therefore I’m not ready. And our male colleagues, as you know, Nancy will say I meet about 60, so that’s good enough for me to throw my hat in the rink. So some of it I think is a mindset change for me. I was very. As I built on, all of those committees, library, childcare, et cetera, I then had the opportunity to be the first woman on the Cleveland Clinic’s Board of Governors. And I think all of those skills that I learned on those small committees, Became very important cuz you walk into the room, the first thing you need to do is decide who is your ally or hopefully allies, , when you ought to speak, when you ought to be quiet. What can you uniquely bring to to the table? And I think women in particular, Need to be still the best prepared in the room because if you are not, it’s noticed. And I think many times our male colleagues are held to a different standard. So for me it was, looking at the opportunities and doing the essential work, even though, some of it isn’t fun, some of it’s not glamorous, some of it’s not easy. And physicians in particular, Nancy, and you and I have talked about this, I think go and get an MBA. Was fortunate I got my mba, but you still have to punch your tickets. You still have to do the work. You still have to understand how an administrative team works, how the C-suite works. So I think it’s about doing the work. I think it’s about recognizing as a woman that you don’t have to have a perfect resume. That you need to be able to look at an opportunity, evaluate it, and then I think it’s the organization that’s helpful. My journey in the Cleveland Clinic, I, I think early on They recognized that they needed some diversity in leadership and an N of one is better than none, but it’s it was the start to to diversity. But, it’s, it also I think, is all about flexibility as an organization because I think women and you’ve been a working mom, we need flex. And it’s not just flexibility in roles, but recognize thing that what’s expected of us is often different. And I think when an organization can do that helps. And to me, those are the things that will make it possible for more women to be in in the C-suite.

[00:08:19] Nancy Howell Agee: Did you find it very different being a physician leader? Then being a hospital or healthcare administrator, what were the differences or what were the similarities?

[00:08:32] Melinda L. Estes, M.D.: I think, some of the similarities I’ve learned over the years as these are very lonely jobs and the higher you go in an organization, the smaller the micropore filter gets. People tell you what they think you want to hear, as suppose. For what you need to hear. So I think there are a lot of similarities there. I think the differences are, you go one day from being a colleague and having a white coat on to the next day being a suit and being an administrator, and somehow the fact that you were an accomplished physician who was shoulder to shoulder with your colleagues. The week before goes away. And I think that’s the hardest thing for physician executives to understand. And, it hurts because these are your colleagues and all of a sudden you’re thinking like somebody else when realistically we’re the line workers of healthcare, physicians, nurses, and, we should all want to have that clinical voice at the table.

[00:09:35] Nancy Howell Agee: As a clinical nurse specialist, I wore a white coat often, and when I moved into a vice president role was making rounds and I had a white coat on. And one of my colleagues actually pulled me aside and I think he gave me really good advice, and it wasn’t so much what I wore, but he said, You have, you need to make a decision. You can have a foot in both camps. You either need to be the vice president or be a clinician, but trying to straddle both is confusing to the people that you’re leading. And I thought that, I really thought about that later. It was good advice.

[00:10:12] Melinda L. Estes, M.D.: think that’s right, Nancy. But I would just add too particularly in some of the clinical roles CMO roles in particular Chief Quality Officer roles, when you have physicians in those roles, I do think it’s important for physicians to continue to practice, even if it’s just a small amount because there is something valuable about understanding what’s going on. On the clinical front lines. And the best example that we all know is, until you struggle with the electronic medical record yourself, you can’t appreciate what others do.

[00:10:46] Nancy Howell Agee: True enough. And certainly during the pandemic I didn’t know about you, I had a lot of fun going out and giving vaccines and using a few of those clinical skills that maybe were a bit rusty. and it meant so much to, to our folks that oh yeah, you’re a nurse. And that somehow made a difference. And I know that you were visible during the pandemic as well. I just turn the table a little bit to the pandemic and maybe as we’re coming out of it knock on wood, what innovations do you see? What, are there any silver linings, things we’ve learned during the pandemic that will help improve healthcare going forward?

[00:11:23] Melinda L. Estes, M.D.: I think the pandemic probably is a. A classic example of what one of my mentors once told me making lemonade outta lemons. I think there, there were several pictures of lemonade that we made. I I think one is just the triumph of science, and I really have, as I know, you have been grounded in science for a long time and the good of science. And I think in the pandemic we saw the best of science. Multidisciplinary, collaborative, global. Science that gave us all the tools that we now have. And you remember back in the march april timeframe of 2020, we had no idea what this was. We knew we could take care of infectious patients, but boy did we have no idea of the magnitude of what was coming our way. So I think that was one. I think another is in healthcare we’re analytic. We like to study things in academic healthcare in particular. We pilot things, then we pilot something else, and we learn to make pretty good decisions with imperfect information and to not be a. Bothered necessarily by the fact that you might make a decision one day and by the end of the week you have to pivot from that decision because circumstances have changed. And I as we’re coming out of this pandemic and we’re coming into this new world of healthcare and, people talk about a new normal, I don’t know what that is, but I think that imperfect information and ability to make quick decisions is really important and something we shouldn’t lose.

[00:12:53] Nancy Howell Agee: So you mentioned mentors just now, and you said you had a mentor. Can you talk about your own mentors and then what you would recommend to perhaps the women listening or watching this video about mentorship?

[00:13:08] Melinda L. Estes, M.D.: I think first and foremost, mentors are extraordinarily important and, mentors good ones have gone through some of what you’re going through. They can give you advice, they can listen, they can be great resources, and I think it’s important. To know though, that you have to recognize that you don’t know everything, that you’re a good listener, and that in fact it’s never wrong to ask questions of a mentor. And I was very fortunate, all of my mentors have been men and, mentors. Don’t fall out of trees. I think you have to seek them out and they can come from anywhere. And I’ve been very fortunate. I spent a good deal of time at the Metro Health System in, in Cleveland as a senior Vice president for clinical affairs and Chief Medical Officer, and I work for a man named Terry White who was the ceo. And he was a great mentor. He was giving of his time. So much of what I learned from him has stuck with me. And two things that I often tell my folks are, one, is hug the thing that scares you the most. Get close to it. Embrace it until it’s not so scary anymore. . And then I think the other thing is don’t let the perfect be the enemy of the good. And those are, life lessons that he imparted to me. And so I think for the women listening mentors are important. They can be men, they can be women, they can be anywhere in the organization. I think you often have to seek them out. And you have to be a good mentee as well. It is a bilateral relationship. And I will tell you, and I know you mentor a lot of people, Nancy, it is a great honor to be asked to be someone’s mentor. And I think we all have a responsibility. As I, I’ve got a fair amount of white hair here to impart some of what we’ve learned and some of what we wish we had learned to to that next generation.

[00:15:05] Nancy Howell Agee: We only have a few more minutes boy, this time has gone by so quickly.

[00:15:09] Melinda L. Estes, M.D.: sure has

[00:15:10] Nancy Howell Agee: let me just ask you a couple other questions and, maybe this is one you can laugh about a bit and that is if you gave some advice to your younger self, what would that be?

[00:15:22] Melinda L. Estes, M.D.: I think it would be that patience is a virtue. And I think I. Have always pushed hard for what I wanted to do and what I was passionate about. But I think I would also tell my younger self that, sometimes you have to let the game come to you and that no matter how hard you push, sometimes it just takes time for things to come your way.

[00:15:46] Nancy Howell Agee: So we haven’t really talked about the American Hospital Association, and you’re chairing yet. We both have that honor of, at least at the time, stepping into a man’s world in so many ways. What did you learn from that experience? And it’s a three year experience, isn’t it? Your chair, act chair and the immediate past chair. But lots of opportunity to go across the country and meet a lot of different people and their different journeys in healthcare. Any thoughts about what that was like for you and what it meant?

[00:16:18] Melinda L. Estes, M.D.: Yeah. It was actually being chair of the aha was really one of the pinnacle of my healthcare career. And I know many of us who’ve had that honor feel that way. It was an opportunity. To learn from your colleagues what all 5,000 hospitals strong who are part of aha. To build a network of trusted colleagues, which is just critical and has proven, I think, to be even more critical with all the challenges that we are facing. I think watching Aha and being a part of trying to be intentional. In being more inclusive in bringing different voices to the table and realizing that if that is your goal, that can be done. And when you have that diversity of opinion and that diversity of experience sitting around your table, good things happen and I think, people may not realize just how smart the aha board is and how accomplished the people around the table are. And one of the things, and I know you did it well when you were chair and I tried to do it is, a lot of it is listening and orchestrating and being sure that all of the diverse viewpoints are are heard. My, my chairmanship was Rick Pollock refers to me as Covid Share one and I did virtually. Virtual is the key. Virtually all of my chairmanship was done on every platform you can think of that we were just learning about. But as a result, I really had the opportunity, I think, to touch even more people than I was traveling if I was traveling. And, I think Aha excelled during the pandemic of providing information, providing tools, and quite frankly, providing a forum and some therapy for all of us. It was a great experience and when you step away from aha, you don’t totally step away from Aha, but I do miss those days.

[00:18:15] Nancy Howell Agee: And not everyone can be on the AHA board or any board for that matter, or certainly the chair, but I think the lessons learned there are how to How to reach out, how to lean in, as you’ve said, and get to know other people all across this great nation who have great ideas learn from others and seek those opportunities. The lessons that we learned, the opportunity that we had. Because of the position that we were in are also things that all of us can do as we reach out to colleagues across the country. And I think women are particularly good at developing relationships and wanting to nurture and honor and respect other women in their leadership journey. So last last question. Boy, I could ask you a dozen but but maybe. Maybe it’s this, what what’s the title of your story?

[00:19:09] Melinda L. Estes, M.D.: I think the title of my story is A Privilege to Care. You, I I believe what we do is a privilege and that we are honored to be able to take care of people at their most vulnerable, from their most desperate moments to their most joyful moments. And that with everything else that. Is going on now in the past and will in the future. That as long as we keep our eye on exactly why we are here and why we went into this business, then I think all will be well cuz it is truly a privilege.

[00:19:41] Nancy Howell Agee: Oh, Mindy, you couldn’t say anything more profound than that. How lovely. You for doing this morning. It’s been just a treat to see you. I’ll be it through a glass screen and spend some time together talking about women leaders. You are a phenomenal leader, an amazing woman, an amazing leader, and I wish you all the best. Thank you.

[00:20:04] Melinda L. Estes, M.D.: Well, Thank you. Thank you my friend. I appreciate it.