Episode 06

Wisdom from Our ‘Elder’

with Elder Granger, M.D., MG, USA, (RET.)

April 22, 2021

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Elder Granger, M.D., MG, USA, (RET.)
President & CEO of the 5P’s LLC

Major General Granger, M.D., is the President and CEO of The 5Ps, LLC, a Centennial, Colo.-based health-care, education, and leadership consulting organization, since August 6, 2009. Prior to his retirement from the US Army on July 1, 2009, MG Granger served as the Deputy Director and Program Executive Officer of the TRICARE Management Activity, Office of the Assistant Secretary of Defense (Health Affairs), Washington, DC, from December 2005 to May 2009. In this role, he was the principal advisor to the Assistant Secretary of Defense (Health Affairs) on DOD health plan policy and performance.

In his role leading, MG Granger required strong, value-based relationships with major insurers to be affiliates. This required clear guidelines to assess and determine “best value”. A rigorous process was implemented to ensure clear requirements and criteria to manage these relationships to measurable, accountable outcomes.

He oversaw the acquisition, operation and integration of DOD’s managed care program within the Military Health System. MG Granger led a staff of 1,800 in planning, budgeting and executing a $22.5 Billion Defense Health Program and in ensuring the effective and efficient provision of high-quality, accessible healthcare for 9.2 million Uniformed Service members, their families, retirees and others located worldwide.

Leadership is truly being inculcated in understanding the mission and the culture. Our culture is based on the constitution. We shall defend the constitution against all enemies, foreign and domestic, and put true faith and allegiance to the same.

Elder Granger, M.D., MG, USA, (RET.) Tweet



Gary Bisbee  0:06  

Healthcare leadership is hard work, but what if you could learn from the most brilliant and influential minds in healthcare and beyond? What would you ask them? Would you ask about politics, policy, or maybe leadership? On the Gary Bisbee show, I’ll do just that. You’ll hear from healthcare’s most successful leaders and those experts who they listened to as together we’ll explore how the health economy is transforming. The great American story applies to Dr. Elder Granger who grew up in a small town in Arkansas in a family of twelve and he’s the first in his family to graduate from high school and college. Not only did Dr. Granger earn his medical degree and practice as a physician, but he retired from the US Army as a major general. He now is the CEO of The 5Ps, which provides advisory and consulting services in the areas of healthcare, education, and leadership. General Granger served in the US Army for over 35 years, holding numerous commands, including TRICARE, which is the health plan for the Military Health System that coordinates military hospitals and clinics with civilian health networks. He is an expert in leadership and decision making, which he studied throughout his military career. The conversation dug into the approach that the military uses to teach and develop leaders. We wrapped up with a discussion of characteristics of leaders in a crisis. General Granger sits on the Cigna and Cerner boards of directors. He’s a graduate of Arkansas State University where he received his bachelor’s and medical degree. Well, good afternoon, Elder, and welcome.


Elder Granger  1:58  

Thanks. I’m looking forward to it and glad to be part of the program and the show today.


Gary Bisbee  2:03  

Excellent. Well, we’re pleased to have you at the microphone. Why don’t we set the stage. We’re very interested in leadership and particularly decisions that leaders make, and we’re interested in the power of questions where we have an expert like yourself to be able to pummel with questions. So thank you for participating. Let’s dig right in about you. You come from a family of twelve in West Memphis, Arkansas. What was it like growing up in your family, Elder?


Elder Granger  2:34  

I was a middle child of twelve and I was the one who was always doing something like reading or enjoying something sort of exploratory to the point that sometimes my mom would say when I was growing up, “You need to spend more time playing with other kids and less time always trying to read the newspaper or watching some show on television.” So I was always big on reading nonfictions instead of fictions. I only read fiction that I required in high school or college. So it was nice. I was sort of the quiet individual among the twelve, and with eight of us still living. And more focused on, what I can tell, the important things in life.


Gary Bisbee  3:11  

Well we were talking about your 95 year old mother a minute ago and can you share with us how you came about with the name Elder?


Elder Granger  3:20  

Basically, my mom was in labor. I was born at home by a nurse midwife. She was in labor, she was having a lot of difficulty. So she grabbed the Bible and started reading about the 24 elders in the Bible and for some magical reason she said, “I want to name him Elder.” The nurse midwife said, “Well, I don’t think you should do that.” So here’s another part of the story. During that time the midwives will take the name and they would submit it to the state Bureau of Vital Statistics and you only saw the birth certificate if you requested a copy. So later on when I got ready to go to college and apply for an ROTC scholarship, they said get a copy of birth certificate. I paid the $10 and mailed it to the Arkansas State Bureau of Biostatistics. My name came back on my birth certificate Elbert, “E-L-B-E-R-T.” So my mother and my father had to sign a corrected birth certificate. My mom was not happy with the midwife and, God bless her soul, but I had to get a corrected birth certificate.


Gary Bisbee  4:20  

Which you did and hence we all know you as Elder. I was joking with you a little bit before, I don’t know whether to call you Dr. Granger or General Granger.


Elder Granger  4:30  

Well, call me Elder. My mom will be happy at her 95th years of age after being called all kinds of ranks in front of my names, which I take honor and pride in.


Gary Bisbee  4:39  

Well, we’ll do that. Throughout your professional life there’s been two tracks – medicine and the military. What came first, I suppose you were interested in science or medicine before you were interested in military, is that right?


Elder Granger  4:53  

That’s right. I was always wanting to be in something in science. Once I wanted to be a biology teacher or math. I was always really good and inquisitive about math or science. So I made that decision based on just being around key peoples in my life, whether it be Dr. Lemuel Diggs, University of Tennessee, the director at that time of the sickle cell anemia program, as are Miss Sarah Eden, a kindergarten teacher who had a great influence in my life or several other individuals. But in addition to the military, so I made that decision based on what I didn’t see. I didn’t see anybody who looked like me in the field of medicine or science. So I was always told it’s important in order to be, you must see somebody who looked like you. So I sought that out and if I didn’t, I wanted to go in that field. From a military standpoint, I have several cousins who had been in the military, but not in my immediate family, father, anybody like that. Some of my distant uncles had served in the military. I saw the military as an opportunity. It was at the end of Vietnam, so I just said, look, I’ve got the permission of my parents and having worked at a National Guard Armory on a special program that would take youths and let them have a summer program and work and on behalf of the federal government, some county, local, or estate agency. I fell in love with what they were doing and I was encouraged. So I made that decision based on, there was opportunities to pursue a military career, opportunities to do more like in the field of medicine. I became an army medic. And then there were opportunities to also take advantage of some scholarships, career opportunity as well, with all those two combined from that standpoint. That was two of the major decisions I made early in my life.


Gary Bisbee  6:41  

So when you joined the military after college, then I believe was that the point you decided to go to medical school? Or had you already thought about that and the military just made it possible? What was that sequence, Elder?


Elder Granger  6:54  

I joined the military while I was in high school. I joined the Arkansas National Guard. During all of my senior year, November of 1971, they had delayed entry program, so if you can either go on active duty, you can join a National Guard or Reserve. And since I had worked at the National Guard Armory in my hometown, had been influenced by several individuals, especially those in the medical sections that were medics. So they said, “Look, you did great on the test,” the military test, entry test. And I said, “I want to do something in medicine.” They said, “Well, you can become a medic, you can become a pharmacy tech.” I said, “I want to be, I want to do something strictly medicine,” so I became a medic. So I left high school, went to my basic training, advanced individual training, where I was trained to be a medic. Did very well in both of those and I came back to the state in the fall of 1972, because I finished high school and ’72 May. And at that point, I started college, the spring of 1973. And I was going through freshman orientation and I saw this table of military individuals, nobody standing over there. So I went to the table and said, “Can you sign my freshman orientation, you know, slip.” They said, “We don’t need to.” And I said, “What do you guys do?” And they said, “Well, we take college courses that are military and we develop officers.” So I said, “Officers?” He says, “ROTC – Reserve Officer Training Corps.” So I took an interest in that and they said, “Well, look. If you had decent grades we can get you a scholarship.” They were giving away scholarships if you had at least 3.0, a 2.5 or above, and I had at least a 3.25 out of high school. So I applied, but I could not accept the scholarship until the following fall because you had to go through the approval process. It was that point when my birth certificate had to be corrected. So I couldn’t be an ROTC and a National Guard, so I was discharged from the National Guard the fall in 1973 and went into the ROTC scholarship program. And it paid for college. And I was a pre med major, zoology the study of animals, and from there, I did well in college. I had a chance to go to Harvard summer school, ’74 to ’75, my health career program by the Robert Wood Johnson Foundation. And then when I got accepted to med school, the military said, “Look, we can pay for medical school, but you’re still going to owe four more years, four years of my ROTC scholarship, four years of medical school.” So I said at that point, “What’s 8 years? I’m getting a good education, I’m doing what I want to do.” So I made that decision based on what are the options – my parents couldn’t afford it. So I had an option to do it, so that’s the rationale. That’s how I got started with the military. 


Gary Bisbee  9:30  

Yeah, that’s a terrific story. At what point did you figure out that you were a good leader and that you were interested in leadership?


Elder Granger  9:41  

It came about, first of all, when I was in high school. I was involved with the church and a lot of leadership positions. So they saw, my parents and my grandparents and other leaders in the church. Let me put it this way, it was oftentimes said I was a lot more mature and acted a lot older than most of my age. So at that point, others saw leadership in me and I felt that I had leadership. So if they saw it, then I need to develop it. So I was in high school and especially when I went to basic training, I was asked to take several leadership positions in basic training – squad leader, always being a person that they would call out to demonstrate a certain procedure, how to use a certain maneuver or marching or certain weapon. And the same thing when I went to medic training. I did very, very well. I was a distinguished honor graduate. So at that point, if these organizations felt I had leadership, I felt I had leadership. So I just developed over time.


Gary Bisbee  10:40  

So once you graduated from medical school, what was your first posting or your first set of responsibilities?


Elder Granger  10:47  

Well, two things. I left for the University of Arkansas School of Medicine in 1980, went to my internship at Fitzsimmons Army Medical Center, Aurora, Colorado, in internal medicine, internship residency, as well as a fellowship in hematology-oncology. So during that time, when I was in training, especially doing my fellowship as a hematologist-oncologist, blood disease and cancer specialists. My fellowship director asked me would I be willing to be the military representative to the American Cancer Society and go teach about, at that time, tobacco cessation, the effects of tobacco and developing lung disease and lung cancer. So I did a lot of volunteer leadership positions when I was in my training because they saw that I was prior service, basically had prime military service, having been an army medic, and going through ROTC. So I would volunteer when he asked for leaders to do certain things. Because if not, sometimes you didn’t volunteer, you get selected out, so.


Gary Bisbee  11:47  

Those of us outside looking in frequently hear about how decisions are part of the training in the military, and I suppose particularly of officers, but what was that decision training like, when did that start, and how formalized was that, Elder?


Elder Granger  12:07  

It started when I was in basic training, because everything you learn, they take you as an individual and a squad of 10, everybody must lead whatever that exercise might be. So if it is just teaching you how to do say, a maneuver, march down a road, so minutes, five on the right side, five on the left, or four and four, you’re leading the squad, looking for any situation awareness. So you’re put in situations where you’re trained to make a decision. And they give you a scenario, but when you go about 200 meters there will be a potential enemy attack. You’re now in charge, Private First Class Granger. What decision, you’re going to have to make key decisions and they teach you how to look at the situation or what is your mission, and develop 1-2-3 courses of action, and then based on your overall assessment of a situation, you sit down with your team, discuss the course of the situation, the mission, and you develop course of action. Everybody input, but you as the leader, you make the final decision based on the input and the situation, everybody else input on the course of action you’re going to take. So you do that when you’re in basic training. You do it when you advance individual training. And also, you learn to do that when I went back to the National Guard. You get that training throughout your entire career. Even when you’re in, say, ROTC, they teach you different levels of leadership training. You get a chance to play different roles. And what they do, they train you to the level of success, but they don’t lower the standards, you train up to the standards. And the same thing when I was in medical school. You train your medical skills, become a very good doctor, get all of your certifications, but then you have to learn your military skills as an officer. In everything, there’s leadership situation awareness, mission decision, course of action, your whole career.


Gary Bisbee  13:58  

What are the characteristics of a good leader? 


Elder Granger  14:01  

Number one is called loyalty, being loyal to the organization. Number two, what is basically your duty? It’s respect. Education, be very good educated in your skills. Have the right attitude, because the attitude will determine your altitude in life. Be respectful. Have a selfless service about you. Do it for the greater good of your mission, your country or organization. Personal courage. And then most important, integrity in everything you do and be willing to trust those you work with, you work for, or who works for you. And be willing to admit when you make a mistake, overcome it. We call it adapt, adjust, overcome, improvise and move on. And another trait that is very, very important, you must maintain calmness and respect and be compassionate in even some of the most tough situations, those are some characteristics.


Gary Bisbee  15:03  

I’ve known you for a while and I would say that you’re a naturally good leader. And some people are, some people are not. So for somebody that’s not, let’s say, a naturally good leader, can you actually teach leadership skills for that kind of person?


Elder Granger  15:22  

You can, but you must make it what we call professional development. You must basically say, this is what we’re looking for as some of the traits of a leader. Among those traits, what are their strengths in those traits? What are their weaknesses? And how you help them develop it, the situations or situation awareness, and giving them tough decision making processes and teaching them how to do the assessment, what are the courses of action, and then taking about 60 to 70/80% of the information you need and making a decision. Then if that decision not 100% correct, then adjust. Don’t continue to do it because you know it’s not correct until you get to the end of failure. You can do that over time. And it can be developed at the right level of schooling and training. We call it professional leadership development. In the military, you go through leadership development from even what we call officer basic course or as enlisted the same thing. You go to officer advanced course by mid career, group of selected go to the command and general staff where you do exercises together in teams or seminars. And a small group is selected to go to the different war colleges of our military. But between those schools, you’re really in a job, applying those leadership skills. And we train you to the level of a leader where you are comfortable. If you don’t go beyond that, you stay at that level as being a leader, and sometimes, you’re not only a leader, you’re a manager too from that standpoint. It is possible. We take raw talent, and I was raw talent, less than 1% of the population, and we train them into a culture. And part of leadership is truly being inculcated, understanding the mission and the culture. And our culture is that it’s the constitution. We shall defend the constitution, against all enemies both foreign and domestic, put true faith and allegiance to the same. That’s part of that oath that we all take. Even our government in terms of civilians when they take positions in government. So it can be, over time.


Gary Bisbee  17:26  

Let’s move through your career. You’ve had a number of different postings in the military. One, the TRICARE one I’d like to pursue more in depth. But what was your favorite posting, looking at all the ones that you fulfilled during your time in the military, Elder?


Elder Granger  17:43  

I would probably say when I was a senior medical commander in charge of all medical forces and the multinational corps rec surgeon as well as being responsible for the oversight of training for the Iraqi medical force. That was a very intense environment, but it was the most testing and I’d say dangerous and fun environment. Because I got a chance to see not only my skills being used across an entire theater of operational of country, supporting 170,000 to including contractors and civilians and others in the military, but also bringing together a team that had been most, at least, I’d say, 75% I inherited when I went to Fort Bragg to go to Iraq in 2004. But a small selection I selected. The others, they came from the National Guard Reserve and we had to pull together a team and implement for the first time in history, put an electronic healthcare record on the battlefield to document the excellent care that we were providing to America’s sons and daughters, civilians and contractors, as well as the Iraqi force and others and our coalition forces. So I would say that was the most fun, but dangerous and challenging job because you get a chance to manage everything – medical, dental, veterinarian, supply, blood products, evacuation, moving assets as close as you can to the battle or what is occurring, and making sure, in any type environment, whether it be a dust storm, hot weather during the day, cold weather at night, whatever occurs, can we be prepared to operate in that environment?


Gary Bisbee  19:27  

That is very impressive. So that was the first occurrence of an electronic medical record on the actual theater battle. Is that right?


Elder Granger  19:36  

That was the first in the history of the military. We had always used paper to document it, but we had developed electronic healthcare record for the battlefield. It had never been deployed nor implemented in a proper way. So I was asked to do it since I had a history of taking things technology and developing units and building teams. So I was asked to go do that challenging job.


Gary Bisbee  19:59  

That’s very impressive. Let’s move on to TRICARE. Would you describe TRICARE for our listeners, please?


Elder Granger  20:07  

I would be glad to. In the military we have what is called direct care, the care we provide in our military hospitals, clinics, and around the world. That’s what we do and those in uniform, both military and civilian providers who work with us as government employees, in some case, contractors. Then we have, part of the healthcare we buy we call a purchase care. So the total TRICARE population is about 9.5 million beneficiaries around the globe. So what we cannot provide in our military hospitals around the globe, we go out and buy it or contract it, either locally or we take large contractors, whether it be the major healthcare providers in these countries – United, Aetna, Cigna, Anthem, Health Net Federal Services, TriWest, you name it. We will allow them to bid and compete and they serve as administrative service organizations. We pay the healthcare bill, they are doing an administrative fee. And we put in certain criterias they must fulfill – quality, access outcomes, and really making sure they select the best providers as well from their standpoint. So I managed that program. It was a $22 billion a year program. That’s what we go out and buy, not including the $7-8 billion of pharmacy. But it’s regionalised. When I was managing we had three regions – they had a north region, a southern region, a western region. And then we have overseas – the Pacific, Europe, and Europe covers all of the continent of Africa as well as several other countries we have to deal with. We have individuals assigned to embassies, Marines, or Army individuals, as well as North American/Canada, or in the islands, the caribbeans and other places.


Gary Bisbee  21:55  

Many people think that TRICARE would be a terrific model for the country. Does that make any sense? How do you think about it?


Elder Granger  22:03  

I do see it as a model because the way it works is that we recruit healthy individuals in terms of the military. But when they come in with a family, when they develop a family, we take the family, all the pre existing conditions. We put in a very strong preventative population health program that is culture based, designed to take care of individuals from the time a baby’s born until they get to a certain age, now age 26, or until you retire, which we call from cradle to grave. It is a very cost effective program. It has all those things you need in healthcare – access, prevention. We eliminate, to the best of our ability, social determinants of health. And then the fact that you have a strong preventative, you’re not doing a lot of weight and individual getting a bad condition, they come in needing emergency care which is very expensive. So that is a model. Some of the things you see right now in the Affordable Care Act – no copays and deductibles came from us powering that idea over in the military. And some of our population that they have to pay a copay or deductible for preventative services. We eliminated it. We increased preventative service usage significantly. So I see it as a model. And plus too, it’s a model that you can basically control the costs over time.


Gary Bisbee  23:27  

Thinking about your entire career in the military, what was the hardest decision you ever had to make would you say?


Elder Granger  23:37  

I would say the hardest decision I ever had to make was probably when I was at the commanding Landstuhl Regional Medical Center which is in Landstuhl, Germany which takes all the casualties from all around, whether it be the Middle East, in that part of the world, the EU and all the other countries we support including Africa. One morning we had to do an exercise where if you’re overseas, if you bring your family overseas, you must have a family care plan. If you’re single with family, or if you are dual military with family, you must have a family care plan. What it means that if we have to rapidly, you have to come in, we have a catastrophic incident that occurs and I’ll give you one in a second, you have to be able to come in within a certain period of time. So if you have to worry about who’s going to take care of my dependents or my kids with me, or in some cases, elderly parents that will sometimes come with you, then what is your care plan? Is there somebody there with you who can take care of that or somebody have to be flown over, but you have to come in. So one morning we had an exercise and it’s coming up to the USS Cole off the coast of Yemen, the Navy ship that was attacked. Well, we had a real world crisis. And so we did the emergency call in and that morning we had to be in within about an hour from the time they called, you had to be ready to get in. So you have to live a certain distance to the base. Well, I was notified that, that the daycare on the installation did not open until six o’clock. We got the alert round about four o’clock in the morning. So it’d mean you had to be there at least by five. They would have casualty coming in from Yemen off the coast of Africa, Djibouti so that everybody not making in time I said, “What’s going on?” “Well, sir, you know, the daycare is not open.” So I said, “Look, I’m going to make a tough decision. And I want nobody to be charged for not having a family care plan. I want to take the daycare that we have within the hospital. I want us to open it up. I want to take nurses and others and medics and go down their with their families and supervise the kids, but I need the troops to come in. And then I want them to feed them. And my wife and I we’re going to pay for it. But I don’t want nobody charged because I wanted them to come in.” So that was a tough decision. I could have taken a hard road that look, I’m going to charge everybody that don’t have a family care plan, etc. But that’s where sometimes you have to have compassion and calmness coming in. We had a real world crisis. That was a tough decision. What do you do? So I said, “Let them come in, bring them all in.” That was one tough decision. The second tough decision was, we had an incident that took place in Iraq. There was a dining facility up north, Mosul, that had bad person walked in, blew up themselves, and had a lot of injuries. So we have to shift assets around in the safest possible way from different Army, Air Force or, as well as Navy facilities we had to move the aid around to help each other out. Same thing with Fallujah when the Marines were in Fallujah. We had to rapidly move assets and sometimes you have to do that. You have a certain amount of assets here, but you need to get them here. And you’re going to take a risk over here if something happens to put them where they’re really needed. Those are always, again, what is the mission, what is the situation, what are the courses of action, and which one has the most success and the least amount of risk? So I would consider those some of the tough decisions. They may seem tough at the time, it was a right and realistic thing to do.


Gary Bisbee  27:22  

That’s another good example of the fact that you’re just a very good leader. Elder, can you share with us The 5Ps, which is your company? What kind of business are you in?


Elder Granger  27:34  

It’s a thought and educational leadership, and what I mean by thought and education, because it’s a consulting business. And I put it around the 5 P’s. The thought should always be around an education around people. What process or procedures, regulations, or rules or laws are you trying to improve or change or modify? And then, what are you really trying to mitigate or prevent? That’s the third P. And the fourth P is productivity. How you look at organizations and individuals and system and make them more efficient and effective. I call it E2, which leads to productivity. So I try to educate and teach on that based on everything I’ve been taught in the military and that I’ve learned in life. And the last one is price. When you approach any situation, what price are we talking about? Not so much we’ll get to the cost, but you got to take people and they’ve got to pay a price, whether it be be risking lives or doing something they’ve never done before, been trained to do it. And then you’re going to say, “Well, what is the price that we must pay? What do we need in terms of dollars, supplies, equipment, all those things?” And then, I always say to myself and I try to teach, are what we trying to do or answer, does it have value? If so, is it relevant? And then, inside of the 5 P’s in the shape of a pentagon, the top is, number one, is a good quality, customer service, that you’re accessible 7/24/365 or utilizing the resources in a proper manner, utilization management or supply chain management. And then, are you using risk management? You can never eliminate it, but you have to decide what risks you’re trying to control to the best of your ability. And then, at the base of it, I said before, is it value? If so, is it relevant? That’s what I do and I do from a consultant standpoint, a teaching standpoint, as well as I try to live it from a life standpoint.


Gary Bisbee  29:38  

Let’s move to governance. You’re on several boards, at least 2 healthcare boards, Cigna and Cerner. When you join a board how do you assess the culture and decision making process of the board, Elder?


Elder Granger  29:54  

Well, first of all, if I join a board, I go out and look at all publicly available sources. What has been the history of the board? What has been the success of the board? What has been some of the critical problems of the board, whether it be sanctioned by government or other type issues? I look at that first of all, number one. And number two, I see, how do I fit in terms of skill matching? What skill do they need that I might possess or what I do possess that I developed over time that might fill in this skill void. But then I want to see well, how does the board interact and what is the culture? Is it a combination of a chair, CEO chair combined? Or do they have a lead director or they have an independent? I assess all those. Then, when I’m being interviewed, when I talk to the governance committee or the CEO or the board chair, I tend to ask some tough questions. What do you see my role and how can I best serve in order to get, number one, shareholder value? Then traditionally are responsible for the duty caring and dual loyalty. And then I see where’s the company fit in term of health, where they can go and grow? And how can I work with the rest of the team and contribute? And I do say team, because team as a very important part of being on any board. And then, the final thing, how well is the board governance? How well the leadership of the current board term chair, lead, directors, and others? So I make those assessments before I say yes to a board.


Gary Bisbee  30:55  

My experience on boards is that a lot of the decision making that you have to make as a director isn’t particularly difficult, but there are challenging decisions that come along from time to time. In your experience, what do you think the most challenging decisions that a board member would have to make?


Elder Granger  31:52  

I would probably say, number one, CEO succession. What is the CEO succession plan? And what if a crisis happens, and, God forbid, something happens to the CEO or, or the combined CEO and board chair? Who are the next one or two individuals who can immediately step in? Is it somebody from the board or somebody internal to the organization? And then what is the next layer of leadership? Could they still continue to operate the organization without being totally dependent on the CEO or the next one or two individuals? And then, what is the continuity plan if there is a major crisis. Case in point – if something happens at the organization headquarters – tornado, flood – what is the contingency operation site of continuancy plan that an organization can still operate in spite of the headquarters being demolished, or say 20% functional or 50% or less dysfunctional in term operation? I see that as a decision. And how often do they practice their contingency operation plan? Another thing I look at, what is the cyber security posture of the organization. Because now with cyber being the new information war that we talked about years ago when I was at Army War College, ’96/’97. And there’s now an information war going on in terms of cyber security. And how well is that company prepared currently as well as future to fight off cyber attacks? And then, the last thing, are they financially sound and do they have a very good strategy to grow the business based on current technology, either buying or developing new technology for the future.


Gary Bisbee  33:41  

Well, you speak about crises and challenges of that sort. And of course, we’re all dealing with the coronavirus pandemic. Do you see any lessons coming out of these crises for directors? And particularly, do you think it’s going to change the criteria for director selection in the next generation of directors?


Elder Granger  34:04  

I see several lessons learned. Number one, I see there’s a huge need for us to really practice and really practice crisis management for, rather it be pandemic, whether it be a hurricane, earthquake, tornado, flood, number one. And number two, training your next leaders on how to truly do supply chain management. How can we get what we need in order to get to what the customer needs? And what are our alternative plans in terms of supply chain. This pandemic and crisis have taught us that we went from having prepositioned stock at our organizations to just-in-time delivery. But everything with all the type of just-in-time, whether it be Amazon, and other type of logistics. We need to start looking at, can we do pre-position stock and teach leaders as well as voice on the stand the importance of logistics. We oftentimes would say in the military and we still do, “Amateurs talk about tactics. How are we going to do it? Professionals talk about the logistics of it.” And can we operate in a virtual world. New board members need to understand the importance of split base or tri base operation, virtual, being in presence, or being remotely in other locations from their standpoint. And do we have a strong communication that is not penetrated by foreign adversaries from a cyber security standpoint. And the last thing, being independent for our supply chain management. And if not, being in partnership with friendly countries, if it gets certain key ingredients or supplies from those countries. Are we part of that priority? If not, we grow it in America, get the ingredients that we need manufactured inAmerica.


Gary Bisbee  35:58  

Elder, this has been an absolutely terrific interview. We appreciate your time and your interest here. I have one remaining question if I could. And you really addressed this at several points along the line before, but I’d like to ask the question directly. And that is, what are the characteristics of a leader in a crisis that are the most important?


Elder Granger  36:21  

Number one, stay calm at all times. Number two, trust your people. Number three, trust your instincts. And number four, be prepared to change your decision if the crisis changes. And be prepared to make sure that you have a group of leaders that if something happens to you, they can walk right in and can continue to manage the crisis. You have to have leadership development. I used to oftentimes say, and I still do, I just spoke to a group of medical leaders the other day. If you’re not developing at least 3 to 5 individuals from a mentoring and professional development, at a minimum, And 3 do not look like you, have the same background, race, sexual orientation or religion, then you are setting the organization up, in my opinion, for failure. So always develop and train them to do the same thing. A cohort of future leaders that represent what we are trying to do and what we’re trying to serve as a country and as a nation and as a world.


Gary Bisbee  37:30  

Well, you’re not going to hear a better lesson than that. Elder, thank you so much. Again, just terrific interview. I’d love to give a call out to your 95 year old mother, by the way, who will be very proud of this interview. So well done.


Elder Granger  37:43  

Velma Granger, thank you. Thank you. I appreciate it, Gary.


Gary Bisbee  37:48  

New episodes will debut every Thursday. Join me in conversations to gain advice and wisdom from CEOs, presidents, and healthcare experts. Healthcare leadership is hard work, but it becomes more manageable as we learn from the remarkable lives and careers of our guests. I’ll see you there.


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