With a multifaceted career that has spanned academic, executive, and clinical roles, Kenneth R. White, PhD, RN, FACHE, FAAN, is in a position to share a uniquely informed point of view on a wide variety of issues that healthcare leaders face.
Dr. White is the associate dean for strategic partnerships and innovation at the University of Virginia (UVA) School of Nursing and holds the UVA Medical Center endowed professorship in nursing. He also holds faculty appointments in UVA’s schools of commerce, business, and medicine.
Dr. White has authored and coauthored many healthcare books. His latest, written with John R. Griffith, LFACHE—the ninth edition of The Well-Managed Healthcare Organization—is a new release from Health Administration Press.
This year, ACHE recognized Dr. White’s contributions with its Gold Medal Award at ACHE’s 62nd annual Congress on Healthcare Leadership in Chicago. The Gold Medal Award recognizes executives who exemplify the highest qualities of leadership to improve healthcare services and the health of their communities. In addition to his professional accomplishments, Dr. White served on ACHE’s Board of Governors from 2004 to 2007, as a Regent-at-Large from 2002 to 2004, and as inaugural chair of the LGBT Forum from 2016 to 2018.
Dr. White’s conversation with Eric W. Ford, PhD, editor of the Journal of Healthcare Management, edited here for publication, is featured on the ACHE podcast “A Leader Who Cares,” available via iTunes and www.ache.org/journals.
Dr. Ford:You are one of the few people I know who is a triple threat: hospital executive, academician, and clinician. Tell us about the personal journey that led you to all three roles in healthcare.
Dr. White: Life’s journey is never a straight line. I always tell my students that you can plan all you want, but things happen along the way, and that’s that. You must pay attention to opportunities and serendipity, things that you don’t expect or ask for.
My journey started during high school in a small town in northeastern Oklahoma. The hospital administrator there headed up a medical explorer’s post to get young people interested in careers in healthcare, including hospital management. (Lesson number one for healthcare leaders: You have a responsibility to talk to young people about healthcare as a great career choice.) I went on to college to get a degree in biology and then a master of health administration degree from the University of Oklahoma.
I spent the first third of my career in management with Mercy Health Center in Oklahoma City and Mercy International Health Services, where I served in a number of roles including chief administrator at Guam Memorial Hospital, managed by Mercy. In the middle third of my career, I turned to academia. I moved to Richmond, Virginia, to earn a PhD in healthcare management at Virginia Commonwealth University (VCU). I have always had the heart and dedication of a nurse, and during my first year there—with the support of Dr. Jim Begun, my doctoral program director—I also enrolled in an accelerated second-degree nursing program. I spent the next 20 years at VCU in various roles and directed the master’s program in healthcare management. The final third of my career journey has brought me back to the patient. I have always had a keen interest in palliative and end-of-life care, so I completed a post-master’s certificate program at UVA to be a nurse practitioner and did all my training in palliative care. Then Dorrie Fontaine, dean of the nursing school, offered me the job of associate dean and the UVA Medical Center endowed professorship in nursing, which I currently hold. Now I teach healthcare management and leadership at the UVA business schools and palliative care at the nursing and medical schools, too. I also have a clinical practice in the medical center as a palliative care nurse practitioner.
Dr. Ford:Along the way in your career journey, what is the best mistake you ever made?
Dr. White: I have always been very careful not to tell too much about my personal life in the classroom. One day about 15 years ago, I was talking about my partner and inadvertently let slip a pronoun that gave away something I generally kept private: I said “he.” You know what? Nothing happened. It was not a big deal. It turned out to be the best mistake I ever made, because the students found me to be more approachable, more real. LGBTQ students then felt like they could open up to me and receive mentoring and guidance they might not have gotten otherwise.
Dr. Ford:Looking around your office, tell me about the objects that mean the most to you today.
Dr. White: I have had a really great career, and my favorite things are the pictures of friends, colleagues, students, and people I have worked with over the years. Happy times. It makes me feel good, to be surrounded by those memories.
Dr. Ford:I know what you mean. I have a bit of nursing in my background, too, and I used to joke with my colleagues about how nurses were the unhealthiest people on campus. So they gave me a picture from the 1950s of nurses smoking, and that is one of my favorite mementos.
Dr. White: I smoked in the 1970s when I was an emergency room technician. Smoking was the only way you could get a legitimate break.
Dr. Ford:How things change! And speaking of change, what current healthcare buzzword is overrated or overused in your opinion?
Dr. White: “Bandwidth” is one word I hear all the time, and it just seems to be an excuse for not doing something. “Patient centered” is another term that is often used—although it is still underrated. I hear a lot about patient-centered values, but I don’t know that we’ve come very far in making a patient-centered healthcare environment. The systems we have in place are not aligned with the patient as well as they could be. One of the National Academy of Medicine’s aims is to improve patient-centered care, and yet that is the one that is studied the least.
Dr. Ford:You have literally written (or at least cowritten) the book on the well-managed healthcare organization. How has that evolved over the years?
Dr. White: I am really excited about the new edition of The Well-Managed Healthcare Organization. John Griffith started the book in 1987, and I have worked with him on it since the fifth edition, which came out in 2002. For the new ninth edition, we did a thorough revision, focusing on the concepts of transformational culture, evidence-based management, and continuous improvement. We addressed those ideas in past editions, but this time, we delved deeply into Baldrige National Quality Award winners’ applications to find out what people are doing to change organizational culture and become more transformational.
Dr. Ford:In developing transformational leadership and processes, what are the trends you see affecting health systems in the next 5 to 15 years that will require providers to change the ways they operate and deliver care?
Dr. White: Patients are more informed, and they are going to expect more and more from their healthcare providers. Consumer advocacy groups, such as The Leapfrog Group and others, also are demanding more accountability.
In addition, I think we have to support our care providers—physicians, nurses, nurse practitioners, and others on the front line—in a way that ensures professional vitality. I choose the term “professional vitality” as the opposite of “burnout.” I see burnout a lot in my clinician colleagues, and I understand why it happens. The pace of care delivery and the requirements of electronic health record documentation and regulatory compliance can be overwhelming. The situation is not sustainable. We need to care for our frontline care providers.
We also need to reach out to partner with providers and other stakeholders in the community to improve population health. It is no longer enough for a large health system to have a mission to provide acute care. We have to prevent people from needing to go to the hospital in the first place. We have to take better care of our patients who have multiple problems and comorbidities. It is not uncommon now for people to have 10 or 12 major medical comorbidities when they are admitted. The situation has become extremely complex.
Dr. Ford:I like your term “professional vitality.” I also study burnout and am casting about for a positive way to talk about it. Another term often used is “resilience,” but that seems a bit pejorative. How can clinical professionals’ roles be improved? What are they going to need from their executive leaders?
Dr. White: We provide our care interprofessionally, but we do not teach it interprofessionally. We have made some strides in undergraduate medicine and nursing programs, but continuing education needs to become truly interprofessional. For example, nurses learn how to take care of patients at the end of life; physicians also learn how to deal with patients at the end of life—but they do not learn together, and they must practice as a team.
To advance that practice, a much bigger emphasis needs to be placed on team science—the collaborative effort that leverages the strengths and expertise of healthcare professionals to address clinical challenges in patient care management. For The Well-Managed Healthcare Organization, we looked at the annual budget for education in high-performing organizations. We found that many of them have substantially larger budgets in team science training and interprofessional education than do other health systems.
Dr. Ford:What are the biggest threats to the U.S. health system that you see on the horizon?
Dr. White: New diseases and new strains of bacteria and infections that are not responsive to available drugs are major threats that we need to face in healthcare. Unfortunately, we are also facing a shortage of care providers. For example, we have far too few fellowship programs in palliative medicine now, and only a handful for advanced practice nurses. With people living longer, and with people having more comorbidities that require more complex medical care plans, we need to train all healthcare professionals in primary palliative care. A physician colleague and I have come up with a primary palliative care program at UVA called Advanced Disease Life Support to train all healthcare professionals in palliative and end-of-life care. Many people are ending up in intensive care units and on ventilators with a quality of life they never wanted. That’s why we need to educate all people about advance directives and healthcare providers about primary palliative care. We can do that, just as we have done with cardiopulmonary resuscitation (CPR) training for basic life support. CPR training is now widely available, and not so long ago, that did not exist.
Dr. Ford:How can educators better prepare future administrators to address some of the issues you have identified?
Dr. White: At VCU, I came up with a patient-centric health administration curriculum. Over time, we introduced courses to include more frontline care experiences because it occurred to me that we were sending out master of health administration graduates into healthcare leadership positions, even though few had direct exposure to the way hospitals operate. It was important to me that we educate our students with a basic knowledge of patient care; so, we started pairing them with interprofessional teams of nurses and doctors and providing shadowing experiences.
Educators need to do a better job of preparing their students for what it’s like to work at the core of our business—at the bedside, in the clinic, or in the community with preventive care, as well as acute care and sub-acute care services. And patient centeredness needs to be woven throughout our curricula so that it’s not just part of a course here or there but rather a way of thinking, a way of problem solving.
Dr. Ford:I agree. Patient centeredness is everybody’s responsibility, and you need to integrate it everywhere. Are there other aspects of healthcare leadership that academia can do a better job of teaching?
Dr. White: I remember in the early 1990s when information technology (IT) was rapidly taking off and schools would create a separate course for it in their healthcare curricula. Today, IT has become so much a part of our world that knowledge of it has become essential to all courses and competencies in healthcare management. If patient-centric designs, processes, and systems and the compassion that goes along with caring for individuals and families are not integrated into a curriculum—and subsequently into the healthcare executive’s practice—we will not achieve the best care possible. And that is the reason for our existence as leaders who care.