Len’s Friends: Dr. Jack Friedman

Dr. Leonard Friedman, the director of the Master of Health Services Administration (MHSA) and online Executive Master of Health Administration (MHA@GW) programs offered through the Milken Institute School of Public Health, is an ardent believer in the idea that “health care is a relationship-based business.” “Len’s Friends” aims to showcase that concept by profiling some of Dr. Friedman’s closest personal and professional industry contacts — and by sharing their expert industry commentary and insights with you.

With over 30 years of industry experience, Dr. Jack Friedman — CEO of Providence Health Plan in Portland, Oregon — is living proof that individuals with a diverse set of interests, skills and backgrounds can have a big effect on health care. Keep reading to learn more about Dr. Friedman’s ascent in the field, his take on buzzwords like “population health” and why he thinks humility, humor and vulnerability are among the most important traits a health care leader can possess.

What drew you to health administration?

My journey here is very different from most. I don’t have any formal training in health administration. I don’t even have an MBA. I have a PhD in cultural anthropology of all things. In the early ’80s, I became a reporter for a business weekly and started writing about the business of health care. I got super interested in prepaid health care, group practice, hospitals becoming insurers and capitation, and I found the field really entrepreneurial. It combined my interest in social good with an interest in business. I was interested in numbers, money, power and the transfer of resources, as well as faith-based and not-for-profit health care. I’ve been at Providence for 27 years and have really learned a ton and have seen a lot of good things actually happen.

I’m a huge believer in vertically integrated systems that have the health plan, medical group and delivery system under the same tent. I think you can do remarkable things with alignment and perseverance.

Like making sure that health isn’t just seen as something that takes place during a 15-minute doctor’s office visit.

I think that the 15-minute doctor’s office visit is going to turn into a 30-minute office visit for the people who actually need to be there. The people who don’t need to be there — half the people who show up — are going to get their health care on the Internet and through e-visits and through retail clinics where they can pop in and pop out. Primary care doctors need to be surrounded by teams of people so they can take care of really chronically ill people who require more time and attention. The incentive system will change that. It’s not going to happen as fast as it needs to, but it is going to happen, and the problem with U.S. health care is that we organize health care around doctors and not around consumers.

What advice would you give to students who are interested in pursuing a career in leadership? What skills and qualities should they possess to make an impact on health care?

I’m a big believer in servant leadership, which is the idea that CEOs exist to serve their employees. Being a good leader requires tremendous humility, a lot of humor, not taking yourself very seriously and being fairly good at self-effacement, and spending a fair amount of your time inside your organization in service to others. Those are the people who I think turn out to be the greatest leaders. So, I would say immerse yourself in [multidiscipline] teamwork and become familiar with the principles of servant leadership.

The times that I feel the most valued as a CEO at Providence are when I spend an hour or two with a team and listen to what they are doing and try to give them feedback, as a peer. I also think about times when I lead all-staff meetings, but I talk about the greatness of people out in the audience, acknowledging them by name and telling their peers how they made a difference for a member or a teammate. Leadership is about inspiration. It’s about appealing to people’s hearts and not their wallets, and it also requires you to be fairly vulnerable. I can think of many times when I’ve been in front of a group of people and really started to cry about something that touched me.

Leadership is about inspiration. It’s about appealing to people’s hearts and not their wallets, and it also requires you to be fairly vulnerable. – Dr. Jack Friedman

You also have to remove fear from any organization. Fear comes when people feel that if they try something that doesn’t work, then they’re going to be punished. You can’t punish people. You learn from your failures. You hope you don’t make the same mistake two or three times, but you learn from them. Those are all learning opportunities, so wiping fear out of an organization is really important. A CEO can do that by being very self-effacing and poking a lot of fun at him or herself. I do that a lot here, and I think it’s helped create a culture of trust. The most important thing in any team is trust, and you can’t have trust where there is fear.

We recently asked you, as a leader in the field of health administration, to define the term “population health” for us. Can you elaborate on that?

Population health is, in its essence, doing the most good for the most people at the lowest cost. It’s recognition that spending money inside of health care is not necessarily where you get the best bang for your buck. I say often to my team that it’s criminal in America that we’re spending 17.5 percent of our GDP on health care when we’re spending less than 4 percent on public education. That’s a criminal act, and we have to take accountability for it. The best thing that we can do is take five points of health care GDP — which, by the way, is a trillion dollars — and redeploy that into the education system, into better housing, into secure food and all the things that a population needs at its core to be healthy. It has nothing to do with money inside the health care system. We’re already spending way too much and getting way too little for it.

In your definition, you talk about the necessity of public and private collaborations. Can you expand on that?

A big part of this is to acknowledge that government and other institutions probably have a larger role in promoting the public’s health — whether that’s community health care workers that we deploy, welfare officers who are out in the field helping fragile families with resources, improving the quality of our parks so that children have a place to go and be safe, promoting anti-smoking campaigns to reduce incidents of tobacco use — all of this requires an investment in the public good.

I’m actually about to visit Cuba to see how they’ve organized their health care system. What I understand is that they actually try to build their system around a community of people, and they make a tremendous effort in educating young people early about the importance of physical exercise. They actually do physical exercise at school. We don’t fund that anymore, so there’s a whole bunch of work that needs to be done in lifestyle management and poverty reduction that will improve population health. Doing any more MRIs is the last thing we should be doing, yet that’s what we do in America because it moves money around.

I hope this new interest lights some people up. The best thing that could happen is that we would significantly reduce our health care spending so we can keep that money and give it away to our children.

Read about more of Len’s Friends.