Renee DeSilva  0:06  

Welcome to Episode 1 of The Academy Table, the new season of our podcast series. I’m Rene DeSilva, CEO of the Academy, and I’ll serve as your host. In each episode, I’ll bring you real conversations with healthcare’s best leaders and thinkers. Our intention is to broaden who is at the table while covering the issues that are critical to driving our industry forward. Mary Jo is the Chief Operating Officer at Cone Health, a Greensboro, North Carolina based health system. Since joining Cone in 2010, she’s held a number of executive positions across the C-suite, and later this year, after the merger with Sentara Healthcare is finalized, she will lead the Cone division as regional president. You can often find her on top female leaders in healthcare lists and more personally, we are really proud that she was one of the first members of the Academy’s GE Fellows Program. In today’s conversation, we dug into a number of topics that are near and dear to both of us. First, why progress has been slow in healthcare for women leaders and specifically for women physician leaders. Mary Jo shared how she has approached supporting and elevating females and physicians in particular, especially now during the times of COVID. We also covered how Cone has thought about creating an environment that supports diverse caregivers and reconciling with their history around race with the broader community. I encourage you to listen for Mary Jo’s willingness to say yes to opportunity, her ability to manage hard conversations with humility and grace, and most importantly, her skill of recognizing diverse talent and inviting them in to lead. So with that, let’s head to the table. Good morning, Mary Jo, really happy to have you at The Table.

Mary Jo Cagle  1:56  

It’s great to be here, Renee, thank you.

Renee DeSilva  1:59  

It’s always lovely to visit with you. Normally, we are doing it with a coffee or tea or glass of wine, so our virtual table will need to suffice for this morning. But you are one of my favorite people to chat with just given the impact that you’ve had across your healthcare tenure. I wanted to start though, with maybe some of the early forces that shaped you as you sort of grew up. Tell us a little bit about that.

Mary Jo Cagle  2:21  

Well, Renee, I come from a family of mostly ministers and teachers and so my decision to go into medicine was really shaped by a female physician I heard speak when I was three years old. She was a missionary physician who was practicing in India and I heard her tell her stories of practicing in India and was fascinated by that at three years of age. And I went to my family physician in the small town that I grew up in Alabama and just pronounced to him at three years of age that I was going to be a doctor when I grew up. 

Renee DeSilva  3:02  

That’s amazing. 

Mary Jo Cagle  3:03  

And that was in 1962. And he looked at me and said, “Well, okay,” and never hesitated. I remember him picking me up and he looked ten feet tall to my three year old self. He was about 6′ 4″, but that big, long, white coat, he picked me up. And he said, “Well, let’s talk about what you’re going to need to do if you’re going to be a doctor when you grow up.”

Renee DeSilva  3:27  

That’s amazing. The clarity of that at such a young age, what a gift that is. So you eventually went on to medical school.

Mary Jo Cagle  3:33  

I did. I became an obstetrician-gynecologist.

Renee DeSilva  3:38  

And when you were in medical school, tell us about just the dynamic of your class. At that point, how many women were in the medical school class?

Mary Jo Cagle  3:47  

So out of a class of 150, there were 50 women and that was the largest class that the University of Alabama School of Medicine had ever had at that time.

Renee DeSilva  3:58  

Amazing. And so, you know, I know that we’ve, we’ve chatted about this in the past, but as you sort of think about healthcare now, the AMA data would suggest that about just under 40% of women represent the physician workforce. And that’s up, that’s been trending up over time, as you know. But when you look at that against the percentage of chief medical officers that are women, that number is 3%. So a clear gap in terms of the pipeline entering medical school to how those folks accelerate into physician leadership roles. I wonder, just given you’ve had such a breadth of leadership positions, maybe you just start by tracking your career path across healthcare, sort of how you, how you thought about that. And then let’s circle back to just observations you have on how we might be able to do better about getting more women into physician leadership positions. But start with how you, how you sort of articulated, or how you sort of move through your own career path.

Mary Jo Cagle  4:54  

Well, I would say when I started it was traditional in that I went into private practice, owned my own practice, was the senior partner with another gentleman, and we grew our two-person practice into a large practice before I entered administrative medicine, became a chief medical officer. I will tell you, how I entered into administrative leadership medicine was that people saw the work I was doing and invited me in. So both men and women leaders saw and said, “Mary Jo, we need you to be a leader.” Whether that was to be a chairman of the department of obstetrics and gynecology, or the president of the medical staff, or eventually the chief medical officer, people invited me in. And I think that is the key, really, to the question that you ask, Renee. If we see talent, we have to go and invite them in. And we have to invite talent in that doesn’t necessarily always look like us. And I think it’s normal for human beings to be comfortable with people that look like us, that’s kind of wired into our DNA. But to understand, ooh, they’re somebody that’s getting things done. And say, “We need to invite them in.” And that’s what was done for me. And successive roles that I had were because people said, “You can do this.” Even at times where I hadn’t even considered the role myself, my first chief medical officer role the female CEO of the hospital invited me into the space when the CMO ahead of me had resigned. And she said, “Have you considered this?” I had not. And she said, “I would love for you to at least do it for an interim time and see how this goes.” And I think that’s our opportunity to increase the pipeline. Look and see who is being successful where they are, getting things done, and invite them in.

Renee DeSilva  7:17  

I think that’s so powerful. I love that. I love that because it speaks to the importance of nudging, right? So noting where talent is and giving people the invitation and oftentimes the confidence to engage in ways that maybe they didn’t think were possible for themselves. So I think that’s a really powerful anecdote. I wondered, where did you have your babies in all of this process? Because that is also, I think, a component of this. So I’m wondering where that sort of happened as you were making these big strides.

Mary Jo Cagle  7:45  

Yeah. So if you wait until there’s a convenient time you won’t ever do it, that’s for sure. 

Renee DeSilva  7:50  

Right.

Mary Jo Cagle  7:50  

So I had my first child during the chief year of my residency, the fourth year of my OB/GYN residency, and then I had my second son in my first year of private practice. They’re thirteen months apart, Renee, so boom, boom, so right there. And so we did that, and we just made it happen and got help and not great planning, but it worked. And, it worked for us. So it can be done.

Renee DeSilva  8:23  

Yeah, well, that I think that’s really notable because you know, what that says is, as you were climbing or as you were achieving, you were doing that in the context of also having family obligations. And I think that’s an important, just an important point to draw out for people who are oftentimes for themselves figuring, trying to figure it out. And I agree with you, I think the message is we can often figure out more than we think if we have the proper support channels around us. So really helpful to get your sense of that.

Mary Jo Cagle  8:49  

You know, it was really important for me to be present for my sons’ sports activities, academic activities, and my husband and I just made it work. And I always had those conversations with my CEOs that I need to be present for this. In some ways, being in administrative roles made it easier than when I was an OB/GYN on call because when a woman goes into labor and is ready to have a baby, they really don’t care what your schedule is.

Renee DeSilva  9:26  

Exactly, exactly. Yes, it can be counterintuitive. I have that same sentiment. I had my first daughter quite young, I entered the workforce when she was already three. And I think it does two things. It just gives you sort of the clarity around what you need to accomplish and it also, for me, it was there was never the luxury of trying to figure it out like you just had to make it happen. And similarly, I was really, certain things mattered to me in terms of showing up. I’m sure I missed a lot too, but this notion of being open with your team around you in terms of what you need to bring your best to work, I think is a really powerful thing that I know that you try to create in the own, the orgs that you manage today and I certainly do as well.

Mary Jo Cagle  10:05  

Yes, and yeah, the other positive benefit of this, Renee, is the teams that I lead, we talk about the importance of their families as well. And what I find is the team appreciates the sense of balance that I’m creating for them. And I urge them to make events for their children. We can all support each other so that they have a sense that their family is important too. And so it creates a healthier workplace and a healthier dynamic. It takes away some resentments that can sometimes be there when people feel like they have to give up things for family to excel in the workplace.

Renee DeSilva  10:50  

So we’ve been chatting about this from, you know, your personal approach and your leadership style. If we can just go maybe one level more macro. As you think about how healthcare organizations, in particular, can do a better job structurally at maybe what we might call this sort of broken rung of management. Are there things that you’ve seen across Cone or in other environments that you think sort of help structurally get greater women and people of color leaders into C-suite roles?

Mary Jo Cagle  11:21  

Yes. I think, first of all, there has to be intentionality to make certain that we have a variety of people doing the interviewing and the looking at candidates so that this unintentional bias that we all have to hire people that look and think like we do doesn’t get in the way. So being very intentional about who is looking at the candidates, it’s very important. And then looking at our policies to make certain that they are fair to all. And, you know, this has really become evident during COVID as children have had to be taught at home and that has been a huge burden on our female workforce. So really looking at our policies and saying, “How can we not disadvantage our female workforce during this time?” We’ve really paid attention to that. But what that’s told us is what policies have been in place all along that have disadvantaged our female workforce.

Renee DeSilva  12:35  

Yeah, I’m glad that you raised that. So you know, as you track some of the data, McKinsey’s recent workplace report indicates that as many as 2 million women are considering leaving the workforce. And so the concern on that is that we start to dial back when there’s an opportunity here to have greater momentum. So I love the level of intention and both processes and systems that can be such a big part of the answer here.

Mary Jo Cagle  12:59  

That’s right. Yeah, so I think all of us bringing our diverse teams, and I mean, diverse in thought, diverse in gender, diverse in color together to look at our policies that say, “Where might this disadvantage us in hiring and promoting women and people of color?” And looking at it through that lens, because I think we have a golden opportunity to change that. And then really looking and saying, “Where do we have gaps in our leadership that don’t look like our communities and don’t really represent well?” You know, what I feel really strongly about is that we need the best talent and leadership because healthcare is difficult and it’s growing more difficult. So we don’t need to rob ourselves of the best talent. And when we eliminate 50% of the talent to be considered, we’re robbing ourselves of some of the smartest people available. That’s true when we look at not giving a fair shake to people of color as well. So I just want the best talent in the room. 

Renee DeSilva  14:16  

Absolutely. So I want to switch gears a bit. And I will say, I was struck when I learned of how Cone as an organization really demonstrated some courage in reconciling some historical moments with its black doctors. And I wonder if you might share a little bit about that story and how the organization approached it because I do think it speaks to the progress and the way in which as leaders we can show up and have hard conversations in a way that can lead to progress and healing. Would you mind telling us a little bit about that?

Mary Jo Cagle  14:51  

I’m happy to do it. So to give a little context to the story, in 1963, there was a landmark case called Simpkins versus Moses H. Cone Hospital in which a group of physicians, the primary lead was Dr. Simpkins, he was not the only physician, brought a case against Moses H. Cone Hospital for refusing to allow black physicians to admit their patients to Moses H. Cone Hospital. It had been done under the separate but equal theory because there was a black hospital in the community. But Moses H. Cone was the tertiary care hospital and had facilities that allowed for some specialty surgery. It went up to the federal judiciary and Simpkins won. The Moses H. Cone Hospital tried to take it to the Supreme Court, but it was shot down on the grounds that it violated the Equal Protection Clause. And it did then allow the black physicians to admit patients to the hospital. It was a very difficult time and no one at Cone acknowledged it all those years until July of 2016 when Terry Akin, our, our CEO who I’ve worked for and the board of trustees intentionally and publicly issued an apology to the one surviving physician on that case Dr. Alvin Blount and then the families of the other physicians and employees whose families were patients that weren’t allowed to be admitted during those years. And they issued an apology for the treatment that those doctors received and for the very fact that they ever had to bring that lawsuit. And it was done in front of the medical staff first and then it was done very publicly and with great humility and asked for their forgiveness for what we had put them through and how they were treated so disrespectfully. I was present for both the ceremony with the medical staff and for the public apology. And I’m going to tell you, I’ve never been in anything more powerful in my life. There was weeping in the room. I get emotional just thinking about that again, Renee, because I would say it was the beginning of some healing. I wouldn’t say that all the healing is done because it will take continued intentional actions for all the healing to take place. But it was the beginning of something really important. 

Renee DeSilva  17:47  

Yeah, that’s really powerful. And I’ve heard the story a number of times and every time I hear it, I too get a little bit of emotion around it, because it’s hard. It’s an example of something that needed to be done, but it’s a hard thing to do. And just deep respect, for Terry and you and the rest of the leadership team that leaned into that. I think that’s, that’s really important. And the work always continues for all of us. So that’s great. I want to now go to the upcoming merger with Cone and Sentara and your exciting new role as part of that. So would you mind giving us a bit of an update on that?

Mary Jo Cagle  18:21  

Well, sure. So we are in the space between having signed the definitive agreement and hope to be closing this thing, you know, so we’re in this space where all the regulatory work is getting done. We are really excited about this because we believe that Sentara is a partner that can help us get to our goal of increasing value-based care in the region. We think we are like minded organizations in that we are reaching for value-based care. We both have a very similar quality, footprint, and results and we believe that we have things we can teach each other as we want to increase our quality. It will move us to around between $12 and $13 billion organization when we join. So we’re very excited about the potential for this. We will have a large health plan. We have an MA plan, they have managed Medicaid and a commercial product, so putting those together will be very exciting. So we’re very excited. My new role will be as regional president for the North Carolina area and so I’m very excited about what that means.

Renee DeSilva  19:40  

That’s great. That’s great. And just that the impact to the Virginia and North Carolina patient community will be, will be really powerful. So excited to see that come together. What made you say yes and do the hard work that comes after the transaction happens in terms of the integration and finding ways in which you realize the potential benefits?

Mary Jo Cagle  20:04  

First of all, a deep and abiding commitment to Cone Health and what we’ve created here and the vision of being able to increase the value for our patients in our communities. We really do believe we’ll be able to provide more care to more people in more places. And that we want to do that well. But also to help ensure that this integration reaches its full potential. And, you know, even when integrations go well, they’re not easy, Renee. So nobody’s naive about that here. And so I wanted to, for the sake of our team here, be able to help lead that work here for us. And then I’ll add in, Cone has never had a physician or a female leader. And I was really honored to be given that opportunity for our physician and female leaders here to say, “This is a milestone choice.” And not so much for myself because I’ve, I’ve achieved a lot of things already in my career but to actually say, “Okay, this is a big step forward for Cone Health.”

Renee DeSilva  21:26  

I’m sure they are delighted to have you at the helm. But I’m sure you’re starting to think about that. But I’d love just any, any early thoughts if you think about the last year and the response that providers had to make on COVID and just the impact that had on your workforce. And when you think about where hopefully we sort of feel like there’s light at the end of the tunnel that we can all see. Have you started to think through, for at least for 2021, how do you think about the major strategic priorities for you, in particular, as as you take on the integration work and probably still need to do the daily work that has been so critical through what’s been a really trying time across the pandemic? What will you focus on in the near term?

 

Mary Jo Cagle  22:06  

Well, first, I just want to stop and acknowledge the providers and how we’ve handled the last year. Truly heroic in what they’ve accomplished. And we opened a COVID-only hospital here and just dramatic work that was led and done by our physician leaders. So I’m so overwhelmed by the kind of work our physicians and nursing and pharmacy colleagues did, and really are still doing as we have now closed the COVID hospital and are integrating back into our other hospitals. I think the work that we have to do to go forward is operationalizing our COVID work into our regular everyday work, right? Because it’s here to stay for a little while, Renee. So how do we take these big bodies of work of testing, vaccinating, and caring for COVID patients and operationalize that into our daily work? I think that’s a big piece of work. And stabilize our operational financial performance and, and get really comfortable with what our performance in the value-based world is going to look like as we continue to make that shift. And then, of course, the integration is a big part of my work. How we determine what are the best practices that Cone has that we’re going to share with Sentara and what are their best practices that we need to absorb here and the whole work of change management that goes with that. So those are really the big things that I need to inspire my team about, right? Change is a big piece of work and so leading them through the why of change and who we need to become as we move toward a company that is even more about value than we’ve been over the past five years.

Renee DeSilva  24:23  

Well, they are lucky to have you in that stead. I’m going to close with one final question on a little bit of a different note. So, in relaunching this podcast one of my intentions and the reason why we call it The Table is to ensure that we have a rich set of voices at the table and that we are representing all elements of healthcare, that was part one. And then part two, I think if I reflect personally on what I miss most in this post or this within the pandemic environment is so many moments for all of us where we find joy and comfort and laughter is often around a table with people that we care about or whom we find interesting. So I wonder if you could think about the following question. If you had an opportunity to curate a table of folks whose conversation and company you’d most like to visit with, who comes to mind in terms of being around that table and why if you’d be willing to share?

Mary Jo Cagle  25:19  

Sure. First, I’d love to have my maternal grandfather because he was born right at the turn of the previous century. And he was a consummate storyteller. He climbed Pikes Peak at the age of 17. And he was born at that time in America when anything was possible, right? And so I’d love for him to be there because I’d love to hear his stories. I would love to have at that table Marlon Priest because Marlon’s role in medicine and the roles that he’s played have been wide and vast. And I think his perspective in healthcare could be fascinating and, and tell us about where we’re going. I would love to have Atul Gawande at the table because I think he’s always forward-looking and brings compassion and empathy that would inform us in ways that I’m always interested in learning. And if I could reach back into time, I would bring Marie Curie because she was brilliant and had to fight for her place at the table always to be recognized for her work. And I would love to know how she did that and how she succeeded against all odds.

Renee DeSilva  27:05  

That’s fantastic. Well, I think this is a great place to land, Mary Jo. I always love visiting with you and I draw personal inspiration from the way that you approach your work. You have a unique blend of being always spot on in your observations and your healthcare knowledge, but you do it in a way where you’re full of warmth and make it really easy to connect with and I love that combination. So thank you for joining us this morning and I look forward to hopefully seeing you very soon.

Mary Jo Cagle  27:36  

Thank you, Renee, always a pleasure to talk with you.

Renee DeSilva  27:40  

Thanks again for joining me at the Table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website theacademytable.com or by subscribing on the podcast platform of your choice. And if you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at renee@hmacademy.com. I look forward to talking with you soon.