Building And Sustaining A Winning Culture In Healthcare: Lessons Learned From Harvard’s Joel Katz

Last week, Dr. Joel Katz announced that he was stepping down after 21 years leading the Brigham and Women’s Hospital/Harvard Medical School internal medicine residency program. This was a seismic event in the nerdy world of internal medicine—Joel was the last of a generation of iconic internal medicine training leaders that included legends like Hasan Bazari (Massachusetts General Hospital/Harvard), Lisa Bellini (University of Pennsylvania), Harry Hollander (University of California San Francisco), and Charlie Wiener (Johns Hopkins), among others. These folks were responsible for maintaining the “aura” and “mystique” of some of the most prestigious hospitals in America—by sustaining a destination training culture for some of America’s top medical school graduates and building the pipelines for their elite medical staffs.

Joel, like his legendary predecessor Marshall Wolf and department chairman, Joseph Loscalzo, is an old-school medical mentor. As I reflected on his legacy and personal impact on me and other alumni of the program he led, I realized he was one of my most important and influential teachers of leadership and talent management—and that I apply lessons he teaches me almost every day. As program director, Joel was the healthcare equivalent of Duke’s “Coach K,” Mike Krzyzewski—masterful at recruiting talent and bringing out everyone’s best.

Joel counts among his alumni the sitting US Surgeon General; the recently departed New York Commissioner of Health; a MacArthur Genius Award winning scientist; the CEO of the Institute for Healthcare Improvement; and the Head of GV (formerly Google Ventures), among countless medical and scientific luminaries in academic medicine.

Joel’s lessons are relevant to anyone building a winning team culture of any kind.

Recruit for Talent and Heart

Talent in medicine comes in many forms. There are countless medical residency applicants from top medical schools with amazing medical board examination scores. There are candidates with long publication lists and unfathomable global health experiences. When you run a top training program, you can have your choice of candidates. How will you choose amongst the countless incredible resumes? For Joel, the answer has always been always simple. In a profession where you have to work long hours and rely on each other for help of all kinds—heart was the most important quality he sought in trainees. Heart for patients, heart for community, heart for colleagues. As a candidate, you could be as brilliant as you wanted, but if you weren’t kind or supportive or good-hearted, or if you didn’t play well in the sandbox, you need not apply. The program’s unique identity became self-reinforcing over time as like attracted like. This was a true differentiator in a field where many top programs define themselves by medical machismo and bravado about independent decision-making—not teamwork.

Use All Available Data When Building the Team

Cultivating and validating talent and heart were difficult tasks. For Joel, not making a mistake was paramount. He would use all available data to identify who belonged—and who didn’t. This meant interviewing candidates with a broad group of gender and racially diverse interviewers who might illicit different behaviors and make diverse observations. This meant soliciting input from residents and faculty who might have observations and input about peoples’ characters and behaviors outside of the shine of their carefully curated applications. This meant cultivating relationships with key medical school faculty (i.e. medicine clerkship directors) at schools across the country to identify the stand-outs. This meant picking up the phone occasionally to verify and validate the descriptions of accomplishments. This meant convening a committee to review all available data and debate it. This was time-consuming, pain-staking work, but this was the work of quality-control for the product he sought to create: the most qualified, high-potential, and high-integrity group of physicians possible.

Enlist the Whole Organization to Close The Deal

When Joel met with a potential residency candidate he would reflexively identify other faculty and alumni of the training program to call the candidate and encourage them about how the Brigham might support their career. If someone was interested in transplantation medicine, he might engage Joseph Murray, the late Nobel Laureate credited with the first successful kidney transplant. A career as a physician-writer? He would enlist Atul Gawande. Global health? He would schedule lunch for your with the saintly late Paul Farmer. When I applied to the Brigham, I already had an interest in healthcare management. Joel and Marshall organized phone calls for me with many in the leadership ranks of the hospital—including its then CEO, Gary Gottlieb, and Tom Lee, then the president of the health system’s physician network. The whole organization recognized the importance talent played in sustaining the vitality of the organization; everyone at every level was expected to pitch in to excite and bring on the next generation of talent. In contrast, when I interviewed for residency at a competitive program in New York and asked to be introduced to mentors who might support my interests, I was memorably told, “we aren’t going to waste anyone’s time unless we are sure you’re coming here.” The difference was remarkable to me—and telling.

Cultivate A Farm Team

Joel was famous for taking cold outreach from medical students from around the country. When they expressed interest in the program, he encouraged them to do rotations at the Brigham so that they could better get to know the institution and so he could get to better know them. He would meet with medical students—even in their first year—if they expressed an interest in the program because he recognized that cultivating a pipeline wasn’t a seasonal process. And he would offer his mentorship and guidance and connections to program faculty and alumni freely in order to build the pipeline of candidates excited about training at the Brigham. Joel spent significant discretionary time teaching a medical elective for medical students focused on one of his personal passions—art—in part to get to know successive generations of candidates. His personal engagement set a tone of approachability that rapidly spread among medical student applicants to the program.

Take Strategic Risks and Chances—and Be Unwavering in Your Support

Joel recognized that excellence didn’t always come in neatly curated packages. While some in Joel’s role give lip-service to diversity, they often hide behind the idea that “there just aren’t enough qualified candidates.” Joel was before his time in realizing that excellence comes in many forms. He was known for taking chances on non-traditional applicants from non-traditional places. It wasn’t enough just to recruit these non-traditional applicants, but even more important to continue to support individuals in being successful, even if they experienced bumps along the way. When residents had troubles and were referred to talk to him (the medical residency equivalent of being sent to the principal’s office), the message was almost always the same: “How do I support you? What do you need to be successful? You weren’t a mistake.” These words of reassurance, offered to people just starting to build their clinical confidence, made all the difference.

Focus on The Person, Not the Institution

Many residency programs are supremely focused on keeping clinical schedules full. This meant that if a trainee had an opportunity that pulled you away from the grind of medical residency, you were seen as abandoning ship. For Joel, the institution existed to enable one’s individual passions. This might add programmatic complexity at times, but Joel was prepared to take on the challenge. Some residents with an interest in global health might want time during residency to do medical relief work in Haiti. No problem—he would find a way and supported the creation of the Howard Hiatt Residency in Global Health Equity. Some wanted to find a way to combine medical residency and an MBA—Joel and I worked together to create the fully-funded John McArthur Program in Medicine and Management with Harvard Business School. Some were compelled to serve in government, so Joel granted them mid-year leaves of absence to serve their communities. Joel set a culture that made people feel visible while recognizing that the institution would survive whatever short-term stresses it endured to support the individual. He also encouraged people to have a broad view of success and to think beyond traditional measures of achievement in academic medicine (publications, professorships, etc).

Commit to a Lifetime Relationship

Joel’s commitment to the success of his trainees extended beyond their time in his program. He was perpetually on the lookout for opportunities for his residents and alumni—out of genuine concern for their success and happiness. Once you were part of the program, you were part of it for life. Joel was generous with his ear and generous with introductions to others who might be able to help, regardless of their situation. The loyalty we all feel for Joel and the program—and what he has done for each one of us—is currency that he uses to support of the current crop of trainees. Most of the program’s alumni will drop everything we are doing to answer Joel’s call and do whatever he asks—because we are all paying it forward, recognizing that the same support is always there whenever we need it.

Joel’s decision to step down—and leave the program in the hands of the highly capable Maria Yialamas—affected me more than I thought it would. While I was but one of his 70+ interns in just one of his 21 years leading internal medicine training at the Brigham, he never made me or anyone else feel that way. He was big part of the reason the program he led feels like “home” for many of its graduates and why the term “housestaff” continues to feel appropriate for medical residents—even though medical trainees no longer live at the hospital.

Every leader of every kind should aspire to build the kind of loyalty, support, and esprit-de-corps that defined the Joel Katz era at the Brigham and Women’s Hospital.