Paul Viviano: Sustaining a Culture of Trust, Consistency, and Follow-Through

Today's guest is Paul Vivano, CEO and president of Children's Hospital of Los Angeles and board chair of Loyola Marymount University. In fact, he's been in CEO positions since the tender age of 26 and has served for profit and not for profit health care institutions and those for plus decades. He's a brilliant leader with lots of incredible insight to share.

In this episode we discuss: 

- The changes in the nature of leading in the past several decades
- The challenges of the healthcare industry
- Characteristics of successful leaders
- Investing in your team
- Mutual trust and care for your team
- Building a complementary team

Learn more about Foster at fostermobleymt.com or follow us on Instagram and LinkedIn at Foster Mobley.

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To purchase Dr. Foster Mobley's book, Leadersh*t: Rethinking the True Path to Great Leading, click here.

Transcript

00:00:14:11 - 00:00:43:23

Dr. Foster Mobley

Welcome back to Step Wise. I hope you found our first several podcasts lived up to their billing. Great conversations with inspiring leaders. This one is no exception. Today's guest is Paul Vivano, CEO and president of Children's Hospital of Los Angeles and board chair of Loyola Marymount University. In fact, he's been in CEO positions since the tender age of 26 and has served for profit and not for profit health care institutions and those for plus decades.

00:00:43:25 - 00:01:13:23

Dr. Foster Mobley

In full disclosure. I've known Paul for much of that time, and while serving him as his coach for over 20 years, he's been one of my very few mentors. I've learned from him the grounding it takes to lead. How to strike a balance between people and performance, and how to lead with exceptional humility and humanity. As I was conceiving the themes in my book, looking to manage this collision of leader space between humanity and high performance, it seems only natural that Paul be one of my very first calls.

00:01:13:26 - 00:01:28:22

Dr. Foster Mobley

In this podcast, Paul speaks of the critical importance of trust, consistency, and follow through and leading with the guideposts of mission and values. I hope you enjoyed this conversation with Paul Viviano.

00:01:28:24 - 00:01:33:12

Paul Viviano

Old man, CEO, veteran, president and CEO of Children's Hospital Los Angeles.

00:01:33:17 - 00:02:15:10

Dr. Foster Mobley

Since you started out as a CEO when you were 26, now you're a couple years past 26. You must have seen an awful lot of changes in the nature of leading others and the the realities of workforce today. So I'm very, very interested to hear when you hear about the things you have to face today and the most important ones, like quiet quitting, social justice, inclusion needs people bringing more of their own humanity into the workplace, maybe multi-generational issues that are we've got more generations in the workforce than ever before, the social media, outside pressures.

00:02:15:12 - 00:02:24:24

Dr. Foster Mobley

All of that stuff, when you show up at eight in the morning. What are the ones generally the factors that are most challenging and the most pressing on you?

00:02:24:25 - 00:02:53:19

Paul Viviano

So there's a whole bunch of external factors in health care today that don't necessarily directly touch on the things you just outlined. Reimbursement pressures and trends. Inflationary trends around workforce costs in health care, pharmaceutical costs, supplies, etc. And so the inflation is outstripping the reimbursement ability to keep up with this sort of a lot of pressure around kind of the short term day to day.

00:02:53:20 - 00:03:32:21

Paul Viviano

How do you generate free cash flow? How do you build your balance sheet? How do you maintain your business from that perspective? That does occupy a lot of time. And it's kind of an intimidating thought to think of how pressurized the healthcare delivery system actually is at the moment. You know, my sense is it's very fragile and a few more years of runaway inflation and either flat or slightly increased reimbursement for those who are dependent upon Medicare and Medicaid, declining reimbursement is likely to cause an access problem that will impact us as a country and ultimately impact the health of the communities that we serve in the whole country.

00:03:32:21 - 00:04:04:10

Paul Viviano

And that gets sort of manifested in a whole bunch of different ways. The workforce issues that you referenced. Generational differences, work, workplace expectations, productivity expectations, etc., is that the workforce of today is less likely to want to work over time, spend more time providing care, being selfless about time commitment, not about how great a job they're doing, but about the time associated with it, you know, likely to lead to some real access problems going forward.

00:04:04:13 - 00:04:23:09

Paul Viviano

So I think I think the healthcare system is, you know, it's not a collision course, but headed for some rocky times. So that that occupies a lot of the kind of just the minutiae of how do we position, how do we redesign the delivery system of tomorrow, given the financial pressures? There's there's not a lot of room for error.

00:04:23:14 - 00:04:32:21

Dr. Foster Mobley

And yet, to create a new system requires slack time, labor or whatever that you don't have the luxury of any extra right and investment.

00:04:32:24 - 00:04:57:00

Paul Viviano

You don't have any extra of that either. And so how do you single yourself out as the organization among many where people can choose to work? What would make this an attractive environment compared to somebody else? And, you know, how do you design that kind of real time? With with the stakes being high quality of care outcomes, sensitivity to the community.

00:04:57:00 - 00:05:17:23

Dr. Foster Mobley

My thesis, Paul, is that leadership plays a big part in creating the kind of place that people would want to come to, that it's part of the value proposition. Should they create that culture, they, you know, kind of create that environment. What are the characteristics of the leaders that are most successful in this pressurized environment? In your experience, what are they.

00:05:17:23 - 00:05:50:22

Paul Viviano

You know, it sure evolved over the long career that you referenced. And so, you know, kind of the command and control leader is less effective or maybe even not effective at all today in the environment. And so the softer skills are in demand. And that includes empathy and listening and inclusiveness and shaping job descriptions and seeking input about how you do things, not just what you do.

00:05:50:24 - 00:06:19:18

Paul Viviano

And so it's an enormous set of responsibilities today as team members look more to their organization to create an environment that they want to be attracted to that transcends just we provide great care. There's a culture aspect to this, a welcoming culture, a safety part of it being valued not just as a professional, not just as a nurse or as a doctor, but as an ethnic group, as an affinity group.

00:06:19:21 - 00:06:35:26

Paul Viviano

And so how do you create that culture where everybody feels welcome and valued and seen and heard? Those are things that are actively part of the environment today that we strive to create. Those were skill sets that many of us had 20 years ago. You know, pick your time frame.

00:06:35:26 - 00:07:11:27

Dr. Foster Mobley

That requires a different relationship between leader and follower and a much more authentic one. It's not something you can fake. And I notice in watching you over the past, let's say just last 20 years, which is a thumbnail of how long we've known each other. Much longer than that. You have led by example. You've been a particularly great example of authentic connection, communication, warmth, empathy, real concern, all while holding people to account, all while getting the organization to perform at its best.

00:07:12:00 - 00:07:14:15

Dr. Foster Mobley

How do you do that? How do you strike that balance?

00:07:14:15 - 00:07:50:27

Paul Viviano

Well, it's the art and science of leadership today. And, you know, there's no textbook for it. And, you know, there are days when you spend most of your time listening, shaping, learning, listening. It is a matter of approach and it is a matter of perspective. And I really, truly value your input in terms of what we're doing. And that becomes kind of the threshold to then set the expectations of now, now that we trust each other, now that you know that I value you and I care about you both personally and professionally.

00:07:51:00 - 00:08:12:24

Paul Viviano

Then we can get into the conversation about how many patients we treat, what the outcomes are, this kind of thing. But if you if you try to reverse that order, you you're liable to have a workforce with a lot of a lot of pushback. This leveling of the playing field, willingness to listen, willingness to meet with everybody. It's it's equally important to, you know, meeting with your board members.

00:08:12:24 - 00:08:14:15

Paul Viviano

You have to meet with your team members.

00:08:14:17 - 00:08:35:18

Dr. Foster Mobley

I noticed over the past 20 years or so, all the way back to your lines, health care days, communicating directly with people through town halls, through one on ones, through one on small groups, all of that stuff has been an important part of your strategy. And my guess is that probably back in the early days, made some people uncomfortable with how much you were willing to share, disclose, and stuff.

00:08:35:21 - 00:09:05:04

Dr. Foster Mobley

When I look around the workforce, workplace, in health care and beyond, it seems like people are catching up to that. People are now expecting their leaders to bring a great deal more intimacy, a great personal sense of themselves. That again, 20 years ago, 25 years ago was not a thing. We didn't share quite that much of ourselves. And yet that seems to be one of the things that many in the kind of Gen Y, Gen Z kind of thing are expecting of their leaders.

00:09:05:05 - 00:09:06:23

Dr. Foster Mobley

Would you mind commenting on that?

00:09:06:26 - 00:09:38:11

Paul Viviano

It's a two way street. If you want people to be devoted to you, you're going to have to prove that you're devoted to them. Yesterday, I had the opportunity to meet with about ten team members who wish to be anonymous. Before the meeting, were concerned about an aspect of our culture that they wanted to share with me, and the fact that they were willing to reach out to me, knowing that it would be safe, knowing that I wouldn't disclose who was there, who said what, allowed us to have a great conversation and for me to learn.

00:09:38:11 - 00:09:56:05

Paul Viviano

And I that's one of the things I'll open meeting with. I want to be a better CEO. I want to be a better leader for you. So help me understand how I can make sure you feel safe. You know, whatever the circumstances were. And it's a hard thing to do as a as a CEO. It's a humbling thing to do.

00:09:56:06 - 00:10:17:27

Dr. Foster Mobley

I'd love to unpack this incredible story because that's a really great example. A group of ten people with some concerns about the culture reach out to the CEO because they feel safe enough to share some concerns they have in the hopes that something can happen in a positive way. What are the antecedents of that? What allows that to happen?

00:10:17:28 - 00:10:23:24

Dr. Foster Mobley

Why you and what is it that you do? The communicate that sense of safety to them.

00:10:23:26 - 00:10:49:29

Paul Viviano

Well, you know, I think it's probably a long story. I think it relates back to, that willingness to meet with people and to keep the confidence of them intact. So, you know, I meet with roughly ten team members every month and then ten faculty members here every month. And, you know, again, I start the meeting by saying, you know, no one knows you're here.

00:10:50:02 - 00:11:11:29

Paul Viviano

And I'm not going to attribute any quote to you. And I'm going to write some notes about the things you suggest or, observe, because that's how I'm going to remember some of these things. But the fact that I've never disclosed about what anybody's ever said. Word gets out. And these are so we have 8,000 employees. So what is small town?

00:11:12:01 - 00:11:47:18

Paul Viviano

You know, word gets out really fast. If you if you betray somebody's confidence or suggest something that's inappropriate or do something that's inappropriate. Word will get out. So I think it's that proving of you can trust me to keep this confidential. And because you reached out to me because other people have told you that my job is to make sure that our team members throughout the entire organization, neurosurgeon to the person who helps park the cars in the valet, that I give them the resources to do their job and that I respect them.

00:11:47:21 - 00:11:56:15

Paul Viviano

How hard their job is. They're on the firing line. Don't question anybody's motives. And, you know, it takes time to build that trust.

00:11:56:17 - 00:12:24:16

Dr. Foster Mobley

I'm going to use a couple of my more academic words. You can always pull me back on these, but it's demonstrated performance over time. As you say, it is creating a safe environment for them by not. Look, I'm not taking notes. It's having the mindset of I'm coming in to learn from you and my job, my, my frame for my job is that it is to support and help you being as good as you can in yours.

00:12:24:18 - 00:12:50:03

Dr. Foster Mobley

That's my that's my stated role. Also, you know, Paul, I would be remiss if I didn't ask you about that little thing in your in your shirt pocket then. It always sticks out that it's, Yep. That that someday, you know, Paul ever steps out of that office. It's going to be one of the things you're going to most remember about.

00:12:50:03 - 00:12:54:12

Dr. Foster Mobley

What is that about the the pen and the note cards?

00:12:54:14 - 00:13:13:10

Paul Viviano

Well, one of the comment, Foster, about prior discussion, it's this notion of it sounds so simple. I'm going to do what I say I'm going to do. And if I can't do it, I'll tell you I can't do it. I'd like to do it, but I here's why I can't do it, because what I can do and then again, it sounds so simple just doing what you said you were going to do.

00:13:13:13 - 00:13:33:06

Paul Viviano

Not for a day, not once, but half over or any time helps engender that trust. So the three by five card in the pocket is very sophisticated. It's not a it's not a phone. It's not a, you know, it's not a smartphone or something like that. I'm in a meeting and, you know, you say something that I need to remember or is very important.

00:13:33:09 - 00:13:50:04

Paul Viviano

I'll write it on the three by five card and before the day is done, whatever's on that three by five cards going to be accomplished. And because it's so important that it needs to be done in a timely way. There'll be a new card tomorrow. Start with start with the first one. If you make it on the card, you know it's going to it's going to be done.

00:13:50:06 - 00:14:07:19

Dr. Foster Mobley

It strikes me that a lot of the things you're talking about kind of basic goodness, following through on your commitments, listening with regard to other people, showing empathy and concern, helping them, working with mutual. None of this stuff new.

00:14:07:21 - 00:14:09:16

Paul Viviano

No. My mother would be very proud of me.

00:14:09:18 - 00:14:32:20

Dr. Foster Mobley

Your mother? Yeah. Absolutely. And I'm going to take a stab here. Your sense of your role in your first CEO job might have been a little different than that. You probably have not. You know, being a great human being is not anything new to you, but how much you can display that in the workforce might be different.

00:14:32:22 - 00:14:34:05

Dr. Foster Mobley

I'm. I'm inquiring.

00:14:34:07 - 00:14:50:22

Paul Viviano

Well, I think it's, you know, it's it's a sign of a lot of things. It's a sign of maturing, and it's a sign of the times. You know, when you're a young CEO or a young leader, you kind of have a lot to prove. And you want to prove your mettle. You want to prove your your value, that you know, you you deserve the job.

00:14:50:24 - 00:15:18:29

Paul Viviano

And so, you know, there are times when you have to perhaps act not the way you prefer, but the way the organization needs. As you see what's successful over your career, you do get back to these basics of this empathy, this leading with, with, relationships that are honoring what's important to team members, to giving them the tools so that they feel successful, that them working at the optimal of their ability to to lead and to be successful.

00:15:19:06 - 00:15:22:17

Paul Viviano

I think it comes with maturity and so times have changed.

00:15:22:20 - 00:15:43:25

Dr. Foster Mobley

Paul, you've always been a big promoter, supporter, promoter, believer in collaboration. You've always paid a lot of attention to the kind of teams that you build, the people that you put on them that can play well with others. Some say that to approach and address the complexity of problems today really requires all of us. You've seen that in health care.

00:15:44:01 - 00:15:48:00

Dr. Foster Mobley

Does this is a collaborative approach? Probably is, really important.

00:15:48:00 - 00:16:19:00

Paul Viviano

Now? I think it's essential. We all have our strengths and weaknesses and takes, a level of maturity to say, okay, these are my strengths. These are my deficiencies that I need to build a complementary team. You have to build a team that can complement you and create an environment where the decision making around enterprise wide, the big picture decisions are made by that complementary team so that you have all the perspectives.

00:16:19:02 - 00:16:30:27

Paul Viviano

And so it's back to creating safety, feeling valued, everybody being at the table together, everybody feeling as if they're equal in terms of decision shaping.

00:16:30:29 - 00:16:56:08

Dr. Foster Mobley

Two follow up questions, Paul. One is kind of the nature of this human approach to leading other people. It's not easy that it on itself is not easy to do. It seems kind of nice to lean in and listen and ask and, you know, inquire about one's pets or one's weekend. But there's a lot of hard work that goes on beyond that, you know, behind it like nobody.

00:16:56:11 - 00:17:20:23

Dr. Foster Mobley

As an example, you have a great grasp of dynamics in your industry. You know, an awful lot of the critical levers that, you know, can be played or maybe have never been played before, etc. but there's a lot of work that goes into allowing you to be open, flexible. Could you talk a little bit about that?

00:17:20:26 - 00:17:52:25

Paul Viviano

It's back to the balance. And so there is listening and there is trust building. And there's also setting the expectations really high. And if you're in a high performing organization setting those goals, those expectations shaping, meeting so that there are KPIs, achievement milestones, etc. that kind of get weaved into the conversation. It's not just all business, and it's not just all, how'd your weekend go?

00:17:53:02 - 00:18:26:08

Paul Viviano

Those things get blended and mixed together, and some days it's, you know, 98% all business and other days, months, you know, 25% family. And, you know, it's just depends upon the circumstances. Time pressures, all those kinds of things against the art and science, the people who you lead to feel that I care about them personally, family, time, circumstances and professionally that I'm helping them develop their leadership skills so that they can aspire to be something bigger or greater.

00:18:26:11 - 00:18:49:03

Paul Viviano

A CEO, whatever they're dreaming of. Your joke is, you know, you know, somebody better be following you. And you know, when you're the CEO, you're accountable for everything. You're accountable for the financial performance, the clinical performance, the the culture, regulatory, legal mean everything across the board. In your deposition some day, some lawyer's not going to ask you, you know, the name of the kids of your legal counsel, you know?

00:18:49:03 - 00:19:11:20

Paul Viviano

Yes, I do. That's not gonna be a question. My question is, did you comply with your compliance program in in accordance with various laws? It has to be both that development that I'm going to help everybody who works with me or for me, develop their career so that they can achieve what they believe is their optimal contribution to our organization or another organization.

00:19:11:21 - 00:19:19:20

Paul Viviano

That's a gift, not from me. It's a gift for them to know that someone's looking out after their development to make them a better leader.

00:19:19:23 - 00:19:39:19

Dr. Foster Mobley

You have established, and I think rightly so, the relationship between feedback, which can sometimes be positive and sometimes not feedback and personal development feedback and growth feedback. So what's that got to do with authenticity? What's the relationship between kind of telling the truth and authenticity in your life?

00:19:39:20 - 00:20:03:28

Paul Viviano

Well, you know, again, people can see through the baloney. And you know, if I'm not authentic and and how I'm articulating that feedback. Yeah, that concern, that genuine care, they'll see through it. I'm going to lead in a way that reflects that. Me being authentic to mission, to values, to to core beliefs, to to leadership skills. And I'm not here to tell you the answer.

00:20:03:28 - 00:20:20:15

Paul Viviano

I'm here to help you think about what the implications are of how you've lead. Is there a better way to lead under those circumstances tomorrow? And that's not judgmental that that's understanding the implications. If I'm judgmental, that I'm not authentic, I'm just telling you what to do.

00:20:20:18 - 00:20:33:22

Dr. Foster Mobley

I've got a couple final questions. One of them is there have to be limits to authenticity in the workplace. Where are the limits of authenticity between leader and follower in the workplace?

00:20:33:25 - 00:20:58:28

Paul Viviano

Well, I guess it depends how you think about authenticity. I mean, I can be authentic and say to you, listen, you know, we haven't achieved what we've what we've agreed to in the milestone or the time frame or, or you should have approached is different. That's that's being authentic. It's not being less performance oriented. Being again, trust, trusting, respectful.

00:20:59:01 - 00:21:20:12

Paul Viviano

Grounded in, a mission, a strategic initiative, a vision, you know, whatever it is you might be working on. And so I don't see those in conflict. I think I can be authentic. And, you know, if you're home and your dogs running around the back ground, but you're getting everything done on time and things are going well, that, that that's that, that's okay.

00:21:20:12 - 00:21:32:09

Paul Viviano

If not, doesn't matter. If you're in the office, there's going to be a discussion about what what can we do to make sure that we're achieving our milestones and our mutually agreed upon goals, that that's being authentic.

00:21:32:11 - 00:21:52:24

Dr. Foster Mobley

That how has kind of this mental health conversation affected your work force, and what do leaders do about it? You know, people come in and say, you know, I'm just I'm really not feeling it today. I'm feeling very down and like, how do you lead in a scarce workforce where you're struggling for labor?

00:21:52:24 - 00:22:20:04

Paul Viviano

We've made an investment. So we do surveys of, you know, every team member, every physician. You know, everybody in our in our enterprise, you know, as an example, we have 140 general pediatric residents and part time to be a medical resident for all the reasons that are obvious. And we surveyed them and listened to them, and we hired a dedicated psychologist for these 140 residents because that's what they needed.

00:22:20:06 - 00:22:57:02

Paul Viviano

So that wellness component of the job, wellness, belonging, whether that's affinity groups, UI efforts, whether it's having psychologists, social workers, readily available IEP programs support internally and externally, meaning we've designed our health plan to have more affordable, more accessible outside psychologist support. That's important to you. So no, no, no copay. I mean, so we designed things to try to be a supportive of the of kind of the evolving needs.

00:22:57:04 - 00:23:00:01

Dr. Foster Mobley

A little demonstration of your concern for your workforce.

00:23:00:03 - 00:23:13:02

Paul Viviano

You know, and again, I wish we could do more. So the the equation of we only have so many resources. And how do you allocate them. And no doubt the last 2 or 3 years the vast majority of those resources were allocated to team members needs.

00:23:13:03 - 00:23:38:01

Dr. Foster Mobley

Paul, my last question for you. You're a great consumer of information knowledge. What are you reading these days? What are you listening to? What's, what's informing you on this? Let's take it out of the the kind of the technical and the economic realm. But reading anything good, that's, you know, kind of giving you insight to these, leadership challenges.

00:23:38:04 - 00:24:19:13

Paul Viviano

You know, I read a lot, and, you know, I'm lucky I, you know, took a speed reading course, you know, early in my, in my educational experience, the news, New York Times, Washington Post, Wall Street Journal, you know, whatever the, you know, read through, glance through, you know, whatever the professional journals that are directly impactful in our work, Health Affairs, Modern Health Care on the kind of the, you know, the lighter side, you know, keeping pace with the profession things, I think in terms of, you know, how that gets complemented with some of the biographies about other leaders, how they cope with, you know, circumstances.

00:24:19:20 - 00:24:20:25

Dr. Foster Mobley

Any favorite ones lately?

00:24:21:00 - 00:24:24:11

Paul Viviano

I mean, Nelson Mandela, you know, Abraham Lincoln.

00:24:24:11 - 00:24:48:08

Dr. Foster Mobley

And, it's interesting to me that the best leaders, of which I include you and I consider you in, an important role model, are leaning into their people, are really regarding their people are understanding the relationship between helping their people be great and the performance of the organization in this balance that you talk about. So, yeah, I appreciate you.

00:24:48:08 - 00:25:00:06

Dr. Foster Mobley

I appreciate all that you do. And the wonderful mission of CLA for the for the many kids you serve and their families giving them hope. So appreciate it. Paul, I appreciate your time today.

00:25:00:09 - 00:25:08:08

Paul Viviano

Thank you. Thanks for thanks for being such a great coach over all these decades. We won't talk about how long. Yeah. Then why?

00:25:08:11 - 00:25:28:27

Dr. Foster Mobley

For a deeper exploration of your own journey, you can find tools, stories, and reflection questions in my book Leadershit Rethinking the True Path to Great Leading, or by following me on Social media. I'm on LinkedIn and Instagram as Foster Mobley. Until next time, step wise.

00:25:29:00 - 00:25:58:06

Jana Devan

Thank you for listening to Step Wise. Step Wise is brought to you by Doctor Foster Mobley, edited and promoted by Zettist. You can listen to more episodes wherever you stream podcasts. Find out more at fostermobleymt.com or follow us on social media at Foster Mobley. That's f-o-s-t-e-r-m-o-b-l-e-y. We look forward to having an inspiring conversation with you soon.