Thomas H. Lee, MD, MSc, interviews Jeffrey R. Balser, MD, PhD, President and Chief Executive Officer for Vanderbilt University Medical Center.
Tom Lee:
This is Tom Lee, Editor-in-Chief of NEJM Catalyst. We’re talking today about lessons learned about communication during the last few very difficult years with Jeff Balser, the President and CEO of Vanderbilt University Medical Center and the Dean of Vanderbilt’s Medical School. Jeff has a complicated title, reflecting the complicated nature of health care in general and academic institutions in particular, but the pressures of the last few years have not been forgiving of organizational complexity.
They’ve demanded nimble decision-making and getting everyone on board with major redesigns of how everything and anything gets done. Jeff has already written and spoken through NEJM Catalyst about academic medicine and high-value health care,1,2 but I asked him to come back for this podcast because I’ve watched as Vanderbilt has undertaken the work of communication in ways they never had before. My guess is that some have worked out and others have not, and Jeff is the kind of guy who will be honest about and ready to share lessons learned.
Jeff, maybe you can start by giving us a sense of the problem. Vanderbilt University Medical Center has grown, and you’ve got over 40,000 people. My own experience is that people at AMCs (academic medical centers) often struggle to communicate outside of their professional silos. Why was it so critical for you to try new communication approaches in the last few years?
Jeff Balser:
Thank you, Tom. Covid-19 has stressed all of our communication channels, but if I’m honest about this, I would say that even before Covid-19, if people would ask me, “Jeff, what are some of the things as CEO you haven’t got the way you want?” — because I’ve been in this role 14 years, and I’ve been in it more than 10 years before Covid-19 hit — one of the things I would say is, “I don’t think I’ve learned how to effectively communicate with such a large audience.” Ironically, Covid-19 stripped away all the traditional patterns of communication so that we [had to become] innovative, and it became especially important to communicate because people were scared.
Covid-19 stripped away all the traditional patterns of communication so that we [had to become] innovative.
We launched into something that was derivative of something we were already doing in person called Leadership Assembly, where we would bring together, once a quarter, probably 600 or 700 people typically in an auditorium (even though the people eligible to come were over 2,000), all managers and higher in the organization. We would do a 2- or 3-hour assembly for them where I would give a TED Talk, several of my senior leaders would give talks, and we would celebrate people who would win awards.
What we’ve discovered during Covid-19 was we couldn’t do that anymore. We were working with a studio called DVL Seigenthaler. It’s a media company, and they were helping us with our advertising. We had this idea that maybe we could produce a TV show. That’s what led to the video-presentation Leadership Assembly, which is literally a 2-hour television show we do for our medical center every quarter.
I love doing it; it’s been an incredible learning experience. The first time we did it [was] in this big studio in Nashville and right next to us was the championship wrestling ring. I keep trying to get them to let me do something in the championship wrestling ring, but they won’t.
Lee:
Your openness is going to clearly take you to places that we have not yet anticipated. Nashville and Vanderbilt have been through so much in the last few years, and not just the pandemic. There was the bombing on Christmas Day 2020, the riots after the murder of George Floyd, and you’ve had floods and wildfires, not far away from you. It must feel like one crisis after another. How have you changed the way you communicate to the organization in this context, beyond doing a video format of the Leadership Assembly you’ve had in the past?
Balser:
Another innovation that we started right as Covid-19 hit was changing the CEO letters that many of us send to our organizations periodically. I was trying to do them once a month; I called them Rounds. I’m pretty convinced that on a good day, maybe 2–3% of the medical center would read them. What we decided to do [instead] was take videos of me talking to the medical center.
Our media and marketing firm, Seigenthaler, and the partner John Seigenthaler, who used to be a national news anchor, worked with me. I would write a script that was less than 5 minutes long, and he would help me practice saying it into a teleprompter.
Speaking into a teleprompter is a learned skill. I was not a one-take wonder when I started this. He would sit in front of me and say, “Jeff, you have to project more enthusiasm.” Because the problem with reading into a teleprompter is you sound like you’re reading. People fall asleep if you sound like you’re reading.
It was really, really important for me to be able to connect directly with 40,000 people.
You have to learn to do it in a way that you project emotion. Honestly, our people needed emotion in the middle of those first few Covid-19 surges when we didn’t have a vaccine and people were scared. They were scared not only that they were going to die, but they were afraid that they were going to lose their livelihoods.
It was really, really important for me to be able to connect directly with 40,000 people. We were able to see that in some of those videos, we had real-time uptake to the level of maybe 20,000 people, which was just remarkable. It said something about the degree to which people were craving information from the leadership, and we were able to provide that.
Even now, we’re doing them once a month as a baseline way to communicate with the medical center, but when things heat up, we do them more frequently. I usually draft those with input from my team, sending me ideas about things that they believe people in the medical center want to hear about.
Lee:
It’s so interesting because it seems clear you’ve shifted gears from the old way of communicating where we felt like people were supposed to read what we wrote because you’re the boss, and of course they’re going to read it because they’re supposed to read it.
Now, you’re in a mindset where you’ve recognized that they probably didn’t read it before, they don’t have to read it, so we have to cater to them, make it easy for them. The fact is, they want information, but then there’s the fact that everyone today has a limited attention span. They probably had limited attention spans before, but now you’re adjusting to the fact that they’re not going to read 1,000 words or 2,000 words from you. You’ve got to give it to them in smaller bites.
Balser:
That’s right. It’s a little bit like the way we’ve figured out that in health care we need to stop making people come to the castle. We need to bring health care to them, and make it convenient and design the health care system around their needs.
It’s like that, Tom, if you think about it. How do people want to consume information today? They listen to podcasts, and they watch YouTube videos, and they don’t just read things. If we want people to pay attention to us, we have to give them information in the format they like, and we have to make it exciting and interesting enough that we capture their attention. That’s our job. We can’t assume that because we have titles people will read our stuff.
I find that if I keep it to under 5 minutes, and I often have to repeat things because we know people hear just a percentage of what you say — we often will do things more than once, [for example] I’ll do a video on something and come back 2 weeks later and present it a bit differently but reinforce the same topics — I rarely hear, “Gosh, he’s saying the same thing over and over.” People need repetition, and we need to let them have that.
Lee:
As you’ve been innovating, I’m sure not everything worked. Was there anything that surprised and disappointed you by flopping?
Balser:
Hybrid formats haven’t worked very well. Somehow trying to mix together having people in a video format and in a live format seems to fail in our hands. It’s because we’re trying to optimize wildly different contexts at the same time, and we end up not providing something that’s good for communication to the whole audience.
If we want people to pay attention to us, we have to give them information in the format they like, and we have to make it exciting and interesting enough that we capture their attention. That’s our job. We can’t assume that because we have titles people will read our stuff.
I’m sure that technology will continue to improve to make hybrid-communication meetings possible, where some people are on video and some people are live, but I don’t think it’s there yet, and so, we’ve backed away from having hybrid meetings. Now it’s all in person or it’s completely via Zoom or one of the video communication platforms so that we can optimize that platform.
Lee:
That has the ring of truth, and that’s valuable insight to share. Let me ask whether you and your management team have taken on the work of honing new skills. You mentioned that this doesn’t come naturally to everyone and that you work on teleprompter skills. How are you going about training your colleagues on communication in this new era?
Balser:
We’re all learning teleprompter skills, and it’s pretty interesting. We all require several takes when we first get started, but the team from DVL Seigenthaler that we’re working with is patient with us. They teach us how to become more animated, to speak louder than you think you need to, to move around and make sure you’re not standing in one place the whole time. The kinds of things you need to do to project any energy to an audience when you’re using a video format may come naturally for some people, but for many of us we have to work at it. The number of people who participate in leadership assemblies is maybe up to a dozen. We all rehearse, we all practice, and we all work at it until we get it right.
Lee:
Jeff, I feel all sorts of anxiety about the fact that I have not taken on learning these kinds of skills in any formal way. I’ve been going with my gut and that probably is not enough. I want to thank you for some very good points. The analogy between organizing care around patients and organizing communication around the audience is a new idea, at least for me.
It’s a big one and an important one, [as is] your observation at the beginning that our old ways of communication were probably not that effective, but the stakes were less high than they are today, and that innovation like you’ve been doing is critical. It’s a valuable lesson for health care in general, not just academic medical centers. Thank you for sharing your insights once again. They’re always great, and I look forward to more.
Balser:
Thank you, Tom. It was a pleasure to be with you.
