The Exec: 'Servant Leadership is a Good Fit for Healthcare'

The chief medical officer of Cape Cod Healthcare embraces servant leadership.

Servant leadership involves preparing people to do the right thing, getting them the tools they need to do the right thing, then getting out of their way, says William Agel, MD, MPH, senior vice president and CMO at Cape Cod Healthcare.

Agel has been the top clinical officer at Cape Cod Healthcare since April 2020. He has also served as a member of the board of trustees at the Hyannis, Massachusetts-based health system. Agel has been a practicing obstetrician/gynecologist at Cape Cod Healthcare since 1999.

Healthleaders recently talked with Agel about a range of topics, including the challenges of serving as CMO at Cape Cod Healthcare, how to generate a positive patient experience in the hospital setting, and recruiting physicians in a tight labor market. The following transcript of that conversation has been lightly edited for clarity and brevity.

HealthLeaders: What are the primary challenges of serving as CMO of Cape Cod Healthcare?

William Agel: One challenge is navigating the competing priorities of managing a complex organization. As a practicing doctor, I understand that my No. 1 priority is the patient in front of me. My No. 2 priority is my practice. Those priorities can cause friction between me and other services or stakeholders such as nursing, case managers, or the friction that occurs between physicians trying to figure out how to take care of a patient.

As the CMO, my competing priorities are the community that I serve here on Cape Cod, the institution that I serve at Cape Cod Healthcare, the medical staff that I serve, and the individual doctors that I serve. The essence of being a good CMO is the ability to balance those priorities for the ultimate good of the patients, the community overall, and the doctors at the health system.

HL: How do you balance those responsibilities?

Agel: If you look at it from the perspective of what is right for the patients, the community, and the institution, it is easier to do the right thing. When I have two doctors who are disagreeing over who is going to take care of a patient, the most important thing is what is best for the patient. When we look at the situation in that framework, most people are going to do the right thing no matter what. It just takes a little bit of rebalancing of priorities. Sometimes, it is just a matter of making folks aware of the frictions and why they exist.

William Agel, MD, MPH, senior vice president and CMO at Cape Cod Healthcare. Photo courtesy of Cape Cod Healthcare.

HL: Cape Cod is a distinct region, and you have few direct competitors. What are the advantages of serving a distinct region with little competition?

Agel: Cape Cod is a distinct, beautiful, and unique place. It has unique problems and opportunities. The Cape Cod Canal represents a physical barrier to out-migration for our patients. With the Fourth of July holiday, if you try to get over the bridge, you can see just how much of a barrier that can be. So, we have an advantage over our competition in terms of market share, but that advantage comes with responsibilities. We can't just rely on our geographic isolation to protect our market share. We must do better by our patients. They are our neighbors. They are our friends. They are our relatives.

If someone chooses to battle the traffic to go up to Boston, which is our true competitor for care that could be provided here on Cape Cod, then we have failed our community.

HL: What are the primary elements of generating a positive patient experience in the hospital setting?

Agel: The most important aspect of patient experience is simply showing the patient and the family that I as a physician and we as a health system care about what happens to them. We need to provide care that respects their individual needs and puts our needs second. If we can work that way, a good patient experience follows.

All of the elements of the HCAHPS scores are important, but it comes down to whether we care about the people in front of us. If you look at the care we provide in that way, then all of the other HCAHPS scores fall into place. If I am truly showing to my patients that I care about what happens to them, and I am communicating with them and my nurses are communicating with them, they will know that they will get the care that they need.

HL: You have embraced a servant leadership style. In practice, what are the main elements of your servant leadership style?

Agel: Servant leadership is a good fit for healthcare. As a physician, my job for the past 30 years has been to serve my patients—offer them the information and therapies they need to live their best lives. As a chief medical officer, I try to follow that same path. My job is to give doctors the tools they need to help build a high-reliability organization. Sometimes, that is individual coaching for a physician with a behavior problem. Sometimes, it is looking at a case from a programmatic standpoint and translating that into something that my doctors can work with.

In the end for me, servant leadership is about identifying good people, preparing them to do the right thing, getting them the tools they need (not necessarily what they want) to do the right thing, then getting out of their way.

HL: By multiple accounts, the physician labor market is tighter than ever. How have you been managing physician recruitment?

Agel: The labor market is tight and getting tighter. Current predictions are that we will have a significant shortage of qualified doctors over the next 10 years. Shortages have been accelerated by retirements as a result of the coronavirus pandemic and provider fatigue. Administrative burdens have not helped.

At Cape Cod Healthcare, we have had success in both stopping the loss of providers and attracting young talent. In that regard, I can think of three major themes that have helped us.

No. 1, our president and CEO is dedicated to the health and well-being of our entire workforce, including our physicians. Over the past several years, we have made progress in decreasing the administrative burden on those physicians such as reducing in-box bloat, off-loading non-critical tasks, and optimizing our electronic medical record to make it more user friendly. Those efforts have paid off. Our doctors are happier in their work. The best recruiter we have for physicians is a happy incumbent physician.

The second theme is Cape Cod Healthcare is a place where an eager young doctor can practice at the top of their license. We do not have the luxury of having the ability to send someone down the road because their blood pressure is elevated. We must take care of the folks in front of us. For a young physician coming out of training, that is an attractive proposition. They have studied and trained hard to become extraordinary, good physicians. To give that away by becoming a physician in a city where they will be pigeon-holed into taking care of one particular type of patient is a downside. We offer an alternative to that type of care.

Finally, I can look outside my window and see the harbor and the beach. That is a pretty good recruiting tool.

We are an institution that cares about doctors and encourages doctors to practice their craft to the fullest. And they can practice in a place that is beautiful. It is a special combination.

HL: Cape Cod has a fluctuating seasonal population. Many more people are in the region during the summer. How do you serve this fluctuating population?

Agel: It is a balancing act. We go from about 225,000 people during the winter months to close to a million people on any given day during the summer. That presents significant infrastructure challenges. We need to maintain the infrastructure for serving a million people, but for most of the year we take care of significantly fewer people. We have learned to scale up and down. My colleagues are fantastic at flexibility in staffing and getting the right resources at the right time.

HL: Does this fluctuating population pose staffing challenges such as in emergency medicine?

Agel: Our providers in the emergency department are good at scaling up in the summertime. The emergency department is busy year-round; it just gets busier in the summer. Our emergency room physicians increase their hours and increase their availability during the summertime. They also have a group of doctors who work more during the summer and less during the winter, so they can scale up. We also scale up our nursing staff and support staff during the summer.

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