'It's Important to Have a Vision:' Retiring Yale New Haven Health CEO

Marna Borgstrom, MPH, speaks about her upcoming retirement, her organization's focus on succession planning and DEI efforts, and looks back on her healthcare career journey.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Women in Healthcare Leadership Podcast. Audio of the full interview can be found here.

Marna Borgstrom, MPH, has served in various positions at Yale New Haven Health for more than four decades, starting as an administrative fellow at Yale New Haven Hospital in 1979. Since then, she's climbed the ranks and now serves as CEO of Connecticut's largest healthcare system.

Last year, Borgstrom announced that she will retire on March 25, 2022.

Mary Farrell, who serves on the Yale New Haven Health Board of Trustees said it best: "As the first woman to serve as CEO of Yale New Haven Health, she was not just a trailblazer, but she became an approachable and compassionate leader for all employees."

In the latest Women in Healthcare Leadership Podcast episode, Borgstrom speaks about her upcoming retirement, her organization's focus on succession planning and DEI efforts, and looks back on her healthcare career journey.

This transcript has been edited for clarity and brevity.

HealthLeaders: Your tenure with Yale New Haven Health System started over 40 years ago. Can you share your career journey and how you eventually became CEO of the hospital and the health system?

Marna Borgstrom: Sometimes, I find when I recount my journey that it's unremarkable and filled with as much luck and good timing as it is accomplishment; I often call myself the accidental CEO.

I came to work as an administrative resident, we called them at the time, they're now fellows out of graduate school, and I had just married my husband.

When I came, I wasn't sure what I wanted to do. I thought I wanted to do operations, but I didn't really know what that meant. Over the course of the first 10 or 12 years, I did a little bit of this, and a little bit of that. I did some staff work, I did some operating work, I had some clinical departments, I worked in strategy and planning. Everything that I did, I liked, and everything that I did, I thought, 'this is where I'm going to focus myself.'

The important thing is that throughout most of this, I had an extraordinary mentor. He's very different than I, very traditional in many ways, white, male. I probably didn't appreciate fully how long his vision was, because he saw things in me that I didn't, and each time I would get to a fork in the road in my career, he would say, 'Well, let's talk about it, we can go this way, or we can go that way.' He kept opening up opportunities without ever requiring me to have an ultimate vision. He would lay out the options, and I had a feeling that this was somebody who was not going to let me make a bad choice.

When he told me that he was going to retire 16 years ago, I had to think long and hard about whether I felt I was ready to be the CEO. I realized that if I didn't put my hat in the ring, I would probably need to be looking for a role because somebody from the outside would want to put a new team in place. I became very intentional at the last moment about vying for this CEO position in a national search and I was very fortunate to be offered the role. There are a handful of us who have had the privilege of developing our careers without ever relocating our families.

HL: In September, it was announced that you will be retiring on March 25. How did you come to that decision?

Borgstrom: When I took this position, and I started working with my board chair, one of the things that that person said to me was, 'you should be spending at least a quarter of your time on talent development.' And I thought, how do you take 25% of your time, and develop talent in the organization? I will tell you that in the first 10 years of my time in this role, I did not spend that.

I have spent every bit of that time and more in the last six years. My decision is very intentional, and began in earnest in 2016, with work that I did with some of my closest senior colleagues and with a committee of the board. We began to talk about what people's horizons were, when people were likely to retire or leave for another position, who was behind them? Then we did a lot of talent assessment among the top five or six people in the health system. What are their strong points? Where do they need development opportunities?

We put together a framework that said, 'if I were to retire, who would be the people who could succeed me, who's likely to retire before me that would also need somebody in.' We put together not just a matrix that said, 'okay, this person has these two potential successors,' but for the people who we identified with succession talent, we put in place a plan for them. Do they need more time with the board, time with our medical school colleagues, time in community relations? So, there was a plan.

I'm about 18 months beyond what the plan originally called for in terms of my departure. COVID had something to do with that, as did transition and leadership at our partner medical school at Yale. But the people who we had development plans for, by and large, have evolved into the roles that we hoped they would.

[Succession planning] is important. I'll share one of the things that we were an early leader on. This person who was my mentor was somebody who, before anybody was talking about diversity, equity, and inclusion, was working on diversity in our health system. So, that also became an intentional part of our plan, because even though we are in a Northeast state that many who haven't lived here view as a wealthy state, we are home to three of the top 50 poorest midsize cities in the United States. Our patient populations and our employee populations are very diverse. And one of the things from a business perspective that we have embraced for a long time, is that the evolution of our leadership needs to reflect the people we serve and the people that we bring into our organization.

HL: It sounds like your mentor has created a lasting legacy. Could you share what you hope your legacy will be?

Borgstrom: I don't know that I've thought a lot about a legacy. But I'll tell you the two things that I feel most proud of.

One, I think we have a culture of accomplishing things and doing things well. People care about one another and it's team-oriented, and I think that team and culture are really important.

The second thing is we've spent time focusing not just on what our business strategy is, and what the success metrics are, but an equal amount of time on how we do the work to get it done. Because sometimes you can accomplish things, but either they aren't sustainable, or everybody's so exhausted and frustrated when you do, that you're not going to be able to go on to the next thing.

We put five leadership success factors in place, which are important to how you lead:

1. Leading with humility
2. Being courageous
3. Building collaboration and alignment
4. Modeling diversity, equity and inclusion, and belonging
5. Supporting innovation

If you bring those five things to the table, at least in our organization, you're going to be successful.

HL: How would you describe your leadership style?

Borgstrom: I would like to think that if you asked other people, they would tell you that I'm a very good listener, because I think that's very important to seek out information and points of view to help you do what you need to do.

Second, is staying in touch with the business that we're in. It's an important way of understanding the work that we're doing.

HL: What changes in healthcare stand out to you that you've experienced during your tenure at Yale New Haven Health?

Borgstrom: There have been so many changes in healthcare in the time that I've been in healthcare. There are obvious technological and clinical advancements that have allowed us to care for what used to be fatal diseases, in ways that now make them treatable.

What's also changed in healthcare are the payment systems, not necessarily for the better. I think that scale has become important in healthcare. When I got into it, the goal, if you had one, was to be the head of a hospital. Now there are very few standalone hospitals. And healthcare systems are not about acute care; increasingly, healthcare is about the continuum of care, it's about navigating that care, it's about bringing value.

There are a lot of things that have made healthcare objectively better and more treatable and the spectrum in healthcare has become much broader. But I do firmly believe that we're going to have a hard time evolving the system into what we need it to be, if we don't fundamentally change how we pay for, what we pay for, and what we value in healthcare, because we have a great sick care system. But we have a healthcare system that isn't overall working as well as it needs to.

HL: What advice do you have for women and others who want to serve in healthcare leadership roles?

Borgstrom: The one thing that I feel strongly about is that it's important to have a vision, to know where in the context of this work, you see us going and where we need to go. But don't have an exact plan of how to get there. If you go back to our discussion about how my career evolved, there was not an exact plan.

A lot of times when I will talk to younger people now, they're so goal-oriented that they want to be at a certain title, in a certain kind of organization, in a certain period of time. I think while having a vision is important, I would say lighten up on the reins on that specific plan, because you may be precluding opportunities that you weren't even aware of. Sometimes, it's those experiences that give you the broadest vision and help you understand things that you might not have been able to understand as well if you followed a linear path.