Now That I Am a Hospital Executive
Authors: Cam Patterson
Journal: Circulation (2016)

A few years ago, I deviated from my pathway as a research-focused academic cardiologist situated in a traditional medical school organization chart to begin a new career as a senior executive at one of the two academic campuses of the largest hospital in the United States, NewYork-Presbyterian Hospital in New York City.As the chief operating officer of Weill-Cornell Medical Center, I have primary responsibility for the strategic direction and management of a campus with nearly 10 000 employees who treat 1 million outpatients and admit 60 000 patients into 910 registered beds each year, in collaboration with 2600 physician partners from our sister organization, Weill-Cornell Medical College.Now that I am past the point of settling in, I have had a chance to think about what I wish I could tell my former academic self and what challenges and opportunities I see for medical school-hospital partnerships going forward.My list of "shoulda knowns" that would have made me a more productive academic and administrative cardiologist is lengthy.I would have been better prepared to advocate for my faculty members, trainees, and especially the patients we cared for if I had been more comfortable with the nuances of hospital finances, healthcare reimbursements, and the regulatory environment.I wish I had had a better sense of the fully loaded costs of education in an academic medical center environment.I probably would have stepped on fewer toes if I had understood the entire scope of unsupported activities most academically affiliated hospitals shoulder, and I could have been more compelling in articulating the unfunded mandates borne by my academic department.I wish I had pushed for sharper conversations to explain to my hospital partners the nearly inscrutable interplay of clinical and research productivity that makes being an academic physician so rewarding.The most impactful piece of advice I would give my former self-this is a big surprise to me-is far less specific to health care and also far less obvious than it needs to be.I would say to pay a lot more attention to the structure and function of the teams that I supervised and participated in.This surprises me because I have spent my entire career thinking that I was engaged in team-based activities, many of them I thought to be highly functioning; I saw myself as a "team player"; and I have spent plenty of time talking about the importance of teamwork in clinical care and biomedical discovery.Nevertheless, it is only since I have taken a more top-down view of teamwork in action that I have appreciated how complicated, difficult, and ultimately rewarding formal team building can be, and how far off the mark about teamwork I often was in the past.In their seminal article, "The Discipline of Teams," Jon Katzenbach and Douglas Smith point out that "committees, councils, and task forces are not necessarily teams." 1 I would extend this list to include research laboratories, clinical divisions, and what we euphemistically refer to as medical teams, groups from different disciplines that round together on inpatients.Under optimal conditions, these groups coalesce as a true team with shared purpose and mutual accountability, yet all