Cardiologist, COO, Culture Changer

Start with cardiology, a specialty that has been at the forefront of positive change. Then add experience, an entrepreneurial spirit and vision. One cardiology leader applies all three in an ambitious effort to improve healthcare.

The first lesson Cam Patterson, MD, MBA, learned as a chief of cardiology was how to adjust for blind spots. He had already accepted that post at the University of North Carolina (UNC) Center for Heart and Vascular Care when the head of finance informed him that his division had been losing $2 million a year. “I hadn’t had the chance,” he recalls, “to do due diligence.”

Rattled but undaunted, he enrolled in UNC’s Kenan-Flagler Business School. He earned his MBA in 2008, launched biomedical startups in 2009 and 2011—and, move by move, restored the division to fiscal health. Last January he left UNC to become senior vice president and chief operating officer (COO) of New York-Presbyterian/Weill Cornell Medical Center in New York City. He shared his thoughts about beginning at the bedside, advancing to the C-suite and building on the momentum. 

What did you learn from your clinical and managerial work in cardiology that you now find yourself applying as a COO?

From a clinical standpoint alone, cardiology touches on so many parts of an academic medical center. From outpatient to inpatient, preventive to acute management, procedurally oriented and nonprocedurally oriented, value on the hospital side and value on the practice side—being a cardiologist, and being an academic administrative cardiologist, gave me bits and pieces all throughout the hospital setting.

Those are experiences that you would not necessarily get with a different background. An endocrinologist who does diabetes care will surely be an expert in outpatient clinical management, but would not be exposed to a lot of what happens on the inpatient side. A busy surgeon would understand how the operating rooms and referral networks operate but might not get population health. I think there’s something relatively unique about cardiology that is helpful in understanding the entirety of the hospital enterprise.

Do situations sometimes arise that give you cause to draw directly from your cardiology experience?

Over and over again. I just walked out of a meeting where we were talking about our integrated models for Medicare and Medicaid. It led me back to my experience at UNC developing an integrated model between UNC and private insurers from which we learned a lot about shared savings, for example, and how to develop strategies for dealing with the state and federal government. Just a few minutes ago I drew from that to say with some degree of certainty what would work and what wouldn’t work here in New York. 

How does an executive with an appetite for entrepreneurialism satisfy the drive to launch new companies?

You translate it into building institutional expertise. For many academic medical centers, innovation is something you don’t do well. Here at New York-Presbyterian I want to see a culture of innovation at all levels of the institution. I want a nurse who observes a shortcut that safely will reduce our length of stay to speak up and to be rewarded for that contribution—not knocked down with “That’s not the way we do things here.” I want my physician scientists to develop relationships that extend beyond the academic medical center and that would include venture partners. I want them to feel they can turn the kernel of an idea into something that will impact us in a dramatic way.

We already have several programs here that are moving aggressively in that direction. I’d like to build on those and take what I’ve learned at an individual invention level, in my own lab, and turn it toward building institutional expertise.

That will probably be considerably harder than inventing things, given the reality of institutional inertia, aka bureaucracy or red tape.

You can call it red tape or you can call it culture. Those two are really one and the same sometimes, when the culture is holding you back. But if you can turn the culture into a culture of innovation and empowerment, what was once red tape becomes grease to make the wheels turn. That’s really what I want to see here.

Cultural change usually happens quite slowly, does it not?

Culture change is difficult, but it’s never impossible. Feeling that a culture is unchangeable is the quickest way to fail. There is a scholarship of culture change. There are principles of culture change. And any leader who isn’t conversant with that literature, and isn’t experienced in the practice of that literature, is severely handicapped.

I hope that practice is what I bring to the table. I was hired to make good decisions for this organization. We have one of the best hospitals in the country, and we’re not going to be able to stay that way if we’re not continuing to evolve in a dramatically and rapidly changing environment.

What are your hopes for, and concerns about, the future of cardiology in this country?

Cardiology is one of the great success stories of the past 50 years of academic medicine. The technological innovations that have transformed cardiology are really second to no other field. In spite of relatively modest investments on a per-patient basis, we have markedly reduced the number of patients who require cardiovascular procedures. We have extended lifespan in individuals with severe problems like myocardial infarction, and we have a population-based prevention program that is second to that of no other disease. The biggest challenge and the biggest danger—not only to the field of cardiology but to people who are at risk for cardiovascular disease—is complacency.

How might cardiology’s record of success help drive change into the American healthcare system as a whole?

We’ve substantially reduced the incidence of major forms of cardiovascular disease. We’ve reduced hospitalizations. At the same time, we’ve introduced a lot of new technologies and medicines—many of them expensive. More new medications are coming down the pipeline that will be even more expensive. What we have to do starting in 2015 and going forward for the next 50 years is to figure out how to do all of this as well as, or better than, we’ve been doing it—and to do it more cheaply.

Any advice for young—and young at heart—cardiologists?

I would encourage any cardiologist who is thinking seriously about a career in hospital leadership to not be afraid of pursuing it. Many of the skill sets that you need to draw from are going to be the same. Hospitals are uniquely positioned to effect the course of medical care, at least over the next decade, compared to physician practices. If you’re looking for a chance to have an impact at a large level, there are very few opportunities that are going to measure up to the opportunities that you get in a hospital leadership position.