Training Future Health Care Leaders to Address Health Disparities

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Tom Haederle
John Bluford's distinguished career in hospital and health system administration has spanned more than four decades. He's been recognized as one of the most influential people in health care, and served as chair of the American Hospital Association in 2011. He's also the founder of the Bluford Health Care Leadership Institute, a professional development program that introduces talented minority undergraduate scholars to health care administration with the expectation that this pipeline of talent will ultimately help to eliminate health disparities among populations dealing with sustained hardship.

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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast, hosted by Joy A. Lewis, senior vice president of Health Equity Strategies with the AHA, Bluford describes how his institute trains promising young talent to assume leadership roles... the impact they've made...and how to deal with pushback in some quarters against DEI efforts in general.

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Tom Haederle
This podcast was recorded at the American Hospital Association's Annual Membership Meeting in Washington, DC.

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Joy A. Lewis
Good morning John. Thank you so much for joining me today. Is it fine to call you John?

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John W. Bluford, MBA
Please do. Good morning to you.

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Joy A. Lewis
Because I am sitting with the John Bluford. And this came together rather quickly, so I guess my timing was right. Thank you for carving time out of your busy schedule to join me in conversation today. Today's conversation is a really important one. We want to focus on how might we think about ways to create a diverse talent pool of health care leaders?

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Joy A. Lewis
We know how important it is to have a diversity of thought, different perspectives weighing in, making decisions that then lead to better health outcomes for the patients and families and communities that we serve. So currently, you are the president, but also the founder of the Bluford Health Care Leadership Institute, which was established over a decade ago in 2013.

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Joy A. Lewis
And your program trains and mentors and prepares early careerists to occupy, to advance through into leadership roles in health care settings. And I guess in addition to how you're spending your time today, we should talk about your tenure. Your career portfolio, which includes...

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John W. Bluford, MBA
It's been a long one.

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Joy A. Lewis
I know! Spans over 50 years.

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John W. Bluford, MBA
Oh, just about...not quite over 50, but we're getting there.

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Joy A. Lewis
Okay. I want to be like you when I grow up. So, former president and CEO, president emeritus of Truman Medical Centers in Kansas City, Missouri. Prior to that, CEO of Hennepin County Medical Center in Minneapolis, Minnesota. So let's start there. Can you walk our listeners through your journey and I guess leading into this question around what were some of the conditions that you observed, you witnessed inside hospitals and health systems that you led?

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Joy A. Lewis
And also, as a former chair of the AHA's Board of Trustees, that led you to create the Bluford Health Care Leadership Institute.

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John W. Bluford, MBA
Thank you very much, Joy. It's a great lead in. And I would start by saying that these 45 plus years in the business have always been in urban settings. Large tertiary teaching hospitals that dealt with underserved patient populations. So that has been my story from day one. As an epidemiologist for the Center for Disease Control and the areas of Saint Louis, Missouri.

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John W. Bluford, MBA
Pruitt-Igoe housing project, which is the first federally funded housing project in the country. And that is kind of where my orientation comes from. More recently as a CEO -and I've been retired for ten years -but I'll say recently as a CEO of two major academe training centers, I discovered that there was not a pipeline of diverse talent coming through graduate school programs for hospital administration.

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John W. Bluford, MBA
How do I know that? Because I was a preceptor for several programs across the country between the late 80s and 90s, and I consistently got very talented scholars to come to my institution to fulfill their requirements for graduate school. But none of them were diverse candidates because they weren't in the pipeline. And the genesis of the program that's in place right now is a request that I made to the Hennepin County Board of Commissioners to give me some funding to go to Morehouse College and recruit an undergraduate student to come to Minneapolis and work with me for the summer.

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Joy A. Lewis
Just one.

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John W. Bluford, MBA
Just one. You got to start somewhere.

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Joy A. Lewis
Yeah.

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John W. Bluford, MBA
Right. And that one student stayed with me for two years while I was at Hennepin, followed me to Kansas City, Missouri, and ended up working for me for 17 years. So that project was very successful in one respect, but not a lot of players. Secondarily, because of the success of that one student and my love for doing that kind of work and mentoring, I did the same thing when I got to Kansas City, Missouri, and that has led me to go to primarily HBCUs, Fisk University, Spelman College, Morehouse, Florida A&M University, North Carolina, and A&T and Hampton University,

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John W. Bluford, MBA
more recently.

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Joy A. Lewis
Not Howard, my alma mater.

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John W. Bluford, MBA
But it will be there next year.

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Joy A. Lewis
Okay.

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John W. Bluford, MBA
And solicit and recruit some very, very, very talented and smart scholars and convince them that health care is a good career path for them and go for it. That's one reason for the BHLI,  and the other is a wonderful experience that I had in the early 80s as a participant in Harvard University's mid-career programs. I was 31 years old at the time.

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John W. Bluford, MBA
And that experience just exposed me to how the sausage is really made in health care. And I wanted to expose these young people to that type of experience. I could go on and on, but that gives you a little bit of the seeding of the Bluford Health Care Leadership Institute.

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Joy A. Lewis
And again, the early beginnings, rooted in looking at expanding and providing exposure to those from historically underserved, marginalized communities and giving them an opportunity to even consider health care. Absolutely right. So if anyone visits your website for BHLI, they will see the Institute is described as an intense professional development program. Can you share a little bit more? What does that mean?

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Joy A. Lewis
What does intense mean in this example?

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John W. Bluford, MBA
Intense. It's a two-eek program, seven days a week. Each day, our scholars are picked up by an executive van or bus at seven in the morning, and their day ends 12 hours later, as the last couple of hours of the day, they're working on a case study that they will present to a community audience at the end of the program.

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John W. Bluford, MBA
So intense, in my view, means first and foremost, looking for very serious scholars that want to be successful and hopefully in the health care field. The idea is that we are preparing them not for the next level, but the level beyond that. We want leaders, not mid-careerists.

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Joy A. Lewis
And we know that there's typically this plateauing that occurs when you get to the midpoint. How do you then move into the more executive senior leadership roles?

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John W. Bluford, MBA
So we have a very strong didactic experiential curriculum with leaders from the industry all over the country coming in and sharing their stories, their personal stories. People like Mr. Rick Pollack, for example, or Mr. Wright Lassiter, for example. I think we've had four past chairman of the boards from the AHA. Mindy Estes comes to mind. Kevin Lofton has been a couple of times.

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John W. Bluford, MBA
Jeanne Wood has been. So they're get experience and wisdom from the top of the industry. That's number one. Number two, not only didactic and experiential learning, but we really focus on executive presence and what people call soft skills. I don't agree with that terminology. I think they are essential skills. And by that I mean presentation skills, language skills, appearance skills, self-awareness skills.

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John W. Bluford, MBA
How to network skills. We drill that into each and every one of these scholars every day and all day. Even though we do have some social activities, but it's not a frat party. You're still on stage. So we have golfing outings, and we've done bowling before, and we go to the performing arts. And we tour a couple of museums in Kansas City, high end.

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John W. Bluford, MBA
But we're constantly looking at our scholars and observing our scholars and how they interact with each other and others.

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Joy A. Lewis
How they show up.

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John W. Bluford, MBA
How they show up. Good point. And we don't grade on the curve. If we catch something that's out of order, we pull them aside and said, you might want to reconsider how you're doing that.

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Joy A. Lewis
No partial credit, huh?

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John W. Bluford, MBA
No partial credit. And I think that's very enlightening for these students.

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Joy A. Lewis
That's helpful. To your point, there's the didactic component, the experiential component. But then there's the: how do you read a room?

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John W. Bluford, MBA
Exactly. There are two things that I could have mentioned too: etiquette training, because part of the interview process is often how you perform at dinner or lunch. So we do that and we have speech coaches come in and really help on the presentation skills. So the underlying theme of that, sometimes it's not how much you know, but how well you can communicate what you know.

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Joy A. Lewis
That's right. Very comprehensive. I don't know what you do with folks like me who are not morning persons. At seven a.m.?

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John W. Bluford, MBA
They get on board real soon or they're left behind.

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Joy A. Lewis
They don't have a choice, right? That's right. So a little bit more about, I get the goal here. To your point, it's not mid-career. It's preparing folks for those senior leadership roles. What's been the impact when you look back over the past decade since the inception of this program? Where have your scholars landed? What have they gone on to do?

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John W. Bluford, MBA
I'm glad you asked that question. And that's the best question of the interview, because we can talk a lot about what is and what is and what we want to be, but what's the impact is the punch line. And we have been quite successful in our goal. Now remember, the goal is to train culturally sensitive, talented individuals to ultimately impact health care disparities among minority and vulnerable patient populations over the next two generations.

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Joy A. Lewis
That's tall order.

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John W. Bluford, MBA
That's a tall order. We've got time, and it's going to take time to get it done. And in that regard, in round figures, we've had 150 participants come through the program over the past 11 years, 11 or 12 years. We've had 120 internships that have resulted from those students coming through our program. Now, internships are fully paid summer internships after their two-week didactic experience in Kansas City.

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John W. Bluford, MBA
And those internships have been in 50 sites across the country. And the punch line is this: out of 121 students who've actually graduated from undergraduate school, because I interview them as freshmen and sophomores. So they're very young.

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Joy A. Lewis
And you're doing the interviews.

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John W. Bluford, MBA
And I do the interviews personally. Out of the 121 that have graduated, 100 of them are in health care space today, 83%. And the others are lawyers, and on Wall Street, they're doing well for their own personal careers. But 100 of them are in health care. So just give you an example, and this is a one hour interview in itself where some of these students are and more importantly, what they're doing.

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John W. Bluford, MBA
And you can project what they're going to be doing in years to come. But we've got one of our scholars who was in our program in 2014. He is now the surgical specialty clinic director at Henry Ford Hospital. We've got another young lady. She's the pharmacy infusion manager at Emory Hospital's Winship Cancer Center, and she took me through a tour of this new facility.

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John W. Bluford, MBA
It is really awesome. And she's in charge. 
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Joy A. Lewis
And she's in charge. She's at the helm.

John W. Bluford, MBA
She's at the helm. And we've got another young lady, and I think you're going to meet her at your program in Kansas City later this summer. She's a deputy director for policy and human services for the governor of Kansas, and she's working on access to mental health and Medicaid expansion, which, as you know, is a big issue.

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John W. Bluford, MBA
So we've got young people five, six, seven years in their career with no ceiling, doing meaningful and important work with good compensation.

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Joy A. Lewis
That's critical. And, well, you started out with them getting paid internships. I noted that.

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John W. Bluford, MBA
Absolutley. And they get paid for their two-week tenure in Kansas City as well. It's a $2,000 stipend because we realize while they're there they could have been working their summer jobs. So we want to be competitive to get the best students. And the best students are being paid for their time right now. Let me tell you a little bit about these sites.

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John W. Bluford, MBA
I mentioned 120 internships, 50 different sites. The American Hospital Association membership and its leadership has been very valuable connectivity for us because we're placing our students in their institutions. So we've had students at Duke University, Johns Hopkins, Atlantic Health in Morristown, New Jersey, Advocate Atrium have taken a lot of our students. Truman Medical Center's my old stomping ground.

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John W. Bluford, MBA
Obviously, it's taking a lot of students University Health and Cleveland, several Blue Cross Blue Shield programs across the country. Saint Luke's Hospital, Dr. Estes' old place, has taken several of our students. Aeon on a long term consultancy..so it just goes to show that networking and the loyalty and concern among my colleagues in the field are paying dividends as well and helping us do this.

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Joy A. Lewis
Amazing, amazing impact. So when you started this Leadership Institute again in 2013, the environment was quite different, the external environment. And so what we're looking at right now are some serious - as my CEO Rick Pollack likes to call them - motivated adversaries with deep pockets who are waging a war against anything that smells or looks like diversity, equity, inclusion.

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Joy A. Lewis
So again, we're in a very different place today. How are you thinking about the existing world that you're training these young folks to show up in? How are you preparing them to be successful with all the headwinds in the midst of these anti-DEI efforts?

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John W. Bluford, MBA
That's a great question, and perhaps one difficult to answer, but it's easy for me. One, we started before these anti-DEI and affirmative action related mentality surfaced and as such very narrowly focused on teaching, mentoring, coaching, and perhaps more importantly, sponsoring the scholars in our program. And that sponsorship, that coaching, that teaching was very specifically directed toward dealing with health care disparities in America, specifically among minorities and underserved patient populations. Rural America, the different pockets that need the support.

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John W. Bluford, MBA
And we wanted to make sure they were culturally sensitive to the issues of socioeconomic determinants, etc., which I now favor the public policy determinants of health, and be laser focused on that and eliminating the disparities. So we don't talk a lot about DEI or anything. We talk about disparities, socioeconomic determinants, and how you can position yourself to get in a decision making role to make a difference.

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Joy A. Lewis
And the disparities have been there. They have a long tail, to your point, well-documented. So keeping a focus on the elimination, not the reduction, the elimination of those disparities.

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John W. Bluford, MBA
Zero.

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John W. Bluford, MBA
And we hope that we've given them enough time frame over the next two generations to make a difference. I certainly don't want my grandson's children to experience some of the same disparities.

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Joy A. Lewis
Correct, correct. And I like the break down. You've done a really good job of distinguishing between mentoring and sponsorship, for example. Those two tend to get conflated and we know they're very different.

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John W. Bluford, MBA
I think many of us who've had the pleasure of serving in this industry were helped quite a bit by someone that was in those positions that we wanted to get to. And it's not unusual for me to pick up the phone and call a colleague of mine and say, you know, Joy Lewis has been in your operation now for four years, and I understand she's doing well.

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John W. Bluford, MBA
We want to see some growth in her career.

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Joy A. Lewis
Right.

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John W. Bluford, MBA
Yes.

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Joy A. Lewis
Makes sense. Appreciate that. So we're coming up on time here. But I want to ask. It would be foolish to have someone of your stature sitting here and not solicit some piece of advice from you to these young scholars. What is it that you wish someone had told you?

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John W. Bluford, MBA
You know, I've had such a positive journey, and I wish someone would have told me about what an opportunity and blessing it's gonna be to help and serve the community in which I work. It's hard work, but the work is twice rewarding when you see the results. That's a very powerful statement. And I tell everyone, at least in my case: never had a job.

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John W. Bluford, MBA
It's always been a mission, not a job. And that's how I've gone about my work. Compensation and those kinds of things have always been secondary. And I tell people all the time, if you're going in it for the money, then do something differently. But if you go in it and do well, get your money.

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Joy A. Lewis
That's powerful, John, and very compelling. This notion of you're in it because it's your cause to make lives better at the end of the day. So I can't thank you enough for your continued leadership. You lay the mantle down in terms of CEO-ship roles a decade or so ago, but you continue to add to that almost 50 year legacy that we referenced earlier, really impressive and impactful career that you've had and continue to have for many of us who are in the trenches here.

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Joy A. Lewis
So it's great to be in community with you and to have this conversation. And thank you for your time.

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John W. Bluford, MBA
Thank you for inviting me.

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Joy A. Lewis
Absolutely.

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Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.