This interview with Ernie Sadau, the CEO of CHRISTUS Health, was conducted and condensed by Eric Larsen, Lisa Bielamowicz, M.D., and Dan Diamond.  

Q: Why did you get into health care?

Sadau: Let me answer that with a story that goes back to when I was a kid.

I was about 16 years old, sitting in a hospital bed at Plaza Medical Center [in Fort Worth, Texas]. I'd come in for some minor procedure.

For years, I'd had a really strong desire to be a physician and even researched the medical field. But as I was lying in that bed, I was thinking—someone has to run this place. Maybe that's a great way to be of service, to be of leadership.

And when they brought my tray of food that night, there was a card that said, essentially, are there any comments you'd like to send the CEO.

So I wrote, I'd like to talk to the CEO about what he does, and what it means to be an administrator of a hospital. I put my number on there.

A week later, my mom gets a call, and it's someone from Plaza Medical inviting me to lunch with Lee Mootz, the CEO. I spent a couple of hours with him, touring the hospital and asking questions about how he spent his day.

That's when I realized: This is what I want to do, this is my calling—and I never looked back.

Leadership lessons

Q: What did that teach you about leadership?

Sadau: Being a kid, I didn't recognize what was really given to me—the opportunity that Mr. Mootz made for me.

By the time I realized his gift and wanted to tell him that, ten years later and having started my health care career, he had passed away.

So it's been ingrained in me ever since: You have to understand those moments and say thank you.

It also hammered home the importance of mentors, and what they can mean in a person's life.

That's why I will make any time available for anyone who wants to talk about careers—whether inside CHRISTUS or out. That's one way that I can give back.

Q: Can you share a recent example?

Sadau: I just had a conversation with a graduate student who wanted to know how to build his own career.

We talked about the importance of health care, and to do what you love, but to keep the balance of family and life outside your job.

I also told him: Always remember why you got into this. Don't get so far into the leadership ranks and forget why you're there.

Because it's not about you; it's about the team and the mission that you have as an organization.

Q: How do you get people on your team to live that philosophy—especially for staff who are trying to move up the ladder?

Sadau: I think it boils down to three things.

1. Preach a commitment to balance. That can be hard on any given day; at 10 p.m. last Sunday, I had to be on a call about a deal that we're working on in Chile.
   
   But those nights are going to happen—which is why you've got to make sure you have balance across a cycle. In my case, it's keeping the balance of being a spiritual person and spending time with my family.
   
   
2. Develop the whole person. For example, we've consolidated our four offices into one new facility, which is designed to boost team collaboration.
   
   But it's also intended to allow our staff to have opportunities for outdoors and indoors wellness activities; there are places to sit for personal reflection throughout the day. We're also putting in a clinic for associates and families to help with their wellness and care.
   
   
3. Prioritize for the organization. As leaders in health care, it's so easy to say yes—to always take on another strategy or item. But then you get a huge list of 50 priorities and have to ask: what have we really accomplished?
   
   So as CEO, I have to decide: we're only going to focus on two to three major initiatives as an organization at a time. That can give everyone breathing room.

Strategic challenges

Q: Speaking of priorities, what are your top challenges for this year? What are the things that keep you up at night?

Sadau: One of them is clinical integration—specifically, is CHRISTUS moving fast enough on CI, and what am I doing as a leader to enhance that process?

So I approach that from an IT standpoint and from an evidence-based standpoint. I'm also thinking about everything else that goes with it: physician alignment, co-management, and employment strategies.

Something else that keeps me up is the push toward population management. Especially because at CHRISTUS, we're not saturated in one market—we have to develop models that work in different places.

That's one reason I'm excited about the partnership we have with Evolent, which is working with us to develop the right strategies, so we don't have to retool or develop that expertise from within.

You know, many health care organizations think they always have to develop their expertise themselves. But I'm a big proponent that you can learn from others.

Growth objectives

Q: Can you talk a little bit more about CHRISTUS and its role in different markets?

Sadau: Our system now has a presence in Texas, Louisiana, and New Mexico. We're also building up our international presence. CHRISTUS has relationships with hospitals in Chile, Mexico, and other countries in South America.

I think that diversification is good, because it mitigates against being too dependent on any given market. And rating agencies agree; they affirmed our bonds this summer, highlighting our diversified approach.

It's part of our effort to position CHRISTUS to grow in a way that's appropriate. We're trying to navigate the consolidation that's already started and going to continue over the next few years.

Q: What tactics have you put in place so CHRISTUS can get faster at making these kinds of growth decisions?

Sadau: When I transitioned into the CEO role about 18 months ago and was talking with our board, we realized: we have to be more agile as an organization—but also learn what we have to make decisions on.

I look at some decisions being made across the industry and think to myself, how the heck do some of these line up?

That's why we try to have all our decisions fit our CHRISTUS 2020 plan, and make sure our governance board understands and supports the need for a certain decision—we don't wait for the quarterly meeting when we have to act quickly.

We also simplified the decision-making process; in our case, we brought the CHRISTUS offices together. And leaders push to delegate out as necessary.

Q: You just alluded to this, but you recently led CHRISTUS through a major shift: A decision to centralize the organization in Dallas. What were the ramifications?

Sadau: It was one of the biggest challenges of the past year—but as a team, also one of the biggest successes.

We took four offices and turned them into one. And by early next year, it'll be complete—we'll have moved about 400 associates to a new location. The shift also involved new hiring, because more than half of our associates weren't willing to transition to a new location.

I had peers tell me that I was crazy to take this on, given all of the other things going on in health care. But overall, it's been seamless.

For example, the month that the revenue cycle department moved offices was one of their best cash-collection months in history.

Q: Given other leaders' pessimism, do you have advice on how to make a major shift like that?

Sadau: Just do it and get it over with. We're already seeing how much more quickly we can make decisions.

We also had to think about what was best for CHRISTUS not just now, but ten years from now. By 2020, that move to centralize offices will be a $60 million-plus savings for us.

Why wait on that?

Demonstrating 'presence'

Q: You're a busy leader. Any tips on making your day more efficient?

Sadau: I'm a big believer in presence. We think we're great multi-taskers—going on the BlackBerry or iPhone, sending emails in meetings. And I used to be the worst offender!

But I think this culture of multi-tasking is hurting our leadership abilities. So I don't allow it in our executive council meetings.

If you have an emergency and need to be on your phone, you declare it at the front-end. Otherwise, our meetings go much quicker, people are much more engaged, and we don't repeat ourselves.