TURNING POINTS: UNC Health Southeastern's Joann Anderson Says, "Don't Overlook the Emotions" Behind Challenging Situations

CHE welcomes Joann Anderson, CEO of UNC Health Southeastern, for this week's installment of Turning Points. Anderson has worked with the hospital for 14 years, and has led it through multiple hurricanes, the pandemic, and a recent acquisition with the larger UNC Health system. She says that enduring challenging situations throughout her career has taught her the value of human connection and the importance of managing your emotions. She will retire at the end of this year.

This transcript is edited lightly for clarity.

Chief Healthcare Executive™: You’ve led your health system through recovery from hurricanes and now the pandemic. What lessons did you gain from these experiences?

Anderson: The hurricanes have been a very interesting situation for us. Again, hurricanes are often short lived; you know they're coming; you prepare for them. Every hurricane or event like that, we learned something about where we possibly weren't as prepared as we needed to be. So, from those events, we always sit back afterwards and say, “What could we have done better?”

I think with the very first hurricane, Hurricane Matthew, which was one that we didn't necessarily expect, it took a turn at the last minute and came to us instead of going where they originally thought it was going to go. And we were prepared for a much smaller event. But what I learned during that is I have the most wonderful team to work with.

I had individuals that, when they knew the hurricane was coming, they left their homes, their families, unselfishly, and came prepared to stay as long as it took to care for the people who needed them most. They sacrificed their personal lives for the lives of others.

They did it out of the goodness of their heart. They didn't grumble and complain. They were tired during that time. But you know, watching them over particularly that first week—it was an extended timeframe for us—it was heartwarming to see how much they cared about each other and how far they were willing to go very unselfishly to make sure that people had what they needed in a great time of need. I saw people come together and the value of a community, not just individuals, but the community support. I saw doctors that were emptying bedpans or serving food trays. They forgot their title and what their job description was.

So more than anything, I learned the value of human connection, but also the resiliency of humans. You have to bounce back; when you go through situations like that, you have to come back and say, "I could do it over again if I need to." And with the hurricanes, we had them back-to-back within 19 months of each other, two major hurricanes. When the second one came around, there were still people who were still affected from the first one who hadn't fully recovered. And then we went through it again. But again, I saw the same thing: that people unselfishly left their homes again and came back in to do what they needed to do. So more than anything, I learned the value of connection, the value of compassion.

And really just resiliency. I hadn't thought a lot about resiliency in my previous job responsibilities at other organizations because we didn't have a lot of those types of things that occurred. But I've seen that here. You don't know how far you can be tested until you are. It was just really good to see the group come together, do what they needed to do, how much they care about each other, how much they care about their patients.

CHE: What is the most important health delivery lesson from the pandemic that you believe will remain going forward?

Anderson: There have been a lot of lessons that I've learned from the pandemic, both personally and professionally. I think from a professional perspective, is that when you're faced with something like a pandemic, which is totally new to not only you but to everyone in the environment, that you have to manage emotions.

Over this past year, we in healthcare have had to adjust, change quickly, pick up new ideas, learn new things, implement things, all for the right reason. That's tiring, physically. It's draining, just psychologically. Emotionally, it's taken a toll on the entire team. When you shift things too quickly, for anybody, it's hard to adjust. We as an organization have had to go through a lot of firsts since I've been here in North Carolina, and whether it's hurricanes or other related events, those are usually short lived. This has been such a long-term situation, that people have not had the opportunity to recover. That emotional toll has been a real learning experience. It's been a challenge from a leadership perspective to be able to help people navigate a situation that they just are not emotionally or intellectually prepared for.

I think learning over the past year from a pandemic is, when you're going into a situation like that, don't overlook the emotions behind it. We can take care of the technical issues. We're good at that in healthcare. But the emotional side of it we give so much of ourselves that once that bucket has drained, it's hard to fill it back up.

CHE: If you could select one major healthcare advance that you knew would be important as soon as it happened, what would it be and why?

Anderson: The first thing that came to mind was telehealth. We're sitting here today on Zoom, very geographically separated, but we're able to communicate. Very quickly at the beginning of the pandemic, we had to find a way to keep people safe and we had to find a way for people to access healthcare in a very different manner. Social distancing in an office was tough to do. So just the implementation, very rapid implementation of a telehealth platform, people being able to access it, I think, we knew immediately that it was going to work, and it was the right thing to do.

I think one of the things that was most interesting to me—I talked to a physician that has been in practice for over 30 years—he called me and said, "I need to talk to you about what you're having us do now through telehealth," and I thought, oh, here it comes, he's gonna tell me this is not working.

And he said, "I just have to tell you, I was skeptical at the beginning that, first of all, I didn't think I could do it, because from a technology perspective, I'm just not that astute. But I care about my patients, I wanted to make sure that they had access to me, so I tried it," he said. "It was amazing. I could still see my patients, I could still take care of them, which is important to me, and it was important to them. But I could do it in a safe environment and I learned to do it quickly. So, I'm a big fan, I just wanted you to know that I overcame my fears and I think this is going to be a way that we're going to be able to offer services to people in the future that I never thought was going to be possible or that I ever wanted to have anything to do with."

So, for me, telehealth is definitely the thing that is probably the biggest advancement and we're going to see that just expand more and more in the future.

CHE: Can you think of a technological advance that was dismissed early on, but turned out to be important to the field of healthcare?

Anderson: There's so many advances in healthcare from a technological perspective, and they're happening so rapidly, that I really can't think of one that was kind of dismissed at the beginning or that [wasn't] going to work, and then suddenly, we realized there's lots of applications for it.

There are a lot of things that have happened that we've seen expanded over time that may have had a very limited use at the beginning. One of the things [is] the drug Keytruda. When Keytruda was first introduced, it was for a very limited population, a very specific cancer, [and] it's now being used for all kinds of different things and being shown to be effective.

I think that's the good thing about, whether it's technology, or whether it's just the science behind new products that are coming on the market—we might start with just being focused on a very specific small population or group, and then just find ways to advance those into other areas. Whether that's a robot that started being used for one specific type of surgical case, and now is being used in multiple surgical cases, or drugs like Keytruda, and that type of thing. I can't think of one that just got dismissed and then said, oh, now we can pick it up and try it again. But so many that have just expanded their use over time.

CHE: UNC Health Southeastern was a separate health system that joined with the larger UNC Health system. What advantages are gained by being part of a larger health system?

Anderson: The advantages have been resources available to us that we couldn't do on our own. When we went into the exploration process for a potential partner, there were things that we were looking for, and one of those things was listed as capital. Most people, when [they] think about capital, it's financial resources, financial capital available. Yes, that could be part of it, it is not part of our relationship with UNC today, but it could be. But what we really wanted was the access to intellectual capital, not that we don't have smart people working at our facility.

But in the complex world that healthcare is today, being able to have as many intellectual capital resources available to you with specific skills and knowledge is almost impossible in a rural location. So, for us, it was, could we find an organization that could help us advance our initiatives at a faster rate because of the resources they had available to them? That would allow us to access those resources when we needed them to help us move faster.

We had a lot of things that we wanted to accomplish. I have an executive team of five other members, so there were six of us who were trying to compete in a world with the mega organizations like UNC, or Novant or Atrium, who have an army of people behind them. If they need a specific issue, they've got an expert they can call upon. We didn't have that and didn't have access to that in any way. So, for us, the partnership with UNC has allowed us to tap into that intellectual capital. We have resources available to us today from an analytics perspective that we didn't have available before.

Just again, using the pandemic as an example: predictive analytics as to when the peak would occur in terms of inpatient hospitalizations, we didn't have the resources to do that. But immediately they did. Immediately they took our data, plugged it into their algorithm, and could help us plan with a certain degree of certainty what our resource needs were going to be in terms of human resources to meet the needs of the peak census. We didn't have that available.

At the beginning of the pandemic, certain drugs and certain supplies were only available to the larger institutions. And for us, since we didn't have access to that, we needed to find a resource for it. I remember we needed syringes to give vaccines and didn't have access to syringes. So, we called UNC and said, "Do you have any idea where we might find syringes?" and the next day we had syringes. It's that type of accessibility to resources that we just didn't have available.

They have clinical experts in every field, so my medical staff are so excited about the ability to tap into people who have written the textbooks, or who are doing the research, or that type of thing that they just didn't have access to before. For us on the administrative level, it's the analytical data that might be available.

I had a leader within the organization that actually left before we made the decision to go with UNC. He left because he said, "I'm one person of one. I have to be the expert. Every time there's a question about my field, I am the only person that can give that answer. That's a heavy burden to bear. When the organization may be turning to you for that expertise, and you feel the burden that 'if I make the wrong decision, or tell them the wrong thing, then I'm the one that did that,' I don't have anybody there to back me up."

The relationship with UNC has allowed us to have a peer group for everybody in the organization. They've got someone that they can call upon to just talk over a situation. We don't have to create something from scratch, there's probably someone in the organization who has experienced many of the same things that we may be getting ready to experience, they can tell us what their experience was, what they would have done different. Learning from them has been a tremendous value for us.

We're seven months into it, so I'm sure there's gonna be bumps along the road somewhere in the future. But so far, the relationship has been very, very positive, just for those reasons. Just having the resources available and to feel like you're not on an island by yourself, that you've got somebody else you can call upon who will be there to support you and to help you work through your decisions or provide resources or whatever.

The other thing we've learned through this is that we're farther advanced in some things than they are and they're learning from us. That gives my team a good sense of their value as well. We didn't want to go to an organization where we felt like we were taking everything, we needed to contribute as well.

My team has got a sense of renewed spirit because they've gotten positive feedback from their peers at UNC who have said, "Wow, I'm glad you shared that with me because we've been dealing with that issue and you've already resolved it." Just being able to share with a peer group is a very positive thing.

CHE: What advances will patients at UNC Health Southeastern see over the next five years?

Anderson: I think our advances will actually be more in the arena of the expansion of some of the services that we're providing. Simply because we do have access to clinical experts at UNC, we're going to be able to introduce a broader array of services, go a little bit deeper into some specialty services, and what we're currently doing today.

Because we may have available to us technology that we couldn't have afforded on our own, there probably will be some technology advances as well. We've not identified all of those just yet. But again, through purchasing agreements and things like that, financially we might be able to afford some things today that we couldn't have afforded in the past simply because of that relationship with UNC. But it's going to be more about the expansion of the services that we currently have rather than introducing a lot of new types of things to the area.

CHE: What advice do you have for someone considering a career in healthcare administration?

Anderson: You need lots of stamina. You need a lot of patience.

I didn't set out to be in hospital administration, I actually started my career as a nurse. My intent was to be at the bedside taking care of people. What you find with that is there's immediate gratification because you see the fruits of your labor, you see what you've done, you can check off the tasks that you've done for the day, you get gratification from that. It's just a good feeling to know that you helped one individual or multiple individuals throughout your shift.

Administration is in many ways the same way because your patient is actually the organization of the community that you serve. My leadership role today is from the standpoint that if I were caring for this organization, or for this population, these are the things that I would need to do for it. Understanding that my outcomes are not going to be immediate, I'm not going to see an immediate reaction or a response to any action that I take, but I'm building on that for the future. It might take five years before I see a response to anything that I've done today. Or my decision making maybe about what we're looking at five years from now, not what we're doing today. Actually, what we're doing today, I needed to have thought about five years ago. If I'd known the pandemic was coming, I could have been better prepared.

In administration, you have to be able to see the future, you can't just focus on what's happening today. It's not really about what's happening today. We're planners, we're facilitators, we're conveners, we're educators. That's what you have to be prepared for in administration.

I have two sons, and they grew up on the floor of my office early in my career. My oldest son is now a healthcare administrator as well.

Early on when he wanted to go into healthcare, he said, "I want to do what you do."

And I said, "What do you think I do all day?"

He said, "You get to go to work, and you just talk to people all day long."

But those that do take it seriously. You have to mean what you say, you have to be willing to back what you say, but you also have to be willing to realize that sometimes what you say is not the right thing. And that it's okay to be vulnerable and to say, "Okay, I didn't make the right decision." You have to be able to back up and say, "Based on what you now have shared with me, or the additional information that I have received, I'm going to reverse my decision and go in a different direction."

You know, healthcare administration can be very humbling at times. And I decided that my leadership team all the time, we all have titles. Everybody has a title. Every job has a title that goes with it. I have a title, but I'm only one person in the organization. I don't believe anyone in healthcare administration needs to feel that they are so important that you know everything stops because of them.

I can be out of the office and very few people notice if I've done my job correctly because other people are doing what they need to be doing. My job is to communicate with them what the vision is, what our mission is for the day, where their guardrails are, how to stay within those guardrails. And then they do their jobs effectively. Let the people do their jobs, don't feel like you have to micromanage or dictate what's happening because you've got great people working for you in health care.

So if you're going into hospital administration, I say go for it. We're going to need some great people leading our healthcare system in the future. It's going to be complex. It's going to be fast paced. It's going to demand a lot of brainpower, flexibility, [and] analytical skill sets.

[It's] very different from when I started. Just the pace itself, because of the amount of information that's out there available to us today. The way we communicate today is very different than when I started. The internet and the advances in telecommunications are much faster than anything that I experienced early in my career. I would encourage anybody to go into healthcare administration if you're willing to be in an environment that's going to make a difference for a lot of people. That's going to be fast paced, high demand, but very high reward.

CHE: What are you looking forward to in retirement?

Anderson: I am looking forward to reconnecting with my family. I've always been at a distance, geographically, from my family and I'm looking forward to having some uninterrupted time with them. I have seven grandchildren, so I want to have a relationship with those grandchildren and get to know them as individuals over a period of time. I'm not going to be their babysitter, but I do want to have a relationship with them that sometimes I've had to forgo because of the demands of the job. I want that flexibility.

Quite honestly, I want some me-time. Over my career, I think there have been times when I've sacrificed personal issues, family time, and that type of thing in lieu of my career or in lieu of the responsibility associated with the roles that I had in the organizations. I don't regret that, I feel good about what I've done, and my family is not regretful of that either. But we're all looking forward to having time where we don't have to worry about balancing the responsibilities between the job and family. So, family time, I think is probably going to be the best.

I know a lot of people say when they retire, "I'm going to travel"—maybe I'll travel, maybe I won't. I don't think I will just quit; I still have a passion for rural healthcare in particular. So, I'm looking forward to choosing what I want to be involved in and not necessarily doing it because it's a responsibility that I have to do. It's a choice. So, there'll be some joy in making those decisions. I can make a difference here and I will do it because I choose to do it, not because I have to do it.

Just looking forward to, for the first month, sleeping, [getting] an interrupted sleep. And just not having that burden of carrying the organization and knowing that it's my responsibility to make sure everything's okay. I think I'm ready for something different.