The Mark of Strong Leadership: Judiann Smith

Today I have with me in the studio Judiann Smith, who is the executive director of the Daniel Hanley Center for Health Leadership here in Maine. Thank you for coming in today. Thanks for having me. So you and I are, we're neighbors. Our kids went to school together. I went to the Hanley Institute, so there's a lot of crossovers. but I don't think I knew just how professionally impressive you were until I saw you in action as one of the people leading this course that I took back. I guess it was a year and a half ago now. Yeah, Thanks for saying that. Yeah. I mean, it's amazing to me that you are trained as an attorney, but you haven't taken a straight path. No, definitely not a straight path. And I have only practiced as an attorney for a little over a year back in Boston, right after I got outta law school. and it was not the experience I had anticipated. And let's just say I was the only female attorney at an all male construction firm. and some of the things that went on at the firm just were, made me very uncomfortable. and so once we decided, my husband and I decided we wanted to move out of state and buy property and started a family, we started looking around and we looked at Vermont and we looked at Maine Maine one, and I started my first job in what was state government as the supervisor of elections under the Secretary of State Bill Diamond as my first main job. And I never looked back. I never went back to for-profit or you know, money was not what I was after. I was after making a difference and being challenged. And the law degree opened a lot of doors for me, but I never needed to practice ever again. . Well, it sounds like for you, that wasn't a bad thing. No, it wasn't at all. I've had great opportunities. I, my, my biggest career move was to move to Spurwink, which is a mental health agency. I like to say I grew up at Spurwink. I spent 18 years there until I took the current gig, and I loved it there. just an amazing organization doing amazing work all over the state. The largest mental health agency out there working with toddlers and children and adults, all with mental challenges, mental health challenges, intellectual disabilities, autism just a great organization. But at some point I took the course, the leadership course at Hanley, and I decided I needed to do something like that. And once I took the course, it really changed me as to what I wanted to do. And I think I just had lots of growth at Spurling. I kept having different leadership roles there. but then I wanted a change in something different. And when the role opened up at the Hanley Center, the then executive director was a mentor of mine and a friend, and I found out that he was retiring. I put my name in the hat and I feel really fortunate to have, have been chosen for the job. It's been, it's been really fun. You also spend time on the school board here in Yarmouth? I did. I did two terms as an elected member of the school committee. And that was also great. I got to meet a lot of people when you're on school committee, you know, a lot of people in town. when I stepped off school committee, it was like I moved into a closet because I didn't, you just not in on the, in stuff anymore. but it was really fun. We had a lot of great times. We had a lot of challenges. We had a lot of winning teams in Yarmouth. a lot of accolades for the schools, and we did a lot of hard work. The school committee probably doesn't get enough credit for how much time and effort they put in. and I really loved those years, and I think I wanna go back into some form of service like that in the future. I just don't know what or when. So you're waiting for the, you're waiting for the call. Waiting for the call and the time to be able to do it. My current job keeps me busy in the evenings as well as the days, as well as the weekends at times. And so it's really hard to try to fit in any other kind of volunteer work. Is true that when I reach out to you, I'm aptt to hear from you anytime day or night. . You're very responsive. And so whether it's by, you know, text message or whether it's by email, you're right there, you're on top of it. So I would think that level of responsiveness and also just meetings and reaching out to people, that would require a lot of on time. It is a lot of on time. And you know what, if you don't respond in the moment, you lose the opportunity as well as things build up and then you're inundated. So I prefer to just get things taken care of when they come in as much as I can. Yeah, I think that's, that's sort of my approach as well. And you know, I think some people have argued, you know, maybe we're a little bit too on, or, you know, we should block our schedules and only respond between, you know, six and eight at night. But I feel the way that you do, like, I mean, and we're, it's, it's, if you can keep your asynchronous communication somewhat synchronous, then you can really calm things down pretty significantly. Yeah. If you, if you let people sit with kind of the story in their mind that they've created, good or bad, sometimes it can go in a direction that really don't, is is probably not optimal. Agreed. Agreed. You know, my youngest daughter used to hide my phone after hours all the time and on the weekends. Because she knew, she knew that if I had something came in, I'd be on my phone trying to respond for work. Even when I was at Spurwink, it was same thing. It was a seven day job. I was an administrator, but there were no weekends where I wasn't working. And she used to hide it all the time. I used to be like, gimme my phone back. This something. I heard something come in , gimme the phone back, . Well, and and don't you think that that is one of the hard lessons that people eventually learn, is that once you move into a leadership position, is not really an off button? No, not at all. That is a big lesson no one tells you about. For sure, for sure. but, you know, you have to have your balance too. And so those were really strong messages from my daughter. And I tried hard to, you know, make sure I was focusing on my family. I have three kids. had to focus on them as much as, you know, they needed me to be focused. so it, you always feel like you did it wrong or maybe you didn't do it right enough, but you do your best in the moment. And that's all, that's all we can do. Yeah. And, and to be clear, I mean, I go to bed early and I wake up early. I don't keep my phone right next to me. I, I put it outside my room. I'm not listening continually to text messages unless I'm on, I'm actually on call. So yes, I agree with you. There is a balance and there is what we're role modeling for our kids and being on constantly, it does have a toll. So it's, it, it's a kind of a funny place to try to negotiate, I think. For sure. For sure. So tell me about the Hanley Institute. I know my experience, but yours is very different because my program was specific to physicians, and I was with a physician cohort, and we met for, I think it was around nine months over the course of a year. We had in-person sessions. It was, COVID was still going on. So I think there was an opportunity to do some remote, but really we were in person mm-hmm. , I think the vast majority of the time. but you have multiple different courses that you run at the Yeah, so the Hanley Center's a 501c3 nonprofit. It's actually now it's not it's own 501c3 anymore. I, I kept to keep reminding myself January one, wemerged to be part of a different 5 0 1 C three called the Main Medical Education Trust. and so this is an organization that has been around for a long time. It's an arm of the ma M m A, the main Medical Association. but we are still operating independently from that organization in terms of how we do our operations, how we do our budgeting, and we're running all the same programs. So nothing's really shifted on our end, which is why sometimes I forget to say it, , I can't say anymore. We're an independent 5 0 1 C three. but we, we have been around for about 20 years. We're founded to carry out the legacy of Dan Hanley, who is a extremely well-known and well appreciated physician leader in Maine. and what we do is run leadership development courses. That's how we started. We started by acknowledging fantastic leaders in healthcare in Maine through awards. And at some point a board of directors was formed, and it was determined that there was really a, a lack of leadership development availability or opportunities for doctors. And so a couple of different levels of courses were created, a foundational and an advanced course. You took the advanced course for physicians, but now we, and we also have a interprofessional course, which is the one I took. so I'm a closet lawyer who was doing policy work and lobbying at the State House for Spur wink. But I took the course then and it was a fantastic experience, life-changing for me and how I thought about and my leadership. So we run that one, it's entering its 17th year, the H L D course that it's called Health Leadership Development, H l d, the physician courses, the PE advanced course. We're recruiting for that right now. It's going into its eighth session. and we're just launching some other new exciting things. Our second version of a Women in Health Leadership Seminar series. So women leaders coming together to network and learn together over three sessions. We have a new nursing curriculum that we just put together with all the chief nursing officers. A bunch of them from the state got together and we developed a curriculum together that's starting up at the end of November for emerging nurse leaders. we have a course that's also gonna be starting up just for rural providers really specialized in what they need to learn about means. So rural, right? So many doctors and so many providers out there that need different skills around community and coalition building and network and community engagement and advocacy. So different skills a different course. we also run an internship program because Dr. Dan he was the college physician at Bowdoin College for about 34 years. And as such, he really cared about undergrads. So we have an undergraduate internship program we run every summer. We have about 22 in interns this summer. We're gonna have a leadership day up at Boin College's coastal Center next Wednesday. It's gonna be really fun. and they're spread out all over the state in different organizations. I'm gonna be doing all kinds of cool projects over the summer, and I'm sure I'm leaving some stuff out because we have so many programs that we're running. But those are the, the big ones right now that I can share with you that I'm thinking hard about because we are in recruitment mode. I think that what you're describing is so interesting and important because we think about leadership just as a, as a, a huge looming topic. And there's some, I've, I've actually heard people in leadership who have I, who I've interviewed who have said, you know, there's a secret sauce and we're all looking for the secret sauce. And when I think about that, I'm like, but aren't there lots of sauces? And they're probably not that secret. It, I mean, it really doesn't, it depend somewhat on context. I mean, there are some overarching things that I think many people should know if they're going to be leaders. And also if you are a nurse or a nurse leader, it's gonna look different than if you're working at Spur Wink. And I mean, you're, it's the groups that you're a part of. It's how you're kind of, the power structure is laid out. It's your educational background. So the fact that the Hanley Center is making all these different types of opportunities available to people is really important. Yeah, I mean, I think, so I know I've drank the Kool-Aid, but you, there's so much happening in healthcare and there's so much change, not just because of the pandemic, but the pandemic certainly increased, ramped up the volume and the the quickness of the changes coming at folks that you need skilled leaders. You know, you need people that have the tools in their tool belt that know how to handle and implement change. And some people think leaders are born, you know, I was born leader and I, I agree that some people are born with some excellent skills and some balance and some diplomacy, and they have some of this natural I don't know, a natural ability for people to follow them. But that does not mean you're a great leader. It just means you have that natural ability. There are a lot of theories and skills that people need to learn and understand to be able to implement change and, and move forward. There's so much going on in healthcare right now, and health equity is such a new issue. It's not a new issue, but it's a new issue for the world. The world all of a sudden is thinking about health equity. Hanley's been thinking about it for 20 years. We've been training on it for most of our ex existence. But the world has now come to understand how important it's to think about all the different communities and making sure care is e equitably delivered. Right? And and talking about that and talking about the importance of mitigating, what are social determinants of health impacting people based on their zip code and where they live and who, you know, where they work and play. all those things are so important. You need strong leaders for that. And I think that's why it's so important that we're out there. 'cause medical school and nursing school don't teach you how to be leaders. They give you great clinical skills. And what happens as you know, is great doctors, great nurses, great social workers, doesn't matter your industry. They get it put into these supervisory and leadership roles because they're good at their clinical work. And then they get there and they're leading teams and projects and budgets, and they have no idea about how to do it well. And so that's where we come in, really help give them those skills and the tools that they need. Well, I, I'm glad to know that Hanley was thinking about social determinants of health from the beginning. Because as a family doctor, I mean, our profession certainly was thinking about social determinants of health. I know the pediatricians and other primary care specialties were thinking about social determinants of health. It is really interesting that as a result of the pandemic, that's like all of a sudden we're thinking about this, but we're not. I mean, I think anybody that practices clinically or really does anything, if you're on, you know, the school committee for example, you always have to be thinking about the context, the ecosystem, you know, the impacts of things that are that make it possible for people to be healthy or to learn. And, and sometimes it has nothing to do with the space that they're actually in while they're learning or while they're gaining healthcare. I guess, No, it has to do with the barriers that may exist that you don't see. And the things that keep them from being able to stay healthy, you know, and the, the adverse experiences they've had across their lives that cause them to be in a situation that's not gonna help them, you know, thrive. And I think that's really important. And that's, that's what we do at Hanley. We, you know, we run all these courses, but we also, when we're, when we are lucky enough to get some grant work we do work in health equity and trying to help people mitigate differences, mitigate the challenges that they have and what they experience in healthcare. So those are really important pieces to us at the Hanley Center. That's why we teach about it in every one of our courses. and there's, it's like leadership is a journey. No one has ever drunk all the Kool-Aid or had all the secret sauce. You have to keep trying different sauces 'cause you keep evolving. And I think that's an important thing for everyone to remember. No one at any point in time can just say, well, now I'm a leader. You, you're, you're never really evolved completely Or you just recognize that being a leader just means that you will continue evolving and you will continue learning. And most importantly, part of learning is maybe not doing it exactly the way that it would be optimal the first time around. Right, right. You gotta try a few things. Yes. Sometimes failure's Okay. 'cause you learn, take a different direction. Yes. I think that's true. It's also interesting to me because I mean, you talked about being the only female attorney at a construction firm. You know, when I went into medicine, even though half of my medical school class were female that was not the leadership structure. And it still is not, I mean, we have, across the country, only 15% of the higher level kind of executive level leaders are women. And that's just women. We're not talking about minorities. We're not talking about people who have different backgrounds, different cultural backgrounds. And here in the state of Maine on the list of names of these higher level leaders, we're at 11%. In my organization, I'm one of three at the chief medical officer level, and I'm a woman. So I guess that gives us 33%. So we're kind of ahead, right. . But it's a hu it's a thing. You know, you and I, we are not that far away from not having anybody around who kind of looks like us to now we don't have people, we don't have enough leaders who are actually leading the people. There's plenty of women, but don't we need more women doing this work? Don't, don't we need more people who are not white, middle-aged males. We do. And what's interesting is that especially for our interprofessional course where we get a lot of administrative healthcare leaders coming through, and some physicians, it's mostly women, which I is really cool to me to see. It is mostly women who usually have out of 30 or 35 people, we might have six, eight do eight men. But it's mostly women leaders who are ascending into this class, which I love. you're right. And I think sometimes I put, I think I have blinders on, but when you look around the state, I'm always so proud of people who have made it to those c e o level positions. Like Lois Skillings who just retired at mid-coast, you know there's a woman who's running the hospital up, up I think in Washington County. And there's, it's just phenomenal that they've made it to the c e o level and was a woman, c e o up at Carey Medical Center in Arista County. But there's not enough. I agree with you a hundred percent. And I do hope that'll change. I do hope organizations like us will provide what women need to feel like they have the confidence and the skills to push forward into those positions. And I should say, I mean, I'm, I'm married to a middle-aged white male and I value him and his leadership skills as am I I . So I mean, I have no, and I, and the one people that I work with who happen to have those characteristics, there's nothing that I have that's bad to say about that. I'm just saying, you know, like, like, let's make the table a little bigger. Let's invite a few more people. Let's start to have more of a conversation. And let's, and let's stop just assigning characteristics based on you know, sex assigned at birth. I mean, I, I've, I've now been in multiple conversations where somebody said, oh, well that person is a woman doctor, so of course she has to act that way. I'm like, but what does that mean? Like, if you're a female leader, do you have to, I don't know, have a harder edge? Do you have to be more defensive? Like why do we have to make it a gender thing? Exactly. Or why do we, why are we the nurturing leaders that are gonna take care of our, you know, that bring the cookies in for, you know, the board meeting? Like, why does that have to be? It's a great question. And that is something we talk a lot about in the Women in Health Leadership Seminar series. It's, we really delve into what are those stereotypes and, and how can we break out of those stereotypes or use what is unique about women to our advantage in leadership. So that's, it's an important conversation for sure to have. And it's hard. It's really hard. I remember when I was starting to join different kinds of boards when I was at Spur Wink, and I was sitting in on lots of different senior level leaders. I was typically one of two or three women around a table of 15 men. And and I took years to even wanna speak at those meetings. I was, I was really having a hard time with putting forward my thoughts. It took me years to feel comfortable with that. So I totally get it. . Yeah. And I think, I mean, what, so, so that's an important point, right? So even inviting people to the table and saying, well, you're here, we're letting you speak. Let as if let is the word. But I mean, that's, it's not enough. You, there actually has to be the ability to draw people into the space and say, Julianne, tell me what you think about this. And I don't know that everybody has sort of, even the leadership and facilitative capacity to understand that that is necessary. You, you can't just put people there and expect that they're gonna feel comfortable enough sharing their voice. Yeah, so true. So true. You have to create that safe space, that safe environment for everyone to feel like they can add to the conversation. And unfortunately that just doesn't happen around every leadership table. Well, I, I should say that not only is our retired now retired c e o from our health system, but our incoming C E O I I, I have only good things to say about our leadership structure. So I feel like I'm actually really spoiled. But I do know that it continues to exist in other places. And I think it, you, I'm, I think, you know, that I, I have my M B A in leadership, I'm, I'm almost done, my doctorate in leadership. And I'm even astounded by the fact that, you know, it all begins with the great man theory that not only were the great men, the ones that were born with these leadership skills, and it was typically in a military setting. And but also the studies that are initially done were that tall men were actually the best leaders. So our studies of leadership that go back, you know, 150 years or something, are all founded on something that is a fundamentally flawed presupposition. Yeah, no doubt. I haven't seen the one about the tall men. That's interesting. Well, I I only know this 'cause I'm a tall woman and apparently it, there's no relationship. So that doesn't help me in any way. It doesn't help you to be a tall woman. I know. It's okay. It helps me to get stuff off the top shelf. So, you know, I'll take it either way. But I think the other thing that I'm, you know, we've talked about kind of skills, but one of the things that I really enjoyed learning about when I was at Hanley in the physician section was kind of subject matter and some of the basic stuff that I don't think a lot of doctors do have access to. So you brought in people who discussed, you know, economics and policy and finance, and I think that's really eye-opening because as doctors and clinicians we're taught to be really good at knowing stuff about health, but we don't necessarily know stuff about all the things that go into delivering healthcare. Yeah. The, the course is, is really, it's very broad and most of our courses are, we try to bring in all the different components and we think about the course as talking about the science of medicine. And the science of medicine includes all the inputs and the inputs are the policy, right? The laws, the policies federal, state and local, that under which you practice as a physician and under which we receive care as patients. and it includes having to understand what is going on in the big picture of healthcare economics. That's such an important piece of it. And, and it is always astounding to me how how much physicians appreciate that session in particular. They, they learn a lot about the healthcare economics and it's very eye-opening how to create value in healthcare. And all of those you know, extraneous people might think sessions are actually really important pieces for everyone, including the one on health equity and strategies to mitigate it, to mitigate the inequities that we have. Yeah, thanks for saying that. Well, I mean, I was really struck by one of the sessions that we had, and you probably remember this, where we had people who were brought in from insurance companies and for other from other maybe not so popular fields and how incensed people in our group really got because they, they just felt like, you know, they're trying to do the best they can for their patients and the perception is that maybe other people are, are taking advantage. And I, I think it's hard when you're a clinician 'cause we really just need to understand where other people are coming from. But I think our immediate response is one of like, but why is it this way? Yeah. Yeah. That was an interesting session and part of what I usually talk about when I'm talking about the Hanley Center and what we do and what you, the outcome of all of our courses is broaden the perspective. And I think that that's a really important piece. And that session in particular is meant to do that really broaden your perspective. We brought in three individuals who work in carrier situations or in advocacy for employer groups. Right. And and from the doctor's standpoint, they're just holding up things, right? They're putting up all these prior authorization requirements. They're, they're denying claims. And I sit on the board of community health options, which is, you know, a health insurance company and that c e o was, you know, Kevin was there at that session. And you know, good people running community health options, doing the best they can trying to improve the health of Maine, but within the parameters of the health insurance industry, . and there's a, there's a perspective there to learn about. So I think it's sometimes you just, that is a learning experience about building the perspective and understanding that everyone has a reason for the reason they do their job and how they do it, and trying to have that conversation in a way that is productive as opposed to, you know, polarized. And I think our, our session that time became a little bit heated. You're right. but I think in the end, I think everyone understood and appreciated that those guys were coming into a room they knew could be a little bit challenging for them, but they were there to say, this is, this is who we are. This is how we're trying to help provide the best services for patients in Maine as insurance companies. 'cause they're, they're all doing this, they're all working toward that. and especially community health Options is not a big national company. So they're a nonprofit . Well, and I think that that is a huge leadership lesson is, is that there are always gonna be stakeholder groups. And if you remain part of a stakeholder group, then you, you will never evolve a situation to the next level. I think that the stakeholder groups all do have to understand each other and they may not like the other people's mission and vision, but you, you do actually have to kind of co-create and co generate, you know, the next step. And if you immediately shut down and say, well, I'm gonna remain over here with my group and I'm not gonna be open to how other people are experiencing this. It just kind of, it's not a bad thing. It just kinda limits how far you can actually move. Absolutely. Absolutely. One of the, the basic tenets of our H L D course is about collaboration and we spend a whole lot of time talking about what true collaboration is. And some people think about coordination and cooperation and those are not true collaboration, which takes time where you build trust in a relationship and you start each giving into the other to benefit the other before you get to a point of mutual benefit and really working together. And in a situation like that, we're just having a session is hard to build those relationships. But that's why we do what we do. Our idea is that we have a statewide network of leaders that are now across Maine in all of our courses who have had a little bit of the Hanley sauce. And we know that if you were as an alum were to call up any other alum in another class and say, I was in this Hanley class, they will talk to you, they will work with you. they will wanna help because they're all part of the same network, had similar training. And we believe that a strong networked group of healthcare professionals will help move the state forward. And our, our alumni are in all the leadership tables around the state and they've ascended into those because of the skills that they have. So I think you're right. I think collaboration is so important and you can't possibly move anything forward if you're not building a long-term trusting relationship with your stakeholder groups. And at the same time, admittedly, it's not easy and no, especially as a physician, I mean, to our great credit, I mean, we are wonderful champions for hopefully for our patients, for our colleagues, for our other people that we work with. So absolutely we feel like we wanna, we wanna be the advocates. And so absolutely nothing wrong with that. But on a regular basis, what I see in my organization as I'm bringing people forward in leadership is that they have to find a way to be a both. And they have to be able to say, okay, yes, I'm a family doctor, I'm a practice medical director, I'm a service line director. And also what, what does the larger institution need to be doing? And what does the larger con context of healthcare need to be doing? And that's, and that's very hard 'cause it really speaks to, at least with physicians, like a very core identity that we all Hold. I think it's important for every physician to figure out where they can insert themselves in that way. There's a place for every physician leader to think about the difference they wanna make and the passion they have inside of themselves and figure out how to insert themselves in, in, whether it's an advocacy way or not. but there's a place for everybody that wants to be making a difference. And I, I appreciate that so much about the physicians that come through our courses. It's somewhat of a self-selected group. I mean, you all come to this because you wanna make a difference. You're so passionate, you're so smart and you're so dedicated and that's why you wanna learn more. And a lot of people would think, we went through medical school residency, all these fellowships, what the heck do you wanna go to another class for? But these are the folks that self-select and take our courses 'cause they're gonna be the rock stars. Yeah. And to be clear, I have no problem with people whose primary goal is always going to be advocacy. And that's a different, and that's leadership, right? Mm-hmm. , it's just it kind of, kind of depends upon which direction you go in with exactly as you've said. Like, what, what is my niche? You know, what is my place in all of this? So I I also really love the fact that this is the Daniel Han