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#WomenofPenn: Learning to Listen, Lead, and Push the Boundaries

The following post is part of a year-long online campaign highlighting #WomenofPenn. The campaign, developed by FOCUS on Women’s Health and Leadership and Penn Medicine Communications, promotes the work being done by women at Penn Medicine and aims to inspire early-career women in academic medicine through the examples of successful women role models.

Women of Penn
Theresa Larivee, MBA, and Serena Dasani, MD, MBA

Theresa Larivee, MBA, chief executive officer of Pennsylvania Hospital (PAH), knew early on that if she wanted a seat at the proverbial table, she needed to make her voice heard while also listening to others. These critical skills — likely the result of growing up among 10 brothers and sisters — have served her well throughout her career in academic medicine. As a strategic leader who cultivates the talents of those around her, Larivee is able to masterfully combine her own financial and operational expertise with the clinical expertise of her colleagues to better understand PAH’s performance across the board, identify opportunities for interdisciplinary collaboration, and develop innovative plans for improvement.

Though Serena Dasani, MD, MBA, is just beginning her health care career, she is already identifying with Larivee’s trajectory. Just a few months ago, Dasani graduated from the Perelman School of Medicine and the Wharton School at the University of Pennsylvania with her dual degree in medicine and health care management. She is spending the first year of her residency at PAH, but while she’s pursuing a career in anesthesiology, her interests aren’t purely clinical. What better way to get a sense of the possibilities for clinicians also interested in the business side of health care than to start at the top?

Dasani recently sat down with Larivee to discuss leadership, balance, and how to develop a big picture, 360-degree mindset.

Q (Dasani): You have a business background and chose to apply that knowledge in the health care industry. Can you tell me about what led you to that decision?

A (Larivee): After I received my undergraduate degree, I spent the first several years of my career deeply embedded in information systems before deciding to pursue my master’s degree in corporate finance. I had a lot of conversations with a friend in my MBA program as we were going through, and I explained that I wanted to land in an organization that would really allow me to use my newly minted MBA, not just my IT knowledge. She said, ‘I absolutely think academic medicine would be able to do that for you,’ and suggested I look into opportunities at Columbia-Presbyterian Medical Center [now part of NewYork-Presbyterian].

I wound up accepting a position that was in information systems, but embedded in the operating room, so I was immediately exposed to the clinical operations of the OR. I was combining my IT experience with my MBA education in order to apply business principles to that work — efficient utilization, cost containment, physician preference versus variability, etc. It was this beautiful blend that allowed me to translate my knowledge to a new industry. That’s how I got my start in health care. After Columbia, I continued to grow as a leader at Fox Chase Cancer Center, before coming to the University of Pennsylvania Health System. [Larivee served as the health system’s Vice President for Financial Operations and Budget before becoming CEO of PAH in 2014.]

Q: I know that one opportunity leads to the next, but can you think of discrete steps that you took that put you on the path to the role of chief executive officer at Pennsylvania Hospital?

A: It wasn’t a prescriptive plan or roadmap. I didn’t say to myself, “Okay, in three years, I’m going to do this, and then in five years I’m going to do this.” A lot of it was luck. It would’ve been easy to stick to finance at Columbia-Presbyterian, but what was unique about that time is that I was rooted in operations. And then I was also given the opportunity to work on the school and faculty practice side. I learned how to work with physicians, how to do business planning, and how to get them to think from a budgetary standpoint. Learning that it was okay to go against some of my own training and my own education and to push the boundaries of where I was comfortable was really what landed me in this role.

When I welcome new employees, I always say ‘Volunteer. Engage. Put your hand up.’ Whenever there’s a need or an opportunity to participate, you will absolutely learn something new and get exposure to new areas. I also encourage others that I mentor in academic medicine to get past those areas that might be uncomfortable. It’s a critical leadership skill because you really need to be willing to go out and get that full 360-degree view to be sitting in this role here.

Q: What would you say is the most interesting project you've worked on as CEO?

A: When I interviewed for the position, I had the opportunity to meet with a number of the physician leaders, and one thing that they indicated was lacking was their input on the hospital’s strategic direction. So, soon after I came on board, we launched a clinical portfolio development project examining our physical assets and our room for growth, and clinical leaders were encouraged to share their thoughts on how we could expand our service offerings. One of the most exciting outcomes was the recent opening of an integrated spine center where patients can see all of the specialists they need to see in one setting. Another example is our crisis response center (CRC), which just moved from Hall-Mercer Community Behavioral Health Center to the Spruce Building on our central campus. It allows us to better serve a vulnerable population, and it allows for much more coordination between our emergency department and the CRC. Engaging physicians in this type of programmatic development and holding them accountable not only benefits our patients, but it helps to build their business acumen at the same time.

Q: Something we talked about a lot in business school is the goal of addressing the Iron Triangle — decreasing costs while still providing high-quality care that’s accessible to the community. Are there any specific initiatives at Pennsylvania Hospital that you think are addressing that complex balance?

A: Absolutely. Our cardiac team is focused on providing enhanced pain management so patients can be extubated after the OR and don’t need to be on a ventilator in the ICU. Many cardiac patients are up and walking on the same day after surgery, and when it comes to shorter lengths of stay, we’re outperforming the benchmark by more than 50 percent. Our MARTTI translation units also allow us to communicate with patients who are deaf, hard of hearing, or speak a different language through a program like FaceTime. Patients who choose to use this service don’t have to wait for an interpreter to travel to the hospital, and this ensures they receive the right care more quickly. MARTTI has also saved us more than $300,000. 

Those are just two examples of how we’re encouraging our teams to look at how we can improve care. I think that always striving to improve is the core of Pennsylvania Hospital. Benjamin Franklin and Dr. Thomas Bond were innovators when they founded our hospital, and we try to honor that. All of the work that I've done in academic medicine over the years has been through a team-based approach, and Pennsy is no different. I think of it like throwing a pebble into a pond; the impact of our teamwork ripples across the hospital, affecting bedside care, patient outcomes, how staff communicate across departments, and how satisfied they are with their roles. We need that teamwork to solve problems.


Q: What advice do you have for clinicians who might be interested in transitioning to the business side of health care?

A: After nearly 30 years in academic medicine, I’m still excited to learn from providers. Working closely with them helps me understand clinical processes and helps them to understand the business analytics side. I’m not a clinician, and many of the physicians aren’t business people, but the only way to tackle any learning curve is to listen and to engage. And so, I think it’s just that — ask the questions about how we’re performing. What are the metrics? What’s the yardstick we’re using? Being curious about that information and being willing to sit down and look at the data is so important.

It’s easy to just point to the chief financial officer and say you don’t need to possess a strong business or financial acumen, but that’s not acceptable in this day and age if you want to be an effective leader. I’ve found that people tend to freeze when you start talking numbers, so I’ve spent my entire career trying to lessen that fear. Something I learned from [former UPHS CEO] Ralph Muller is that if you just strip away some of the zeroes, it quickly becomes like your household budget. There are a couple of more commas and expense lines, but at the end of the day, revenue that comes in and we spend that money and make those investments. So, I think it’s really important for physicians to become comfortable with taking out their calculator and figuring it out.

Q: You touched on your collaboration with Ralph Muller. How did you identify other role models or people who could offer guidance or coaching throughout your professional career?

A: Again, it wasn’t architected — it was more about how particular individuals led by example. For example, in my time at Columbia, I found myself in one partnership that I will always treasure. Pretty much on day one, they linked me up with a very well renowned thoracic surgeon who had just retired and never took no for an answer. He taught me how to interface with physicians, and I explained how we got the data and drew conclusions. He wasn’t just there to mentor me; we worked together as great partners for many years. So, I’ve always been drawn to and inspired by people who live by leadership principles, who say things that made sense, whose actions absolutely resonated with who I want to be as a leader. 

Q: Do you have any recommendations on how young professionals can achieve fulfillment and balance in their professional and personal lives?

A: Family is critically important. After many conversations with my husband when I was pregnant with my third daughter, we decided that he was going to be the stay-at-home dad, and that worked out perfectly for us. While it just seemed so normal and like the best solution, I suppose it was pretty revolutionary at the time. So having a really good support system at home I think is really, really essential. And then identifying boundaries is really important modeling for leaders. In my role as CEO, I don’t need to be involved in everything, and if I’m not delegating, ultimately it’s disrespectful to my team. It comes down to trusting your colleagues and identifying what role, if any, you should be playing.

Also, I’ve realized that the hospital is not going to burn down if I don’t have my cell phone with me at all times. I've made a commitment that I don’t take my cell phone with me to meetings. There are times where we use our phones as a crutch, right? If we're bored or the conversation goes in a direction we don't want to engage with, we disengage. It really is a societal issue with not being able to really break away, so I’m hoping your generation will help us come back to the middle! But again, it’s about modeling those leadership behaviors, both inside and outside the hospital.


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