Make Magic Happen: CMO Ash Gokli, MD, Shares His Thoughts About the Physician Leader‘s Role

This transcript has been edited for clarity and length.

Healthcare costs keep climbing, quality needs improvement, and physicians are burning out. These are a few of the reasons Ash Gokli, MD, believes physicians must step into leadership roles and create the future of healthcare. In this episode of SoundPractice, Gokli describes his path to leadership, his strategies for leading effectively despite a constant onslaught of meetings and time-consuming commitments, and how physicians can create their own path to the C-suite.

Cheryl Toth: I'm here with Dr. Ash Gokli, chief medical officer for the Sutter Health Valley area. Dr. Gokli, we are so happy that you're here. You are a former board member of the American Association for Physician Leadership and you have taken time to spend with us today. So, thanks for being here on SoundPractice.

Dr. Ash Gokli: Oh, thank you. And it's my pleasure and a privilege.

Toth: Great. Well, we're going to talk about leadership today. And for the folks listening, I want to just tell them a little bit about you, Dr. Gokli. You have a job at Sutter Health Valley Area, as I mentioned, and your responsibilities include the oversight of 10 Sutter acute care facilities as well as Sutter Medical Foundation and Sutter Gould Medical Foundation. Your leadership tenure is not just at Sutter, but you've spent the last 25 years as a leader in emergency medicine. And you were chief medical officer for 12 years at St. Mary Mercy Hospital, Trinity Health in Michigan. And you also served as the CEO of Memorial Hospital in Los Banos Sutter Health for two years. Oh, and you are board certified in internal medicine and emergency medicine, right?

Gokli: Yes.

Toth: So that's quite a pedigree. And I thought I'd start by just asking you, what's a day in the life like for you, Dr. Gokli?

Gokli: So first of all, thank you for inviting me today. It's really a privilege. I consider myself an avid student of leadership and I'm very blessed that I get to be a leader for a large organization, Sutter Health, and I can help create the future of healthcare and make a difference in the health of our communities that we serve.

So, a day in my life, it's very different every day. But I start the day spending time with my team at the visibility wall. And on the visibility wall we have the main projects that I'm involved in, in creating the future. And we look at the status of each of the projects and make sure that we are on course or something that needs to be done to make sure that we are focused on the true north. Having done that, then I would spend time with my assistant on the calendar for the day, reviewing some meetings that are coming up.

And then a lot of times my day is spent in meetings. So, the meetings would be system level meetings. Those are not my meetings, but I'm contributing to those meetings as a team member. Then there are my meetings with my hospitals and ambulatory physician groups, nursing groups and administrators. And then there are one-on-one meetings with my reports. So a lot of my time is spent in meetings during the day.

But I try to walk away from meetings with what are my action items and deliverables. So after every meeting, I try to keep some time for debriefing with myself in terms of what I need to do and what really was the essence of the meeting that would help advance our mission. I also try to, it's not every day, but in a week I would try to have about 10 hours for thinking and strategy. So with my immediate team, I would also have sessions. And thinking is very important to me as a leader because that is where we create the future strategy. So we do invest a lot of time in that.

We also, when I talked about the visibility wall, we talked about leading measures or process measures that ultimately lead to the outcomes that we are looking for. So, are we hitting on those process measures? And Lean language is the leading measure. So we spend a lot of time making sure that we are hitting the milestones that we set out to achieve.

Toth: Let me ask you about that visibility wall. Is this actually a wall in your office or in a conference room? And this is everyday people check in and look at this?

Gokli: Yes.

Toth: So, it's physical, it's a physical wall.

Gokli: Sutter Health is a Lean organization and I'm certified as a Lean physician executive. So, in my office I used to have picture frames. I love mountains, so I would have Mt. Everest and other mountain picture frames. Those are gone now. And I have maybe 60 by 90 whiteboard. And that board has stickies and it has a list of all the projects going on, timeline, red, yellow or green in terms of are we achieving the milestones or not? And if we are, this is good. And if we are not, then what are the counter measures? What are we going to do about it? And who is going to do what and by when? So that creates accountability. So that visibility wall tells me at a glance how I'm doing the things that I need to do. Those are my true north projects that's going to take me to my goal.

Toth: Well, I like that. And I like the fact that you come together each day, you've got something visual that you are following, obviously you're schooled in Lean. I also am interested in what you said that the thinking time. And that's what I feel like so many physicians, where can I find that time? You're saying you're baking in this time to debrief after a meeting, to think about things and have your actions and your takeaways. How did you carve that time out? How do you make time a priority for yourself as a leader?

Gokli: Yes, that's a great question. And there is no easy answer because meetings eat up all the time. And if you're not careful, the calendar gets filled up. So every week on my calendar, my assistant knows that I need 12 hours of block time. Sometimes I would tell her I want the whole day blocked. Or she knows to block three half days. And on the calendar, nothing can be scheduled on those days. Sometimes I have to give up those blocks. But most of the time I think they do stay intact. And then I have a couple of other leaders that are on my team and we go into full day strategy sessions. And sometimes people laugh about you need another strategy session. But personally I believe that is where the future is created.

There are four steps to being successful in my mind. You start out with a vision. Based on the vision, you come up with the strategy and tactics. And then you have to execute on those strategies and tactics successfully. And then you need to have a measurement system that tells you that you are really achieving the goals that you set for yourself. So, vision to strategy, to execution and measurement of results. I think the most difficult part of the course is still, in my opinion, execution because the answers are all out there, but good leaders are able to execute versus not.

Toth: Yes. Well, and let's switch over to that a little bit and talk about good leaders and execution being important. What would you say are some of the characteristics, in addition to being able to execute, that a good leader needs? What kinds of things should they bring to the table?

Gokli: That's a great question. And I'm a student of leadership. I've had formal education, experiential learnings. I always try to learn from my mistakes, and I still make mistakes all the time. I've had executive coaches pretty much all my career. So, I believe that a good leader surrounds himself or herself with a great team. And if you are surrounded by good people and then you use inspirational leadership, you light the fire in your team and then you remove barriers for them, then you empower them. Then I like to use this word a lot, then ‘magic’ happens.

Toth: Well, what is inspirational leadership? What do you mean by that?

Gokli: Inspirational leadership would be creating a vision of the future and selling the vision. And it starts with the why. And for me, it's always the why. Why do we do what we do? And for me as a physician leader, the why for me is, and these are my personal whys, is be the best I can be. Excellence heals the body, the mind, and the spirit. Make a difference in the health of the patients and the communities that we serve. So those are the whys. So based on those whys, if we create a vision and we share that and sell it to the team, the team would buy into this because everybody goes into healthcare to make a difference. And if you touch their core and help them understand the whys, then it becomes a lot easier as opposed to selling a task that we are going to achieve something.

Toth: So you're kind of getting behind what's really driving them. And what would you say to physician leaders out there who are wanting to inspire their teams or instill some of these things like getting people to understand their why? How do you do that in an organization? How have you worked with your team to get to that place?

Gokli: I think I start a lot of meetings with the why. And then I go to, from why, I go to how. And the how for me is integrity, honesty, collaboration, teamwork, empathy, being open-minded, being loving and compassionate and being curious about things. So that's the how. And then once the whys are clear, then the hows are already known by the team, saying this is how we work. So that question doesn't come up in terms of are we going to steer away from integrity? Absolutely not. Are we going to be compassionate all the time? Yes. Are we going to celebrate mistakes? Yes.

And then we talk about what it is that we are going to do. And in what, we talk about the actual milestones, the tactics, the task and the measurement system, the execution, and then the measurement system. But I think if you light the fire amongst your team members with the why, that creates a passion, that creates an energy. And I like to say this, but I've experienced this so many times. Two plus two becomes 22 and magic happens. Magic, that's the word I like to use a lot because literally what would be impossible suddenly becomes possible.

Toth: I just really appreciate that perspective because it brings in an imagination quality I think to conversations that people think bigger. And clearly listening to you, you are inspiring your team to think bigger and broader and across possibilities. You also mentioned this celebrating mistakes, which in healthcare, I know there's a lot of conversation around this and people say it's different because it's healthcare and mistakes are looked at differently. But in a leadership role you've got to learn from those mistakes. I've heard you mention it a few times. So how would you advise physicians out there to embrace mistakes with their teams and how they do that in a way that's compassionate with integrity and all the things you mentioned and still learn?

Gokli: Right. I also believe in science of high reliability. So, I think as it pertains to physicians, when you are doing surgery or you're treating your patients, there is not that much room to make mistakes. So that's where the science of high reliability, standard work, checklists and those type of things come into play. In leadership roles, you are making decisions based on incomplete information just about all the time. So you make your best decision based on the information available and give it your best shot. And if it does not work, then you at least know that don't go there again, that did not work and these were the reasons that it didn't work. If those reasons are fixable, you fix those reasons and stay course. And if the direction proves to be the wrong direction, then you change course and try something different. So, there are three things people do. Inaction is the absolute worst. Action in the wrong direction tells you what not to do and puts you in the right direction.

Toth: Like a wall. You have to turn back.

Gokli: But shying away from acting because you're not sure. And indecisiveness slows down progress. So, a good leader is able to make decisions based on the best judgment among the available information as opposed to inaction.

Toth: That's great. How would you advise those physicians, especially younger physicians, who'd like to create a path toward C-suite leadership, chief medical officers, CEO, COO? Because I know that you're big on having physicians in those roles in helping transform healthcare. Where should they start? How would you advise that they kind of guide their career path? Any thoughts?

Gokli: Physicians are very intelligent and smart people. But sometimes that works to their disadvantage because sometimes they feel like they have easy answers to complex problems when they don't. Treating patients is a one-on-one activity where the physician is the captain of the ship. What he or she says usually goes. But leadership is all about teamwork, collaboration, give and take, making compromises, and you are not the captain.

And unlike the practice of medicine where there is instant gratification, in leadership, there is delayed gratification at best. But when that gratification comes, it's many-fold larger, bigger and much more gratifying because you are making a difference on a much larger scale. So physicians are key to transforming healthcare, creating the future. Physicians are intelligent. If they get the leadership skills that they need to get, combine that with the clinical knowledge, I think that puts them in a very powerful place to help create that magic that I talk about in terms of creating the future of healthcare.

And in my opinion, the future of healthcare is creating value. Creating value is high quality, safe care in an affordable manner. So it's about quality and safety, efficiency, surveys, access and coordination, everything at an affordable price. So cost is important, too. So, creating processes, creating structures, transformation, innovation to create the future of healthcare.

Where do you get started? So being a physician is good. You know the clinical side. But don't take it for granted that you know leadership skills. You need those skills in your bag. And there are content leadership skills and then there are soft leadership skills. And the content leadership skills are the quality science of reliability, health law, ethics, compliance, management of physician performance, how to run meetings, on and on and on. Those are important, very important. And that's the basics that you must have. But that alone would not make you successful. You need soft leadership skills. And that's where the negotiation, influence, inspiration, servant leadership and all those other leadership skills come into play. Negotiation, conflict resolution, on and on. So, you need a combination of those and some of those are didactic training and you need to have that.

In my journey, I got the leadership training through, which was ACPE at that time, American College of Physician Executives, and now it is AAPL. So I got my certification in physician executive through AAPL. And this was about 20 years ago. I did follow that with a master’s in medical management from USC. So those were good didactic trainings. But that alone was not enough. I had to go back and at work, do projects and get experiential leadership. So some of that started with committee memberships and medical staff, ultimately department chairmanship. And then I became a chief medical officer. So, taking different responsibilities, incremental responsibilities to further develop and use the knowledge that I had.

And I think over time as you make mistakes and as you go through experiences, you become better as a leader and can make greater contributions. So for physicians, getting that training is very important. Taking opportunities to take responsibilities.

Toth: Step in and, yes, be on committees.

Gokli: Even on committees, even at medical executive level, if you're on the ambulatory setting department level, different committees on the ambulatory group side. And then get into gradually higher roles. And I think being assertive, being aggressive about grabbing those opportunities and staying a student of leadership because there is no point where you can say you know it all. There is always new information emerging and you are always fine tuning your skills.

Toth: That's that Zen mind, beginner's mind, always thinking like a beginner then you're asking questions and being open.

Gokli: Yes, yes, yes.

Toth: Did you have a good mentor throughout this or several mentors? Where do you fall on mentoring and coaching and things of that nature in addition to the didactic training, the stepping in and taking on projects and the soft skills?

Gokli: That's a great question. Having a mentor or a coach I think is a gift. I have had good mentors in my life. And I've been very blessed over the years to have different mentors at different stages. Currently I have one that I'm really blessed and benefiting from. I've also been very proactive in always having an executive coach for myself. So I just finished the six month session about me and I had some new ‘ahas’ that currently I'm working on and that's making a huge difference in my leadership ability.

Sutter Health, our organization, we also have our own university, Sutter Health University. And through that we offer multiple leadership development classes. And I've been fortunate to have access to those as well. So coaching and mentoring and ongoing education, I think together makes a big difference.

Toth: Just for way of definition, because I find that sometimes if people haven't had coaching, they don't really understand exactly what it is. In your words, how would you describe the value that you get from your executive coach?

Gokli: I think with the executive coach, it is like having a shrink. I would go in, talk about some difficult situations that I would have. And out of that, the coach usually would ask questions. And as opposed to giving me answers and fixing those for me, through the questions that he or she would ask, I would come up with my own answers. But as I'm doing it, I get a better insight into the problems.

And I think what helps is usually a pattern comes out. Similar situation, you end up in similar places because your reactions are similar. So through that pattern identification, then you would come up with what can you do to change that? And that makes me, hopefully, a better leader. And when something goes wrong, I'm very introspective. I can blame others, but I try not to because even if I was right and the other person was making the mistake or they were wrong, I can't control them. I can only control me. So how do I react differently or manage the situation differently to come out in a better place? So being introspective and trying to work on me as opposed to trying to change others has been very helpful. And I think coaching gives you that insight into your strengths, but also your opportunities.

Toth: Yes. Terrific. Any final advice? This has been just so enlightening, everything from the vision board to the celebrating mistakes and the path that you've suggested, all these great tangible things that physicians can do. Any final thoughts or advice before we finish our interview today, Dr. Gokli?

Gokli: My advice to the physicians is go into leadership roles, transform healthcare, create the future. This is a very critical time in healthcare. The costs are getting out of hand. The quality is not as good as it needs to be. Patient satisfaction is at its lowest. Physicians are burning out. So, through all these difficult situations, physician leaders can bring out solutions and transform healthcare, improve physician satisfaction, and for that matter, all clinician satisfaction. Improve patient outcomes, patient satisfaction, improve financial situations of healthcare organizations, overall healthcare cost for our country. And improve the health of our patients and our communities. So, make a real difference in the world. This is a worthwhile cause. And physicians being clinicians, they know the clinical side. And if they have the leadership skill, the combination together would create two plus two equals 22 and it will create the magic that I'm talking about.

Toth: Terrific. Great thoughts. And I can't thank you enough for taking the time to be with us today on SoundPractice, Dr. Gokli. Thanks very much.

Gokli: As I said, it's a privilege. Thank you.

Listen to this episode of SoundPractice.