John Fernandez Interview Transcript

The following is a transcript of my interview with John Fernandez. To find links to the audio files and more information about the interview, please click here.


These transcripts are made possible by a gift from the NNEAHE.

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Bonica:	Welcome to Forge John.
Fernandez:	Glad to be here.
Bonica:	You went to the College of Wooster in Western Ohio and studied political science. What drew you to Wooster, and why political science?
Fernandez:	Two things to Wooster, one was independent study, that’s one of the only colleges that requires a thesis done in your senior year. That was different than most colleges and universities I looked at. Number 2, important in an 18-year-olds mind was baseball. I’d say the 3rd one was, it struck me, especially when I went to Ohio, but in specific Wooster, and you would walk down the pathways, and people would say hello. I grew up in the inter city of Philadelphia, and when somebody said hello, you worried about them robbing you. It was such a different place for me, and also to be able to place baseball. That actually ended about the year and a half into college, I got an injury.
Bonica:	You were a college baseball player?
Fernandez:	Yes.
Bonica:	At least at the beginning.
Fernandez:	At the beginning. I’d moved to softball after I had several injuries unfortunately, but then decided that pro baseball was not my future. I probably knew that when I went to college, but it was independent study baseball, and a different environment.
Bonica:	Okay, and what drew you to political science?
Fernandez:	I thought about that when you gave me the questions, and political science. For me I think was the place that Wooster, because it’s a small liberal arts school where I could mix my interests and business and politics. There was no business school, there were no ... I guess I could have been an Econ major, but didn’t really know what I wanted to do. I would say it was largely I fell into it. My parents were very politically active, even to this day. There is a part of me that really liked politics, but there is another part of me that was interested in business, and how money moved, and finance. I thought, with the professors there ... Lastly, there is a professor, Mark Weaver, that taught political theory, which could be the most deadly, boring class known to man, but he made it interesting. That’s one of the things that really attracted me, was the faculty. I’m not just saying that because your faculty.
Bonica:	Well, we like to work hard to make our stuff interesting. Good, so you graduated, and your first job, it looks like about you to Cambridge. I was wondering if you are from the Boston area originally, but you said you’re from Philadelphia. What brought you to Cambridge?
Fernandez:	It was actually simple. It was at the time I was dating a young woman, and she was from West Hartford, I was from Philadelphia, and neither of us wanted to move to New York. I wanted to try something different than Philadelphia, and we wanted to move to the East Coast. We chose, it was either Washington DC, or Boston, and I had several aunts and uncles that lived here. My dad actually is a Winchester native, and my mom was a Wellesley College and Harvard Master’s degree.
Bonica:	You had a Boston connection.
Fernandez:	I had some Boston roots. I have an aunt, 2 uncles that still live here. We vacationed at Swan Lake New Hampshire. I felt like, let’s give it a shot. The romance only lasted another 3 months once I got to Boston, so it’s a good thing I chose a great city.
Bonica:	Yeah, yeah, okay. Cambridge is in the Boston area, and you came and worked at Bell Associates. What was Bell Associates, and what were you doing?
Fernandez:	Bell Associates who was, and I have not looked them up recently, but was a small management consulting firm. They did projects like surveys, and poles of T ridership. Back then Harvard community health plan, we surveyed patient access, it was a very small contract. Had a big, big contract and affirmative action management and planning. It had a whole variety of services it rendered, and I was out looking for a job, and they said, “We’re looking for somebody to help us with computers.” At that time, if you knew database is our spreadsheet, you were special. Nowadays you can’t get out of junior high without that skill, or maybe even elementary school.
	Interestingly, my worst grades in college was computer science, but I got hired because I actually knew something about databases and spreadsheets. I had the opportunity to be the assistant to the president, and what that meant was, anything that needed to be done in a firm that had 12 professionals, a few support staff, and then a ton of data collectors and so forth. It was a really small firm, it was a great experience because you had to make payroll. I got to be involved in marketing our services, writing proposals, analyzing research we had done. Because it was a small place, I got to do a lot of things, and most importantly for my career I got to manage people.At age 22, 23, 24. Not that I should have been.
	It was like, “Well, we’re doing a survey, and we have to do data collection at 8 different T stops, and we need 50 data collectors, who’s going to do that? John, could you figure that out?” Very early in my career, at the time, I had no idea that this was a good thing to do. I just thought I was just do my job, and isn’t that nice. I’d look back on it and I go, “Hm, that was fortunate.” I now encourage people to, the sooner you can get some of that people management experience, the better, because it’s the hardest part of leading and managing. It’s also the best part, but as you can imagine.
Bonica:	Yeah, so you were at Bell for about 3 years, and then you went to the University of Pennsylvania where you earned a Master’s degree in government administration. What attracted you to government administration? You had done policy, you had some experience in business, you said you had an interest in business and politics. What was the draw to this program in government administration?
Fernandez:	Graduate school for me was a lot of luck and circumstance. I was down visiting my parents in Philadelphia, and both my parents, my dad’s a minister, so went to seminary, which is a Master’s degree in religion, and my mother had multiple Masters and PhD. They were hey, you thinking about grad school? I said, “Yeah, in a couple years.” My campaign manager, she had been a city counselor, after I had left for college, she ran for office, she became a city counselor at large. The guy who ran her campaign went to this school called the Fels Center center of government. My mom said it’s really a fascinating place because, you can take a few government courses, but then you take your business courses at Wharton, your law courses at the law school, public policy schools, so it was a place you got to dabble in a lot of different areas.
	Then you had electives. She said, “It’s done in a year and a half, so have you ever considered?” I said, “Mom, I hadn’t really given it much thought, I was thinking of applying to business school.” It just seemed like a nice balance of public, because I knew I wanted to do some good, but also do well from a personal financial perspective. She said, “You want to meet the director? I happen to know him.” A few days later I go have lunch with the director of the program, and he said, “Would you like to come to Fels next year?” I said, “Well, I haven’t taken my GREs, or whatever test I was supposed to take, and I have a job.” He said, “You really ought to give it a shot.” I thought, “How am I going to turn down a Ivy league school when I haven’t even given much thought to which business school or anything.” I thought, “That will open a lot of doors for me.”
	Jumped in and started the next school year back in. I grew up 5 blocks from Penn, so it was like coming home. There is 2 parts, coming home, but also an opportunity that presented itself. The director said, one of the main reason they were after people was work experience. I happened to have 3 years of work experience. It’s a long, twisted story, but it just shows you sometimes you show up in the right place at the right time, you get lucky.
Bonica:	Yeah. Coming out of Penn you had, what sounds like your first job in healthcare, which was back to Boston city Hospital. How did you decide, I’m going to make the jump to healthcare, when did you decide, that might be a thing I would like to do?
Fernandez:	Right before I went to graduate school, I had a lunch with a guy named John Couples. John Couples still works in the Boston area, at the time he was a vice president at Brigham's women’s Hospital. He is a friend of my fathers, he also went to seminary, so it was interesting they trained a religious Master’s degree minister, was an executive at a pretty fine hospital. He said, “Hey, you know what? Don’t go to graduate school, come work in healthcare because it’s going to ... You can do good and do well, there’s going to be a lot of change in the next 25 years or so, and if you got a few genes from your father and you can manage people, there’s a great opportunity for you because healthcare is missing this, and it’s going to be huge.”
	That’s an amazing diagnosis in 1988 and 89. Of course healthcare has grown, and grown, and grown. I didn’t take his advice about skipping graduate school, but when I came back I thought, I do want to ... We were talking before we got online here, in graduate school, one of the things the director had to do was write down on one page what did you want to do when you grew up? Not that some of us had already grown a little, and some were actually 40 and 50 years old, so insulting probably to the 50-year-old.
	He had us write down what it is, what kind of work, not what job you wanted, how did you want to do personally and professionally? How much money did you want to make? Did you want to be in government, and private sector? What is it that motivated you? Doing that exercise may be realized I still ... There was a do good part of me that I want to do something that helps people, but at the same time do well financially. I thought, “Boy, where could I do that?” Healthcare was the answer. Now, there were a couple other places. When I got out of the grad school, and also looked at transportation, Massport in Philadelphia market. Healthcare was really where I spent some time. I only took one course in healthcare in graduate school, but it seemed like a place that I could contribute, and what’s better than helping people with their healthcare?
Bonica:	How did you come to land on the job at Boston city Hospital?
Fernandez:	It was a job.
Bonica:	You wanted to come back to Boston you had decided?
Fernandez:	Again, my personal life shaped my professional life. I had just, a few months before I had decided to go to graduate school, I started dating a woman, fantastic woman who’s now my wife. Going to grad school, I came back and forth. Actually found school to be relatively easy, only have to do at 17 weeks in a row. When you worked at a consulting firm where 80 hours is a normal workweek, grad school frankly, no offense to you professors, seemed actually pretty easy.
	From a time perspective, I decided I wanted ... The other part is, I think I did not feel like living in my, at the time, in my mother’s shadow, or being the son of the well-known politician in Philadelphia. Everybody in grad school said, “Why don’t you just stay here? God knows you could get a job anywhere.” I didn’t know it at the time, but I think there’s part of me that said, I said, “I want to be out on my own, and give it a shot.” I loved Boston, what’s not to love? That’s what got me back to Boston, I looked for jobs, I got one. I knew at the time, why was it so short at Boston City Hospital?
Bonica:	Because you were only there for about 6 months.
Fernandez:	Yeah, and I took the job because it was a bird in the hand, but I had been interviewing at several other hospitals, and physician groups in the Boston area, and I was very close to this job at the brigand that I eventually ... Eventually called in, they said, “Hey, we have to wait for a budget.” I was like, “Well, I’m not going to wait around for that.” That was in August. Then they called me back and said, “Hey, the position we were talking is available.” I was like, “Here I come.” That was the job I wanted, but in February after you get out of grad school, and you got debt to pay ...
Bonica:	You have to have a job.
Fernandez:	You got to have a job. I always thought it was better, in general, in a career, better to have a job, you were more attractive.
Bonica:	What was it like to jump into healthcare? You had had no real background in healthcare, you said you took one healthcare class, so what was it like to suddenly be in a large hospital in a large city? Was that transition like for you?
Fernandez:	It was a lot of learning, but there were also a whole lot of other people learning their way. The good thing is, there were so many management problems in each of the couple positions that I started with, so when I was at Boston city Hospital, the first thing was, hey, there’s all these grants that we don’t seem to be getting paid for. A little investigating and following the money, and having a skill of process ... Not TQM, or you pick the ... The basics of have you diagnosed a problem? And have you talked to people about what’s going on, and follow the dollar and the people? There is $750,000 of research funding that hadn’t been built to the state of Massachusetts. You send them a bill, and they send you the cash. That’s not a complicated problem.
	It took somebody to dig in and look at, why aren't we getting paid for some of the services? Lo and behold, after a little work, and how did this happen and so forth. The good news I think, in both that job, and the trauma job at the Brigham, there had been nobody in that position before. They wanted to develop a level 1 Trauma Center at the Brigham, they didn’t have one. The green field to some degree to go figure out how to do that, and nobody else was going to spend the time doing it, so I read the manual, I went around and interviewed other level I Trauma Centers, okay, this is what we need to do, and then worked with people. To me, I’m sure my wife and kids would say it, but I have a plenty large ego. I think at work I was humble enough, and because I didn’t know that much, I just go ask people, “So how does this work, and how does that work?”.
	I think doing that, then you learn how things work. Like a mechanic, you sort of, “Hm, I wonder how this works.” How does the money work? Who are the people? Who are the nurses, the doctors? The other great piece of my first Brigham job is my office in this little 80 foot closet on the 7th floor right next to the burn trauma unit. The ICU on the floor on the inpatient floor. Sort of a weird spot to have an administrative position, but in hindsight, it was just like being a sponge, because you watched the craziness of healthcare, trauma patients coming in, ICU, floor, emergency department, EMS, medical services, med flight, they’re all these pieces to the healthcare system that, because I fell into this position, I got to see them across the institution as opposed to being in one particular area. At the time I had no idea how fortunate I was. Another thing, there was no billing system.
	Physician billing system for the trauma center. They had billed like $70,000 the first year. Even back in 1992, 70,000 wasn’t enough. You had to go figure out how to, first of all, how do we get this billing fixed up? People thought, “Wow, you figured out how to get the ...” It wasn’t really that hard, in encounter form, and how do we use the computer system, and how is it done in other places? I think I was fortunate to get in the places that there were problems to be solved, and I was humble enough to go around and ask how might we do this? The last part, especially the one at the Brigham, is putting together a game plan for how you want to ... You’ll hear the story over and over, putting together that game plan about how we are going to become a level I Trauma Center, and then following up, following out, following up is a very important leadership management skill that, there are many, many, many people that cannot put a plan together and execute it. The 2 together, not separately. There’s plenty that can do both, do either.
Bonica:	One or the other.
Fernandez:	Yeah. It is interesting how many people cannot do that. Not cannot, don’t. There is a difference, they can, but whether they do it or not on a regular basis, it’s a interesting ... One of your questions at the end is, what book would I recommend? The One Minute Manager.
Bonica:	Okay. Why?
Fernandez:	Because it reminds leaders and managers to consistently congratulate people when they do a good job. They call it reprimand, but they give feedback when it’s not going so well. To keep following up is one of the few themes. It’s amazing how far that can get you of just managing the people in the process on a, every day, every week consistent basis. Most people, you read the book, he listened to the thing, it seems like the silliest thing you’ve ever read, and the book’s this thin and-
Bonica:	It’s like 60 pages, yeah.
Fernandez:	Most people go ... I said, “Tell you what, take every senior executive and say, do you do that every day?” They’ll sit there and go, “No.” “Would you be better if you did that every day?” The answer would be yes. They’ll all say, “I wish I had given people better feedback on the people side of life.”
Bonica:	Where do you think you picked up those skills? It sounds like you’re saying you’re already starting to do that right at the beginning of your career at the Brigham. Where did you think you learned that? Was it in the consulting, was it just something you knew from before?
Fernandez:	This is a common question, where did you get your leadership management skill, where they talk? Is it genes or teaching? I’m a 50-50 guy in that I do think there’s something about who your family is, how your brought up, the positions you play in sports, or in music, or whatever your hobbies are I think do shape you as a person, and then trying to get into healthcare management, or business management that, there is a part that just comes from how you were developed. I would say along the way I had people, none of whom were perfect, but many of whom I learned from. Some of what they did not so well, some that they did well.
	That first job working for a small consulting firm that, you had to manage lots of people that didn’t necessarily report to you, that you had to care about the people that worked there, that you had to get the chief financial results, that you had to have a plan, and that if you didn’t have a plan, the chance of being successful with your client, whether it was consulting or in healthcare, were things that you picked up along the way. I don’t remember this aha moment, it’s the daily, weekly presence of doing, and doing, and doing, and you pick it up along the way. I do think graduate school, the way that the courses we took, like business management, and you do case studies, why was L.L. Bean successful or not?
	You study the case where they tried to open up a retail shop in Japan, and how well that didn’t go. What’s core competency, and in graduate school did sharpen the mind in terms of how did other places become successful. I think each one of those added a little piece to my development, but there wasn’t one ... There was the mentor, there was the experience that turned the corner for me. I look back, like in high school I was involved in student government. I played catcher on the baseball team.
	If you’re not managing and leading, when you’re a catcher, your team ... Yeah, you have to call the plays, you’re calling the pitches, you have to manage a pitcher that doesn’t want to be managed. Compared to other positions, or other places in school, I started doing it at a young age and liked it. There are other people that, managing people is tough on your mind and your soul. If you don’t like that, don’t do it. We need people that, not everybody can manage people, we need people that are going to do the work like the analysis, or great engineers, doctors, nurses. God bless, we need all those different talents.
Bonica:	Right, but not everybody’s cut out to be a manager.
Fernandez:	Yep. A lot of people may want to because it looks glamorous when you get to be the CEO or something, but managing process and people is hard work. You have to like or love the people interaction part of it. I always tell people, that come in and talk to me about why I want to get into the ... I want to be a COO, I want to run a hospital, I want to do this. I said, “Do you like answering telephones?” They look at you like you’re crazy. I said, “Well, do you like managing people?” They may or may not have done that. I said, “You ought to try that first, because if you don’t like that you have to answer a telephone effectively, you’re not cut out to be in operations, because you have to actually care that the phone gets answered, or the email in modern. That’s how patients get scheduled, and if you don’t care about that, it’s beneath you, or you don’t like managing people and giving them feedback, then I would advise don’t do that.”
	I was thinking about careers, I thought I wanted to be a sports agent. I was a sports guy, kid growing up, that’s what I want to do, I want to negotiate those big fancy contracts. He said, “You ought to go downtown and talk to one of my friends who is a lawyer just because, hey, you probably need to get a law degree to do that.” I said, “Okay.” I wandered down to this lawyer, talked to him about what he did, and the training he got, I said, “That’s not for me. Done.” It wasn’t quite that quickly, it was like, boy, law school, writing those briefs, contracts, oh, that’s not what I’m ... I’m not going to actually enjoy that. To this day I go, “Thank God we have good lawyers.” I wasn’t going to be your guy to make sure the 50 page contract was perfect. I have to read a lot of contracts now.
Bonica:	Yeah, but you have a lawyer to help you.
Fernandez:	But I have a lawyer to help with all the issues.
Bonica:	Okay, so you came to Brigham women's, and your first job was as the administrator for the trauma burn critical care division. Briefly, you spent 15 years or so at Brigham, can you briefly describe Brigham as an organization, how large is that? Beds? Give us a sense of how big that organization is.
Fernandez:	The Brigham in Women’s Hospital is an enormous health care hospital physician group organization. Their probably, in today’s world, about a $2 billion a year operation. They have 700, 7 to 800 beds today. Back then it might have been 650, but in the world of healthcare, a large Harvard teaching hospital, hordes of top residency programs so you had trainees, you had research, and then patient care. Patient care being the biggest component. Probably at that time I think there were about 12,000 employees. My guess is they are approaching 18,000 employees at the moment.
	A large, complex physician, unionized nursing, you just read about that in the newspaper. We had Harvard professors and faculty, so plenty of egos to go around. An interesting place because it was in ... Brigham and Women’s Hospital as an organization was actually a young organization. Its founding members have been around since 18 whatever, or 17 whatever, but in 1980 there is a merger of 3 hospitals, the Boston Lying-In Hospital, the Women’s Hospital, and the Peter Brigham Hospital. In 1980 they built the first inpatient tower. If you think about that, I got there in 1992, it was 12 years old, which in the life of the organization is actually relatively young, or a life of a human it's relatively young, but for an organization, and DRGs came to be in the 80s, there was a lot of ...
Bonica:	There was a lot of change.
Fernandez:	Lot of change. It was this merged organization it was now, actually in the 1980s the name of the company was The Affiliated Hospitals. A moving name. I’m glad they moved to Brigham and Women’s. It was an exciting place to be, so I had a sense, and then there is a part, a physical part of the break and that’s really fascinating, it’s called The Pike. It’s this long hallway that connects, I forget how many, but somewhere between 30 and 50 buildings. The Pike is this main traffic walking traffic, and so long that pike you bump into doctors, and nurses, and management people.
	It’s very different. It’s one of the few times I referenced the physical part of an organization, because it’s different having The Pike than an elevator. There were elevators there, don’t get me wrong, but there is a lot of activity, cafeteria was connected to The Pike. It was an organization trying to prove itself in the Boston healthcare market. Then very shortly into my tenure at the Brigham 2 very significant things happened from my professional development, and the organizations development, 1994 or 5.
	Partners Healthcare was formed, so the Brigham, and the mass general created Partners Healthcare, that was a huge ... Over the years after that, just the implementation of that, was a huge change in the healthcare environment. The 2nd one was that my job in the trauma division, and then I moved up to a division manager, then I managed several divisions. All in the department of surgery at the Brigham. I think it was 1994-ish, there was a new chief of surgery hired named ... A guy by the name of Michael Zinner, who is, to this day, one of my mentors, friends, colleagues. Him coming presented an opportunity, that change presented an opportunity for me to take on more responsibility.
Bonica:	Why was that?
Fernandez:	He was looking for new leadership. I had been involved in a project of improving the billing for the whole department, a financial task, and when he got there, he wanted to understand the finances and the billing improvement projects, so I met with him, and one thing led to another. He asked me to work on the transition team for his transition about, what should we do as a department? Etc. etc. he was planning to replace the woman who was the department director or manager at the time, and wanted to know what I thought we ought to do, and how we ought to be organized. Along with one other person we helped him through that transition, built trust. I just got to do more and more as time went along. I tried to convince him to make me the department head, administrative director, whatever the title was at the time, but he said really need somebody with a little more experience, because at the time I was 27 years old, or something like that. I had plenty of confidence of course.
Bonica:	How large is the department of surgery, how many people are we talking about here?
Fernandez:	We’re talking about, now it’s probably 200 surgeons. At the time it was maybe 120 surgeons. I don’t know, several hundred employees, millions of dollars, it’s a big department-
Bonica:	This is a big organization.
Fernandez:	The department’s big.
Bonica:	I want folks to understand that this-
Fernandez:	The Brigham Women’s Hospital is a big, complicated organization by any measure of big and complicated to this day. It’s even more complicated as we speak.
Bonica:	You didn’t eventually progress up to the administrative director for the department?
Fernandez:	Yeah, he tried a few other people, they didn’t work out, and I was sitting there, and was in term, and then became the department director, which was great fun. Along the way I realized, professionally, that to be even more effective in the department of surgery, being able to lead and manage these surgical services, the operating rooms, the beds, the stuff that really make it work for the surgeons, because there’s all the physician practice part, the billing and office management.
	The thing that really what the driver in the surgical areas is the operating rooms. How could I get involved with that, and from a career perspective I was ... Then the vice president position came open, and although it looks really smooth in my resume, there was a year plus national search for that position, of which I was the internal ... One of the internal candidates. It seemed to go on forever and ever, but eventually when I was considering another internal position at the Brigham, the brand-new chief operating officer called me up and said, “Look, we’ve had a national search, and I’d like to take you out to dinner and talk about the job.”
	It took a long, long time for that to come to pass. A big reason, when he looked across the table he said, he was hired as the new COO, the young guy, he’s probably only 5 or 6 years older than I am, the young COO to bring change to the organization, hire new management team, get some outside blood into the place, etc. etc. his first, 2nd actually, he said, “My first major higher the young 32-year-old young insider.” Not exactly the mandate I had been given. He said, “Don’t screw up.” I think I succeeded meeting that rather low expectation.
Bonica:	By not screwing up. Let me back up for a second, so as you progressed through your pre-vice president period, so you were moving from administrative director to director, with your relationship, what is the relationship between a director and the physician who were reporting to? What were the titles, and what were your relationships?
Fernandez:	The relationship, I always took as a partnership. First name basis, I’m there to make it easier for them to do research and practice medicine. That is why they have a manager of an area, or director, it’s a title. I think some of the titles on my resume, administrative director, director, basically the same thing. God knows why they were different in some places, but I’ll give you an example. I was the administrative director for the thoracic, cardiothoracic programs, so I worked for the chief of thoracic surgery, and the chief of cardiac surgery. I reported to-
Bonica:	The Chiefs were physicians?
Fernandez:	The Chiefs were physicians, yes. They were the head of the top heart surgeon, top thoracic surgeon, and learned a lot from them. I think one of them recently passed, but I think they also learned from me, here’s somebody that can actually manage some of the people in your divisions. How they wanted it done. Part of the art was to bring them information and ideas, and make it their ideas, and to also know where they wanted to take their division clinically, or research, or otherwise, and be part of that team of he and the other physicians about, how do we want this to work?
	Had the pleasure of being treated very well. I think it also helped for me, I didn’t work for, most of the time did not work for just one chief. When I became the department director, I reported to the chief of surgery, but you had to keep the 100 surgeons reasonably happy, because that was part of your job. You got some of the dirty work, you had to go get rid of people, reorganize things, or stuff that the surgeon wanted to do, the chief of whatever the division. That’s why they had hired you. Like CEOs, or COO's, you have what, here’s some tough operational stuff. That’s what they’re paying you for it. I’m going to go make the speech, or to help my presentation. Let me know how that goes. I had a lot of those tasks.
Bonica:	You had been managing people right from the beginning of your career, but when did you actually become a supervisor as opposed to organizing ... There’s one thing to organize and move people around, then there’s actually, being the supervisor, and having the hiring and firing authority, and then moving into a managerial role where you’re managing supervisors. How did you do that?
Fernandez:	When I was in the consulting firm, I was hiring, and firing. In hindsight, not when it happened. What was happening is this, well, this is what my boss wants me to do, so that’s what I’m going to go do. In hindsight I go, “Wow, was that lucky, fortunate, whatever it might be, right place right time.” When I got into healthcare, I really didn’t hire and fire people, I was also not there that long at Boston city Hospital, it was like go fix this problem or that problem, nobody really reported to me. Same with the trauma division, I had like 2 people that I supervised, a billing person, and there’s a whole quality program, there’s a nurse that, in our quality outcomes for trauma. Supervise managed a couple people there, but then the next jobs, I usually had a clinic manager, or a research manager, so I was managing the managers.
	Even in those jobs where you’re managing the physician practice, you really had to know the administrative assistants, the medical assistance, the nurses, it was a very ... Even though there were supervisors, you had to get in to the, how’s the clinic working day, are the phones being answered? Why is there a long wait time? What’s happening with our work schedules? You had to be into the details, even though you had supervisors that were reporting to you. Then obviously in the department of surgery job, I was managing the ... Some of them really felt like they worked for you, and others would go, “Oh, no, no I’m managing the division of X, and I report to the chief of cardiac surgery, or the chief of this.”
	A lot of the managing had to be by influence, and by encouraging, and goal setting, and coming up with a game plans for those divisions, and saying, “What’s your plan to grow general surgery? Or what's your plan to enhance research?” Getting people to submit those, and review those was probably the most effective tool, management tool was getting people to think 2, 3, 4, 5 years out, what’s the capital going to need? What’s the business plan? It’s amazing how many people struggled with that exercise. Even at a Brigham and Women’s Hospital, there was, Harvard teaching hospital, world-famous, inside the walls, getting the pieces to move, I found probably the most effective way was put the data on the table, and what’s the plan? Then pick up the plan, and try to make it better. Then each year review how that’s going, or each month, or quarter, depending on what the ...
Bonica:	That goes back to what you said at the beginning about, you make a plan, and then you execute, and follow-
Fernandez:	Execute. If you interviewed Mike Zinners, the chief of surgery, he would say, back when John and I started together, we developed this thing called the Surgical Action Plan. I love giving names to the project, I think it adds some fun to the things. Then you get criticized by your colleagues, “What’s this corny name?”, but it adds some fun to it. We had the Surgical Action Plan, which was a five-year plan to grow surgery at the Brigham, what’s the capital needs? We put that all together, took us several months, lot of analytics, etc. why you want to grow, what’s the financial benefit, huge capital needed. What’s the return on investment to the institution, and to the department, and to the surgeons? It really got buy-in from the surgical faculty, staff that work for them.
	Mike would say, “We came up with this plan.” He said most of his career prior to that, there were lots of plans and they sat on shelves. He said, “This is the one that we actually executed on, and it worked.” He says that sometimes with great surprise. That’s the kind of planning and executing I took great pleasure to go into a ... We got our Surgical Action Plan approved at a board meeting, and 3 years later we were asked to come back and see, how are you doing? Because there was a lot of skepticism, how could you do this? Blah blah blah. It looks really difficult, 3% growth per year for 6 years. That hasn’t been done before.
	We did it, we went back and showed the power points on, here’s what we said we were going to do, and here’s what we did, and here’s what we missed. That was so much fun to go back and go to the room where people are looking at you a little skeptically, but said, “It’s worth a shot.” You got a new executive, you got a new chief ... Relatively new chief of surgery, let’s give it a whirl. It wasn’t quite that simple, but being able to go back and say, “Yes, we spent a lot of money, but we also hired a lot of surgeons, and grew the surgical program faster and quicker than anybody else would have imagined.” We took great pride in that. Learned a lot about the organization when you are doing the planning, because you unearthed some of the problems in different areas, or why aren’t things growing? Why aren’t the phones being answered? Or what’s wrong with this process or that?
Bonica:	What would you say you were learning? What skills did you develop during that phase of your career leading up to becoming vice president? What were the most important things you learned and developed?
Fernandez:	During that period, prior to becoming the vice president, I think I honed my people skills, both working with physicians, and nurses, and clinical staff, but also managing people. Experience made me better, because you make mistakes. That was 1. 2 is the honing and, probably formalizing I guess that developing a plan is actually important, and having some structure to that, whether it’s ... Now my mantra is, if there is not a spreadsheet at the end of your plan, you haven’t finished your plan. You can see all the time, people come with beautiful power points, here’s my plan.
	How is that going to work for us financially over the next 6 years? They go, “Oh, well this is just the plan.” I said, “It’s not a plan until you talk about money.” I think I honed my planning skills and my people skills. The 3rd part is, I got very involved in space planning, which was a probably more valuable resource at the Brigham, in hindsight, than money. Working on complicated space projects. It wasn’t the space, it was how we were going to work in that space. People always look at it as the bricks and mortar, and the exam rooms, but you really learned how to peel apart, how is that clinic, or operating room, or procedure area going to work? Then how do you design the space around that? I learned a lot in those years on space planning that helped me understand people, and process, because I was involved in the space planning efforts.
Bonica:	In 1998 you are promoted to your first vice president role, and you came in with low expectations of not to screw it up. I served in the military for a long time, we have divides between company grade and field grade officers. You come in initially as a company grade, and you’re learning your ... A lot of the skills we were just talking about, early management skills. And you move into field grade, and I’m imagining this is the same shift, now you’re more of a strategic player. Is that an accurate description of what a vice president would be expected to do or move into?
Fernandez:	Yes, but also at the Brigham, the way we were organized is, the vice presidents had a responsibility for their areas. For me it was surgical, and then imaging services. There was a department chair, like this guy Mike Zinner I mentioned. Mike Zinner didn’t report to me, he reported to the president of the hospital. My job, for the surgical services areas, was all the functions, the hospital-based functions, for example operating rooms, presurgical evaluation center, how that whole surgical put beds, how that whole surgical process works.
	You had operating responsibility and directors that had 50, 100, 200 employees working for them. Your job really was making sure those places work with the metrics, how many cases are we doing? What can we do to improve? You really were more in the overseeing, planning, multi-year view of this as opposed to, how are we doing today? Although, every day I would come into my office, and I look up, how many cases are we doing? How busy are we? What’s going on? Because you need to have your finger on that pulse, but I wasn’t cleaning surgical instruments. There’s a fleet of people cleaning surgical instruments.
Bonica:	How did your scope change?
Fernandez:	Because when I was with the department of surgery, it's largely about the office practice, and professional billing, and all the stuff that goes into a physician office practice. One of the things I learned in those years was, or philosophies I developed was, there’s not a separation of hospital and physician. I’m not naïve enough not to think there’s some of that politics that goes on, but I figured the more I could espouse that hospital needs great physicians, and physicians need a great hospital. This historical we and they, I constantly tried to make sure there was no we and they. And luckily we had, and surgeries perspective, we had some great chiefs that lived and walked that walk 2.
	Chief of orthopedics, chief of surgery, eventually the chief of anesthesia that realized that our futures were tied together, they weren’t somehow, the surgeons did great, and the hospital did bad, or vice versa, they are totally connected. We had a every week meeting, me and the chief of surgery, and the department manager about where we are taking surgery over the next month, year, who were the new recruitments. It wasn’t the hospital this, the doctors this. We would occasionally have to work some of the how we pay for stuff out, but we developed a, how we do this together, not the we and they.
	Which you see in healthcare all the time, and it’s not healthy. Even if you’re in a hospital that has private practice physicians, this notion that you’re really separate I think is something we need to overcome as a provider side of the industry, because guess what? Insurance companies and everybody else does, they pick us apart. The more we are together, you can’t have healthcare without doctors and hospitals. I took that philosophy into the surgical services, and lived every week. I had great physician leadership that were great partners, and was very fortunate to have those people as your partners.
Bonica:	Okay, so you move from reporting to the chief of surgery, to now partnering with him, and providing him the environment that surgery ...
Fernandez:	Yeah, because my job was provide those surgeons a terrific operating experience, and the chief of surgery’s a lot happier. Because, when the operating rooms work well, there’s a lot less work for the chief of surgery, then he can focus on how a resident’s doing, how are we drilling the programs? Who’s the next recruitment? The chief of surgery, chief of orthopedics, anesthesia, I was really fortunate to have people that bought into the we component.
Bonica:	From 2003 to 2006 you continue to add more responsibilities to your portfolio, you kept Surgery, and you added imaging, and then cancer services, pathology and lab services, and network development. By 2006 you were responsible for managing and mentoring 15 directors who were responsible for over 2100 FTEs, and budgets in excess of 300 million. How did your leadership style have to evolve as you took on those additional responsibilities?
Fernandez:	Hiring fantastic leaders. The other directors had to be fantastic, because I’d spend less and less daily time directly supervising those areas. You had to get good at hiring people you thought, hold them accountable, but let them do their thing. Whether it was the nursing director, or administrative director of surgery, or the network development person, finance, that’s… That’s what you had to get. That’s also where having your game plan ... If people know what that game plan as, it makes it a lot easier. If everybody knows, hey, next 3 years ... In surgery for example, we have a 3% per year growth target. Whatever you’re doing, let’s make sure we’re doing things that make sure we hit those numbers from a numbers perspective. What that means is not just numbers, it means hiring good nurses. If we get a new doctor on, how do we get them ... their practice ramped up, how do we get the marketing resources? How do we attract quality? There’s a whole bunch of steps that go with the making that happened, it’s not just add water, stir.
	Let me give you an example, the network development part was part of helping to grow surgery. A cancer center at South Shore Hospital, or Patriots Place, or a better relationship with Dana-Farber, what that meant. That is part of making your surgical services, because guess what? Surgery is a big part of cancer. South Shore Hospital, the first 3 or 4 things were cardiology, and surgery where we planted surgeons down at that institution, and came up with smaller contractual relationships as compared with the bigger ones that came over time.
	It wasn’t a complete disconnect like surgeries here, radiology's here. Some of these were just, you are the person standing when another vice president left. I’m like, “Well, he seems to be doing good with these, but let’s add a few more.” When I added pathology late in my career, in Brigham was, some vice president left, and the president, or chief operating officer, depending on who was there said, “You’re doing a good job with these other things, take that one.” I got known for getting things done, and to get known for getting things done, then people just keep giving you more. That happens in most organizations, no matter what their healthcare or not. You look around and said, “Here’s your reward for being great, or good at you ... More.”
Bonica:	As you moved up into those higher levels of responsibility, and in larger scope, you describe, when you are initially working in the Department of surgery, you really knew all the admin staff, and you were able to go down, really focused on all of the actual operations. At some point you had too many of those to do that on a day-to-day basis. How did your management style change to deal with that?
Fernandez:	A lot more on metrics, but I think one of the things about having been in the day to day operations, and managing people at a different level of the organization is your ... You had a lot of experience, or instincts that, when you look at the weekly, monthly, daily management reports on volume, quality, length of stay, that experience made it a lot easier to handle more and more areas because ... Those sets of experiences, if I had not run several clinics, or reengineered how we did surgical services early in my career, and learned how the nurses worked, and so forth and so on, it would have been harder to trust the bits and pieces of information. 2 other things, hiring good people. I spent hours and hours, I would make the extra time to walk to a clinic, or have a meeting. I would always try to have my meetings at somebody else’s office, whether it was a chief of service, or a manager.
	I would go to my, our nurse manager, and meet her in her office, or the director of this, I’d meet in their office. There came a time when people said, “Well, we really want to be coming to your office.” Because it feels special to go. I’m like, “That ain’t happening.”I also spent a lot of time building a network, going out and having a cup of coffee with a young person, or somebody looking for a career change, and just keeping that network of people. Some of whom had never worked for me, or worked at the organization, either Mass Eye and Ear or Brigham. That continuing to be interested and talking to people, no matter where they are, about their career and so forth, meant, when you went to go look for people, you go, “I remember so-and-so.” Or you asked one of your managers, “Who do you think might be good and fit here?” Then when you have that opening and you go, “Hey, there is at least somebody I can consider.”
	The development of your network, and taking that great advice when I took this vice president job from another executive, he said, “Make sure you have time to think, literally take time in your schedule, thinking time, because you will get so busy with all the stuff, if you’re not thinking about what’s best for the organization, what’s best for your areas, if you don’t carve out time,” he said, “Do not make it from 4 to 6 on Friday afternoon when you’re the most tired.” Not that you’re tired, but ... She was significantly older, she said, “As you develop, Friday afternoons from 4 to 6 is not the only time to do your good thinking, or Sunday at 7 AM. Carve out some time.” I think that lesson was a good one.
	The 2nd one was, make sure you’re not so busy, or perceived to be so busy you can’t take the next cool project. If you’re perceived to be too busy, or you want people to perceive you as too busy, then the next merger, the next new project that’s really exciting, they think of somebody else because you’re too busy. I made an effort to make sure, even though I might have been really busy, make sure you have time when the next cool project comes along. That was true when I had the trauma job, that was true when I had the division director job. The things that got me noticed for the special projects.
	Also, getting your day job. If you don’t get your day job done, it’s going to be a problem. Having a little extra time to serve on the emergency department process improvement committee and you go ... Because I was doing the the trauma center I was on that committee. Okay, or the critical care committee, how do we take better care of patients? Or improve the processes they are? That’s not in my job description, but getting on those committees, more people get to see you do your work, you get noticed, you get asked to do the next thing, and the next thing. You just have to be careful not to always say yes, because you end up maybe overstretch, then you don’t get your day job done. I’ve seen that happen, yes, yes, yes, and then you go, “Oops, the phones aren’t being answered in the clinic.”
Bonica:	Right, so you have to balance that.
Fernandez:	Yeah, if the day jobs not getting done, that’s job one, but if you can then trade time. You know what helped? It helped me that early in my career, before marriage, before kids, you have a lot more time. I used a lot of that time to spend the extra hour or 2, or the evening, or go to the extra event, you meet more people. You just took the extra time. Then the last several years, my wife understands it’s hard work, and you cannot be home all the time. In healthcare I’m not traveling, so I’m home every night, spend plenty of time with my kids. Still, their long days, and you got to say that’s part of ... You have to have a partner that’s going to ... If you decide you want a partner, and you want kids, which is your decision, or young person’s decision, then you have to find a good balance, or it can be very, very challenging if you don’t have that.
Bonica:	You came to Massachusetts Mass Eye and Ear infirmary in January 2007 as the president and chief executive officer. Before we talk about your current role, can you tell us a little bit about Mass Eye and Ear?
Fernandez:	Yes, Mass Eye and Ear is a Harvard teaching hospital, specialty hospital, we only take care of patients who have eye, ear, nose, throat, balance problems from the neck up, except the brain. Although, some of our hearing involves the brain, so we have the largest eye research program in the United States, the largest hearing program in the United States. We are home to the Harvard residency program, so we have a three-part mission, patient care, teaching, and research. Our residency program is tops in the country, one of the largest, if not the largest, tied for the largest. We have the most NIH funding. Then in the Boston area, we have 70 plus ophthalmologists, 70 plus otolaryngologists. Most other places have a handful or 2 at best.
	There’s a few private practices that have a few more ophthalmologists, but by far the biggest group of physicians, ophthalmologists and otolaryngologists. We are about $400 million, so even in Boston, we’re considered a small hospital, or a small teaching hospital. That’s $400 million a year, and 2200 plus employees. It’s small in healthcare land, especially when you’re next door to one of your most important partners, small PE, and they have 20,000 employees, and their multiple billions, and you get perceived as small, but it’s still a large organization. Lots of people, lots of action. The other thing I point out is, what’s also different, is that 95% of our work is outpatient. We only have 41 beds, but we have 21 operating rooms. To give you an example, dude in Wellesley Hospital has 14 operating rooms, 15, something like that, and they have 300 beds. The MGH has 50 plus ORs, but 900 beds. We are the opposite, and really focused on the outpatient services, as opposed to, most of the hospitals at the inpatient service delivery is the largest function for the organization.
Bonica:	Mass Eye and Ear is referred to as a specialty hospital, how is that different than an ordinary academic medical center, or community hospital?
Fernandez:	Different in that, we only take people with those diseases, eyes, ears, nose and throat. A lot of the functions you have at all those other hospitals, you still have payroll, purchases, you have all the same hospital hotel functions, security, you have all those things. It just means focusing on that patient population, those patient populations. As opposed to taking out commerce. We have our own emergency department, so that’s really the difference is, you’re focused on that population.
Bonica:	You do both basic research and clinical trials, what’s the difference, and what does that mean?
Fernandez:	Clinical trials are the studies that are done on humans. We say, “Mark, we have this new treatment, and you signed a consent form.” We’re actually, after having a lot of testing and making sure it’s safe on animals, and so forth and so on, my clinical trials really testing, will that device or drug work in a human being? There are different phases of clinical trials. Clinical trials are really focused on our patients. The cochlear implant back in the early 70s and 80s when it was being developed, somebody had to try the first cochlear implant, and that was here. They were enormous big boxes of things. Now they’re these little tiny electrodes that go into your head and ear. You need to get new treatments, somebody has to give it a whirl the first time.
	Basic research is people working on the biology, and chemistry of a potential ... All of our work is driven by finding new treatments and cures for hearing, and cancer, head in the cancer, opthomalogic diseases. It’s studying the chemistry biology of a potential solution for somebody, it doesn’t involve patients, it evolves test’s and animals, and laboratory work. In your brain you could think, if you see all the beakers, and laboratories, and mad scientists, they’re working on the basic research, and the clinical trials are really ... What comes out of that lab, hey, we found the gene, or the possible drug mixture that could help a patient. After we tested in mice, or other animals, after we test that and make sure it’s safe, then we try it on human beings.
Bonica:	How do people come to get their care at Mass Eye and Ear? From how far away do people come?
Fernandez:	They come from literally all over the world. Now all over the world are international patients coming from international locations, it varies between one and 2% per year. Most of our patients come from the Metro Boston area, and then we get a large number of New Hampshire, Maine, Vermont patients. Then probably a handful of percentage from national, they come from other states. People call from New York, Connecticut, Philadelphia because of some expert, or sometimes one of the clinical trials, people go hey, they Google, and with technology nowadays, people say, “Who’s the best ophthalmologists, or retina Doctor?” They come from Detroit, LA, Texas.
	We have a great story about this young woman with macular degeneration from Texas, tennis player, heard about the work being done at Mass Eye and Ear and said, “We’ve got to come.” They flew up here, they get seen by one of our positions. Some of the diseases are really rare, some people travel a long way, and some are because people are looking around for the best physician, most trained, most experienced. When it comes to ophthalmology and otolaryngology, there’s a so few places that have this depth and breadth of services around the world, that this is one of those places. Having been around since 1824, they developed a name and a reputation, and being part of Harvard Medical School helps. All those factors are what draw people here.
Bonica:	You’re an affiliate of Partners Healthcare, what is Partners Healthcare? What does it mean that you’re an affiliate as opposed to a member?
Fernandez:	The member of Partners Healthcare means you’re owned in part of the Partners Healthcare Company. Mass Eye and Ear is a separate 501C3, we have our own Board of Directors, we are owned by no other entity. One of our strategies, one of our main strategies when I got here was to, how do we partner officially with other places to be their eye and ear service? We have the largest number of eye and ear physicians, we have one of the great services in the world, why don’t we export that to other places? We have a contract with Brigham and Women’s Hospital to provide their ophthalmology services. We actually, although we are right next to MGH, not until 2009 that we have a contract with the MGH to provide ophthalmology, and the NT services to Mass General. 2009 we signed that contract.
	Affiliate, what it really means is, we have a contractual relationship with those institutions to provide clinical services and leadership in those 2 areas. Generally don’t use the affiliated word, because it has a ... What does that mean you’re affiliated? We also buy services from partners, and from the MGH. For example, our information systems, we’re on the same information system right now, Epic, as all partners. We buy that through a contractual relationship with them, because we’re not big enough to put in our own ... We could buy another system, but 55% of our referrals come from Partners Healthcare entities, so why would I buy another system when we have such an integrative relationship? Not to mention, Epic is a well-known popular system, brings its own headaches, but ...
Bonica:	You mentioned your board, and Mass Eye and Ear has its own board, what is the role of the Mass Eye and Ear board?
Fernandez:	The role of our board, they provide leadership, oversight, really take their job, their oversight jobs in terms of finances, quality of care very seriously. They also help us raise money, we’ve increased our fundraising from 9 million to about 25 million in the last 3 years. We’ve taken the role of the board, which you read in governance in one of your classes that are teaching governance. I, and the board chair, and I think the other board members view the board ... It’s an all volunteer board, so it’s not a paid board like a lot of companies. It’s a volunteer position. We tried to make it easy on our board by providing them information, and their jobs are, number one, to hire the chief executive who works for the board, and I make sure I remember that I work for them, not the other way around.
	Number 2 is oversight of, in particular, the finances, and the quality of care. Doesn’t mean they do it, it just means make sure management is on their game when it comes to the financial, and quality of patient care. Then 3rd, and probably most importantly, the review and oversight of our strategic planning. What are we doing, where are we going, and the board and management ... When I say management I mean, our management structures, we have vice presidents of different areas, finance, and operations, etc. It also means our chief of ophthalmology, physician chief of ophthalmology, physician chief of otolaryngology, chief of radiology, and chief over anesthesia, is our physician and management team together, it’s not a separate ... Every Wednesday we have a meeting, it’s not doctors over here, everybody else over here, it’s a one company.
	Our board holds us accountable for that. Strategy, CEO and oversight. It’s terrific. We have a fantastic board chair that joined in 2010 who is really committed to our mission, and research. He has a blind son, he also happens to be the good guy and the owner of the Boston Celtics. We have somebody that can really open doors for us when it comes to getting things done in Boston, are raising money. It’s been a real, real big pickups. Then several other board members from very prestigious financial firms, law firms, some people are retired.
	It’s a constant effort to keep your board with people that you would be proud of, because it’s a volunteer ... Actually it’s a volunteer, and they donate money to the institution. Here the job opportunity for you, would you please come give your time free? Would you also donate some money, and would you also oversee a large organization? How does that sound to you? Management here really works hard at making sure that coming to do that is attractive from a time management perspective. We have 5 board meetings a year, we have a few committees, and send them emails, then as informed as they would want to be.
Bonica:	How does somebody come to be on the board?
Fernandez:	2 ways, there’s probably 20 ways, but 2 main ways. One is, we actually have a list which I won’t share with you. We have a list of people who we would be interested in having on our board. Well-known figures, people with financial resources, men, women. It’s hard to keep that diversity of our board, it’s probably something we haven’t done as good a job. We have good but not great male-female, but people of color, more diverse backgrounds, it’s very hard work, but we are constantly looking in the interviewing. We have a list of people that we go out and meet with, and say, “Hey, would you be interested in this? Would you be interested in this great job?”
	The other ways that our board members, or other people who are patients become interested through either that personal connection, or the patient connection say, “What can I do to help?” Then we look at their profile because if you’re going to give money and time, you have to have money and time. I’ve also taken the approach, and for anybody in one of your classes, if you’re hiring somebody for a nonprofit, and there is personal fundraising, or fundraising to be done, we have taken, it's probably gone a little overboard on being very direct when we’re talking to people about it, about, here’s the financial expectation, here’s the time expectation. Saying, “Look, I tell the same story to everyone of the people sitting around the table.” You don’t get there and go, “Oh my, all these people are giving a lot of money, and I’m not.” They feel uncomfortable.
	Or, “I can’t really give much time.” They’re all donating their time. I said, “When you’re talking about the type of people that are on this board, they don’t want to have a surprise, and we make sure they have no financial or time surprises when we’re recruiting them.” That is not universally true in other nonprofits, it’s usually a little more vague. I would encourage anybody that’s doing it, the more direct you are, the less surprises you get, and the less surprises they get later on. People go, “That’s a pretty big financial commitment, I’m probably not your guy or gal.” Other people go, “That’s not a problem, what else is there? How much time?” It’s a hard conversation. That’s largely been left to me, so I think the other board members like, “I don’t want to do that.” These are peers, or friends, or whatever. I go, “Not a problem.” I’ll tell them just like I was telling you, I just don’t want you to be surprised.
Bonica:	Can you describe your role as CEO? What do you do on a day-to-day basis, what’s a day in the life of John Fernandez look like?
Fernandez:	Highly varied. I tried to spend most of my time on projects, and initiatives that generate revenue for the organization. Fundraising, new projects, things like that, new clinical programs, drilling our clinical programs. That’s really what I try to spend most of my time, but you do have management issues, you have personnel problems, you have security breaches, there is stuff that comes up. Then another big part is managing our board, but also managing the vice presidents, and chiefs of service that report to me. Those people are largely self-motivated. The most important thing is hiring good folks. Just to quickly add, one of the things we talked about earlier is, what might I wished I had done earlier in my career, or as CEO? Number 1 is public speaking.
	Whoever is taking that class, take it seriously, and practice, practice, practice, practice. I wish I had done that earlier in my career, I wish in graduate school I had paid more attention. It’s a skill I needed to work on as a CEO, which I could have worked on my whole career and I didn’t. Number 2 is in the CEO job, getting your team together sooner than later is easier said than done, especially when I joined as a new outsider, or CEO, 41 years old. I tried a little lighter than I probably should. In retrospect, getting the team, whether they are here or not, getting the team that you feel you got the right people in the right positions, the sooner the better. Even if it’s a little painful, it’s just a different world when you get fantastic people working for you, that many of whom are well smarter than I am. They’re really good at what they do, and then want to work here.
Bonica:	When you say a little painful you mean, managing someone out that you don’t think fits in?
Fernandez:	Yeah, just telling somebody that it’s just not going to be a great fit, and I need it. Or restructuring. One of the positions that the person’s on not quite the right fit. Or getting the CFO, or COO that works ... When you get to this level, it's the fit of the person more than it is are they qualified? You need to get a ton of qualified people, are they going to work well with the other members of the team as well as really be able to take what you’re doing, and translate it to their part of the organization?
	It’s much more of a, does that person have the drive, the personality, and the skills? There are plenty of people that have left here that are very skilled, good people, that they just weren’t the type of person we needed for the next 5 years, or the next 10 years. For your people in your class, you get to the point of management where a lot of people take it really personally when they’re not the right fit. Don’t. It happens, and you move on to the next one. That’s easier said than done, it’s emotionally difficult if you’re that person, but when you get to the senior levels, there is a lot of how you fit with the rest of the team, or your skills fit into the organization at this point in time.
Bonica:	Can I ask you, what is organizational culture, and why is it important? What aspects of organizational culture are particularly important to you?
Fernandez:	Culture to me is hard to get your handle on it, and you don’t know it until you’re in. Even though we talk a lot about it, and management land it’s like what is it? It’s the way people feel, and the way work gets done, and the air of the management team, or the organization, or whatever it might be. I don’t have something that’s really that one little nugget, it’s more a series of ... Like people say the culture has changed here. I think part of that is the people, part of that is you have a strategy, I think getting back to the culture change is, where are we going? Then when people get that idea, that becomes your culture for a period of time, and then they might have to change a little bit.
	Like at Mass Eye and Ear I got here, and I would say the culture was the Eeyore culture. We always thought it was going to rain, or somebody was going to merge, or we were going to go bankrupt, or whatever. Now I think it’s a culture of growth, and we’re the biggest and the best, and a little more ego. Not a lot, but it’s not, “I wonder if something bad’s going to happen, or MGH is going to take us over, or we’re going to lose too much money.” I think that comes with hiring people, having a plan, sharing how we’re doing with the plan, sharing our financial results talking about the strategy of the organizations, for us, changed the culture to be, how do we get after it? As opposed to, boy, something is going to be done to us.
Bonica:	What would you say is your leadership philosophy?
Fernandez:	Plan and execute.
Bonica:	Plan and execute, okay. We talked about that a couple times.
Fernandez:	It’s-
Bonica:	That straightforward.
Fernandez:	The other thing I would say is, mine is probably also, how can we be kind to each other? In Healthcare there is so many hard problems, and you get to see people who are suffering. To me, asking your staff, I know it doesn’t happen all the time, but boy, can you just be kind to your colleague? They’re here trying to help another patient, or do another research project. 99.9% of the people are not here trying to make your life more difficult. Don’t treat them that way.
	If we treat each other a little better, my guess is it will translate to our patients, that you actually care how somebody is doing. It’s interesting to add caring to healthcare, and I think that’s something that I ... Sometimes it gets perceived as you’re too nice, that does not mean you have to be too nice. Yes, you have to make tough decisions, and you have to do all that, and set a strategy. A big part of strategy is deciding what you’re not doing. You don’t have to say, “Well, we’re not doing that.” We can say, “We are doing this.” You can choose to tell somebody that they’re just a horrible person, or you could say, “There’s a few places you can improve.” Same message, a different level of kindness. That’s been my approach to it.
Bonica:	In closing, what advice would you give to an aspiring early careerist who would like to maybe be the CEO of Mass Eye and Ear someday?
Fernandez:	I would say hard work, which doesn’t mean long hours, although can mean that, but it’s like, figure out your plan, and really focused each day, each week on what are we getting done, and working at your craft hard and well. Put in the hours if you need to put in the hours. If you’re not the smartest bulb like me, you’ll spend a few extra hours reading and learning, and, and have that interest. 2nd is to actually enjoy what you do. If you don’t enjoy it, you can’t do the first part of it, it just becomes drudgery. Find another career, find something you like to do. Then I’ve talked a lot about the plan and execute part of it for a young person in the public speaking part. You can take your iPhone now and practice your public speaking, and you need no help.
	Go find a speech that somebody gave, Gettysburg address, to 20 times, and then do it 20 times. You want to get humbled? Look at your iPhone after you speak, and you’ll be, “Oh my.” You’re going to have to edit the tape because my diction is not so good, or this or that. Those are the things to me when I talk to people. Get your own personal plan. I gave you the handout. What you want to be as a person, I want to be married, how much money do I want to make? Where do I want to live? Sort that out first, the career comes 2nd. Because if you don’t want to live in another place, and you work for a company that, their main offices are somewhere else, guess how well that’s going to work? If you want to make a lot of money and you go try to be a schoolteacher? That’s going to be hard to do.
	I’m exaggerating to make the point. If you want to have 15 kids that all need to go to college, you might want to pick a career that generates the income to do that. So on and so on. I think figuring out what you really want as a person, which when you’re 22, the good thing is, take that list after you wrote it down, you can go back and erase and say, “No, I didn’t want 15, I had 2 kids, I’m done.” You can change your plan. Yes, I only want to live in Boston. Well, maybe I’ll live in Hartford. I’m change and you may change, but knowing in your head what matters to you as a person, then the career things will fall in your lap. If you work hard and you have a few brain cells, which if they’re going to UNH, and they are in your class, they’ve at least passed that test. That would be my advice.
Bonica:	Thank you, and thank you for all this for you give to our program at UNH, as well by providing internships, and career opportunities for our students.
Fernandez:	They keep doing good work, we keep hiring them.
Bonica:	Thank you so much for your time today.
Fernandez:	Thank you.