When Jennifer Daley was asked to join the Dallas-based hospital chain Tenet Healthcare, she could see that she would face enormous obstacles. The company was under investigation for allegedly overbilling Medicare, making illegal payments to doctors, and performing unnecessary operations. Her job as senior vice president, for which she would commute from Boston, would be to lead a dramatic overhaul of quality and service, including removal of long-established doctors from Tenet hospitals. Daley has since become chief medical officer for Partners Community Healthcare back in Boston, to be closer to her adolescent children. She was recently honored with a Leadership Excellence Award, sponsored by the Vice Admiral James B. Stockdale Center for Ethical Leadership at the U.S. Naval Academy in Annapolis, Maryland, and Harvard Business Review. HBR asked her how she was able to make the difficult choices the Tenet job entailed. At first, you didn’t exactly jump at the opportunity to take on an overhaul of Tenet’s clinical quality. Why not? When CEO Trevor Fetter offered me the job, I felt strongly that I needed some reassurance about his and the company’s commitment to promoting clinical quality and making the hard decisions that needed to be made. I told him there were two conditions for my taking the job. The first was that although I would report to him, I would work for the patients. The second was that I would think of every day at Tenet as my last. He was very shocked. He said, “What do you mean?” I told him I couldn’t stay if the company or the hospitals compromised patient care or continued to perpetuate the kind of substandard care that had been found in a few places. I said, “If I find out about a problem like that and we don’t remedy it, that’s the day I will quit. There will be no discussion about it.” Were you concerned that such a statement might signal to the organization that you weren’t committed to seeing through the changes you hoped to implement? I would never have stood up in public and told people about my terms. My agreement with Trevor was private. He knew I was serious, and his support showed me he was serious about improving quality and safety and restoring confidence in the corporate and hospital boards—that he intended to make real changes in structure, process, and outcome. Once we understood each other, I could feel comfortable and empowered to make real changes and take on internal resistance to altering the status quo, with his support. Having laid down the law, you did take the job. Can you describe the resistance you met? Some people didn’t believe that we needed to move aggressively to remove doctors from the hospital medical staffs who either provided substandard care, as measured by objective clinical standards, or were disruptive to the process of patient care. There were groups of people in the company who felt that I was overly zealous or had clinical standards that were too high. I later learned that a faction in the company referred to me as the “witch doctor.” Fortunately, the CEO completely supported me. I think that because I was clear about every day being my last, I was able to be more effective. I was beholden only to my strong personal and professional set of core values about patient care. Any job that I have in the future, that’s the attitude I’m going to take toward it, because it gives me an incredible sense of personal freedom and integrity. The only thing you have in this world is your personal integrity—if you compromise it, you’ve lost everything. How does a big company convey integrity all the way to the end user—in Tenet’s or Partners’ case, the patient? A big health-care company typically has thousands of employees, from nurses to technicians to physicians to people who work in environmental services. The company’s executives have to be models for them by leading with integrity, and we have to educate every single one of our employees and provide them with the resources—so that they can do the right thing every time.
