Seth Teigen on the upside-down pyramid in healthcare leadership

What this conversation is about

Seth Teigen was in his fifth year as a hospital chief executive when he joined Glenn Llopis on Personalization Outbreak, in a summer when every health system in the country was losing people. Glenn set the stakes at the top of the episode:

"It's become less about the business, defining the individual and much more about the individual defining the process towards the mission." — Glenn Llopis · 00:01:05

Teigen’s reply is a career told in one line, and it is the quote at the top of this page: at fourteen he was washing dishes at the community hospital in his hometown. He kept that job through college, became an x-ray and CT technologist, and took his first supervisor role at twenty-four.

A ladder climbed by looking up

How he moved is almost comically simple. As a clinical person he looked at the leaders above him, not critically, and thought he could do that job. As a supervisor he looked at his manager and thought the same. Then director, regional director, vice president, regional vice president, and eventually a hospital chief executive.

What he misses is patient care, and the feeling of walking out at night knowing he was part of someone’s healing or diagnosis. His argument is that a leader can still get that feeling, if the priorities and the vision point the right way. He also gives credit to mentors who handed him work he had no business doing, because they knew he would say yes.

Nobody in a room with no windows

Teigen gives the same speech at every new caregiver orientation. The priorities are quality, safety, patient experience, caregiver engagement and financial performance, and the secret in the recipe is the people. What frontline caregivers want to know, he says, is whether they have a voice in their work and whether they can shape how things are done.

Which brings the line he repeats often, and openly attributes to a former boss:

"We don't want people in a room with no windows making the decisions about what the frontline caregivers and physicians are gonna do." — Seth Teigen · 00:06:55

He puts a structure behind it. The legacy picture of leadership is a pyramid with the chief executive on top and everyone working for him. His version is the pyramid turned over. Speaking in 2022, with roughly 2,800 caregivers across two campuses and hundreds of physicians on the medical staff, he described it this way:

"I work for them. I mean, I have 2,800 bosses. I have 800 bosses on the medical staff and where we get our credibility as leaders is listening, intentionally listening" — Seth Teigen · 00:14:25

He is not doctrinaire about it. Sometimes a chief executive has to decide, and consensus is not available. But most of the time, the people closest to the work should have their fingerprints all over it, whether that is a quality process, the food in the cafeteria or a benefit nobody offered last year.

Better outside, better inside

His organization declared a year of the caregiver. Teigen took that a step further with his own leaders, because the managers and directors had also worked through the pandemic without the option of doing it from home, and frontline engagement runs through them:

"I think we recognize if you are better outside the four walls of the hospital, I guarantee you'll be better inside." — Seth Teigen · 00:08:36

The chain he describes is concrete. A caregiver who reports to a disengaged supervisor is less likely to stay. A caregiver whose supervisor listens, and who feels heard, brings that to the bedside, and patients measure the difference. His analogy is the restaurant with mediocre service where the food tasted worse, and the mediocre restaurant with a wonderful server where it tasted better.

Knowing people is the prerequisite. One person’s challenge is an aging parent, another’s is a child struggling at school. He dislikes the word manage; leading means making the personal connection, down to whether a supervisor knows your name after six months and asks about your weekend. His system has a phrase for it: know me, care for me, ease my way.

Influence by making other people powerful

With his own senior team, Teigen says plainly that he has no interest in managing content experts. What he wants is a shared way of leading, and he makes an argument that lands with executives raised on control:

"where we get our real influence... is through making the people around us more powerful and more influential." — Seth Teigen · 00:17:31

It makes his own job easier, and it gives other people pride and autonomy. It also protects leaders from themselves. Burnout has been a theme in healthcare for years, and he points out that leaders manufacture their own: if he believed he had to be involved in every decision at a major medical center, he would lose everything outside work.

"You have to trust and empower the people around you and then hold them accountable to the results." — Seth Teigen · 00:19:53

The last piece is succession, and it starts with a question he was asked as a radiology manager, when he told a chief executive he wanted to run a hospital. That leader spent the next several years handing him responsibilities he had not earned yet:

"we should be asking the folks that are coming into our organization. What do you want to do when you grow up? Who do you want to be? What are your professional aspirations?" — Seth Teigen · 00:21:49

He does the same now. He asked every member of his senior team what they wanted, which is a tricky question coming from a new boss, and then built plans around the answers. One of them, his chief operating officer, spent two years filling specific gaps and is now a chief executive in his own right.