In the Lead Magazine, Fall 2022

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Retaining Healthcare Talent, Right Now Examining ways to reverse higher-than-normal shortages in healthcare workforces.

FALL 2022 A Seton Hall University Publication



Insight and foresight The 2022 survey contributes to the national discussion on the CROWN Act (Create a Respectful and Open World for Natural Hair), and provides actionable insights for organizations on the impact of remote work on leadership development. Check out the full story on page 20

The 2023 edition of the survey will expand the respondent base to include 18-30 years old, and further examine the impact of work experience on leadership insight and foresight. We welcome institutions that would like to partner with us on the 2023 survey.

FALL 2022


Developing Agile Leadership Skills in Future Health Professionals Current leadership styles may be mismatched in today’s healthscape. BY ANNE M. HEWITT


Letter from the Editor


Leadership Lessons

Six ways a leader can learn the skills necessary to become more agile and promote a learning environment. BY PAUL FONTEYNE



Insight and foresight from the survey’s second year findings.

Andrew Aguilera ’18 says that among the many leadership qualities needed for success, problem-solving remains a critical skill.



Retaining Healthcare Talent, Right Now Examining ways to reverse higher-than-normal shortages in healthcare workforces. BY RITU GUPTA JAIN

In Focus


In the Crucible

Suggestions that could help leaders identify ways to strengthen the succession management process. BY STEPHEN DWIGHT


Case Study

The COVID-19 pandemic exposed the healthcare industry’s need to reshape the way it cultivates its future leaders. BY BRYAN PRICE and STEVEN LORENZET


In the Lead with Shalini Sharad Madan

A conversation with a healthcare industry leader on key trends and leadership challenges. BY THE EDITORS


Book Review

Redefining Innovation examines the evolution of the biopharmaceutical industry and highlights the possible signs of the industry’s decline. REVIEWED BY PAULA ALEXANDER and STEPHEN WOOD

In the Lead | A Seton Hall University Publication 3

Andrew Aguilera

Paula Becker Alexander, Ph.D., J.D.

Karen Boroff, Ph.D.

is a senior associate at PricewaterhouseCoopers LLP, performing assurance services for the pharmaceuticals and life sciences industry. He is a Certified Public Accountant in N.J. He received his B.S. in Business Administration from Seton Hall University. During his time at SHU, he led the creation of the Food Recovery Network to reduce food waste and hunger.

is an associate professor and chair of the Department of Management at the Stillman School of Business at Seton Hall University. She developed the curriculum for Corporate Social Responsibility, a core course in the school’s M.B.A. program. Routledge published her business ethics textbook, Corporate Social Irresponsibility, in 2015. Her research focuses on firm financial performance, executive comp and socially responsible management.

is professor and dean emerita at the Stillman School of Business at Seton Hall University. She also served as dean of the school as well as interim provost. Among other work as interim provost, she led the creation of the Universitywide Leadership Development Program. Boroff earned her Ph.D. from Columbia University in Business where she concentrated in Industrial Relations and Human Resources Management.

Anne M. Hewitt, Ph.D., M.A.

Steven Lorenzet, Ph.D.

Alexander McAuley, M.B.A.

is professor and acting chair for the Department of Interprofessional Health Sciences and Health Administration. She is also director of the Elizabeth A. Seton Institute for Community and Population Health. She received her Ph.D. in Health Sciences from Temple University, her M.A. from Immaculata University and her B.S. in Interprofessional Health Sciences from Otterbein University.

is dean of the School of Health Sciences at Touro University. His teaching and research experience is in applied psychology, leadership, and management. He has published numerous peer-reviewed journal articles. He has also consulted in the military, life sciences, higher education, and banking industries. He earned his Ph.D. in Organizational Studies from the University at Albany, SUNY.

is a global market insights associate at Atheneum in New York City. He attended Seton Hall for six years, studying economics and finance as an undergraduate and going on to pursue his M.B.A. in Information Technology Management. While studying for his M.B.A., he worked alongside the Future of Leadership Research team, contributing to the survey design, distribution and analysis.


In the Lead | A Seton Hall University Publication

Stephen Dwight, Ph.D.

Paul Fonteyne

Ritu Gupta Jain, M.P.H.

is the chief talent officer at Takeda, a global pharmaceutical company. Previously he held senior talent management roles at Vertex, Novo Nordisk, Bristol-Myers Squibb and Sunovian. He also has consulting experience, working at Aon Management Consulting and the Hay Group early in his career. He holds a Ph.D. in Industrial/ Organizational Psychology.

is the retired chairman and CEO and of Boehringer-Ingelheim USA. He has served on the board of PhRMA, chaired the National Pharmaceutical Council, and CEOs against Cancer. He also serves on the board of several clinical-stage biotechnology companies including Gelesis, DalCor, Amylyx, Apellis, Ypsomed AG, and Covetrus (CVET). In addition, Paul serves as an executive in residence to Canaan Partners.

is the incoming AVP, Women’s Health & Physician Network Development at Maimonides Medical Center. Previously, she served as executive director, Medical Affairs Operations at Stamford Health. She holds a B.S. from Brandeis University, M.P.H. from University of Illinois at Chicago, and a health administration residency from Johns Hopkins Health System. She is a certified Lean Six Sigma Black Belt.

Shalini Sharad Madan

Bryan C. Price, Ph.D.

Stephen Wood, M.S.

has over two decades of experience in healthcare innovation and digital health. She is a corporate leader, public speaker, fitness coach, inventor, commercial model, super mom, globetrotter and now proudly Mrs. India USA 2022. She was featured on a Times Square billboard as a “role model” depicting many aspects of life. She is a “Distinguished Alumnus” of Sri Venkateswara College, Delhi University, and Amity University.

is the founder of Top Mental Game, where he helps business leaders and athletes perform at their best when it matters the most. He served as an Army officer for 20 years, with combat deployments to Iraq and Afghanistan. He is a certified executive coach and keynote speaker who works with Fortune 100 companies, military units, and athletic teams. He earned his Ph.D. from Stanford University.

consults and writes on policy topics after 43 years on Wall Street and in governmental finance. He specializes in infrastructure and project finance, public-private partnerships, federal and state grant and finance programs. He is also an expert in financial modelling for large, complex capital programs. A speaker at numerous industry conferences, he teaches about corporate social responsibility at Seton Hall.

In the Lead | A Seton Hall University Publication 5

Taking Care of Our Caregivers WE ALL AGREE that change is the only constant. In health care, the rate of change seems to have accelerated lately, driven by the pandemic, advances in technology and an evolving reimbursement landscape. Healthcare practitioners, the frontline workers, the doctors, the nurses, the managers and the leaders all are feeling the pain. There is fatigue, and there is disenchantment. It feels like we are on the cusp of a breakdown. At the same time, the need for a good healthcare system has never been more acute. As a country, we are aging rapidly and increasing the burden on our healthcare system. We are spending more dollars per capita on health care — $10,921 in 2019 and increasing — than any other country in the world. Yet, according to the Legatum Prosperity Index ranking from the same year, we rank No. 18 when it comes to quality. What can we do to enable our healthcare workers to keep up with the change, provide good care and take care of themselves? These are the questions we answer in this issue. Various healthcare leaders share perspectives on the challenges faced by the industry, and what we can, as leaders, do now to address them. We also share the results of the second edition of the Future of Leadership Survey that captures insight and foresight on leadership from the leaders of the future. There is another change that you will notice. My co-editors, Bryan Price, Ph.D., and Steven Lorenzet, Ph.D., have left Seton Hall University to pursue other opportunities. The magazine would not have launched without their significant contributions. I miss them dearly and wish them both all the best. Enjoy the issue! And please email us at with your comments, suggestions and feedback. – Ruchin

Ruchin Kansal, M.B.A., leads the Business Leadership Center and teaches The 5th Industrial Revolution. He has spent 20 years in healthcare, the first 10 as a management consultant with Capgemini & Deloitte, and the next 10 serving as head of innovation at Boehringer Ingelheim, and then as senior vice president and global head of strategy for digital services at Siemens Healthineers. He received his M.B.A. from NYU-Stern.


In the Lead | A Seton Hall University Publication

Pioneering the Future of Interprofessional Health Care Seton Hall’s Interprofessional Health Sciences (IHS) campus, located in Clifton and Nutley, N.J., features world-class facilities for health science research and discovery. Located just 10 miles from our main campus in South Orange, the IHS campus is home to the College of Nursing and School of Health and Medical Sciences as well as the Hackensack Meridian School of Medicine. The campus creates a forward-thinking approach to healthcare education, bringing together future doctors, nurses and health professionals working in a variety of fields. COLLEGE OF NURSING


M.S.N. Programs (Online) • Adult-Gerontology Acute or Primary Care Nurse Practitioner • Nursing Administration and Nurse Executive Leadership • Pediatric Primary Care Nurse Practitioner • Psychiatric-Mental Health Nurse Practitioner

Master’s Degree Programs • Athletic Training (M.S.) • Healthcare Administration (M.H.A.)

Certificate Programs (Online) • Post-Master’s Certificate in Adult Gerontology, Pediatrics, or Psychiatric-Mental Health Nurse Practitioner • Graduate Certificate in Population Focused Nursing Practice

Certificate Programs • Global Health Management • Healthcare Administration • Population Health Management • Practice Management for Health Professionals

Doctoral Degree Programs • Ph.D. in Nursing (Synchronous online or in person) • Doctor of Nursing Practice (Online)

Programs for Registered Nurses (Online) • R.N. to M.S.N. Degree Bridge Bachelor of Science in Nursing (B.S.N.)

Doctoral Degree Programs • Health Sciences (Ph.D.) • Physical Therapy (D.P.T.)

(Online and on-campus)

• Occupational Therapy (M.S.) • Physician Assistant (M.S.) • Speech-Language Pathology (M.S.)

Undergraduate Program • Interprofessional Health Sciences (B.S.) *Undergraduate-to-graduate dual degree programs also available

VISIT US: What great minds can do.




The Learning Leader Playbook Here are six ways a leader can learn the skills necessary to become more agile and promote a learning environment. BY PAUL FONTEYNE NO ORGANIZATION — from the board of directors to lower-level employees — wants a senior leader that is just resting on knowledge from past decades. When you get to the C-suite, don’t be a one-dimensional leader, either from a “vintage” perspective or from a functional perspective. You need to continue to stretch from a learning perspective throughout your career. As you rise through the ranks the roles you take on are increasingly complex from a leadership and management perspective. There is a high risk that once in these roles, you will not find time to keep up with industry advancements and best practices along the way and, therefore, your decisionmaking ability will suffer.


In the Lead | A Seton Hall University Publication

It is important that you deliberately invest in your own learning agility, as well as that of the teams and organizations you lead. A learning organization is a healthy organization, one that can quickly adapt to environmental changes and recover from ever-present business cycles or crisis situations. BECOME BEST-IN-CLASS IN ONE OR TWO DISCIPLINES In many organizations, functions are where the highpotential talent incubates, and then gets noticed and tapped for leadership assignments that become increasingly crossfunctional. No matter how high up your career takes you, you will always have a function you originated in, and thus your deeper insight will usually be from that “root” function.


We encourage all high-potential leadership candidates to continue to deepen their functional expertise to not become dated in the area where you were once “best in class.” As you progress, your base of expertise needs to broaden. Proactively seek sources of knowledge, and educate yourself to become best-in-class in one or two disciplines or functions beyond the “root” function “you grew up in.” A thorough review of what the key drivers of organizational growth are in the next planning period for the company can be a good guide to which areas of expertise to prioritize. For example, my commercial background in the biopharmaceutical industry is broad as I spent 20 years in marketing and sales. As my responsibilities were expanding, I made sure I spent a lot of time at the intersection of R&D and commercial to be able to best support strategic development decisions, and I became involved in the decision-making process about which projects to focus on. Fortunately, it was made part of my responsibilities along the way, and I was able to learn from attending and contributing to these decision-making meetings, which can be quite complex and involve integrating input from very different disciplines. The key expertise the senior leader must develop is spotting who and what to pay attention to the most in order to arrive at the best decision. BECOME A MULTI-FUNCTIONAL LEADER When you enter the C-suite, it is critical that you are not only best-in-class in your function, but you also understand the best practices across all other functions of the organization you lead. This makes for an effective leader who is not just a caretaker, but also one who can make effective decisions. The time to learn that is before you enter the C-suite. When you represent the whole enterprise and all the teams within the company, you must have a general understanding of what all the groups do to engage with all teams credibly and be recognized as their leader. In addition, when urgent action is required, you cannot be at the very beginning of your learning curve about a particular business or function. This learning process should start before you become a very senior leader.


JUMP-START YOUR LEARNING BEFORE YOU ARE IN THE C-SUITE It is unlikely that you will have the time to learn to be a multifunctional leader once in the C-suite. You should jump-start broadening your understanding of the industry you operate in before you get to the C-suite. Be curious to learn from the people that are not in your own group. That gets you noticed. Some people have the attitude of, “I don’t understand what you do, so it must be unworthy.” In fact, it is you who


are “unworthy” because you haven’t invested the time to understand what others in the company do. The best leaders of any function are well-connected across groups and do not operate in a silo. So, aim to be that person as you develop; it will make operating at the C-suite level feel more like just “what you do.” These leaders are also often recognized by members of other groups as a bridge across groups. This recognition can be very useful along the way, in particular when one needs help solving tough problems, as you will have a richer pool of advice coming your way. DEMAND THE SAME LEARNING AGILITY FROM YOUR TEAM When crises happen, there is little time to react. However, a learning organization can tackle crises much more effectively. It is therefore important that your senior hires have learning agility. Teach them to teach themselves, their peers and their direct reports. Put into place incentives (start with time on agendas) that encourage a learning and teaching organizational culture. Spend time as a leadership team debating topics that keep you up at night and learning how to solve these problems as a team, as well as listening to internal and external exemplars on how to solve complex problems on an ongoing basis.


CREATE A LEARNING ORGANIZATION It is not enough to have a leadership team with learning agility. The recruitment process should be focused on hiring employees with learning agility. The talent management processes should incentivize learning at all levels. As soon as employees are identified as developmental talent, they should spend time working on cross-functional teams and learn beyond their core expertise. An organization that keeps learning will be able to deal with setbacks faster.


LEADING IN HEALTH CARE Understanding the nuances of the industry you operate in is critical to success as one of its leaders. For example, in health care, it is important to understand how your offering/ modality fits into the larger ecosystem — reimbursement, physician behavior, patient behavior — because if you don’t and if your plans fail, you will struggle to explain why, and you will struggle to improve performance. At that point, leadership will start doubting you, and not the plan. Also, understand that the barriers to entry in health care are relatively high. Innovation tends to be incremental and not disruptive. So, if you can develop deep knowledge of the industry, you are almost assured a long-term career within it. L


In the Lead | A Seton Hall University Publication 9

Andrew Aguilera ’18 Among the many leadership qualities needed for success, problem-solving remains a critical skill.

IN THE LEAD Thanks for taking the time with us, Andrew. Can you describe your current position at PwC? ANDREW AGUILERA Happy to participate! I am currently a senior associate in Health Industries. I spend most of my time auditing a large, public, multinational pharmaceutical client, but I also audit small, non-public biotech companies. ITL What attracted you to the accounting field? Is the practice of accounting in health care different than other industries? AG It may sound cliche, but accounting is the foundation of business, and the most universal. I knew accounting would be a challenging and rewarding area for me to start my career. Accounting in health care is different as you may be auditing notfor-profit entities, such as hospitals and foundations. You may also audit pharmaceutical clients, which may involve gross-tonet accounting that is specific to the pharmaceutical industry. ITL How did the Buccino leadership program prepare you to lead after graduation? AG The Buccino leadership program placed me in challenging and “uncomfortable” environments, where I was forced to think on my feet and find solutions, even when the path was not always clear. It also developed my networking skills and my understanding of how to work with others. Perhaps the most notable takeaway from the leadership program has been my confidence. From the moment I began at PwC, I have always felt confident in my ability to find solutions and find opportunities to lead the team despite being new at the firm.

HOMETOWN Parsippany, New Jersey CAREER Certified Public Accountant, Senior Associate in Health Industries at PwC SETON HALL STATS Accounting and information technology management double major; The Stillman Exchange (student newspaper); Seton Hall Pep Band; Student Government Association; Blue Crew Tour Guide; founder of the Food Recovery Network (Seton Hall chapter); graduate of the Gerald P. Buccino Leadership program


In the Lead | A Seton Hall University Publication

ITL Is there a moment or an activity that sticks out as being a turning point in your leadership development at Seton Hall? AG During my freshman year, I had a turning point in my leadership development. My parents were blue-collar workers, operating a sandwich shop for 30+ years, and growing up in a family business, I learned the challenges of owning a business. However, I did not have a great understanding of corporate business. Starting in the program with other individuals who were excellent leaders and had parents/family in business, I lacked confidence to speak up and participate in the leadership courses. Through the peer 360 feedback, it was evident that my peers were recognizing the same trend. Over the remainder of the year, I gradually put the feedback into action and started to realize my leadership potential, which gave me the confidence to lead others. ITL What specific skills allow you to be successful in your position at PwC? AG Through the leadership program, I learned that care,

flexibility, adaptability and problem solving are the four most important skills in being successful, not only at PwC, but at any profession. While I am continuously developing these skills, they have certainly placed me into successful positions at PwC. ITL What leadership skills do you find that recent graduates often don’t have but need to be successful? AG Problem solving continues to be the recurring skill that recent graduates need, but don’t often have. We are often taught through our many years of schoolwork that there is always a definitive answer. However, in the workplace, the answer may

not always be clear and having problem-solving skills allows one to thrive in positions of discomfort and to think critically. ITL What advice would you have given your younger self at Seton Hall? AG I would tell myself to remain open to opportunities, since you do not know where they will take you. I never thought that I would be in a position today where I have learned so much about health industries, traveled around the world and met so many distinguished individuals in the first few years of my career. L

In the Lead | A Seton Hall University Publication 11

Seven Deadly Succession Management Sins

Suggestions that could help leaders identify ways to strengthen the succession management processes and provide a guide to more success. BY STEPHEN DWIGHT, P.h.D. I AM THE chief talent officer at Takeda Pharmaceuticals and have been working in this management area for over 25 years. One of the most important focus areas for me and my team has been ensuring we have a robust pipeline of internal or external successors for our most critical positions. Why is this one of the most important actions for me and my team? It has to do with how a critical position is defined: These are positions that left vacant will have a negative impact on the company in terms of risk, performance and innovation. As Peter Drucker once said, “a company’s very survival depends on its ability to develop independent leaders below the top who are capable of taking top command themselves.” This is why many companies engage in succession management. Succession management aims to build the bench strength of an organization by retaining and developing internal successors or building relationships


In the Lead | A Seton Hall University Publication

with external talent who could quickly take on a critical position should the incumbent leave. While succession management might sound like a relatively simple process, there are several ways it can break down. In my experience, there are seven ways succession management can be diminished; I refer to them as the “Seven Deadly Succession Management Sins.” Each is presented below, in no order: NOT ENOUGH TIME This occurs when not enough time is devoted to discussing talent, identifying ways to accelerate succession readiness, and vetting the succession plans. This is a common “sin.” I frequently hear that we should have scheduled more time for the discussion given its importance, but it is not prioritized. What typically happens is the plan is reviewed but names on the plan are not challenged and/or specific development actions are not agreed upon. Investing the

necessary time is also important to address the bias that might exist in the process or the person responsible for creating a particular succession plan. TOO MANY SUCCESSORS This occurs when the leadership team identifies more talents to actively develop than they have capacity. This occurs for two reasons: (1) The leadership team doesn’t accurately estimate their capacity to develop talent relative to their other demands and/or (2) they have difficulty prioritizing the individuals they will focus on. The main problem with this “sin” is that the list of talents becomes so overwhelming that little action is taken. In my experience, identifying a small list (one to two individuals per leadership team member) to focus on typically results in development support occurring. PAD THE PLAN This “sin” occurs when people are included on the succession plan who are not true successors, to make the plan look stronger than reality. It is natural for a leader to see the strength of their succession plan as a reflection of their own strength as a leader and then succumb to this pressure of “bulking up” the succession plan(s) for their role or organization. To confront this “sin,” it is important to allow sufficient time for others to challenge the plan and for the leader to justify the names on their plan. It is also important to reinforce and recognize individuals who have realistic plans, even if they have few internal successors. In fact, having a realistic view of the internal successor pool helps identify opportunities to cultivate external talent to strengthen the succession plan. While the preference is always for internal talent to fill a role, it is not always possible, and creating plans to build relationships with external talent is a good strategy that would be missed by an unrealistic plan. “OUTSOURCE” DEVELOPMENT One of the most important responsibilities of a senior leader is to identify and develop their successor(s). However, all too often senior leaders “outsource” development of successors to a consultant or HR versus the leadership team and direct manager owning it. Steve Jobs recognized his responsibility as a senior leader, saying, “My job is to make the whole executive team good enough to be successors, so that’s what I try to do.” A senior leader is smart to partner with HR and consultants but should not lose sight of the importance of their individual role in developing successor talent. UNDERVALUE EXPERIENCES It is often the first impulse of a leader or leadership team to look to an executive coach or mentor or send the individual to an executive seminar at a respected business school to develop successor talent versus looking for challenging experiences to build readiness for the next level. I am guilty of this “sin” as well, as each of these actions feeds the desire for quick action. The problem is that we often let the discussion and development action end here when

the most effective way to develop leaders is through “crucible moments,” moments that transform the leader, forcing them to think and/or act differently. Identifying these moments takes time, planning and often financial support; it is the hardest part of developing talent but the area with the greatest impact. NO TALENT PHILOSOPHY This occurs when an organization doesn’t have a clearly stated talent philosophy to help guide talent decisions (e.g., differential investment in high potential talent). A defined talent philosophy helps guide the succession management-related actions of the leadership team. For example, one tenet of the philosophy may be for transparency to be a hallmark of the culture. If this were the case, it would naturally follow that all successors would be told they are on one or more succession plans. A talent philosophy has the additional benefit of being a tool for communicating to the broader organization the point of view of top leadership on all talent-related decisions.

“A company’s very survival depends on its ability to develop independent leaders below the top who are capable of taking top command themselves.” – PETER DRUCKER IGNORE DATA The final “sin” occurs when the organization does not leverage the rich amount of data and insights that exist within the Human Resource Information Systems. There is a myriad of tools, such as talent profiles and demographic information, that can inform the succession management process. Not taking advantage of this information to strengthen things such as successor diversity or help identify targeted development actions for an individual is a big, missed opportunity. In addition, analyzing the plans themselves provides insights into the overall strength of the succession plans, identifies actions to strengthen the plan and tracks progress. It is my hope that this list will help both talent practitioners and senior leaders identify ways to strengthen the succession management processes in the organizations they support or lead. Certainly, the use of “sins” is tongue-in-cheek and an opportunity to have a bit of fun with the topic. Nonetheless, each offers organizations the opportunity to strengthen their succession management, thereby providing a greater likelihood of continued success. L

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In the Lead | A Seton Hall University Publication


Leadership Skills in Future Health Professionals By ANNE M. HEWITT, Ph.D., M.A.

Leadership is definitely not easy in the health sector. Surveys regularly report the average length of time a health system CEO remains in office is less than five years, and the industry has a consistent turnover rate of 17-18 percent yearly.1 Given technological advancements, such as artificial intelligence, continuing COVID-19 disruptions, the clinical impact of precision medicine and entrepreneurial companies like Walmart and Amazon entering the health sector, today’s health leaders face a never-ending stream of extreme industry challenges. Current leadership styles seem mismatched for today’s contemporary healthscape. In the Lead | A Seton Hall University Publication 15













Within academia, faculty routinely teach well-known leadership styles to prepare future health providers and practitioners for the unknown. These traditional models range from top-down control approaches, such as autocratic and bureaucratic styles, to more recent options, such as transformational and pacesetter strategies with their clear priorities on goal attainment and improving productivity (See Figure 1). New and original leadership theories often emerge as responses to challenging situations. Once tried in practice, they either disappear or enter the list of tried-and-true options taught within business administration and health management programs. Contemporary drivers of health sector change, such as health professional shortages, supply chain breakdowns and a majority of patients who have delayed needed health care entering the system daily, require leaders to adopt a more responsive approach — one that provides flexibility, presence and innovation to solve unprecedented situations without a predetermined playbook of strategies.


In the Lead | A Seton Hall University Publication

AGILE LEADERSHIP TODAY Agile leadership skills offer a modern framework for emerging health leaders and managers who have not experienced the top-down decision-making models that today’s senior leaders learned and continue to practice. Agile leadership emphasizes characteristics drawn from computer software development strategies of the early 2000s that were designed to deliver products as quickly as possible. Although similar to the wellknown and popular LEAN business model, agile leadership differs substantially because of its primary principles of teamwork and open communication processes for both employees and end-users or consumers. The goal is to remove any consumer barriers or obstacles quickly, receive feedback and continue innovating. In the case of the health sector, the consumer is the patient, and the goal is always a positive health outcome and experience. A major agile leadership objective is to remove any patients’ barriers or treatment process “pain points” that traditional and more bureaucratic organizations may lag in overcoming successfully.

Core leadership skills, embedded in agile leadership principles, emphasize adaptability, openness and empowerment of teams. A recent roundtable of CEOs identified 15 key qualities that exemplify an agile leader.3 These executives emphasized adaptability as the skill set necessary for facing continuing disruption, showing resilience and generating innovation. Other leadership traits associated with agile leaders included demonstrating capacity to accept shared decision-making with others by empowering teams to work in inclusive environments (See Figure 2).

ALIGNING AGILE LEADERSHIP WITH THE HEALTH SECTOR Why is agile leadership a match for future health sector professionals? The core set of traits identified in Figure 2 relate to essential skills taught to all types of healthcare providers and practitioners regardless of their chosen vocation or their health practice site. Three brief health organization examples show direct application of agile leadership concepts and competencies.

Health Care is a Team Sport Given the incredible responsibility and accountability that accompanies caring for another human being’s health, it is not surprising that few other industry sectors require the level of integration and trust among team members. They

must function effectively and efficiently for the sole purpose of ensuring a patient’s positive health outcome. Agile leaders empower team members to create an environment of openness by fostering trusted communication channels and enhancing transparency of work without fear of retribution. A typical healthcare team can include as many as 10 different healthcare professionals, ranging from physicians or physician assistants; nurse practitioners or nurses; pharmacists; specialists; physical, occupational or speech therapists; technicians; patient navigators or community health workers; and the administrative support staff and healthcare managers. Imagine a football field diagram, but this time insert all the health professionals identified above as team players with the same goal of improving the patient’s health. Inclusion, cooperation and openness remain essential leadership characteristics.

The CEO is Probably Not in the Emergency Department Critical decisions involving health consumers/patients happen in real time. Everyone has a specific role, and the majority of team members will have completed advanced degrees and are specialists in their field. Healthcare provider teams operate within a scope of practice, but they also daily face process and procedure questions that lack clarity or strategic guidelines. Agile leadership empowers team leaders to resolve these













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situations by encouraging shared decision-making. In the case of health care, the quarterback changes often, based on the patient’s needs, and the coach usually remains on the sidelines. Shared governance contributes to quicker healthcare decisions for the patient’s benefit.

The Incredible COVID-19 Health Sector Pivot The COVID-19 challenge may be remembered as the transformative period that changed American health care in the 21st century. The pandemic challenged significant components of the entire American healthcare system and spiraled into a scenario never before imagined. Within two weeks, the entire “game” was no longer the same. Despite incredible and unimaginable barriers, healthcare systems converted to untried and unknown innovative care models. How was this possible? Experts suggest that the crisis thinking allowed leaders to disregard previous strategies and processes and to consider “what if” and “will this work” scenarios. American health systems completed the task of transforming cafeterias into viable acute care units in the space of two days and then provided thousands of vaccines to the public in their parking garages. Technology advances, already available but not widely used, permitted healthcare employees to work remotely and health practitioners to consult with their patients via telehealth. The COVID-19 pivot proved that the health sector could readily adopt innovation and transformation. Today’s health leader recognizes

that the agile leadership capabilities of resilience, innovation in the face of multiple disruptions and the ability to face uncomfortable scenarios were essential to the COVID-19 pivot.

BENEFITS OF AGILE LEADERSHIP The health sector in the 21st century expected change to be a constant due to recent technology applications, genetic discoveries and population health’s emphasis on value-based outcomes. Leaders intended to rely on change management models proven useful in past transitions. But these frameworks often focused on a single project or process change and lack the adaptability for handling multiple initiatives. The agile leadership framework offered strategies appropriate for multitasking transformations needed to survive and succeed during these last few years. As outlined in Figure 3, the benefits of agile leadership can be categorized as positive for both organizational and personal outcomes4 (See Figure 3).

SETON HALL’S SCHOOL OF HEALTH AND MEDICAL SCIENCES: CHAMPIONING AGILE LEADERSHIP LEARNING Today, we know that agile leadership skills are applicable for the early careerist as well as the seasoned C-suite executive. How does Seton Hall encourage students to develop the desired characteristics such as teamwork, inclusion and adaptability? First, the Center for Interprofessional Education









In the Lead | A Seton Hall University Publication

in Health Sciences (CIEHS) offers collaborative workshops and learning modules for six graduate programs in the School of Health and Medical Sciences. Students from physician assistant, physical therapy, occupational therapy, athletic training, speech and language pathology and the master’s in healthcare administration (MHA) programs combine to learn in diverse groups throughout their curriculum. One of the four core signature experiences involves students examining a medical error video case and then applying the TeamSTEPPS® approach.5 TeamSTEPPS®, a nationally recognized, evidencebased training program, aims to improve team performance of healthcare professionals, and helps students learn to respond quickly and effectively to whatever situations arise. This learning opportunity mirrors the agile leadership skill sets of teamwork, inclusion and innovation. A second opportunity to develop agile leadership skills is available for MHA students who enroll in an emergency management for health professionals’ course. Using the Simulation Center at the Interprofessional Health Sciences campus in Nutley, graduate students experience a full-fledged health system crisis when their “hospital” loses its internal computer network, and the system immediately loses access to patient medical records, medications and all internal communication networks. Based on the Hospital Incident Command System (HICS) decision-making frameworks,

students collaboratively adapt and develop innovative processes to assess the crisis and maintain operating capacity. Flexibility, adaptability and the capacity to address uncomfortable situations relate directly back to agile leadership competencies.

SUMMARY Will agile leadership be the panacea for future health sector leadership? Today’s health practitioners can expect continuing and emerging mega-challenges to occur on a regular basis given rapid industry environmental and regulatory changes. The diverse and continuing challenges of the past few years suggest that the benefits of agile leadership can be instrumental for future health professional leaders as they develop valuable skill sets that lead to innovation and better health outcomes for all. L

1 Michael Kelly Associates. (n.d.) Hospital CEO turnover rates remain at higher levels. Is your hospital prepared? hospital-ceo-turnover-rates-high-levels 2 Minning, L. (2022, January). 10 types of leadership styles: Are you the right type of leader?

Forbes. (2020, June 17). 15 Key Qualities that define an “agile” Leader. il/2020/06/17/15-key-qualities-that-define-an-agile-leader/?sh=3514c1de7f31


Masgo, E. (2021, August 19). What is agile leadership and why is it important? Management 3.0.


TeamSTEPPS® Pocket Guide App. Content last reviewed April 2018. Agency for Healthcare Research and Quality, Rockville, MD. pocketguideapp.html.


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In the Lead | A Seton Hall University Publication



In the Lead | A Seton Hall University Publication 21


EXECUTIVE SUMMARY BUCCINO LEADERSHIP INSTITUTE, the recipient of the 2022 Outstanding Program awarded by the Association of Leadership Educators, joins the elite list of previous awardees including Rice University, Virginia Tech, Purdue, Texas A&M, and last year’s winner Notre Dame. The Institute continues to strive to be a thought leader in leadership and leadership development. To that end, the Institute launched groundbreaking research in 2021 in the field of leadership. This longitudinal research specifically examines the insights and foresights of those beginning their professional lives. Heretofore, leadership research tended to center on C-suite executives, either on their own behaviors or as observed by those who report to them or by other stakeholders. There was a significant gap in the literature on how the next generation viewed leadership and how best to develop leaders of tomorrow. This, we believed, was a serious omission in research for two reasons. First, the absence of research did not help guide organizations on how they may want to respond to the leadership aspirations and expectations of tomorrow’s professionals. Second, there was concomitantly a dearth of guidance on how to develop the leaders of tomorrow based on their own wants. In 2021, the first year of our unique approach to studying leadership, we learned that respondents expect leaders to embrace diversity, believe that leaders can be developed and expect leaders to have strong people and engagement competencies, and they prefer high-touch leadership development models.







■ NO

In the Lead | A Seton Hall University Publication

To track the development of leadership insights and foresights of this group and provide this important longitudinal perspective, we reissued the survey in January 2022. The 2021 survey instrument was modified to probe into leadership development in the face of remote work. The results of the 2022 survey are largely consistent with the previous year with respect to physical traits, values, competencies and challenges faced by a leader. The consistency of results points to a stability of perspective, even with respondents living through the pandemic and then subsequently emerging from it. In this article, we discuss how our findings on personality traits, especially hair, have contributed to the national discussion on the Create a Respectful and Open World for Natural Hair (CROWN) Act. Further, we discuss our findings about the impact of remote work on leadership development, which has also become part of the national dialogue and provides actionable insights for organizations.


Recognizing the persistent gap in leadership scholarship centered on the perspectives of college students aged 25 or younger, we again surveyed these students about leadership and leaders. The survey questions focused on the personality traits of respondents and a known leader they admire. We again asked about the relevant physical traits of leaders, nested in the prior traits research, some of which is more than 50 years old. From there, survey questions were constructed to seek respondents’ input on important competencies and values of the mid-level leader. These questions were posed to obtain a

impact of the pandemic on leadership development. Finally, respondents replied to a set of demographic and work experience questions. In January 2022, more than 9,000 Seton Hall University college students and recent graduates, all under the age of 25, were sent electronic copies of the survey instrument. The University’s social media accounts were leveraged to invite responses to the survey. The survey was also shared with the members of the national business fraternity Alpha Kappa Psi. Several reminders were also sent. More than 800 completed surveys were returned.











Remote Work Threatens Leadership Development 36%






form of leadership trajectory for young leaders. In other words, we would learn what competencies and values would be important in a leadership position they envisioned 10 years or so into their own future, as well as the competencies and values they would seek from their own boss. From there, the survey instrument put forth questions on the emotional and social skills required of leaders, as well as challenges facing future leaders. There was also a series of questions posed on how best to develop leaders of tomorrow. In addition, the original survey instrument of 2021 was enhanced to include a question on the

We added a new question in the 2022 survey to understand if Gen Z has experienced a lack of leadership development at work because of remote work. Unfortunately, the answer is “yes,” with 76 percent of the respondents saying so. (See Illustration 1) Fortunately, this research also provides practical insights on how to mitigate the ill effects of remote work on this critical development. The respondents to the survey, those from 18 to 25 years old, agree that the pandemic and the shift it created in work habits has negatively impacted their own growth as leaders. These diminished growth opportunities included: 1. T he inability to observe the role model impact leaders have on respondents’ leadership development, including seeing the leaders in action and their communication style. (See Illustration 2) 2. T he inability to have access to all-important high-touch leadership development opportunities, as well as access to leading initiatives and learning informally about job progression opportunities. (See Illustration 3) It is evident that with remote work, organizations



22% 45%




28% 38%



39% 34%

37% 37%




30% 36%




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16% 0%


are losing daily opportunities to give feedback, express gratitude, inspire excellence and more — acts that help advance leadership development, regardless of one’s formal leadership role. The research also indicates that if firms manage to keep remote work to less than 50 percent, there is a slight positive uptick in certain leadership growth dimensions. However, if employees experience more than 50 percent of their work remotely, a negative impact on leadership development is observed. Since the respondents value the role model impact of leaders on their own leadership development, there must be strategic consideration of the “who and when” in designing remote work arrangements. In other words, if employees’ “50 percent in the office time” is coordinated to occur at the same time as others, the chances increase that today’s younger generation will experience both the formal and informal instances of observing leaders. These observations include working with others, dealing with clients, working with peers and handling the many one-minute-manager interactions and the other leadership glue that keeps a team growing. More specifically, “any 50 percent” of the time is not the same as a “coordinated 50 percent” of the time. For the latter, the entering workforce can observe the contact sport that is leadership, from the many upper-level team members with whom they work.


In the Lead | A Seton Hall University Publication










A Desire for Adaptive and Ethical Leadership The insights on values and competencies of a leader and the challenges they face remain consistent with the 2021 survey.

1. Values and Character Traits: The respondents were provided a list of 12 value and character traits and asked to rank the top three traits. An ability to admit mistakes ranked the highest, followed very closely by being ethical. An ability to persist despite failure and ability to recognize the dignity of employees received equal votes. What is also of note is that “driven by higher purpose” received the least votes. These rankings indicate a desire for more human, ethical leadership. (See Illustration 4) 2. Competencies of a Leader: When asked to rate the top three competencies from a menu of choices, respondents ranked “uses observations to find and implement solutions to problems,” “can innovate and help inspire change” and “is a role model who sets standards for professionalism in the organization” as the top three competencies. These would indicate a desire to see leaders as role models, change agents and problem-solvers. We also observe that “demonstrates awareness of market trends,” “demonstrates knowledge and application of financial and accounting principles” and “demonstrates

an ability to utilize technology for strategic advantage,” all competencies necessary to manage business performance, did not rank as high. We conclude that respondents are not saying that these competencies are not important in a leader, but less important than an ability to inspire and lead change. Again, the results may be indicative of the challenge leaders are facing as the business environment becomes more fluid and unpredictable, and staying solvent requires continuous adaption and innovation. Organizations should review their competency models for leadership development with these findings in mind. Any misalignment has the potential to create disharmony. In any case where there is misalignment, either the competency models need to be updated or expectations for leadership

development need to be more clearly communicated along with the why (See Illustration 5 on page 26). 3. Challenges Facing a Leader: Our conclusion above — that leaders need to create ethical and adaptive organizations — is confirmed by the respondents’ ranking of challenges facing leaders. The top three challenges facing leaders were identified as how to “manage work-life balance,” “create ethical and socially responsible organizations” and “deal with crisis and failure.” Next in ranking was “protecting organizations from external and internal risks.” To summarize, our findings indicate that the respondent set is searching for adaptive and ethical leaders that can lead in a highly volatile and disruptive business environment (See Illustration 6 on page 27).

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55% 51%


















9% 0%


Expectations on Physical Traits of a Leader Remain Consistent with 2021 Results Diving deeper into physical traits, the survey shows that the current generation still has expectations that their leaders should be attired appropriately for the given leadership role. In addition, they should be healthy and have well-groomed hair. Interestingly, even though ranked in the top three, those who identified as non-white judged well-groomed hair as less important than white respondents. (See Illustration 7) The U.S. House of Representatives recently enacted the CROWN Act of 2022. We examined the insights from our survey to ask: Is CROWN needed? We acknowledge that anytime we can work to reduce bias and discrimination, we move closer to the goal of all our Equal Employment Opportunity laws. The CROWN legislation aims to remove another bias: To prohibit hair discrimination throughout the workforce. We also acknowledge that hair, regardless of the race or gender of an employee, can pose a safety or health hazard at work. As such, even without CROWN, employers can continue to set job requirements for their work. However, these requirements must have a nexus to the job, cannot run afoul of important rights under the federal Civil Rights Act and


In the Lead | A Seton Hall University Publication







associated state-level laws, and must be applied even-handedly. At the same time, we find that there is the recognition among leaders of tomorrow that leaders, regardless of organization, have a figurehead role in that organization, representing all who are employed there. Given that figurehead role, it seems the Gen Z cohort surveyed still places value on their leaders being attired appropriately for the organization that they lead, being healthy and having hair that is well-groomed for the position.


The 2022 survey confirms that the discipline of leadership continues to evolve. We find that the respondents to our 2022 survey, 18- to 25-year-olds, continue to view leadership as an important topic. They are looking for ethical and adaptive leaders who can inspire and lead organizations through change as the business environment becomes even more volatile and uncertain. Respondents do continue to believe, as professionals have for years before them, that leaders hold a figurehead role in organizations. They are open to a diverse set of leaders, but still expect them to be well-attired, healthy and with well-groomed hair, as indicated by their preferences in response to the




45% 39%








31% 29%






23% 22%



question on physical traits. Gender, race and ethnicity-related physical characteristics do not rank as high for this generation. They also recognize that virtual work impacts their own leadership development — and are seeking to overcome that. Organizations and leadership development institutions should embrace these lessons and continue to find paths forward to develop future leaders. It is the most important investment they can make.








2.47 2.33

















At the same time, we are curious as to why the respondents have ranked competencies such as financial acumen, technological savviness and market insights at the bottom of their rankings. Is it because all business leaders are expected to demonstrate these competencies and therefore assumed to be in their possession? We intend to explore this topic further in the next survey. Additionally, during our first survey, we had some data that signaled that work experience moderated insights and foresights on leadership. With the current survey, we were not able to confirm this impact as our data set did not have an adequate sample size of those with work experience to draw any statistically valid conclusions. To enhance the survey insights, in the third release of the survey we will expand the respondent base to include 18- to 30-year-olds to measure the impact that any amount of experience might have on views and expectations of leadership. That way, we will not only get insights from the generation getting ready to enter the workforce, but also those who have already gained some work experience. Additionally, we are looking for partners for our next survey to broaden its outreach. If your organization is interested, please contact the research team at or L

In the Lead | A Seton Hall University Publication 27

Retaining Healthcare Talent,

Right Now Many leaders in healthcare have experienced higher than normal shortages in their workforces for similar reasons. There is a way to reverse this trend, but you need to act now. By RITU GUPTA JAIN, M.P.H.

LET’S FACE IT, it’s tough to be in healthcare management right now. There are shortages of almost every level and type of staff. It’s hard to manage in this environment and achieve the strategic goals laid out by leadership. Historically, there have been intermittent shortages of nurses, physicians and other allied health professionals but a manageable rate of employee turnover. However, as a manager for almost 20 years in hospital administration, recent shortages and turnovers have felt different. While there’s a healthy amount of turnover in any organization, I’ve noticed a general feeling of fatigue after two years of staff dealing with the pandemic who are now dealing with burnout. Many of us are also experiencing the exodus of long-time, loyal employees who perhaps didn’t feel valued for all that they did during the pandemic. Most hospitals probably didn’t have a work-fromhome policy prior to the pandemic, and now they’ve had to scramble to develop one. Hospitals don’t have a culture of hybrid work environments, and it is creating a sense of inequity among staff. There isn’t one single reason for this exodus. I’ve noticed that it’s multifactorial, with many root causes. But it can be corrected by acting now. So, what to do at this very moment if you are a healthcare leader?

WHAT HEALTHCARE LEADERS NEED TO DO RIGHT NOW What are three things healthcare leaders need to do right now to retain their employees? They are: engage talent, ask key questions and identify top talent. As a result of the pandemic, employees are looking at new job opportunities, whether that’s a promotion, advancement, a hybrid work environment or a new opportunity to start afresh. As the manager, you have the greatest power in the organization to retain your staff. Use it! Conversations and powerful questions are proven to increase engagement and reduce turnover. One of the greatest business challenges we face in a competitive environment is keeping good employees. Even more so, an engaged employee is the key to any organization’s success and in achieving its strategic goals.

In the Lead | A Seton Hall University Publication 29

ASKING FOR INPUT AND NOT DOING ANYTHING IS WORSE THAN ENGAGE TALENT NOW, NOT LATER Proactive Versus Reactive It’s far wiser to ask the questions now that will successfully engage and develop our talent than it is to find out what’s missing after the person gives notice. This is often overlooked when you have well-meaning employees who are quiet and do not complain. Attention is instead focused on disruptive, bad-behaving employees. As a manager, it is hard to focus your attention on those that are just quietly chugging along and hitting all their goals year over year. But don’t overlook them; they are the reason behind your team’s success.

How to Have a Post-Pandemic Stay Conversation

5. What talents do you have to contribute that have not been recognized or leveraged? As you think about your next step, what new skills do you want to develop? 6. T o what extent do you feel recognized for your accomplishments? 7. What can I do better to support you? 8. W hat additional feedback would you find helpful? 9. W hat are your career goals, and how can I support them? Asking for input and not doing anything is worse than not asking in the first place, so be sure to follow up.

Desired Outcomes

1. You are a valued member of our team; we’ve been through a lot together and we do not want to lose you. 2. We are committed to you for the long term and want to help you build your career at this organization. 3. We would like the opportunity to address your concerns. 4. We want to do everything we can to help you be satisfied and productive. 5. You can talk to me at any time about your experience here. My door is always open to you.

1. E mployee and manager have an open and candid conversation about the employee’s feelings about staying with the organization or department. 2. E mployee and manager commit to discussing job satisfaction and future aspirations regularly; this may involve a hybrid work environment. Be ready to discuss your organization’s policy. 3. E mployee knows where they stand in their career and have realistic expectations about career opportunities. 4. Employee and manager have established or enhanced their partnership in their development.

Goals of the Stay Discussion


1. Communicate to the employee that the organization values them and wants to retain them. 2. Confirm prior discussion, if applicable, of the employee’s career aspirations. Post-pandemic employees are reexamining their prior choices in their career, degree, work-life balance, jobs and goals. 3. Gain an understanding of employee’s commitment to stay with the organization and collaborate with the team, their manager and HR to work out a hybrid work environment. 4. Let the employee know you are willing to address concerns, but you need to know about them first.

•Y ou, the manager, are in charge, not HR. Remember your team’s success is your success and a demonstration of your ability to lead people, not just projects. •T ake responsibility for employee engagement and retention. •A dopt an attitude that supports learning and growth and that inspires loyalty. •C reate an environment where people love working. •B e honest about opportunities for advancement; work with HR to develop a career ladder if one does not exist in your department.

ASK KEY QUESTIONS 1. What do you look forward to at work each day? 2. What do you like most about working here? 3. I f you could change one thing about your job, what might that be? 4. What will keep you here? What might entice you away?


In the Lead | A Seton Hall University Publication

IDENTIFY YOUR TOP TALENT How do you know who your top talent is? Would those individuals be a regrettable loss to your organization if they left? Here is what I have learned are the qualities of top talent: •M otivated to achieve ever-improving results. •D emonstrates enthusiasm and positivity.

NOT ASKING IN THE FIRST PLACE, SO BE SURE TO FOLLOW-UP. • Constantly strives to raise the bar on their performance and do better. • Always shows moral courage and are not afraid to make tough decisions. • Shares and constantly demonstrates your organization’s vision and values. • Represents the organization well both internally and externally and are spoken of highly by people who deal with them. • Earns the respect of their colleagues and are known as people

who demonstrate high integrity. •S uccessfully manages situations in difficult times with challenging obstacles. •P ossesses open communication, transparency, decisionmaking ability, and consensus building. •A re skilled at developing others. •C reates a culture for team success. •R aises their hands for assignments beyond their own scope of work. L

In the Lead | A Seton Hall University Publication 31

“In the Lead” is a conversation with an industry leader on key trends and leadership challenges. In this issue, we present a conversation with Shalini Sharad Madan, a leader in the healthcare industry and recently crowned Mrs. India USA 2022.


You are Mrs. India USA, a keynote speaker, a fitness coach, and a healthcare industry executive. Where do you find the confidence and belief in yourself to pursue such varied pursuits? What is your mindset when you take on new initiatives? I believe in self-actualization to live our full potential. We are more than just one role that we play in our lives. In order to be happy and content, I have always liked to learn new skills and follow passions and unfulfilled dreams. It wasn’t easy for me to get to reprsent my country as “Mrs. India USA” after spending two decades in the corporate world, with limited exposure to the pageant world. With the pandemic, there was hardly a support system available to me. But I came across a video, “The Universe Has Your Back,” and it struck me that my only job is to work toward my dreams. Have a “discipline for passion.” There is a hidden dream in all of us; it just gets buried as life goes on. I am a believer of the concept of “better our best” — how to strike a balance among all things life throws at us, stay motivated toward our passions, and live a wholesome life. That is what I am here to pursue. My mindset when I take on any new initiatives is to find the right balance between what I aspire for and how to get there. It is never an overnight success, but following my dreams and finding a way toward fulfilling them gets me to the right path.


What led you to compete for the Mrs. USA pageant? As women, we often seek constant validation, think twice, or stop ourselves from taking an endeavor that may break pre-built norms. Coming from a middle-class family in India, I often had to seek validation before any new endeavor. I kept justifying why I was in corporate roles that involved global travel or were focused on innovation while I had a family to take care of back home. But I kept putting myself against many obstacles that life threw at me. In 1996, I had a dream of being on that pageant stage and representing my country for the crown. I got the opportunity in 2021 amidst the pandemic, and I decided to give it my best, irrespective of the fact that I was coming from a corporate world that was nowhere close to fashion and beauty. Winning this title has taken away all my feelings about getting validation before embarking on anything outside of my comfort zone. I will say this to all women who need to hear it:

In the Lead | A Seton Hall University Publication 33

I was going through a midlife crisis. Comments on how I was focusing on myself and ignoring family responsibilities were common. Fighting with the limited availability of resources with the ongoing pandemic was another big challenge. The most rewarding challenge to overcome was learning that although society and the people around me might not support my vision, the success that follows gives me more strength to take on the next challenge. I have moved from seeking validation to seeking self-validation, and now the same external environment/people ask me to share my journey to success.

4 5

You are doing a lot. Do you have a support system? Is it necessary? I do not have a support system that aligns with my vision — be it my complex corporate roles or pageant journey. I believe if we continue the journey toward our vision, we end up finding the path. What I mean is that the right people — family or friends — who can offer support are shown to us, and we get the needed support at the right time. It is not necessary that we have a support system to begin with. People follow us and support us if we believe in ourselves.

Get out of your comfort zone to get more comfortable.


What have been some of the challenges in your Mrs. USA journey? Which was the most rewarding to overcome, and why? While I was preparing for this pageant, I was juggling three jobs. The first one was my corporate career, second was being a mom, and third was finding time over weekends or in the evenings to prepare for the pageant. My external environment was not very supportive, and many thought

What are the core leadership lessons you have learned from your different pursuits? I would say there are three key lessons I have learned over my two decades of experience. First, think big and focus on your own uniqueness. There are many people watching us and consider us their role models. Let us give our best for them and for our dreams. Second, work in a village. Have the right professional and personal networks; have mentors who have been there. We can never win anything alone, but in the company of great minds, we can. Lastly, do not give up. Even if you don’t know how to get to success, the universe has your back.


Health care is ever transforming and has its own leadership challenges. What have you learned from your work outside of health care that you apply to your healthcare career? I have always held roles that were focused on innovation in health care. I believe that we need personalized treatments for patients. We need to treat patients like people: Everyone is unique with unique needs. Merging treatment with lifestyle changes — mental health, stress levels and fitness — all of this together makes integrative healing possible. We need an ecosystem approach to drive personalized care. L

If opportunity does not knock at your door, BUILD THE DOOR.” 34

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Wanted: More Leadership Development in Health Care

The current pandemic has exposed the healthcare industry’s need to improve and reshape the way it cultivates its future leaders. BY BRYAN PRICE, Ph.D., and STEVEN LORENZET, Ph.D. ALTHOUGH THE CRY for more effective leadership these days seems to be emanating from every industry, the cry from health care may be the most urgent. No other industry has faced as much adversity since the pandemic started in 2020, and the demand for more effective leaders in this field, at every level, is only increasing. Health care is behind its peers in the corporate world in terms of routinizing leadership development for its doctors, nurses and administrators.


In the Lead | A Seton Hall University Publication

There is no other industry, in our opinion, that is as ripe for leadership development as health care. We believe that by developing better leaders, health care can improve overall care, employee engagement and patient satisfaction. When combined, these forces also have the potential to improve the bottom line for healthcare providers. The authors have a unique perspective on leadership development in this field. Bryan is a retired Army officer who ran the Buccino Leadership Institute at Seton Hall, which includes one of the only nursing leadership programs in the

country at the undergraduate level. Steve is the dean of the School of Health Studies at Touro University and has worked with healthcare organizations throughout his career. We examine the leadership development challenges facing the healthcare industry, make the case for why more robust programs are needed and propose several solutions to fix the problem in the long term. THE LEADERSHIP CHALLENGES IN HEALTH CARE

Pandemic Stress and Unprecedented Turnover = A Perfect Recipe for Burnout

Perhaps the greatest leadership challenge facing the healthcare industry is that it has been under constant siege since the pandemic began. With each successive wave of COVID-19 and its variants, there has been no respite for healthcare workers. As a result, more than 50 percent of all healthcare workers have experienced symptoms of burnout during the pandemic. This burnout and the stresses of the pandemic have accelerated retirements and increased turnover, the likes of which our economy has never seen. In May, the U.S. surgeon general warned of a shortage of more than 3 million essential low-wage health workers in the next five years, including a projected shortage of 140,000 physicians by 2033. With almost 500,000 nurses expected to retire by the end of 2022, the U.S. Bureau of Labor Statistics projected that we’ll need 1.1 million new registered nurses (RNs) to replace them to meet current demand. A 2021 study conducted by Nursing Solutions Inc. (NSI) found that since 2016, the average hospital has turned over 90 percent of its workforce, including 83 percent of its RN staff. The average cost of turnover for one bedside RN is $40,038, and each percentage change increase in RN turnover costs a hospital $270,800 per year. Could leadership forged through purposeful leadership development help stem this tide? We think so. In any industry, people often leave due to lacking leadership, not the job itself. Better leadership would reduce this turnover, increase employee satisfaction, improve efficiency and retain much needed talent and institutional knowledge.

Imagine the costs of uprooting officers and their families from one duty station and moving them to a temporary location, specifically for the purpose of additional leadership development. Then, six to 12 months later, moving their households again to another duty station. In a 20-year career, this happens, on average, three to four times. That’s how seriously the military takes leadership development. In health care, however, leadership development is not seen in the same light. The most common refrains from many healthcare leaders as to why they cannot provide more leadership development? “There’s never a good time” and “we can’t afford it.” Two classic arguments. While it’s true that healthcare workers have a never-ending mission, we would argue that healthcare leaders can ill afford not to provide more leadership development to their people. We believe the healthcare industry must see leadership development as a “need to have” component of their profession, not a “nice to have” add-on when time and resources are available. First, ineffective managers ruin morale for both employees

Two Classic Arguments for a Lack of Leadership Development: ‘Can’t Afford It’ and ‘It’s Never a Good Time’ No other profession emphasizes leadership development like the military. Despite spending hundreds of thousands of dollars developing future officers at the military academies or ROTC detachments, the military still sends all of its leaders through full-time (and often in-residence) leadership development courses at various points in a typical career.

In the Lead | A Seton Hall University Publication 37

and patients, both of which damage the bottom line. They can create toxic environments that ultimately lead to increased turnover and early retirements. Both are bad for profits. Second, compared to other industries, replacing healthcare specialists is expensive. A 2016 study by Physician Career Advisor looked at the replacement costs for physicians. On average, it costs a hospital over $31,000 in recruiting costs alone to fill one physician vacancy. In fact, “the cost to train, credential, market and onboard a physician” was estimated at between $200,000 and $300,000. Finally, when you factor in these costs with the lost revenue during a particular vacancy, one hospital director estimated that it routinely costs between $400,000 and $600,000 to replace a physician, and more for physicians with low-density specialties. Healthcare providers could spend a fraction of that on developing better leaders and, in turn, save themselves the time, energy, costs and frustrations associated with replacing unhappy and burned-out workers.

Health Care: An Industry Great at Training Specialists but Poor at Training Leaders When Seton Hall created a four-year, interdisciplinary leadership institute for competitively selected undergrads, the school conducted market research to see what other universities had in place for developing leadership skills in nursing and pre-doctoral students. Except there were none to be found. While we did find some leadership programs at the graduate level, we were surprised that our program was alone in providing future healthcare leaders with rigorous, foundational


In the Lead | A Seton Hall University Publication

leadership development at the undergraduate level. In fact, it is quite possible that a nursing or pre-med student in our program will receive more leadership development in their four undergraduate years than they receive in their professional healthcare career. The nursing and pre-med students in the program take a suite of professional leadership assessments like the Eq-i 2.0 emotional intelligence assessment (twice), the DISC behavioral assessment and the Strengths Finder 2.0. They participate in weekly leadership workshops and projects that require them to lead themselves and small teams, and they are assigned an ICF-certified executive leadership coach to guide them on their journey. By the time our students graduate, they will have received eight semesters worth of professional leadership development and critical feedback on their leadership effectiveness from peers, faculty, assessments and professional coaches. Thirty years ago, or even 10 years ago, healthcare providers might have been willing to overlook a lack of leadership skills in a nursing floor manager or a doctor’s deplorable bedside manner as long as both individuals were “good at their job.” Not today. In today’s patient-centric world where patients have more choice, more agency and higher expectations, it’s not enough for providers to be just technically skilled. Additionally, patients have more voice than ever before, often communicated through satisfaction surveys, which impact hospital rankings. In an environment where nurses are retiring earlier than expected and, as reported by NSI, almost a quarter of RNs (24 percent) are in their first year of nursing, hospitals can’t afford,

both figuratively and literally speaking, to have caregivers who are great technical specialists but bad leaders. To be successful today, healthcare providers need to be both. They need to be technically sound at their jobs and be effective leaders. INCREASED CORPORATIZATION MEANS MORE COMPLEX ORGANIZATIONS, WHICH REQUIRE DIFFERENT LEADERSHIP According to a 2022 report by Advisory Board, 248 hospitals changed ownership between 2016 and 2021, either through merger or acquisition. Most of these transactions (85 percent) have a single direct organizational owner. This level of consolidation is expected to increase in the years ahead. What does that mean in terms of leadership? In many cases, this aggressive consolidation increases the size, scope and complexity of healthcare providers. It requires leaders who can effectively operate during times of uncertainty and at different levels of responsibility. Large healthcare providers often assume a doctor who was amazing at leading a small department will be able to do the same with larger, more complex teams that result from a merger. Because these roles require different leadership skills, this is often a costly and incorrect assumption. The military often has the same challenge. Officers who excel at leading their smaller formations at the tactical level often find it difficult to transition to leading systems and processes of larger organizations when they advance through the ranks. To address this problem, the military mandates that all officers who get promoted to operational-level ranks receive specific leadership development to prepare them for this new way of leading. As healthcare providers get larger and more complicated, they should consider a similar model. RECOMMENDATIONS FOR IMPROVING LEADERSHIP DEVELOPMENT Health care in the United States must balance the two-pronged mission of taking care of patients and making money. Although it is true most hospitals are nonprofit, even nonprofit hospitals care about the bottom line. Be assured that health care cares about the business side just as much, or at least nearly as much, as taking care of patients. And rightly so. If you can’t meet your financial obligations, then you won’t be in the business of taking care of patients for very long. To address the leadership development challenges noted above, we provide the following four recommendations.

➤ Major healthcare providers should include and elevate ‘chief

of leadership development’ positions into the C-suite. Doing so would institutionalize leadership development as a key component for both patient care and business success. ➤ Similarly, larger healthcare providers should consider tiered levels of leadership development. For example, they could consider various stages of leadership development to reflect the distinct stages of leadership responsibility. The military provides standardized leadership development for leaders at the tactical, operational and strategic levels. Health care could emulate that system, especially given today’s increase in mergers and acquisitions. ➤ Normalize executive leadership development coaching for senior healthcare leaders. There was a time, many years ago, when a Fortune 500 CEO who sought a leadership coach would have been perceived as weak and broken. Today, it could be

argued that Fortune 500 CEOs who don’t have a leadership coach are perceived the same way. Given the importance of caring for the caregiver, executive healthcare leaders should make leadership coaching a priority. ➤ The healthcare industry should be more involved in shaping leadership development programs at the undergraduate level and expanding them at the graduate level. It is problematic that many emerging healthcare leaders cannot receive rigorous leadership development at the undergraduate level. Health care should heed the lesson that corporate America has had to painfully learn: Waiting to provide leadership development until an individual has reached middle management is a wasted opportunity. Why wait? L

In the Lead | A Seton Hall University Publication 39

Casting a Wider Net

Examining the evolution of the biopharmaceutical industry, how it became a “unicorn industry,” and highlighting the possible signs of the industry’s decline. REVIEWED BY PAULA ALEXANDER, Ph.D., J.D., and STEPHEN WOOD, M.S.

IN THEIR recent book, Redefining Innovation, authors Ruchin Kansal and Jeff Huth offer an exciting vision for the biopharmaceutical industry and lay out a powerful framework to spur not mere innovation, but innovation that inexorably leads to outsized profit growth. During its golden era between 1995 and 2005, the biopharmaceutical industry produced unicorns (companies, or products, that generate over $1 billion in annual sales) at a rate that would be the envy of any high-tech investor. While the data presented is not exhaustive, there were at least 21


In the Lead | A Seton Hall University Publication

unicorns in 1995, 47 in 2000, and 101 in 2005, for a total of 169 in these three years alone.1 By comparison, the tech industry only produced 101 unicorns between 2009 and 2017. Kansal and Huth explain, in part: “a wave of innovative products coupled with the ability to increase prices created a potent combination … companies found the sweet spot regarding the investment allocation between R&D and marketing and sales, with R&D investment averaging about 20 percent of net sales and marketing and sales investment averaging about 40 percent. This model allowed the industry to generate 16 percent-24 percent profit margins.”2

Kansal and Huth identify the hallmarks of unicorn production: Find a “white space” where there are few competitors (or, ideally, none), where the traditional discipline of customer-product-price-value decision is detached from the patient and placed in the hands of those who are incentivized to grow the product market. Once a drug has emerged from the regulatory proving ground with certified efficacy, the only sales friction is the lack of prescribers’ knowledge (in the United States, doctors). The pricing tension is overcome due to (a) the proprietary nature of the product coupled with (b) a third-party payment model where the pricing is largely negotiated en masse. When viewed from the vantage point that a company’s purpose is solely to produce profit growth, the presence of these key ingredients – monopoly, prescriber capture, user disengagement – creates an irresistible framework that begs to be repeated. However, as noted more fully in the counterpoint section below, if the drug should also be addictive, as in the case of oxycontin, the healthcare system’s duty to the patient can be compromised.3 Kansal and Huth stress that the imperative for profit is growth. However, the authors point to myriad headwinds: products become commoditized, lower pricing in overseas markets undermining pricing power in the U.S., and the healthcare share of the overall consumer wallet reaching unsustainable levels. For all the past success of these unicorn products, the reality is that, over time, they have become a herd of cash cows, generating millions of dollars of profits each year, but are unable to continue to extract premium returns. It begins to look more like a public utility — steady cash flow, perhaps with small risk, generating returns of 11 to 12 percent — as opposed to the unicorn conveyor belt generating the 20 percent returns that were experienced in the past. One example of profit peril is an interesting circumstance that might not be apparent to profit maximizers in other sectors. Consider the example where a product is developed for the treatment of condition A, and the negotiated price is P. There can arise a situation where the product is discovered to be helpful in the treatment of condition B, albeit not quite as efficacious as treating condition A. This new condition, despite opening an entirely new market of potential patients, ends up creating a drag on the profitability of the product because the forum for negotiating en masse pricing sets the price of the product used to treat condition B well below the price charged

for its treatment of condition A. The existence of the lower pricing for condition B erodes the pricing power for extracting greater returns for condition A. Why not charge the same price either way? What most businesses consider a boon — i.e., a new population of customers — in this case, undermines a highly profitable return model. COUNTERPOINT: PROFIT GROWTH VS. PATIENT OUTCOMES The downside of a model based on finding a “white space” where there are few or no competitors and where the traditional discipline of customer-product-price-value decision is detached from the patient/consumer is that the model tends toward monopolistic pricing, which works against the best interests of patients and their families. Two examples demonstrate the downside of the “unicorn” approach for consumers. The price of insulin has increased so much that California has announced it will undertake the production of insulin for its citizens.4 And the U.S. Senate has introduced a bill, the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, that would limit out-of-pocket co-pays for insulin to $35 per month and restrict preauthorization. Moreover, President Biden’s budget proposal for the fiscal year 2022 reopened the prospect that the government will negotiate with Big Pharma on behalf of patients accessing Medicare.5 The Inflation Reduction Act of 2022 was passed by Congress and it was signed into law by the president on August 17; it authorizes Medicare to negotiate drug prices, caps out of pocket costs for seniors for prescription drugs at $2,000 per year, but failed to include a monthly cap for insulin of $35 on the cost of co-pays for patients.6 An egregious example of monopolistic pricing adverse to the interest of patients and their families is the EpiPen. After it acquired the EpiPen from Merck in 2007, Mylan Company, under CEO Heather Bresch, raised the price of a pair of EpiPens from $100 to $600.7 Mylan also entered into an agreement with generic drug manufacturer Teva to delay the production of a generic version of the EpiPen, a medical device that reverses anaphylactic shock, a life-threatening allergic reaction to such allergens as bee stings and nuts. The situation was so egregious that a class action lawsuit was brought against Mylan Company, Viatris Inc. and Heather Bresch. A $264 million settlement has been negotiated, and the deadline for filing a claim was July 25,

In the Lead | A Seton Hall University Publication 41

2022.8 The EpiPen and the insulin pricing practices illustrate the downside to the consumer of the “white space” of no competition to a Big Pharma company’s product. The authors assert that the outlook for the research-based pharmaceutical industry is cloudy. It appears to be headed for the perilous zone between Charybdis and Scylla, the whirlpool and rock of Greek mythology. On the one hand, there is a failure to recognize a fundamentally disruptive wave about to swamp your core value-producing concept — Kodak would be a prime example of this folly. On the other hand, rather than standing pat with the comfortable status quo, there is the GE example.

• Experiment With Breakthrough to Define New Futures: Focus on health versus disease: zero downtime for patients. Kansal and Huth’s three-part approach offers a balance between harvesting the values that underlie the current business success, while simultaneously teaching the organization how to see the world through a new lens. Albert Einstein’s insight is apropos: “No problem can be solved by the same consciousness that created it.” Ultimately, the new lens offered by Kansal and Huth for health care is an exciting one: Imagine a Central Nervous System (CNS) product (or no conventional pharmaceutical at all) coupled with a VR-enabled program of Cognitive Behavioral Therapy (CBT), meditation, healthy eating, and exercise. The NewCo markets this offering through partnerships with payers, organized providers, self-insured employers, and patients bypassing the traditional sales models focused on individual prescribers. The NewCo spawns the new S[i]M industry subsector! Here, then, is a vision that forges a path to thinking about health as a total wellness proposition as opposed to a concentration on disease. See the future through the lens of order and health rather than disorder and illness. In conclusion, we hope the leaders of tomorrow will implement a holistic health business model and address both the interests of the pharmaceutical industry in developing innovation and the public good by providing equitable access to holistic medical care. L

Jack Welch transformed GE from a company worth $14 billion to one worth over $600 billion through downsizing, deal-making and financialization. (By the end of Welch’s tenure, most of GE’s profits came from GE Capital, essentially a giant unregulated bank). But GE lost its focus and abandoned a sound business model for an expansionist one that eventually went sour. At its nadir, GE required a $139 billion bailout from the government.9

1 Ruchin Kansal and Jeff Huth, Redefining Innovation: Embracing the 80-80 Rule to Ignite Growth in the Biopharmaceutical Industry (New York: Productivity Press, 2022), p. 25. 2

Ibid., p. 24.

4 U.S. companies will pay $26 billion to settle claims they fueled the opioid crisis, NPR Health, February 25, 2022. Available at opioid-settlement-johnson-26-billion 3

4 Susan Kelly, “California to manufacture its own insulin, Newsom says,” Healthcare Dive, July 11, 2022.

See “Budget of the U.S. Government: Fiscal Year 2022, Office of Management and Budget, The White House, 2021.


To avoid both of these mistakes, Kansal and Huth propose three areas to energize the drive for innovation: • Drive the Core: This is the current engine — fine-tune, reduce costs, maintain competitive advantage — but know that it is a short-term game. • Invest in Adjacent: The smart integrated medicine concept (or “S[i]M” as coined in the book) is an extremely exciting concept in and of itself, a worthy take-home regardless of the other content.


In the Lead | A Seton Hall University Publication

What’s in the Climate, Tax and Health Care Package. Byline of Emily Cochrane and Lisa Friedman, New York Times, Aug. 7, 2022. Available at politics/climate-tax-health-care-bill.


Mylan CEO Heather Bresch Defends EpiPen Pricing as ‘Running a Business: Heather Bresch makes no apologies for Mylan’s business practices. By GILLIAN MOHNEY. ABC News, August 26, 2016. Available at mylan-ceo-heather-bresch-defends-epipen-pricing-running/story?id=41667388


8 Mylan $264 Million EpiPen Price-Gouge Deal Gets Final Court Nod. Bloomberg Law, July 12, 2022. Available at mylan-264-million-epipen-price-gouge-deal-gets-final-court-nod.

Anitha Moosath, “Book review: How Jack Welsh paved GE’s spectacular decline, and broke capitalism in the process,” Money Control, August 3, 2022.


Ideas & Trends Business Leadership Center Business leaders are required to be adept at dealing with ambiguity, managing uncertainty, and working in teams where members bring diverse perspectives to the table. Ideas & Trends is designed to challenge secondyear students in the Business Leadership Center within the Buccino Leadership Institute to create an unconventional presentation on a broad topic. The goal is to give the students experience in solving unstructured problems while working in large teams with minimal guidance.

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Looking back, my biggest takeaway is to not let the past define what you do in the future. In Ideas & Trends, we were so focused on what we had done in the past that we had to learn how to unlearn and relearn. – ERIN MURPHY

Ideas & Trends taught me multiple lessons that I will never forget. First, the importance of a leadership structure. Second, the importance of communication. Lastly, the importance of product quality. Every compliment we received was on our final product. It was then I realized that no matter how hard we worked, we would be judged only on our output. – AIDAN KELLY

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