Paul Viviano – Vision & Excellence in Healthcare Leadership Award
Mr. Viviano joined CHLA as President and Chief Executive Officer as well as a member of the Board of Trustees in 2015. He has enjoyed three decades of success leading academic medical centers, for-profit health care organizations and nonprofit community hospitals.
Prior to joining CHLA, Mr. Viviano served as the Chief Executive Officer of UC San Diego Health System and Associate Vice Chancellor of UC San Diego Health Sciences. There he oversaw the entire $1.7 billion UC San Diego health care enterprise, which included leading-edge medical care; training of medical students, residents and fellows; and patient care delivery for two teaching hospitals.
Mr. Viviano serves in leadership capacities on various community and health care organizations and was named a 2016 Leader of Today honoree by the Health Policy and Management Alumni Association of the UCLA Fielding School of Public Health; and one of the LA500, LA’s Most-Influential, in 2018 and 2017 by the Los Angeles Business Journal.
Mr. Viviano is a California native and earned his bachelor’s degree at the University of California, Santa Barbara, as well as a master’s degree in public administration-public health at the University of California, Los Angeles.
Mr. Viviano is a deeply respected leader and highly deserving of the honor this evening represents.
New Frontiers of Health: A Partners in Care Interview Series with Paul Viviano, President & CEO of Children’s Hospital Los Angeles
Partners in Care Foundation will present the Vision & Excellence in Healthcare Leadership Award to Paul Viviano at its upcoming 21st Annual Tribute Dinner at the Beverly Hilton Hotel in Beverly Hills on Monday, June 21, 2021.
Mr. Paul S. Viviano serves as President and Chief Executive Officer at Children’s Hospital Los Angeles (CHLA). It is his significant work with that institution and before that brought Mr. Viviano to the Award Selection Committee’s attention. Building on a mission and history spanning 119 years, Mr. Viviano and his CHLA team have developed a vision of access to services, coupled with a commitment to measurable excellence that has vaulted CHLA to the upper ranks of children’s hospitals.
Partners sat down with Mr. Viviano for a conversation about his background, interests, and career path. We are pleased to share his observations in anticipation of the upcoming Tribute Dinner, where he will be recognized with this prestigious award in recognition of his work.
Paul Viviano’s Background
Partners started the interview by asking Mr. Viviano about his background and experience leading up to his time at CHLA.
I’m kind of an old school guy in the respect that I believe you’re going to do things in life that sometimes are really challenging and you’re not always going to succeed. Like in sports. You know you will get knocked down and you’re going to have to dust yourself off, stand back up and try again. Sometimes you’re not going to succeed the second time, but you can dust yourself off and try yet again.
So, to me, it is an ‘old school mentality’ that your effort, your work, and your determination can lead to success. That determination and work ethic informed my college experience, my graduate school experience, as well as my professional experience to this day.
As I finished my undergraduate studies, I started thinking about various disciplines and different careers, and was attracted to healthcare management for a couple of really important reasons: I had a strong desire to help others and a deep appreciation for how important health status is in allowing individuals to achieve their best and really live up to their potential.
Management was an option because I had an interest in leadership. I wanted to have an impact on an organization focused on improving the healthcare of others, that impacted the lives of those who reside in the community and beyond.
That led to a graduate program at the University of California Los Angeles (UCLA) in Public Policy and Public Health. I was really lucky that there was a great program at UCLA with people willing to help and mentor me about creating a career and choosing among different options. In the course of graduate school, I learned right away the impact public health has on society, which reinforced my desire to be in healthcare management.
Responsibility, Accountability, Performance
My very first job out of the program was as an analyst for the Public Health Department in Orange County. It was a traditional department, overseeing clinical operations for a variety of clinics, ranging from pulmonary infectious diseases, to veterinary medicine, prison and jail medicine. From my start in clinical operations, I earned several promotions which resulted in a broader set of responsibilities.
At that time, the Health Department was being restructured. It had included a county hospital, but as part of the restructuring, the county was transitioning ownership of the hospital to UC Irvine, which eventually became UC Irvine Medical Center. This left the health department on its own and I was asked to help restructure the department to function without that acute care service.
This really was a lesson in self-sufficiency, how to make sure that we had the resources necessary to accomplish the department’s goals without the hospital’s revenue stream or a place to transfer patients in need of such care. We had to be self-sufficient both clinically and operationally.
So many things shape a career. Helping to restructure that department so it could stand on its own was an important point in mine.
After serving the Orange County Health department, I accepted a job running the Dialysis division of a large healthcare company. At the time I still didn’t know much about hospitals and that path really wasn’t on my radar screen. I wasn’t too far along in my orientation when the company asked me to help out in one of their hospitals. Not long after, they tapped me to serve as COO there, and before I knew it I was asked to become that facility’s CEO. It happened quite quickly. Just three days past my 27th birthday.
I don’t know what they were thinking. They certainly took a big risk.
Looking back, I’d like to think they saw a responsible, hardworking, sober-minded, performance-driven person who had built a reputation based on a very simple set of principles. I did what I said I was going to do and if I couldn’t do it, I’d tell you why.
Sounds easy. Sounds rudimentary. Of course, a hospital CEO does what they say they are going to do. But sometimes it’s hard to actually follow through. I simply delivered on what I promised. Some days it was easy, and some days it wasn’t. That opportunity really taught me about hospital finance and performance in a well-rounded organization that operated well. I learned a lot there.
That was also true when I worked for the St. Joseph Health System in Orange, California, a 14-year experience that began in 1987 when I took a position as president and CEO of St. Jude Medical Center in Fullerton. I later became president and CEO of St. Joseph Hospital in Orange before serving as president and CEO of the Health System’s Southern California Region. I later became the Executive Vice President and COO of the entire St. Joseph Health Care system.
We were a large, strong, and vibrant health system with lots of resources, but at the local level, we needed to make sure we were self-sufficient. There was always a need to be self-reliant.
At the end of the day, you’re always accountable for the outcome, no matter what the structure might be, no matter how big or how broad the organization might be. So, these experiences really informed me about that need to be responsible and accountable for your performance.
Thinking about my career, this focus on performance is a really important theme because it reflects my management style, which is to be accountable, and to focus on outcomes and performance. This has been a consistent theme every place I’ve ever worked or where I’ve had the opportunity to lead.
A Changing Healthcare Landscape
A few years before I joined the St. Joseph Health System, the world of healthcare finance underwent a dramatic shift when Diagnostic Related Groupings (DRG) were adopted. I bring this up because change is a constant in the healthcare industry. I was the CEO of the Los Alamitos Medical Center at that time and we had to learn how to shift gears and manage risk. That meant educating the entire team about how the change impacted the organization and then convincing them that we were in this together and needed to devise a new system in response. We worked with our medical staff, our team members, and our patients to learn how the changes affected each group, and then worked together to figure out how to improve our work in the new environment. It was a massive learning effort.
As the CEO it was my job to orchestrate the process.
A mistake would have been for me to say to the team, “You know, you’ve got to go do these specific things now.” It would have been easy to say, “Okay, you do this and you do that, and we’re going to be ok.”
That isn’t the way we approached it.
Instead, we identified the new facts and the new ground rules and talked to each other about what the implications were. We walked through each of the steps and agreed as to how we were going to hold ourselves accountable to the metrics of performance. And then improve from there.
We took advantage of all the resources within the organization, starting with a sound business plan, a strategy to go with it, and a team for implementation. We collectively thought through the questions, “What’s the best way to achieve our vision, our mission? What’s the best way to allocate resources? What’s the best way to organize ourselves to be successful?”
Right or wrong, that was the approach we took. It reflects my management style and my personality. I believe you succeed because you have a great team. That approach has been a significant framework of my career.
Focusing on Children’s Health
I first became aware of Children’s Hospital Los Angeles after taking a call from a search firm wanting to know if I was interested in a new opportunity as President and CEO of the top children’s hospital in California. I was really happy at UC San Diego as CEO of its health system and associate vice chancellor of UC San Diego Health Sciences. It was a marvelous job at a well-respected, large organization that is part of one of the greatest public universities in the country.
I was very familiar with CHLA. It is regularly ranked among the best children’s hospitals in the nation while also serving as the safety net hospital for our community’s most underserved families and children. Its clinical care is led by physicians who are faculty members at Keck School of Medicine of USC, an affiliation dating back to 1932. I had also previously served as president and CEO of the USC University Hospital and the USC/Norris Cancer Hospital, so I was very familiar with CHLA’s incredibly special and unique mission – to create hope and build healthier futures for children.
Today, it’s a privilege beyond words to be here to help lead this organization. I joined CHLA in 2015 and cherish every day. You can literally take three steps into the hallway from my office and see our mission in action. We treat hundreds of thousands of children a year and it’s clear that for every family walking through that front door, they are experiencing one of the darkest days of their life. Their child has come here because their life is at risk.
What helps me past that?
Knowing there’s no better place for that child to go.
In this part of the interview, Partners asked Mr. Viviano how he arrived at his vision for health care, and how he sees it in application at CHLA.
“My vision for healthcare – aside from the role of CHLA’s pediatric care – would be that everyone deserves, and should have access to, high quality healthcare services, in a timely way that augments routine preventive care with access to care for chronic conditions and urgent care.
This is grounded in my public health background. It’s grounded in my fundamental belief that healthcare is a right, and we do our best at Children’s Hospital to deliver on that vision.
What Keeps Me Going
Upholding the legacy and the greatness of this place.
Supporting our faculty, our nurses and caregivers. In the middle of one wall in my office is a framed poster of our mission, vision and values. Around that poster is a whole field of images picturing our patients, their families, their nurses and teachers. It exemplifies how that mission, vision and values are at the center of what we do.
We’re able to say, “We’re here for our patients first no matter what.” Our people actually get to live that vision and mission.
One thing I’m very proud of here at Children’s Hospital Los Angeles is the strategic planning process we undertook shortly after I arrived in 2015. From that exercise we developed a strategic plan that reflected how to build, grow and optimize the care we’re now providing. We’ve also developed a team to implement that plan, which has led to a lot of success in terms of growth, improved rankings and recognition.
In the last four years, CHLA has climbed two spots to become the No. 5 children’s hospital in the country and the best in the western U.S. Our research organization, The Saban Research Institute, is one of the top-10 NIH-funded pediatric research facilities. Children’s hosts some of the largest training programs in the country for pediatrics. On top of all that, Children’s Hospital is a safety net hospital – a unique and special element of this organization.
I refer to this as “defying gravity.”
It shows you can invest millions of dollars every year into research and still be a safety net. That you can have the largest training programs in the country and still be the safety net. We will treat you regardless of your financial situation or personal circumstances. We don’t care if you have a green card or $10.00 in your pocket.
And we’re not going to just care for your child today in our emergency department. We are committed to care for that child until they are 18, sometimes beyond, no matter how complex their case, no matter how expensive their care. That’s our commitment to this community. It’s an impressive legacy that means so much to this community.
It’s important to me that it isn’t just my vision driving this institution.
It’s also the mission and the vision of CHLA. It’s been the legacy here for 119 years. In that time, we have had this same principle of caring for all our patients regardless of any financial considerations or concerns. It just so happens that my personal beliefs and viewpoint about what healthcare should be is mirrored in the tradition of this organization.
I am fortunate that I found myself in such great circumstances where these things align perfectly. It allows me to work with our management team, our faculty and our employees to make sure we deliver on that promise the best we possibly can as the destination for more than 600,000 patient visits a year.
Of all the children that were hospitalized in Los Angeles County last year, we admitted approximately one-third of them. More than 50% of children with a complex diagnosis in LA County are admitted to and cared for at CHLA. So, that vision of access gets translated into action here with 350 programs, 550 faculty, and about 7,000 employees all dedicated as fully to this mission as I am.
It’s a wonderful example of how a mission can get baked into an organization and support the vision of its founders.
Keeping the Mission and Vision Alive
My biggest job is to make sure that our clinicians, our nurses, our physicians, our nurse practitioners, our faculty, our researchers, our educators, and all our other staff have the resources they need in order to do their job successfully.
That has translated over the last four years to a very substantial investment in bringing employee salaries up to marketplace rates. It’s investing in our research enterprises and expanding our educational responsibilities. To do this, we had to determine how to generate the additional resources necessary to grow those resources.
We had unused capacity, so we adopted a strategic plan based on the stated goal of using that capacity to treat more children. Let me be clear though, the goal wasn’t to treat more children just for the sake of treating more children. It is to treat more children here because we know the care here is unparalleled.
We can point to our rankings. To the prominence of our programs. And to their size as among the largest in the entire country. Together, they make a strong case that the care we provide here is indeed superior.
So, growth became a strategy to generate more cash flow, and that cash flow in turn is invested in recruiting faculty, recruiting more nurses, and improving salaries for our faculty, our nurses, and all of our other team members. In turn, we can provide the care children need.
That growth happened more quickly than we expected.
We’ve gone from 26% of the market to about 32% over the last four years. We’re caring for more children, which helps stabilize and improve our financial performance. In turn, that adds to the stability of the organization, and leads to more resources for those investments in people and programs. This includes developing new treatments and new cures, along with those new programs and services.
In whole, this ensures CHLA will be part of this community for the next 100 years.
Another piece of that access vision is making sure our services are available as soon as they are needed.
We’re the only level one pediatric trauma center in LA County, yet we’ve got this broad swath of responsibilities all the way from providing pediatric trauma care, world-class quaternary and tertiary care to help those with the most complex illnesses, to helping those in dire need of services anytime of the day or night but don’t have the means to afford private insurance. We treat everyone the same – same rooms, same nurses, same doctors and same surgeons.
At Children’s Hospital Los Angles, our promise is we’re going to take care of our patients until they are 18 years old. Not just today in our emergency department. We’ll be there to take care of all of our patient needs until you are 18, no matter what. There aren’t a lot of places that can say that “no matter what” part.
So, going back to that first point, I’m really proud that we were able to put a plan together and have been able to implement it successfully to support our vision of accessibility for all who need our services.”
In this final section of our interview with Mr. Viviano, we asked about excellence and how he views it at CHLA.
“At Children’s Hospital we have a desire and a determination to be the best across every dimension of performance. Achieving excellence means measuring outcomes and paying attention to service. That starts with how a patient feels about being here, to the welcoming attitude, to the nurturing and supportive culture, right through to the sensitive and compassionate care we provide.
We want to be the best.
To be the best in our clinical programs. To improve our rankings. To improve access. To have a compassionate, patient-centered care culture. To have a research enterprise that transforms health care, that develops new treatments and new cures literally every day. To be training the pediatric clinicians and researchers of tomorrow, and to be the community’s safety net.
I don’t think anybody aspires to do that. There’s nobody in the Top 10 on the children’s hospitals rankings that aspires to do what I just outlined. They all aspire to do great clinical work, research and academic work, but none of them succeed as we have doing all these things and providing the widest safety net of any children’s hospital in the country.
Yet that is our legacy.
Earlier, I explained that in this regard we’re defying gravity.
We’re all of those things AND we’re the safety net. For that I am proud, proud of the compassionate team I serve that makes it all possible. Patient satisfaction surveys are important indicators, and for two out of the last three years we’ve been the national leader in patient satisfaction rates for any children’s hospital in the United States. For two out of the last three years!
That desire and determination, combined with efficient systems and a drive to develop better clinical outcomes, is reflected in the fact that seven of our pediatric specialties are ranked in the top 10 nationally. We are the highest ranked children’s hospital west of the Rockies.
We have one of the largest pediatric residency and fellowship training programs in the country.
Our research enterprise is thriving. Last year we had about $130 million in funding – mostly federal dollars – for our researchers, 237 of whom are investigators with grants to develop new treatments and new cures.
It is a remarkable achievement for our team. It reflects all the planning and work to improve and provide both compassion and world-class care.
Again, we are blessed with an incredible team that embraces this mission. Everybody who works here – from the person who parks the car to the person who helps find your sandwich at the lunch counter, to the nurse in the pediatric ICU to the neurosurgeon and everybody in between – they all embrace this mission. Hiring, training, orienting is really easy when people who want to work here demonstrate and reflect those values and that mission every day and in everything they do.
Culture isn’t about the CEO. Culture reflects every team member embracing the calling to protect these precious children.
We’re here to serve the needs of children. Period.
That’s what we’re here to do. We are a haven for families who, in their darkest hour, don’t know what to do or where else to turn. Every single person they talk to, every single person they seek care from, reflects this compassion and this great expertise.
One of the immutable truths of health care today is that there a correlation between volume, clinical outcomes, mission and success. When you have some of the biggest programs in the country dealing with high patient volumes and providing complex care, the outcomes are going to be better. When all those aspects work together it’s an incredible demonstration of the power of a culture.
When I first arrived at CHLA, we began work on a new interfaith chapel so we could create a diverse space where all our families could worship in a time of greatest need. It was based on our determination to focus on the families and the whole child – not just the acute episode that brought them here. It is a beautiful room with stained-glass windows to serve as a place of solitude, solace, and meditation for families. It welcomes those of all faiths or no faith, to serve families as a place to compose themselves during some of the most challenging times they will ever face.
It has been a benefit to our caregiving teams as well, with a chaplain and many special services. Open 24 hours a day and highly used, this sacred space is a testimony to our decision to provide something holistic for the benefit of all.
Our commitment to our diverse patient population is a reflection of one of the great things about Los Angeles – the diversity of this city, the surrounding county, and the region. There are 2.3 million children living in LA County alone. Within a two-hour drive of the hospital there are 2.5 million children within a total population of 12 million people. It is a massive market with countless sub-markets, each with its own specific needs. That’s led us to deploy targeted strategies to get closer to those communities so we may understand them better.
First, we have a partnership with AltaMed –one of the largest Federally Qualified Health Centers (FQHC) in California and one of the largest nationally. They cover several hundred thousand capitated lives and have plans to grow well beyond that current number. We’ve become their pediatric provider with 35 pediatricians on our main campus, many of whom are graduates of our general pediatric resident program, who care for children through AltaMed FQHC.
AltaMed has seven other very distinct community locations where we will soon also be providing pediatric care. We’re really trying to meet the needs of those communities by placing pediatricians, nurse practitioners, nurses and other caregivers directly in those communities. Besides providing care, we have offered health fairs, healthy cooking classes and all manner of other educational activities in those location so people can get what they need close to their home.
We’ve also created a health network of more than 200 general private practice pediatricians who have integrated with CHLA. To achieve that, we’ve installed IT systems in their offices for easy information sharing and developed clinical protocols to help improve their quality of care. We contract together with health plans, and we hope to expand that network significantly over the next few years. As part of the CHLA family, when they need to make a patient referral to one of our specialty pediatricians, it’s now much easier.
We have expanded relationships to community hospitals where we consult with their faculty on issues that might arise in their neonatal intensive care units or pediatric ICUs.
We have five ambulatory care centers with pediatric subspecialty care available five days a week. Our hope is to expand those centers to include ambulatory surgery, diagnostic imaging, infusion, physical therapy, occupational therapy – the things that a patient and their family shouldn’t need to visit our main campus to receive.
We believe we can enhance access to care if we can provide this variety of services at a local level using the same caliber staff, same quality services, same medical protocols, just more proximate to home. If our patients don’t have to travel to the hospital as frequently in a town full of traffic, we think that that will be an improvement in their lives as well as care.
This diversity of locations also provides us the ability to hear what families want for services in their communities. Learning that firsthand allows us to plan for how best to respond through what we design and provide through AltaMed, our network of community pediatricians and our ambulatory care centers.
That is a high-level strategy. Some of those things we’ve been doing for years, some of them are brand new. It’s our desire to make sure that we can provide appropriate care and support closer to where families reside.
One challenge for us is the homeless population of L.A. County. At latest count there are about 60,000 people living on the street in Los Angeles. This includes many families. We engage in special outreach through our Division of Adolescent and Young Adult Medicine and actively care for about 1,200 homeless children and young adults residing in the general area where we are located.
Of course, we will care for any patient. But this is true outreach to meet their needs on a regular and routine basis. We want to make sure these kids are getting their health care needs met, and other support they may need, such as for nutrition and safety.
The homeless population is an enormous challenge and goes well beyond the scope of what we can do on our own. But we do help, the best way we can, to provide support in this very needy environment. It’s not unique to LA, but the size and magnitude of the problem here is just enormous.
Let me close with a story.
A while back we had an event on the west side of town over toward Beverly Hills. I was there with a couple of our faculty members and they were talking about how special their program is and how they’re treating children with cancer, and that we have one of the leading cancer programs in the country.
They were sharing a lot of information and everybody in the audience was receptive and quite enthusiastic about what they were hearing.
We get to the question and answer section of the evening and a gentleman sitting in the back row of the room raises his hand and he says, “I don’t have a question for you but I do have something to say to you.”
He’s looking right at me and he says. “Sounds like you have a really easy job.”
And of course, what do you do? You laugh, right?
And I said to him, “You know, you’re right. Let me tell you, sir. I have the easiest job in town. Let me tell you what it is. My job is to get all the resources I can and put them in the hands of these brilliant doctors and their nurses so that we can treat those precious children that have been entrusted to us. That’s my job.”