Q&A: Art Ushijima reflects on his career at Queen’s

Art Ushijima is the President and CEO of the Queen’s Health Systems and is considered by many to be one of Hawaii’s most influential and consequential health care leaders. Last summer, Ushijima announced his retirement after 30 years at Queen’s. In anticipation of his retirement in January 2020, we spoke with Ushijima to reflect on his career, discuss his guiding leadership principles, and look ahead to trends on Queen’s horizon. 

Karianna Wilson: Having been at Queen’s for decades, are there any particular accomplishments you are most proud of during your time there?

Art Ushijima: “More recently, I get asked that question quite a bit. And my typical response is that chief executives don’t do the work; it is really the work of the staff.

There are many things that the organization has accomplished that I’m proud of. But if there’s any singular thing that I could point out during my tenure, it’s that I think that the organization is really focused on its mission. And that mission goes back to 1859 when the hospital was founded. The way that the mission is stated today is: “To fulfill the intent of Queen Emma and King Kamehameha IV to provide in perpetuity quality health care services to improve the well-being of Native Hawaiians and all the people of Hawaii.”

And I think that the programs and services that have been developed, and the focus of the last 30 years — and I won’t take credit for the things that have preceded me — but certainly the organization has clearly become much more focused on its role in serving its mission.”

KW: Queen’s has been very supportive in terms of its mission in taking care of the Native Hawaiian community but also the community in general. In supporting H4 as one of the key stakeholders, how does that fit into the conversation around mission?

AU: “You know, some of our staff were telling me, ‘we’re just seeing so many more homeless than we did a number of years ago’ — similar to a lot of hospitals around the country. So, we looked at the data and we found that we were doing 66% of the homeless care at Queen’s in downtown. And so we asked, what’s the strategy, what do we do? And we decided to really take a different approach and to see if we could make a difference in a different way.

We started to look at how to mitigate the demand, because most of those patients came through the emergency room. And we analyzed the costs — $40 million a year, roughly, and about $12 million unreimbursed. That’s about $1 million a month based on the data that we had at the time.

I contacted Lt. Gov. Josh Green, who at the time was Chair of the Senate Human Services Committee which oversees the Medicaid program. And I also contacted Kirk Caldwell, the mayor, because a lot of the issues emanate from the city, and we started to broaden the network of folks involved.

There were a number of initiatives that were targeting folks that could actually hold jobs, they just didn’t have a home. So, we identified that really it’s the chronically homeless – those that have particular problems with substance abuse and mental health issues – that represent about 20%. And that’s also the volume of patients and individuals that drive a lot of our ER visits too. And so we started to come up with a project that would target that population.

And fortunately, HMSA said they would volunteer to contribute up to $8 million over 5 years, which gave us some additional capital to work with.  And later on in the process, Kevin Webb, who owns Islands Hospice, said he would personally commit $2 million. So we had about $10 million of capital to help us. And then Hawaii Homeless Healthcare Hui, or H4, was created as a not-for-profit.

So this H4 project has really been one in which we worked with different community agencies that all have a stake in the homeless issue… But my expectation is that it’s a piece of the homeless puzzle. But we’re trying things that, hopefully, we can make as innovative as possible.”

KW:  One of the things you are known for is how close you have been to the details of the people and the patients that you guys are caring for. I have heard that you know some of the patients by name, some of those people who are visiting the ED frequently. I remember hearing about a frequent ED utilizer who had a pet duck, is that a true story?

AU: “I can’t say that I know all of these folks, but I do encounter some of these folks and I do get to know them a little bit. But, there’s probably more myth and legend than reality because it’s hard to get to know everybody.

But I do encounter and know our staff who deal with them, and I admire them for what they do because it’s a difficult job to do when you have to manage individuals who are difficult themselves. But this duck story — I use it a lot when I do new employee orientation. People will often ask, ‘how do you follow through on the mission?’ Because if you take the mission statement, it’s pretty broad as most mission statements are. And so I say, the way you deal with it is by virtue of how you present yourself to the people you interact with, and how you understand what their needs are.

And so the story of the duck is that I was in the emergency room and I was talking to one of the ER physicians. And he said, “have you met the duck?” And I thought it was a nickname for one of the patients, but he said it was a real duck. We have this little storage area by the ER, so I went over there and there was this black duck with a red bandana around its neck peering out of this pet carrier. And the story is that he belonged to one of our frequent users, one of our homeless patients.

And what our staff realized, is that in order to treat the patient, they had to make sure that the duck was taken care of because this patient would always be concerned about his buddy the duck. That was his companion. It’s just a really great story because our staff had the insight to know how important this duck was to this patient and they couldn’t treat him until this patient was assured that the duck was cared for. That tells you the insight and also the compassion that our staff had for this man. The ER is a great place to find these kinds of stories because you have all kinds of folks that come through the hospital.”

KW: In being so involved with your staff and with your team, what leadership principles have guided you and helped you create a compassionate and empathetic team?

AU: “You know, you want to hire people that share the values of the organization, that understand and appreciate the mission. So that’s one.

But as a person and as an individual in the role that I’m in, what I don’t always realize is that im kind of in a fishbowl. And so you want to be able to portray the values and live by them. Our values are very clear in that it’s codified in the acronym CARE: Compassion, Aloha, Respect, and Excellence. Compassion guides our actions, Aloha inspires us in all that we do, respect and understanding are essential for the dignity of all, and excellence is our quest. And so you strive to live by that.

And then we try and get involved with organizations that also support the communities. For example, with the American Diabetes Association and the American Heart Association. We try and get involved with those kinds of organizations that can help our patients and our community.

I also do as many new employee orientations as I can. I use the opportunity to greet the new staff, I talk about Queen’s relative to Hawaii’s history, and talk about our founders, but also the other monarchs of Hawaii and how we are relative to the history of Hawaii, and our place, and why we were founded. So we do these kinds of things and we remind people that the issues that caused Queen’s to be established are still there. I, as the CEO, have to be really clear about supporting the mission and demonstrating that both organizationally as well as personally.”

KW: Looking forward, what do you think are the challenges that will face Queens in the coming years? Are there trends that are developing that you think are going to be on the horizon for Queen’s?

AU: “There are many similarities in what we face here in Hawaii as most other health care organizations. You have to work with your third-party payers, you’ve got to work with your physicians — those kinds of things that everybody is faced with that we have to do as well.

There’s another component of what we do, and I think that it’s not necessarily unique to us, but it’s important that we really look at health care in a broader context. Some will say, well it’s really about dealing with the social determinants of health. And I think that every health care organization needs to really understand and work with those things that drive demand, and how we mitigate the demand because the acute care health care services are hugely costly and resource intensive. So, we have to deal with those kinds of issues.

One of the things that we’ve been doing as part of our community health needs assessment is we started to work with one of the local intermediate schools. We started to look at diabetes as an issue. Now, according to the American Diabetes Association, nationally, 30% of the people who are born after the year 2000 will develop diabetes in their lifetime. In Hawaii, that number is about 40%. And what we’ve learned is that if we start to look at these young adolescents, as we worked on this project, there was significant concern about their dietary habits, and obesity issues, and all that could result. So, we started to study that problem, and we’re not at the point where I can say that we’ve done much in terms of execution, but we’re learning. And what it says is there’s so much front end work that we have to do.

And then there’s the other side of the spectrum and that is the seniors. One of the fastest growing groups in this country is those 85 and over. Well, we know that demand for health care services are going to increase and that’s the expensive part of the spectrum. That’s me; I will be in that category and I want to know that I’ve got a health care system to go to when that demand starts increasing. It is going to be a real challenge to deal with the demand as the population ages. But also, what I didn’t fully realize is how much we have to put into the younger population in driving them to be more preventatively oriented and wellness oriented because it’s just too expensive to deal with it on the health care side.”

KW: As you look back at your legacy, are you excited to leave Queen’s where it is now and focus on the future? What are your plans?

AU: “Well, first of all, I get asked about ‘what’s your legacy?’ and I don’t have a legacy, but I work for one. And that legacy is 160 years old. And I would expect that this next phase of Queen’s is going to continue on because the direction of this organization was set 160 years ago. We need to continue to drive and focus on those needs that are still there today.

I look at Queen’s and organizations like Queen’s as social enterprises, meaning that we have a social mission – that is to serve the broader community. But we have to also manage these enterprises prudently. I think that organizations like Queen’s have to really be able to engage —  not just health care institutions, but the broader community — to deal with the health care issues that confront us. We cannot be just a singular, standalone, monolithic institution where people come to us; we have to do more. And we have to get out more and we have to engage people and organizations. It’s hard to do, but important to do.

It’s not just mitigating demand. You can’t always just mitigate demand by rationing services — that’s not the point, right? It’s really how do you improve health and wellness of people in the community. So, I think sort of the secret sauce is going to be how health care organizations can engage communities and businesses in improving the overall health and wellbeing of a community.

One of the things I’ve learned about H4, an important lesson, is that engaging stakeholders can create solutions. And I say solutions, because there’s no one solution. And that you have to stay on top of it; you have to work at it. It’s all about building relationships. It’s about building those connections that enable you to serve a societal need.”

This interview was conducted by Karianna Wilson and was transcribed and edited by Emily Boerger. The Q&A has been edited for clarity and length.