Over its 23 year history, the Commonwealth Fund Fellowship, along with California Endowment Scholars program and Joseph Henry Oral Health Fellowship, has a proven track record of creating physician/other health professional leaders; the Alumni Spotlight interviews showcase the expertise and dedication to care for vulnerable populations as a testament of that success. Interviews have been edited for length and clarity.
Jean Le Clerc Raphael (CFF '06)
Division Chief, Academic General Pediatrics; Director, Center for Child Health Policy and Advocacy; Vice Chair for Clinical Affairs; Professor of Pediatrics; Department of Pediatrics; Baylor College of Medicine, Houston, TX; President, Academic Pediatric Association
Q. Can you tell us about your current role in your organization?
A. I am the Division Chief for Academic General Pediatrics at Texas Children’s Hospital, and I oversee clinician operations, education, and research related to primary care. I am also the Vice Chair for Clinical Affairs for the Department of Pediatrics, which involves maximizing access to care, supporting our clinical operations and different specialties, and ensuring family-centered care throughout our health care system. My third role is Director for the Center for Child Health Policy and Advocacy at Texas Children’s Hospital. In all of these roles, I embed the principles of health equity into my leadership.
How did your training prepare you to do the job that you have? Are there areas you've identified for continued leadership development and additional training in order to move towards leadership positions at senior levels?
The Commonwealth Fund Fellowship fundamentally transformed how I approach leadership. During the fellowship, I learned how to develop a vision, empower myself with data, and use framing to articulate my perspective. I also learned how to engage different stakeholders, particularly those with alternative views from mine. The fellowship gave me a core foundation to lead and amplify the voices of those who are most vulnerable.
Leadership training is essential and a life-long process. I think some components of leadership are best learned when you actually start in those leadership roles, because then you have a better understanding of what your needs are. For example, understanding finances becomes much more important once you're involved in that. Another area I think that is helpful is negotiation—whether you’re negotiating about your own employment or about issues within your organization. Understanding how you come together with other people to find solutions where everyone gets what they need, as opposed to what they want—that's a critical one. And then the last area is understanding organizational culture. That culture can vary so much. It might be different on the academic side of a health care system from how it is on the executive side of the health care system. Organizational culture informs expectations of how individuals engage each other, the language used, how data is to be received, and the toolkit of strategies used to advance the organization and problem-solve.
Q. Describe your leadership style and talk about a difficult decision that you've had to make as a leader.
A. I would describe my leadership style as collaborative, in the sense that I want to bring everyone's intellectual gifts to the table. There are so many talented people out there; I want them to feel like they can thrive, that they can put their ideas out there and feel validated as leaders whether they have formal titles or not. What collaboration means to me is that we all come together in more of a circular form, as opposed to just one person who's at the head of the table. Otherwise, you lose out on the richness of the intellect around you.
There are difficult decisions that come all the time. Sometimes they could be in the form of budgetary cuts—thinking about different parts of your mission and vision, and what needs to be cut or downsized to preserve the most essential aspects of what you do. And that's difficult, because those things may mean a lot to different people who you oversee. It can also be when someone no longer fits with what you're doing, and unfortunately you have to terminate someone. Those are extremely, extremely difficult situations. Again, it means thinking about the mission and vision you're trying to accomplish. How does that person fit into it? And also, what's best for that person, moving forward? They may thrive in a different setting more aligned with their unique skills, work style, and vision for their career.
Q. When you're in a situation where stakeholders may not share the same values regarding health equity or social justice that you do, how have you been able to move the needle and seek the outcomes that you're after?
A. I think one way is considering where the incentives line up. Sometimes, stakeholders may not share your perspective on health equity. They may not see it as valuable. They may have health equity fatigue. Or they may think they've already incorporated it into the work they do, and then they refuse to do more. In those times, you have to ask: What are their incentives from their career, from their specific job duties? What type of data do they find compelling? When you find those particular points, you can leverage them together. Unfortunately, it is not always possible to align incentives. In these situations, forging alternative stakeholder coalitions provides the best path forward.
With respect to health equity, there have been major shifts in the health care industry. The Joint Commission has put forward new standards around health equity. The Centers for Medicare and Medicaid have released health equity quality measures. U.S. News and World Report has added a robust set of survey questions on health equity to determine hospital rankings. So, when you talk about health equity with others in your organization, you can say it's not only the right thing to do, it not only enhances quality and patient experience, but now it is a core component of national standards.
Lastly, you need the right political window. That's something I learned from the fellowship. There are these political windows where there's an opportunity to advance your cause. And so right now, having all these regulatory and reputational levers brings unprecedented opportunity to address health equity.
Q. Can you tell us about how mentors have played a role in your life, and whether your mentoring relationships have developed or evolved over time?
A. Mentoring has played a huge role in my life. I grew up in inner city Boston, without tons of mentors, and in a single-parent home. As I advanced through high school and college, some of my first experiences with mentorship were through the Office for Diversity at Harvard, where I first got to meet Joan Reede and understand the value of mentorship.
If you establish a mentoring team, you have people who can contribute in different ways. They could be career mentors, life mentors, leadership mentors, research mentors. Because it's unrealistic to think that all that mentorship can be attained in one single individual. What you hope to do is craft a team that is complimentary and can support you in all these different ways.
Sometimes you have mentors who are assigned to you, and these are individuals who others have felt could have great value to you as a mentor. But there are times when the match just doesn't work because it's not as tailored as you might have hoped or your mentoring needs change over time. There’s great benefit to being able to seek out your own mentors as well. Because then you can think, "Oh, this person seems to approach work-life balance in the way that I value, so that person will be a meaningful mentor to me," or "This person is in a kind of career I'm not currently in, but I think at some point I'd like to consider. So, this would be a great person to continue to have dialogue with about future possibilities."
In addition to mentors, sponsors are essential for career advancement. Sponsorship is a bit different from mentorship in that sponsors take a greater direct role in supporting your career by giving opportunities such as being on committees, proposing you for open leadership positions, and just putting you forward in a way that’s much more proactive than a mentor typically does. Whereas a mentor gives career guidance, a sponsor really puts their hand on the scale to ensure that opportunities come to you. I think those sponsors accelerate your career in a way that complements mentorship.
Interview date: August 2023
