In Defense of Paul Levy

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Paul Levy, the blogging CEO of Boston’s Beth Israel Deaconess Medical Center, found himself in hot water last

month over an inappropriate relationship with a female subordinate. While some of the details of the transgression remain sketchy, I think I now know enough to opine on it. To my mind, Paul has been an extraordinary healthcare leader, and – while the episode represents a lapse in judgment that deserves censure – he should not lose his job.

Let’s start with some background. Paul took the helm of BIDMC 8 years ago. At the time, the hospital – which operates in the shadow of its more storied Harvard cousins, Brigham and Mass General – was in crisis: its staff was dispirited, it was losing a million dollar a week, and it was still reeling from the challenges of blending the cultures of its two recently merged progenitor hospitals, Beth Israel and Deaconess. (Hint: the religious mismatch was only the start of the tsuris.)

Paul was an unusual choice for the position of CEO. BIDMC CEOs have historically been physician-leaders, whereas Paul’s major prior roles had been to teach Environmental Policy at MIT and to lead the Massachusetts Water Resources Board, where he spearheaded the cleanup of Boston Harbor. Some folks wondered whether he was up to the task of being CEO.

But soon after he began, jaws began to drop and many skeptics became fans – this was clearly not your father’s hospital CEO. An extraordinarily hands-on manager, Paul literally gushed with pride over the accomplishments of his physicians, trainees, and nurses; even the housekeepers and transporters. He embraced transparency with bottomless zeal, reporting all of BIDMC’s quality and safety data (good or bad), and challenging fellow hospital CEOs to do the same. He launched a blog, “Running a Hospital,” which became a widely read window into his thinking and management style. Within a few years of assuming his role, Levy had become arguably the best known and most highly respected hospital CEO in the nation.

Sure, it was great theater, but the important thing was that it worked. Last year, I had the honor of being visiting professor at BIDMC, and was struck by the organization’s wonderful people and by their passion for the joint. In the past decade, BIDMC has become a model of innovation, transparency, and collegiality, winning several awards and serving as the subject of a number of case studies regarding hospital quality. When I asked people at BIDMC for their best explanation for the remarkable turnaround, most of them gave the same answer: “Paul Levy.”

There are many examples of Paul’s leadership style and impact, but my favorite happened occurred in 2009, when the economic meltdown pulverized BIDMC’s finances (on top of the usual reasons, some of BIDMC’s key donors had major Madoff issues). Rather than mindlessly triggering scores of demoralizing layoffs, Paul called the entire staff to a meeting in the hospital’s Sherman Auditorium. Kevin Cullen of the Boston Globe described the extraordinary scene:

[Paul Levy] looked out into a sea of people and recognized faces: technicians, secretaries, administrators, therapists, nurses, the people who are the heart and soul of any hospital. People who knew that Beth Israel had hired about a quarter of its 8,000 staff over the last six years and that the chances that they could all keep their jobs and benefits in an economy in freefall ranged between slim and none.

“I want to run an idea by you that I think is important, and I’d like to get your reaction to it,” Levy began. “I’d like to do what we can to protect the lower-wage earners – the transporters, the housekeepers, the food service people. A lot of these people work really hard, and I don’t want to put an additional burden on them.

“Now, if we protect these workers, it means the rest of us will have to make a bigger sacrifice,” he continued. “It means that others will have to give up more of their salary or benefits.”

He had barely gotten the words out of his mouth when Sherman Auditorium erupted in applause. Thunderous, heartfelt, sustained applause.

Paul Levy stood there and felt the sheer power of it all rush over him, like a wave. His eyes welled and his throat tightened so much that he didn’t think he could go on.

That, folks, is what I call leadership.

So let’s get to the problem. Last month, the BIDMC board announced that Paul had demonstrated “lapses of judgment in a personal relationship,” leading it to express its disappointment along with its “unanimous continued confidence” in Levy’s leadership. (Well, not exactly unanimous: one board member resigned.) The board also announced that it was fining Levy $50,000, would be considering the matter in setting his salary next year, and had asked state attorney general Martha Coakley (of How’d-You-Lose-Ted-Kennedy’s-Senate-Seat-To-A-Guy-Driving-A-Pickup-Truck? fame) to investigate. Neither the board nor Levy said more, leading to predictable cries of hypocrisy – after all, here was a CEO who branded himself as being all about transparency, invoking “no comment” – and some calls for his resignation.

I’ve wanted to comment on the Levy situation for weeks, but it was difficult to do so without knowing more about the specifics of the “lapse.” Although we still don’t know everything, last week (after obtaining the BIDMC board’s permission) Paul opened up to the media, giving interviews to two Boston newspapers and one TV station.

Apparently, the story is that soon after he became CEO, Paul gave a job to a “very close friend,” a woman who began an administrative position at BIDMC’s main campus and was later transferred to the hospital’s suburban Needham site. Paul, who is married, has declined to specify the precise nature
of the friendship, it’s clear that it is substantial, and that the woman
spent considerable time with the CEO at work.
This was a poorly kept secret for years, and several colleagues urged him to sever the relationship or end the woman’s BIDMC employment. Finally, earlier this year, she did leave her job at BIDMC, accompanied by a severance package.

Clearly, the optics on this aren’t good and the episode demonstrates a lapse in judgment – both in hiring the woman and in failing, for years, to listen to colleagues who asked him to end the relationship or let her go. On the other hand, there is no evidence that the woman was unqualified for her role or was paid above market rates (her yearly salary was about $100,000), that the relationship compromised Levy’s performance, or that Levy profited in any way from it.

While the situation calls for criticism, it also begs for perspective. Paul Levy has transformed the quality, safety, and efficiency of patient care at BIDMC, a $1.2 billion organization that cares for hundreds of thousands of patients each year. Moreover, his openness has inspired other healthcare leaders to be more courageous in their approach to safety and quality. In the process of making some hard decisions in a very public job, Paul has amassed some enemies – particularly local unions like the SEIU – who are likely behind more than a few of the vitriolic comments about him that have recently appeared on various Boston-based message boards. That, of course, is their right.

As for me, I’m hoping that the BIDMC board, which showed great courage in hiring Paul Levy and allowing him to make safety, quality, and transparency into signature issues, will show similar courage by retaining him as their leader. He deserves it.

More importantly, so do the hospital’s patients.

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20 replies »

  1. It’s a shame to see so many professionals so willing to condemn someone without all the facts in hand. I wonder, is this how you practice medicine? If so, I would be very concerned to walk through your door for treatment. I am not from the medical industry, I don’t know any of the above authors and heck, I don’t even live in the same state. However,I do believe facts should speak for themselves, and void of fact, you are simply guessing. Given the accomplishments of this man, does your envy so supercede your good judgment that you are willing to undermine the hopsital and its patients with sheer speculation? Not that my opinion matters, but the ones who should really cast the first stone are those directly harmed by his actions. Now ask yourself, is that you?

  2. If there was no sexual relationship, why is the gender of the subordinate mentioned in every article about this? What does gender have to do with it at all?

  3. Really, what is the difference between smiling and grinning mischeviously? Intent!
    Can’t you tell the difference between an honest smile and a facade? Maybe that is his look. But, years of dealing with those who are not honest but have mastered the facade, one has the right to be cautious and wary.
    That is my take. So you have yours. And stop insulting me about how I practice. My patients who are interested in treatment seem to like and appreciate me, for one reason is my honesty and directness.
    How many physicians practice that these days?
    How many patients smile in your office?

  4. Exhausted;
    Well, I hope none of your patients come into your office smiling; they might be judged!

  5. Paul Levy is a self-centered man who cares more about his mistress than his wife and daughters. He has violated his marriage and family by his ongoing affair. He has violated those who work for him by his deceit. It this the type of guy that should be leading the BIDMC?

  6. Exhausted,
    You now know why he has a perpetual smile. It is the opposite of why cows faces are so long.
    You make some interesting suck up comments. Is his hospital all that safe? What has he done to foster safety, actually? His blogging is a facade, hiding his true character, as witnessed by recent events. He blames his evasiveness on the BOD. Sure.
    It is one thing to violate his family, but it is another to elevate the mistress rather than another employee equally or more deserving.
    I have lost respect for you.

  7. Bev MD:
    there you go again!
    “When the situation calls for criticism, it also begs for perspective.” What?! That line alone is a red flag. When a situation calls for criticism, it should beg for reflection, and tough review. Begging is a sign for sure guilt, and mercy, like trust and respect, is earned, not just granted because you did some good things.
    Here’s a question I would like to hear readers consider:
    can one bad thing erase a strong history of good things? It depends on what is bad. Life is about consistency, and I truly believe people are consistent. Consistently good, or bad, and if they tend to the dark side, their “good” moments usually reflect a lack of true and honest intention to do so, just to distract and try to equalize when the bad is caught.
    You, the readers, ponder and decide. I don’t know Paul Levy, but, I have found his picture at this site to be smiling too much. Maybe I am over thinking about it now, but, that was my instinct when I first saw that shot with the grin. Just an opinion.

  8. Good grief. That this exemplary manager would be raked over the coals for a long-lasting friendship whether with or without sex, one which, it seems clear, does not constitute any harassment and which has not interfered in exemplary on-the-job performance whatsoever is unconscionable. Issues are between him, her and his wife. When I worked, my fellow workers and I were always aware of “relationships” going on, rules or no. The idea that somehow people can steer clear of meaningful relationships which may have sexual content to them at the places where they spend most of their working hours is ridiculous. Let him who is without sin, etc. There is something in the culture which seems to like to destroy heroes by fixing on irrelevant “sins.”

  9. Seriously??? The guy had an affair, or not…. I don’t see what this has to do with his job performance and/or his judgment. As far as I know, BIDMC is not a subsidiary of the Vatican. Maybe everybody should just mind their own glass houses and leave other people alone.

  10. Tim;
    I think “the problem” is as Dr. Wachter states:
    “Clearly, the optics on this aren’t good and the episode demonstrates a lapse in judgment – both in hiring the woman and in failing, for years, to listen to colleagues who asked him to end the relationship or let her go.”
    Since his interview states they were friends for 15 years, I don’t see how sexual harassment even enters in.
    So, Exhausted, still mad at me for the Ronald Reagan crack?

  11. The best defense is one that can maintain the best air of unbiased and objective perspective, not friends, colleagues of close nature, or family, and certainly not people who profit from the accused’s actions.
    The way this post comes across, it seems to be a premptive shot across the bow to try to deflect/deter/diminish attacks that could have at least some credibility to present. Rule number one in life: be honest and direct, and if you innocently and unintentionally made a mistake or had the random chance lapse of judgment, admit it, fix it, learn from it, and move on. This sounds Clintonian in it’s presentation, eh?
    And now I have to ask yet again is this post just trying to cover it’s butt for having a commenter who is perhaps not the most responsible and reliable participant to promote this site’s agenda?
    Where there is smoke, there is usually fire. The question is, who’s gonna get burned here?

  12. Bev,
    Good questions.
    Now I’m really puzzled. If the relationship was not sexual, I actually don’t understand what the problem was. She was his friend? So? Was she qualified for the job? Was she paid appropriately?
    That he was her “acknowledged mentor” makes the hiring more legitimate, not less. Unless there are details we’re not hearing.
    You read more into my word choice than I do: I’m not interested in the sex, I’m interested in the possible sexual harassment. The first is between Mr. Levy and his wife; the second between him, his employer, and the Federal Courts. That would be a “sin” here, in the sense of “actionable against the employer.”
    Those other things you list? They sound worse, indeed, but I have no idea what they have to do with this subject.
    If he did do something wrong, and knew it “for years”, that’s not a mistake. We have a whole host of words available, so pick one untainted by religion if you like, but “mistake”? No, that’s indulgence, and probably less severe than Mr. Levy himself would use.

  13. I must say, this situation does not seem to follow basis principles of crisis management. First, get all the facts out; second, the Board Chair or designee must take charge of communications on behalf of the institution, not Mr. Levy. Third, Mr. Levy, who seems to be a capable leader who has made some errors in judgment (magnitude unclear) should ask himself some hard questions e.g. “what is best for the institution”?; “am I capable of continuing to effectively lead given what’s happened”?

  14. Tim;
    Since you used quotes from my comment, I will assume you are disagreeing with me, so I take exception to your remarks. First, from all public evidence the relationship was not sexual, and also he actually was her acknowledged mentor prior to either of them coming to BIDMC. Second, I wonder what other things you would call a “sin.” Is habitual vicious abuse of nurses and other subordinates by physicians not a sin? Is an administrator who colludes with a cardiologist to put stents in normal patients not committing a sin? (see Dr. Wachter’s May 14 post).Where are you going to define a “sin” compared to a “mistake”? Compared to my examples above, our national preoccupation with sex as a “sin” pales in my opinion.
    Mr. Levy made an error which hurt his company just like any CEO who makes a bad judgment hurts their company. In his case he should, in retrospect, not have hired a personal friend of long standing to work for him and then allowed that to damage morale. He screwed up, he admitted it, and surely won’t do THAT again. I do not consider accepting this as “indulgence.” We would have precious few leaders if so.

  15. Either there was sex or there was not. If the relationship was sexual, then it was not “mentorship”, it was not “treacherous to navigate”; it was arguably quid pro quo sexual harassment, and the arguable part will be decided by the lady in question after she has the leisure to contemplate her prospects and listen to her attorney friends.
    He exposed his institution to significant liability.
    He gives every reason to believe his reputation for transparency is fake. And fake transparency is worse than opacity.
    Those who defend him are constructing the indulgence theory of leadership redemption: do enough good, and you earn the right to one free sin. This works, once, but the second sin is always the hardest to shrive.

  16. His actions are not defensible. Many a physician was brought to sham peer review to coerce pro administration alteration of behavior. Was the paramour a deep throat to Levy?

  17. I think Paul has had his friends send in comments. In any other organization, a CEO who has an affair with his subordinate; gets her a high-paying job in the organization; all the while employees are taking pay cuts, would be let go IMMEDIATELY. Clearly, the Board is very sleazy, as is Levy. For patients, you ought to think many times before you hand over your healthcare to this organization. I would never go back while he is CEO – there is no excuse for his egregious behavior.

  18. I think people deserve to be judged on their entire career and their entire record. This episode is part of Paul’s record, and I think the Board dealt with it in a fair, appropriate, and balanced way. His record in its totality is still extraordinary in my opinion. Would our national healthcare system be better off if every hospital in the country were led by someone with executive and leadership abilities comparable to Paul’s? My answer is absolutely yes!

  19. As a female physician, I have had many older male mentors. Some became friends. I have no doubt that people talked. This is a shame because in male-dominated professions, women cannot advance without male mentors. Breaking the glass ceiling is difficult enough.
    I say that, recognizing that a direct boss-subordinate relationship is more treacherous to navigate. However, I hope these incidents do not discourage cross gender mentorship in the future.
    As for Paul Levy, as I have mentioned before – I do not like hospital administrators in general, but I consider him a model for what a hospital administrator should be like. He has been a strong voice and actor for improving patient care and, more important, has walked the walk in his own hospital. Too bad that more administrators don’t follow in his footsteps, instead of counting their $$ secreted away in their offices.

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