Episode 8 – A Bias For Action | Scott Smith, MD

This is the first of many conversations with remarkable, consistent, and accomplished leaders in order to put a spotlight on the behaviors that contribute to their leadership effectiveness. In this episode, I talk with Scott Smith, MD, a healthcare leader, and physician. His journey wends its way from his role as chief of cardiopulmonary medicine at the Kirtland Air Force Base; through his role on the executive team at Kaiser Permanente in Colorado; to his current local, system-level and international roles with CHRISTUS Health. In this episode, you’ll hear how attention to clarity, respectful behavior, and an ability to hold people accountable are the ideal complements to a bias for action.

Dr. Smith looks through a lens that is patient-focused and then pours his high-octane energy into doing the right thing for patients, his team, and the organization. He lives in Texas, but he has an otherworldly capacity to get things done.

Dr. Smith is an internal medicine physician and the Vice President of Primary Care and Clinic Operations for the Texas-based CHRISTUS Health System. He has responsibilities for ambulatory care in four states and in Latin America (Mexico, Columbia, and Chile). In addition, he is the Senior Vice President & Institute Chair of Primary Care for CHRISTUS Trinity Clinic in Tyler, Texas.

Scott Smith’s enthusiasm for his work, his breadth of knowledge, and his ability to create systems that solve problems are all brought into sharp relief in this interview. The framework I find most useful when considering the work of leaders is based on a model developed by Mary Beth O’Neill (Executive Coaching with Backbone and Heart):

  1. Leaders communicate the territory: They understand the organization and the industry and clarify the vision and goals to stakeholders.
  2. Leaders create outstanding teams and they facilitate the work of those teams.
  3. Leaders produce results primarily through others and they hold their teams accountable.

I highlight these critical areas and attempt to define the specific behaviors that Dr. Smith uses to fulfill these leadership roles. In future episodes I will continue this approach—my intention is to zero in on behavioral characteristics of leaders as opposed to hashing over their leadership philosophies or broad concepts.

Scott Smith describes a continuity of care initiative he led in Columbia, noting that their systems have many of the same challenges we see in the United States. One sharp difference was a lack of continuity of care-patients simply did not have personal physicians. If a patient needed care they would show up and be seen by whoever was available.Dr. Smith describes launching the continuity of care project by focusing first on providing a personal physician for patients who had four or more chronic conditions. As the program expanded to include more patients it grew to over 100,000 patients signed up for the network. The results included a decrease in program costs of $700,000 per month, and dramatic quality and patient satisfaction improvements. He said he got a bit choked up when the Columbian healthcare team showed him a video with testimonials from appreciative physicians and patients.

Dr. Smith led successful change initiatives with Kaiser Permanente in Colorado including EHR implementation and an Advanced Access project that improved patient access from several weeks to three days. When he moved to Texas to take on a leadership team position with CHRISTUS Trinity Clinic, he saw they also would benefit from better access to care. Once again, the advanced Access process led to dramatic reductions in wait times and big improvements in CG-CAHPS scores(Clinician and Group Consumer Assessment of Healthcare Providers and Systems).

In this interview, I asked a few of Dr. Smith’s colleagues to weigh in on Scott’s particular brand of leadership. Why did I do that? He has such a penchant to give credit to other people that it was difficult to get a clear picture of his actions. Listen in as a former boss and colleagues describe the keys to Scott Smith’s leadership effectiveness.

In addition, Dr. Smith goes around the world in this episode as he talks about:

  • how to manage resistance to change
  • the need to have criteria for success written down and widely shared before starting a project
  • the outstanding COVID-19 command center team that he leads
  • why some leaders are unwilling to hold direct reports accountable
  • the indispensable role of clarity
  • a particular pet peeve: leaders who don’t manage poor performers

and even why one patient spent six months making him 13 Christmas stockings!


Here’s the link to a case study on the AMGA website, written by Scott Smith, MD.

Building the Ideal Health System by Scott Smith, MD