Title:Leading roles

In navigating an ever-more complex health care system, Georgetown alumni in executive roles are guided by the mission of cura personalis.

From an early age, Katie Skelton (N’75) knew she wanted to become a nurse. When her older sisters went off to college in Washington, DC, she visited them frequently—falling in love with the city and setting her sights on Georgetown as the perfect place to study nursing.

Although only a high school sophomore, she requested an appointment with Rose McGarrity, then dean of the Georgetown School of Nursing, to speak about the educational opportunities offered at the school.

“She actually met with me, which was remarkable,” Skelton says. “She encouraged me to continue pursuing my interest in Georgetown. I look back now and think, ‘What an amazing woman she was.’”

Rising through the ranks to become vice president of patient care services and chief nursing officer at St. Joseph Hospital in Orange, California, Skelton has been in a position to pay forward the support she received as a high schooler from Dean McGarrity. Most recently, she joined the faculty at Azusa Pacific University as an adjunct, teaching a nursing leaders course. Skelton also works as a health care consultant at Force 10 Partners.

In advising young professionals seeking health care leadership roles, Skelton emphasizes that, along with clinical skills, business knowledge is essential. She is among a growing number of clinicians—many Georgetown alumni included—who have earned advanced business degrees.

“You need to pick up an additional skill set on the business side if you want to be successful in an executive role or as a patient advocate,” says M. Joy Drass (M’73, R’74), executive vice president and chief operating officer for MedStar Health, who holds an MBA from the University of Pennsylvania’s Wharton School along with her medical degree from Georgetown.

At the same time, Georgetown-trained practitioners in particular bring to their leadership roles a dedication to cura personalis, balancing financial imperatives with patient needs.

“What I take from my experience at Georgetown is that Jesuit tradition of compassion,” says Nicholas Holmes (C’89, M’93), president of the Benioff Children’s Hospitals of the University of California San Francisco. “In each and every decision I make I know that, yes, it’s a business decision, but having been a clinician I know how that decision impacts the patient, as well as the parents and other caregivers.

“It allows me to keep the patient at the center, striving to make the best decision not only for the hospital but also for the patients who seek care here.”

Adding Value

While the percentage of U.S. universities offering MD/MBA programs increased from 26.4% in 2002 to 60.9% in 2022, it’s still relatively rare for health care administrators to have clinical backgrounds. The Centers for Medicare & Medicaid Services estimates that only 5% of hospital CEOs are physicians. (At children’s hospitals, Holmes notes, that figure is much higher, at 30%.)

Universities across the U.S. have responded by developing innovative programs tailored specifically to prepare clinicians to assume leadership roles. At Georgetown, in addition to a joint MD/MBA program between the School of Medicine and McDonough School of Business, the medical school offers a well-established Healthcare Leadership Track (HLT), overseen by former dean Ray Mitchell (W’86, MBA’13, Parent’15).

The School of Health has developed a renowned values-based Master of Science in Health Systems Administration as well as an Executive Certificate in Clinical Quality, Safety, & Leadership. This past year, the McDonough School launched an MBA Certificate in the Business of Health Care.

Skelton decided to attend a program for nurse executives at Wharton relatively early in her management career. “At that time, clinical leaders were being thrust into much bigger roles than directors of nurses had historically been. The finance piece of it was probably the most uncomfortable part of my early work, and I knew I needed that background,” Skelton says.

“It was a three-week intensive program on campus and I had to commit to bringing my boss for several days, who agreed to come. It was a great, great opportunity for me.”

Similarly, Holmes completed a business of medicine certificate program at Johns Hopkins University’s Carey Business School while serving in the U.S. Navy. Both Skelton and Holmes went on to earn their MBAs.

When advising current medical students contemplating a health care leadership role, Drass stresses that while a business skill set is essential, it’s best to start off in clinical practice.

“You have to experience the joy of practicing medicine first,” she says. “That’s why you went to medical school. What comes from that experience is an understanding of the dynamics between physician and patient—the human part, but also the complex operational systems that are foundational to the delivery of care.

“Having that understanding is where you can add real value, both in your journey as a leader and also in your advocacy for patients.”

The Language of Business

Drass went into clinical practice after graduating from Georgetown School of Medicine in 1973—where she was one of only 10 women in a class of 115—and completing a residency and critical care fellowship. She worked for 13 years as an intensivist in the surgical intensive care unit at MedStar Washington Hospital Center.

She then made the decision to attend Wharton’s MBA program. “I went to business school at a time when there was a lot of disruption in health care,” she says. “Initially, it was not about how it would change my career, but more that I couldn’t be a good patient advocate if I didn’t understand the financial realities.”

At Wharton, she took only one course specifically focused on health care. “My thought process was, I’m not here for you to teach me health care—I know health care. I’m here for you to teach me business,” she says. “So I really stretched myself into the more core business courses. And I think in retrospect that was the right decision.”

After earning her business degree in 1991, Drass didn’t intend to move immediately into an administrative role. Kenneth Samet, then president of MedStar Washington Hospital Center and now CEO of MedStar Health, offered her a position as vice president for professional services and associate medical director. “It was a terrific opportunity that I couldn’t pass up, so I made the transition more quickly than I might have.”

In that position, Drass played a crucial role in establishing the Georgetown/MedStar Health partnership. She went on to serve as president of MedStar Georgetown University Hospital for nine years before moving into her current job.

As she took on successively more challenging responsibilities, Drass continued to draw on her business training. “What business school gave me was language and skills so that I could bridge the gap between clinicians and administrators. I often tell people that my main job every day is translating what the clinicians are trying to say to the administrators and translating what the administrators are trying to say to the clinicians, because not infrequently, they’re on the same page but they just don’t know it.

“I think our North Star, both with MedStar as a whole and at MedStar Georgetown University Hospital, is to provide high-quality, safe care to every single patient. Decisions are made through that lens,” she says. “As we become more and more evidence-based in our practice of medicine, that’s helpful. We’re better at understanding what treatments help which subset of patients.”

She thinks Georgetown and MedStar are particularly well-positioned to comprehensively address the complexities of the U.S. health care system.

She cites as an example the Georgetown Health Justice Alliance Perinatal Legal Assistance & Well-being (LAW) Project, which provides legal services to pregnant and postpartum patients receiving care at MedStar Washington Hospital Center. The project is part of the larger MedStar Health’s Safe Babies/Safe Moms initiative supported by the A. James & Alice B. Clark Foundation.

“I love the Georgetown MedStar partnership. What we learn from the things we do, we share,” she says. “When you put the two organizations together, with care delivery, education, and research, it’s a pretty powerful force for change.”

Leadership as a discipline

Like many clinicians who transition to executive leadership, Drass views her position as an extension of her previous responsibilities providing direct patient care. “I don’t feel like I left the world of care delivery,” she says.

Nicholas Holmes shares that perspective. “I can take care of one patient at a time being a physician or surgeon, but being a leader in health care, I’m responsible for thousands of patients,” Holmes says. “I can really make an impact in changing people’s lives, not just on an individual level but on a macro level.”

A pediatric urologist, Holmes served as senior vice president and chief operating officer at Rady Children’s Hospital San Diego before moving into his current position in March 2024. In addition to overseeing UCSF Benioff Children’s Hospitals, he is responsible for all pediatric clinical services across the health system—encompassing six affiliated hospitals, 12 specialty satellites, and more than 180 primary care pediatricians.

Holmes credits his Georgetown education for starting him on his current path. “Being at medical school at Georgetown really gave you the opportunity to be hands-on. We used to have this phrase, ‘See one, do one, teach one’—that made you be active in how you engaged in the workplace. It opened my eyes to what it’s like being a leader of teams.”

After medical school, Holmes served as a physician in the U.S. Navy for 15 years, rising to the rank of commander. “The Navy really honed those leadership skills. As I got older, I realized that leadership was a discipline, just like being a surgeon,” he continues.

It was then that Holmes decided to pursue opportunities for advanced executive training, first in the Johns Hopkins certificate program, then in the Physician Executive MBA program at the University of Tennessee, Knoxville.

Attending business school also enabled Holmes to pair leadership training with the necessary financial education. “It’s absolutely paramount if you’re going to be a leader in health care that you understand the financial side,” he says.

That knowledge is especially vital because the health care payment system is unique, Holmes says. “We’re the only industry where what we charge is not what we get paid nor does it reflect the value of what we provide.”

Pediatric care presents an additional set of challenges, he adds. “A lot of what we do in pediatrics doesn’t contribute to the bottom line. You have to weigh that all the time, because many of the activities that aren’t revenue-generating are absolutely critical in childhood development—especially related to psychosocial support and also the support we provide to families that’s essential to the way kids heal.

“We keep our programs open to anyone regardless of their socioeconomic status, so it forces us to be creative in what we do. We’re so fortunate to have philanthropic support as well as community support. And sometimes it’s better that you don’t lead, but you instead collaborate with an organization that may have more support and more assistance.”

From his undergraduate years at Georgetown to his current position as hospital president, Holmes sees service as a throughline in his life.

“I went to Georgetown for the academics, but the spirit of Jesuit education and service really spoke to my soul. I just didn’t realize it at the time,” he says. “I think that was pivotal in forming who I am as an adult and as a leader in health care.”

Practicing Equanimity

Katie Skelton found her calling as a health care leader while working at City of Hope comprehensive cancer center in California. “I loved oncology nursing, but as it turned out, I really loved taking care of oncology nurses,” she says. “I saw my calling as creating systems and processes that support nurses in the work that they do.”

Moving into management at City of Hope, she eventually was appointed chief nursing officer. In that position, she succeeded in integrating all clinical departments into cross-functional teams.

Soon after accepting an executive position at St. Joseph’s Hospital, she made the decision to attend the Wharton School nursing executive program. A decade later, she enrolled at Claremont Graduate University, where management education pioneer Peter Drucker had developed one of the country’s first executive MBA programs for working professionals.

“I very carefully picked where I wanted to go to graduate school. I spent three years learning the Drucker method of leadership and I think it help- ed me form my own philosophy of how to lead,” Skelton says.

“Lobbying for resources and supporting the frontline versus being a team member in the executive suite, that is a balancing act. There’s a lot of give and take,” she says. “It’s the people connection that makes a difference—you’ve got to have relationships and communicate well.

“Everywhere I’ve worked, I’ve always had advisory councils of frontline staff nurses. And I made it a point to round on days, on nights, so I wasn’t afraid to know what was going on,” Skelton adds.

“There’s a word—‘equanimity’—that means something isn’t necessarily good or bad. Say you need to merge with an organization—there are plenty of people who just jump to ‘that’s terrible,’ or ‘oh my gosh, that’s wonderful.’

“In that situation, equanimity is an important word to keep in mind. You have to say, ‘We’re going to move in this direction, I’m going to have all your input, we’re going to see how this works, we’ll tweak it, we’ll revisit it, and do it so it works.’ It’s moving forward with an understanding that perfect is the enemy of the good.”

Skelton was able to apply that leadership approach during a financial crisis at St. Joseph Hospital when an entire service line was moving to another hospital. “We gave every department a challenge—how do we do work with 10 to 15% fewer resources? The frontline came to us with many more opportunities than we had ever hoped for.”

As a teacher and mentor, Skelton emphasizes that leadership requires self-knowledge. “Spend time defining your own values. In leadership, you are constantly challenged to make sure that what you’re creating—or dismantling—is consistent with your values.

“I always asked my leadership group, ‘Would all of us still want to work here after we make these changes?’ I think it’s helped some nonclinical people especially to rethink things they were advocating for.”

Above all, she says, strive to be a servant leader. “It’s all about the common good and caring for the individual—mind, body, spirit. I was fortunate to work at City of Hope, where their mission stated: ‘There is no profit in curing the body if you destroy the soul.’ That went along with my upbringing, my training, my Georgetown education.

“I am grateful every day for the education I received. The experience at Georgetown made me the leader that I am today.”