Message from ACHE Regent – Southern California

Health Care Executives of Southern California is positioned for a wonderful year. The Board of Directors of HCE, under the very able leadership of Dr. Tricia Kassab, FACHE, has launched 2020 with exceptional education programs and networking opportunities for its members.

I would like to thank the 2020 HCE Board of Directors, Vice Chairs and committee members for their volunteer leadership. If you are interested in getting more involved in your Chapter, there are many opportunities on committees, so please reach out!

Nationally, ACHE offers many educational and career advancement opportunities as well. I encourage you to take a tour through to access all of the resources that ACHE has to offer. The opportunity to explore advancement to Fellow status in ACHE is available for members who meet specific requirements. Again, the ACHE website offers information about the FACHE process. Please keep an eye out for a Board of Governors study series to be offered by HCE this year.

I would like to introduce Dr. Harry Sax, FACHE, as your newly elected ACHE Regent for Southern California. It has been an honor to serving as your Regent for the past three years and connecting with so many of you. As health care leaders, we do our best working together for the patients and communities we serve.

As always, our industry continues to face many different challenges. It is more important than ever to stay informed and engaged. Stay tuned for many innovative programs at the local level from your HCE Chapter!

Ellen Zaman, FACHE

David Nugent

David Nugent

Member Spotlight

David Nugent

Performance Improvement Analyst in the Value Improvement Office 
Keck Medicine of USC

Tell us a bit about yourself, your current position and your background.

I am originally from the North Shore of Chicago, a group of suburbs just north of the city. I completed my undergraduate education at Indiana University – Bloomington, majoring in Healthcare Management & Policy. After completing my undergraduate education, I served in several Performance Improvement/Lean positions in Indiana. In 2018, I relocated to Los Angeles for my current role. I serve as a Performance Improvement Analyst in the Value Improvement Office at Keck Medicine of USC. The department is split into “Pods”, and my Pod supports Verdugo Hills Hospital in Glendale. We provide Project Management, Process Improvement/Lean Methodology, Data Analysis, and Decision Support for the leadership team. I am also continuing my education at USC in the Master of Health Administration program.

When did you become a member?

I became a Student Associate of ACHE in 2015, I am now a Member.

Why did you decide to pursue a career in health administration?

My mom is a physician, and as many children of healthcare workers do, I grew up wondering if healthcare might be a good fit for me, too. However, although healthcare continued to be of great interest to me as I approached my undergraduate years, I decided that I wanted to explore my interest in business. I started school as a Finance major, and soon found that it was not the path for me. I was lucky enough to have a guidance counselor who knew my situation well, including my interest in healthcare. She informed me that the university had a Healthcare Management & Policy program. At the time, I had no idea what this degree entailed, or what doors it would eventually open for me. It was an excellent fit, and I have been fortunate to have very rewarding academic and professional experiences so far.

Why did you join ACHE/HCE?

I joined ACHE as a Student Associate at IU. One of my professors, also a Fellow of the American College of Healthcare Executives, encouraged all students to join.

What is the greatest benefit you have received from HCE so far?

By far the greatest benefit I have received from HCE was the networking and professional development opportunity that the BridgeRoads program offered. In 2017, I was ready to relocate out of Indiana – either back to Chicago, or to a new city. I reached out to several Early Careerist Council Chairs in various cities and inquired about any opportunities I might have to network. I had my eyes on Los Angeles as a destination, and through the HCE ECC Chair at the time, was connected to the BridgeRoads program. It was there that I met Tricia Kassab, who became my mentor, and Kenny Pawlek, who helped create the connection to my current position.

Who had influenced your career most?

I am so grateful for Tricia Kassab’s mentorship! She truly influenced my career the most so far. Having a mentor is so important. Prior to my relocation, we worked on developing my professional brand and building my network in Southern California.

Where do you see yourself in the next 5 years?

I see myself in a leadership position within Performance Improvement within the next 5 years.

Do you have any good book/newsletter/podcast recommendations for other HCE members?

Recently someone recommended the TedMed Talks to me. So far I’ve enjoyed them!

Mirna Orihuela, MBA

Mirna Orihuela, MBA

Member Spotlight

Mirna Orihuela, MBA

Manager of Post-Acute Networks
Martin Luther King, Jr. Community Hospital

Tell us a bit about yourself, your current position and your background.

I’m the Manager of Post-Acute Networks at Martin Luther King, Jr. Community Hospital. Prior to joining Martin Luther King, Jr. Community Hospital I was the Interim Manager of Post-Acute and Detox Services.

I obtained my master’s in business administration from California Baptist University and my bachelor’s in Health Science from California State University, San Bernardino.

I’m a first-generation college graduate raised by a single mother. I’m originally from El Centro a small farming community in southern California.

When did you become a member?


Why did you decide to pursue a career in health administration?

My passion for healthcare began early on at the age of 6 years old, I was inspired by Doctors Without Borders providing free services to my community in Mexico. My journey in healthcare and giving back to my community began.

I discovered health administration during my term as Chapter President for Health Occupations Students of America (HOSA) an international career and technical student organization. I had exposure to many talented healthcare providers and leaders from around the world. These talented individuals inspired me to consider giving back to my community and make a difference by being a leader and ensure high-quality care is provided.

Why did you join ACHE/HCE?

I discovered ACHE/HCE SoCal during my undergraduate education in 2013, we had a guest speaker (Mark Maramba) who spoke about the benefits of being a member and invited us to attend a networking event and meet people in the industry.

The people I meet there were welcoming, supportive, and inspiring.  These individuals took me under their wings and helped me navigate the industry and different stages of my career and life. I wasn’t only a member but part of a healthcare family.

I’m very thankful for Ebi, Lodel, Mark, and Mario M.

What is the greatest benefit you have received from HCE so far?

The greatest benefit I have received from HCE has been meeting other members who share the same values and develop friendships during networking and educational events.

Who had influenced your career most?

Joe Avelino, CEO of College Medical Center influenced my career the most. He saw potential in me and gave me an opportunity as an early careerist to gain exposure in healthcare. During my time working at College Medical Center, I learned a lot about hospital operations and finance. Most importantly extremely supportive of me during my growth in the industry.

Where do you see yourself in the next 5 years?

In the next 5 years, I see myself being part of a senior management team, obtaining my FACHE, teach and mentor future healthcare leaders, and be a speaker at Congress.  Additionally, I see myself continuing to travel the world and sharing the experience with a life partner.

Do you have any good book/newsletter/podcast recommendations for other HCE members?

The New Leader’s 100-Day Action Plan: How to Take Charge, Build Your Team, and Get Immediate Results  by George B. Bradt

Message from Healthcare Executives of Southern California President

Transformation occurs when organizations recognize the old way of operating can’t deliver the business strategies required to meet new marketplace requirements for success. A key feature of transformation is when a new state of functioning is unknown, and the change process must be shaped and adapted as it unfolds. A second key function of transformation is the essential role that mindset, behavior and culture change play in its successful transformation. Leaders must be willing to engage in their new personal change process to shift how they think, lead and relate; engage stakeholders earlier in the change process and to a greater extent; and overtly set up the change process to welcome and respond to rapid course correction (Ackerman-Anderson & Anderson, 2010). True transformation that delivers breakthrough results require a conscious change leadership approach. I highly recommend you read the “Change Leaders Roadmap” how to navigate your organizational transformation.

As the 2020 President of Healthcare Executives of Southern California, I am excited to engage and envision with our members in transforming our chapter to new levels. We welcome our members’ thoughts and ideas of innovated ideas and invite interested members to provide content for our quarterly newsletter. We want to better understand the value Healthcare Executives So Cal provide our members and execute strategies to exceed member expectations. There are numerous members who are ready to embark their FACHE, and our goal is to provide the tools and resources for your success. We are planning many educational events in our geographical regions (Los Angeles, Orange County, Inland Empire and Ventura/Santa Barbara) that will offer both face to face and qualified credits. Our networking events are essential for getting to know each other and we have several planned in 2020, including our joint event with the San Diego Chapter (SOHL) in Dana Point this summer. Learning from experience events involve C-suite members sharing success and challenges as they have progressed in their careers, and we have several events planning in 2020. In addition, we recognize the importance and needs of early careerists, and have planned several events this year beginning with the College Bowl competition in April!

Finally, we need to recognize our loyal Healthcare Executive members and amazing sponsors whose support is invaluable for our successful education and networking events! I humbly thank you for the opportunity to serve as your President in 2020!

Tricia Kassab, Ed.D., MS, RN, FACHE, CPHQ, HACP
President Healthcare Executives So Cal 2020

Ackerman-Anderson, L., & Anderson, D. (2010). The change leader’s roadmap: How to navigate your organization’s transformation. San Francisco, CA: Pfeiffer.

Emerging Healthcare Leaders: Five Career Traps to Avoid

By Dr. Kevin Nourse

Leading healthcare organizations recognize the value of investing in developing high-potential future leaders in order to establish a pipeline of talent ready to step into future management roles. Proactively developing future leaders can make a big impact on reducing the likelihood of career derailment later in their careers.

Having designed and facilitated several leadership programs to develop high-potential talent in healthcare organizations and related professional associations, there are five common career traps experienced by participants in these programs.  In this article, I identify five common developmental challenges faced by emerging leaders in healthcare:

  • Perfectionism
  • Inability to delegate effectively
  • Excessively blunt communication
  • Failure to say no or set boundaries with others
  • Overly self-critical

The good news is that emerging leaders challenged by these traps can employ strategies to mitigate them before they negatively impact their careers.


Perfectionism often appears as an overriding need to avoid errors while preparing a work product such as a plan or report. Perfectionists often become fixated on some inconsequential detail and may lose sight of the big picture on a project or initiative. While perfectionism isn’t always a negative quality, for many leaders, it goes to the extreme and leads to analysis paralysis, procrastination, lost career opportunities, and career derailment.

Consider the case of Guadalupe, a new supervisor. She advanced her nursing career to the point of becoming a supervisor in one of her organization’s clinics. She always prided herself on high quality, error-free work. Because the scope of her role has grown substantially, she has a hard time staying on top of her work demands. Her manager has become frustrated with her inability to meet monthly deadlines for reports. Guadalupe struggles with completing these assignments, checking and rechecking her numbers, and report formatting.

What causes perfectionism? In a 2011 study, a team of social science researchers clarified a definition of perfectionism and developed the Measures of Constructs Underlying Perfectionism (M-CUP) instrument that identified nine key components. Of the nine constructs, there are five that frequently challenge my clients:

  • Perfectionism toward others, which appears as having excessively high expectations of others and may result in harshly evaluating others’ work.
  • Reactivity to mistakes in which an individual experiences stress to real or perceived errors.
  • Perceived pressure from others in the form of internal beliefs that others have high expectations or will be overly critical of their work products.
  • Dissatisfaction in which a person does not believe they or their work products are never good enough.
  • Black and white thinking is the tendency to think that the lack of perfection translates to failure.

If you struggle with perfectionism, there are some strategies you can use to reduce your perfectionistic tendencies:

  • Build awareness of situations that trigger you to become excessively perfectionistic
  • Assess the benefits and costs of perfectionism – are there situations when it is warranted or instances when the opportunity costs are too high?
  • Clarify both the time allowed to complete a work product and the need for perfection with your key stakeholders.
  • Ask for feedback from others including peers and subordinates about the level of achievement you expect.
  • Experiment on low-risk assignments by setting a time limit on the amount of checking and review you perform.


Inability to Delegate Effectively

One of the most significant barriers to the ability of emerging leaders to advance their leadership careers is the ability to delegate effectively. Symptoms of faulty delegation include:

  • Holding onto tasks for which others could complete more effectively.
  • Micromanaging subordinates when delegation occurs.
  • Miscommunicating expectations to subordinates.
  • Not willing to invest time in developing direct reports to be able to delegate downward.
  • Fear of having to share constructive negative feedback subordinates if their performance does not meet expectations.

The negative impacts of poor delegation can be substantial. Past participants in high-potential development programs describe how an inability to delegate leads to a sense of overwhelm, adverse effects on work-life balance, diminished growth of subordinates, inefficiency, and limited opportunities to work at the highest level of ones’ abilities.

In this book Leadership Agility: Five Levels of Mastery for Anticipating and Initiating Change, leadership experts Joiner and Josephs argue that one of the most critical shifts in the development of leaders in the evolution from heroic to post-heroic stages. Heroic leaders derive their power from their achievements and knowledge, not recognizing the need to leverage the skills other others. As a result, it is increasingly difficult for them to play a bigger game in their role since their skills and capacity constrain them. The ability to delegate is one critical skill associated with successful leader growth and evolution.

Susan, a new supervisor with three direct reports, was excited when she received her promotion but is quickly growing frustrated with her inability to focus on critical priorities. Susan initially believed that “if I want something done right, I do it myself.” In the last few months, she has tentatively attempted to delegate more. However, when she reviews the work products of her subordinates, they completely miss the mark. As a result, she feels compelled to rework their work products in addition to her tasks. Since she does not provide developmental feedback to her team, they never learn how to improve, and the pattern continues.

Strategies you can use to better delegate include:

  • Review your and prioritize them using this schema: (1) mission-critical tasks or projects that only I can complete, (2) essential tasks or projects that others have skills to achieve, and (3) tasks or projects that are not critical and others could complete.
  • Experiment with delegation by assigning two of the least essential tasks.
  • Interview a colleague that is skilled in delegation to find out their insights.
  • Interview your direct reports to understand better their interests and skills that you might consider in your efforts to delegate.
  • Ask one of your direct reports for feedback about your effectiveness as a delegator.

Excessively Blunt Communication

Authentic communication that is direct and unambiguous is an essential leadership competency. However, leaders that communicate with a harsh tone without consideration for others can seriously damage their reputation and relationships with others. Symptoms of excessively blunt communication include:

  • Questioning others competence in a group setting
  • Using an accusatory tone
  • Cutting people off in conversations
  • Harshly worded emails that are copied to multiple recipients
  • Using the same approach to communication regardless of the audience

Leaders that are excessively blunt when they communicate may be overusing a strength for task-oriented communication, talking when they are emotionally triggered and are unconscious of their behavior, or lacking empathy and awareness of others’ feelings. The impacts of this communication style include damaging relationships with others, destroying trust, and stifling creativity and innovation. A clinical supervisor in a high-potential development program I facilitated suggested, “the negative impact of my blunt communication style is a reduction or loss of credibility, respect, morale, and staff productivity…I could lose forward-progress or even my job.”

Consider the case of Steve. As a highly experienced healthcare finance manager, he prides himself on speaking truthfully and directly to others. However, Steve tends to overuse this skill or use it in inappropriate situations – both interpersonally and through email. During a recent meeting, he became defensive and used excessively harsh language with a new manager, putting him on the spot in a meeting with his peers. While he apologized afterward, he quickly developed a negative reputation as being easily triggered and lacking leadership presence.

There are several strategies to use if you struggle with your communication style:

  • Identify your patterns for being overly blunt – do you demonstrate this with specific individuals or situations?
  • Take three deep breaths when you are triggered to speak harshly.
  • Proactively build relationships with others, so you have established a trusting foundation as a way to counteract future episodes of harsh communication.
  • Communicate your expectations to others in advance, so you are not triggered if they don’t hit the mark.
  • Leverage the talents of others on your team to diplomatically communicate in sensitive situations.
  • Enlist others to support to review your tersely worded emails before you send them.

Failure to Say No or Set Boundaries with Others

Supporting others and going above and beyond the call can make a positive impression on others. However, emerging leaders who are unable to say no or set appropriate boundaries may find others taking advantage of their helpfulness. Symptoms of an inability to set proper boundaries and limits with others include:

  • Feeling taken advantage of by others
  • Unable to complete your core duties and tasks
  • Feeling stressed and overwhelmed
  • Afraid of the conflict that might result from saying no
  • People-pleasing tendencies

Leaders that are unwilling to set appropriate boundaries and limits may do so because they are overusing a strength of building relationships, don’t believe they have the power or authority to say no, or lack assertiveness skills. Others struggle with this because they inaccurately assume others know their limits. In essence, they teach others through their actions that they will continue to take on more and more. One participant described how she “feels a responsibility to do what I can when I can, even if that makes it personally challenging for me. I feel guilty if I say no to something I could have completed even if it would have overloaded me substantially.”

Barbara is a new manager who struggles with setting limits and boundaries. When asked by colleagues to take on specific tasks, she does so without hesitation. Barbara prides herself on having an open-door policy. As a result, colleagues and direct reports stop by to ask her “quick” questions that result in much more extended conversations. As a result, she works overtime on nights and weekends to catch-up creating negative impacts on her work-life balance. She is growing frustrated and angry. Because of her pattern, she has little time to proactively build relationships throughout her organization, including her boss – a strategic career mistake.

What can you do if you struggle with an inability to say no?

  • Before committing to taking on tasks from others, wait 30 minutes and reflect on the opportunity costs of taking on the additional work.
  • Proactively communicate to key stakeholders when you are not accessible except in emergencies.
  • Pay attention to your patterns associated with people-pleasing – do you do this with certain people or situations? Do you tend to say yes at the end of the day when you are exhausted?
  • Interview a colleague who is skilled at boundary setting to find out their approach.
  • Enlist your boss to help in setting boundaries on requests from peers or other departments.
  • Learn negotiation skills and the art of exchange – if you take on someone’s task, what are they willing to do in exchange.

Overly Self-Critical

Effective leaders pay attention to their performance and development, periodically critiquing their effectiveness to improve their skills. However, some leaders go to an extreme when critiquing themselves, resulting in several symptoms:

  • Unable to take action for fear of making mistakes.
  • Missed opportunities to contribute their ideas.
  • Catastrophizing and expecting the worst.
  • Lack of confidence.
  • Negative self-talk that focuses more on failures and mistakes versus successes.
  • Obsessed with a need to prove themselves to others.

Why are some leaders overly self-critical? In some cases, these leaders set excessively ambitious goals that are likely unattainable. Others experience an imposter syndrome anchored in a fundamental lack of self-regard, causing them to doubt themselves. Regardless of the cause, negative self-talk tends to persist unless leaders recognize the patterns of self-talk and unproductive rumination.

Carol is a supervisor who excelled as an individual contributor. With her promotion into her first management role, Carol’s boss expects her to speak about the performance of her team in leadership meetings. Before attending these meetings, Carol is obsessed with critiquing herself and consistently overprepares. When she shares her ideas in leadership meetings, she unconsciously apologizes to the group. As a result, many of her ideas get little traction with her supervisor and other stakeholders.

There are several strategies you can use to mitigate being excessively self-critical:

  • Evaluate the factors that trigger your tendency to become overly self-critical.
  • Create and periodically review a journal of accomplishments and accolades received from others.
  • Ask trusted colleagues for feedback on your strengths and weaknesses.
  • Practice mindfulness to build practical self-awareness skills for noticing negative self-talk.
  • Focus on self-care and wellness including adequate sleep, exercise, and diet.

Emerging leaders in healthcare may experience these five common challenges, including perfectionism, an inability to delegate, overly blunt communication, saying no, and being excessively self-critical. These challenges can limit your career progression. By building awareness, experimenting with new behavior, and enlisting the support of others, you can eliminate these potential career traps and prepare yourself for a successful leadership journey.

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Dr. Kevin Nourse is a member of HCE-SOCAL and has more than 25 years of experience developing resilient change leaders in healthcare. He is the founder of Nourse Leadership Strategies, a coaching and leadership development firm based in Palm Springs. For more information, contact Kevin at 310.715.8315 or