Leading for Longevity

Marji Karlin and a faithful team renew Montefiore’s patient billing experience

Marji Karlin has spent almost her entire thirty-plus-year career at New York’s Montefiore Health System as a partner and witness to its extraordinary growth. In 1986, Montefiore was an academic medical center in the Bronx with two divisions; in 2018, it’s an integrated health system of eleven hospitals with more than three thousand beds. Now, as the health system’s vice president, finance, Karlin leads a department of about 170 employees. Despite the system’s transformation, her team is stable and loyal, many to the degree that she herself has been.

Karlin credits their longevity to a simple leadership approach. “I hire well, and I take interest in the individual as well as the collective,” she says. While not everyone on her team has to be friends, they have to share the ability to prioritize Montefiore’s mission. Her success at that mission is clear, as some of her direct reports have been with Montefiore for nearly twenty years.

Paradoxically, Karlin has discovered that one key to keeping her team together has been her willingness to
recommend them for openings in other departments within the organization. Her investment in those individuals—doing what’s best for them, at whatever stage of their careers—has often paid off later, when they returned to her team at a higher position, more seasoned and capable than before. Three of her five current direct reports have left for other opportunities, then returned; a fourth is coming back to fill a recent vacancy.

“I’m not afraid to help people fly and launch. That’s what people should do in their careers: get different experiences and not get stuck,” she says. While Karlin naturally wants to hold onto the best talent, she remembers to take care of their needs, too. “I’m not afraid to recommend them. That’s what’s best for the individual and the organization, and I think my staff appreciates that,” she explains.

Marji Karlin, VP of Finance at Montefiore Health System

Karlin also develops her colleagues within the organization by providing ongoing access to training. “We’ve always been very focused on trying to create a career path, developing a pathway for people to move up through our department and our organization,” she says.

A number of her department functions, such as application support and data analysis, are highly technical, so Karlin encourages her staff to hone their skills and keep abreast of evolving technology and practices. Along with leadership training, these tools help prepare Montefiore associates to climb within the organization; a visible upward career path is another key to fostering engaged and loyal associates.

Fostering an engaged team is crucial both to Karlin’s team members and to overall Montefiore initiatives. Today, Montefiore is overhauling patient-facing billing and scheduling procedures to make them as patient-friendly as possible. They’re crafting new, streamlined billing communications, and empowering providers and patients to make smart, informed decisions.

Karlin identifies two major challenges. The first is to examine the various materials with a patient’s eye. “So many of us in the financial and medical arena are used to lingo,” she says. “We’re translating for people who don’t necessarily understand the terminology we use. While that’s been a challenge, we’re always revising based on feedback we get from patients.” Leaders and associates collaborate with patient advisory boards, which include providers and current patients, who provide iterative feedback on patient-facing materials. Karlin calls it a continuous feedback loop that guides the team toward smoother, more patient-friendly communications.

“We’re translating for people who don’t necessarily understand the terminology we use. While that’s been a challenge, we’re always revising based on feedback we get from patients.”

The second challenge is to examine the institutions internally, tracking the pulse of the health system itself. “The health of Montefiore is everybody’s shared goal, but sometimes you get caught up in your own day-to-day work,” Karlin explains. “You have to pull people out of what’s best for this physician group or that department, break down those walls, and move toward the greater good.” Her collaborative approach, both within her department and in connection with others, continues to bear results.

“If you start with the groundwork and head toward a goal, people will come on board,” she says. “Sometimes it takes a couple tries.” Karlin notes that some of today’s successes have roots a decade deep; the current work to improve patient access was found in Karlin’s conversations in 2008. “Through some recent collaboration, we’re able to get it off the ground now,” Karlin says. “I don’t see that as a failure in 2008; I see it as priming the pump for what’s happening in 2018.”

Montefiore has already reduced the quantity of paper statements by 50 percent. Minimizing the amount of paperwork makes the process more efficient for all parties and prevents communication fatigue for patients. In step with the rapidly evolving convenience of online shopping, banking, and other consumer services, the Montefiore team is working toward an online payment system that presents all relevant information up front and in one place.

Karlin hasn’t noticed any real friction, but she acknowledges that her strategy for building connections across the organization might go above and beyond the traditional boundaries. But that’s fine with her, if it means that colleagues across the organization are banding together to advance the mission. “We all work for Montefiore Health System, and Montefiore is here to support our communities,” Karlin says. “That’s what we’re all about.”