Margaret E. O'Kane
Margaret E. O'Kane is founder and president of the National Committee for Quality Assurance (NCQA), a not-for-profit organization dedicated to improving health care quality. Peggy founded NCQA in 1990 to build consensus around key health care quality issues by working with large employers, policymakers, doctors, patients and health plans to decide what's important, how to measure it, and how to promote improvement.
26 years later, under Peggy's leadership NCQA continues as a health care policy leader, informing and advocating for quality. Peggy is a member of the National Academy of Medicine, and as a result of her continued and passionate guidance, received the Picker Institute Individual Award for Excellence in the Advancement of Patient-Centered Care, as well as the Gail L. Warden Leadership Excellence Award from the National Center for Healthcare Leadership.
Modern Healthcare magazine has named Peggy one of the "100 Most Influential People in Healthcare" eleven times, most recently in 2016, and one of the "Top 25 Women in Healthcare" three times.
Peggy serves as a board member of the Milbank Memorial Fund and is Chairman of the Board of Healthwise, a nonprofit organization that helps people make better health decisions. Peggy holds a master's degree in health administration and planning from Johns Hopkins University, where she received the Distinguished Alumnus Award.
How has your life experience made you the leader you are today?
That's a big question. I guess one experience that helped is being a mother. You realize your children grow at their own pace, and that helps you learn patience. Starting a new enterprise was similar to parenthood: I had to be patient while we all learned a new set of capabilities. Also important was learning what I'm not so good at, so I could build a staff that collectively has the necessary competencies.
And along the way, I learned that persistence is a virtue. Refusing to get discouraged has been essential, as well. When we started out, people in health care (with some exceptions--mostly academic researchers) believed that quality couldn't really be defined or measured. Measuring quality is complicated; no single approach is the answer to every situation. But working through situations and issues, one by one, we have made a lot of headway on preventive care and care of common chronic conditions. Patient safety has been illuminated; hospitals get ratings. Many good things have come out of the determination to do better by patients.
How has your previous employment experience aided your tenure at NCQA?
I taught for a year (second grade) and that helped me grow up, become more confident, develop creativity. There was the basic curriculum--what we were required to teach--but we were free to try different ways to help kids learn. All the different learning styles was a revelation!
For 5 years I was a respiratory therapist, and that was very important in sharpening my focus. I worked in one really good hospital and in a few that were not so good. I found that, universally, care was not well organized. Health care workers often worked as "lone rangers," with very little in the way of standard operating procedures or process design. Of course, at that point I didn't know what process design was, but I did know that there had to be a better way. And that's what got me started on a career in quality.
I've been in my current position at NCQA for 26 years, and I've learned so much--from my colleagues, from NCQA's board members, from health care leaders. And experience is the best teacher, especially when you're doing something new. That's what makes it exciting.
What have the highlights and challenges been during your tenure at NCQA?
What comes to mind immediately is when NCQA Accreditation was mandated by large employers like Xerox, General Motors, Ford, GE. Suddenly, hundreds of health plans were required to go through a rigorous accreditation process. It was difficult for health plans to learn to be accountable for the quality of care their members received.
NCQA launched a national report card pilot in 1993, and 25 health plans from around the country committed to reporting on quality. That made the front page of the Wall Street Journal, definitely a highlight! At the same time, the project was challenging--for the plans, and for NCQA--but we all made it through, we reported on time and laid the foundation for all our work since then.
In 1997, we got our first contract with the Health Care Financing Administration to develop more measures for Medicare Advantage plans, and to collect HEDIS data for Medicare. That was a huge watershed!
What advice can you offer to women who want a career in your industry?
I believe strongly that women are the backbone of the health care workforce. Most nurses are women. It's been wonderful to see so many women emerging in the last 10 years as health care and physician leaders. I've seen many women settle for lower-level jobs because the path to higher positions is so circuitous. My advice to women: Believe in yourself! Ask your leaders how you can advance by helping the organization advance. Starting a new organization was an enormous opportunity for me, and for a number of other women I know.
Quality is a great field, but management's got to be on board 100 percent, or your efforts will just be an exercise in frustration. Just remember that good quality doesn't necessarily cost more. There are many opportunities to do things better in health care, and more efficiently.
What is the most important lesson you've learned in your career to date?
Don't expect to be good at everything! Hire people who are better than you, and let them run. Learn from the people who are out there doing great things. Ask your friends for help and advice when you need it. Develop a network of trusted women friends and use it to support yourself--and each other.
How do you maintain a work/life balance?
My kids required my attention and engagement, and that was good for all of us. I keep myself sane with yoga and meditation. I do things I love to do: travel, hike, cook, read, learn. And I have a wide group of friends who enrich my life.
What do you think is the biggest issue for women in the workplace?
I think the two big issues for women in the workplace are selling themselves short and unconscious bias. I'm often struck by highly talented women who don't realize how talented they are, so they don't push a little harder. I think Lean In by Sheryl Sandberg has a lot of good advice about that.
Unconscious bias is harder to deal with. First, we all have it, to some degree. The first step is to become aware of it, to recognize when it's getting in your way. And sometimes you just have to try to dissipate negative stereotypes through your own actions. You have to pull yourself up! It's an ongoing process, and I certainly don't have all the answers--but this is where a network of women executives has been so important for me.
How has mentorship made a difference in your professional and personal life?
My first mentor was my boss at the Health Services Administration of HHS, Victor Heyman. He helped me through a crucial transition in my career--from respiratory therapy to health policy and administration. That happened at the same time my first child was born, so it was two very big steps in a new direction. I cannot say enough about how he helped me believe in myself, giving me a million practical suggestions about my work.
Another boss, John Marshall, head of the National Center for Health Services Research at HHS (now AHRQ) was also a terrific mentor. And Gail Warden, the first Chair of the NCQA board, helped me in so many important ways over more than a decade. There is no doubt that NCQA would not have gotten to to where we are in health care without him.
Which other female leaders do you admire and why?
I admire Hillary Clinton, for her dedication to children and to an improved world order. I admire Christine Lagarde, head of the International Monetary Fund, for her fearlessness and grace in very uncertain times. I admire Patricia Gabow, now retired from Denver Health and Hospitals, for her fearless leadership and for demonstrating that you can take world-class care of the poor on a limited budget.
What do you want NCQA to accomplish in the next year?
After almost 30 years of laying the foundation, we're now working on the framework. We are committed to having outcome measures drive health care more directly--particularly, patient-reported outcomes. I recently had the privilege of visiting Sweden, seeing examples of patient-driven systems, among them a self-dialysis unit and patient co-designed community-based services for the elderly. Trying to figure out how to make space for innovation as an accreditor and quality measurement operation is a challenge--but a welcome one. Solving the puzzle of how a collective quality enterprise that's grown so much, with little attention to alignment can avoid hindering people who are trying to give good patient care, but still hold them accountable...these are some of the knottier challenges that keep me up at night!