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Vassar President Elizabeth Bradley

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(SOUNDBITE OF BELA FLECK AND THE FLECKSTONES' "BLU-BOP") 

AARON CAIN: Welcome to Profiles from WFIU. I'm Aaron Cain. On Profiles we talk to notable artists, scholars, and public figures to get to know the stories behind their work. Our guest today is Elizabeth Bradley.

(SOUNDBITE OF POPPY ACKROYD’S “SALT”) 

She's the 11th president of Vassar College a residential liberal arts college in Poughkeepsie, New York. Before taking the helm at Vassar, Elizabeth Bradley was the director of the Brady-Johnson program in grand strategy at Yale whose goal is to train undergraduates in the finer points of leadership. Bradley was also the founder and faculty director of the Yale Global Health Leadership Institute which operates education and research programs in China, the United Kingdom and a number of African countries – Ethiopia, for one, where Bradley led teams that helped transform that country's health care system. Before Vassar and Yale, Bradley was a hospital administrator at Massachusetts General Hospital in Boston. She holds a PhD in health policy and health economics from Yale and an MBA from the University of Chicago. Before that, she graduated magna cum laude from Harvard where she studied economics and art history. Recently Dr. Bradley was on the IU campus to give a lecture about her work in health care. While she was here, she joined me in the WFIU studios. Elizabeth Bradley, welcome to Profiles.

ELIZABETH BRADLEY: Thank you so much, Aaron.

AARON CAIN: Now, I expect we'll talk a fair amount about education so may we start by talking a little bit about yours? You are now the president of a college that I think U.S. News and World Report has ranked 11th in the nation for liberal arts schools, and your own successes seem to me to be compelling evidence of the importance of a well-rounded liberal arts education. And I imagine if I were in a room with about 100 university presidents about 40 of them would say, “Well, she owes her success to the fact that she studied economics,” and about 40 of them would say, “No, she owes her success to the fact that she studied art history.” And probably about 18 would say, “No, she owes her success to the fact that she studied both,” and probably about two of them would say, “It doesn't matter because she graduated magna cum laude from Harvard and the actual subject matter is irrelevant.” So, what would your answer be to that?

ELIZABETH BRADLEY: I would probably say one of the things that is most important in the way I look at education is just the root curiosity a person has. And you want to be able to be in an environment where that root curiosity can be fulfilled. So, the broader the more diverse the more complicated the interactions might be between fields, I think the better education you come out with. So, I guess I'd align with the person who said both.

AARON CAIN: As a student, what was it like balancing the two areas of focus of economics and art history?

ELIZABETH BRADLEY: When I first got to Harvard, I was completely befuddled by what on earth I would want to do. Every classroom I walked into I thought, “That's what I like.” And then, you know, I'd get through the semester and think, “Well, but do I want more of that? I'm not sure. I'm interested in the next thing.” And I started my sophomore year still confused over what would I possibly want to do. And I happened into an economics class - that year, that was actually called the economics of socialism. So it was a very, you know, six students in it very off the beaten track class that just opened my mind into thinking about economics broadly and thinking about economics not only from profit maximization of firms but all the ways in which economic thinking influences the way a country develops influences the way a person develops. So, it was really a course in economics that was tremendously broad that made me say, “OK I think I can major in this.” But funnily, my very first class I took in economics again as a freshman I felt like I barely passed it. I mean, it was a hard class. I didn't know anything about economics. So, both those things - it being broad, and also, it really being a challenge, something that isn't going to be easy for me - was important. At the same time, I was taking art history because I have an older brother who is an artist. And I'd spent years and years watching him paint and develop sculpture and create. And so, to go into a classroom where they douse the lights and just show you art, all your senses come alive. And then to have a professor - I remember I had Henri Zerner who is just a fabulous professor of French Renaissance art history - talk about the way art expressed the national spirit of the time and then the rebellion against expressing the national spirit. Wow. I thought, “Here's another incredibly broad field that again is studying really the way the larger world works and how we express ourselves.” So, then I just decided that's it. I don't know which one I'm gonna major in. I'm going to declare both. Harvard wouldn't actually let you do that. So ultimately, I went with the practical road and said I'll be an econ major and then do what equivalent of an art history minor.

AARON CAIN: Was there a point when those two subjects began to connect in your mind, and you started to see ways in which they interrelated?

ELIZABETH BRADLEY: Absolutely. I actually saw ways in which they interrelated all along the path. And it culminated in my thesis which I did in my senior year. And I wrote an empirical paper on the market for contemporary art. And my data collection was in Soho in New York in the time. And this was 1984. I got to interview the greats like Leo Castelli and Paula Cooper. Just amazing to be able to spend time there to really understand - what I was seeking to understand is how do we get the price of contemporary art when there's no market yet but it's in a gallery? How do we actually get that price? And how does the surplus from that price accrue to the gallery owner the artist maybe the consumer surplus? So that ended up being a very, very interesting study and I enjoyed it so much. My thesis advisor was Richard Caves who was an economist but a huge art collector and I used to go into his office to get advice. And I'd sit down right in back of a Lichtenstein right in his office. So, if that wasn't the integration of economics and art history nothing is.

AARON CAIN: I was wondering if we could dig a little deeper into that just because it seems to me that the modern art world might not play so nicely with some of your classic models of economics.

 ELIZABETH BRADLEY: Exactly. Modern art - contemporary art when you think about the information asymmetries you think of the transaction costs. There's so many market failures potentially. Quality - how do you judge quality? It doesn't really abide perfectly with neoclassical economics. And trying to understand the implication of some of those market failures was indeed part of my thesis.

 AARON CAIN: It seems like you had to grapple with something else, too, which was evaluating in real time worth - the worth of something which would seem to be a real challenge in the contemporary art world and in other things besides when looking at it from an economic point of view. After Harvard you got your master's at the University of Chicago in organizational behavior and health administration. Now organizational behavior is not a subject that I have ever discussed with anyone to be perfectly honest. And I do know that the general idea is that a scientific approach can be applied to the management of workers. But if we could get a bit more specific what sorts of things does one learn when one studies organizational behavior?

ELIZABETH BRADLEY: Organizational behavior is a field closely allied with management but really focuses on how teams work, how people work. How do they behave in an organizational setting? And one of the sort of key insights of organizational behavior is that we all play roles. And those roles inside an organization are paramount to our behavior and how we will relate to our jobs and our organization independent of what one's own personality is or one's individualism. So, it's really the study of how people and groups work together to achieve the outcomes that they share - the goals that they share. There's a lot of studies in the area of hierarchy. What does hierarchy do to communication? Role definition, boundaries, boundaries between roles and how those work or not - a lot of research on different ways to organize work and the impact of those different choices on how you organize work on the actual performance of the institution. So, it's been an incredibly relevant field for me to know something about as a college president.

AARON CAIN: How much of it was relevant because what you chose to do and how much of it was relevant because it steered you in the directions of the career path that you were on? Do you see that one of those things might have won?

ELIZABETH BRADLEY: (Laughter) Well actually the way I got into health administration and the desire to do that was back in my junior year. I was trying to figure out again - with an economics and art history degree - I kind of wanted to maybe run a museum someday. But I did a summer internship at a gallery and realized this just isn't for me. It's too sophisticated. It's too fancy. I'm just not gonna be able to do this kind of art world. So, I was a junior in my spring junior term, and I ended up taking a class as so many of us do because it happened to fit into my schedule. And it was called the Public Private Boundary. It was a sociology class cross-listed in economics six students in it with Paul Starr who was writing the book on the transformation of American medicine - one of the seminal pieces of our health care system. And I got completely enthralled by yet another market that has information asymmetries - hard to tell the quality. And it seemed in 1984 it was at an absolutely important moment in life where the costs were going up wildly fast and the federal government was starting to regulate those costs. So, it was an industry - hospitals - that was really changing. And I thought to myself, you know, I think I could be a manager - so this is the organizational behavior interest - a manager in health administration. And I remember at the time thinking when you graduate from Harvard - I didn't have any practical skills in 1984. I barely knew how to fill a stapler. (Laughter) It felt like I can't just go get a job. I'm gonna have to get more tools to really understand management and understand health care so I went to the University of Chicago that combined these in their business school. When I got to the business school it was then I knew I was in health administration but all of the majors in business school - like accounting, finance, marketing - I realized organizational behavior was really what I was after because I've always been very interested in how decisions about organizational structure and management can really influence the outcomes. So, I put those two together and from there went into hospital administration.

 AARON CAIN: But it also seems to be the thing that kind of stealthily all those other disciplines have in common, you know?

 ELIZABETH BRADLEY: Yes.

AARON CAIN: The organizational behavior is in there, whether or not it's acknowledged. So, when you look back at what originally enticed you into health care management, did you have any impressions of, “Ah, here were the managerial things that I saw or didn't see that now I'm armed to deal with?”

ELIZABETH BRADLEY: Absolutely. I mean, I think how a team works - you know that from childhood. You're on teams that do well. You're on teams that don't do well. You're in groups when you're doing class projects that you thrive in the group and you're in groups that really you don't do well at all. You see free-rider problems. You see good leadership. And I think as children and young adults we don't necessarily have the words or the theory to understand why certain ways of organizing actually produce good outcomes or not. So, at the University of Chicago studying this material, I think I started to feel empowered that it's not just about your personality and charm. There are actually tools and concepts that can help one lead more effectively and play that role of leadership more effectively. And what a gift, because that allows you to use existing resources more effectively more optimally more efficiently. And usually it allows people to feel better, too - if they're the A-team, they're getting good performance from the same old resources just because it's been managed better.

AARON CAIN: You are a sterling example of the lifelong learner it seems to me. You're still a writer and researcher...

ELIZABETH BRADLEY: Yes.

AARON CAIN: ...Even though you are the president of a college. And I read a study of yours from a couple of years ago on promoting positive cultural change in hospitals. And I was struck by one of your findings that - and I hope that I am merely paraphrasing this and not utterly misunderstanding it. The finding that inclusion of staff from different disciplines and ranks in medical teams appears to reduce mortality rates in the hospitals that participated in the study. Now am I understanding that correctly?

ELIZABETH BRADLEY: Yeah. You're right on target. The study actually was a culmination - we published several along the way - of about three years of work in a study that we called Leadership Saves Lives. And it was a study I did with my good colleague Leslie Curry and also Erika Linnander. And it was a study that took a look at 11 hospitals that were having absolutely top performance in mortality rates after heart attack comparing them to hospitals that really were not doing very well. And across the country we have enormous variation – two- to three-fold variation in mortality rates after heart attack depending what hospital you get to.

AARON CAIN: And just to be clear, by top scorers, you mean low mortality rate (laughter).

ELIZABETH BRADLEY: ...High survival, low mortality.

AARON CAIN: It's not the definition of scoring high here. I thought I'd clarify that.

ELIZABETH BRADLEY: And this huge variation even exists when you adjust for the risks people have for death when they get there. So, it's not just because some hospitals have sicker patients. Adjusting for all of that we still see a large variation. So, our hypothesis was maybe something's going on in the way they organize their work. So, we spent three years really understanding what distinguishes the high performers and the low performers from a qualitative point of view. We visited. We talked to everyone. We got hypotheses about what we think is going on. We then surveyed them quantitatively for all of those potential reasons, all of those factors that might predict performance. And then, using statistics, identified the statistical association between these sort of cultural norms and the performance, publishing this along the way. And then the last part of the study was to actually intervene on hospitals with those tools we knew had been working from our previous studies to see whether one can proactively influence the culture. And that was one of the more fascinating ones. And we selected 10 hospitals. We intervened on them for two years. And this means we had many workshops - a lot of teaching, a lot of getting their groups to talk to each other about what they found best practices to be. And six of these hospitals ended up being very successful in shifting their culture and four did not. And when we looked at, “What is the key distinction? What are they doing differently in these that are being so much more successful?” There were sort of three critical pieces that all have to do with organizational behavior. The first was that they put together a guiding coalition of diverse staff from physicians to EKG techs to nurses to, you know, transporters. They put together a diverse team really to try to work on reducing mortality rates. The way they managed the team is they ensured that these diverse voices were actually heard at the table. So that's the inclusion part. And that's so fundamental. I mean there are a lot of times you can bring in the EKG tech into a physician's office to talk like teamwork, but when you really say well what do you think is going on - to the low power person in the room. So, we have wonderful examples of hospitals that were able to do this - really get the voices from the frontline into the team that was trying to make improvements. And then the third thing that they did is they managed conflict well. So, when you put a team that's diverse together, they have different views. You know, “I think it's your fault. I think it's your fault.” You know they’re, like, “erupting” will be controversy. And in the hospitals that were successful they were able to really work through that controversy in a way that depersonalized the issues that focused on the overall goal they shared that took people seriously when they were unhappy and tried to meet their needs. Conversely in those hospitals that really did not do well with the change, when controversy came up, people withdrew. They said, “Well, I'm not going to go to the meeting anymore.” Or people will report being very bored, you know, just fatigued.

AARON CAIN: ...Disengaged.

ELIZABETH BRADLEY: ...Disengaged and kinda - you know they didn't say angry but you figure probably angry underneath it - just leaving the common goal for somebody else to do rather than really walking towards the anxiety - something that organizational behavior teaches - to really unearth what are the root problems that need to be addressed before you can make the changes. So, it was a very interesting study.

(SOUNDBITE OF POPPY ACKROYD’S “STRATA”)

AARON CAIN: Elizabeth Bradley, the 11th president of Vassar College, you're listening to Profiles from WFIU.

You've published upwards of 300 maybe 400 peer reviewed papers and you've co-authored three books including "The American Health Care Paradox: Why Spending More is Getting Us Less" which you co-wrote with Lauren Taylor - a pretty intimidating subject and it seems to pose the question in a nutshell. If we as a country are so rich, why aren't we healthier? Why are we still spending more and getting less when the overall health of our country is compared with those of its international peers? Care to give us the Cliff's Notes version of some of your and Lauren Taylor's findings in this book?

ELIZABETH BRADLEY: Sure. Thank you. The book was a fascinating experience to write and particularly with Lauren Taylor who I first met when she was a sophomore at Yale. I taught a course called "Paradox and Promise: The U.S. Healthcare System." And in that course, I started to develop some of these ideas that eventually got augmented with her tremendous contributions into this book. She is now studying to be a professor, I think, of health management and health policy. and so I'm extremely proud and humbled really to have spent just about a decade working with her. The book's main thesis is: we spend more on medical care than pretty much any country. And it's not just a little more. We spend about 18 percent 19 percent of our GDP on health care. And Western Europe tends to spend 11, 10, 12 percent of their GDP. That is an enormous difference. And if you look per capita you know we're like double per capita on what we're spending. And yet if you look at our outcomes our outcomes are just not that good. You know we're near the bottom of all of the high-income countries in terms of infant mortality. In other words, we have close to the highest infant mortality, maternal mortality, obesity rates, disability rates, HIV rates. I mean, it just goes on and on and on. How could this be? It seems crazy that we would be investing so much and yet we just aren't seeming to reap the benefits of that. And the thesis of the book is if we look at other countries, they're spending about the same amount we are if we put together both what we spend on medical care and what we spend on many social services that are very productive for health, like housing, nutrition. If we think about employment programs - job training, environmental support programs - all of these programs which are not doctors and hospitals, but they certainly influence our health the United States underinvests in relative to Western Europe. So, if you look and compare us to Sweden, England, Austria, France, we all spend between, you know, 32 percent of our GDP and 35 percent of our GDP on this whole bucket of things - the medical care and all of these other social determinants of health as they're called. But we do it in a very different way. We spend two thirds of that money on medical care and one third on the social services and they're just the invert of that. They are actually spending the lion's share on those social pieces and less on the medical pieces. Maybe that just reflects our politics and our economics and our privatization and our individualism, our culture in America. But my question, and our question, was really, “Does it matter? Does it matter for health outcomes?” And that's what the book is about. We do a lot of statistical analysis and case studies to put forward, perhaps, what America is doing is trying to deal with its social problems through a medical care system which is very expensive and not very effective. And perhaps what we need to do is look at the balance of this kind of investment and understand what would our health be like if we invested a bit more in the areas of housing, nutrition, job training, et cetera and a little bit less in medical care?

AARON CAIN: I imagine another way to look at it is one that I'm pretty sure you've thought of before me, which is that maybe it's also a matter of lackluster organizational behavior?

ELIZABETH BRADLEY: (Laughter) Well if we think about organizational behavior at a higher level, you know, the way counties are organized or the way cities are organized, the truth is some of the lessons from what we learn at a hospital level I think can give us some insights at these larger levels of organization. And again, it is how much cooperation do you really find? How inclusive are we when we're looking at organizing larger systems for instance in a city? How inclusive are we of the hospital with the homeless agency with the nutritional support agencies with the schools? Not always that much and we have started to do some studies. And again, I think Lauren's work will really tell us much more of this over her career of those counties that have been able to be effective in driving good health outcomes. We have one study that looks at obesity as the outcome because this varies greatly across our country also. We found six counties where the obesity rates are very low even though the state they're in the obesity rates are very high. So, they're kind of positive deviants, you know. Everyone around them is having high obesity, but somehow that county was able to drive it down. We did in-depth case studies of these six counties. And what did we find? Of course, we found that they were using tools that organizational behavioral scholars would say are very important. They usually had a team driving at this single outcome organized by a backbone organization usually public health departments sometimes a hospital. They worked at including everybody in the conversation elevating low-power voices and really trying to keep people at the table working through conflicts that emerged. So, again, those weren't medical things they were doing to fix that. Those were really social and organizational interventions that we think had a huge impact on the obesity rates.

AARON CAIN: You got involved in a lot of large-scale initiatives while you were still at Yale. I imagine it started while you were getting your PhD there but continued when you stayed on. One of these things was the Yale Global Health Leadership Institute which operates education and research programs in many places around the world supported by National Institutes of Health and by the Bill and Melinda Gates Foundation the Clinton Foundation. Now, is this something that to this day you are still involved in in your copious free time?

ELIZABETH BRADLEY: (Laughter) I'm not as involved with the Global Health Leadership Institute. I retweet them all the time.

AARON CAIN: (Laughter).

ELIZABETH BRADLEY: I'm so proud of them and Sten Vermund, the new dean at the school of public health at Yale has just done fabulous work really supporting the global health initiatives at Yale. So, I'm really proud of that. However, I am, in fact, still working from time to time with some of the counterpart African countries that we worked in because we are quite interested in understanding the liberal arts model for Africa. Liberal arts really allows you to be curious to be empowered to think outside the box. So, we have been asked by one of the universities in Rwanda if we would come to visit to talk about this model of education. Is this something they would be interested in? And a common theme from our Global Health Leadership Institute work and what I'm working on now is let's listen to the voices that are on the ground. What are they asking for? What do they experience? And that's always been my approach maybe from my learning in organizational behavior that the frontline knows what it needs. They are in the best situation to be able to articulate what works and doesn't work. And sometimes from the outside, and as researchers and as Americans, we do the best work by visiting listening truly responding trying to work with them to think creatively about how they can use the resources they have to accomplish the goals that they articulate.

AARON CAIN: Am I correct that you first got involved with this back during your time at Yale partly based on the fact that a student recommended that some interested parties seek you out?

ELIZABETH BRADLEY: Yes. That's exactly what happened. You've really done your research. Yeah. I had a wonderful student named Kaakpema Yelpaala who was Ghanaian and American but his roots were from Ghana. And he was a junior I believe. I think he was a junior maybe he was a first-year school public health student. I'd been working with him and during his summer he got an internship at the Clinton Foundation. And during that summer, President Clinton had visited Ethiopia and met Dr. Tedros, who is currently the head of the World Health Organization. But back then in 2006, he had just been announced as the new Minister of Health in Ethiopia. And he and President Clinton spent a good time together. And President Clinton, as he often did, said, “What do you need? How can I be helpful?” And Dr. Tedros said his priority was hospitals in Ethiopia. He knew he had a terrible health problem awful public health issues but he wanted to begin with elevating hospitals. And he particularly wanted to elevate hospital management. They only in those days had 120 hospitals in the whole country, yeah, for in those days 80 million people. And he wanted to really make these hospitals work better. So, President Clinton came back to the United States and he just was sort of befuddled as I understood it because he said, “Gee, we do all this HIV work but hospital management? How do you do that?” But we really want to help this Dr. Tedros. So, Kaakpema was in the office and said, “Well, you have to talk to my professor because she does that.” So, I got an email I remember in December of 2005. I was on sabbatical. And I got an email from Ed Wood, a very, very close friend and colleague, who was the chief operating officer of the Clinton Foundation at the time - the health part of it. And he said, “You know, I'm from the Clinton Foundation and we'd like to meet with you.” And I immediately got this email and thought, “Why do they want to meet with me? I don't know anything about HIV. I don't study HIV. I'll triage this to my friends on the faculty who really do study HIV.” And so, I sent out this whole email and I copied the dean. It was Mike Merson actually who ran global health at Duke who was the dean at the time in December. And he wrote back and he said, “What are you doing? You ought to meet with these people. They're asking to meet with you.” And I said, “Oh really?” So, we organized this meeting at Yale. And I remember we actually organized it on December 19, somehow that sticks in my head because in the morning of that day - I think the day before that day - I got this email out of the dean's office saying the new dean Paul Cleary was going to come. He wasn't the dean yet but he was gonna come and do an interview right at the time that I had this meeting with the Clinton Foundation with all these faculty I'd invited. And I wrote to the Clinton Foundation and said, “I just can't do it unless you can slip it in instead of at 10 from 1 to 2 in the afternoon.”

 AARON CAIN: (Laughter).

 ELIZABETH BRADLEY: And Ed, bless his soul, said, “Sure, we'll be there.” So, in they came - Ed Wood and I don't know about six or 10 faculty around the table and myself. And I literally thought, “I'm here to triage. They're going to come in. They're going to tell me they want to do all this HIV work. And I'm going to give it to one of these other very, very talented faculty I was working with.” But that's not what happened. They came in. We went around the table. And as they described what they want, I thought, “Oh my gosh, I think I could actually help you,” because they wanted to have an academic who understood hospital administration. And I had done this for six years at Mass General after my MBA. I knew what hospital administration was all about and their hospitals were really nascent. I mean, they were small; 60 to 120 beds. You know, a manageable size. So, after the meeting, I said, “Well, why don't you come back to my office,” and I sat with them. And they said, “Would you come to Ethiopia?” And I was on sabbatical. I literally thought, “Oh my gosh I don't - Ethiopia? Wow. I've never been to Africa.” And I thought, “I guess,” - I actually called one of my alum who I trusted very, very much - Martha Dale who ran an HIV Hospital in New Haven for many years. And I called her the alumna. And I said, “Do you think I should do this?” And she said, “I'll do it with you.” And I said, “Oh OK.” And I went home that night. I talked to my husband. We had three little kids and we just said let's go. So, we went for several weeks and we did an assessment. And I'll tell you, as soon as I got to the ground and really spent time in those hospitals, saw what was happening, saw the mortality rates, saw the lack of management, I just never looked back. That was it. And I spent a decade actually working on and off in Ethiopia. So proud about what they've accomplished in that country.

AARON CAIN: What are some of the other places that you've traveled to under the various global health initiatives like that one? And what did you experience there?

ELIZABETH BRADLEY: Well, also with the Clinton Foundation, we worked in Liberia in 2008 and '09 and very, very different country on Western Africa instead of Eastern Africa but again, a similar concept. They also wanted to work on their health system's management, specifically that piece of it. And there we found an awful lot of trauma from their civil war and an awful lot of, again, desire to improve but not really having the knowhow or the structures. So, we did a lot of education research in Liberia. That program is still ongoing as they reform their medical school. And one of my colleagues, Christina Talbot Slagle, is working on that now. I spent a good amount of time in Rwanda. Ghana, of course, we worked with their mental health system - South Africa for a little bit. We also did some work with Cambodia, Vietnam and Laos on developing health systems and strategies to care for their disabled population. So, the Global Health Leadership Institute really has a broad span. I think the focus on management was quite unique in public health. Most public health people don't focus on that management side of it. And that really was my expertise and my inspiration that while we can do more for the resources we have if we just manage them better.

AARON CAIN: What are some of the changes that you've observed in those places?

ELIZABETH BRADLEY: Well, in Ethiopia it's just been transformational - transformational and actually their Minister of Health now is one of our students. And I'm very proud of that and their state ministers both had been in our program. So, they're taking that country and they are changing so many things. They've at least tripled the number of hospitals. They now have a masters in health administration that people must get before they run hospitals. They're tracking their mortality rates. They're tracking their maternal mortality rates - a very hard number to track. So, the data collection and the decision-making from the data collection - recently started a food and drug administration that's really working hard on being sure that the medication supply chain works well, which is a huge problem in low income countries. So those kinds of changes are so gratifying to see.

AARON CAIN: What have those experiences taught you about leadership in general? And how has it informed your approach to presiding over a liberal arts college in particular?

ELIZABETH BRADLEY: Well, the many different experiences have taught me quite a bit about leadership. It's really underscored what I had learned academically, but I have it much more in my instinct now that listening is job one - really understanding and being curious. Leadership, I think, really is about being curious. I think it also taught me about the power of optimism - that you can be in a situation that seems very desolate, very poor, very under-resourced and still you can make progress. The human spirit is just magnificent. And if one can unleash people and their ideas who are really experiencing the struggles - if you can unleash that I have just seen so many good things come of it that I think my experiences have led to optimism and the importance of optimism. And I would say that the last piece that I've really learned about leadership is you just got to stick with it. Nothing happens fast. We're talking about moving large systems, changing people's way of working with each other, changing culture. You take three steps forward two back, four forward three back, one forward one back, five forward two back. The apparatus is moving forward and you have to maintain the optimism with that, but you really have to be in it for the long haul and resilient to the kinds of setbacks, recognizing it's part of a larger system. For me, that is very, very important. I think sometimes people going into leadership believe all you need is a good idea and it will happen. All you need is charisma and it will happen - wrong. You, I think, really need good listening and a lot of curiosity. You really have to be optimistic. And I think you have to be in it. You really have to be committed for a fair amount of time being able to be resilient to the setbacks.

AARON CAIN: Do you find it to be challenging to convey those sentiments to students in what seems by a nature is going to be a result-oriented culture of learning what you gotta learn in four years...

ELIZABETH BRADLEY: Yeah.

AARON CAIN: ...Maybe five at the outside...

ELIZABETH BRADLEY: Yeah.

AARON CAIN: ...You know teaching them patience and listening and that things are complex and don't get resolved quickly - is that challenging?

ELIZABETH BRADLEY: I think this is the liberal arts (laughter). That's what the model is, is to try to from every minute of the days beginning with orientation impart to students that the world is nuanced. And the easy answers are wrong, typically, and listening. And listening to everyone. This is what I think in our country today is just so important is, how do we listen long enough to evaluate what am I learning here? And how do we listen to understand rather than listen to rebut? That, I think, is one of the most important things - is listen in a way that you're truly open to maybe I'm going to change my mind. Maybe I'm going to leave this room being in a different place than I was when I began. So, I think it's hard. It's hard for all of us particularly when we're emotionally engaged with something. It's very hard to take a breath and teach others to take a breath. I think you do that by talking about it. I think you also expect people to make mistakes. And I'm a big believer in this as a president of a college. These are young adults who are 18, 19, 20 years old. Everybody makes mistakes. We're still making mistakes as 39-year-olds like me...

AARON CAIN: Of course, of course.

ELIZABETH BRADLEY: ...(Laughter) in our older lives and so to recognize a mistake as an opportunity to talk about how that occurred rather than an opportunity to condemn somebody or something. It's such an important piece of education that, of course you didn't do that right. And even students will say, “Oh, I can't believe that actually happened. But if you just take it at face value and say, “Let's talk through how on earth did such a great person like you end up in that situation?” Sometimes we can identify systemic things going on that actually make that student say, “Right. Now I got that.” And that's what grows us up. So, I do find it difficult, but I also find it exhilarating and exactly what we're there for as educators.

(SOUNDBITE OF POPPY ACKROYD’S “ROADS”)

AARON CAIN: You're listening to Profiles from WFIU. I'm Aaron Cain. I'm speaking with Elizabeth Bradley the 11th president of Vassar College and co-author of "The American Health Care Paradox: Why Spending More is Getting Us Less."

Given its rankings and its reputation as selective diverse and an institution with very favorable student outcomes, Vassar seems like a strong example of what private liberal arts colleges can accomplish. But I'm wondering if you'll pardon the really cheap classic joke here - I'm wondering what your platonic ideal for liberal arts instruction is. What should be the model?

ELIZABETH BRADLEY: Well I believe there probably are a lot of models and one has to tailor models to different students and different things that people are looking for from their college education. Not everybody is looking for a small liberal arts college, but I do believe there are some common themes even as the model can be tailored. Is it residential? Is it not residential? How much online learning is there? How much isn't there? What does one have in terms of requirements? Is there a science requirement, a math requirement, a writing requirement or not? Some of those decisions, I think, need to be tailored to the kind of organization and culture one is in. But I nonetheless think there are some common themes for the liberal arts model. And I think one of the most important common themes is breadth, that one is taking a moment in their young adulthood to study humanities, to study some science, to study some social science and art and language. If we don't keep that breadth, I really think we're doing a disservice. The liberal arts platonic idea is that we are liberating people's minds. We are allowing people to be free so they can go participate in a democracy so that they can fully be citizens and fully have voice. But how does one have voice effectively if one is not curious to learn about everything and is empowered that they know something about a few different things? They can have an opinion about something because they studied something related to that. So, I think that breadth is just fundamental. The other piece that I think is fundamental to liberal arts and one of the reasons I was so eager to be part of the Vassar community is the exposure to diversity. I think the part about liberal arts that opens one's mind and develops masterful skills and confidence is that one has really been challenged about the deepest held beliefs and how does that happen? You know, I think it happens by being a roommate with someone completely different or being on a sports team with someone who just has a completely different view or being in class and you can't believe somebody is actually a socialist or is actually a capitalist - you know, has a just different world view than you might have. And being able to make friendships - really have experience with difference - I think makes us so much more of a tolerant and pluralistic society. And so, I think that breadth of exposure in the academic world and then breadth of exposure in the social backgrounds of people and diverse political views of people those have to be in any model of a good liberal arts education.

AARON CAIN: How much of that has been informed by your career since hospital administration as you've gotten much more academically focused all the things you experience when you encountered diversity? And how much of it was already kind of baked in because of your experience in studying organizational behavior?

ELIZABETH BRADLEY: I do believe my interest in diversity and understanding the power of diversity, if it's managed correctly, was absolutely honed by the early study of organizational behavior. I also think I was very influenced by my root childhood in this interest. I grew up in a town New Britain Connecticut that was wildly diverse. And it had a heck of a time in the sixties with that diversity - lots of really more violence than you'd expect in a town of 60000 people. It is a tough town - three factories, lots of people lost jobs. It's now post-industrial and really is in a tough space. But I think I was very influenced in my school by seeing, “Wow, this is not the way to deal with diversity.” I mean, I didn't have those words as a kid, but it was visceral that, “OK this isn't going well.” People are fighting about race and ethnicity. People are fighting about income. The disparities were wild. You know, it was the time of busing, so it was really not an ideal picture. And so, I think probably those early experiences placed in my mind a real interest and some experience with diversity that wasn't positive. You know, it wasn't smooth in any way but a drive to think how can we do this better? And then to sort of absorb the tools - oh there are ways. There are actual practices of leadership that can help diversity become inclusion. What's so interesting about diversity in our world today is we're really as an American country we are more diverse than probably ever before. We're incredibly diverse in the higher education area. The percentage of our population that are immigrants or foreign-born today is about what it was in the early 1920s. And that's the last time it's been so high, like 13, 14, we're pushing 15 percent. And in those days of history, in that early 1920s, was a rebirth of the KKK. So, we never really have done that well (laughter) at pluralism even though it's in our blood. It's in our constitution. It's in what we believe that, you know, we're a country that is diverse. That's what's so special about the United States. It's tough. And what the research literature shows is diversity can completely backfire or it can actually be the exact ingredient to make for top performance. So I'm particularly interested in, “OK what can I do in my life and what can I teach about and research about to unveil those specific actions that can be taken that turn it from a disaster into a really potent asset for us?”

AARON CAIN: You had other offers to join and I think even helm other institutions of higher learning over the past few years that you did not accept. So, what about Vassar attracted you?

ELIZABETH BRADLEY: I think here I'd like to thank my predecessor, Cappy Hill, who was the president of Vassar for a decade. She had a vision. She had a vision to diversify socioeconomically Vassar. And she was successful. So, the college went from a college that had some tuition assistance, but not that much - fewer faculty of color, fewer students of color - to a college where about 20 percent of our students are very low income and Pell grant eligible. About 30, 35 percent of our students are of color. About 30 percent of the faculty is of color. Fifty percent of our senior team is of color. We have got a real commitment to diversity from the board and socioeconomically it's just so interesting. We have a veteran’s program now, a tremendous program. So, her getting Vassar to the place where it was very diverse, I think was really important to me. And at the same time, they were really struggling. They were struggling with the unhappiness on campus, lots of activism on campus, lots of racial and ethnic challenges of how really can these groups come together? So, for me, when I saw they've made the commitment, but they haven't yet really become the fully inclusive culture that I believe organizations can become, I really thought I have something. I felt a little like I did when I spoke with the Clinton Foundation. I didn't think it was gonna be what I would do. But then when I actually researched it and was open to it, I thought, “Wow, I think I could help you.”

AARON CAIN: You've said that another one of the things that attracted you to Vassar, and I'm paraphrasing here, was that it was a place where the faculty with the board and the president really run the place. That the ideas lead. That education leads. And you've also said that not every institution of higher education does that. What are the other things that you fear might be leading at such colleges and universities and what should we or what can we do about it?

ELIZABETH BRADLEY: I think one of the unfortunate features in higher education has been increasingly the drive. You know you have to bring in revenue to survive and there are lots of ways to get revenue. There are many corporate contracts people can take to teach and do research. Research dollars can come from all kinds of areas. They can come from NIH but, they can come from pharmaceutical if you're in my field. And they can come from a variety of even politically-oriented groups who have an agenda. And the agenda isn't let's develop people's curiosity and let them think what they want to think. Their agenda is it could be political or economic or corporate benefits. That is a tough thing. And I find that we have to stand very strong that the scholars should direct the curriculum. The scholars are the ones we delegate education to. It shouldn't be driven by the state. It shouldn't be driven by the corporations, the political parties. These aren't what should drive it. The scholars should drive it. Now it's important that scholars take that very responsibly and think I personally as a scholar need to study broadly and bring the breadth to the classroom because scholars also can become politicized which I think is not helpful to higher education. But most scholars - 99 percent of scholars are there because they want to bring about the mind of a student - to teach really how to think not what to think. And I trust that. And I think at Vassar I've really seen that. And the engagement of the faculty on issues of what the curriculum should be, on issues of how the classroom should be, how do we create engaged pluralism in the classroom? This is something they really spend time on and they care about. It's quite different from being in other settings where faculty might really be incentivized and more interested in their own specific research agenda, which is important, but with less balance on the common organization and the common theme of what the curriculum is. So, it's a part of Vassar I'm really happy with.

AARON CAIN: And yet as president, you're the one placed in the hot seat there.

ELIZABETH BRADLEY: (Laughter) Yes.

AARON CAIN: Because whenever there's a disparity between what is best for the college if you are perhaps courting some sort of grant or a large endowment versus the day-to-day needs of the student - which brings me back to the idea of diversity - so clearly a publicized priority of Vassar and certainly one that's near and dear to your heart, I'm wondering if it's challenging to reconcile diversity among the student population with the common goals that an institution has to have for them - honoring different perspectives while at the same time standardizing outcomes to the best of your ability. At Vassar I know you have at least one means of doing this. Could you tell me about the engaged pluralism initiative?

ELIZABETH BRADLEY: Yeah. The engaged pluralism initiative is a five-year program supported by the Andrew Mellon Foundation and a match from Vassar. The goal of the engage pluralism initiative is nothing short of cultural change and developing in the sort of fabric of Vassar the ability to engage across differences - political differences, social differences, economic differences, racial differences, religious differences, gender identity differences - and engage. That's a lot different from tolerate difference. This is more about how do we make Vassar be a place where people who have their own perspective - they come from their own socioeconomic background - can fully participate in the leadership at Vassar - the student leadership the faculty leadership etc. And this is not easy. We found that paradoxically one really has to invest in affinity groups and spaces and places where people can really live with others from the same perspective and really get some sense of belonging from that. We have to do that and we have to find ways to bring people together across those differences. So, it's a both and rather than an either-or approach. One of the concrete ways in which they engage pluralism initiative is influencing us is in our residential model. We have started a program where a faculty member lives in the house with - a house is about 200, 250 students - lives with the house. Student leaders live with the house. An administrator lives in the house and they are all trained on how to hold community how to hold space while people work through their pluralistic conflicts. And I guess this ties back to the study we talked about. We are working at creating lots of avenues in which people can be in a diverse group, listen to the voices in an inclusive way, and manage the conflict in a productive way towards learning not towards shutting down. We are just about to start this summer a summer bridge program in which we are bringing people to campus - first years - for five weeks. They'll take two courses and we will have this program be one in which there are people who are first-generation low income to introduce them to all the things of Vassar in a way that when the classes actually begin in the fall they will be one level up. They will already be aware of what the campus is about and what the opportunities are. How does this tie to engage pluralism? One of the things we realized when we talk about first-generation low-income students is too often it's thought to be a deficit model versus an asset model. This allows them to come feel like they have a lot to offer which they do. And that they can actually take leadership positions at the college. So, it's not sort of like, oh, you know, yeah. We have a lot of first-generation students and we just hope they make it through. No. We are looking at this group as fundamentally they can really lead. And one of our strong goals with this engage pluralism initiative is that our graduation rates our employment rates for first-generation low income will be equal to those of the rest of the population at Vassar. So, time will tell on that, but that's our goal.

AARON CAIN: Another word that I've heard you say a lot, and I know it's also an area in which Vassar is well ranked, is innovation. I think we live in a time when the importance of universities and liberal arts colleges are not, shall we say, universally enthusiastically embraced. But it seems that pretty much by definition colleges and universities are places where innovation has always been of vital importance irrespective of whatever social climate. What are some of the ways that you think that institutions of higher learning can or really must innovate here at the beginning of the 21st century?

ELIZABETH BRADLEY: ...The innovation in the area of being sure the liberal arts education is relevant and socially beneficial. So much of the criticism of liberal arts education now is how are they going to get a job? And we just cannot have our heads in the sand about that. We have to not see it as either liberal arts or practical. The innovation is to bring these together. For instance, the Career Development Office at Vassar is beginning to think about how career development is just another course. What is it? You become self-aware. You look at the ecology of options. You think, “How am I going to fit myself now that I'm aware of who I am into these potential needs of the world?” I mean that's really an intellectual and emotional journey and should not be seen as oh, over there. When you want to get a job put your resume in. No. It has to come right in at the beginning. One of the innovations that we are working on with this in mind is a new curricular approach and really the faculty are leading this. But they're called intensives. And intensives are classes that a faculty overseas of six to eight students. And they will do something that is applied - something that is kind of out of the box. It's not in the classroom. And they have to have at least 10 contact hours a week. So, it's just as much work as a class. But it is maybe engaged in Poughkeepsie the town we work in. So, somebody is interested in the economics of environmentalism, we have a very large group that's working on cleaning up the Hudson Valley rivers. So maybe it'll be a project that engages people from their economics environmentalism with the actual agencies that are working on this. How do we make this cost beneficial? These intensive courses also allow one to work in the governor's office or the mayor's office. So, it's really, I think, giving people practical skills and giving people the opportunity to reflect on those experiences. It is community-engaged learning which I believe will really allow us to be relevant. At the same time, I think we have to measure our relevance. So, I'm very proud that 94 percent of Vassar students within six months of graduation are either employed or they're in graduate school or they're in some competitive fellowship. That is a number we'd love to see stay high and continue to grow. And you know we graduate about 92 percent of people who start. So, I think these sort of innovations that are all kinds are cultural and they're also actually pragmatic curricular things can be monitored. And they can be measured and the measure is, you know, six months after graduation where are you? What are you doing? And how does the return on investment - how is it clear? I have been gratified by some of the research on return on investment. I know the public thinks liberal arts education is very, very expensive, which it is. With the intense financial aid that a place like Vassar gets, it's definitely affordable really for anybody who gets in. But it is nonetheless a bit of a sticker shock. You're talking about four years of one person's life. You will empower them. They will find out who they are. They will be fed and housed. And they will be new people. They will be young adults that can really participate in society. That's expensive. I also remember our literature on this return on investment. I mean the most recent study from the Federal Reserve suggests a 15 percent return on investment for the tuition dollars paid. That's pretty high. That's a pretty good bargain for most things you buy today. So, innovation so that we're relevant I think is exactly where we need to be working.

AARON CAIN: Elizabeth Bradley, thank you so much for speaking with me today.

ELIZABETH BRADLEY: Thank you, Aaron.

(SOUNDBITE OF POPPY ACKROYD’S “SALT)

AARON CAIN: Elizabeth Bradley - president of Vassar College founder of the Yale Global Health Leadership Institute and co-author of the "American Health Care Paradox." I'm Aaron Cain. Thanks for listening.

(SOUNDBITE OF BELA FLECK AND THE FLECKSTONES' "BLU-BOP") 

MARK CHILLA: Copies of this and other programs can be obtained by calling (812) 855-5317. Information about Profiles including archives of past shows can be found at our website - wfiu.org. Profiles is a production of WFIU and comes from the studios of Indiana University. The producer is Aaron Cain. The studio engineer and radio audio director is Michael Paskash. The executive producer is John Bailey. Please join us next week for another edition of Profiles.

Elizabeth Bradley (Photo courtesy of Vassar College)

Elizabeth Bradley is the eleventh president of Vassar College, a residential liberal arts college in Poughkeepsie, New York. Prior to becoming president of Vassar, she was the director of the Brady-Johnson Program in Grand Strategy at Yale, a university-wide, interdisciplinary program primarily for undergraduates, whose goal is to train emerging leaders. The program, which employs a comprehensive approach, and examines disciplines such as history, political science, and classical literature as context to address a wide range of current-day challenges, including security, economic inequality, global health, and climate change.

Bradley was also the founder and faculty director of the Yale Global Health Leadership Institute, which operates education and research programs in China, the United Kingdom, Ethiopia, Ghana, Liberia, Rwanda, and South Africa. Bradley led teams that contributed to transforming Ethiopia’s health care system, enhancing the quality of hospital management and availability of primary care.

Prior to her work at Yale, Bradley was a hospital administrator at Massachusetts General Hospital in Boston, where she helped lead the first generation of quality improvement efforts as part of the National Demonstration in Quality Improvement in Health Care, the inspiration for much of her subsequent research.

She is co-author of The American Health Care Paradox: Why Spending More is Getting Us Less. The book examines how and why the US health care system developed as it did, contemplates possibilities for reform, and highlights inspiring new initiatives from around the world.

Bradley focused on economics and art history as an undergraduate, graduating magna cum laude from Harvard University in 1984. She earned an MBA from the University of Chicago in 1986, and a PhD in Health Policy and Health Economics from Yale University in 1996.

Recently, Elizabeth Bradley was on the IU Campus to give a lecture about her work in health care. While she was here, she joined host Aaron Cain in the WFIU studios.

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