New AHA president leads with a cardinal rule: Put the patient first

Dr. Keith Churchwell was enjoying Christmas Day 1991 at home with his wife when their phone rang. He was needed at the hospital.

As the chief resident for Grady Memorial Hospital, one of four hospitals in the Emory University system in Atlanta, Churchwell oversaw about 160 early-career doctors, including the caller — an anesthesiology intern who'd made a mistake.

The intern (or, first-year resident) had stuck himself with a needle contaminated with the blood of an HIV-positive patient. At that time, most people who became HIV-positive developed life-threatening infections and cancers.

Churchwell was 30, a few years ahead of the intern, yet also still at the outset of his career. Nothing in his undergraduate studies at Harvard University, medical school at Washington University or his residency at Emory prepared him for such a predicament.

However, growing up as the youngest child of Robert and Mary Churchwell had.

Churchwell went to the hospital, consoled the intern and arranged for medical and emotional support from the human resources team. Then he turned his attention to the rest of the intern's shift. As the boss, Churchwell could've called in another intern. Instead, he handled it himself, visiting 20 patients and performing two spinal taps.

All these years later, Churchwell remembers the specifics of that shift because it was a milestone day. It was when he first grasped what would become his true calling within the calling of medicine: leadership.

Churchwell went on to hold top roles at the Vanderbilt Heart and Vascular Institute in Nashville and the Yale New Haven Health system in Connecticut. On July 1, he takes on another, becoming president of the American Heart Association. His tenure begins just weeks after the AHA's 100th birthday.

"Keith's vision, drive and leadership have profoundly impacted our organization for many years," AHA Chief Executive Officer Nancy Brown said. "We're so excited to have him at the helm as we boldly enter our second century."

The path to cardiology

Churchwell was in ninth grade when his economics teacher asked everyone to write about what they wanted to be when they grew up.

Having never really thought about it, he started by asking himself, "What am I interested in?"

The answer: math, science and art. What profession touched all three, plus offered a way to support his community?

Medicine, he realized. Like his brother Andre, eight years older, was pursuing.

As Keith wrote the report, he began envisioning himself wearing a white coat, treating patients. The idea continued to blossom. Soon, becoming a doctor was his North Star. He also set the goal of attending Harvard, just as Andre had.

In retrospect, it's no surprise that Keith, Andre and all their siblings pursued a great education as a gateway to a career rooted in helping others.

Because their role models were Robert and Mary.

***

Robert began forging his work ethic and values in childhood.

To help his impoverished family, Robert got up before the sun to collect wood and other items to sell. Some winter mornings, he showed up at school with icicles dangling from his clothes; for the rest of his life, his closest friends called him "Jack," short for Jack Frost.

After high school, he joined the Army, seeing action in World War II in Europe and the Pacific. He rose to staff sergeant despite having rankled higher-ups by starting a newspaper to write about segregation and how poor conditions were for Black soldiers.

Once home, he graduated from Fisk, a historically Black university in Nashville. Then he and a friend started a newspaper. Soon, the Nashville Banner hired Robert, making him the first Black reporter at a major Southern daily newspaper — or, as he became known, "the Jackie Robinson of journalism." If that sounds celebratory, it was anything but.

The Banner publisher only wanted a Black reporter to help with sales in Black neighborhoods. He even told community leaders to pick whomever they wanted. Robert was flattered and burdened at being their choice. Meanwhile, he wasn't welcomed in the all-white newsroom. He had to work at home and drive to the office to turn in each story.

He continued writing until shortly before his death at 91, in 2009. Today, his fedora and typewriter are displayed at the National Museum of African American History and Culture in Washington, D.C. In Nashville, his name is on an elementary school — a tribute that's especially fitting because of his wife.

Mary grew up in the tiny rural town of Bell Buckle, Tennessee. When she was old enough for high school, her parents sent her to Nashville. She started college but left to marry Robert. They had three children when she became pregnant with a fourth child. Or so she thought. She delivered identical twins: Kevin, who was expected, and Keith, who wasn't.

The twins were in diapers when Mary went back to college. She earned a bachelor's degree, then a master's. She went on to teach elementary school for over 30 years.

After she died — in 2020, at age 89 — Keith learned the secret of how a teacher and a newspaper reporter put five kids through college, including a stretch when four were in graduate school at the same time.

"Her financial adviser says she was the smartest woman he'd ever met," Keith said. "He called her 'the Warren Buffett of Nashville.'"

***

By the time Keith was at Harvard, Andre was doing his residency.

During Keith's sophomore year, he shadowed Andre for a shift. Everything about the experience assured Keith that he'd chosen the perfect career.

Except, he wasn't sure yet what kind of doctor he'd become.

In his second year of med school, Keith took a class that studied the body, system by system.

"When we got to the cardiovascular system, after that first lecture, I said, 'That's it!'" he said. "It all just made sense to me."

Washington University is best known as a research hospital. Yet Keith was more interested in becoming a clinician. Since ninth grade, he'd been imagining himself putting a stethoscope on a patient's chest, making a diagnosis and trying to heal them.

He had great timing, too.

When Keith started his residency, a heart attack patient faced open-heart surgery and 30 days in the hospital. By the end of his residency, patients were undergoing a noninvasive procedure to have their clogged coronary arteries propped open with stents and going home in about a week.

By doing his residency at Emory, Keith again followed Andre's footsteps. Ditto for becoming chief resident.

Andre was Emory's first Black chief resident; Keith became the second. Both had the role known as "the chief chief," meaning they oversaw residents at Emory's primary hospital as well as the chief residents — and their residents — at the other three hospitals.

Up to this point, Keith's biggest leadership job had been starting a movie club at Harvard. He raised money to buy projectors, acquired films, got people to show up and more. He did such a good job that the club had $15,000 in the bank when he graduated. Of course, that experience was nothing compared with his duties at Emory: filling out schedules for about 160 people and dealing with whatever issues each might have — such as the anesthesia intern's accidental needle stick.

Another lesson Keith learned involved two residents quitting late in their final semester.

The pair were fed up with one of the main doctors. Keith tried talking them into riding it out for a few months. It didn't work, leaving him to "beg, plead and cajole people" to fill the void created by their absence. Six weeks later, they asked to come back. It was up to Keith. He was leaning against it. Then he spoke to the doctor who'd scared them off. His advice changed Keith's perspective.

"I remember that story so well because it wasn't about medicine. It was about life," Keith said. "You've got to support them, help them become a better person, a better doctor, a better human being — and you become a better human being by doing this."

During this year, Keith also developed one of the hallmarks of his leadership style: inclusion.

While being in charge forced him to be extroverted, he's more comfortable being introverted. Figuring that others might be, too, he insisted during rounds and meetings that everyone speak up. This way, no ideas get lost simply because someone felt timid.

Most of all, what Keith learned from the experience was that he liked leading.

'What's best for the patient?'

After three years of cardiology fellowship, Keith did a fourth year focused on nuclear cardiology. He considered making a career of it until something else happened.

Andre called.

His cardiology practice in Nashville was hiring. So Keith and his wife, Dr. Leslie Douglas-Churchwell, an internal medicine specialist, headed to his hometown.

Just as cardiology care changed rapidly while he was a resident, the business side of medicine began changing soon after he entered private practice.

Academic hospitals began buying private practices, often to turn them into a network under the school's umbrella. In Nashville, Vanderbilt entered into a relationship with their group, which ultimately led to the practice being purchased.

At first, Keith was the liaison between his team of clinicians and Vanderbilt. When the Vanderbilt Heart and Vascular Institute was created, Keith played an integral role, eventually becoming executive director.

By adding hospitals and clinics in Nashville and rural Tennessee, VHVI's reach surged. The number of monthly patient visits went from about 9,800 in 1999 (the year Keith joined the staff) to roughly 145,000 in 2014 (the year he left).

As much as Keith treasured the one-on-one interaction with patients, he rarely had the time. Yet the tradeoff was easy to justify.

"When I worked in the clinic, I saw about 3,000 patients," he said. "As an administrator, I was touching 100,000 lives every month — over a million people per year."

Still, Keith's background as a clinician shaped him as an administrator.

Every decision he made was viewed through the lens of, "What's best for the patient?"

Answers weren't based on gut instincts or anecdotal evidence. His stock line: "What does the data tell us?"

***

One day, VHVI's chief of nursing asked Keith what it would take for their institute to be the safest in the country.

He loved that challenge. They just had to figure out how to do it and how to collect data to prove it.

Step 1 was a meeting with key members of every aspect of the institute. They wound up developing a scorecard for a particular type of procedure. Metrics included how patients were doing 30, 60 and 90 days after discharge.

It worked so well that other procedures were tracked. The data exposed variances between physicians, between groups, between days of the week and even times of day.

They addressed weaknesses. Some problems resolved themselves; knowing they were being scored, staffers became more diligent.

Then came another idea.

Instead of merely measuring patient outcomes by whether they checked back into the hospital, patients were called and asked how they were doing.

The big lesson was that many patients didn't get prescriptions filled — and many who did weren't taking their pills, not even something as basic as aspirin.

Price was usually the reason. But VHVI took much of the blame for not doing a better job of preparing patients for life at home. Out went their long, complicated discharge note; in came a simple one-page document.

All this played out over two years. In retrospect, it's a case study in Keith's leadership style. He doesn't see himself as an all-knowing leader; he's the guy who recognizes a good idea when he hears it, empowers a coalition of subject-matter experts to take on the challenge, comes up with a solution, then keeps refining the process.

He likes to compare his approach to a shark, although not for the ferocious reasons such an analogy inspires.

"Do you know why sharks have thrived for hundreds of million years? Most never stop," he said. "They have to have water going across their gills; if they stop, they'll suffocate.

"We need to be like sharks — always moving, always adapting as we go forward."

***

The best part of Keith's 15 years at Vanderbilt was working alongside Andre and also Kevin, who worked his way up to chief executive of the children's hospital.

Even if their interactions were sometimes limited to passing in a hallway or attending the same meeting, living in Nashville meant quality time together for the entire Churchwell family.

Kevin left first. Within a year, Keith did, too, becoming a vice president in the Yale New Haven Health system. In a few years, he became chief operating officer, then president of Yale New Haven Hospital, the system's flagship institution. Almost 200 years old, it boasts a lengthy list of "firsts" and having the artificial heart pump developed there.

Also noteworthy was the timing of that promotion: a few months into the COVID-19 pandemic.

Keith approached it much like his bid to make VHVI the safest institute in the country. The goal this time was for Yale New Haven Hospital to have better outcomes with COVID-19 patients — of all ethnicities, races, genders and ages.

"Given that we didn't know what to do or how to treat this disease, we needed to be led by the data and the information that we were accumulating to actually think about and work toward best practices," he said.

Their approach is best illustrated this way: Imagine two patients showing up with COVID-19, both with an oxygen saturation of 85% (anything below 90% is trouble). One patient is a 35-year-old fit white man; the other a 65-year-old Black woman with obesity. Who gets what treatment?

At YNHH, they got the same treatment because they had the same disease and it was manifesting the same way.

YNHH wound up with a greater overall success rate than the national average and was among the best for patients from historically underrepresented communities.

Keith is quick to credit others for these results. Still, the wide smile while sharing that credit revealed the pride of someone who aced the biggest test of his career.

Helping patients another way — via the AHA

Talking to his wife, Keith had an epiphany about his work at VHVI.

Sure, he was helping improve the cardiovascular health of everyone who came through the institute's doors. But what about everyone else in Nashville?

He knew the AHA was involved in health screenings, CPR training and more. Plus, the AHA invested over $20 million per year into research done at Vanderbilt. So he called the Nashville office and asked to join the local board.

Right away, he knew he'd found the right organization.

Keith became a member of the Southeast Affiliate board, then president of that board. Soon he was taking on national roles, too.

"It was all a lot of work, but I liked that work," he said.

About a week into his job in New Haven, a team of AHA representatives showed up at his office to welcome him. He soon found himself on this affiliate's board.

At one of his first meetings, they discussed criteria to become recognized as a gold-, silver- or bronze-level board. Keith spent the next 20 minutes detailing a path to gold status. The room became quiet. He feared having alienated himself. Instead, months later, he became president of that board, too. And they indeed achieved gold status.

Nationally, Keith has served on the Diversity Leadership Committee, the Science Advisory and Coordinating Committee and the Quality Certification Science Committee. He went from serving on the Advocacy Coordinating Committee to leading it for four years.

During the pandemic, he was the lead author on an AHA presidential advisory titled, "Call to Action: Structural Racism as a Fundamental Driver of Health Disparities."

"It's a generation of work, of course, to fix it, but it starts with identifying the problems," he said. "The AHA is not going to fix structural racism, but we can be an agent of change in identifying the problem and providing examples of ideas and policies that can lead to real improvement in the delivery of medical care."

Structural racism would soon become one of the key barriers to health that the AHA would tackle aggressively, along with social determinants of health and the unique health challenges facing people in rural America.

As Keith approaches his yearlong term as the AHA's top scientific volunteer, one of his goals is enticing more practicing cardiologists to make the decision he made long ago.

"It sounds like a recruiting pitch: 'Help us help you,'" he said. "But a greater understanding of the AHA's role can improve the lives of the patients and communities the cardiologists are serving, and that's an important investment they should be making."

***

Most mornings, Keith can be found on a treadmill.

If it were up to him, the rest of the day would be spent watching movies and/or listening to music.

He'll watch pretty much any movie, although he has a fondness for the classics. (He started that Harvard club as an excuse to watch certain ones.) As for music, favorites include opera, show tunes, jazz, symphonic music and the Great American Songbook.

He's been president of the New Haven Symphony Orchestra the last four years.

For about nine years, Keith was a board member for Columbus House, which works with people in New Haven who are experiencing homelessness.

"Leslie and I have always been very big believers that wherever we live, we need roles outside of our day-to-day job to invest time, money, effort and planning initiatives to help the overall community," he said.

They also love traveling, particularly overseas. Domestically, a favorite destination is Baltimore, home to their daughter, Lauren, a newlywed pursuing a Ph.D. in archaeology and art history at Johns Hopkins.

Keith also loves going home to Nashville.

Three of his siblings live there, as do many of their offspring. The entire Churchwell family gathered in May for the law school graduation of Kevin's son.

In recent years, the three Drs. Churchwell have delivered talks together. Each offers a unique vantage point: Kevin is president and chief executive officer of Boston Children's Hospital; Andre is senior advisor to the chancellor on inclusion and community outreach at Vanderbilt University.

Sometimes they agree, sometimes they argue. Always, they have fun.

And when Keith speaks, the message is succinct:

"It's really about the patients that we take care of," he said. "Because if we do that incredibly well, everything else takes care of itself."