'The Biggest Risk Is Staying Tied to the Dock'

He’s produced a hit Broadway musical, performed life-saving surgery, and guided a nearly 2,000-person health organization through a pandemic.

But Dr. Mark Mugiishi still credits his two-decade run as a high school boys basketball coach as one of the most informative leadership experiences of his career.

“Team building, creating coordinated movement, the organizational things,” he said.

“You really teach players and your team life skills about how together you can achieve great things. That's really come in handy as I run a big organization.”

Mugiishi is the winningest coach in Hawaii high school basketball history, guiding the ‘Iolani School to seven state championships. He’s also worked as a general surgeon treating gunshot victims and cancer patients — and is presently the CEO of the Hawaii Medical Service Association (HMSA).

The Daily Coach spoke to Mugiishi recently about applying critical lessons from his coaching years, taking action amidst the unknown, and why good enough is often better than perfect.

This interview has been edited and condensed for clarity.

Dr. Mugiishi, thank you for doing this. Tell us a little about your upbringing and how it shaped you.

I grew up in Hawaii. I was born on Oahu and went to ‘Iolani School, where I ended up coaching. The only time I lived away from Hawaii was when I went to college, to medical school at Northwestern. That was great because it showed me another world.

With Hawaii in my soul, I came back after that, and my whole career has been here. Hawaii is a tight-knit community where we have a concept called “Ohana,” which is family. It’s far extending from your actual related family. The whole community is part of your ohana. I think that’s very accretive to the concept of being a coach where you’re trying to get everyone to buy into a general culture as opposed to worrying about their own stat or their own achievement or being in the newspaper. The team being successful or having a good outcome is way more important than anything individual.

What led you to high school coaching?

I was not a good basketball player, not even good enough to make our school team.

I finished medical school six months early, so I had time to kill before the start of my residency. My old school had a job opening because someone went on sabbatical. I started to coach that team, fell in love with coaching, and when I finished my residency, the varsity coaching job opened up.

The head of school hired me straight out of residency, starting a surgical practice with my only experience being not having played basketball, (just) coaching parks-and-rec community basketball, and coaching one semester while covering for someone on sabbatical.

How did you overcome that lack of experience to ultimately become the winningest coach in state history?

My philosophy about basketball — and it remains in my heart to this day the reason why I was successful — is at the high school level, it’s more important what you do in aggregate with the kids than the technical aspects of what offense you’re running and what defense you’re running. Those things are important, of course, but the real thing is creating coordinated movement. It’s to get a dozen or so teenagers all rowing in the same direction and saying, “Yeah, we’re going to do this together.”

I did feel inadequate about the technical part, so I became a big student of the game in those early years. I went to a bunch of clinics, tried to listen to as much as I could, and tried to steal stuff that I thought could work for our team.

Not really understanding what wasn’t possible was really a benefit to me. We’d create a scheme and say, “We’re gonna do this!” The kids would look at you like, “Are you crazy? We can’t do that.” But the encouragement for them to try and to go for it was good, and often they’d surprise themselves and get it done. It was good not being someone who could understand the limits before you asked them to try. 

You make the decision to leave coaching after 20 years. What skills did you find translated to your career as a surgeon and now as the leader of a large organization?

For surgeons, it's almost like an individual sport. You go into the operating room and have a very important task. When things get tough, you roll up your sleeves and try harder.

The things that overlap are perseverance, resilience and focus. The team building, the creating coordinated movement, the organizational things, which I think are the more transformative parts of coaching where you really teach players and your team life skills about how together you can achieve great things, that's really come in handy as I run a big organization.

I'm at a place now where we have a couple thousand employees and are taking care of the health of half the population of Hawaii, which is more than 780,000 people. You're trying to coordinate all of these stakeholders, whether it's providers delivering care, customers buying it, government regulating you, communities impacted. Everyone has a different perspective of what you should be doing. To be able to wrap all of that together and take all of the different perspectives and put them into one vision that pushes the whole thing forward, that's actually what you're doing when you're coaching a team sport. The things I learned during the years I was coaching really define how I am as a leader today.

Do you have any particularly memorable stories or lessons you can share from the operating room?

Most of the memorable stories have to deal with the most difficult things. Those were usually a gunshot wound, some sort of terrible trauma because it's acutely life threatening and nothing you can plan for that's in a book. Things are just destroyed, and you're trying to use creativity to put it together.

It requires every skill in your body. Focus, stamina, dexterity, resilience to complete the operation. You're doing something incredibly important for that person to try to save their life. When I think back on all of the greatest memories, they were always the most difficult trauma cases, maybe the most difficult oncology or cancer surgeries where the cancer was invading a bunch of other organs and you have to be creative about how you get it out and reconstruct it.

There was obviously a lot on the line when you stepped into surgery. How did you successfully perform when you essentially had to be perfect?

First, focus is important. Second, and this may be scary to someone who's about to undergo surgery, but the most important thing a surgeon can learn is that perfect is the enemy of good. If you're striving for perfection, you can screw everything up. What you want to do is make sure it's good enough and can push you forward.

In the operating room, if you make a stitch pattern, if it's good enough to hold everything together and to heal well, that's good enough. If you worry about, "The spacing between a couple of these stitches is just slightly off. I'm going to pull that one out so I can do it again” and then you tear tissue doing that, and you're trying to sew torn tissue, then pretty soon the whole anastomosis is falling apart. You did a total disservice by not realizing that good is good enough.

When you have a big organization like (HMSA), you are never going to achieve perfection. Striving for it is what can break the whole machinery that makes the thing run and actually creates the music that you want at the end of the day.

You mentioned earlier the many stakeholders you're trying to satisfy with your work. How do you embrace knowing what’s good for one entity may be disappointing another?

From the basketball context, you run a play, and this person is going to end up shooting the ball. Four other people might be disappointed. They just set a screen or were the decoy. But I think part of the whole thing is to create a compelling vision, to take the opportunity and the time to be persuasive in your communication of it, and to have people understand what their role is in creating that coordinated movement to get everybody together.

You have to take the time to do that, and if the first time you don't succeed, you keep doing it because at the end of the day, that persuasive effort gives people the takeaway you actually care about the outcome. The outcome is good for them even if the individual task might not be.

You've been in many scenarios in your career where you haven’t had complete information. How does a leader take action without knowing all of the facts?

In my current job, the healthcare landscape is changing so fast. Running this organization is ambiguous and you're just trying to move forward, but I think there's a few things. The first is to make sure your intent is good. As you're looking for “What am I trying to achieve?”, make sure it's something that in the light of day, you could stand up in front of everybody and say, “This is what I was trying to do,” and people would embrace that.

The second is you just put one foot in front of the other. In all of these situations that are complicated, the biggest risk is staying tied to the dock. You've got to throw the rope off and start to go.

The last is, regardless of the outcome — obviously we all hope for good ones — but good, bad, indifferent, you just try again with the next issue. You don't let a single failure derail your ability to do other things.

And I think all three of those are relevant to basketball, relevant to surgery, relevant to running a big Blue Cross Blue Shield organization. 

Q&A Resources

Dr. Mark Mugiishi ― Bio | LinkedIn

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