Andy Mueller, CEO of MaineHealth, has practiced medicine at the highest levels, literally.

A former flight surgeon for the Air Force, Mueller cared for pilots and their families after his own dream of becoming an astronaut was derailed by asthma. He later decided to leave family physician work and pursue a career in administration, recognizing that he had an opportunity to create more value as a leader than he could seeing 30 patients a day at a clinic. After a short stint as a CEO at a small health care system in Virginia, he was recruited to become CEO at MaineHealth, a post vacated in 2019 by longtime CEO Bill Caron.

Despite a series of Zoom interviews he unpretentiously calls “not good,” Mueller said he kept his hat in the ring. Then he accepted an offer to come to Portland during a Nor’easter in the midst of the pandemic. While he attended multiple Zoom interviews via his Portland hotel room, his wife explored the area. As much as he liked the people and the opportunity coming to Maine presented, he had decided to withdraw from consideration when he was sitting at a stoplight in Virginia and he noticed the car in front of him was plastered in Maine bumper stickers.

He changed his mind.

For Mueller, the decision to come to MaineHealth was agonizing because he was making progress in the Virginia system, which had been rocked by huge losses, lay-offs and a sex scandal. But he said he realized he would have an opportunity here to deliver health care on a larger scale and in a totally different way than he could in Virginia.

Here are some takeaways Mueller offered in a chat about leadership with Lisa DeSisto, CEO of Masthead Maine and publisher of the Portland Press Herald, before a live audience gathered April 29 at Portland House of Music.

• Listen to your heart. Mueller started his career as an electrical engineer, thinking that would be his ticket to become an astronaut. But it wasn’t a passion. His desire to do something cool that would fire him up led to medicine.

• Listen to family. An instructor at a leadership conference told him he had to make a choice between being an executive who went to medical school or a physician with a leadership role. Mueller’s middle daughter told him he could always be a family doctor but the opportunity to lead an entire health care system wouldn’t come along often. He chose leadership.

• Be open to the unconventional. Health care in this country has been based on a fee-for-service model for decades. Mueller said we have to get away from that model and create a health care system that is based on trusted relationships between providers and patients and is more affordable. There are unique opportunities at MaineHealth – people care for each other, local pride, enough scale to survive financial challenges yet remain nimble, an engaged business community and great relationships with leaders of other Maine health care systems — that need to be capitalized upon.

• Be comfortable with turbulence. DeSisto asked Mueller how he leads through some recent challenges: the formation of a nurses’ union and a dispute over payments from Anthem, the state’s largest health insurance provider, which is severing services between Anthem and Maine Medical Center, MaineHealth’s flagship hospital. Mueller said that’s the nature of leadership — you will always be faced with a challenge you didn’t see coming. Respond by really committing to the work that needs to be done, prioritize what’s important and work together as a team.

• Connect with employees. Mueller launched Open Door, a live stream program every two weeks where he connects with employees by sharing updates for 15 minutes and then taking questions for another 20. He said the questions are often variations of whether employees are getting a raise, and sometimes some real zingers come his way. But he’s building a relationship with staff; about 15 percent of the system’s 22,000 employees tune into Open Door. Additionally, he schedules a day a week where he goes around to different departments within the health care system and connects with employees, sometimes working side-by-side. The experience -sometimes inspiring, sometimes crushing – gives him a healthy perspective on people’s journeys as employees, and has been embraced by other administrators.

• Engage and empower employees. Medical teams are exhausted by fighting the pandemic. Mueller said besides the obvious things like paying a fair wage and offering good benefits, it’s imperative managers battle burnout by being flexible and challenging the paradigm around what’s important. Giving voice to employees in decision-making is also essential. Among MaineHealth’s new offerings to help employees and their families is unlimited access to virtual counseling on Talk Space.

• Reinvest in rural health care systems. Mueller said he believes it’s essential to deliver health care as close as possible to where people live and work, especially in a rural state like Maine. He acknowledges that goes against conventional wisdom of the past 15 years, which has stripped access to advanced services at smaller hospitals and sent patients to urban centers. But as populations age, it’s essential to consider disruptive ways of delivering health care, such as in schools, churches and workplaces, through telehealth services and home-based care. “I think we’re going to need jobs that don’t exist today. We’re going to have to rethink how we do work in health care.”

• Embrace innovation. MaineHealth supports an Innovation Center, which is working on a multitude of projects to deliver better care, such as Hospital at Home where care is delivered outside the walls of hospital. MaineHealth is also partnering with Agilon to change its fee-for-service model for Medicare Advantage patients to a whole-patient model that is expected to improve care, keep patients out of hospitals and lower costs.