Upfront: Critical Care Women at the Helm of Hospitals

Women at the helm of hospitals mix caring for people with business savvy and sensibility. Although hospitals through the centuries have followed the creed of healing the sick, the idea of running a health care institution like a business is a relatively new idea. It would seem that combining the ethical standards of medicine with such hard-edged business concepts as operational effectiveness and, in some cases, profitability might present a conflict for those at the helm. Take a look at Denver’s hospitals, and you’ll most likely find synergy, innovation and compassion. You’ll also find a lot of women in key leadership positions. Here, you’ll meet several women who are chief executive officers and/or presidents of local hospitals. They are meeting the challenge of addressing the complexities of combining the health care needs of the communities they serve with the essential business practices that allow them to fulfill their mission of care.

UpFront1Patricia Gabow, M.D.
CEO/Medical Director, Denver Health
It’s good to have goals. Patty Gabow is shooting for no less than to lead an organization that serves as a model for national health care reform. So far, the score bears out in her favor. Denver Health is the city’s integrated public health care system, combining diverse health care services such as the Denver Health Medical Center, the city’s 911 system, a network of family and public school clinics and caring for prisoners in the state’s correctional facilities. It is also the home of the Rocky Mountain Regional Level One Trauma Center, treating critically injured patients throughout the region. Denver Health is the city’s fourth largest employer. Its services touch one in four Denver residents and 35 percent of Denver’s children. It would seem that creating a unified path for such a complex and diverse organization to follow would be an insurmountable challenge. Gabow has somehow defied that assumption to create what she calls “great unanimity” within her organization. “People are amazed at how we are all on the same page,” she says, almost as if she’s wondering why anyone would be surprised. The reasons are clear to Gabow: “There is no replacement for spending time together. It’s the only way I can understand how all of the components are running in such a large organization,” she says.

Gabow started her career as a physician specializing in nephrology. As a medical student at the University of Pennsylvania, one of the few women teaching at the medical school was a nephrologist, and Gabow remembers identifying with her and discovering her own affinity for the specialty along the way. Gabow loved being a doctor, but she found herself at a fork in the road when she became Denver Health’s chief of renal medicine in 1973. It was a clinical position with significant administrative responsibilities. Over the next several years, subsequent promotions got her deeper into hospital administration and further away from the clinical work she loved. “I was in love with Denver Health, and it was going through some troubled times,” Gabow says. “I believed I could save it if I kept working on the administrative side.” Her family questioned her decision. “My mother thought it was a huge mistake to move this way with my career,” she says. “I told her that being able to care for individual patients is good, but if I can fix an institution that serves many people, that’s more than I could do as a doctor.”

There was another challenge: Gabow’s background was in medicine, not business, management or administration. When she accepted the CEO position in 1992, her son asked her pointedly, “Exactly how are you taking a job for which you have no training?” Gabow laughs. “He was right. I had no training for this job. But being a good doctor is good training for being in management. It’s problem solving. As a doctor, you need a diagnosis and you need a treatment plan. That served me well as a physician, and it’s served me well as an administrator,” she says. Gabow used that wisdom to move Denver Health from being a subset of city and county government to an independent public institution that’s been hailed as the best of its kind in the nation. Leading the city’s public health initiative has also led Gabow to an issue that’s become a passion for her: Finding the solution to the nation’s health care challenges and improving access to basic medical care for all Americans. “As a country, we have this mistaken belief that we have a health care system,” she says. “The truth is, we have lots of disconnected pieces, and our country can’t guarantee a minimum standard of care for everyone. Most people don’t understand the human and economic cost this country is paying by not creating an integrated health care system.” Gabow’s response is to make such a system work in Denver and serve as a model for other communities, and eventually, on a national scale. “Ideas and solutions are fine in theory, but people need to see an example of an integrated health care system that actually works,” she says. “We try to do that at Denver Health. Almost half of all our charges are people who can’t pay us, and we still manage to run in the black.”

Mimi Roberson
Presbyterian/St. Luke’s Hospital
When you ask Mimi Roberson to describe her job and responsibilities, she laughs, then she ties it up into a short, neat summary: “Just do it.” While it might satisfy some to know that CEOs have “other duties as assigned,” just like the rest of us, Roberson sees herself simply as someone filling a necessary organizational role. Roberson’s path to leading a hospital was somewhat accidental. She was a lawyer in a solo practice in New Orleans in the 1980s. She felt fortunate to have what she called a “wonderful life,” and she devoted much of her time to volunteering in the community. One such volunteer position was on the board of a women’s and children’s hospital. She was elevated to chairman of the board, and soon after, she was asked to join the hospital’s paid staff as its CEO.

“I had never managed people. As a lawyer I had always been a solo practitioner,” Roberson recalls. “I had no experience in managing strategic vision, much less a huge staff, and suddenly, I was identifying and creating service lines to care for patients.” Roberson remembers thinking that she had underestimated the complexity of managing a hospital. “It was nice that people had that confidence in me, but I felt a lot of pressure to make sure I did right by everyone. I was accountable 24 hours a day to so many people,” she says. She may have felt overwhelmed, but she quickly drew some parallels between her past and present career paths. As a solo practitioner, she was the one in charge; she was accustomed to wearing all of the hats and understanding how all the parts of her business functioned. The requirements of her new job were similar, just on a larger scale.

Roberson moved to Denver to take the reins at Presbyterian/St. Luke’s seven years ago. “One of the big lures was the chance to be a part of a system of hospitals,” she says. “There are strong and capable CEOs here, and I welcomed the level of collaboration.” She also welcomes the diversity. “Every day we’re putting together jigsaw puzzles,” she says. She marvels at how the hospital’s staff works together to care for patients. “It’s remarkable,” she says. “The easier it looks, the harder it is to do. The path of a patient from admission to discharge is complex, with lots of moving parts. Everyone here works with the sole purpose of providing extraordinary patient care.” Roberson says the payback is simple: “Our greatest reward is when a patient is discharged. We get such gratitude. When a family member thanks us, we feel that emotion, and we know we did our job.” Hospitals are unique communities. There is a certain hierarchy and division that defines the subcommunities within: Clinical and administrative, staff and patient. Obviously, each has distinct reasons for being in a hospital.

It is Roberson’s job not only to lead the organization from a strategic standpoint, and to ensure excellent patient care, but to make sure every voice is heard and represented. “I want to make sure nobody here feels less important than someone else. If something is a big deal to even one person here, it needs to be a big deal to me. This hospital can’t survive unless we have everyone in the balance,” she says. That’s especially important when everyone is working with a singular focus: Caring for patients. “Patients come first,” Roberson says. “Everybody here is on call. Our families have learned to work around that and to help protect the integrity of what we do.” Her sense of equanimity gives Roberson perspective on her own role. “This is seen as a powerful job, but power is not the allure for me,” she says. “I don’t see myself as powerful. There’s got to be someone in charge, and I just happen to be that person. I’d be just as happy in another role.” Roberson prefers “empowerment,” and she poses a philosophical musing: “You don’t need a job title to be powerful. My challenge is not to become the power, but to help others use their own power to succeed.” Her outlook prevents her from having to do an ego downshift when she leaves work to go home to her husband, Ed, a dentist, and their four children, ages 19-23. “When I go home, it’s not about power, it’s about being a good wife, good mother and enjoying life,” she says.

UpFront3Sylvia Young
Medical Center of Aurora
Early in her career, Sylvia Young set her sights on being the CEO of a hospital. Her focus paid off: The opportunity was presented to her when she was just 38 years old, and on her birthday, no less. But her career, as exciting as it is, hasn’t always been a walk down Easy Street. When she came to Aurora’s Humana Hospital 20-something years ago, she was a 24-year-old assistant hospital administrator. One of her biggest hurdles was managing relationships with her employees, many of whom were years older than she was. “I had some bridges to gap,” she says. “I knew early on that it was important to seek people out for their knowledge and to respect their experience and expertise.” Humana’s business model required management to make frequent moves. Young wanted to stay put. At that time, Aurora was a two-hospital town. She made what she calls “a leap of faith” and took a job at Aurora Presbyterian. In the mid-1990s, a corporate health care venture joined the two hospitals together. Young remembers having to re-interview for her job as Chief Operating Officer for what would become Aurora Regional Hospital. One of her responsibilities was to orchestrate the merger. Young’s husband, a cardiothoracic surgeon, predicted the change would take at least five years. “I thought he was nuts,” she says. Young went in believing that the faster they moved through the changes, the sooner people would adapt to the new organization.

She wanted to take what was good about each hospital and create a “best of both worlds” culture, but she was also working with the realities of the moment: She had people in duplicate positions, and she had to make some tough decisions. “We had to go from two to one in many instances,” she says. “We made a lot of mistakes,” she says now. “We moved too quickly to consolidate the management team, and we weren’t respectful enough.” While the merger was bubbling inside the hospital walls, another situation was erupting on the outside. The hospital needed to expand the facility and had just unveiled the architectural renderings. The proposed design was patient-friendly and would improve flow and efficiency on the inside, but Young says the hospital was unprepared for the backlash when members of the surrounding community saw how the expansion would encroach on the adjacent residential neighborhood. “We needed to be more collaborative, and we should have brought the neighborhood in earlier,” she says. In the years since, she’s been promoted to the top spot, and Young says the hospital’s relationship with the neighboring areas is “warm and collaborative” these days. So much so, in fact, that when the hospital recently unveiled plans for its new Heart Tower and a multi-level parking facility, not a neighborly eyebrow was raised. “This time, we did all of the work with the community on the front end, and we were sensitive to their needs,” Young says.

Like other hospital leaders, Young needs to connect with her constituents. She is at work early in the morning and stays late into the evening to make herself available for as many of the hospital’s working shifts as possible. In fact, it’s that connection with hospital employees that is a primary source of Young’s job satisfaction. “This is a fast-paced, complex working environment,” she explains. “Our first responsibility is always to our patients, so it’s important for me to connect when and where we’re fulfilling that mission.” Meeting staff and patients where the rubber meets the road is one way Young tries to overcome the misperception that hospitals are cold, impersonal bureaucracies. “We work hard to humanize the hospital experience here,” she says.

Mary M. White
Swedish Medical Center
Mary White’s father was a doctor and her mother was a nurse when she was growing up in rural Pennsylvania. “It was a small-town solo practice, and I helped with everything around the office,” she says. But the small-town opportunities didn’t offer much of the kind of future White saw for herself. In college, she was attracted to the sciences and studied to become a medical technician. Her vision was to take that expertise back to a small community. “I truly thought I would be the savior of rural health care,” she says. After several years, White decided that the clinical side of medicine was not her calling. She went on to get a master’s degree in public health and health administration and moved to Colorado for an internship, where she began working in the newly established rural health office at the state capitol.“Where I grew up, even when you were in a rural area, it was still populated,” she says. “Out here in the western states, there are some counties that don’t even have a nurse or a hospital.” It became clear to White that access to health care in rural areas was a problem that wouldn’t be solved quickly with a few conversations between civic leaders. “It’s more emotional and political than that,” she explains. “The hospitals that are out there in remote areas are critical to the fabric of those communities.”

White decided she was better suited for a more hands-on environment, where she would see the results of her work more quickly. She began working at Rose Medical Center as a strategic planner, which was a good foundation for the jobs that followed. “It was very educational for me,” she recalls. “Planning requires a lot of research, and I also had to be equal parts listener and interpreter. I had to fit needs, talent and resources together.” At Swedish, where White has been CEO since 1996, her small-town sensibility is right at home in Englewood. “This is a small town in the middle of this big city,” she says. Swedish is Englewood’s largest employer, emphasizing the importance of connecting to the community. “Many of our employees live in Englewood, so this really is our home,” she says. “We know the city leaders, we support the schools, we participate in fund-raisers — this is our town.” This past summer, she was asked to participate in a focus group for long-range city planning in Englewood. “We talked about development and the impact of different industries. It’s interesting to see how we are all woven together in the fabric of the community,” she says.

One of the key factors that keeps White motivated is the 2,000 employees who work at the hospital. “I guess that anyone who loves her job would say that the people are a big part of that, but it really is true,” she says, adding that it’s important to her to know what’s happening in the lives of employees. She confesses that she likes a friendly chat in the corridors to catch up on people’s lives. “That’s how people connect with one another; that’s how we share news about our families,” she says. “I feel like we all believe that we come here every day knowing that we’re making a difference.”

White understands that many people are uncomfortable with hospitals: “Patients aren’t here because they want to be here. Hospitals are hard for people to navigate, and as more people don’t have a doctor who knows them well, patients often feel like they’re here without an advocate.” She says that the key to counteracting that perception is to create comfort and be as focused on the individual as possible. “We do a great job of taking care of a patient’s clinical needs,” she says. “In the complexities of patient care, it’s important to do an equally good job of listening, hand-holding and answering questions.” One of the newer programs at Swedish brings White back to where she started —providing health care to rural areas. The hospital’s stroke center is the first such center to be certified in Colorado. The center’s emergency response team is trained to quickly identify stroke and to perform early intervention to reduce its damaging effects. A key part of the program enables the stroke center team to connect with rural emergency staffs to quickly diagnose stroke and guide immediate treatment via the Internet and cameras placed in the operating rooms of remote hospitals. “The ramifications of this program go beyond stroke,” White says. “It gets us closer to providing access and expertise of all kinds in rural areas. It will help increase the confidence of these remote hospitals and clinics, knowing that they can care for the people who need them.”

UpFront5Maureen Tarrant
Sky Ridge Medical Center
One thing surprises Maureen Tarrant: “I’m amazed at how many times I have to tell people they’re not bothering me,” she says.“They say, ‘You’re probably too busy to take this call,’ or ‘you’re too busy to listen to me.’” She has a message for anyone who thinks she’s too busy: “Don’t apologize for bothering me. I have the time, and I enjoy the dialogue.” As CEO of Sky Ridge Medical Center, Tarrant has conveyed a few common-sense expectations that defy bureaucracy: Respect for people. A pox on excessive meetings. No finger pointing, to name a few. “We’ve tried to establish a culture where we embrace honesty and problem solving,” she explains. Tarrant also wants to portray herself as a normal person. “People think CEOs are distant and aloof,” she says. “I wasn’t born a CEO. I tell new employees that I used to be a waitress and that I’ve had a lot of different jobs, so I can relate to their experiences as employees.” She answers her own phone when she’s in her office. should I waste anybody’s time by having someone else answer the phone, only to transfer the caller to me?” she asks. This is the hospital that Tarrant built, literally. Sky Ridge is new to the south metro landscape, and the first hospital built in Douglas County. Appointed as its CEO before construction began, Tarrant was directly involved in the planning, design and construction of the hospital, which opened in 2003.

Sky Ridge has already surpassed its capacity in this fast-growing area of the city. It employs two-and-a-half times the number of employees it had when it opened three years ago, and the number of beds has increased by one-third. Four current projects will add six more operating rooms, 30 more beds, a pharmacy department, a multi-level parking structure and a third medical office for physicians. Tarrant knows that Sky Ridge, while being a health care anchor for the community, is an economic one as well. It is already a major employer for people living in the area, and the additional businesses and medical offices that tend to cluster near hospitals are another factor. “In the industry, we call it the ‘medical mile,’” she says. As with all hospitals, the priorities here are the hospital’s patients, delivering quality medical care, operational effectiveness and fiscal strength. She understands, though, that to be strong from the inside out, her staff and the hospital’s employees have to buy in to the environment she wants to create, and she knew that she had a unique opportunity to set the tone from day one. “My team spent months before the hospital opened, talking not only about operations and logistics, but about committing to a vision and culture,” she explains. Tarrant likes being part of a changing landscape. “Technology is constantly changing. I need to stay on top of changes in medical specialization, business and legislative issues and public policy,” she says.

Key to Tarrant is an awareness of her surroundings. “The pulse of the community changes,” she says. “This area is growing at a rate of 7 percent annually. This hospital is affected by the community around us, and we respond to that,” she explains. When the hospital’s data showed that most of its emergency room patients were children, the hospital responded with an extended-hours pediatric emergency team and a redesigned ER that’s kid-friendly. Tarrant simultaneously pushes for excellence and steps back to give empowered employees room to work, a process she claims makes her job easier. “The appeal of this role for me is that I’m not successful unless I have success in creating a team that’s willing to be empowered and to take responsibility,” she says. She admits that the push is unrelenting: “We can’t have a bad day, hour, week or month. We can’t have a bad patient outcome. That means we have to run on all cylinders.” To Tarrant, caring for patients and running a hospital like a successful business reflects the balance of life. “Everything has to work like that: Schools, churches, families. There is no utopia of unlimited resources and limited demand,” she declares.

Dori Biester
The Children’s Hospital
Nobody ever wants to bring a child to a hospital, and sick and injured children are tragic, no matter what the circumstances, so providing medical care exclusively for children takes emotional investment to a new level, with unsurpassed rewards. For The Children’s Hospital, high on the list is not only a facility that can make sick children well, but doing it in a place that looks warm and friendly through the eyes of a child. Rising balloons and kids’ art create a festive entry for visitors, and the hospital is designed to accommodate kids and their families as well, which is exactly as it should be, according to CEO Dori Biester.

“This is a different kind of hospital,” Biester says. “We work hard to reverse the idea that hospitals are cold, sterile, scary places. Kids should not feel alone here. We take warmth and caring to a different level.” The Children’s Hospital is a freestanding, not-for-profit facility and the only hospital in the area that is completely dedicated to caring for kids. The hospital and its staff address the range of issues, from researching childhood diseases and their prevention to health care access for underserved populations to caring for a fever and stuffy nose in the middle of the night. It also provides specialized services in satellite locations throughout the state and is a regional level one trauma facility. Biester joined the administrative staff at TCH in 1979. With a doctorate in nursing and a career focus on pediatrics, Biester describes her career path as “an evolution” more than any sort of planned course. “Along the way, it was always exciting to see what doors would open for me, and I’m glad this one did,” she says. She has guided the evolution of TCH, including the growth of its network facilities around Denver and across the state. She’s currently pouring energy into TCH’s next stage, a new main facility on the Fitzsimmons campus at the University of Colorado Health Sciences Academy that is scheduled to open in 2007. “Everything we do here to care for kids will be amplified at our new facility,” she says.

She also believes that she’s not alone in charting the hospital’s path. “One person’s knowledge is limited when compared to the collective knowledge of an organization,” she says. “I’ve learned to draw upon the wisdom of the ‘knowledge workers’ here, and how important it is to have them intimately involved in the decisions we make here,” she says. Biester admits to somewhat of a grueling schedule. She’s a tireless advocate and ambassador, both for the hospital and for children’s health issues on a national scale. She is a frequent traveler and called-upon expert, lobbying for children’s health policy issues, and is a favorite guest and keynote speaker on the national pediatrics circuit. Leading a place where no child wants to be is a tough challenge. Biester’s focus stays on a positive track: “My goal is successful outcomes for children,” she says.

Photography KIT WILLIAMS

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