April 01. 2013 9:00AM

Alpha women

Female executives guide hospitals through historic reforms

By Dan Shafer

  
Five years ago, Catherine Jacobson, Peggy Troy and Susan Edwards all held high-ranking positions in health care systems outside the state of Wisconsin.
Susan Edwards, Catherine Jacobson and Peggy Troy

Since then, they have taken the reigns at three of the largest health care systems in southeastern Wisconsin, and they are calling the shots at an historic time in the industry's history, as the Affordable Care Act is rolled into action.
  • Jacobson is president and chief executive officer of Froedtert Health.
  • Troy is president and CEO at Children's Hospital.
  • Edwards is president and CEO at ProHealth Care.

Should it still be notable in 2013 when women are successfully running major organizations? Perhaps not, but the facts shed light on a landscape that hasn't changed as much as we'd sometimes like to think. Male CEOs still outnumber female CEOs by a wide margin. As of Jan. 1, 2013, 21 of the Fortune 500 CEOs – less than 5 percent – are women.

This discrepancy is largely the case in the health care industry, as well. A 2012 report by RockHealth found that just 4 percent of health care organization CEOs and 18 percent of hospital CEOs are women.

These facts make the situation here in southeastern Wisconsin all the more remarkable. Under the leadership of these three women, more than 17,000 people are employed, and the three health care systems represent nearly $3 billion in combined annual operating revenue.

The trio of female executives all took over for men who retired after long careers at their respective organizations.

Jacobson, whose 2012 appointment at Froedtert Health gave her the distinction of overseeing the largest organization – of any kind – in Wisconsin that is run by a woman, said the local dynamic is unique.

"This is such an unusual community where you have three health systems – half of the health systems in southeastern Wisconsin – are being led by women," Jacobson said. "It's hard to find."

But perhaps the number of women in leadership roles, like many other aspects of the health care industry, is changing.

"Over the years, there were not a lot of women in leadership roles," Edwards said. "But now I see a major evolution where women are taking leadership roles and doing wonderful jobs."

Some changes are evident, as women are now launching businesses at 1.5 times the national average. But that doesn't mean there aren't times when a certain "boy's club" nature of leadership isn't apparent.

"Every once in a while you're in a place where it starkly stands out," Jacobson said. "I was just at a national conference where I was on a panel, and they had a brochure on the 25 to 30 people who were on panels or speakers. I was the only female in the entire brochure, and that was a national health care conference. It was noticed."

Leading the large health systems as Obamacare is enacted poses unique challenges for the executives.

"This is the first time in my career where the landscape's not as clear as it's been in the past," Troy said. "The uncharted waters are very, very sobering."

Among the aspects of the reform law receiving the most attention are the federal and state-run health insurance exchanges.

"The health insurance exchanges that are supposed to go live on Jan. 1, 2014, have not yet been designed, so we don't know what's going to happen as a result," Troy said.

Quality and costs

Other aspects of the law having major impact are its emphasis on improving quality and reducing costs.

"There's always been a move to improve quality and lower cost," said Edwards. "The key driver has been payment reform through the Affordable Care Act, which forces organizations to learn new and different approaches to improving quality and reducing costs."

One part of that effort that is already taking place is the transition to electronic medical records (EMR). Each of these health systems has made the transition to Verona-based Epic Systems Corp.'s system in recent years.

Jacobson faced a particularly difficult challenge in making the EMR transition at Froedtert, southeastern Wisconsin's only level one trauma center.

The weekend of Aug. 4-5, 2012, was Froedtert's "go live" weekend with the new EMR. But on the morning of Aug. 5, tragedy struck in Oak Creek when white supremacist Wade Michael Page fatally shot six people and wounded four others in a mass shooting at the Sikh Temple of Wisconsin.

Despite the pressure of the mass shooting and the national media attention that followed, "No one knew," about Froedtert's EMR transition, Jacobson said. "That says a lot for the staff at Froedtert. They just went off without a hitch. They did what they were supposed to do."

The first of the three CEOs to land in Wisconsin was Troy, who officially became president and CEO of Children's Hospital and Health System in January of 2009. Landing the job marked a full-circle career journey for Troy, as she went to nursing school at Marquette University and had her first internship as a nurse at Children's Hospital.

"I'm a boomerang," she said. "That's what we call people that come back (to Milwaukee)."

While her career took her many other places, including Chicago, Fort Worth and Memphis, family ties to the Midwest and her early-career connection to Milwaukee kept Children's Hospital on her radar throughout her career.

"I have always loved Children's Hospital," she said. "I've always watched the success it's had over many, many years. It's such an honor for me to be here and to be leading this extraordinary institution. I love it."

There are also major challenges that Troy has had to address in her role as president and CEO. More than 50 percent of the children served at Children's Hospital are on Medicaid, a number that has grown during the challenging economic times of recent years.

"The only reason people typically end up on Medicaid is either they have a very, very chronically ill child and Medicaid adds a supplement, or, because people have no work," she said.

The uncertainty of how cuts in Medicaid will impact the hospital's ability to provide the best possible care is a concern, Troy said.

Another important component of her job is ensuring that Children's Hospital is fully invested in the future of Milwaukee.

"When young families are being recruited to communities, they want to know a couple things: what's the education system and what's the health care for our children," Troy said. "That's a very important thing that employers in our community can absolutely assure their future potential employees that they're going to get the very best health care in the country for their kids."

Collaborations

Partnerships with state and national organizations are key for Children's Hospital, and one of the most important partnerships for Troy is with Jacobson at Froedtert Health, as both of their facilities, along with the Medical College of Wisconsin, are at the Milwaukee Regional Medical Center in Wauwatosa.

People from around the country are taking note of the work Jacobson and Troy are doing in their roles. Last year, Becker's Hospital Review named both to the list of 120 Health Care Women Hospital and Health Leaders to Know. Jacobson was also recognized by "Health Exec News" as one of the 10 Most Powerful Women in Health Care.

Jacobson took a path to health system leadership quite different from Troy's, having earned her bachelor's degree in accounting. Though her first job out of college was at Arthur Andersen in Chicago, health care was a big part of her background, and it is part of what led her to a career in the industry.

"My family is a health care family," Jacobson said. "For her entire career, my mother was a registered nurse at a hospital in our local community hospital where I grew up outside of Rockford (Ill.). So you heard all the stories, having a working mom who was a nurse."

Jacobson even worked her first job in high school washing dishes at the hospital kitchen, so she's never been a stranger to the hospital environment. Despite coming from a financial background, a career in the health care industry, was a logical choice for her, and a decision to enter that field came early in her career.

"When I got out of college and went to Chicago and worked for one of the big accounting firms, they all asked us to check off our industry preferences. I checked off hospitals," Jacobson said. "Then, you found out nobody checked off hospitals. So what I ended up doing was a lot of hospital audits."

The complexities of specializing in health care finance piqued her interest, she said, and she was soon hired by her largest client, Rush Health Plans. There, she rose in the ranks. At 27 years old, she became the health plan's chief financial officer. There was a fairly steep learning curve in the role, she said, but she managed to meet the job's challenges.

"When you're 27 years old, you have no business being a chief financial officer of anything, quite frankly," Jacobson said. "I probably worked 10 years of time in five years."

A big part of what Jacobson learned was how to collaborate with and rely on the other members of the team. Collaboration is a big part of her leadership now, not only with the others at the Regional Medical Center, but also with organizations such as the Health Finance Management Association (HFMA), where she served several years on the national board of directors and as the organization's chair.

In addition to HFMA, she is a member of the American College of Healthcare Executives and the Chicago Network. She has also become part of many Milwaukee-area organizations since joining Froedtert Health, serving on the boards of the Wisconsin Hospital Association, United Way of Greater Milwaukee, Blood Center of Wisconsin, the Greater Milwaukee Committee, the Metropolitan Milwaukee Association of Commerce (MMAC) and is a member of women's leadership organizations TEMPO and Professional Dimensions.

"It's a focus on looking outside of yourself and outside of your organization," Jacobson said. "When you belong to those professional organizations – and now I'm finding even as you get to be involved in boards that are outside of health care – is that there's always somebody doing something better than you are. It's so much easier to talk to them and learn from them than try to make it up on your own to solve a problem. Having a network of folks that have dealt with your problem or are struggling with it at the same time, they make you a better professional."

Jacobson makes a point to bring speakers into Froedtert from outside the system and outside the region to talk about the "next thing coming."

Part of this approach, for Jacobson, is a continuation on the legacy of William Petasnick, Jacobson's predecessor as president and CEO, whom Jacobson said was a big part of the reason she came to Froedtert.

"Bill was a visionary in making sure that you looked outside the organization to make sure that you were moving in the direction that you needed to," she said. "And not just outside the organization, but outside southeastern Wisconsin. He really had a national view."

The 'clinical side'

Edwards has worked all over the country, with stops at health care systems in Youngstown, Ohio, Detroit, Harrisburg, Pa., and Phoenix, Ariz., before taking the top job at Waukesha-based ProHealth Care.

Her path toward health care administration came after she earned her undergraduate degree in biology at Emory & Henry College in Virginia, but was not interested in working in a laboratory.

"It dawned on me that I was going to end up working in a lab somewhere and did not want to do that," Edwards said. "I wanted to be in an environment where I had the opportunity to work with people as opposed to machines and microscopes. I made a decision to go to Duke University to get into health administration."

Biology, however, still had a significant impact on her career.

"Understanding the sciences really helps you understand the clinical side of what we do," she said.

Edwards also continued to pursue further education even after she became the executive vice president and chief operating officer at Mt. Clemens General Hospital in Detroit in 1987. She took night classes at Wayne State University and earned her law degree in 1993.

"The legal world touches every part of what we do," she said.

In addition to that experience, however, she faced a brand new set of challenges when she became her mother's legal guardian in 2009.

"(My mother) has vascular dementia and fell and broke several bones," said Edwards.

Seeing health care from the perspective that came with being her mother's guardian has had a profound effect on Edwards' view of the industry.

"I always thought I knew exactly how everything worked," she said. "Having to provide guidance in this situation has really helped me understand that our system needs to be fixed as an industry."

Navigating the complexities of how seniors deal with Medicare has been an eye-opening experience for Edwards.

"It's very difficult, it's very cumbersome, it's very complex and it's just downright confusing. I wonder, honestly, how people who don't work in health care figure that out. I'm not sure they ever actually do," Edwards said. "It's also helped me become a lot more aware of the cost of health care. Probably more than anything, just the understanding how fragmented care is in today's world and how we all have the opportunity to change that going forward."

Addressing fragmented care is a priority at ProHealth Care, the largest health care provider in Waukesha County. The nonprofit organization's network includes Waukesha Memorial Hospital, Oconomowoc Memorial Hospital, 15 Medical Associates clinics with more than 125 primary care physicians and specialists, home health care, hospice care, rehabilitation services, assisted and independent living communities and a health and fitness center.

"There are a lot of great components to ProHealth Care, but when I first came, they were functioning in silos," said Edwards. "You had two separate hospitals, you had clinics, and they were not really integrated. In today's world with accountable care, we have to deliver care across the continuum in a seamless way. A lot of the integration work was to break down the silos so (the process) is a lot more seamless."

Edwards has worked to create the vision of integration by spearheading a major leadership organization early in her tenure and realigning all of their boards. She also has placed great emphasis on becoming more efficient, eliminating duplicative services and preparing for the requirements of reform.

"Any change is new change, and new change is hard for folks," Edwards said. "But the team has really done a great job of coming together from a system standpoint and really thinking system as opposed to silo. It's been great to watch."

However, change is not something Edwards shies away from.

"We had a lot of opportunities here to reengineer a lot of things – governance reengineering, leadership reengineering, structural reengineering, strategic plan development," she said. "This organization had a lot of opportunities to make an imprint. That was exciting."

Transparency is key

Edwards said the key to making changes is an approach emphasizing transparency, which she said has been a priority throughout her career. One example of this at ProHealth is in employee "town hall meetings" that she has held. The meetings, which have been at many different locations on all three shifts, serve two purposes: to allow employees to hear and understand what is happening and to hear back from employees on their ideas to improve the process.

"It's really pretty phenomenal because our employees have a lot of ideas around things that we can do better to improve what we do, things to create efficiencies in our system. It's been very positive," Edwards said.

Edwards, Jacobson and Troy have found positive relationships with each other, as well. The uniqueness of the situation here in Wisconsin has brought about a friendship between the three CEOs. They go out to dinners together, and it's evident that they have professional respect for each other.

"I enjoy Peggy and Cathy a great deal," said Edwards. "Our backgrounds are very different, and I think each of us came here with specific goals in mind of recognizing that the world was changing."

The bottom line is that the three health care systems will navigate through this historic era with women at their helms.

Said Jacobson, "That's why I find it refreshing being in Wisconsin."

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