Barbara Biehner was lucky. Her career choice virtually fell into her lap.
An interest in science led to her first job in college: conducting benchmarking research for the department of physiology at Emory University Hospital in Atlanta. Based on her encounters with administrators at the hospital, she made the decision to pursue a master's degree in hospital administration at Georgia State University in 1979.
Apparently, she made the right choice.
Some 15 years later, Ms. Biehner's resume displays administrative positions she held at Children's Hospital National Medical Center, Washington; Bon Secours Health System, Columbia, Md.; Alliance Health Services Corp. (now Sentara Health System), Norfolk, Va.; and Chesapeake (Va.) General Hospital.
Now, she is chief operating officer at Children's Hospital of the King's Daughters, Norfolk, where she oversees 1,700 employees and 500 physicians.
"Working at a children's hospital adds a whole new element to how you are committed to your job," she said.
Her experiences as a mother also add to her commitment at work. She had her first child, Mary Carole, in May 1991. The baby was one month premature and needed special attention at the hospital.
"I realized how frightening it can be on the other side and the importance of patient satisfaction," she said. "You can't expect a tiny baby to come into the world and have the family know exactly what to do from the beginning."
Children's in Norfolk recruited Ms. Biehner as a senior vice president in 1989, when the hospital staffed 144 beds at nearly full capacity. "With over 6,000 admissions and 25,000 outpatient cases per year, my first year at the organization was spent deciding what resources were needed to increase the quality of our delivery system," she said.
Last month, Children's dedicated a $50 million, 350,000-square-foot expansion that increases the hospital to 186 beds and features an upgrade of ambulatory and diagnostic services. Many hours were spent securing state approvals-especially for the expansion of inpatient beds, she said.
She organized the transition into the new building by putting in place eight teams of employees, management and physicians. The project was completed on budget and ahead of schedule.
But the expansion is only one component of what she terms the "Building Excellence" initiative at Children's. Using a model for healthcare comparable to W. Edwards Deming's TQM philosophy, Children's is focusing on the patient's needs by breaking down tiers of management. "We are asking ourselves, `How can we do things better?'*" she said.
"I have found Children's to be greatly challenged by the cost-containment pressures of reform," she explained. With a $130 million annual operating budget, she has maintained an annual operating margin of 3.5% to 4.7%.
Not all the tasks she has faced have been pleasant. The organization began a gradual downsizing just two years after Ms. Biehner came on board with a 50% reduction of vice presidents and a 40% reduction of middle managers. Of 53 midmanagement positions, 11 employees were terminated and 11 were redirected into expanded roles within the organization. Seven vice president positions were cut to three.
Ms. Biehner helped coordinate employee interviews and hands-on support committees to ease the burden.
Because of the pressures of healthcare reform, she has established collaborative relationships with regional networks, including the 12-hospital Neonatal Network in the eastern part of the country. She currently serves on the Grievance and Credentials Committee of Children's newly formed physician-hospital organization of 70 pediatricians, 65 subspecialists and 20 pediatric surgeons.
"The greatest lesson I've learned in my career is the need and importance of teamwork," Ms. Biehner said. This lesson must carry over to her personal life as well. She is a member of the Ronald McDonald House Board of Directors and Rotary Club of Norfolk, and sees herself playing a larger role in the community in the future.
Her husband, Carl, works as an administrator at nearby Chesapeake General Hospital and both struggle to balance their careers with parenthood.
"I would still like to be part of a healthcare delivery team," Ms. Biehner said. "But I would like to find a balance with my family life as well."