Popular Boston Mayor Thomas Menino may have been the architect behind the merger of Boston City Hospital and Boston University Medical Center, which formed the new Boston Medical Center, but Elaine Ullian was the deal's builder.
And she went through hell getting it done. The next time you've had a bad day at the office, think about Ullian, Boston Medical Center's president and chief executive officer, who in the past year has dealt with picketing at her home, threatening letters, hecklers at public appearances and vandalism to her car. The situation is so acute that Ullian's board of trustees insists a bodyguard stand outside her office and accompany her around the medical center campus.
Yet through it all, she remains as enthusiastic and effervescent as ever.
"It's the mission of this place that keeps me going. I'm convinced that we are doing the right thing," she said. "When things get rocky, I remind myself that this is only a job. If it disappears, I still have my family and my friends and my identity away from the hospital."
But lately that identity never remains too far from the glaring spotlight of politics and healthcare reform.
In arguably the most pro-union and political town in America, Ullian has pulled off a healthcare management miracle-the July 1 linkage of a public hospital with an academic medical center. The result is a 633-bed not-for-profit organization committed to serving a growing indigent population. But instead of dealing with a patronage-heavy public hospital work force and the bloated costs of a university medical center, the merged entity intends to compete in a Boston marketplace rapidly moving to managed care.
"We are becoming more efficient and conscious of value without sacrificing our public health mission," she said.
But the merger triumph hasn't come without pain and suffering, and more-perhaps much more-is in store. Since the merger, BMC has closed its Boston Specialty and Rehabilitation Hospital, finalized tough union agreements and laid off approximately 150 workers.
Last month, Ullian announced plans to slice 10% off the $400 million annual budget, and there are fears that hundreds more jobs will be lost. At the time of the merger, the organization employed some 4,400 workers. The rapid-fire changes are producing high anxiety and unrest among employees. While Ullian is sympathetic, she notes many of the cuts would have occurred earlier if not for a stand-still pact the hospitals signed with the unions during the two years it took to arrange the merger.
And to think that Ullian gave up the relatively cushy job of running Boston's Faulkner Hospital to take on these headaches. But after seven successful years at Faulkner, she was ready for new challenges. Enter Menino, who worked closely with Ullian when he served as councilman in the district that included Faulkner.
The mayor helped grease Ullian's 1994 appointment as president and CEO of BU Medical Center, knowing full well they would attempt to merge it with the adjacent Boston City.
"This mayor is a keen student of healthcare economics. We agreed that the two hospitals would be unable to survive managed-care pressures and government spending cutbacks," she said. "But we also agreed that unless serious steps were taken, the people of Boston would lose a valuable medical resource."
Ullian discusses public health issues with the fervor most Bostonians reserve for politics, chowder or the misfortunes of the Red Sox. She received a master's degree in public health from the University of Michigan and once helped manage the Massachusetts Department of Public Health. Always ambitious, Ullian in 1984 was a founding member of the A Team, a group of women healthcare managers in Boston who yearned to break through the glass ceilings of hospital executive suites.
Friends say her well-honed package of political, people and professional skills paved the way for success. They say she's especially strong in dealing with physicians.
But selling physicians on the merger was relatively easy because of the proximity of the two hospitals, their ties to the BU Medical School and a history of sharing services. Instead, it was unions and political opponents who came close to queering the deal.
So organized was Boston City's work force that even medical residents were unionized. And all the labor leaders wanted sweeteners before agreeing to the merger. It was an agonizing experience.
Meanwhile, consumer advocates, political foes of the mayor and union bosses jabbed away at the plan.
"I can't believe we got this done in two years," Ullian said. "There were many days when I thought it would all unravel."
While local media were mostly supportive during the merger process, news coverage of late has focused mainly on the heartache of lost jobs and what cutbacks could mean to BMC's quality of care.
"We have to evaluate every job and every department and determine what is essential," she said. "It's not whether he is a good person or she is a good worker. It's whether the job is actually needed, and that's a rough process."
Because of the whirlwind activity since the July 1 merger, a planned celebration dinner with Menino at the Ullian home didn't occur until the day of our interview, Nov. 15.
"She had a tough time over (the past several) years, and sometimes I was the cause of it," the mayor said. "But all of us are better off for her vision and effort."
Ullian's latest vision is merging BMC into New England Medical Center, which also is being courted by Columbia/HCA Healthcare Corp.
"I can feel the synergy of a Boston Medical-NEMC combination," she said. "And for me, it would be a dream. I really respect the place." Ullian's resume includes a stint from 1984 to 1987 as NEMC's vice president of clinical operations.