Urban Knobbe returned to Carroll, Iowa, in 1992 for what he thought would be a relaxing retirement in a rural community.
But his longtime rival in the grain elevator business had other plans for Knobbe.
Wayne Seaman had banged heads with Knobbe for decades as Knobbe spent 40 years building Farmer's Cooperative Co., 30 miles northeast of Carroll in Farnhamville, Iowa, into one of the state's largest grain elevators.
Seaman was nearing the end of his term as a trustee at St. Anthony's Regional Medical Center in Carroll at a time when he and fellow trustees were determined to find out why Carroll's 10,000 residents went elsewhere for much of their healthcare.
"In a couple of years, I was going to leave the board, and we had so many things up in the air," says Seaman, who was chairman of the 142-bed hospital's board in 1992. "If we were going to follow through on our plans, I knew we were going to have to have good board members."
For his ability to step in and lead St. Anthony's expansion, Knobbe has earned MODERN HEALTHCARE's Trustee of the Year award for hospitals and healthcare systems with fewer than 200 beds or revenues of less than $25 million.
From competition to cooperation. "Knobbe and I had been very strong competitors for years, but we never lost respect for one another," says Seaman, who is chief executive officer of West Central Cooperative, a grain elevator 15 miles east of Carroll in Ralston, Iowa. "He was very willing to go on the board and assume that new challenge."
It helped that the hospital was profitable. St. Anthony's had net income of $3.5 million on net revenues of $20.8 million in 1996, according to HCIA, a Baltimore-based healthcare information company.
"I told him I would only serve on the board if the hospital was going to be run as it was advertised, and it wasn't," Knobbe recalls. "If they were going to call it St. Anthony's Regional Medical Center, it was going to have to become regional."
Knobbe hadn't lived in the Carroll area for many years, but he had many relatives and friends there. He grew up in nearby Breda.
"Urban is a very caring person and has so much experience working with people," Seaman says. "It took him about half of a board meeting to fit in. It's a compliment to his ability to relate to people."
His previous board experience gave Knobbe almost instant respect on St. Anthony's board.
He served on the board of 49-bed Stewart Memorial Community Hospital in Lake City, Iowa, from 1978 to 1982. He served a stint as a trustee and chairman of Farmers Commodity Board in Des Moines and as a trustee of Associated Benefits Corp., a Des Moines-based pension fund for cooperative employees from around Iowa; and United Purchasers Association, a Des Moines-based group that represented buyers of fertilizer and other related products.
"I think Wayne wanted me on the board because he thought I'd be bored in retirement," Knobbe, 73, says with a chuckle. "I always say I'd rather wear out than rust out."
Because St. Anthony's didn't have the specialty physicians for certain community needs, Carroll residents were traveling more than 90 miles southeast to Des Moines or 100 miles west to Omaha, Neb. For example, a dialysis patient was losing a day or more of work each week for treatment compared with the hour or less it would have taken if the service was available at St. Anthony's.
In the past, the board had bandied about the idea of adding more outpatient services, but it took the arrival of Gary Riedmann as St. Anthony's president and CEO in June 1992 to swing into action.
With Knobbe beginning his service as a trustee the next month, the duo would complement each other in achieving success for St. Anthony's.
"Gary is really a visionary, and Urban supports that quite well," says Sister Rita Heires, a fellow trustee and member of La Crosse, Wis.-based Sisters of Perpetual Adoration, sponsor of St. Anthony's.
First steps. At first, the board started small, approving the purchase of two dialysis units in 1993 serving some 20 Carroll-area residents. Realizing more space would be needed to add more outpatient services, the hospital board approved plans for a major capital campaign.
"Urban and the board decided early on that we were going to do this ourselves," Riedmann says. "We hired our own staff from within the hospital and avoided hiring outside consultants. Urban and the board were out front of this all the way."
The board gave the go-ahead in January 1993 to have the campaign raise funds for a new community health center and an outpatient addition. The 86,000 square feet of construction cost $14.7 million.
Knobbe had so impressed the board with his enthusiasm, he was elected chairman in his second year.
Knobbe and the board have an excellent relationship with St. Anthony's management, but they certainly aren't a rubber stamp. "We question," Knobbe says. "Maybe question isn't the right word. We agitate to make sure things are moving along."
The board agreed to the capital campaign, but only if it was done locally. The board and management called the $2.7 million campaign a "friend-raising" campaign and worked to get as many citizens involved as possible. The remaining $12 million of capital costs was to be paid through a $5 million bond financing and cash reserves.
The campaign was a tough sell. The largest previous capital campaign in Carroll was a $1.2 million effort to build a residence for developmentally disabled adults known as New Hope Village. The community completed that campaign in the early 1990s.
The board and staff tried to apply a human touch. "We brought people into the hospital in groups," says Knobbe, who spearheaded the 17-member committee. "We wanted them to see what their community needed."
Through small community meetings, more than 2,500 area residents were sought out for advice. Knobbe was available on a regular basis for community questions.
In turn, board members and management would recount the many stories about people who had to travel far from Carroll for healthcare.
"They take off work, family takes off work or a neighbor takes off work to take someone 90 to 100 miles to Des Moines or Omaha," Riedmann says.
Solid results. The campaign started by soliciting the board and hospital staff. When it ended, the goal of raising $60,000 from staff was doubled to $120,000.
The stories, hospital tours and community meetings also paid off when the campaign surpassed its goal by $200,000 for a total of $2.9 million.
With the new outpatient services up and running, 13 additional physicians and two physician assistants have come to St. Anthony's. More recent recruits have included an ophthalmologist, an anesthesiologist, an otolaryngologist and a podiatrist. St. Anthony's now has 30 physicians on its staff.
The 86,000 square-foot project includes a new 56,000 square-foot Community Health Center. The center includes a multispecialty clinic, which houses physician offices.
The additional physicians have helped St. Anthony's develop clinics in five smaller towns within 25 miles of Carroll.
"Just like we don't like to go to Des Moines or Omaha, other people shouldn't have to go 25 miles to Carroll if they don't have to," Knobbe says.
New physicians have also led to a burgeoning outpatient business. A new radiation therapy center has provided care for 350 area residents a year.
The entire development project has increased net patient revenues 25% to $17.3 million in 1996 from $13.9 million in 1994.
The hospital estimates it now is providing more than 90% of community healthcare needs, but Knobbe has greater targets for his final three years on the board.
"Forty percent of our gynecology work goes out of town, and we want to change that," he says. "We should have a female OB/GYN. We haven't achieved it, but we will before my term is up. We have to."
After the successful capital campaign, Knobbe says the community has a much better understanding of healthcare. Citizens also feel a sense of ownership and pride in St. Anthony's, he adds.
"One of the most important things I can do is make sure our board understands our mission," Knobbe says. "We want to be a regional leader in providing our community's healthcare needs."