In an era when the average hospital chief executive officer spends just four years on the job, Robert Harman isn't just unusual. He's a phenomenon.
Next January Harman will celebrate his 40th anniversary as administrator of Grant Memorial Hospital in Petersburg, W.Va., a public hospital that serves three counties in the Potomac Highlands. His unflagging commitment makes him the longest-tenured hospital CEO on record, according to the American College of Healthcare Executives.
Harman, 64, shows little sign of slowing down. He is such a fixture at the 56-bed hospital that many people can't imagine a morning when his Buick LeSabre will not pull into the hospital's hilltop driveway overlooking his hometown of 2,500.
In four decades, Harman says he just hasn't seen any reason to leave. "There never was a point where I said, `There's nothing more I can do here.' There's always been an opportunity to expand the services or do something better," he says.
Modest, soft-spoken and passionate about public service, Harman embodies the values of rural northeastern West Virginia. He's tightfisted when it comes to money and astute about anticipating trends, which many colleagues say has allowed the hospital to expand while other rural facilities in the state closed their doors.
Harman's influence extends beyond the hospital's three-county service area, even 120 miles east in the nation's capital. The state's U.S. senators, Robert Byrd and Jay Rockefeller, use Harman as a sounding board for healthcare policy, especially the impact of Medicare changes on rural hospitals. Harman has served on bodies of the American Hospital Association almost continuously since 1974, currently as a member of the AHA's governing council section on small and rural hospitals.
Known as a trusted consensus-builder, Harman has been on the board of the West Virginia Hospital Association for most of his career and is the only person to have served two terms as chairman.
Harman's depth of knowledge is tough to match. His tenure at Grant Memorial predates Medicare by 18 months. Under Harman, the hospital navigated Medicare's shift to DRGs in the 1980s and numerous state Medicaid crises, although its remote location shielded the hospital from the pressures of managed care in the 1990s. Harman has ushered the facility through two major expansion projects and several smaller renovations.
Remaining in Petersburg allowed Harman to stay close to his roots. Simultaneous to running the hospital, Harman has operated a cattle farm. "It's my hobby," he says and adds, "I don't golf." Harman's two sons have followed his path. One operates the hospital's pharmacy and the other has taken over daily operation of the farm.
But Harman admits he wasn't sure when he took the job that he would like it. "It wasn't too many years, six or seven, that I decided that I like small hospitals. I like small communities," Harman says. "If I were to move, I would go to another small community."
Working in a large hospital "would drive him crazy," says John Hahn, an OB/GYN who has worked at Grant Memorial since 1987. "His slow, methodical pace in a bigger facility where there are more knee-jerk reactions to things would aggravate him."
Harman was in high school when the hospital opened in 1958 with funding assistance from federal Hill-Burton Act. But as a teenager, he had no interest in healthcare. He played basketball and worked hard at both his grandfather's clothing and grocery store and his father's poultry farm. "He learned as a young person to be dedicated," says Cathy Alt, a childhood friend who is now the hospital's patient accounts manager.
In college he studied business. "I was majoring in finance and accounting, and probably had ambitions of being a CPA," he says. But a professor put him in touch with Eugene Staples, the first administrator of West Virginia University Medical Center in Morgantown, who Harman says attracted him to the public service aspect of healthcare.
Less than a year after earning an MBA, Harman became Grant Memorial's third chief executive. Although he was only 24, Harman brought an air of managerial professionalism: His predecessors were a laboratory technician and a local car dealer who also served on the hospital board. "At that point there were not a lot of professionally trained administrators in healthcare in the country," Harman says.
The nature of the job was different in those days, as well. During Harman's first years, his daily routine included visiting every patient. "That was part of the expectation of your job," he says. Now, Harman spends more time culling through periodicals to keep up with market trends and federal regulations. One of the biggest changes, he says, is the ongoing need for capital to invest in new technology. "You never get away from paper," he laments.
In 2001, the hospital created a chief operating officer position to allow Harman to focus on policy issues and strategic planning. It's held by Mary Beth Barr, a registered nurse and the former patient-services director at the hospital.
A growing region
Grant Memorial serves a population of about 30,000 people in the only growth area of West Virginia, and the nearest competitor is 40 miles away. Lacking such amenities as a movie theater or a Wal-Mart, the town has a tough time attracting doctors. But lately the area's economy has been bolstered by wood products manufacturing, poultry processing and increasingly Washington-area transplants.
Harman says favorable geography has helped the hospital remain profitable. Grant Memorial has always generated a profit with the exceptions of the first two years of Harman's tenure and three years after the Medicare reimbursement changes under the Balanced Budget Act of 1997. In the fiscal year ended June 30, 2003, the hospital posted net income of just over $752,000 on net patient service revenue of $22.4 million.
Barr says the hospital never laid off staff, even after it was hit hard by the BBA. "There was a time where we didn't give raises, but we didn't shut our doors and we didn't lay off people," she says.
Some rural West Virginia hospitals improved their finances in the post-BBA era by converting to Medicare's critical-access designation, which allows a hospital to receive lucrative cost-based reimbursements. Harman says the hospital examined and rejected such a move because it would limit access to care by requiring the hospital to downsize to 25 inpatient beds.
Harman says he's not an original thinker. Rather, his strength is keeping ahead of the curve by talking to colleagues who know more than he does. Grant Memorial has been an early adopter of new strategies, opening a skilled-nursing unit in 1970 and becoming the first local provider of home healthcare. It handled half of its surgeries on an outpatient basis back in the late 1980s. In 1999, it won a contract to house a Veterans Affairs outpatient clinic.
But Harman has also dodged some capital outlays by relying on regional institutions with deeper pockets. Grant Memorial avoided the cost of a new computer system by affiliating with a regional referral center, Winchester (Va.) Medical Center, in the early 1990s. The hospital also buys discounted supplies and receives consulting services from Winchester, which is part of Valley Health System. Recently, a physician group affiliated with WVU Hospitals opened a dialysis center in the area after Harman resisted pressure from a state legislator to finance a dialysis center so local patients wouldn't have to drive 75 miles for treatment. He contended such a center would have been a financial drain on the hospital.
Harman's fiscal conservatism doesn't sit well with everyone. As a young doctor, Hahn says he threw a fit when Harman failed to approve simple purchases such as a copier. Hahn says he was "dumped" at Grant Memorial by the National Health Service Corps, which funded his medical education in exchange for four years of service in an underserved area. He recalls the hospital having a poor heating system, a leaky roof and no central air conditioning when he arrived, much to his dismay. But he came to realize Harman was right to limit spending as a state fiscal crisis that reduced Medicaid and state health program reimbursements bankrupted other hospitals. "I learned patience," he says. Hahn ended up staying at Grant Memorial, he says, because the place was so friendly.
In the 1990s, Harman and other hospital leaders embarked on a $10.2 million overhaul, funded partly with a tax levy that was approved in a special election. The project, completed in 1998, renovated about 70,000 feet of existing space, established a separate outpatient surgery unit and created a new emergency department.
Still, spending money isn't one of Harman's great passions. Besides his 5-year-old Buick, Harman's weekend vehicle is a 1985 Ford F-150 pickup truck with mismatched paint colors on the doors. Colleagues recall him driving the same car through punishing mountain highways for years until it finally broke down. The hospital's immediate past chairman, William Kline, says Harman never asked for a raise, but the board finally gave him one a few years ago after realizing he was drastically underpaid. Still, he earns just $120,000 a year. "He's one of the lowest paid administrators that I know of, especially for his years of service," says hospital CFO Sandy Michael.
Defusing the situation
Another key to Harman's longevity is his expertise when it comes to settling disputes. For example, the county's emergency medical services technicians, who are managed by the hospital, recently wanted a raise that the hospital couldn't afford; Harman arranged meetings with the technicians and the county commissioners to work out a compromise in which the county paid some of the cost of higher salaries, Barr says.
An effort to organize hospital staff a few years ago went nowhere, some say in part because employees trusted Harman when he said they were better off without a union. "He listens and finds facts. He's not the type to dig his heels in just to make his point," Barr says.
Since last year Harman has been working on a program to improve customer service, taking inspiration from hospital consultant Quint Studer's recently published book, Hardwiring Excellence. He's also leading a task force to recommend future policy on the sensitive issue of state rate regulation for the state hospital association.
"My secret of keeping Bob around is always getting ready for his next assignment. As long as I keep him actively engaged, I think he'll stay around our table," says Steven Summer, president and CEO of the state hospital association.
No one who works with Harman seems to want to raise the issue of retirement, and Harman says he has no plans to do so. Certainly, it's unlikely that Grant Memorial, or any hospital for that matter, will see someone of his ilk again. Says Summer: "I think the days when CEOs can stay that long and do the right things for the right reasons are gone. It's much more difficult to lead in an era of diminishing resources."
Birthplace: Cumberland, Md.
Family status: Married with two children, six grandchildren
Education: B.S. in business administration, Fairmont (W.Va.) State College, 1962; MBA, healthcare administration, George Washington University, 1964
Previous jobs: Administrative resident, Prince George's General Hospital, Cheverly, Md., 1963-64
Hobbies: Cattle farming, singing in church choir, reading historical fiction
Quote: "You don't have to be an Einstein to be successful. If you are able to take the resources you have available and apply them, you can do as well as the next person."