Taking it to the next level

Two years ago, Modern Healthcare's list of the Top 25 Women in Healthcare was crowded with Washington policymakers and lobbyists as they sought to recast the industry into a more accessible, accountable and efficient system of care. Today, the list is dominated by leaders outside the Beltway, just as health reform moves from policymaking to implementation on the local level.

Many women on the list are champions of a better healthcare system—they are advocates, dealmakers and powerbrokers. Many also are savvy business executives who have weathered the turbulence of the past three years and come out of it with even stronger organizations.

Mostly, they are women who have doubled down on their slice of the industry—and are now seeing those bets pay off.

Take Debra Cafaro, chair and CEO of Ventas, one of the leading healthcare real estate investment trusts. Twelve years ago, when Cafaro took the helm at the Chicago-based REIT, the company had fewer than 10 employees and was collapsing under the weight of its single tenant, Vencor (now Kindred Healthcare), which was struggling with cuts to Medicare and Medicaid payments.

Cafaro had no prior healthcare experience—she was an expert in real-estate law and finance—but company leadership believed she could institute a much-needed turnaround.

“I had to learn the long-term-care business very, very quickly,” Cafaro says. “It was baptism by fire.” Cafaro immersed herself in the industry, and she liked what she saw. She refused to sell any assets, even as others were getting out of healthcare property management, and the wider REIT industry still viewed healthcare as a backwater.

Instead, she restructured the company in 2001. Since then, she has grown Ventas to nearly 300 employees with real-estate value of $11.6 billion as of Dec. 31, and a portfolio of more than 600 assets—including long-term-care facilities, assisted living and medical offices. In February, Ventas announced plans to acquire Nationwide Health Properties for $7.4 billion, which would make Ventas the largest healthcare REIT in the nation.

Cafaro says she loves the business. “I continue to see tremendous potential,” she says. “What's really exciting for me, in real estate, I would argue that healthcare real estate is the most dynamic and the biggest opportunity.”

It's a trillion-dollar sector, she says, that is still very fragmented. “That's a recipe for success,” she says.

She saw continued upside during the collapse of the overall real-estate market in recent years. Cash flow in healthcare and senior housing continued apace because of sustained supply and demand. An aging population and increased outpatient-care delivery helped keep the sector going in hard times.

“That is something that is resonating within the industry,” she says. Her continued success has made her a sought-after speaker. And she seems to truly enjoy touting the sector's promise.

She sees even more potential in national healthcare reform.

“The cost-containment part of health reform is all about providing the lowest-cost, highest-quality and most-efficient care,” she says. “That growth is in the post-acute and outpatient side rather than in the emergency room and acute-care hospitals.”

Like Cafaro, Nancy Schlichting saw potential where others did not. She came to Detroit in 1998, at a time when most people were running out of town as fast as they could.

A seasoned hospital administrator, she was lured to the city by her mentor, Gail Warden, now president emeritus of Henry Ford Health System. Schlichting held a variety of leadership positions within the organization until 2003, when she took over from Warden as president and CEO.

“I came at a difficult time, and there were significant financial challenges,” she recalls.

The state was making deep cuts to the Medicaid program, and culturally, she says, there was a great need for renewal. The city was on a downward spiral for decades, and it seemed to be accelerating with continued job losses and economic flight.

“It's easy to be a victim sometimes in Detroit,” she says.

Schlichting refused to be a victim. She grew up in Akron, Ohio, and in childhood experienced a lot of family illness. When she was 10 years old, her mother spent a month in the hospital for care. None of the four children, all between the ages of 2 and 12, were allowed to visit her.

Schlichting became fascinated with the healthcare system and wanted to change it for the better.

In Detroit, she has taken on that challenge. “My approach was anything is possible,” she says. “And we began to prove it.”

Conventional wisdom said people in the suburbs would not come downtown for their healthcare. But Schlichting believed they would if Henry Ford could give them something they couldn't get elsewhere in the area. So Henry Ford revamped its urology program. The system hired pioneering surgeon Dr. Mani Menon and approved the purchase of a $1 million robot-assisted machine to perform prostate cancer surgery. The system soon became known for excellence in prostate cancer treatment.

“We began attracting patients from all over the United States,” Schlichting says. “That built our confidence.”

In the decade since, Schlichting has doubled the size of the system, both in revenue and staff. In 2009, Henry Ford opened a new $360 million suburban hospital in West Bloomfield, Mich., and completed a $310 million five-year renovation of the Detroit facility. Today, the not-for-profit independent system is a $4 billion organization with 23,000 employees.

Hospital admissions for the Detroit facility grew from 33,000 in 2001 to 42,000 last year, despite a shrinking city population.

Schlichting accomplished this through her “seven pillars of performance” program, which focuses on hiring the best people; executing on quality; engaging with the broader community; fulfilling the academic mission; consistent service; infrastructure; and financial reinvestment.

No doubt Henry Ford continues to face immense challenges with the ongoing state budget crisis and high numbers of uninsured.

“We just have to be that much better,” Schlichting says.

Maureen Bisognano is no stranger to big challenges, like working to transform healthcare delivery worldwide. And proving she can do as good a job as her very well-known predecessor.

Last July, Bisognano took over as president and CEO at the Institute for Healthcare Improvement when Dr. Donald Berwick stepped down to become CMS administrator.

Berwick had been the face of the IHI since he co-founded the organization in 1989. Bisognano served as executive vice president and chief operating officer at IHI for 15 years before taking the helm.

Already, Bisognano is shaping the not-for-profit organization in new directions—with an increased focus on international programs and helping stateside providers adapt to the realities of health reform.

The eldest of nine children, Bisognano says she was a nurturer from early in life. Her mother was a nurse, and her father an executive at IBM Corp. She followed her mother into the nursing field, and worked in various hospital positions before being drawn to administration.

“I always had a nurturing side,” she says. “I always loved patient care but, in addition, I found that I loved innovation and management.”

In the late 1980s, while CEO of Massachusetts Respiratory Hospital, Bisognano had the opportunity to work on a national demonstration project on quality that brought together 20 hospital CEOs with 20 employers to learn about workplace improvement strategies.

“I didn't know how to do transformational change,” she says.

Paired with Florida Power & Light Co., a statewide utility, Bisognano says she learned how to get to root causes of problems, methods to apply change, and how to implement and measure improvements. She saw that increased market share, better outcomes and lower costs could be the outcome. She also learned how methods that worked in other industries could be applied successfully to healthcare.

She moved on to the Juran Institute, where she started a healthcare consulting practice and developed leadership improvement tools for healthcare executives. In 1995, she was recruited to join the IHI.

“I'm still here because the need is big,” she says. “We're always inventing new ways of working. I have the great joy of having no two days be the same. We are constantly trying to look for solutions to problems troubling the system.”

Bisognano is passionate about the IHI's work overseas, and she says the U.S. can learn lessons from transformational changes happening in other countries. The IHI is now working on five continents. For instance, in South Africa, Ghana and Malawi, the IHI is working with local providers to improve maternal and child mortality and improving access to HIV/AIDS treatments.

In Scotland, the IHI is engaged with hospitals on patient safety. All hospitals are participating in the program, which includes medication management and instituting early-warning systems of patient deterioration.

In Malawi, the IHI has worked with local providers on village-centered care, including teaching select women to become health coaches to the village. These practices, Bisognano says, can translate to the U.S., where health reform is about to have an enormous impact on the delivery system. “I believe the way healthcare is delivered will need to be redesigned,” she says.

This includes really seeing the whole patient and where they are in the care continuum. “Once you start to look at each patient, are they in the right spot?” she asks. “These concepts are still fairly new.”

Recasting the delivery system around the patient means giving patients more opportunities to be heard. “We need to dramatically increase the voice of the patient in every design element” of healthcare, she says.

Bisognano still has a sense of urgency around healthcare. “I'm seeing the clock ticking,” she says. “We need to pick up the tempo of change.”

Dr. Tracy Gaudet is also feeling a sense of urgency around change in patient care. In December, Gaudet was selected to lead the Veterans Affairs Department's Office of Patient Centered Care and Cultural Transformation. The new office was created last year to redesign the delivery of healthcare to more than 6 million veterans nationwide.

“This is the most amazing opportunity,” Gaudet says. “I think we can really do it at the VA in a way the private sector cannot.”

Trained in obstetrics and gynecology, Gaudet had barely finished her residency at Duke University when she had the opportunity to work with the godfather of American integrative medicine—Dr. Andrew Weil. Gaudet was selected from a competitive field in 1996 to help Weil establish the Program in Integrative Medicine at the University of Arizona. Gaudet served as founding executive director.

There, she helped Weil design the nation's first comprehensive curriculum in integrative medicine and launched a two-year fellowship program for practicing physicians. The idea was to transform the entire care experience, and not just do traditional Western medicine “with herbs and acupuncture thrown in,” she says.

Gaudet returned to Duke University in 2000 to establish Duke Integrative Medicine, a facility that serves as a “living laboratory” to explore new models of holistic care.

“We're not dealing with the person; we are dealing with their body parts,” Gaudet says of most medicine practiced today. “We want the patient to be the driver of care, but right now disease is the center of care.”

Among the projects she piloted at Duke was Personalized Health Planning, with funding from the CMS. The idea was to have patients think about what they want to get out of their health. This involved nutrition, mind-body issues and Western medicine. What she found is that what people wanted was different from what providers often think, Gaudet says.

One woman in the program said what made her happiest about achieving her goals was that she was now able to tie her own shoes. The woman had lost 70 pounds.

“It was pivotal for me,” Gaudet says. “It was her life that mattered; losing the weight was secondary. I really think that is the central thing that needs to be transformed in healthcare.”

About a year ago, the VA called Gaudet. The department had set up a task force on patient-centered care and wanted to see what she was doing at Duke. A delegation went down to North Carolina for a site visit.

“I was blown away by the vision,” Gaudet says. “They have the most dedicated and passionate workforce.”

Upon meeting Gaudet, VA officials asked her to leave Duke and lead the new governmental initiative to serve veterans.

“It's an amazing organization and I'm so privileged to be part of it,” she says. Gaudet's father was a World War II veteran who served in the Air Force, so working with veterans strikes a special chord for her.

What she hopes to bring to veterans is a process of getting to their root goals for their health. By identifying what matters in patients' lives, providers can give proper support to achieve those goals, she says. Gaudet adds that she believes this approach to healthcare is scalable within the VA.

Right now, the office is starting with four regional implementation teams located in Birmingham, Ala., Dallas, East Orange, N.J. and Los Angeles. “They clearly understand the vision,” she says of the VA. “They asked me to be bold.”

Being bold is second nature to Pamela McNutt.

Shortly after McNutt first became a chief information officer 20 years ago, she decided she should learn how to play golf.

That's because she started going to health information technology conferences where she often was the only woman in the room.

“The question was, ‘Everybody's going golfing. What's Pam going to do?' ” she recalls. “It became very apparent to me that I better learn how to play.” Luckily, her husband played. So he taught her.

Since that time, McNutt says not only has the health IT field become more open to women, it has developed the potential to truly transform healthcare delivery.

With the advent of real-time technologies available to providers at the point of care, care coordination can improve significantly, she says. “That's what we've been waiting for. It was a matter of waiting for the technology to catch up with the demands of caregivers.”

McNutt has loved technology since she was a small child and played with punch card-based computers. She was pre-med but then switched her focus and did post-graduate studies in management information systems. Her first CIO post was at Hermann Hospital in Houston (now Memorial Hermann-Texas Medical Center Hospital).

In 1993, she joined Methodist Health System in Dallas as CIO. In 2001, she launched a five-year technology replacement plan to integrate clinical data and electronic health-record systems.

“It was a difficult sell,” she says. “It was bringing in a bulldozer and scrapping what we had done and starting over. We decided to jump in and start doing something that was just starting to be popular.”

That is, switching from what most were doing in healthcare—using multiple vendors and platforms and retooling them to fit together. “It was becoming harder and harder to maintain that strategy,” she says. “It was not sustainable in a rapid growth mode.”

The five-year process streamlined Methodist's information systems.

“Now, in retrospect with where we are with meaningful use and certification, being on an integrated platform is absolutely the sweet spot.” McNutt says. “I wish I could tell you I saw it coming but I just thought it (transferring to an integrated platform) made sense at the time.”

While still working today to improve information systems at Methodist Health, such as bringing more useful data to the bedside and working to reduce errors through IT, McNutt has also taken on a wider role as speaker and educator. As chair of the policy steering committee for the College of Healthcare Information Management Executives, McNutt works with other senior leaders to craft the group's comments on proposed federal IT regulations.

“This is the first time that health information technology has been put so much in the limelight,” McNutt says. “Personally, I'm very excited about the potential of health IT across the continuum of healthcare.”

Her goals include continuing to contribute to the discussion as a thought leader while working hands-on.

“There's nothing like having your feet grounded in a health system,” she says. “You see the day-to-day struggles and successes.”