Stepping down

As Sister Mary Jean Ryan officially steps away from an operational role at SSM Health Care, she and her colleagues say the St. Louis-based system is ready to thrive without her.

Ryan, the leader of SSM since its formation in 1986 and now 73, has become one of the few remaining nuns in a CEO role at a healthcare system and is known as a national advocate for improving healthcare quality. She was scheduled to give up her role as CEO on Aug. 1 and remain as chair of the 14-hospital system, a move that was first made public in July 2009.

“She's really been a great, great asset to not only her own system but to all of Catholic healthcare and (to) healthcare in general,” said Sister Carol Keehan, president and CEO of the Catholic Health Association. “She will be missed personally a great deal,'' Keehan said, adding, though, that “the organization will do very, very well.''

Moving into the role of CEO is Bill Thompson, currently president and chief operating officer, and also a longtime employee, having worked there since 1980. Thompson said he is looking forward to having Ryan work as board chair while he is CEO. “We're very committed to the same things,” he said. “Mary Jean will be a very valuable adviser to me personally” and to the system as a whole.

Ryan, described by SSM's own in-house news publication as “subject to being, at times gruff and demanding and stubborn,” was warm and positive about the prospects for SSM going forward if less so regarding Congress' actions in healthcare. “I am always enormously proud of our employees,” Ryan said. “I have had the privilege of working with the best team in healthcare as far as I m concerned. I've had it good and great in so many ways, most of which I had nothing to do with,” she said.

In addition to acting as chair of SSM, Ryan will chair SSM's six regional and divisional boards, and will continue to travel the globe discussing SSM's efforts to improve quality.

Because she has taken a vow of poverty as a nun, Ryan's salary has been paid to her religious order, the Franciscan Sisters of Mary. SSM declined to release how much the sister's order received for her employment but said it is included in a service contract paid to the order for the work of all its members working at SSM. In 2009, the contract was worth $1.9 million, according to SSM's tax filing with the Internal Revenue Service.

Her retirement from an operational role further reduces the ranks of Catholic nuns in CEO roles. Among those remaining is Sister Judith Ann Karam, a member of the Sisters of Charity of St. Augustine who is president and CEO of the Sisters of Charity Health System, Cleveland. Karam, who was unavailable for comment because she was traveling, has headed the four-hospital system since 1998 and has no plans to retire, according to a spokeswoman. She declined to provide Karam's age.

Keehan said the Catholic healthcare community has been preparing for the loss of nuns as top leaders since the 1980s. “They've had a 30-year head start” in preparing organizations and leaders to continue the approaches of religious leaders in healthcare, she said.

Ryan, though, noted one difference between a nun such as herself and lay healthcare CEOs: Religious leaders do not have a family to return to at the end of the day. “This was our life,” she said. Nonetheless, Ryan said she anticipates no problems for healthcare as a result of losing nuns in upper management.

Quality has become what SSM and Ryan are known for, and she was at the helm in 2002 when SSM was the first healthcare winner of the Malcolm Baldrige National Quality Award. Ryan said the Baldrige award itself is less important than the process of applying, and as such, SSM is giving it another go.

Among its benefits is that it is a great process for integrity. “If you want to say something (as part of the application), you're going to want to be able to back that up,” Ryan said.

SSM also was an early adopter of electronic health records, beginning the process of installing a $400 million, corporate-wide EHR system in March 2008 (Dec. 15, 2008, p. 10).

The system is undergoing other changes in leadership. Jim Sanger, president and CEO of the seven-hospital St. Louis region of SSM and a system vice president for SSM overall, announced last month that he would retire after more than 14 years with the system. Chris Howard, regional president and system vice president of SSM Health Care of Oklahoma, was named last week as Sanger's replacement.

SSM is in strong financial shape, according to financial documents. SSM finished 2010 with a total profit of $248 million on total operating revenue of $3 billion, producing a margin of 8.2%. That's down from 2009 when it posted a total profit of $356 million on total operating revenue of $2.9 billion, producing a margin of 12.3%. Amid a robust environment for mergers and acquisitions, Thompson said the system is willing to look at buying hospitals as opportunities arise.

Ryan said a large part of SSM's financial success can be attributed to its process- improvement efforts. Now, she said, the organization must look for ways to boost revenue, rather than cut costs. “We can't keep cutting, cutting, cutting despite what Congress seems to think,” she said.

Congress' approach to healthcare reform received less than a ringing endorsement from Ryan. “Their first goal was really to reduce cost,” she said. “They've instituted the stick, not the carrot, (though) I guess there's a little bit of both,” she said.

Ryan suggested that a single-payer approach would have done a better job of providing broader coverage than the version of reform that passed. “That's a national disgrace, really, that we have all these people without insurance,” she said.