Biggest difference for younger execs is embracing social media

For just over a year, Terika Richardson has been CEO at Retreat Doctors' Hospital, a 227-bed HCA facility in Richmond, Va., and the oldest hospital in the city, dating to 1877. It's an acute-care facility, including emergency services, but with a primary service line in urology. Richardson has been working at HCA facilities for 10 years. Before joining Retreat Doctors' Hospital, she was interim CEO and chief operating officer at HCA's Spotsylvania Regional Medical Center in Fredericksburg, Va. Modern Healthcare Managing Editor Harris Meyer recently spoke with Richardson about the unique challenges facing young CEOs, the importance of diversity in healthcare organizations, and the political battle over Medicaid expansion in Virginia. This is an edited transcript.

Modern Healthcare: How did you get into the healthcare business?

Terika Richardson: I always wanted to be in healthcare and in the hospital realm. As an undergrad, I gravitated more toward management and business and toyed at one point with becoming a physician. Then I found the School of Public Health at the University of Michigan and it was a definite game-changer for me because it combined the business and clinical setting that I was looking for. I left Michigan after graduate school and went to North Shore-Long Island Jewish Health System in New York, where I had an administrative fellowship. After I worked there awhile, I came to HCA.

MH: Does HCA have a mentorship program for young executives like you?

Richardson: I had the pleasure of being a part of HCA's chief operating officer development program, and it definitely was a catalyst in my career. When you have those opportunities to work with some of the great thinkers within hospital management and learn from them, it definitely enriches your perspective.

MH: Has it been a little scary to take over in your first CEO position?

Richardson: I didn't feel afraid. It a humbling experience, because you recognize there are hundreds of people who are counting on this organization for their livelihood, and it is humbling to recognize that the decisions I and my team make have an impact on that. I believe in servant leadership, so I am here to support them. I am here to make sure they have what they need to do their jobs well. Anything that stands in their way of providing excellent care, it is my responsibility to remove that barrier.

MH: What have been some of the most interesting unexpected challenges you have faced as a CEO?

Richardson: One of the things I often underestimate is that every hospital has its own unique story. It's the people who make up a facility. Making sure you understand that dynamic and that you understand the culture is so important. It's making sure that when you walk through the door, it is not about your agenda. How do we ensure the legacy of this facility lives on? How do we ensure that the great work being done is understood and appreciated by the community we serve? How do we tell the story and make sure our community understands who we are and what we stand for?

MH: Can you give examples of how you've been working to make your hospital more efficient and effective?

Richardson: A lot of our focus has been on OR efficiency, making sure we are as streamlined as possible, creating a great experience for surgeons. I think every CEO, every operating team, is focused on those things. But it is so important in a smaller facility when you are oftentimes given one shot with a surgeon. A lot of surgeons spend a lot of time at some of the larger shops, and so to court a physician in a smaller facility can be a challenge.

A lot of our focus is on how we deliver service, not only to the patient but also to the physician. We have done some great things in that space with our turnaround times, looking at how we streamline that process.

I had a surgeon come up to me—a new surgeon who we've courted and finally got him over to our OR.

He told me, “Quite frankly, you guys nailed it. In my world, as a surgeon, time is money and it is the most valuable thing that I have.”

MH: What is your hospital's payer mix?

Richardson: We are one of two hospitals within HCA in Richmond. We have more of an urban mix. We see quite a bit of Medicare and Medicaid. As we attract different surgeons and different providers, we are starting to see that commercial payer side change and increase as well.

MH: What was it like for you to lobby the Virginia Legislature to expand Medicaid?

Richardson: Regardless of whether a patient has the ability to pay, we will take care of that patient. It is very important to everybody who is a hospital provider in Virginia to make sure our patients are covered and that they can seek healthcare services when they need them. We are constantly trying to get in front of our legislators and in front of our regulatory officials to make sure they understand the implications of not expanding Medicaid.

Unfortunately, without access to care and the ability to pay for it, sometimes the way patients seek care is in our emergency room.

MH: What are your predictions about winning over Republican legislators on Medicaid expansion?

Richardson: What I usually hear about are the budget constraints and the uncertainty of whether Medicaid expansion would be funded from the federal government into the future. How do we balance the budget? That's the piece that prevents a lot of people from supporting it. I was just reminded that even though Medicaid has not been expanded in Virginia, Medicaid expenditures within the state still have grown during the past decade from 5% to 21% of the budget.

When I think about the feasibility of expansion in Virginia, I don't know if there is tremendous support around this issue.

MH: Are you seeing progress in diversifying healthcare leadership?

Richardson: Absolutely. When we look at all of the hospital companies and we look at industry in general, diversity of leadership is probably a bullet point on everybody's strategic plan and agenda.

We want to make sure we have diversity of thought in our decisionmaking and within our ranks to reflect the communities we serve.

Most importantly, it is vital that we make sure diversity is not just about gender or race. It really is about making sure we have people around the table who all have like-minded goals but bring different experiences.

MH: As part of the younger generation of hospital leaders, what skills and leadership traits do you bring that differ from the older generation of leaders?

Richardson: I don't know that I see a difference in approach. What I notice more is that social media has become a very real component of our business. And embracing that has been something that not only myself, but also my colleagues take very seriously. If you're not on social media, as a company, as an industry, it is truly a disadvantage.

So that is something I see as the biggest difference, just how we embrace technology and social media and incorporate it responsibly into our organization.