Health Care Hall of Fame
Patricia Cahill took unlikely path to become first CEO at Catholic Health Initiatives
When a fresh-eyed Patricia Cahill entered the workforce in 1960 as a middle-school teacher outside Boston, there was scarcely any hint in her lessons on French-speaking skills that she could go on to one day head up the nation’s largest integrated Roman Catholic health system.
“I was a French major, and I went into teaching French. I loved teaching,” Cahill says. “I had no plan in any way or form that matched what eventually became my life.”
Now at age 69 and deep in a busy post-retirement, Cahill can look back and smile about her work as the first person ever to sit behind the desk in the chief executive officer’s suite at Catholic Health Initiatives in Denver. Though it was a gamble at the time, the system is widely seen today as a pioneer in how to combine the talents, assets and institutional gravitas of disparate Roman Catholic systems into a whole stronger than its parts. Her success has landed her a nod as one of four inductees this year into the Health Care Hall of Fame.
Was it the hand of God that led her to CHI? Fate? Destiny? “The truth is, my career was one of being in the right place at the right time,” she says. “I did not plan this.” Yet, somehow a woman with a law degree who never practiced law rose to the top of what was in 1996 the largest religious system in the country, and a whole new type of Catholic system, without ever attending a healthcare management course in college.
“That takes someone with special skill and the ability to work well with lots of different people and different backgrounds and perspectives,” says Sister Carol Keehan, president and CEO of the Catholic Health Association. “Pat has given her whole lifetime over to Catholic healthcare, and has been very successful in terms of making it not only affordable and available, but of high quality. And that is a tremendous achievement.”
Six years after her 2003 retirement as president and CEO of CHI, Cahill is still so active that she says she has to turn down requests to take part in groups. In addition to being board chairwoman at Covenant Health Systems, a three-hospital system based in Lexington, Mass., she serves on the boards of Hospice & Palliative Care of Cape Cod, Hyannis, Mass., and at Seton Hall University in South Orange, N.J. “While I’m retired, I’m not dead,” Cahill says.
Despite her atypical career origins, Cahill’s curriculum vitae does show signs and precedents for her role at CHI, such as her ability to gravitate to top jobs and navigate complex group transitions involving numerous stakeholders.
In 1972, she started as a budget director at the Association of University Programs in Health Administration and within six years she was a vice president managing day-to-day operations. She spent three years as vice president of government relations at the Catholic Health Association before taking a job in 1983 as president of 225-bed Calvary Hospital, a cancer center in the Bronx. In the 1990s, she went to work for the Archdiocese of New York in Manhattan, spearheading efforts to establish a network of 18 hospitals and nursing homes under a joint religious sponsorship, and another alliance of 43 hospitals under 15 religious sponsors.
Colleagues say part of her success stemmed from her ability to say good things when Catholic healthcare deserved it and difficult things when it was necessary, while employing a sense of humor and a deeper grasp of how to balance finances with the social and spiritual goals of the Catholic sponsors.
Cahill was also among a new wave of lay people who took on high-level executive roles in religious hospital governance. “She sees an important role for laity and women in the church,” says David Lincoln, president and CEO of Covenant Health. “She is continuing the legacy of the women religious and lay people who came before.”
Whatever uncertainty may have existed about the original formation of Catholic Health Initiatives, Ron Aldrich says he never had any doubts about Cahill’s ability to lead CHI through its difficult early years. And that’s a compliment coming from one of the three CEOs whose systems were ceding all their assets and individual identities in order to form CHI.
“She was the perfect person to lead Catholic Health Initiatives,” says Aldrich, who was CEO of Chadds Ford, Pa.-based Franciscan Health System until 1996, when it became part of CHI.
At the time, Catholic systems around the country in the mid-1990s had been reaching the conclusion that they had better strengthen their financial positions or risk joining the other Catholic hospitals that were feeding the voracious appetites of acquisition-hungry investor-owned systems. “Catholic healthcare needed to change quickly and build on the strength that was there,” Aldrich says.
So in 1995, 10 separate Roman Catholic religious congregations that owned more than 100 hospitals, clinics and free-standing facilities decided to merge their three disparate systems: Franciscan; Catholic Health Corp., Omaha, Neb.; and Sisters of Charity Health Care Systems, Cincinnati.
At that time, it was the largest such Catholic system in the U.S. and represented a new way of thinking, with laity holding key executive positions in the C-suite and a new diversified business model in which no market generated more than 10% of the new system’s $5 billion in operating revenue.
But who could lead such a new system? After some initial factionalism between supporters of the various leaders in the existing systems, the CEOs decided that none of them should take the reins of CHI because lingering loyalties could derail the cooperative spirit. The in-house search committee, which included Aldrich, eventually narrowed the final CEO candidates to three people, and called them for interviews.
Cahill had a reputation for consensus-building when she was director of health and hospitals for the Archdiocese of New York in Manhattan. In that role she developed the Alliance for Catholic Health and Human Services, a loose affiliation of 43 Catholic hospitals under 15 religious sponsors that worked on collaborative programs in areas such as purchasing.
“It was like all of her experience before had brought her to that point,” Aldrich says. “In the interview … her clarity around that role was so strong and clear.”
The steering committee eventually voted 12-0 to hire Cahill.
After taking the helm, Cahill says she never looked back—not that it would have done her much good to try. The corporate structure did not include any structured way for the systems to pull out through a formal escape clause in the initial corporate agreements.
“If you build in an elaborate exit clause, you can be sure that the first time you hit difficulty, someone’s going to try to use it,” Cahill says. “We never built an exit.”
Praise for staff
She says she can never recall a time when she realized that the formation of CHI was going to work, because it never occurred to her that it would not work. Despite the praise lavished on her leadership in retrospect, she would not take the credit for the system’s success, saying her extraordinary staff was the greatest such group in the nation at the time. “I’m not being humble. It would never have happened without the commitment and competency of the people I hired,” Cahill says.
But other insiders from that time such as Kevin Lofton, who went on to succeed Cahill as president and CEO at CHI, say a different leader could easily have led CHI down a bad path by not managing the financial and cultural differences or shying away from clear directions on difficult decisions.
“During those first years we had some very difficult financial times,” says Lofton, who was chief operating officer under Cahill. “Pat was the type of leader that would stand up and make sure what needed to be said was said, but she was diplomatic.”
Colleagues say Cahill guided CHI on the right path, even through difficult early decisions, like when the young system decided to sell New Mexico’s last Catholic system, St. Joseph Healthcare in Albuquerque, to one of the Nashville for-profits because of ailing finances—a decision cited by Aldrich, Lofton, and Lincoln as tough but right-minded.
Such leadership proved to the entire industry that a hybrid upstart organization like CHI could be run successfully and profitably, which observers say may be her ultimate legacy. “People have seen that there are benefits that can be achieved by consolidation. … No longer is it driven by the threat alone of investor-owned systems,” Aldrich says.