Why taking a hospital not-for-profit was Dr. Bruce Siegel’s boldest move

For more than a decade, Dr. Bruce Siegel has been the public voice for safety-net hospitals throughout the country. But his role as protector of these providers started even before that. As CEO of America’s Essential Hospitals, the advocacy organization for the nation’s safety-net hospitals, Siegel has used his extensive background in healthcare management, policy and public health to achieve the association’s strategic vision of its members as integrated delivery systems and leaders in access and quality. Prior to taking the helm of that organization, Siegel was CEO of New York City Health + Hospitals and then after, Tampa General Healthcare in Florida. It was at that system that Siegel made his boldest move.

WHAT WAS YOUR RISKIEST DECISION? Advocating for the conversion of Tampa General Hospital from county ownership to 501(c)3 nonprofit operation. It was a big decision, but there just wasn’t a viable alternative. It was the classic “burning platform”—mounting financial losses, decreasing volumes, and a county that would tax itself for a new football stadium … but not for its hospital.

WHY WAS THAT MOVE RISKY? A long history of community distrust, based on the hospital’s history as a segregated, all-white institution, and later allegations of secret talks to sell the hospital to private operators and abandon its mission. We were able to start growing the hospital again; get us through accreditation, which had previously been a struggle; and redo our retirement plan to save us a lot of money while getting a better plan for most of our employees. But none of it was easy. I was most proud of the fact that the conversion agreement guaranteed the same urgent and emergent care to residents that was part of the county hospital charter. We made an explicit, written, public commitment to the mission. I believe that language is still in force.

WHAT WAS THE OUTCOME? The conversion went through despite huge controversy and litigation. Today, I am told, most people in the area see the change as having saved the hospital, a vital community resource that is the only Level 1 trauma center for millions of people. Leaders can be about themselves or they can be about leaving things better than they found them. At the end of the day, the latter is a lot more satisfying. When I made the final push for the conversion against the wishes of some of those in county government, I knew there might be a price to pay. Perhaps it’s the kind of thing you do when you are rash and young. As I tell people now: It was a truly once in a lifetime experience. I have no desire to do it a second time.

RESPONSE FROM THOSE INVOLVED: Intense opposition from some, apathy from most. It was the apathy that was most disheartening. We found that people had only the foggiest notion of what a safety-net hospital did and did not know that we did things that were unique like large transplant programs. Add to that years of public drama over the fate of the hospital, and you had a recipe for exhaustion and apathy.

ADVICE TO EXECUTIVES IN SIMILAR POSITIONS: Change is really hard, especially because your allies are usually quieter than the naysayers.

DESCRIBE YOUR LEADERSHIP STYLE: Back then—more confrontational and combative. I’ve grown older and wiser.

HOW WOULD OTHERS DESCRIBE YOUR STYLE? I think leadership demands humility and knowing what you don’t know. So I think others could best answer that question.