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Best Healthcare Leaders Know When to Exit

 |  By Philip Betbeze  
   May 18, 2012

With 40 years of tenure, including 20 as the CEO, Patricia Gabow, chief architect of the model of safety net care that Denver Health has become, could stay on in that role pretty much as long as she wants.

Instead, she's pulling down the curtain on her reign, effective this October. She'll be replaced—everyone is replaceable—but her legacy will live on. Not that she cares, by the way.

When Gabow's son heard she had been named CEO of Denver Health 20 years ago, the then-teenager, who his mother says is the family comedian, asked her a serious question.

"'Mom, why are you taking a job for which you have no training?'" Gabow recalls him asking, chuckling. "That was a reality check, and I've had lots of those over the years," she says. "But I found that being a practicing physician and a researcher was extremely good preparation for this role."

She may not have had any training, but as a longtime leader of the city's safety net health system, she now has the experience, and the accolades. And she's giving it all up.

Why now? The health system is consistently profitable, it amply fulfills its mission to take care of all comers, and has received international acclaim as an early, and very successful adopter of Lean manufacturing principles in healthcare. Gabow could certainly be forgiven for basking in the sun for a little while.

"I don't know if it's the right time. But I'm 68 years old and I've been here for 40 years and CEO for 20," she says. "That certainly made me think perhaps it was time. I also think that one of the issues with leadership that's key is to know when to leave. It seems the error is most often made on the staying too long side than leaving too early."

No argument here. But then again, that's from a guy who would retire tomorrow if he could.

Motivated to reduce waste
One of Gabow's biggest legacies will be her embrace of Lean manufacturing techniques in healthcare. Lean considers any work that does not increase value for the end user to be wasteful.  While she wasn't the first senior executive to embrace the practice, she was one of its most ardent believers when she and her executive team unleashed it on Denver Health in 2006.

"I would list Lean as one of the key things we've initiated here," she says. "I'm an old lady, so I've seen a lot, and it's one of the most powerful tools I've seen in healthcare in my 40 years."

That power wasn't immediately apparent. Most of the $158 million in waste reduction attributable to Lean have come relatively recently, within the past couple of years. Gabow thinks what's truly revolutionary about Lean is that it empowers people in the front lines of care to take action when they see waste at work, but it's far from an immediate fix.

"Most of the time when people talk about empowering the front lines, it's meaningless because they don't have the tools," she says. "Lean gives you those tools."

In healthcare especially, she says, Lean can make big positive changes happen.

Looking forward to $200 million

"Getting rid of waste not only saves money, which, heaven knows we need to do in healthcare, but it also improves quality," she says. 

The implementation of Lean workgroups throughout the organization, which, in another of Gabow's list of accomplishments, includes a wide variety of connected organizations outside the hospital, has taken some time. As the savings have accumulated, she remains underwhelmed.

"I'm not amazed by that number. In fact, I'm looking forward to when we are going to hit $200 million."

Gabow is aware of what she's sacrificed in order to lead Denver Health for the past 20 years. Sometimes she regretted the decision to leave her clinical work behind. Once again, her son gave her a much-needed reality check.

"He said to me, 'Mom, you never come home anymore and say you had a great day like you did when you were a doc,'" she recalls. "I thought about that for awhile. I ended up telling him that when you're taking care of patients you do have great days because you can markedly improve or save someone's life over that period of time. But when you're taking care of an institution, you don't have great days, you have great decades."

Patience pays off
That sentiment goes to the heart of Gabow's leadership. She's not afraid to take a chance when the data bears out her position. With Lean, it literally took years for the efforts to show real monetary dividends, although many of her executive team and especially the front line leaders said the change was improving attitudes and engagement.

"It takes a long time to see things pay off," she says. "If you look at our Lean journey, we started in 2006 and took several years before it really jumped up and started working. Working on the authority transition was truly a six-year effort."

One of Lean's overriding principles is that front line workers are best able to determine the most efficient ways to do their jobs. It's up to senior management to support the changes they feel need to be made to cut waste and improve quality. She stresses that much of the success that Denver Health has achieved is "really about the will to do it."

4 success factors
But she will name some of the specific actions that brought Denver Health so much success while other safety nets were failing spectacularly. All the points below are direct quotes, except bracketed material:

  1. Employing our physicians [who are] also high-quality academics. 
  2. Being an independent governmental entity. All of what we make in profit goes back into what we're doing [not to general city or regional governmental entities]. I'm convinced that you can't run healthcare within the confines of city, county, or state government and that's a core issue with many safety nets.
  3. We're very sophisticated users of IT. We've been one of the 100 most wired 6 years in a row.
  4. We never want to stay where we are, ever.

Gabow's not sure what the next phase of her life will consist of, but she's excited to begin with a trip to Italy with her husband of 40 years. After that, she may return to Denver Health in another capacity (there's a mandatory 90-day period of disassociation for all employees who leave the health system) or she may write a book about Lean. Or both. One thing she's not concerned about is her legacy. "The best tax break in America"
"I don't care if people remember anything about my tenure," she says. "I want people to realize that Denver Health is a model that says to this country that you can treat everyone—including the most vulnerable—at an affordable cost and at very high quality. No one person made us successful. We have an unbelievable team of people and it takes that team."

She wants America to use Denver Health as an example of what can be accomplished.

"We are a model—a solid example. This isn't theoretical," she insists. "We've done $4.6 billion in care to the uninsured since 1991 and we've been in the black every year with a very low annual city/county subsidy of roughly $27 million. We are the best tax break in America."

Philip Betbeze is the senior leadership editor at HealthLeaders.

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