Gundersen CEO, Momentum in Place, Hands Over the Reins

"There are CEOs who stay on too long, either for the money, or the prestige, or whatever… That's not good for staff, patients, or the community," says Jeff Thompson, MD, who is vacating the top slot at Gundersen Health after 14 years, and defining a new role for himself.

Jeff Thompson, MD, president and CEO of Gundersen Health System, is always in motion, so it came as no surprise that he mentioned the term "momentum" at least 20 times during our conversation a few weeks ago, after he had announced that he would step down as CEO, but before his successor was named.

Thompson is in good health, fit, and only 62, so many were surprised when he announced his impending exit as the leader of one of the nation's more progressive health systems. So progressive, in fact, that former CMS administrator Don Berwick, MD, in closing remarks at the Institute for Healthcare Improvement's annual conference in late 2014, suggested six items healthcare leaders should accomplish in 2015. One of them was to contact Gundersen, which is based in La Crosse, WI.

Why He's Leaving
Thompson's decision to leave hinged on his desire that his successor not lose momentum in a rapidly changing environment for both the business side of the organization and clinical practice.

"There are CEOs who stay on too long, either for the money, or the prestige, or whatever," he says. "If they do stay on too long, the organization starts to lose momentum. That's not good for staff, patients, or the community. I thought I would not allow that to happen."

He's careful to avoid the term "retirement." Gundersen and its predecessors are the only places Thompson has ever worked as a physician and he'd like to continue to work with staff development and external opportunities in addition to a limited practice schedule. He's board-certified in critical care, neonatal and perinatal medicine, and pediatrics.

"My request is that the next CEO will let me stay with the organization, at arm's length from the executive suite—and allow [him] to steer [his] own ship."

Last week, the organization named Scott Rathgaber, MD, a gastroenterologist and fellow longtime Gundersen employee, to replace Thompson.

Thompson, who says he's "not tired of the job at all," says he decided last year to make the change while things were going well, "not when we're in an organizational crisis, or a health crisis for me."

He didn't set a hard timeline, which gave the organization's board time to fully vet all internal candidates before expanding to a national search. The search committee, three Gundersen physicians and three community board members, did not include Thompson.

But Rathgaber can thank Thompson for the creation of a CEO training program set up to identify top leaders so that the next leader of Gundersen wouldn't have to go through a protracted and divisive selection process, as Thompson did 14 years ago. And the committee can thank him because no outside search was necessary.

That Thompson was able to ensure a much smoother transition for his successor is not lost on Rathgaber. "Jeff has proven to be a tremendous transformational leader," he says. "I will use what I have learned from him to chart my own leadership course and style… but his imprint will be on me as well and will inform my actions in the future."

Thompson explains his lack of involvement in the selection process for his successor: "I wanted [the board] to pick my successor because they will need to be behind this person to lead us into the next decade," he says. "I will be vigorous in my support, but… the board is responsible for the success of the CEO."

A Legacy of leadership
Under Thompson's leadership, Gundersen has ranked in the top 5% of hospitals in the nation for clinical quality care for seven straight years, as ranked by Healthgrades, and has recently opened a new patient tower.

Less visibly, but more importantly, says Thompson, the organization has had a longstanding focus on quality improvement. In fact, its top leaders still gather each Friday morning for an hour to review and share quality improvement efforts. As a physician-led organization, Thompson says all of Gundersen's clinicians are expected to lead and contribute to these initiatives.

Other achievements of his tenure include being among the key organizers of AboutHealth, a 47-hospital regional collaboration among Wisconsin's top-performing healthcare organizations. The coalition's goal of improving quality and lowering costs through regional partnership is in its early stages, but members have the same electronic health record platforms and care for 90% of Wisconsinites as well as sizable populations in parts of Illinois, Iowa, Minnesota and Michigan.

And, Gundersen is the only health system in the nation to achieve 100% energy independence through a combination of efficiency initiatives and renewable energy projects.

The Transition and Beyond
With that momentum solidly established, Thompson was ready to transfer the reins.

"It's a very hard job. It takes a lot of courage and durability. If not, you can't live your values. I get up every morning and I say, boy, I have hundreds of thousands of lives, seven thousand employees, and billion dollars of the community's money that I'm responsible for," Thompson says. "I have to admit over time that that does wear one down, but I have a fair amount of energy and I love making a positive impact."

Thompson plans to stay on in a leadership capacity during a transition period, but will leave it up to Rathgaber as to how long that period will last.

"I'll start moving in the direction of letting [him] get a feel for this, but there are a lot of things he can benefit from, including external people he needs to know," he says. "So I will leave it up to him. A few weeks would be fine, but several months would also be fine."

In the meantime, Gundersen's five-year strategic plan, which debuted this summer, is rolling along.  Among the priorities are continuing to build out Gundersen's outlying clinic presence and developing the AboutHealth network.

Thompson says the biggest challenge for Rathgaber will be to avoid becoming overwhelmed by the complexity of the job's challenges. "You can't get buried in the complexity to the point where you're not delivering improvements to care and health to the individuals we serve," he says. "The people who will serve their communities best will be those who can rise above the complexity."

As for the shifting ground caused by health plan and provider consolidation, senior leaders need to keep in mind the ultimate goal—improving the health of the communities they serve, he says. If that can be done better through consolidation, Thompson is all for it. But it's easy to lose track of the top goal.

"Staying independent or not is not the goal, it's a tool, while the goal is serving the community," he says. "Sometimes that might be [merging], other times it might be partnering."

Though he'll chart his own course, Rathgaber says he'll try to imitate Thompson's admirable qualities. Rathgaber told me that before he embarked on leadership training, he was quite sure his career would have been very satisfying providing the best care for patients one at a time. But as he took tentative steps into leadership, he understood how much more impact he could have at that level.

"I was surprised by how energizing and exhilarating the learning was," Rathgaber says. "I came to understand and believe that I could positively affect more people's lives (both patients and staff) if I could lead successfully. With each increase in leadership responsibility, I found this to be more true and quite gratifying. The CEO position became a natural progression to the opportunity to enrich the most people's lives."

It's a valuable lesson for all health systems.

On a personal note, I will miss Thompson. He was one of the first health system CEOs I interviewed when I started covering finance, and later leadership, for HealthLeaders Media. He was not only routinely a great, thoughtful quote, but he always made me feel as though I was talking with a peer, and treated me with respect. He never big-timed me—that happens surprisingly often in this business—and was always ready to share best practices generously with our readers.