The Exec: Tiffany Miller on Being a Purpose-Driven CEO

Tiffany Miller, DBA, MHA, became CEO of Yoakum Community Hospital following Karen Barber's retirement in January 2023.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Podcast. Audio of the full interview can be found here and below.

In December 2022, Yoakum Community Hospital (YCH), a 100-year-old, rural, 23-bed critical access hospital in Yoakum, Texas, announced that Karen Barber was retiring after serving as CEO for 30 years.

YCH, which is managed by the Community Hospital Corporation in Plano Texas, chose Tiffany Miller, DBA, MHA, as Barber's successor.

Miller, who has a decade's worth of executive healthcare experience, joined YCA as CEO in January 2023, hitting the ground running in her new role. In her previous role, she served as CEO of Encompass Health Rehabilitation Hospital of Humble, a 90-bed inpatient rehabilitation hospital in Houston, Texas.

During the podcast interview, Miller talks about transitioning into her new role as CEO and strategies she's looking forward to implementing in her first year, and she gives advice for aspiring healthcare leaders.

This transcript has been edited for clarity and brevity.

HealthLeaders: What have the past few months been like as you settle into your role as CEO?

Tiffany Miller:  Anytime I have started in a new role, I like to compare it to drinking from a firehose. One thing that holds true in healthcare is that you can expect things to change and change can be hard, and the transition can be even harder. While these constants seem to be universal truisms in the healthcare industry, I do have to say that this experience onboarding at Yoakum Community Hospital has been quite different. The board and the team extended me the warmest welcome. I immediately felt at home and like I was truly a part of the team, even though I was obviously the newest person on the team and a big change given the tenure of Karen Barber being at the hospital [before me]. Yoakum Community Hospital [has] strong community support and it's truly what I've felt since I was onboarded in such a short amount of time.

HL: In a recent press release, the Community Hospital Corporation's president and CEO, Jim Kendrick, is quoted saying: "Rural hospitals should develop and implement strategies that will help them successfully navigate a challenging healthcare environment this year." What pain points are you focused on developing strategies for during your first year as CEO?

Miller: One of the biggest focus areas for Yoakum is the recruitment and retention of qualified staff; that starts with the culture of our hospital, especially given the current environment of higher labor costs. It's about creating an environment where people not only want to be, but they also want to stay.

The pain point is overcoming those extremely high salary rates that make it hard to compete with larger institutions that are in closer proximity or contract travel gigs.

As a leader, I believe it's important to be transparent with your team and being able to make that connection—that purpose—and help bridge that gap between action and the why behind it. I've already started having those conversations with team members to help make the connection that underscores that importance of fiscal stewardship and being able to get creative on how do you create an environment where people want to work and that they want to stay?

Another focus area, especially as a critical access hospital, is service-line growth. We are the health lifeline in the community. We are the reason our patients can receive care close to home. Think about a time when you were sick, or maybe something was just not quite right with your health. The last thing that you would probably want to be doing is travel; you're not going to want to travel a long distance to receive care to address the underlying health concern. Yoakum has a robust family practice clinic and outpatient offerings, so now that focus is how do we further develop our service line offerings based on that community need? Cardiac services is a big one in our community.

Along those lines is the opportunity for medical staff succession planning. One thing I've quickly grasped, even during the interview process, is the tenure here. It's pretty unheard of. It will be important to ensure we have providers available to continue providing care in our community for another 100-plus years.

Tiffany Miller, DBA, MHA, President and CEO of Yoakum Community Hospital. Photo courtesy of Yoakum Community Hospital.

HL: What initially drew you to work in healthcare? Can you walk me through your healthcare career journey?

Miller: I attended undergrad at Texas Lutheran University in Seguin, Texas, and [during] the fall of my junior year, my advisor asked me what I wanted to do with my business degree. I quickly realized I had no clue. I grew up in a home where "I don't know" was not an acceptable answer, so I had asked for time to consider my response to his question. A week passed and I still had no clue. Fast forward from that conversation, my advisor, who was on the board at the local hospital in Sydney at Guadeloupe Regional Medical Center, set up a meeting for me to have a conversation about completing an administrative internship for independent study credit. And once I started, I was bitten by the healthcare bug.

I'm a purpose-driven individual and I knew I wanted to make a difference. I knew I wanted to be a good steward of my skills and abilities, and I wanted to make an impact in the lives of those whom I was serving. I knew that I ultimately wanted to become a hospital CEO and I knew I would need to obtain my Masters. After undergrad, I was working full time and I was going through the full-time Master's in Healthcare Administration Program at Trinity in San Antonio.

I started in a regional acute care setting in Victoria, and while I was there, I took a slight detour when I started my full-time Doctoral program. I shifted over into an administrator role for emergency medicine at a hospitalist medicine group. Fast forward a little bit more to the point of my life when I was writing my dissertation, I shifted [to] working in population health.

When I made that initial pivot out of the hospital setting, I knew I always wanted to get back to the hospital setting. I started working in the post-acute industry, I was running a long-term acute care hospital. Unfortunately, Houston was over-bedded with LTAC beds, so I closed down that  LTAC right before the pandemic hit and transitioned into an inpatient rehab setting, running an inpatient rehab hospital, which I absolutely loved.

One of the things that parallels between the size of Yoakum Community Hospital and being in a critical access setting is you're afforded the opportunity to get to know your staff. You know something about every single staff member. And so when this opportunity became available, I threw my hat in the ring.

I grew up in a small community about this size, and I was ready to be back in that kind of place. I've got a really great team of amazing community support, and I'm looking forward to carrying on the hospital's legacy.

HL: What advice do you have for women and others who aspire to be leaders in healthcare?

Miller: You have to be willing to work hard. There is absolutely no substitute for sweat equity. If you are willing to persevere through any kind of circumstance or any odds that are stacked against you, the likelihood that you achieve a goal that you set for yourself is much greater. Be willing to bet on yourself. Relentlessly believe in yourself and affirm that you're both capable and able.

Expand your circle of influence to include people who will hold you accountable to the standards you set for yourself and who will empower you and encourage you along the way.

Specifically for women, I would say to be confident in who you are, and don't ever apologize for it. I think as women, we have a tendency of minimizing who we are, so we don't get labeled a certain way. Give yourself permission to take up space and play to your strengths. Take time to understand your strengths, understand what drives you, and then go for it.

Along those same lines, it's so important to understand the strengths of your team and those who support you. I jokingly will tell my team—and it's really not a joke—"I'm a generalist, and I know enough to be dangerous." There's a reason why there are key leadership positions within the hospital in those roles. They serve a purpose, and it's understanding the strength of your subject matter experts, being able to tap into that, take time to understand what motivates them and what inspires that shared vision.

Have fun while you're doing it. What we do is hard. Being in the healthcare industry is a business and we're dealing with human lives. Enjoy what you're doing, because while it is hard, it's also extremely rewarding. And it's important to celebrate those successes no matter how big or small.

Finally, I would say embrace the notion that every experience is a learning opportunity. Whether the outcome is either what you intended or maybe not what you intended, it's about what you do with that learned experience that determines what comes next for you. Having an open mind and choosing to have a growth mindset allows you to capitalize on those learning gains and move forward from that experience.