RJW Hamilton’s Executive Women

Corrections or additions?

This article was prepared for the February 15, 2006 issue of U.S. 1

Newspaper. All rights reserved.

Healthcare Hardball: CEO Christy Stephenson leads RWJ

Hamilton into the 21st Century

by Kathleen McGinn Spring

Female healthcare CEOs may be more free to be themselves. While their

counterparts in other industries operate in male-dominated executive

suites, often overseeing operations with a long history of macho

culture, healthcare CEOs know that a good 80 percent of their

employees are women. Healthcare is a women-friendly culture at most

levels – but not necessarily at the top. Of the 120 hospitals in New

Jersey, only 21 are headed by women.

One of them is Christy Stephenson, CEO of Robert Wood Johnson

University Hospital at Hamilton. She leads 1,750 workers and oversees

600 doctors. She is responsible for a 67-acre medical campus, eight

child care centers, a new 86,000 square-foot fitness center, an

ambitious building program, and care given to hundreds of thousands of

patients every year. She has implemented a comprehensive quality

control program that last year culminated in her institution becoming

one of only four hospitals in the country ever to earn the Malcolm

Baldrige National Quality Award.

Yet Stephenson starts a interview not by talking about awards,

expansion plans, or market share, but rather about an upcoming trip to

Seattle to see her baby grandson – whose smiling portrait she fetches

from her desk. She works from an office where a cranberry throw

artfully accents a floral couch, talks about the log cabin,

Amish-style quilt on her wall, and divulges that she lets nothing

interfere with her monthly book club meetings.

Dressed in a smart black suit with a pencil skirt that ends in a

five-inch pleat, Stephenson is a warm, confident woman who is at ease

with her femininity. The lanyard that holds her hospital ID around her

neck is made of multi-colored beads. Her black heels are more chic

than sensible. Her voice is soft, and there is an undeniable aura of

calm in her executive offices.

But Stephenson, who has led RWJ Hamilton since 1998, can be tough, as

she is when she tears into one of her hospital’s competitors, whom she

thinks is diverting dollars from its primary mission in a push to move

into the suburbs – her territory. She is also disciplined, and driven.

Yes, she made the quilt, but her packed schedule meant that the

hand-stitching on its pumpkin seed and feather patterns took her a

year.

She walks every morning at 5:30 a.m. with a friend, but, in a

concession to her work schedule, says "we’ve cut back to 30 minutes."

She sets her alarm to go off between 4:30 and 5 a.m. most mornings.

Then, after her walk, she checks E-mail, which her staff typically

starts sending at around 6 a.m.

Her pre-commute routine also includes a go at the day’s Suduko puzzle.

Hooked on the craze, which requires the placement of the numbers 1 to

9 in 9 compartments on a page, she complains – ever so mildly – that

the Trentonian Sudukos are too easy. She likes USA Today’s Sudukos

better, because they vary in difficulty and each puzzle’s fiendishness

is rated in stars below it. But mostly she takes her Sudukos from

books. "I’m a black belt," she says, with no trace of modesty.

While she prefers pencil to keyboard when it comes to Sudukos, she

reveals another personality trait when she says that she does like two

features of online puzzles – "You can be timed, and rated," she says.

"Yes, I am very competitive."

Suduko conquered, Stephenson leaves her Pennington home in time to be

at her desk by 7:30 a.m. Once there, her routine revolves around

meetings, the first of which takes place at 8 a.m. There are medical

staff meetings, senior leadership meetings, community meetings, task

force meetings, department meetings, employee committee meetings,

board meetings, and building project meetings. In-between meetings she

makes time to walk the floors, taking her hospital’s temperature by

talking informally with staff and patients. She generally is ready to

head home sometime between 8 and 10 p.m. on weekdays, and is back at

her desk on Saturday for relatively uninterrupted catch-up time.

Stephenson’s compensation for this schedule in 2004 was approximately

$314,800 in salary and $384,847 in a benefit plan, deferred

compensation, and a two-year long-term incentive payout. These figures

were obtained from the 990 forms that non-profits file each year with

the IRS. Each non-profit calculates CEO pay in a different way, and,

according to Ron Czajkowski, vice president of communications for the

New Jersey Hospital Association, it can include everything from

signing bonuses and incentives to pay for work done for hospital

enterprises in the for-profit sector. So it is difficult to make an

exact comparison, but, while executive women still make less than

their male counterparts in many industries, the IRS filings seem to

indicate that Stephenson’s earnings are on a par with those of male

healthcare CEOs in central New Jersey.

Barry Rabner, CEO of Princeton Healthcare System, parent corporation

of the University Medical Center at Princeton, earned $574,525 in

salary and $16,734 in benefit plan contributions and deferred

compensation in 2004. Al Maghazehe, CEO of Capital Health Systems in

Trenton, earned $892,118 in salary and performance incentives and

$48,477 in benefit plan contributions, but the annual revenue for the

hospitals he oversees is more than double that of RJW Hamilton, where

revenue is in the same range as that of Princeton Healthcare System.

Stephenson’s healthcare career has taken her to the top of her

profession, but it began not with the careful plotting that an

ambitious 21st century woman might employ, but rather with the

relatively simple career choices that so many young women made in the

1960s.

"My dad’s sister was a nurse, and I admired my Aunt Maxine

tremendously, so I went to nursing school," she says. She earned a

three year R.N. in 1971. The school was near her home in Holland,

Michigan. A photo of a red lighthouse in Holland sits just to the

right of her office door. Surrounded by little whitecaps and soaring

gulls, it looks idyllic, and that is how she remembers her childhood.

"It was a nice little town in central Michigan," she says. "I knitted,

crocheted, sewed. It was part of my growing up." The family, which

included a sister and two brothers, spent lots of time playing cards

and Scrabble. Her mother, Myrl, was the school librarian, but she took

time out from work to raise her four children, returning to the

workplace at age 50. Her father, Howard, owned a construction company.

The family remains close. "My parents travel with a laptop," she says.

Every Sunday, after her grandson, Samuel, has awakened from his nap,

and her parents have returned from church, the family holds a video

conference. "We use Sitespeed.com," she says. "It’s something like $50

a year." There they each appear in their own on-line squares and have

the 2006 version of a nice Sunday get-together.

Halfway across the country from her childhood home, Stephenson has

retained the thread of her youthful career choice. After earning her

R.N., she worked as a nurse in Michigan, upstate New York, Florida,

and Kansas, following her then-husband’s career. The pair, along with

their children, landed in New Jersey when he was offered a teaching

job at Rider.

Stephenson has two sons. Nathan, the father of her grandchild, lives

with his wife, Alison, in Seattle. He is an emergency medicine doctor.

"He’s interviewing for a job closer to home," says the doting

grandmother with unconcealed delight. Jordan, an IT professional who

lives in Lawrenceville, is an interface specialist at RWJ New

Brunswick. Stephenson’s first marriage ended in divorce, and she is

now married to James Lytle, who works for the U.S. Postal Service in

Trenton.

Before coming to New Jersey, Stephenson lived and worked in Kansas for

four years, the longest time she had stayed in one place since

becoming a nurse. "During that time I started a hospice along with a

doctor I had met there," she recounts. "I had to incorporate it as a

business, and everything that took tickled something inside me." Her

next career move could have been coursework toward a B.S. to go along

with her R.N., which would have taken her to higher positions in

first-line patient care, or a business degree that would lead to

management of all elements of a healthcare institution. After some

thought, she chose the latter, and began moving toward the business

side of healthcare by taking courses at the University of Kansas. When

she moved to New Jersey, she continued her studies at Temple, earning

an MBA in healthcare administration. She also took business courses at

Rider.

"The business side doesn’t have to be all hard," she says. It’s a

telling remark. It meshes perfectly with her personal style – with the

huge garden-scene watercolor behind her desk, for example – and with

her administrative style. Again and again, whether talking about the

Baldrige award or about her healthcare center’s rapid growth, she says

"it’s all about the people." Told about a recent study in which female

healthcare CEOs ranked people as more important than technology to the

future of their organizations, she agreed. But somewhat reluctantly,

because she does love technology, too.

Running to her desk, she grabs her brand new Treo. She had been in

love with her Blackberry, "my crackberry," she jokes, referring to the

highly addictive nature of the devices. But her Treo, she boasts,

offers even more. It is a full computer, with a Microsoft operating

system built in. "It’s a camera, too," she says. She is expert at

typing out text messages with its tiny, tiny keyboard, and obviously

enjoys fingering its sleek, beautiful face.

Technology powers her healthcare center now, and will do so even more

in the future, she says, thanks to a close collaboration with RWJ New

Brunswick’s IT team, which is busy digitizing dozens of types of

interactions between patients and healthcare providers. But people

power still rules, particularly in a field where outsourcing to

consultants or overseas workers is rarely an option.

Stephenson began to learn about how technology and people come

together to form healthcare, the industry, when she took her first

administrative jobs. After earning her MBA, she began working at RWJ

Hamilton. She was director of planning and of ambulatory care before

becoming COO. She left the hospital in 1995 and went to work in the

for-profit side of healthcare for Happauge, New York-based Curative

Health Services. The company partners with hospitals on wound care

centers. Her territory was New York, New Jersey, Delaware, and

Pennsylvania.

The experience was like "a survey," she says. She worked closely with

18 hospitals, and saw first-hand how each was run. "It was a great

experience professionally," she says. "I saw that it’s not about the

structure. It’s about the people." What she saw was that it didn’t

matter whom she was working with, whether the person was a

highly-educated upper administrator or a relatively uneducated

technician. It wasn’t the position, or the level of education, it was

the character, work ethic, and personality of the person that made the

project go smoothly – or not.

Three years after she left RWJ Hamilton, the hospital’s CEO departed,

and she was asked to return to take over that position. She readily

agreed. That was eight years ago. The institution was already

beginning a growth spurt, and it has only accelerated since she took

over the top spot.

In fewer than 10 years, RWJ Hamilton has added an outpatient building,

a new ICU, a maternity unit, and an extensive, free-standing cancer

center. The eighth member of its Lakeview chain of childcare centers

recently opened in Ewing.

In its Baldrige award write-up, the federal quality gurus found that

"over the past five years, RJW Hamilton has been New Jersey’s fastest

growing hospital." Measures of this growth include not only buildings,

but market share. It found that the healthcare center’s market share

in cardiology had grown from 20 percent in 1999 to 30 percent in 2003;

its market share in surgery from 17 percent to 30 percent in the same

period; and its market share in oncology from 13 percent to above 30

percent in those four years.

"Did you hear that ’emergency bed management meeting’ announcement?"

she asks. It had come over the hospital PA within the half hour. The

hospital is running at an average of 102 percent of capacity, and

finding room for everyone is a challenge. The announcement, Stephenson

says, is not uncommon, and means that there must be a scramble – STAT

– to find room. Discharge paperwork may have to be speeded up for

patients ready to leave, and some patients may have to be moved to the

pre-discharge lounge.

This is a most unusual situation, and not the worst problem to have in

New Jersey, where average occupancy for all hospitals tends to range

between just under 50 percent to just over 65 percent.

Poised to ease the crunch at RWJ Hamilton is a new three-story patient

care building. It will contain 96 new private rooms, and is set to

open in one year.

Walking around a scale model, Stephenson shows how the wedge-shaped

building will fit into the existing patient wings, and points out that

every room will have a view of gardens or lake. She has had a

prototype room built near her office. She says that few hospitals do

this, but in her view it is far better to have extensive input before

construction. Doctors, nurses, orderlies, housekeepers,

administrators, and patients will give the room the once-over.

Everything from carpet color to placement of outlets for oxygen and

other gases will be scrutinized.

The room is huge, and its amenities provide insight into the fight for

customers – patients – that New Jersey hospitals are waging. For

several years hospitals have been using luxe maternity suites to lure

patients, and now it appears that the treatment will be available to

everyone who needs to stay overnight at a hospital. RWJ Hamilton’s

rooms are to have flat screen TVs, enormous windows, sofa beds for

loved ones who want to keep the patient company, and curving walls

that enclose bathrooms large enough to give Toll Brothers a run for

their money.

Both Princeton Healthcare System and Capital Health System have

announced that they are building new, amenity-filled medical

facilities on suburban campuses. The appeal is to health concerns –

private rooms can help stop the spread of infection, and spacious

campuses can accommodate the latest imaging technology – but also to

suburban sensibilities.

In one case, Stephenson states her strong opposition.

Capital Health System, with two Trenton hospitals, Fuld and Mercer,

pulls in tens of millions of dollars in government subsidies to serve

its urban population, she says. It is wrong, in her opinion, that this

money be used to set up shop in the suburbs. Fuld alone, she says, has

a bottom line of $29 million, "more than the total bottom line of the

other three Mercer County hospitals – St. Francis, Princeton, and

Hamilton."

The money comes in the form of subsidies for trauma care, charity

care, unreimbursed care, and other needs. "Most comes from the tax

bucket," she says. It is to be used, she says, for the poor of

Trenton. Among the many needs she sees in Trenton are programs to

battle childhood obesity, to provide early pre-natal care, and to

start smoking cessation programs. In the city, "the money could make a

huge difference," she says, but "in some cases these dollars are being

used to fund care outside of the area."

She says Capital Health System’s contention that it must provide

services in the suburbs to ensure economic survival is not backed up

by the facts. "It rattles my sense of justice," she says. "Charity

financing was put in place for needy populations."

Asked to comment on Stephenson’s contentions, Dennis Dooley, vice

president for planning and development at Capital Health Systems,

points out that RWJ Hamilton has its roots in Trenton, and moved to

the suburbs in 1971. "When both hospitals were founded, two-thirds of

the population of Mercer County was in Trenton," he says. That is no

longer the case, and he takes umbrage at the idea that Hamilton

Hospital, now RWJ Hamilton, sees no problem with expanding to serve a

burgeoning suburban population while, at the same time, suggesting

that Capital Health System should not expand into the suburbs.

As for the tax money, he says that Capital Health System receives $20

million a year in charity care reimbursement from the state and $7

million in "disproportionate care" funds from the federal government

to compensate it for the high number of uninsured people it serves.

This money also is meant to cover some of the costs the medical center

incurs in caring for people with certain diseases, including AIDS,

which are very expense to treat.

None of this money is being used on any suburban programs, says

Dooley. What’s more, he says, "it does not even cover our costs. We

spends millions more." Yes, Capital Health System does receive more

tax money for caring for indigent people than its suburban

competitors, he freely admits. This is so because so many people in

its population are uninsured, he says, while nearly everyone in the

surrounding suburbs does have health insurance.

If there is money to be made in pulling in charity tax dollars, he

asks, "why wouldn’t Hamilton or the others establish a site in

Trenton?"

His medical center takes its mission of serving the poor of Trenton

very seriously, he says, pointing to $37 million it has just put into

its Fuld campus for an expanded ER, new ICU and CCU units, an

emergency psychiatric unit, and other improvements. Another new

Capital Health Care System initiative is a newly-opened family care

center, which tripled the hospital’s capacity to serve patients. "It’s

as pretty as anything you’ll find in the suburbs," says Dooley. But it

will not make any money for Capital Health System. "We spent $2.5

million to triple our capacity to lose money," he says.

Capital Health System has done well financially during the past few

years, says Dooley, but it is his contention that will not be the case

moving forward. He sees accelerating erosion in his institution’s

population base and, at the same time, rising costs.

If his healthcare institution is to survive, he says, it has to expand

into the suburbs, "where the paying customers are." Only by doing so,

he says, can it obtain the financial stability to continue to serve

the poor of Trenton.

Regardless of whether one hospital’s strategy is or is not "right," it

is undeniable that healthcare is a fiercely competitive industry –

particularly in New Jersey. A report by the Advisory Commission on

Hospitals found that "there has been a significant decline in the

financial condition of New Jersey’s not-for-profit acute care

hospitals since 1995."

Asked about the biggest challenges facing all hospital CEOs,

Stephenson puts the regulatory environment in general, and

reimbursement in particular, high on the list. "We get a fair number

of denials," she says.

In addition to frustration over non-payment or inadequate

reimbursement, problems common to all hospitals, New Jersey’s 84

hospitals, operating in close proximity to one another in one of the

smallest states in the country, also have to go head to head with

world-class medical centers in Manhattan and Philadelphia.

There isn’t much that hospitals can do to change managed care and

government reimbursement policies, but each hospital can – and must –

compete for its fair share of paying customers. Each must find a way

to shine. Every year New Jersey hospitals that could not distinguish

themselves enough to operate at least slightly in the black close.

Approximately 12 have been forced out of business in just the past few

years. Stephenson’s strategy in keeping her hospital ahead of the pack

centers on the principles of the Baldrige National Quality Program.

The Baldrige award program, begun in 1987, operates under the auspices

of a federal agency, the National Institute for Standards and

Technology. It recognizes quality across every industry and in

companies of all sizes. This quality is documented through the

achievement of measurable results. In healthcare this could mean

reduction in waiting time in an emergency room, improved patient

satisfaction, greater market share in specific services, or employee

retention. The organization sets the goals, works toward them, and

uses objective standards to quantify results.

In naming RWJ Hamilton a winner, the Baldrige committee gave credit

for quality results in a number of areas, including an increase in

registered nurse retention from 94 to 99 percent, an increase in

employee training hours from 38 to 58, a Gallup-measured customer

loyalty greater than that for any of its competitors, a downward trend

in hospital-acquired infections, a downward trend in mortality rates,

and a guarantee that no one will spend more than 30 minutes in the

emergency room before being seen by a doctor.

Goals are big at every level of the hospital, and across all

departments and functions, says Stephenson. Each department has

concrete goals, and every employee in that department knows what they

are. In addition, each employee has his own top goal – and wears it

every day, printed on the ID tag around his neck. Once a month, each

employee sits down with his supervisor to talk about progress toward

that goal.

While employees are working on their goals, the hospital keeps its

finger on the pulse of employee satisfaction. It knows exactly what

percentage of its workers are happy with benefits, leadership,

participation in decisions, and the recognition they receive.

Employees meet with their supervisors and with Stephenson on a regular

basis to air any problems. Recently, she gives as an example, the

problem was dirty shoes.

"Employees told us that the parking lot was uneven, and puddles

gathered when it rained," she recounts. "Then they would get to the

sidewalk, and, because it was too narrow, they would step off to the

side and get their shoes in the mud." Taking the problem seriously,

the hospital repaved the parking lot and widened the sidewalk.

Another recent concern involved night shift workers. "They felt they

were getting short shrift in the cafeteria," says Stephenson. "By the

time they got there, the only thing left was vending machine food."

The hospital wasn’t able to offer a full service cafeteria around the

clock, but did arrange for the chefs to prepare a big pot of soup each

night.

Stephenson says that her hospital "doesn’t have unlimited dollars to

pay at the top of the range or to offer the richest benefits

packages." It does offer flexible hours when possible, and has even

instituted work-at-home arrangements with some employees. There is

also on-site day-care, and massage therapists give back rubs

throughout the hospital. Perhaps most important, every employee is

given the benefit of being heard and having his concerns given real

attention. Good work is recognized "both formally and informally."

Third party polling the hospital has commissioned confirms that this

is enough to vastly increase employee satisfaction.

Satisfied, engaged employees – especially at the highest levels – may

be a good part of the reason that Stephenson appears completely

relaxed and unruffled during an interview on the 11th hour of what

will grow into a 15-hour work day. She says that she is able to

delegate to her senior staff with complete confidence. Asked about how

involved she is in the construction of the new three-story building,

she says "not very." She is given regular reports, but has little to

do with day-to-day decisions.

Stephenson nurtures senior management with a leadership development

plan that features rotating responsibilities, which allows her inner

circle "to grow as a team." She says that it provides the depth that

is right for the organization. "It’s better to have more people in the

know," she says.

She also has a detailed succession plan. "People move on," she

acknowledges. While she has always known this, Stephenson got a sharp

reminder last year. She was riding the train down to Washington, D.C.,

for a Baldrige presentation with her COO, when the COO announced that

she was moving to Florida. "I had known her the whole time I’ve been

here," she says. "I felt like I had been hit by a brick."

She met with her whole senior team to try to figure out what to do. As

the discussion evolved, she asked each team member if there was a part

of the COO’s responsibilities that he or she would like to take on.

Diane Grillo, director of communications, says that she raised her

hand and offered to take a role in physician relations, an area that

had long interested her. Other people quickly put forth their own

requests.

The unintended result of the COO’s departure has been "a complete

re-energizing of the senior team," says Stephenson. New niches were

created, and everyone was given the shot of adrenalin that comes with

a new job – without having to go out and get a new job.

As for new jobs, since the Baldrige award was announced Stephenson

says that she has received lots of job offers. But she is not tempted

to follow up. "I don’t have that restlessness anymore," is her

explanation.

But she has been accepting many offers to speak about the award, and

is genuinely amazed by them. "I never, absolutely never, not in my

wildest dreams, thought that anyone would pay me to speak," says

Stephenson. As she talks about her speaking engagements, the

sophisticated New Jersey CEO becomes, just for a minute, the girl from

tiny Holland, Michigan, who just wanted to follow her Aunt Maxine into

nursing.

Top Of Page
RJW Hamilton’s Executive Women

Everyone knows that hospitals are full of doctors and nurses and

white-coated technicians who operate complex diagnostic equipment, but

few see into the executive suite. Just as in any industry, there are

dozens of high-ranking executives in every hospital. They oversee

everything from public relations to purchasing to the operation of

discrete hospital operations – perhaps a cancer center or a chain of

day-care centers.

Unlike many industries, however, healthcare centers often provide

avenues through which employees can move laterally to gain more

experience and then vertically into positions of increasing

responsibility. Many smart, ambitious women have used this structure

to climb into executive jobs.

Deborah Baehser, pictured in the print edition, is one such woman. She

started her career by earning a nursing degree from Bucks County

Community College, and is now making approximately $200,000 a year,

including benefit contributions and deferred compensation, as vice

president for clinical services at RWJ Hamilton.

She joined the hospital in 1999 and was appointed vice president for

patient care and chief nursing officer in 2003. She is credited with

leading development of a new emergency, critical care, and telemetry

nursing departments as well as a neonatal intensive care unit level II

nursery and maternity department. In December, 2005, Baehser, who also

has a master’s in health care administration, was appointed senior

vice president for clinical services.

Here are four other executive women at RWJ Hamilton.

Diane Grillo, met CEO Christy Stephenson when they worked together at

Curative Services. Stephenson brought her to RWJ Hamilton as division

director for health promotion at 1998. In December, 2005, Grillo, who

holds a bachelor’s degree in organizational development from Eastern

University in Radnor, PA, was promoted to vice president for health

promotion. She has 20 years experience in managing community education

and outreach programs.

Jennifer Hunara accepted the position of executive director of

surgical services at RWJ Hamilton in January. She came to the hospital

from Lehigh Valley Hospital in Allentown, Pennsylvania, where she had

served as the perioperative services business manager and as an

administrative resident and consultant working in surgical and cardiac

services and administration.

She holds a bachelor’s degree and a master’s degree in health

administration and an MBA, all from the University of Scranton.

Lisa Breza, has worked for RWJ Hamilton for 20 years. She began her

career as a medical-surgical nurse, and worked her way up through the

ranks. She was named executive director of the Cancer Institute of New

Jersey Hamilton in November, 2005.

She has held a number of positions at the hospital, and was director

of the emergency department during the anthrax attacks in 2001. Breza

received her bachelor’s in nursing from the College of New Jersey.

Shashi Madhok, was named vice president for quality at RWJ Hamilton in

December, 2005. She is responsible for quality initiatives related to

staff credentialing, patient safety, discharge management, medical

research, and compliance standards. She is in charge of programs

related to organization performance, Six Sigma quality methodology,

and the Malcolm Baldrige National Quality Award.

Madhok earned a bachelor’s degree in nursing from the University of

New Delhi, India, and a master’s in public administration, with a

focus on hospital administration, from Rutgers. She is a board member

of Quality New Jersey.


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