‘A leader is different from a manager,” says Sheryl Slonim, right, CEO of St. Peter’s University Hospital in New Brunswick. She says this in such an off-hand way that it is easy to glide over it. But wait, what exactly does that mean?

“Leadership is the ability to think strategically, to think critically, to gain the respect of the community,” she says. “It means that you create a model that people will follow.” A leader is not task oriented, she says, but rather makes sure that managers under her become leaders in their own areas of responsibility.

Slonim is charged with leading a 422-bed city hospital, which is about to celebrate its 100th birthday, through the booby-trapped maze that is the delivery of healthcare services in New Jersey in the 21st century. “This is a uniquely challenging time,” she says. “It’s not just St. Peter’s or New Jersey, it’s national. We’re all in the same challenging bucket.” The issues range from the need to invest in wildly expensive technology to the soaring cost of malpractice insurance.

After an extensive search, St. Peter’s choose Slonim to lead it through the toughest environment healthcare it has ever experienced. She was named CEO in 2003 after serving as interim president and CEO since 2001. She oversees 2,800 staff employees and 900 doctors and dentists in a hospital that serves 30,000 inpatients and 200,000 outpatients every year. Her hospital, with a specialty in obstetrics, also delivers 6,400 babies annually. Its neonatal intensive care unit was the first in New Jersey, remains the state’s largest, and is the reason that Slonim first came to St. Peter’s.

Slonim’s route to a healthcare CEO began before she entered third grade. “I was in a hospital visiting a relative, hand-in-hand with my mom,” she recounts. “I was at most eight years old, but I knew that I wanted to work at a hospital. True story.”

Her mother was a homemaker and her father a systems analyst at American Cyanamid, “back when computers were the size of this room.” She grew up in Fairfield, and, when she was a junior or senior in high school, decided that the healthcare career she would pursue was nursing. Like many high school students, she didn’t necessarily go over all of her career options in detail, and certainly didn’t plot a path to top management. “It was a happenstance,” she says.

She attended Fairleigh Dickinson, where she earned a bachelor’s degree in nursing in 1976. Her first job was in the neo-natal department of the Children’s Hospital of New Jersey in Newark. She isn’t sure exactly why she chose her nursing specialty, but says that one reason is that care of pre-mature babies was “cutting edge” when she entered the field. “Treatment of respiratory distress syndrome, which is very common in pre-mature babies, didn’t begin until John F. Kennedy’s son was born pre-maturely,” she says. (The president’s son, Patrick, born five weeks pre-maturely in 1963, died two days later.)

Slonim remained at Children’s Hospital for 10 years, eventually moving into a teaching role within her specialty. When she relocated to central New Jersey in 1985 she accepted a similar position at St. Peter’s. After a brief stint as a nurse educator, she became divisional director of maternal child health, and then, in 1988, was promoted to assistant vice president of nursing. She held that position for 10 years, and then left to become vice president of patient care services at Clara Maass Medical Center in Belleville.

It was difficult to move away from a job she enjoyed, but Slonim says that, after so many years as an assistant at St. Peter’s, “I needed to move to a place I could call my own. It was a career advantage.” She says that she would encourage other executives to take a similar path. “It’s easy to get comfortable,” she says. If a job that will advance a career comes along, “by all means, go,” is her advice.

It turns out that Slonim was not away for too long. Just a year after she left St. Peter’s, the hospital’s vice president of patient care services departed, and she was asked to take that job. Despite the quick return, she thinks that her time away turned out to be a good thing. “It’s better to move in than to move up,” she says. “It sets a different tone.”

From that position, she was just one job move away from the hospital’s top position, and it was soon hers. She is one of a trio of central New Jersey hospital CEOs who began their careers as nurses. Robert Wood Johnson Hamilton’s Christy Stephenson is a nurse, as is Judy Persicelli, who served as CEO at St. Francis in Trenton before being promoted to a job in which she oversees a number of hospitals for Catholic Health East.

Despite this central New Jersey cluster, Slonim says that it is unusual for a nurse to rise to the top management position. But she is proof that it is possible for a nurse to end up doing much more than carrying out a doctor’s orders. She uses her career success as an example when she speaks to her hospital’s nurses about the range of possibilities open to them.

She also thinks that it makes a great deal of sense to choose a nurse to lead a hospital.

“Clinical and managerial experience is a good combination,” she says. What’s more, she adds, “trust is such a critical factor.” A nurse rising through the ranks is likely to have earned it both from those above her and from those she supervises. A nurse is also likely to be very good at working with physicians — a key job for a hospital CEO. “I’ve interacted with physicians all through my career,” says Slonim. “When you do that you know what they need. You can anticipate their requests.”

Attracting staff and physicians — and keeping them happy — is always on Slonim’s mind. Not only is there a “huge” labor shortage in healthcare in the United States, particularly for nurses, pharmacists, and many types of technicians, but the situation, she says, is even more difficult in New Jersey. Tight supply combined with high living costs adds up to a big problem for the bottom line.

“Salaries are more of a challenge in New Jersey,” she says. “That is why there are shrinking margins in New Jersey versus other parts of the country. Other parts of the country have 5 percent margins, but here we’re doing well if we can have 2 percent margins.” The reason, she is convinced, is the higher wages that New Jersey hospitals must pay.

Nurses, technicians, and orderlies need to make more money to afford New Jersey’s housing, tax, and insurance costs, but doctors need to deal with those expenses and also make enough to cover their malpractice insurance premiums.

“Malpractice is a huge crisis, especially in New Jersey,” says Slonim. The insurance is a direct drain on her hospital’s resources, and also affects its ability to keep some of its biggest specialties staffed. Obstetrics is an important specialty for St. Peter’s and is one of the areas hardest hit by malpractice insurance rates. “Physicians in obstetrics are not only facing shrinking re-imbursement,” says Slonim, “but also high malpractice rates. The combination has been enough to force some to leave the specialty.”

While dealing with issues in obstetrics, which, in one form or another, has been with us forever, Slonim is also focusing on the new millennium issue of technology — which she sees as both a blessing and a burden. “It’s crucial to maintain cutting edge technology,” she says. She points to her hospital’s electronic documentation system, which goes live in May, as an example.

The documentation system will replace pen and paper as the main method of recording and transmitting all kinds of patient data. “It’s important from a safety point of view,” says Slonim. “There will not be a whole lot of interpretation.” In other words, a nurse or pharmacist will no longer have to guess at what doctors, with their famously erratic penmanship, have written. The downside is that the price tag for this one system alone is $42 million.

Money is an issue for St. Peter’s, as it is for nearly all hospitals. In addition to staffing, insurance, and technology expenses, it has to deal with the fact that it often performs services for which it will never be paid. As a city hospital, St. Peter’s cares for a number of charity patients. “It’s part of our mission,” says Slonim, and her hospital doesn’t shrink from it. Yet it does have to come up with services that do pay.

Slonim has had success in generating revenue through physician partnerships. St. Peter’s ambulatory surgical program is an example of how this works. It is a for-profit center in which the hospital provides the space, and the doctors provide the services. Profits are split 50/50. “This kind of joint venture helps us,” says Slonim.

There could well be more such partnerships in the hospital’s future, and Slonim shows interest in another money maker, the hospital-affiliated fitness and wellness center. Both Princeton and Robert Wood Johnson Hamilton hospitals have turned to these souped-up gyms for revenue, and have found that area residents are so eager to join that finding a parking spot at one of the facilities has become a sport of its own. She says that St. Peter’s does not yet have a fitness and wellness center in the works, but that it is looking at the phenomenon.

What Slonim’s hospital does have is a new strategic plan whose main aim is to identify and implement profitable services so that it can keep on providing all of its services.

The strategic plan, due to be unveiled soon, has occupied much of Slonim’s time for months. She says that she spends about 70 hours a week at the hospital when major initiatives like this plan are in the works. She commutes from Middletown, where she lives with her husband, Robert, a musician who “plays all of the woodwinds, but especially the sax,” and who also teaches music to junior high school students. She uses her commute to unwind, but it easily adds an hour to her day — and sometimes as much as two-and-a-half-hours. Her leisure time, what there is of it, is spent on her power boat.

“My husband is an avid boater,” she says, adding that she is somewhat less avid, but happy to go along as first mate. She remains connected to work via laptop and cell phone during weekend boating outings, and says that her position makes it hard for her to get away for much more than a long weekend.

On the job, Slonim says that she spends a lot of time with city officials and with politicians at other levels of government. “A hospital may appear to be a fortress,” she explains, “but it’s not. It’s part of the community, and needs community support.” She also devotes a part of her day to talking with patients and “being visible to the staff.” The rest of the day, which begins with a one-on-one talk with her COO, is “meetings, meetings, and more meetings.”

Slonim knows that she has to develop and inspire confidence in a complex vision if she is keep her hospital healthy. She needs to adhere to its traditional mission as a teaching hospital and regional care center, while at the same time moving it into new, profitable niches. As she well knows, that is what leaders do.

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