As Mike Poore waited for an elevator between floors at Haywood Regional Medical Center Monday morning, he gazed out the sixth floor window to see cars circling the packed parking lot hunting in vain for a space.
“That’s a good problem to have,” said Poore, the hospital’s new CEO.
It’s a far cry from a year ago, when the parking lot was nearly deserted. Haywood Regional had lost its Medicare status after failing a federal inspection. An exodus of private insurance companies followed, and daily patient counts plummeted to single digits.
The hospital dried up for more than three months while rebuilding its inner workings. The progress of the past year is astounding, but there remains a long road ahead. The community is pinning hopes on Poore to get it there.
Poore won’t shoulder the entire burden of rebuilding the hospital. But he could make or break the efforts. In the people he hires, the tone he sets with doctors, the course he steers in merger talks, the financial advice he gives the board, Poore holds more sway over whether the hospital succeeds than any single person.
Doctors in particular are relying on Poore’s ability to turn things around. So far like what they see.
“I think Mr. Poore has been a breath of fresh air. He is forthright and accessible and seems to be knowledgeable,” said Dr. Steven Wall, a long-time physician in the county with Haywood Pediatrics.
The sentiment seems unanimous. When asked to reflect on the hospital’s progress over the past year, Poore’s arrival appears high on most doctors’ list.
“I have high hopes for HRMC and the new leadership we have in Mike Poore and the team he is building,” said Dr. Shannon Hunter, an ENT.
Poore and his near sweep of top managers ushers in a new era for Haywood Regional. His style is vastly different from his predecessor, David Rice. Rice was commanding and authoritative, while Poore is cooperative and congenial.
The medical community harbored distrust toward Rice, but see Poore as someone who will look out for their interests.
“I think we’re still in the honeymoon stage, but I believe this administration seems to be a lot more transparent,” said Munoz. “I have heard staff say they can discuss problems and issues much more openly than the prior administration.”
Pam Kearney, a hospital board member, agreed that it’s premature to pass definitive judgment on whether Poore will succeed, since he’s just four months into the job so far. But like Munoz, Kearney believes Poore is promising.
“He seems to get along well with the hospital staff and medical staff. The comments we’ve gotten have been very encouraging, and his interaction with board members is transparent and open,” Kearney said.
Poore, 44, left a job at the helm of a five-hospital system in the greater Atlanta area to come here. He stood out in interviews, according to Dr. Henry Nathan, a hospital board member who helped hire him.
“He seemed to be very committed to wanting to do this. He was excited about the prospect of having this job,” Nathan said. Nathan said it was obvious in the interview that he knew how to run a hospital.
Poore says he was attracted to the job for the challenge and desire to make a difference.
Assembling the best
One of Poore’s greatest strengths lies in the people he’s hired. The hospital has replaced nearly a dozen department heads, vice presidents and manager types in the past year — the majority since Poore came on board. There’s a new chief finance officer and chief operating officer. New department heads are found through the hospital from human resources to nursing to the emergency room. Some jobs, like quality oversight, are still being filled.
Before Poore arrived, the hospital was run largely by Compass, a consulting group hired to rescue the otherwise sinking ship. Compass initially worked in tandem with administrators left over from Rice’s era.
When Poore’s arrived, he began building a permanent team.
“He has brought with him an excellent group of upper and middle managers,” said Dr. Richard Lang, a radiologist. “A lot of the folks he has brought with him he has known in other places. I think they look on this as a challenge and they are doing a great job.”
Poore called on people he knew from the industry for key spots in the cabinet, assembling a team with higher qualifications and experience than HRMC has seen before.
“We came because Mike asked us to,” said chief operating officer Teresa Reynolds. “We have a lot of respect for Mike. He has good business and leadership skills. He has pleasant personality. He is an easy person to get along with.”
Dr. Henry Nathan, a gastroenterologist, said Poore’s ability to attract top talent has been an asset.
“One thing that he brings to the table is his connections and knowledge of so many talented people. He can say, ‘boy, I’d like to get so and so to come work here with us,’” Nathan said.
Poore is quick to credit the longtime employees for helping to pull the hospital through.
“There are a lot of people who were here through the storm,” Poore said. “There are really conscientious smart people who take care of patients every day, and they’ve been here throughout.”
For the big picture of steering a hospital, Poore said the influx of fresh ideas from across the country that are manifesting in his new team certainly don’t hurt.
Poore has also enlisted the help of a recruiter that specializes in health care fields. That helped land one of the most important posts: the chief finance officer. Gene Winters, the CFO, is a dynamic numbers guy who relishes in saving struggling hospitals. He talks about fixing hospitals like most talk about a trip to the grocery store. Winters was attracted to the challenge of pulling HRMC up, but more importantly wanted a good community in which to raise his new son.
“It is a place where I could be challenged and also be a hero, to be honest,” said Winters, who has a connecting door to Poore’s office.
Where to start
Poore’s first day on the job in October was likely overwhelming. Cash reserves were dwindling, patient confidence was still shaky, doctors were sizing up his every move as they decided whether to stay put or jump ship, and staff were walking on egg shells in constant fear of surprise inspectors.
“One of the things I had to do was accelerate my learning. I had to learn as much as I could as quickly as I could,” Poore said. “I set up a learning plan to educate myself from people internally and externally about the hospital about all the information in the hospital.”
Poore ultimately held face-to-face interviews with 120 people in the medical community, the hospital ranks and the community at large. He asked them for their thoughts, ideas and perceptions on what the hospital needed to do. He asked them what landmines to avoid, what needed changing and how he should go about it.
That first move was savvy. It bought Poore face time with people he needed on his side: the hospital board, doctors, key staff, county commissioners and VIPs in the community.
“He was pretty smart. A lot of people come in and make changes, but the first thing he did was interview everyone he could find to find out what we knew and what we thought,” said Cliff Stovall, a hospital board member.
For most doctors, the interview was their first encounter with Poore. When Poore showed up at their office with lunch in hand, it immediately showed a marked difference from the former administration. Past CEO Rice rarely sought opinions from the medical community. In fact, some doctors feel Rice actively discouraged their input and squelched their ideas.
Trust was lacking under the old administration. But Poore’s ability to listen sent a message to doctors and staff that they could trust him.
“He met with just about every physician face to face and asked us what could he do better, how could he help improve things in the hospital,” Lang said. “I was very impressed that he was such a good communicator.”
The interviews those first few weeks set the stage for future interactions. Doctors felt valued and saw that Poore’s door was always open and he would respond to the their concerns. For example, when radiologists brought up an issue in the medical staff meeting two weeks ago, Poore took it seriously.
“He was in the radiology department the very next day when he had more time to spend on it,” Lang said.
The attitude extends not just to doctors but to the rank and file as well. Morale among nurses and staff has improved under Poore compared to Rice, according to Dr. Al Mina, a surgeon.
Mina still remembers the stinging assessment of Rice’s regime by consultants brought in to help rebuild the hospital a year ago. In a lengthy report, the Compass Group characterized Rice’s regime as a “lone ranger” dictatorship that propagated “a culture of fear.”
“In retrospect, unfortunately, I think that was an accurate assessment,” Mina said. “I don’t think Mike runs his ship in a culture of fear. He is open to suggestions, as is his team.”
The approach is one of Poore’s talents as a manager.
“I give people the tools they need to do their job,” Poore said. “I knock down barriers they aren’t able to knock down and then get out of the way and let them do their job.”
Poore said hospital staff are finally getting the opportunity to shine.
“Whereas in the past they felt like they didn’t have the support of administration,” Poore said. “They tried it once and nobody listened to them. What I am seeing now is people are stepping up and saying ‘I have an idea of how we can improve this.’”
When Poore makes rounds in the hospital, he asks employees what’s working, what’s not, and if they need anything. A believer in positive reinforcement, he also asks if there is anyone he should recognize.
When employees address him as Mr. Poore, he implores them to use his first name.
“He’s Mike to the people in the hospital, and that’s hard for them to get used to,” said Cliff Stovall, a hospital board member.
Empowering the rank and file could well be Poore’s biggest legacy.
“I think one of the main things is that we had to change the culture, and he’s gone about that in a great way by being able to communicate and listen,” said Mark Clasby, another hospital board member.
County Commissioner Kevin Ensley, who was the subject of one of Poore’s 120 interviews, feels like Poore is someone he can call with a concern. Before when Ensley heard complaints, he didn’t know what to do with them, he said.
“I just didn’t think by going to David Rice anything would get done,” Ensley said. “I think now if you complained about a certain situation things would get done.”
Taking the fall
Ironically, the hospital’s first chief of staff under Poore is one of the few remaining fans of Rice. The chief of staff is chosen by doctors from among their own ranks to serve as a liaison between them and the hospital and generally represent the doctors’ interests. It’s a duty few envy, given the time it takes away from the doctor’s own practice.
This year, the position went to Charles Thomas, a cancer doctor, who is one of the few who will stand up in support of Rice to this day.
“I do not think Mr. Rice was a bad person,” Thomas said. “I think Mr. Rice was an honorable man who made some errors. It had terrible consequences but he is and was a fine person.”
Thomas remembers the dire straights the hospital was in when Rice arrived in the early 1990s. Rice was the hero then who brought it back into solvency, investing in equipment and recruiting doctors heavily.
“The hospital was almost bankrupt,” Thomas said. “Mr. Rice came here and did an awful lot of wonderful things. There was huge progress.”
Thomas credits Rice with growing the number of doctors in the community, modernizing the hospital and expanding the medical care it offered. Patients and revenue followed. Rice had built a war chest of $19 million in cash reserves the day he left. Rice was saving it to build a surgery wing — including a floor of offices for himself and the administration.
But that money is nearly all gone now, spent to keep the hospital afloat during the year since the crisis.
“I grimly joked we should be grateful to him that the money they saved up got us through,” Thomas said.
Rice’s drive to build ultimately led to his downfall. His energies initially were dedicated to building a quality hospital. But as he amassed more and more power for himself, he pushed aside the interests of doctors, nurses and even patients to make way for his own agenda, according to his critics.
While Thomas is quick to defend Rice, he has also embraced Poore. The two can be spotted regularly over breakfast in the hospital cafeteria.
“He is a good fellow to meet even at 7 a.m.,” Thomas said. “He is bright, energetic, well-educated has a good depth of experience and has a commitment to our hospital.”
Dr. Richard Lang, another doctor who sympathized with or at least understood Rice’s point of view, called Poore an “extremely bright spot” in the hospital’s past year.
A better relationship
A pivotal moment for the hospital’s future is whether new doctors come here, and that could largely depend on whether they like Poore. Dr. Steven Wall with Haywood Pediatrics said Poore proved helpful in recruiting a new pediatrician recently. Poore spoke to prospective doctors enthusiastically and ultimately helped land one, Wall said.
The relationship between doctors and a hospital can be tumultuous or indifferent, cooperative or combative, one of admiration or mutual dislike. Under Rice, it was strained at best. Many doctors lived in fear of retaliation for speaking out.
Rice couldn’t exactly fire a doctor — they aren’t employees of the hospital. But doctors rely on the hospital for space and equipment to perform surgeries, deliver babies, run tests, take MRI’s and generally care for their patients beyond office visits.
Should a hospital pull a doctor’s privileges to practice there, it would effectively run them out of the community. Many doctors feared Rice might ruin their reputations in this manner if they expressed concern over the direction he was steering the hospital.
Rice once appointed a committee of doctors to recommend the best software to implement electronic medical records hospital-wide. When he didn’t like the top picks, he disbanded the committee, appointed a new one stacked with his own people and chose the system he wanted all along.
Doctors who were upset by Rice’s policies were barred from going over his head to the hospital board. Rice conveyed the attitude that everyone was dispensable and didn’t seem to care if doctors or nurses walked, chalking them up to a poor fit with the hospital anyway.
The broken relationship between the hospital and administration needed fixing, Poore said.
“There was no basic level of trust in the organization,” Poore said. “I told the medical staff I’m not asking you to trust me. I’m asking you to let me earn your trust.”
Poore also found the lack of communication troubling. The organizational structure was permeated with what he calls “silos.”
“There were silos where the executive teams did not communicate,” Poore said. “They felt these are my departments and I take care of them and these are your departments and you take care of them.”
While Rice controlled the flow of information, Poore encourages it.
“We are constantly receiving emails from him with information about what’s going on with affiliation, with inspections, with specific guidelines. There is much more communication,” said Dr. Munoz, the pathologist. The emails from Poore average twice a week, but Munoz can’t remember ever getting one from Rice.
Poore keeps staff informed by holding what he calls town hall meetings three times a year. It’s not an uncommon practice — West Care’s CEO Mark Leonard holds them with each shift every quarter. But Rice rarely took the podium in front of employees for a state of the hospital report.
Poore has been willing to take his show on the road as well. In the aftermath of the crisis, Haywood County commissioners demanded that hospital leaders to make regular progress reports at their meetings, a practice Poore continued after taking the helm.
“We haven’t even asked him a couple times and he’s just showed up,” said County Commissioner Chairman Kirk Kirkpatrick. “I am impressed with his willingness to come before the board of commissioners and explain exactly what is going on with the hospital in a matter of fact and truthful way.”
Poore has already proved willing to cooperate with doctors on a major front: a new surgery center. The hospital has long needed a makeover of its surgery wing.
For years, several doctors tried to make the case for a joint venture with the hospital and physicians. They would share construction costs and run it together as business partners. But Rice preferred to go it alone, with the hospital building and running it all on its own.
“There was a huge wall,” said Dr. Chris Catterson, an orthopedist. “We got shot down very quickly. That’s not the case now.”
Unlike Rice, Poore is open to the idea of a joint venture, and not just because the hospital no longer has money to go it alone.
“It is important to me to make sure we have physicians involved,” Poore said.
The hospital and interested doctors are splitting the cost of a feasibility study. It will determine whether there’s enough demand in Haywood County for a surgery center, and if so, what model would work.
Poore set out in college to become an orthopedic surgeon. He had been a heavily-recruited football player in high school but tore up his knee. A series of surgeries landed him in the care of doctors and nurses and the halls of hospitals during an impressionable time, driving him to combine his new-found admiration of health care with his love for sports.
But in college at Auburn, the dreaded organic chemistry course frustrated his plans to become a doctor.
“It kicked my tail,” Poore said. “I started looking around for another career, but I really liked health care.”
Perusing course catalogs, he signed up for classes in health administration instead. What sealed the track was a summer internship at the university hospital. Poore found he loved walking through the doors of a hospital each morning.
“It’s the people in the hospital. There is a different culture there. They go into the health field because they want to help other people. It’s that culture that I love,” Poore said.
Poore made the dean’s list for the next three semesters.
“I was so on fire after that,” Poore said. “I knew that was what I wanted to do.”
Poore got his first job as a hospital administrator at the age of 22. It was several years later before Poore refined his definition of a hospital administrator, though, when his kids were little and asked him what he did at work.
“I told them my job was to take care of the people who take care of people,” Poore said.
Poore’s bible when it comes to hospital leadership is called Hardwiring Excellence by Quint Studer. Poore buys copies in bulk, passing them out to each hospital board member and his management team. The book lays out five pillars of a hospital that must be keep in sight at all times.
During his first month at HRMC, he shared the five pillars with the entire staff during a series of town hall meetings. Poore’s talk on the five pillars has also become a requisite part of orientation for every new hire.
Poore likes the community so far. His three children attend local schools. His wife, Penny, has a seat on the hospital foundation board.
Poore was well-liked at the hospital he left. His going away gift from his old employees occupies prime real estate on his desk along with a photo of Poore driving his antique Corvette in a hometown parade with a bouquet of balloons.
During his first weeks on the job, Poore was talking to a doctor back home about the challenge he faced here convincing the medical community to trust him.
“He said ‘I’ll come up there, I’ll tell them,’” Poore recounted.
People have been impressed not just by Poore’s attitude, but his skills as well. He has been invaluable in talks with larger hospital systems about a possible merger with HRMC.
HRMC was well into talks with other hospitals when Poore was hired. Poore’s first brush with the affiliation team was during such a talk with a prospective partner.
“I can remember sitting across from him and thinking ‘This guy knows what he is talking about,’” said County Commissioner Chairman Kirk Kirkpatrick, a lead player on the affiliation team. “He immediately added a lot to our committee.”
Poore, with the help of his CFO Gene Winters, has made big strides on the financial side as well. HRMC is not only breaking even, but making a few cents. It’s an area everyone is watching.
“You also have to be impressed with the bottom line,” Lang said. “Nothing has overtly changed except the management, and yet we have stemmed the flow of losses every month and are showing a small profit. It won’t be enough to keep us going for 10 years, but it is real progress.”