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Dartmouth-Hitchcock’s new chief executive sets her priorities

  • Joanne Mather Conroy, Dartmouth-Hitchcock’s new CEO, speaks during an interview last week at the Lebanon medical center. Conroy discussed ensuring the organization’s financial stability and expanding services to the southern part of the state. Valley News

  • Valley News photographs — Geoff HansenJoanne Mather Conroy, left, speaks with Anne-Lee Verville during a planning meeting in Conroy’s office at Dartmouth-Hitchcock Medical Center in Lebanon on Friday. Verville is the chair of the Dartmouth-Hitchcock board of trustees. In the foreground at left is Stephen Leblanc, D-H’s chief administrative officer, and Kimberley Gibbs, director of governance and leadership for the organization. Valley News photographs — Geoff Hansen

  • Dwayna Covey, left, speaks with Conroy at the DHMC cafeteria on Friday. Conroy drops in for lunch with employees almost every day since starting work on Aug. 7. “On the first day, the employees thought I was a nosy family member because I didn’t have my ID badge on,” Conroy said. Covey is the director of operations for the Center for Learning and Professional Development at Dartmouth-Hitchcock.



Valley News
Monday, September 04, 2017

A photograph of the golfers Jack Nicklaus and Arnold Palmer hangs above the desk in the corner office of Dartmouth-Hitchcock’s new chief executive Joanne Mather Conroy.

“The two of them laughing kind of makes me smile,” the 61-year-old Conroy said during an interview on Wednesday, the 18th day of her tenure at the helm of the state’s largest private employer and sole academic medical center.

Conroy is beginning to settle in at D-H and in the Upper Valley. Conroy, her husband, Douglas Johnson, a commercial photographer and woodworker; and their two cats, Pancake and Goose, have been living in the Residence Inn in the nearby Centerra office park for the past few weeks while they buy a home in Hanover.

She hadn’t quite unpacked her office in Dartmouth-Hitchcock Medical Center yet. A couple of boxes containing diplomas and awards sat neatly stacked against one wall.

But, in addition to the picture of the golfers, the office walls were adorned with other images intended to inspire strong leadership and hard work.

There’s a photograph of former Yankee shortstop Derek Jeter flying through the air horizontally while diving into the crowd to catch a baseball.

“I know it’s Yankees, but I just think that was a demonstration of total commitment as a leader,” she said.

“Notice that A-Rod, who should be going for that ball, is standing off to the side,” she said, referring to third baseman Alex Rodriguez.

While she may derive inspiration from the joy and commitment exhibited by professional athletes, Conroy, an anesthesiologist and 1977 Dartmouth College graduate, also draws on her own experience in the service industry when she thinks about the role that health care providers ought to play in the lives of the people they serve.

While pursuing her bachelor’s degree in chemistry at Dartmouth, Conroy, then Joanne Clark, was a scholarship student who supported herself by working as a server at the Dartmouth Outing Club and at Peter Christian’s Tavern in Hanover.

“In the health care industry, you’re really serving people in more ways than you think,” she said. “I think the most successful health care providers actually get that.”

In her work as an anesthesiologist before becoming a full-time administrator almost a decade ago, Conroy said she loved taking care of patients. She would often use a regional anesthetic, so patients would be awake during their procedures.

Her voice in and of itself could sometimes help soothe them. She joked that she has to be careful when giving a lecture.

“My voice is sometimes like 5 milligrams of Valium,” said Conroy, who went to high school in New Jersey and medical school in South Carolina, where her 93-year-old mother lives.

Conroy said she’s gone back and forth on whether or not she will maintain a practice while in Lebanon. Though she has maintained her license over the years, she would need to be observed should she return to practice now.

“It’s not like riding a bicycle,” she said.

Plus, she said it might inspire some fair questions from patients.

“I’m sure patients would say, ‘Why as CEO are you putting me to sleep?’ ” she said.

Plus, other people have counseled her that she may have enough on her plate right now.

Creating Stability

Helping D-H’s employees find more pleasure in their work and therefore provide better service to patients is among Conroy’s top three priorities right now, she said.

Just before the Conroy took over leadership of the hospital system last month, D-H officials released results of an engagement survey of about 7,000 of the organization’s 12,000 employees. Conducted in May, the survey results indicated there is room for improvement in employees’ willingness go above and beyond to support each other and their patients.

“Engagement is tied to patient experience,” she said. “It’s tied to outcomes, so it’s a really, really important barometer of what we need to work on.”

Conroy has been reading through the comments employees provided through the May survey, and she said they highlight opportunities for improvement in areas such as pay, benefits, staffing, leadership stability and communication. Some employees also focused on positive aspects of working at D-H such as their connection to purpose, their pride in the organization’s reputation, their job, opportunities for advancement and the spirit of teamwork.

One step toward increasing employees’ sense of engagement with their work will be to ensure the organization’s long-term financial stability, she said. D-H recently reported a $18.7 million surplus for the fiscal year that ended June 30, on the heels of a $12.2 million loss the prior year.

Providing financial stability is likely to help improve the way employees and patients feel about the organization, she said.

“They know that we’ll always be here,” she said. That’s “so critically important.”

As part of restoring financial stability, D-H had a reduction in force of 84 workers last fall. In terms of her focus when looking at D-H’s labor force, Conroy said, she doesn’t have plans for further layoffs.

“It’s not obvious that that is a priority right now,” she said.

But expanding the workforce also seems unlikely. Instead, Conroy said, she plans to work with other leaders within Dartmouth-Hitchcock to determine how to best match current employees to the work that needs to be done.

“I think that we just maybe don’t have everybody in the right place,” she said. “We might be expanding the portfolio of what some people do in order to meet staffing needs.”

It’s unclear how much Conroy will earn for her efforts. D-H officials have declined to release her salary information before it is reported on the Internal Revenue Service Form 990.

Her predecessor, Dr. James Weinstein, earned a total of $1.49 million in 2015, according to the most recent 990 available.

A Growing Health System

Conroy is also focused on advancing D-H’s plans to expand its presence in southern New Hampshire. Discussions with Elliot Health System – which runs Manchester-based Elliot Hospital, a trauma center in the state’s largest city, as well as several clinics and health centers from Londonderry to Hooksett – fizzled earlier this year.

In the next two or three months, Conroy said, she plans to meet with the chief executives of all of the hospitals in the southern part of the state in order to assess how the organizations’ cultures might mesh.

“It’s probably a little early to say who’s going to be our partner,” she said.

In the meantime, Conroy emphasized that D-H already has a formidable presence in the southern part of the state, as well as in southwestern Vermont, through the D-H Putnam Physicians practice, a partnership with Southwestern Vermont Medical Center in Bennington.

D-H’s multi-specialty group practices in Nashua, Concord and Manchester offer imaging and lab services, she said.

“The facilities down there are beautiful,” she said. “People can get everything they need in those practices.”

And the patient volume is significant, she said. “We take care of at least one-quarter of the people in Nashua, maybe a few more in Manchester,” she said.

‘Thinking as a health system’

Expansion is nothing new for D-H. Under Weinstein’s leadership, D-H developed formal affiliations with a number of smaller hospitals: New London in 2013, Mt. Ascutney in Windsor in 2014, Cheshire Medical Center in Keene in 2015 and Alice Peck Day Memorial in Lebanon last year.

D-H also entered into a similar agreement with Visiting Nurse and Hospice for Vermont and New Hampshire last year.

Large health systems like D-H, and the two others she’s worked for, “do serve patients because there are opportunities to take invisible pieces of delivering health care and actually integrate them across the organization and do them less expensively,” Conroy said.

Prior to coming to D-H, Conroy led Lahey Hospital and Medical Center in Burlington, Mass., the flagship hospital for the Lahey Health System, which also serves as a teaching and partner research location for Tufts University School of Medicine. She previously held leadership positions at Atlantic Health System in New Jersey and the Association of American Medical Colleges in Washington, D.C.

Among members of a health system, integrating services such as human resources, pharmacy and supplies is “the easy part,” she said.

It’s more difficult, though important, to integrate clinical services, she said. Patients should know what to expect in terms of quality and experience when they come to a D-H facility wherever it is.

“(We’re) getting close to the tipping point where we have to start thinking as a health system, rather than as individual entities that are all linked through D-H in Lebanon,” she said. “That’s kind of a little bit of a mind shift.”

D-H and its affiliates also need to sort out what services to offer in which location, she said.

“Most patients don’t want to drive more than an hour even to get specialty services,” Conroy said. “(We) need to take the same perspective when we look at our expanding geography.”

In some cases, Conroy said, there are services that it simply does not make sense for D-H to offer. For example, D-H closed its Reproductive Endocrinology and Infertility program this spring as a result of being unable to recruit new providers, she said.

“Whenever you are recruiting providers, especially if they’re young providers, they actually want to build up a vibrant practice,” she said. “Their focus is in really creating a suite of services, where not only they meet needs of the community, but they continue to grow professionally.”

The needs of the community are in part defined by the region’s demographic trends.

In the case of the fertility clinic, Conroy said, “We were just affected by the declining birth rate in this area and it wasn’t attractive to some of the young up-and-coming providers that we would want to recruit here. Sometimes you have to make the tough decisions.”

Health Care Reform

One of the things that drew Conroy to D-H was the national leadership the organization has shown in rethinking the path to a better health care system, she said in an interview at the time her hiring was announced in a June.

Through the Dartmouth Atlas of Health Care, which uses Medicare data to show variations in how medical resources are distributed in the United States, leaders at D-H and Dartmouth College have helped to shift health care policy, she said.

Compiling information about health costs “made people think about how much care was right,” she said in June.

Weinstein, a spine surgeon who took over the top D-H job in 2011, was an evangelist for health care reform, even authoring a book with a D-H colleague in 2016 titled, Unraveled: Prescriptions to Repair a Broken Health Care System.

Conroy plans to continue to move forward with D-H’s existing commitments to health care reform, but, due to uncertainty in Washington, she said she does not have immediate plans to make additional commitments to reform.

“It’s kind of watchful waiting,” she said last week.

Because most of the care D-H provides in the southern part of the state is outpatient, it is a good place for the organization to enter into risk-based contracts, Conroy said. Such contracts, through Dartmouth-Hitchcock Health Next Generation Accountable Care Organization, distribute savings resulting from preventing Medicare patients from developing conditions that require more costly care to providers and insurers.

Under this model, D-H will be paid based on how well it does in terms of certain quality metrics such as managing patients’ diabetes, blood pressure and cholesterol, she said. There’s also a focus on reducing the total medical expense, keeping people out of the emergency department and preventing inpatient hospital stays.

While there may be disagreement about how and when exactly to move toward payment reform, there is general consensus among the country’s health care leaders about the direction those reforms should take, said Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice.

“There’s a very strong commitment in theory to moving toward paying for better care and efficiency and lower cost, alternative payment models,” Fisher said in a telephone interview last week. “I think there’s a strong sense that that’s where we must go.”

The question is how quickly payment reforms will be implemented, Fisher said. The source of resistance to change isn’t at the federal level so much as at the individual health plan level, he said.

There are areas for reform inside a health care system like D-H and outside it, he said, adding that one of Conroy’s strengths seems to be knowing how hard to push for change.

“Having a steady hand on the tiller here is just going to be wonderful,” he said.

Outside D-H, Fisher said there is an opportunity to pressure state and insurance leaders to participate in payment models that support communities’ health, rather than simply shifting to higher deductible plans as insurers have done as the fee-for-service model persists.

“(It’s) not okay to have costs go up so rapidly for our communities,” he said.

While Fisher would like to see reforms implemented quickly, he said, he understands there’s a need for patience. The pressure leaders like Conroy ought to apply to payers should be “gentle and firm,” he said.

“Come on, payers, let’s get with it,” he said. “Let’s share savings. You can have some savings, but we need them too. Let’s recognize what we’re doing to our patients. They can’t afford to have costs be as high as they are. We can deliver better care.”

Building Relationships

Conroy is well aware that providers’ responsibilities have expanded beyond the walls of the hospital.

She’s also aware that D-H, on its own, can’t address all of the things that combine to influence people’s health.

She noted that 60 percent of the babies in DHMC’s neonatal intensive care unit are covered by Medicaid and are likely to leave the hospital with more than just medical needs. These needs are known in the industry as social determinants of health and include things such as transportation, food access and housing.

Providers need to make sure that the babies and their parents have access to the resources they need – such as quality child care – to stay healthy outside of the hospital, Conroy said.

“You don’t lose the responsibility once they leave,” she said.

Conroy said she aims to collaborate with community partners to deliver health care and the many other things that contribute to people’s overall health.

“We have the data now so we know what ZIP codes have what issues and there are people in those ZIP codes who are committed to fixing them,” she said. “The hospitals shouldn’t drive everything. We should ... allow communities to actually help their citizens to become healthier.”

In addition to building relationships with community organizations, Conroy has set about relationship-building with state leaders, including Gov. Chris Sununu. Given that he sits on Dartmouth College’s board, Conroy said, she and Dartmouth’s president, Phil Hanlon – a classmate 40 years ago, though they didn’t know each other then – hope to bring the governor to the Upper Valley soon.

Conroy spent Wednesday afternoon in Concord, where she met with Jeffrey Meyers, the commissioner of the state’s Department of Health and Human Services, and DHHS Deputy Commissioner Lori Shibinette, as well as the leadership team at New Hampshire Hospital, the state-run psychiatric hospital that D-H staffs through a $36.6 million contract.

The relationship between D-H and leaders in Concord was recently tested in a dispute about staffing levels at New Hampshire Hospital.

But, Conroy said, she hopes future disputes can be settled calmly.

“Part of it is really starting with the relationship and feeling free to just pick up the phone and just call each other and work out differences or just understand the other position,” she said.

She’s also making efforts to understand the views of the people who work for her. To do so, she stops and talks with people in DHMC’s cafeteria at lunch. She takes a map and follows it to explore different parts of the Lebanon campus.

“You learn a lot from employees,” she said. “They all have an unwavering commitment to the patients we see.”

And, her own commitment to the work at hand may be illustrated by a photograph, showing the lower legs of people in cowboy boots, that she picked up in San Antonio in the early 1980s and is now in her office.

“There’s nothing that just describes getting down to work like dirty cowboy boots,” Conroy said.

Valley News Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.