Business

Pardee CEO sought accord amid discord

Pardee president and CEO Jay Kirby, left, and board chairman Bill Moyer share a light moment as Pardee counsel Sharon Alexander looks on.

By Bill Moss, Published: June 15, 2014

Jay Kirby's first hospital job was working as a nursing assistant in an emergency room while attending the University of South Carolina.

A big bear of a man — 6-foot-5 and "north of 250" — Kirby often got the call from doctors and nurses when they needed help handling an uncooperative patient.
"Funny story. We had a professional wrestler at Township Auditorium one time," he said. "He was incoherent. He was out, and he came to on the table in radiology. He was this big brawny Russian wrestler, kind of like Koloff at the time. He came to, and he rips his IVs out, he starts throwing the stuff, and the rad techs come running out of the room — 'Jay, call security.'
"So I go in there and here's this strappin' 300-pound wrestler and it's just me and him and he looked at me and he passes out — right when I walked in the door. I pick him up, put him back on the table, I walk out," and here Kirby brushes his palms back and forth, re-enacting his "job done" gesture before he nonchalantly pronounced to the medical staff, "He's OK."
"From then on it was ... 'call Jay.' I've just been lucky," he added. "I was lucky that day."

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People still call Jay Kirby but not because he's big and strong.
Three years ago today, the Pardee Hospital Board of Directors announced the hiring of Kirby, then second in command at Self Regional Hospital, a 400-bed facility in Greenwood, S.C. Pardee's leaders had a lot riding on the hire. They hoped that after six directors in 10 years, the county-owned hospital had at last found a leader who could balance the complexities of running a community hospital while mastering public relations and putting the patient first.
If the universal demand of providing quality care without going broke was not enough, Pardee stood in an especially precarious position. The summer before Kirby came on board, rumors that the Board of Commissioners was plotting to sell the hospital sent the medical staff and Pardee supporters into an uproar. Although commissioners tried to put the question to rest with a no-sale vote in October 2010, caterwauling over a joint venture with Mission Health on the county line in Fletcher was just ramping up. Exploiting local fears that any deal with an Asheville player would end badly — see the Asheville Regional Airport, the 1995 Mills River water agreement and the WNC Ag Center property — opponents painted the joint medical campus as the first step in a power play by muscular Mission Health to annex Pardee.
"I remember Tyra and I, after we accepted to come here, we started taking the newspaper and watching on line what was going on, and we're thinking 'What in the world are we getting ourselves into?'" Kirby said in an interview on June 2. "Clearly it was a great decision for both of us three years later. But it was a trying first six months, just trying to gain perspectives and understandings of why it was such an emotionally charged issue."
He'd seen politics and public debate before. He'd seen nothing to match Henderson County's high volume brand of it.
"I guess what really impacted me was how passionate and how spirited people were about what they believed in," he said.

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Bill Lapsley, who was Pardee's chairman at the time, knew that the joint venture and a new partnership UNC then in the works would make for a challenging break-in period for the new CEO.
"We were impressed by his credentials at the time, impressed by how he did in the two or three interviews and we hired him," Lapsley said. "I told him in the interview, 'If you get this job I don't want any misunderstanding. You've got to deal with local government. We're tied to the county.'"
Lapsley and Bill Moyer, who had just finished three terms on the Board of Commissioners, ushered Kirby around to meet his many bosses.
"We introduced him to the county manager and county commissioners," Lapsley said. "He didn't flinch. There were a couple of other candidates, and that bothered them. They didn't like dealing with that.
"He came into the job with open eyes and he came into a hornet's nest. It was right after we had all these issues with selling the hospital. That was six months after all that came down and the relationship between the commissioners and the hospital board was strained, I guess is the right word. He worked through that like a professional and he handled the job extremely well. He took the ball on the joint venture on the county line and got that done, which was a great accomplishment for the county I think.
"He is the only employee of UNC Health Care at Pardee and that was part of the deal at the time, too. We were negotiating with UNC and he came in knowing he was going to be technically an employee of UNC but was also going to answer to the Pardee board, so technically he's got two bosses and he has handled that extremely well."

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The "hornets nest" included stinging criticism over quality of care at Pardee.
A former Pardee board member, Linda Sokalski, with the backing of the newly appointed County Commissioner Bill O'Connor, began email blasting the results of patient satisfaction surveys showing Pardee ranked poorly.
"I think he had acknowledged to the board that we had issues," Lapsley said. "He'd been in the job six months and he was reporting to the board that some of the patient satisfaction scores were not good and he was going to get them corrected. He was in the middle of that when Linda made a public stink about it."
Instead of ignoring the criticism, Kirby got on the Board of Commissioners agenda. Patient satisfaction, he said, had been atop the job list from the first day he interviewed.
"The board at the time was very clear with me that this needed to be a priority, so much so that it's a significant part of my performance evaluation," he told the board. "So it has been a priority of mine and the administrative team long before Dr. Sokalski started sending this in."
Kirby said he recognized from the start that he needed to hear everyone out, get lots of input and then figure out how to move Pardee forward.
"There was a lot of emotions and strong feelings at the time, and the best thing I could do was listen that first six months," he said. "Listen to board members, listen to commissioners, listen to the medical staff, listen to team members, the community. What was unique was they all wanted the same thing — what was best for Pardee. But the political process and/or what they read in the paper and what they heard on the street wasn't always true. One common denominator was for the most part people wanted a strong Pardee Hospital.
"Once I was able to distill that down, build trust and build relationships with folks, it was a whole lot easier. I think there's a book out now — 'The Speed of Trust.' If you've got a relationship with somebody and you've got trust and you've got rapport, you can get things done. If you don't have that, it's clearly a disadvantage. I spent my first six months outside of this office, on the floors, in doctors' offices, whether it be Charlie's store on Hoopers Creek (the cracker barrel meeting place owned by Board of Commissioners Chairman Charlie Messer) or whether it be at Miss Piggy's (Harry's and Piggy's) eating barbecue with Tommy Thompson and board members, it was building rapport and building relationship."

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Kirby had a way of disarming critics by taking ownership of problems and directly addressing challenges. Even if they disagreed with the board's decision to join forces with Mission or form a partnership with UNC, critics felt they could talk to Kirby. He made stump speeches at community organizations, civic clubs and political meetings to describe Pardee's growth strategy and advocate for it.
"He never shirked dealing with the public aspect of the job and dealing with the commissioners," Lapsley said.
Kirby finds it hard to give specifics when asked where he got his communications skill and political instincts.
"You know, I really don't know," he said. "Two things I would tell you. My dad was always a very approachable individual that people enjoy being around. We spent a lot of time in church growing up, whether it be a prayer meeting or Sunday school.
"But also my first job in health care was being a nursing assistant in the ER for four years. You never knew what was coming through that door — whether it was trauma, someone with a fishhook in their thumb or someone that was dying. You never knew what was walking through that door and how you reacted with that family and that individual. With those 18 rooms, there was a different story in every room, so you had to adapt to the people that were in that room. I think that's helped me a lot over the years."

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Confronting the patient satisfaction scores, Kirby immediately made it known that he planned to be as accountable as the doctors, nurses and housekeepers.
"I had a boss, he used to tell me the fish rots at the head. If you don't have leadership at the top (attitude is) not going to change," he said. "I think two things (accounted for a turnaround). One, the first thing I did is give every patient that's admitted to this hospital my cellphone and say if you've got a problem with a physician, your housekeeping, the food or your nurse, or if it's too cold, give me a call. To date, in three years, I have less than 10 phone calls."
"No. 2," he added, "position may give you power but it doesn't give you influence. The influencers in this organization may be a nursing assistant on the third floor, it may be a tray line worker in the cafeteria. It doesn't mean that they're a supervisor or director or VP. It's just who are the go-to people in this organization."
Kirby ordered meetings during which the "go-to" employees from every department brainstormed about how to make Pardee better, top to bottom.
"And out of that came standards for employee behavior, and out of that came the 'I am Pardee' magnets and the 'I am Pardee' slogan," he said. "At that point we rolled them out to the other 1,200 people that work here, and they weren't stuff created by Jay, they weren't stuff taken off a bookshelf and they weren't stuff passed down from UNC. That means sometimes our chief nurse, Denise Lucas, puts on scrubs and goes and cleans bedpans, like she did two weeks ago. And others too."

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In Kirby's three-year tenure, Pardee has recorded higher operating margins, increased cash on hand and investment returns, and reduced debt. It has won state and national awards for patient safety, surgery, women's health and affordability. The public has a more positive feeling toward the county-owned hospital than it did when Pardee headlines pointed to a political fight or a financial crisis.
"He's built bridges between the hospital and the physicians and the public and the county commissioners," said Dr. William Medina, a retired oncologist who serves on Pardee's Board of Directors. "He's an important reason that the relationship with UNC is working as well as it is."
Medina has seen the hospital's fortunes rise and fall under the leadership of six fulltime or interim CEOs since the mid 1990s — Frank Aaron, Bob Goodwin, Jon Schurmeier, Kris Hoce and Jerry Maier.
"Kris Hoce did a good job," Medina said. "He was in a difficult position when he came in and the hospital made a good bit of progress under his leadership. I thought he did a good job. ..."
Unlike Hoce, Kirby doesn't mind plunging into politics — whether that means chewing the fat over a diet Coke at Charlie's on the Creek or tucking into a plate of barbecue at Piggy's.
"It's a sensitive job being a hospital CEO and you need to have good political skills and good people skills and I think Jay has those," Medina said.

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Kirby, who is 47, deflects credit for Pardee's progress.
"I wouldn't say it's happened in my time," he said. "We've got a long history of being a quality provider and having tremendous safety scores."
Threats for the hospital range from changes in the Affordable Care Act, the migration from inpatient to outpatient care and the migration of outpatient care from hospital day-surgery suites to surgery practices, even chain stores. Overarching all of that, the chief threat is "relying on our past," Kirby said. "Thinking what's worked in the past will work in the future. ... It used to be you'd come and have a gallbladder and appendix out and you were here two or three days. There are many procedures today that you're in and out the same day. Modalities of care change, and if we don't change with it and be more consumer-centric and customer-focused we're going to find folks seeking care at Wal-Mart, CVS and Walgreens, which they're beginning to do now."
Instead of trying to force patients into the doors of a big brick building with patient rooms, pink-clad volunteers and an ER, hospital-based providers will increasingly go where the patients are.
"I would say it's less about providing care in this facility that we sit in today and more about providing care within each community, within schools, within homes, within work settings," he said.
And will Jay Kirby be a part of that at Pardee in Hendersonville?
He says yes. Like a lot of newcomers with young children, Jay and Tyra have found Hendersonville to be an accepting, safe and pleasant place to be, with quality offerings in the arts, education and nature that few places can match. It's fertile ground for growing roots. His rabid allegiance to the University of South Carolina Gamecocks notwithstanding, Kirby likes his home state's northern neighbor just fine.
"Tyra tells me 'You better hold on to that job, big boy, because we're not going anywhere until our kids graduate from high school,'" he said. "We feel people have been good to us, they've been gracious, they've been open, they've been welcoming. You couldn't ask for better schools. You couldn't ask for a better park system that supports (youth athletics), whether we're playing basketball or soccer or volleyball. It's just a great place to live and raise a family."