Fletcher Allen’s CEO Melinda Estes: No Soloist

By Roberta Nubile

If Dr. Melinda Estes – chief executive officer and president of Fletcher Allen Health Care (FAHC) – had pursued an earlier life goal of becoming a symphony orchestra bassoonist, Fletcher Allen’s story of redemption might well have turned out differently. Under Estes’ leadership since October 2003, the state’s largest hospital has experienced nothing short of a transformation.

Vermonters will recall the mismanagement of the Renaissance Project – a $371 million expansion project that included a new emergency room, birthing center, ambulatory center, and parking garage – which culminated in 2005 with former Fletcher Allen president and chief executive officer William Boettcher pleading guilty to federal conspiracy charges, in exchange for a two-year incarceration and rescinding of his retirement package. With a few exceptions, the entire board of trustees at Fletcher Allen resigned.

With Boettcher gone, interim CEO Ed Colodny stepped in from 2002-2003, while a search went on for a new CEO. The job was offered to Estes, then CEO and chair of the board of governors of Cleveland Clinic Florida, and a practicing neurologist and neuropathologist – with a Master’s degree in business administration.

Bill Schubart, chair of Fletcher Allen’s board of trustees and a member of the search committee that ultimately hired Estes, recalls, “Of the three finalists, she was a standout for me. Not only because she was a physician with business experience, but it was the absolute clarity of answers she provided that made her my first choice, and eventually the whole committee’s.”

Estes saw great potential in the beleaguered but inherently strong Fletcher Allen which, she says, “had all the pieces: an academic medical center and a community hospital with a dedicated work force.” But, she adds, “they had their head down. I wanted to restore [morale] to where it should be.” The Burlington community also appealed to her.

The Fletcher Allen CEO holds the distinction of being the first female in that position as well as being the first combination MD-MBA CEO at an academic medical center in New England.

Estes hit the ground running. “First and foremost [there] was a large hole in the ground with footers where the parking garage was meant to be,” she says with characteristic understated humor. “We had to figure out financing and how to finish construction. Next we were facing a deficit in 2002 of $3 million. We went back to basics – we looked at every process, and every way people entered our organization, and turned it upside down. Every fiscal year since 2003, we have [had] a positive bottom line, and in the last three years we have met or exceeded [the goals of] our budget.”

Estes’ plan was not just to get both the budget and the expansion project back on track but to simultaneously craft a cultural shift at Fletcher Allen, restoring employee morale and the trust of the community.

“What you need to know about this time was that we were at a nadir,” says Schubart. “We still provided quality health care, but we’d lost the trust of the community as well as the state regulators. Employees had lost trust in administration.

“In a short period of time Mindy regained that trust,” Schubart continues. “She told employees she would always be truthful with them, that it wouldn’t always be good news, and that she looked to them to provide leadership. She told middle management that we needed to be flatter, that we needed more leadership from less people. She gave them a couple a weeks to redesign a new architecture for management. They came back, and some of them had eliminated their own jobs. Very few leaders can engender that much trust and inspire that much commitment.”

Paulette Thabault is the commissioner of the Vermont Department of Banking, Insurance, Securities and Health Care Administration (BISHCA). After the Renaissance Project mismanagement was exposed, BISHCA ordered several financial requirements of Fletcher Allen. Of Estes, Thabault says, “I found her to be a leader. She turned the organization around financially. She has been forthcoming with providing us quality financial information and has been in compliance with requirements placed on the institution. They have also submitted quality applications for any new proposals, under her leadership.”

Estes’ original short-term vision, now part of the long-term hospital mission statement called Vision 2010, was to “become a national model for the delivery of high-quality academic health care for a rural region.” Lofty words, these, and Estes set to work defining those words on a practical level within every department in the hospital. She recruited virtually an entire new executive team. She held public and private meetings with employees, physicians, nurses, fellow CEOs in Vermont (who meet on a monthly basis), and BISHCA to precisely craft Vision 2010. Her bottom line: Put the patient at the center of everything.

One example of that patient focus was Estes’ strong support for establishing electronic medical records, which provide patients with greater continuity of care by allowing all authorized health-care providers instant access to each patient’s records.

Estes’ vision of quality patient-centered care is now a quantifiable entity at the hospital. In 2006, Fletcher Allen was named Business of the Year by the Lake Champlain Regional Chamber of Commerce. In 2008, the organization received the Rising Star award, one of five annually granted by the University Healthcare Consortium (UHC). According to Mike Noble, hospital spokesperson, “Fletcher Allen was ranked 15^th of 88 academic medical centers participating in the annual UHC Quality and Accountability Study. In the past three years prior to the award, the organization has risen from 48^th to 15^th in this study.” The study uses a variety of measures such as mortality rates and patient satisfaction.

And, since 2006, Fletcher Allen’s Web site includes links to quality care reports and a “hospital report card.” In the interest of public accountability, they also post quarterly and annual financial reports.

Patient-centered innovative programs that have commenced since Estes’ hiring include the STEMI program. (This is a system that sought to ensure that all patients with a particular kind of heart attack requiring aggressive treatment who arrived at the Burlington hospital could get needed treatment within 90 minutes, the national goal set by the American College of Cardiology and the American Heart Association.) Now, the standard of that 90-minute clock is being expanded to regional hospitals to ensure that patients who arrive in St. Albans, Morrisville, or Berlin are transported to Burlington in time for treatment.

Estes says of the STEMI program, “It’s really been a collaborative effort. Patients can now bypass rural ERs to come to Fletcher Allen for needed treatment. It took those ERs being willing to say, ‘Yes, I am going to give up needed revenue to support this program.’” According to 2007 data from 84 teaching hospitals, Fletcher Allen had the fourth-lowest heart attack mortality rate of those facilities, the first time it ranked so favorably.

Another beneficial, though less dramatic, example of Vision 2010 in action has occurred in Fletcher Allen’s acclaimed Nutrition Services where, Estes says, “We have high standards for quality food. We have cook-to-order room service for every patient, where you can order fresh, local, and organic choices. We source locally when we can, buy shares from local farms, and are members of the Vermont Fresh Network. It is cutting edge to be so involved with the agricultural fabric of the area. I’m very proud of that.”

Estes’ involvement at every level has impressed Susi Douglas, RN, Administrative Nurse Coordinator, and an employee of Fletcher Allen since 1967. Douglas has worked under “a handful” of CEOs, and she is unabashed in her praise: “Mindy is very special. As a CEO, she came when we were in a dark place. Her leadership, guidance and influence has [relifted] our heads. Mindy comes on night rounds at least twice a year. The night staff love that because they don’t usually see administration then. She’ll sit down and pull up a chair to talk – not just about work, but people’s kids – and [she] talks about [own].

“She says hello to everyone, no matter who,” Douglas continues (and perhaps substantiated by the ease with which so many individuals refer to the hospital leader as ‘Mindy’). “She’s very approachable. The only other CEO I can compare her to is Jim Taylor [1982-94]: he had the same kind of sincerity and connection. She also takes such pride in this institution herself. She will stop and pick up a piece of paper off the floor. Though I never lost hope, I really am proud to be at Fletcher Allen again.”

Joe Woodin is the CEO of Gifford Medical Center, and chair of the Vermont Association of Hospitals and Health Systems (VAHHS). Woodin says, “Mindy has embraced outreach efforts to smaller hospitals. She has made it a priority to bring together rural hospitals and assist them. Her style is to choose her words carefully. When she expresses an interest or willingness, we know there is consistency and integrity behind her words.”

Although a quiet, intuitive person, Estes nonetheless comes across as a dynamic, decisive, big-picture leader who is also willing to let others excel in their areas of expertise. Southern-born and bred, she grew up in a transient military family with parents who told her she could do or be anything she wanted.

Estes considers her high school band director Fred Junkin an important mentor. For it was Junkin who encouraged Estes to switch from flute to bassoon, and told her it was a complicated challenge she needed to try. Junkin “knew I wouldn’t shy away from it,” recalls Estes, who successfully rose to the task. “But whether I was just a bad flute player, I will never know,” she laughs.

The Vietnam era figured prominently in Estes’ teen life in a military family. She recalls that “sitting with her mother to watch the 5:30 evening news with Dan Rather [reporting from overseas] was sacrosanct – it was how we learned back then how our fathers and sons were doing.”

Armed with an undergraduate music scholarship, Estes set herself the goal of being a professional symphony bassoonist. However, she says, “playing music well requires 90 percent hard work, and 10 percent musical talent, and I didn’t feel I quite had that full measure of that 10 percent. I knew it wasn’t going to happen, and I looked around for something else to do.”

She informed her father, a two-time Vietnam veteran, that she was going to study Russia and Russian history. He instead steered her toward “something I could make money at,” explains Estes. “So I settled on pre-med, as I’d always liked science. I also liked the potential for diversity and the altruistic aspect of medicine.”

Estes claims she did not court leadership roles. “I never gave much thought to it. [But] I would often find myself in leadership positions as president of some club or fundraiser. I didn’t think of it as actively seeking leadership. I just could easily figure how to do something and how to get others to do it as well.”

These days, Estes enjoys cooking as much as being a left-brain scientist and business administrator. She is a devoted mother to Sarah, 21, and Megan, 23, and wife of nearly 30 years to Dr. Harold Morris (a neurologist at Fletcher Allen). She is someone who takes time to take care of herself through her passions of hiking, canoeing, biking, and race walking.

The bassoon is one of the more challenging instruments to play: It takes a strong person with excellent control to make a good sound, and it is rarely played solo. It may have been just the thing to prepare Estes for turning around Fletcher Allen.

Q&A with Dr. Melinda Estes

Vermont Woman: What are some of the ways Fletcher Allen delivers quality care to the rural regions in Vermont?

Melinda Estes: When I first arrived here, I was [promptly] told, ‘This is the city’ – referring to Burlington – I got that right away! Fletcher Allen serves a huge geographic catchment area. Twenty percent of our clients are from New York. If you are in Ticonderoga, Lake Placid, or Malone, we are the nearest Level I trauma center [providing the highest level of surgical care to trauma patients].

We’ve got the FACT team [Fletcher Allen Coordinated Transport, Fletcher Allen’s critical-care transport service, begun in 1995]. We utilize two-way video telemedicine, which allows our trauma surgeons to view patients in rural ERs to determine when it’s safe to transport.

Some of our providers travel to other Vermont and New York hospitals to provide specialized services. We have kidney dialysis units in six Vermont counties and a coordinated pharmacy service in all 13 state hospitals.

VW: How is Fletcher Allen responding to the current economic landscape?

ME: It’s a myth that heath care is recession-proof. It is impacted by job losses and then loss of health insurance, plus [the current trend of] high-deductible plans, as well as delayed Medicaid payments. There’s been a large piece of cost shift under reimbursement for care – there is a larger piece of uncompensated care than ever. People are trying not to spend money if they don’t have to. Elective surgeries are delayed.

I think, though, we are in good shape from an organizational perspective. We are asking employees to notice where they can save money – for example, make sure you are opening the right suture pack [before you break the seal]. We are scrutinizing hiring. Before, we would automatically repost a vacated position. Now we are hiring people with special skill sets, and the number of job postings are lower.

There’s no road map in this situation for anyone. My strategy is to control the things we can control and plan for contingencies.

VW: How does Fletcher Allen care for uninsured individuals?

ME: No one is turned away for lack of payment. (Author note: according to the Fletcher Allen Web site, in Fiscal Year 2007 $8.7 million was spent on free care).

VW: What are some of the ways you personally connect with Fletcher Allen patients and employees?

ME: I talk with them and read and respond to their letters and suggestions. I’m simpleminded in that I believe those of us who work in this field are altruistic – and that instructs everything we do. When something like paperwork gets in the way, if we [then refocus and] put the patient in the center… everything falls into place.

I think some of the patient stories say everything. My father was recently admitted via ambulance. He’d been at Fanny Allen getting physical therapy. The therapist knew he was scared and worried and took the ambulance ride with him. In another instance, an ER nurse stayed with a UVM patient whose family had not yet arrived, and our hospital security services drove to the airport to pick that family up to get them here without delay. We give people permission to tell their stories – we have coined a cultural strategy called “Becoming One.”

There’s a corollary between taking care of our patients’ needs and taking care of each other in the work place. It frees up employees to do their jobs in the best way they can, and the patients only benefit.

VW: What are your thoughts about how the nursing union functions at Fletcher Allen?

ME: The union is committed to being fair, as are we. I see our relationship with the union as a partnership. We have two successful contract negotiations; the next is due in July. Our nursing turnover rate is low – 3.7 percent. We have a huge investment in nursing here, and a great partnership with UVM and the health sciences. We are fortunate to hire new graduates, and this is the first year we weren’t able to offer jobs to everyone who wanted one. There is no nursing shortage at Fletcher Allen and no cap on care if patients need it.

VW: Do you miss practicing medicine?

ME: I practiced until I came to Vermont. I found I couldn’t keep current and do what I need to do to be at the top of my game as CEO. I couldn’t do both. I feel that what I am doing now is my line of work.

VW: What motivated you to acquire an MBA?

ME: It was something I chose to do, though I was strongly encouraged by a mentor, Dr. Ralph Strafing. I was elected to the Board of Governors at Cleveland and was associate chief of staff there. I found I liked the administrative side of things, and I figured I ought to get an MBA to know the right questions to ask! Back in ’95, this was rare, but now it is much more common to get a combined MD-MBA degree.

VW: What wisdom do you have for women establishing their own careers?

ME: To always keep in mind [that] a career is like a sailboat race! Either the current or the wind changes and you have to go in the other direction. And if you feel contained, you have to look for opportunities. It is never a straight line, and you never finish where you thought you would. And you can learn from anything you do.

VW: What inspires you about your work?

ME: It’s different every day. This organization is like a city with its diverse challenges. I’m incredibly proud of what we’ve accomplished. It keeps me coming back each day.

VW: What defines a good leader; and tell us about your style?

ME: To be an effective leader, one has to know [ones] self. One has to be a good listener, and have an appreciation of the tactical. My job is to think strategically. An organization is like a person – there is a rhythm. I have to know when to push, when not to, and when to pull back. I never underestimate the power of the collective, but I also ask, ‘Who is the person and how do I motivate them?’ I surround myself with the best people I can and let them do their jobs. I tell them I will stand side by side, or have their back or be in front; I just need them to tell me what they need.

VW: Who is Melinda Estes?

ME: I’m a quiet person. My essential belief is that in life you have two things: family and integrity. You have to work hard to take care of both – and you don’t have to be at the center. At Fletcher Allen, if this organization and its people succeed, then I have succeeded.

VW: And, if you weren’t doing this, what would you be doing?

ME: I would own a successful restaurant on a beach in the Caribbean.