Interview with James G. Springfield, FACHE, president and chief executive officer, Valley Baptist Health System, Harlingen, Texas.(Interview)(Interview) - Journal of Healthcare Management

James G. Springfield, FACHE, joined Valley Baptist Health System in 2001, and in 2003 he became the system's president and chief executive officer. Valley Baptist is a not-for-profit organization composed of a 613-bed regional academic referral hospital, a 243-bed acute care hospital, health clinics, a health maintenance organization, an ambulatory surgery center, a continuing-care retirement community, a wellness center, and other outpatient facilities. From 1988 to 2000, Mr. Springfield held a variety of positions with Memorial Hermann Healthcare System in Houston, Texas.

Board certified in healthcare management, Mr. Springfield is a Fellow of the American College of Healthcare Executives (ACHE) and a member of the Healthcare Financial Management Association. He is also a guest lecturer for the University of Houston at Clear Lake as well as for Houston Baptist University. He earned a master's degree in healthcare administration from the University of Houston at Clear Lake and a bachelor's degree in business administration from Baylor University in Waco, Texas.

In 2002, he received a Texas gubernatorial appointment to the Interim Committee on Bi-national Health Plans. In 2004, he was honored by ACHE with the Robert S. Hudgens Memorial Award for Young Healthcare Executive. Most recently, Baylor University named Mr. Springfield the Outstanding Young Alumnus in 2004.

Dr. Grazier: Congratulations on receiving the 2004 Robert S. Hudgens Memorial Award for Young Healthcare Executive from ACHE. To what do

you attribute your rapid advancement in healthcare?

Mr. Springfield: I got into this business in 1988 with training in finance. When I moved back to Texas, where I went to school, I called people I knew and one of them was Dan Wilford who was president of Memorial Healthcare System in Houston. Dan hired me as a financial analyst, and that was my introduction to healthcare. I went to graduate school at night, and during the day I worked with some of the greats in the field. Dan was a wonderful mentor, and others at the organization helped me along the way. I also had an opportunity to be part of a range of services and changes. All this gave me a broad understanding of how the industry works.

I entered healthcare at a good time--when the industry was expanding rapidly and not a lot of young people were in it. When I started at Memorial, the system had three hospitals; when I left, it had thirteen. Frankly, my growth in the business has a lot to do with timing and having a good professional support structure.

Dr. Grazier: Most people experience a longer 'early' phase of their careers than you have. What were your shortcuts?

Mr. Springfield: For the first 10 to 15 years of my career, I lived, slept, and breathed healthcare. When I was not at work, I was at home reading about the industry or involved in local and national committees. I loved the environment, even though there was a steep learning curve because I didn't know much about healthcare. Back then, some notable pundits were saying that hospitals were dinosaurs--too many beds, too many specialists, too much of the wrong thing. They were dead wrong. The hospital is a hub in the healthcare system where all kinds of critical forces come home to roost--financing; managed care; insurance, physician, and patient interfaces; employee issues; and a broad spectrum of people whose educational background ranges from almost none to Nobel laureates. I was very fortunate early in my career to be in such an environment and to learn to deal with all of these converging forces. That understanding of how the hospital dynamics work and how to cope with those dynamics prepares you to work with physicians and insurance companies or to run an entire health system It's very difficult, however, to learn how to run hospitals from other healthcare venues. Most of my career experiences have been in hospitals or in and around hospitals.

Dr. Grazier: How central was your early experience in a hospital to your later successes?

Mr. Springfield: Once I finished my MHA coursework, I was accepted into an administrative fellowship program at Memorial. That was my first on-the-ground experience with hospitals, allowing me to see their relationship with the medical staff. From there, I became an assistant administrator. When Memorial merged with Hermann Healthcare System, I became the chief executive officer of its children's hospital. I also served as the chief operating officer of the system's medical center operations.

Dr. Grazier: That was a fast climb up the career ladder.

Mr. Springfield: Other people have done it a lot faster than I have, but I've been really fortunate. I have a wonderful family and a very supportive wife who is tolerant of the commitment required to do this job. A lot of people' have given me opportunities and have been very gracious toward me. I'm the most fortunate guy in the world to be doing what I love to do.

Dr. Grazier: When you are faced with a new and particularly challenging problem, where do you go for advice or knowledge on how to handle it?

Mr. Springfield: We look at practices in other industries; although their problems may not be the same, they are certainly clustered in similar ways. We also examine how these companies deal with challenges and introduce improvements. We can learn a lot from some terrific minds in other industries. We have worked with General Electric, for example, to help us implement Six Sigma at our organization. We are two years into this process, and we have seen spectacular results.

It is also useful to find out the views of consumers on healthcare. They feel differently about healthcare than the past generations did. Before, consumers would do anything that a healthcare provider asked them to do, unquestioned; that's simply not the case today. Today, patients go on the Internet to find out about different medication therapies, procedures, and providers. The industry is struggling to deal with these changes in consumer attitudes and actions. We look to the consumer to educate us about them.

Dr. Grazier: What responsibility do local or regional leaders like you have in focusing national healthcare policy?

Mr. Springfield: We have to respond to federal policy but be careful not to be parochial about it. We work with policymakers at the state and national level to advocate for and to effect good policy, which is lacking in healthcare today. Policies are disparate, disjointed, and have disenfranchised 48 million (and counting) Americans who don't have insurance. Our state and federal programs only cover little buckets of people, although some states have done a better job in terms of covering their uninsured. This problem with the uninsured is unconscionable. Until we seriously address it, we will continue to suffer unintended consequences. Fifteen percent of the inflation in healthcare costs this year is, partly, the result of healthcare systems subsidizing the care for the uninsured. The uninsured do not seek care when they need it because they can't afford the cost, so they arrive at the hospital much sicker and caring for them becomes more expensive. The trauma safety nets out there are fragile at best, and this is a direct result of the glaring lack of guidance in policies that have been promulgated by the federal government and largely enforced by state governments. As leaders in this industry, we are in a unique position to see the impact of poor policies and we have a responsibility to make changes.

Dr. Grazier: Considering national issues is great, but pressing local issues also need to be addressed.

Mr. Springfield: That is true. Valley Baptist Health System serves the fourth fastest growing region in America. Our patient population is composed of the relatively uneducated, unhealthy, overweight, and poor. Forty percent of them have no insurance and 40 percent are Medicaid dependent. Ninety percent of the residents in the region are Hispanic and suffer from early-onset diabetes, cancer, heart disease, renal disease, ophthalmologic diseases, and stroke; these conditions are more prevalent here than any place else in the country. Our system runs the largest outpatient dialysis unit in the state to meet this huge need. We are the most medically underserved area in the United States in terms of physicians and nurses per capita, and the population continues to grow. We are working hard with our medical school and residency programs to address these needs.

Dr. Grazier: How do you finance the services to address these challenges?

Mr. Springfield: The system is growing. We just bought a 245-bed hospital in Brownsville, and we have a large insurance company that thus far has been very successful. In addition, we have a stable provider network that is the basis for our insurance products and that allows us to have a geographically distributed integrated delivery system. This market has been fragmented, marked by few large employers, many governmental payers, and numerous municipalities and school districts. Improvements in employment and in healthcare are happening, however, as competition is starting to come in. In about ten years, we will see more progress, and that is very exciting and is a significant factor in our success. People are starting to view this area as one of opportunity, not of isolation.

Dr. Grazier: Where do you get your capital?

Mr. Springfield: We have a good balance sheet and strong reserves. There have been opportunities on the cost side and on refinancing our current capital and restructuring our debt. We also pursue partners who approach healthcare in the same way we do. One of our great partners is the Driscoll Children's Hospital in Corpus Christi. We are open to collaborative relationships with doctors and other payers and organizations.

Dr. Grazier: What advice do you have for other young managers ?

Mr. Springfield: Try an administrative fellowship, if possible, because it provides a unique and valuable learning opportunity. Choose mentors and bosses wisely. Never accept a job for the money or the promise of another, better position. Find whatever it is that you are passionate about, and pursue it. The money, prestige, and position will follow. View your career in strategic steps, and take a job only after careful consideration of its impact on your overall career goals. Align yourself with organizations that are progressive and that are facing challenges. Spend as much time continuously learning about healthcare, other industries, and new and innovative approaches to make yourself indispensable. Volunteer and get involved in professional organizations; this is a way to help, mentor, and be a resource to others. Remember that the business we are in is about taking care of people and that none of us would be where we are today if no one helped us along the way.

Dr. Grazier: Why did you choose healthcare?

Mr. Springfield: I have a passion for what I do. In this industry, the work and the environment are horribly complex, demanding, ever changing, and raging with a lot of fires and sparks, so passion for what you do is essential. I made one departure from the hospital track when I ran a dot-com--a healthcare information company. I learned a lot from that great but tough experience, but I am certainly glad to have gone through it. It is great to experience many different things professionally. What a privilege it is to work in this industry--to do the best job possible to help others and to one day be able to leave the field satisfied that you have accomplished this task.