An Interview with Patty Gabow
Keeping the Patient at the Center in Hospital Administration
Patricia A. Gabow, MD, MACP is Professor Emerita of Medicine at the University of Colorado and the former CEO of Denver Health. She is the author of more than 130 articles, 36 books and book chapters, and a recent book, The Lean Prescription: Powerful Medicine for Our Ailing Healthcare System. She will be giving a keynote address at the Lown Institute Conference on Saturday May 6 about structural barriers to health, and what the role of the health care system can play in addressing social and economic inequalities. We spoke with Gabow about her background, her experiences from 20 years in hospital administration, and asked her advice for practitioners and administrators who want to practice social justice.
Lown Institute: What first brought you to medicine and later, to hospital administration?
Gabow: Education was always paramount in my family. My grandfather, who came to the U.S. from Italy in the early 1900s, used to tell me, “If you get an education in America, there isn’t anything you can’t do.” He taught music in public schools and he worked hard to put my mother and her siblings through college during the Great Depression. Many people in my family were schoolteachers, but I wanted to be a doctor from the time I was 12.
I came to Denver Health because working at a safety net institution appealed to me. When I started in medicine, hospitals were segregated by income. Those with money got suites and afternoon tea, while the poorer patients stayed in open wards. My mother always said, “Patty, you have to be good to the poor.” I always wanted to work with the ward patients, so I looked for a place that focused on underserved patients. I worked at Denver Health as an academic nephrologist for 20 years including my time as Chief of Medicine, which was my entry into hospital administration.
I wasn’t actually seeking out the CEO position, it just happened. We had a CEO then who was a problem and who ended up being fired. They needed a new CEO so the mayor asked me to co-manage the hospital with a finance person. I decided to take the position because I thought I could help Denver Health. My teenage son said to me, “How can you take a job in which you have no training?” But that was the circumstance we were in, and I felt it was my responsibility to step up.
How did your background affect your experience as CEO of Denver Health?
As it turns out, not being a career administrator gave me a different perspective. I knew I could always go back to being a doctor, so I had the freedom to make tough decisions. And being a doctor helped me keep the patient at the center when making these decisions.
Because of my medical background, I approached administrative problems like patient problems. Some administrators treat the symptoms without knowing the root causes, but to solve the problem you have to diagnose the disease. My approach was, let’s make a diagnosis and a treatment plan and monitor the treatment. Then, if it doesn’t work, we will do some more research and either change the diagnosis or the treatment. I had a lot of experience and trust in data from my years doing medical research. So I was committed to getting good data and making decisions based on that data.
Denver Health was a family of committed people working together. We had no contracts or bonus plans for executives or physicians. The employees were not there for the money, they were there for the mission – to deliver better care to the poor than the rich got. We integrated health care into the community with school-based clinics, primary care clinics, our own HMO, detox centers, etc. It wasn’t a hospital that just focused on our bottom line, it was a delivery system focused on the population.
What would you recommend for clinicians or health care administrators who want to reform their institution, to address disparities and social determinants of health?
First of all, try not to be part of an institution that fosters greed, overuse, and misuse or places barriers for service to the poor. Such institutions are not the places to practice social justice. If you’re already at such an institution, it’s really hard to change it. At a national meeting a mid-level manager once asked me, “I want to reform but the leadership doesn’t want to.” I said, “Leave!” It’s important to join an institution whose values align with yours, because changing the values at an institution by yourself is very hard. All you have to do is look at CEO and executive salaries and benefits compared to the front line to know if the institution values equity.
When I was chief of medicine, I used to tell medical students and residents coming to Denver Health, “You’re one of the few educated elite in America who can actually see what it’s like to be poor. Once you have seen the other America, you have to ask yourself, ‘What are you going to do about it’”?
Is there anything you’re looking forward to in particular at the Lown Conference?
I’m a data girl at heart, so I’m looking forward to seeing the new research presentations on Friday. But the best part about this conference is connecting with the other people who are there. After my first Lown conference, I was talking to my son about the conversations I had. He said, “Mom, I think you found your people.” For me, it’s the interactions with like-minded people who see that the medical-industrial complex is not delivering what we want and need for America and are committed to lead the change.