Interview with former CEO, Charlene Stuart

Charlene Stuart

I have been here since December 1968, and I came during the labor unrest and strike. For an inexperienced person right out of college it was overwhelming. I guess what struck me the most as I was thinking about this is that I have had the opportunity to work with and for three MUSC presidents.

Dr. (James B.) Edwards (MUSC president) in my opinion has left an indelible mark on this institution. Dr. (William) McCord was a politician and could get the government funds that we needed, but we didnāt really have enough talented people on our team to do as much with the dollars. Dr. (William) Knisely was strong academically, but not the kind of administrator who understood how important political image was, and he had a lot of problems that he inherited.

But to watch Dr. Edwards, his leadership has been tremendous. He has personality and credibility. What he has done for the institution is phenomenal. This institution has forever changed. We were once a Charleston institution. Now weāre statewide and beginning to get regional and national recognition. Thatās what Dr. Edwards has done.

Marion Woodbury (CEO, University Medical Associates) has been a mentor to me. He and (Dr.) Layton McCurdy (vice president for medical affairs, dean of the College of Medicine) are two people who have taught me the importance of diversity. These people recognized that I had something to offer, and never have I felt discriminated against by these individuals. Both of these gentlemen only look at how effective you are, and over the years weāve been colleagues and friends. We disagree, but we are not disagreeable with each other. The three of us have worked hard and have enjoyed the support of Dr. (Conyers) OāBryan (chairman of the MUSC Board of Trustees) and Dr. Stanley Baker (a former chairman), in particular from our board, and Mr. Berlinsky (former vice chairman). Those individuals working with us have enabled us to help Dr. Edwards move this institution to where it is.

Believe me, I know hard times. I can remember when we couldnāt pay the bills. I can remember when we had serious roach infestations. And when we had personnel issues. Stuart Smith (interim vice president for clinical operations and CEO) and I have been here so long that when we start telling some of our newer members of the team what it was like, they canāt believe it.

Do some people still see MUSC as a local institution?

Itās unfortunate that the parochialism in this area has been used to delay us from doing whatās best for MUSC. Itās about greed. Itās about who will survive and who will thrive. And itās exacerbated by the fact that the persons who are anti-MUSC have a long track record of not being able to work with anybody else either.

Our industry is just like the banking industry or any other industry. Weāve seen that if youāre a stand-alone hospital, you can be successful, but you canāt exert enough influence with payors. You just donāt have access to the patients or the capital you need and you donāt have access to the kind of management expertise you need. Youāre a little fish in a big pond, and the going is tough. I donāt think our opposition recognizes that.

They would be better served if they quit throwing obstacles in our way and got a life of their own. We will succeed, and when we do, they will have lost a lot of time. This city is large enough for two systems in competition with each other, and the health care of our citizens would be better served. They would have better care at a better price for that care. Non-profits need to be more accountable. Our market share is growing. We have to grow in the Tri-County area, because the statewide referral patterns weāve established are going to be weakened as managed care penetrates South Carolina. Our future depends on our growth locally.

The good news for both our opposition and us is that we are a growing community. We need to compete over the influx of new citizens. We donāt have to steal each otherās business, but we do have to grow in the Tri-County area.

I just hope that we donāt lose our commitment to excellence. Iāve seen Dr. Edwards have that fire in his belly, as he describes it, for excellence in education, research and patient care. We would fail miserably if we tried to be a community hospital, because we are always going to have those higher costs. What we need to do is remember the teaching and research aspects of our missions and complement it with the patient care that we give. Our College of Medicine is strong clinically. Itās our foundation, but our scholarship and research are important to differentiating the product that we deliver.

What do you anticipate for the future, your life in Saudi Arabia, and are there any plans to return to MUSC?

Iām excited about the opportunity to go with (Dr.) Rob (Stuart) to Saudi Arabia. And Iām not planning to continue my career right away there. Iāll do most of the settling in. Iām learning to be a good Saudi wife. I havenāt quite got the walking three feet behind him down yet, however.

The Saudis are a warm, hospitable people, a lot like Southerners. Itās going to be exotic, but weāre adaptable. This is what we want to do, my husbandās opportunity to lead a cancer center. They have a fine facility and very good clinicians there, and the cancer patient care is good. The technology is great; cancer is the flagship of this 500-bed facility.

What Rob wants to do is help them with the few things that they need to improve and get them involved in clinical trials. So their clinical research component will be one of the things that he will work on. The hospital is called the King Faisal Specialist Hospital and Research Center. And they just recruited a really top notch person to run the research there.

We are an aging population, but in Saudi Arabia half of the population of 14 to 16 million are under 15 years of age. The nomads are clannish, and there is a lot of marrying among family (first cousins) for the passage of rights to authority and wealth. For that reason, they present opportunities for geneticists.

Their roots are important. Even the king returns to the desert. They may dress like they are on Wall Street, but on the plane to Saudi Arabia youāll see them go into the bathroom and put on their travel robes. The women are spectacularly dressed in designer clothes and jewelry, but an hour out of Riyadh they come out of the bathroom totally veiled.

The Saudis have very strong family and religious ties. That value system, I think, is pretty easy for Southerners to identify with and appreciate. I would not rule out anything in the future. I hope we are leaving with the kind of relationships that would encourage people to think of us in four years. My son, Darren is house-sitting for us. Weāll be back a couple times a year. I probably have MUSC tattooed on me somewhere, because I keep coming back. I do know I wouldnāt come back to Charleston and work anywhere else in the same industry.

What vision do you have for MUSC?

I was telling our administrative team that this preliminary score of 97.5 (of the Joint Commission on Accreditation of Healthcare Organizations÷ JCAHO) is like a booster rocket. I think itās going to be a tremendous boost to the little bit of a sagging morale weāve experienced with regard to (the affiliation with Columbia/HCA) being held up and all the outside agitation. I think things are going to be great here.

Weāve got more people than weāve ever had who are truly leaders and who understand management and can combine those two qualities, particularly in the Medical Center. The clinical staff weāve got are recognized nationally in terms of their expertise and they work well with us. I think thatās due to Dr. Joanne Conroy, president of the medical staff, and Dr. Fred Crawford, president of UMA, who provide leadership in the physician areas. Dr. Bruce Elliot, the former president of staff, actually nutured that collaboration and built a good relationship between the clinical staff and the administration of the hospital. Dr. Conroy is continuing to build on his legacy.

I really think we are well-positioned for the future. My vision is for us to be the premier system in the state, so that there is no question but to come here when someone needs tertiary or quaternary care. Iād like to see us become the choice for the Tri-County area. Iād like to see us be more attuned to caring for the health of the whole population. I think we can do that as we expand our continuum of care.

I believe that our research component will differentiate us from other health care providers. What Dr. Rosalie Crouch, Dr. McCurdy and others have done, I think, is phenomenal. I admire them because they picked the ball up and ran with it. If you look at those numbers. Itās pretty impressive for a school that didnāt have a lot of research to be garnering those kind of dollars. I think that says something about the quality of the people weāve recruited. For instance Dr. Ian Taylor, chair of medicine, who has built a triple-threat department.

Stuart Smith and Pam Cipriano, Ph.D., administrator for clinical services, are excellent leaders. They are doing a great job in the Medical Center. They will have to work closely together. We in the Medical Center do pretty well with the team concept. We are all different, and I think that strengthens us. We donāt expect to agree with each other. We have pretty much different personalities and different styles. Our strengths are our fact-based decisions, accountability and adaptability.

What happened last week here in the Joint Commission survey and the week before was a culture change. We set out in change management in ā93 to have people buy in to the decisions they helped make and be accountable for their outcomes. There was pride in the preparation for the survey, and the effort was interdisciplinary. We observed clinical staff talking with environmental service workers about our mission, what our value system is and the kind of vision we have. The survey results were like the icing on the cake, because weāve enjoyed such a good year. That culture change is the most positive thing that Iāve seen. You canāt get a job done if you canāt trust the organization you work for. Weāve made major strides in building that trust in the Medical Center.

Do you have any regrets? What are you particularly proud of?

I think my reputation is that I am seen as a tough manager. I would say that I hold people accountable. Iām really a people person, and I regret that over the years the effectiveness of my direct leadership style might have put off some people in the organization. I can be brusque and impatient. I always have a list of things that I want to get done. I even do this with my family, unfortunately. In my haste to be effective and get things done, I am less sensitive to peopleās feelings, and I acknowledge thatās something I need to work on.

Iām not proud of all the hoopla, or whatever you want to call it, over changing the G-lot parking and raising the rates. I learned a lot with that one. So I guess if I picked something I would do differently, itās the parking situation.

Change management was very painful for me. I put on 25 pounds from the sheer stress and depression after change management was in place. That is a side of me that only my family sees. I can think of that now and want to either cry or throw up. It was the right thing to do. It had to be done, and I signed up to do it. Thatās one of those once-in-a-career experiences. I received hate mail. My life was threatened. My family was written about in unrelated issues in the newspapers. It was a very painful experience for everyone who was associated with it. I had no pride in that when it was going on. It was painful to everybody involved. To compensate, I ate. I will never do that again.

Iām proudest of the legacy of changing forever the nursing organization here. We have a wonderful group of nurses, both in our leadership and at the bedside. They are professionals. I think I was the first administrator to invite the nursing leadership to the table and recognize them for the important decision-making role they perform here. I really feel good about that. We are interdisciplinary.

Iām proud of our strategic planning. Stuart Smith brought the strategic planning initiative to me and Layton (Dr. McCurdy), and I formulated a meaningful strategic planning process for the College of Medicine and Medical Center. Dr. Edwards sometimes gets his nose out of joint when people criticize us for not having earlier planning. To me planning is getting the nurses and doctors, the support staff and the university people together and creating a consensus so that when we leave that room itās not a document thatās put on a shelf. Itās the whole process thatās important. Itās knowing where weāre going. I believe Dr. McCurdyās desire to do strategic planning marked the beginning of our doctors working collaboratively with the hospital. We donāt have the internal fights you see in other institutions. Instead, we all work together.

And third is the quality issue. Stuart (Smith) started this when he worked with me when I was vice president for finance. That quality emphasis is what made the difference in the joint commission. Everybody in this hospital understands that ćqualityä is not a buzz word. We are truly living each of these process improvement projects and weāre making permanent improvements for our patients. Those are the things Iām proudest of.