The controversy will just melt away

New Aurora CEO talks about job, Waukesha County plans

Waukesha Freeman, September 23, 2006

Erik Brooks
Freeman Staff

WAUKESHA Ed Howe founded Aurora Health Care in 1984 and has been the face of the hospital system since.

In a few weeks, he passes control to Dr. Nick Turkal.

The change was announced this week. Turkal takes over as CEO on Oct. 1, as Howe plans to officially retire from Aurora three months later.
The two have distinctly different backgrounds. Unlike Howe, Turkal is a doctor and he still plans to see patients on a limited basis even in his new role.

Turkal said that background as a family physician as well as 19 years spent in various positions with Aurora, most recently as head of its metropolitan Milwaukee hospitals and clinics will only help as he starts his new job, one that will include construction of a long-discussed, and argued-about, hospital in the town of Summit, likely starting in 2007.

Backgrounds aside, Turkal credits Howe, who helped build Aurora into the states largest health care system and one of its largest employers.

The Freeman interviewed Turkal this week.

Q: What strengths do you bring to the job because of your background as a physician?
A: Fundamentally, we are a health care organization, so our primary commitment and one of our values is our patients deserve the very best care. So that relentless focus on quality and improvement of outcomes is part of what I will always be doing in any role at Aurora, and certainly as CEO. ... The other thing that I think being a physician does is give me the advantage of understanding what it is like for the clinical practitioners in our communities physicians, nurses, pharmacists and others to understand their roles and how we make this puzzle work very well together.

Q: Ed Howe had a different background. How much of a business background do you really need in your position?
A: Clearly, I have to have a good business background because this is an organization that has many different aspects, and I need to be responsible for making sure they all work well together. I have done a lot of additional training in the financial area and actually very much enjoy that part of health care, particularly around how we become more efficient and reduce costs. I am also very committed to looking at our processes and seeing how we can work with GE and other partners to streamline some of the things that we do.

Q: It has been said that physicians are under-trained in business when they come out of medical school. That is just not part of the curriculum. Did you find that as well?
A: Yes. I think that is true in general, although there are many more physicians now who have done other types of training and undergraduate work in business, or have gone on to get MBAs after their MD degree. That is a reflection of the fact that traditional medical school training doesnt give you everything you need around business. My personal background started in private practice, so I ran that sort of small business early on, but then was really committed to a lot of extra training to make sure I have the right tools.

Q: Do you want to differentiate yourself from Ed Howes leadership (or) embrace it?
A: Ed has been a tremendous leader and a mentor. I think its important when you follow someone like that to acknowledge what a wonderful leader they have been and to demonstrate your own leadership style. I have had several people ask me how I am going to fill Eds shoes. I typically say, Well, we dont wear the same size. And I really need to wear my own shoes. I am very comfortable with that, and very appreciative for all the things Ed has given the organization and me.

Q: What are some of the biggest challenges you face?
A: The health care world is evolving rapidly. We are now experiencing what many industries did 10 to 12 years ago, around the pressures for efficiency and cost reduction, the ability to do more with less resources. We are going to feel that for a number of years, and thats all right. That is part of being a good community resource.

Q: What will that mean? I hear about that kind of model and think of closures and job reductions. Does that necessarily mean that, or is it finding better ways to do things?
A: It is finding better ways to do things. If you look at our quality outcomes ... we have done something that really no other organization nationally has done with quality in terms of moving all of our quality measures at all of our sites to the top levels. As we have done that, we have seen very nice reductions in hospital length of stay, readmission rates. So our insurance partners are now telling us that as they compare us with others, we are providing a better value.

Q: You have heard the arguments that Aurora drives health care costs higher. Obviously you would argue against that, and you would say numbers right now are proving that.
A: Numbers are proving that. We are seeing that in our region some of the increases for 2007 that employers are seeing are less than they have been. Its not perfect, and we certainly have a ways to go, but the degree of increase is lower. We have certainly limited our increase in prices every year for a number of years and are continuing to do that. So if people say, are we driving costs in our market? I am now saying to them, yes, and we are driving them in the right direction, and we are driving them down.

Q: Ed Howe worked for years to bring a hospital to western Waukesha County, and it now looks to be a done deal. Would you have done anything differently?
A: It certainly has been a long and difficult process. And if you look at our motivation for it, it has been consistent all the way through. What we have wanted to do is have the opportunity to enhance care for the patients we take care of. ... That is all weve wanted all the way along. Were there different ways to do that? I dont know. Its an interesting question, but I really prefer to look forward rather than back.

Q: Are you happy they stayed the course?
A: I am absolutely happy that we have stayed the course and am absolutely committed to the project.

Q: The issue is still divisive, however. I wonder, now that it is essentially a reality, how do you help bring people together?
A: I think there are a couple of ways we do that. One is that we will be the best community partners we can be in every community were in. So being good listeners, being good assessors of what the community needs by hearing what they need for health care, we will do that. The other thing is that in the end people will judge for themselves what we produce for them. Some of that controversy may stay around until the hospital is opened and people have a chance to experience it. I am confident that once that happens, the controversy will just melt away.

Q: Obviously, ProHealth Care was vocal in that debate. You are competitors. Is there a way to have competitors in the same marketplace that are not in a divisive situation?
A: Certainly. We are in the same marketplace across eastern Wisconsin with competitors and have a very good relationship with them, and I would hope for the same thing with ProHealth. I believe in competition in health care, and I believe that if that competition is around the best quality care, in the end, the community wins. I dont think it has to be an unhappy relationship between providers.

Q: Do you know Ford Titus?
A: I do. We serve on some committees and boards together. I respect Ford, and I had a chance to see him yesterday and had a very nice conversation.

Q: Was he happy to see you in charge?
A: Yes. We have a very nice relationship.

Q: You shook hands and everything?
A: Absolutely.