Just over seven years ago, the university faced the real very possibility of losing its connection to one of the institutions most integral to its mission: Tufts Medical Center, the principal affiliated teaching hospital where the School of Medicine's approximately 700 students train to become doctors and where a sizable number of undergraduates gain research experience.
Coming off a failed merger, the hospital in 2004 was on the brink of collapse, hemorrhaging money to the tune of $18 million that year with potential repercussions for the center's 5,000 employees, the university and its host neighborhood, Chinatown.
Cue a fateful phone call from University President Lawrence Bacow to then-Network President of Partners Community Healthcare Inc. (PCHI) Ellen Zane. Explaining everything that was at stake, he asked Zane to take on the challenge of turning around the troubled hospital.
As Zane tells it, it was in her blood to say yes to this immense challenge despite the fact that she had already built up an enormously successful career and had been planning to join her husband Peter in retirement.
"I think most people in their careers want to do something important; after Larry explained to me what was on the line here, I often tell people half of me … was totally daunted — it almost took my breath away — and the other half of me was totally juiced up wanting to do something really important," Zane told the Daily. "And my own DNA is such that I'm not afraid of challenge, I'm not afraid of risks, I'm pretty fearless as a person … So I think I did it because it was important."
With her husband's blessing, Zane accepted the job of CEO and has never looked back. Today, the hospital is not merely stable, but thriving even in the midst of a hugely uncertain economic climate.
The University Health System Consortium (UHC) last year ranked the center sixth in the country out of 98 academic medical centers in terms of quality and safety, and the hospital brought in $6.9 million while increasing patient volume.
"There was a time before she took it over when every time the [Boston Globe] mentioned the medical center, the word ‘troubled' was before it, and it was always ‘the troubled New England Medical Center,'" interim dean of the medical school Harris Berman said. "I haven't seen that word attached to Tufts Medical Center in a long time, because it's no longer troubled."
Given the hospital's success and personal circumstances, Zane will finally be retiring in September, she announced in February.
"A lot of it is personal. My husband has been retired for almost 10 years and has been unbelievably supportive of me, but I've been AWOL," she said.
Many of Zane's personal characteristics — including sharp communication and negotiation skills, prescience and a commitment to transparency — have been cited to explain her success in turning the hospital around.
Above all, however, the real key to Zane's success and a demonstration of her leadership has been her ability to assemble an exceptional team of workers, according to Chairman of Medicine Deeb Salem, who has worked at the hospital since before Zane's tenure.
"We've always had very good doctors and nurses and did very good research," Salem told the Daily. "In terms of management of the hospital, she has brought in wonderful people, she has seen people already here and helped them grow."
Salem explained that Zane models her hiring practices on one of her favorite sayings — "nines hire tens, sevens hire sixes."
"She takes pride in hiring people that may know more than she does … instead of feeling threatened. That saying of hers is very telling; if you know what you're doing, she has great respect for you," he said.
It is no surprise, then, that Zane cites as her greatest accomplishment the team of people that make up the medical center.
"I'm a firm believer that one is only as good as the people around you, and in spite of the fact that this hospital was almost gone, I was able to encourage really great people, both physicians and non- physicians, to come here," she said. "If this whole hospital depended on Ellen Zane, I would have failed. But I'm going to retire and this place is going to go on with truly excellent people."
When Zane arrived at the hospital, "Rome was burning" and the center was months away from failure, requiring immediate troubleshooting.
"I often tell the story where I pick up a glass and I look under that cup and I say, ‘You know, I'm going to put that cup right back down' because there were so many problems under every rock," she said. "I needed to look at the things that were going to bring us the most money the fastest."
Zane and a number of consultants set about identifying the hospital's five immediate challenges, which she still remembers clearly and in detail today.
The center needed an immediate injection of cash, so it sold a building to the university to raise $28 million. Then, it had to resolve a cash-flow problem — compared to the industry average, it was paying its bills too quickly and collecting revenue too slowly.
Additionally, data revealed that because of inefficiencies, the length of stay for inpatients was one day too long. Finally, poorly negotiated contracts with various health plans meant that the hospital was being underpaid for its services.
The biggest challenge, Zane said, was to mobilize everybody to tackle these problems.
"The culture in this organization as a hospital is the best culture I've ever worked in. People here are more collaborative and they're more team-like and they're nicer than any place I've ever worked," Zane said. "That positive is also a bit of a negative because on the negative side, people said, ‘Oh Ellen Zane will get us out of this soup.' I needed people to understand that I'm not smart enough to do this myself and that I needed help and everyone needed to know that it wasn't somebody else's problem."
Beyond efforts to pull the hospital back from the brink, however, Zane has also strived to craft a long-term strategy for success, particularly to cope with an evolving health care scene that is pressuring health care providers to "do more with less."
Zane points out that while the health care reform law, first in Massachusetts and then on a federal level, has extended coverage to many individuals, it has come at the cost of reimbursements to providers. When the law was passed in 2006, the hospital received 80 cents for every dollar of care provided to Medicaid, and today the number is 60 cents and falling, according to Zane.
"There's no magical pot of money somewhere waiting to pay for those people … Our costs are all still there but the state is walking away from its responsibility to pay for it," she said. "We've insured everybody, but the way we're paying for it is on the backs of the providers. That's the truth and we need to be honest about that."
Thus the hospital's strategy for continued success has centered on improving quality while maximizing efficiency.
"When we give great clinical care, it's not to some people, it's to all people irrespective of ability to pay," Zane said. "That's why management has a responsibility to continue to innovate … to constantly be more efficient, recognizing that there's not going to be any new revenue stream and the demands on us are not going to go away."
These efforts have attracted detractors, however, who claim that patient safety has been compromised by efficiency measures.
The Massachusetts Nurses Association (MNA) last week called a strike to be held May 6 in protest of unsafe staffing levels. Zane, pointing to the hospital's quality metrics, maintains that the union's claims are unproven and part of a selfish national agenda. She has no intention of backing down, despite her impending retirement.
"I feel more juiced up and more committed to deal with this firmly and head-on probably because I am leaving. … We saved this place; this place was almost gone and for some union to be coming in here for their own self-serving, selfish reasons — to me I find it offensive," she said.
"Leaders are supposed to lead, and it would not be very leader-like of me if I left this for my successor," Zane continued. "As part of my legacy, I refuse to wimp out, and I will not."
Berman and Salem firmly believe that the hospital will not miss a beat following Zane's departure in September, expressing confidence that she has prepared the institution to succeed.
"She's done a great job, and frankly, I think the hospital will continue to do well because she's set it on the right path," Berman said. "Whoever her successor is has a good trajectory to begin with and should be able to bring it to new heights."
For such a tireless personality, retirement is unlikely to involve much time spent in a rocking chair. Zane has agreed to stay on as a consultant and vice chairman of the Board of Trustees for a year. She added that she will continue serving on a number of boards and has been approached to teach at area universities. While the maze of politics fascinates her and she intends to be involved in matters of health care policy, running for office is not on the cards as it would be "the fast-track to divorce."
"[My husband] keeps saying to me, ‘I know you're going to flunk retirement,'" she said.
Beyond her professional accomplishments, Zane's affection and passion on a personal level for the institution and its people is clear. She calls her seven-year tenure at the medical center her most joyful work experience.
"There hasn't been one minute when I've been here where I haven't felt embraced and welcomed," she said.
The feeling appears to be mutual. To illustrate the personal impact Zane has left on him, Salem tells the story of how she helped him out of a tight spot.
"One day she was taking a vacation with her husband to Italy and she heard that my wife and I had an anniversary coming up, and I'm sort of known to possibly miss anniversaries," he recalled. "She called to say she could get hold a very nice purse and went out of her way to get it to me to give to my wife on my anniversary … that's something you don't forget."
