The single most important thing I’m doing is engaging the staff.”
During Mr. Manning’s tenure, MetroHealth grew into the largest public healthcare system in Ohio.
During Mr. Manning’s tenure, MetroHealth grew into the largest public healthcare system in Ohio.8 Incredibly, it added patients more rapidly than the Cleveland Clinic. In addition, Mr. Manning improved the health system’s financial footing by increasing revenues, not cutting expenses.9 His leadership and achievements were acknowledged in 1999 when the twin towers at MetroHealth were named the Manning Towers. A few years after his departure from MetroHealth, at the age of 62, Mr. Manning died of complications from lung cancer.
In 2011, he was inducted into the MetroHealth Medical Hall of Honor.
“He insisted that public care should not be inferior to that of private pay and insured patients,” said retired Chair of MetroHealth’s Department of Dentistry, Leonard P. Weiss, who nominated Mr. Manning for the honor. “And thus Cleveland’s public hospital ranked among the country’s finest.”
Experience in leadership positions at Lutheran Medical Center and University Hospitals in Cleveland as well as at the University of Cincinnati Hospital helped prepare Terry White for success when he was chosen as MetroHealth’s next CEO in the spring of 1993. The groundwork laid by Henry Manning helped, too.
“Henry Manning was a titan,” said Mr. White. “I inherited an organization with a soul and just had to get other people to understand what a wonderful organization it was. The organization had to do it,” he said. “To believe in itself.”
In his first year, Mr. White figured he talked with more than 3,000 employees. What he learned first-hand was that employees wanted “the suits” to understand that listening to the staff led to buy-in from the staff. “What employees really wanted,” he said, “was to be listened to. And taking action on what they said built trust.”10
In addition to his listening tour, Mr. White improved finances at MetroHealth by beginning to sign contracts with managed care providers. Within three years, MetroHealth inked more than 100 of those contracts, which enabled the health system to care for more patients with private insurance.
“I felt the services that MetroHealth offered were very valuable and very unique and high quality and I wanted them to be available to as many people as possible,” Mr. White said.
“This stabilized us financially so we could continue to invest in the quality and growth of our programs. It brought thousands of patients with private insurance to MetroHealth. It was a win-win situation.”
His step-by-step approach reflected his commitment to incrementalism. In one of their early meetings, Mr. White told the medical council, made up of the chairs of each of MetroHealth’s medical divisions: “I won’t take anything to the board of trustees—significant policy changes or anything that could directly or indirectly affect patient care—without your approval.”
“My philosophy,” Mr. White later said, “was that to bridge the gap that often exists between medical leadership and administrative leadership, it’s important that people be empowered to participate in the decisions.”
In 1999, MetroHealth became the first hospital with an Epic electronic health record system in Ohio. Adopting the system helped solve two problems. The first was the inability of primary care doctors working at MetroHealth’s community health centers to connect their patients with specialists on the main campus. With the electronic medical record, there was no longer a need to dictate notes, prepare paperwork, and mail documents, a process that delayed care and sometimes resulted in lost referrals.
Second, the Epic health record system made billing more efficient. The electronic record couldn’t be closed until proper billing codes were added. That ensured that coding was complete—with fewer errors. “And the physicians’ collections tripled in the first year,” Mr. White said.
Mr. White also continued MetroHealth’s push to deliver care to patients by opening health centers in shopping centers, especially centers with nearby grocery stores and pharmacies. With that, families eligible for the federally funded Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were able to one-stop shop for healthcare, prescriptions, and healthy food. These new centers, like the ones he opened at Lee Harvard Plaza and in the West Park neighborhood, also provided plenty of parking.
“People are often intimidated by large medical centers,” Mr. White said, “whereas everyone knows how to access shopping center parking. It made it geographically and psychologically accessible for the people. And that was important to keeping people healthy.”
Long after his departure in 2003, Mr. White kept tabs on MetroHealth, and on Dr. Boutros’s leadership style in particular.
“He understands that quality healthcare not only depends on treatment,” Mr. White said. “It has to do with all sorts of societal issues. And you can’t treat one without addressing poverty and the lack of access to education. He’s taken things that I thought about to a whole new level.”
The construction of new health centers in Cleveland neighborhoods such as Broadway, Brooklyn, and Buckeye helped Mr. Sideras work toward a goal of making healthcare more accessible.
Mr. Sideras also worked with then–US Senators Mike DeWine and George Voinovich and then-Governor Bob Taft to write and lobby for legislation that increased federal funds for indigent care. That work resulted in billions of dollars, not just for MetroHealth, but for all public hospitals in Ohio.
Two other points of pride highlighted Mr. Sideras’s years as CEO. The MetroHealth Foundation grew to more than $30 million with donations to support research, teaching, and patient care. And his prioritization of Inclusion, Diversity, and Equal Opportunity led to the hiring of Winnell Mason as the health system’s first Director of Diversity.
“We were celebrating some ethnicity, some nationality that reflected who we were, every single month,” Mr. Sideras said. “Prior to that we weren’t doing anything. And the ironic thing was there was no organization around that was more diverse than MetroHealth.
“I grew up in Cleveland. I’m a West Sider. A chance to work in the community was a real treasure for me. It was the most gratifying stage of my 45-year career, without a doubt.”11
His departure in 2008 led the Board of Trustees to hire Mark Moran as MetroHealth’s next CEO.
The Cuyahoga County Corruption Scandal was just one headache Mr. Moran faced during his five-year tenure.
Six weeks into Mr. Moran’s tenure, MetroHealth was contacted by the FBI regarding a corruption investigation. What followed was the imprisonment of two MetroHealth employees who were charged with bribery, conspiracy, and other crimes in a county-wide investigation that came to be known as the Cuyahoga County Corruption Scandal.13 That scandal was just one headache Mr. Moran faced during his five-year tenure.
In May of that year, MetroHealth told 73 employees—a little more than 1 percent of the staff—that they would be laid off. The move was in response to first-quarter losses of $8 million, which followed a loss of millions the previous year.14 One reason for the economic trouble was an increase in uninsured patients who had once been cared for by Mt. Sinai Medical Center and St. Luke’s Medical Center, which closed in 1996 and 1999, respectively. With the recession of 2008, fewer patients were coming to MetroHealth’s emergency department and being admitted to its hospital,15 and more cuts were announced later that year.16 Mr. Moran responded by focusing on operational excellence through the creation of “patient care units.”
“I changed the leadership of the clinical teams to be responsible for delivering care to patients efficiently, with a sharpened focus on budgets,” Mr. Moran said. “I knew the department chairs would assure our research and teaching strengths—MetroHealth is an academic medical center—but we needed clinical and administrative leaders to be operationally oriented.”17
Other cost-saving measures included working with a single manufacturer for electronic implants, for example, which saved the health system more than $1 million. That success was repeated with surgical tools and prescription drugs, too.
And it worked. MetroHealth finished 2008 with a slim profit and, in March 2009, the Board of Trustees named Mr. Moran the permanent President and CEO. He warned then that the health system had another tough year ahead with more layoffs possible.18 But MetroHealth’s finances were rebounding, and the health system announced audited net income of $58.5 million in 2009 and $27.1 million in 2010.19
In September 2011, MetroHealth announced that another 450 jobs would be cut to save $30 million and prevent future losses.20 Three months later, Mr. Moran announced he would leave his post the following March, when his contract ended. The announcement was met with praise from MetroHealth Board Chair Ron Fountain, who commended Mr. Moran for putting the health system on strong financial footing, increasing cash on hand to $376.6 million, up from $250.5 million in 2007.21
“The trajectory of the hospital,” Dr. Fountain said, “is dramatically better today than it has ever been.”22
The following February, at MetroHealth’s State of the System address, Mr. Moran outlined a vision for the future of the health system that included building four new health centers, revamping the main campus, and obtaining health coverage that would help care for more of the county’s uninsured residents. That plan would be one of Mr. Moran’s lasting legacies.23
The effort to help the uninsured was led by John Corlett, Vice President of Government Relations and Community Affairs at MetroHealth from 2011 to 2015 and the former director of Ohio’s Medicaid office. Mr. Corlett led a team of clinicians and administrators to design the insurance plan and presented it to federal and state leaders to develop broad backing for the program. He succeeded in obtaining a waiver from the federal government that allowed MetroHealth to offer Medicaid to about 30,000 more people in Cuyahoga County who previously did not qualify for the government-funded program.24
The program, called MetroHealth Care Plus, made sure those who enrolled had primary care providers, dental care, prescription medicine plans, mental health and addiction services, and electronic medical records, as well as care coordinators who scheduled follow-up appointments and took other steps to keep patients healthy.25
“It fulfilled our mission and saved the hospital,” Mr. Moran said plainly. “It set it up so that [Dr.] Boutros and his team didn’t always have to worry.”
In its first year, the program brought $70 million in additional revenue to the health system while improving the health of thousands of residents of Cuyahoga County.
By reducing emergency department visits and complications often caused when those without insurance delay care, it saved the Medicaid program money, too. And it was so successful, it led to support from lawmakers for then–Ohio Governor John Kasich’s statewide expansion of Medicaid.26
In addition to that, outpatient centers Mr. Moran helped to launch opened in Middleburg Heights in 2013 and in Brecksville in 2016, and his planning laid the groundwork for MetroHealth’s campus transformation.
“I recognize that there have been 28 individuals who have had this leadership position in our 185-year history,” said Akram Boutros, MD, who was named President and CEO in 2013, after Mr. Moran’s departure, “and that our individual efforts must be viewed as one leg in a relay race. That in order to succeed and win, it is not only what you do during your part of the race, it’s critically important to build upon the success of the past runners. And it’s just as important to make sure that the person you’re passing the baton to has as much opportunity to succeed as possible.”27
“The single most important thing I’m doing is engaging the staff.”
Just as important to Dr. Boutros was finding ways to turn what many thought were MetroHealth’s weaknesses into strengths. A prime example is the high percentage of patients MetroHealth cares for who are uninsured or covered by Medicaid, the government health insurance program for the poor, which pays doctors and hospitals less than Medicare or commercial insurance.
Dr. Boutros found a way to make that a win-win-win by drawing down additional federal funds to expand treatment and improve the health of Ohioans through the Care Innovation and Community Improvement Program. This innovative program provides enhanced care to children, pregnant women, those addicted to opioids or other drugs, people struggling with mental illness, and patients who depend on more expensive emergency departments for routine care instead of heading to a doctor’s office. MetroHealth, along with three other health systems in Ohio, not only increased federal funding and improved the health (and lives) of low-income patients, its participation in the program saved the state millions as people on Medicaid became healthier.
Dr. Boutros’s nine years at MetroHealth were also defined by his insistence, unapologetic once again, that a person’s health has little to do with the medical care he or she receives. He made this point loudly and clearly in a blunt City Club of Cleveland speech he delivered on June 7, 2019, titled “What Hospitals Are Getting Wrong and How We Can Fix It.”
He made this point loudly and clearly in a blunt City Club of Cleveland speech he delivered on June 7, 2019, titled “What Hospitals Are Getting Wrong and How We Can Fix It.”
“Here, home to some of the best medical care in the world, we can’t get it right. What’s wrong with us?” he asked the crowd. “What’s wrong is that we continue to believe that good healthcare can be measured by the size of our hospitals and the prestige of those who work inside them. . . . We’ve got to stop promoting what happens inside our hospitals as if it really matters to the health outcomes of our communities. It doesn’t.”30
It was time, he went on to say, to promote health beforehand rather than fight illness later. And he called on others to join MetroHealth in doing that.
“It’s time for us,” he said, “you, me, the business community, philanthropic and civic leaders of Cleveland and Cuyahoga County, to come together and invest in fixing the health-outcome crisis before us.”
Three weeks after that City Club speech, at the health system’s Annual Stakeholders Meeting, Dr. Boutros announced that MetroHealth was creating the Institute for H.O.P.E.™: Health, Opportunity, Partnership, and Empowerment. (See Chapter Seven.)
“It will remove obstacles and help people of all backgrounds reach their dreams—more education, better jobs, higher wages, healthier food, reliable transportation, and adequate housing,” he said. “The things we all need to live a life of opportunity, dignity, and hope.”
Over the next few years, the Institute partnered with dozens of organizations to better the lives of people throughout Northeast Ohio.
Throughout his tenure, Dr. Boutros, publicly and in private meetings, continued to encourage other organizations—businesses, nonprofits, governmental agencies—to join MetroHealth in improving the community.
The closing of his 2021 Annual Stakeholders Meeting speech is just one example. “As you leave today,” he said to the hundreds who turned out on a cool, rainy evening, “we’re asking you to . . . open your hearts, to shine a light on some struggle society has overlooked. And plan to make it right.”31
He called it a great way to celebrate the dream that MetroHealth’s founders made sure came true. “And to remind ourselves, like they did, that we can be the change the world needs.”
It was something he’d been saying all along.
“If we want to change how health care gets delivered in the U.S., the only way we’re going to do that is by influencing others,” he told a reporter from Smart Business magazine in 2015. “That’s why our vision is to become the most admired public health system in the nation, so we can influence others to follow the good works we’ve done.”32
It was that vision, and his long list of accomplishments, that drew more employees to—or back to—MetroHealth.
“When Dr. Boutros arrived, it appeared early on that things were going to be different,” said Richard Blinkhorn, MD, who left MetroHealth in 2004, returned in 2019, and serves as Chair of the Department of Medicine.
“It became clear that this was a renaissance. And I wanted to be a part of this. This was getting back to who we were. Back to a sense of pride in who we were as physicians and that MetroHealth was not to be considered second rate to anyone.”33
In November 2021, Dr. Boutros announced he would step down at the end of 2022.
“I never knew what a life’s calling is, until I came to MetroHealth,” he said then. A few months later, in an interview for the health system’s archives, he explained how he felt as he prepared to leave.34
“I believe in this organization,” he said. “I believe in the people who work here. There’s nothing they can’t do, literally nothing they can’t do. They are the most capable, courageous, supportive, loving folks I’ve ever had the privilege of working with. . . .
“The frontline staff are so extraordinary. They supported and encouraged me. They are patient, kind, and committed. They have shown me how to love at work,” he said, as he finished the interview. “I pray that the next CEO gets to feel that from Day 1.”
“I never knew what a life’s calling is, until I came to MetroHealth.”