As Marna Borgstrom prepares to retire as CEO of Yale New Haven (Conn.) Health next March, she is reflecting on her healthcare career and sharing advice for her successor.
Ms. Borgstrom began her career in 1979 as an administrative fellow at Yale New Haven Hospital. After that, she continued to serve in leadership roles, including executive vice president and COO of Yale New Haven Hospital. She became president and CEO of Yale New Haven Health in 2005.
Ms. Borgstrom told Becker's Hospital Review she has enjoyed her experiences, but she knows it's time to retire and hand the reins over to the health system's president, Christopher O'Connor. She shared her thoughts on retiring, discussed the evolution of healthcare and offered some advice for Mr. O'Connor.
Editor's note: Responses were lightly edited for length and clarity.
Question: How are you feeling about your retirement?
Marna Borgstrom: I have mixed emotions. I have loved just about everything I have had an opportunity to do and experience in my career. Yet, I know that it's time. I'm looking forward to having time to do the things I haven't had time to do, and I'm going to miss the people I've been working with for a long time.
Q: There weren't many female CEOs when you started your healthcare career. How have you seen healthcare and leadership in that space evolve?
MB: I've seen it evolve tremendously as we would hope and expect. There were years and years when I would often look around and I would say, "I'm the only woman in the room." But I also didn't see too many people of color or of very diverse backgrounds. I do think that is changing. When I look around the room at the boards I serve on — the American Hospital Association or the Healthcare Institute — they are often chaired by women now. There are many more people of color, so I think as our lives and our world have become richer and more diverse, our business world mirrored that quite nicely.
Q: What would you say to a woman who aspires to become a health system CEO?
MB: Being in healthcare leadership is a great career. It's a privilege to do this work, and I honestly mean that. I never went into this thinking I would be a CEO. I just really liked the work we did back then, and I like it now.
The first thing I would say is make sure you are passionate about it, because if you're going to become a leader in healthcare, it is part of every aspect of your life, and if you don't love it, it's going to be harder to do it and do it well.
The second thing I would say is, "Be your authentic self." Follow other people's guidance, look at your mentors, but decide who you are — what makes you successful, what works for you — and be that person. Don't try to be somebody else.
Q: You said earlier this year that one of your biggest priorities was getting the health system back on track financially, after the organization lost money for the first time in your career because of the pandemic. Have you managed to get Yale back on track?
MB: Getting back on track, moving forward is a constant journey. We are for the first time going to budget an operating loss for next year, which we have never done before.
Why is that? We have never been busier. The average length of stay throughout our system hospitals has grown, and case mix index has grown, so we're seeing slightly fewer discharges but a lot more daily activity in the hospitals. That translates into taking a workforce that is already pretty fried after all the pandemic issues and then having them deal with organizations that are running at 93, 94, 95, 98 percent occupancy. They're tired, and the ironic thing is it doesn't translate into more revenue because if these were shorter stays and faster turnovers, it would translate into revenue, but as length of stay grows, those last couple days the patients may stay, that last day is pure cost for us.
Why is length of stay growing? The case mix index is higher, people are sicker. They deferred things, they delayed things. Also, we can't discharge many patients who are ready to be discharged because there aren't enough available skilled nursing facilities, rehab facilities to take these patients. So you may have patients who don't need to be in the acute care environment, but you can't get them safely discharged to another setting.
Another reason is the insurance companies are managing denials and delays in approval for covering transfers. It's lost, inefficient time in the system right now.
There are a lot of factors contributing to that, and it's hard to explain to staff who know they are so busy that this is not turning into a sustainable, successful business model for the system.
Q: What is your advice for the incoming CEO?
MB: Keep your sense of humor. I have worked with the incoming CEO since 2012, when he joined our health system after we did an acquisition of New Haven-based Hospital of Saint Raphael, which he headed at the time. He's a wonderful person, very talented, and a joy to work with. One of the things I have always found is no matter how hard any of this gets, if you find appropriate ways to keep a sense of humor and perspective, you can tackle almost anything.