George Hernandez Jr. has been the CEO of University Health since 2005, but the job has never grown dull. In fact, he told Becker's it still gives him a "high" and that he would probably do it even if he were not paid.
In his 19 years at the helm of the San Antonio-based system, Mr. Hernandez has seen it all, from Hurricane Katrina to COVID-19 to the rapid evolution of technology. And although the industry has ebbed and flowed, his commitment to succession planning has remained consistent, beginning just one year after he assumed the top job.
Ahead of his planned retirement, Mr. Hernandez connected with Becker's to reflect on nearly two decades as CEO of University Health.
Question: Over the course of your 19-year tenure, how have you witnessed the healthcare industry shift and change in ways you didn't expect?
George Hernandez Jr.: I want to zoom in on one way, and that's technology. I think that technology has become a big part of being able to run a health system efficiently and provide high-quality care and do it effectively. I'll give you one example.
Right before the pandemic started, we had decided to switch our electronic health record to Epic. We went live in July of 2020, right in the middle of the biggest spike here in San Antonio. But had we not been able to do that, we would not have been able to run the mass vaccination site we did so efficiently. We didn't have any waits. We vaccinated the first week roughly 1,500 a day, by the second week we were doing 2,000 a day, and nobody was waiting more than 20 to 30 minutes. That technology allowed us to do that.
Q: COVID-19 was certainly an unprecedented hurdle in so many executives' careers; what other major bumps have you had to overcome?
GH: When I started here as CEO, the biggest challenge was that our facilities were out of date. We were a public system, and I knew we provided excellent care — but when you're trying to provide excellent care in 40- or 45-year-old facilities, it becomes quite a challenge. We were operating on manual systems, and that didn't make us efficient.
We started early on in 2005 with surveying the facilities we had, surveying our equipment, asking, "What do we need to upgrade? What do we need to change? What was our long-term vision?" I read a great book called "Good to Great" that helped me concentrate on what's important and had all the vice presidents read it, and we started marching forward. Today, I think we're one of the more progressive systems because we never stopped, we never took a break. We just kept on going.
Q: In today's evolving healthcare industry, how do you prioritize given the vast amount of information coming at you as a CEO — and how rapidly that information changes in regards to the latest and greatest technologies?
GH: Part of my strategy has been to hire people that are experts in their particular area. We want team players, but we also want players that are experts in operations, records, finance, corporate communications. And so it's typically a team decision where we try to decide, "OK, what's next? What should we do, what's more important?"
And sometimes it's the public. During the pandemic, we could tell from the news media from around the country that we needed to step up to the plate and that we were probably the only health system that could do it.
That same thing happened with Hurricane Katrina in 2005, in my first year as CEO. The hurricane hit Louisiana, but it resulted in about 17,000 people from New Orleans coming to San Antonio. And we set up clinics right away, and we operated one of the three clinics that was set up here.
Sometimes external factors determine [what to prioritize] for you, but other times, you have the good fortune to be able to plan ahead.
Q: Now that you've been in the role for 19 years, how do you handle catastrophic problems like Hurricane Katrina differently? What have you learned?
GH: You know, I'm not sure we'd handle them differently. Our network is stronger now than it was back then, because we [now] have a particular organization called STRAC [South Texas Regional Advisory Council] that coordinates hospital responses. I think we were learning back in 2005. And then in 2024, we're pretty accomplished with being able to respond to issues. I mean, the CEO of that organization has all our cell numbers, is able to pick up the phone and call any CEO in San Antonio and call a meeting with the mayor or the county judge — and that's exactly what happened during COVID. He would pick up the phone and say, "Here's this issue, how do we want to handle this?" I think we're more accomplished today than we were back then, just a little bit more sophisticated.
Q: I've been speaking with CEOs and clinician leaders over the past couple of months about executive burnout. What habits have you cultivated outside of work that have allowed you to remain levelheaded throughout your time in the role?
GH: I have a son who's an engineer — none of my kids wanted to be lawyers. When he got his first job, I called him and asked how things were going. And he said to me, "I would do this job even if they didn't pay me. I love it so much."
I think what's kept me going on this job is that it is something I want to do and like to do. Yes, I have hobbies, like taking care of and seeing my grandkids, and when I was younger, maybe a little bit more travel. But for me, it hasn't been so much having a diversion, it has been liking the job that I have and the ability to make a difference. I get a high when I drive by the hospital or the downtown facilities, or whenever we're going to have a ribbon cutting for a facility that wasn't here before, and now someone is going to be able to use it and get care.
I think everybody gets that high in a different way. I've not traveled to Europe yet, but my kids have all gone. You know?
Q: University Health hired Furst Group to identify its next CEO. What has been your approach to succession planning?
GH: I've been focused on making sure that we had plenty of outstanding leaders in the organization today. This is a very planned retirement that's gonna take a couple of months — but you know, any of us could be here today and gone tomorrow. So from 2006 or 2007, I started thinking really strategically about the importance of having people in the organization, the organization doesn't depend on one person. I think in healthcare, it's very dangerous to have a hero mentality, where you believe that someone's going to come and save it and save the organization: a "Lone Ranger."
I think it's more important that you have the positions filled with key people that can handle their areas of responsibility, no matter who's in charge, and give them enough authority over their areas to manage. The next CEO is the board decision, but my succession planning has been ongoing — putting the right people in the right jobs in the right place so that we can succeed day in and day out, and if something happened to me or them, the organization will still be strong.
Q: If you could go back to that very first day on the job knowing all that you know now, what advice would you give your younger self?
GH: I've always believed that we need to take the long view. I would tell myself not to rush anything that we did, to take a look at the big picture. If we set our sights on concrete, identifiable things, we can accomplish those things and accomplish them very well.
And, taking the long view: There will be others that will accomplish the things that I can't.