Sandra Bruce has had a remarkable and extensive career as a healthcare leader. Bruce, who officially retired on September 30, 2015, at the age of 70, has been actively involved in healthcare since 1968. I had the pleasure to speak with Sandra Bruce about her impressive tenure as CEO for multiple public and faith-based hospitals, and her perpetual desire to continue to help others both locally and globally after her retirement. Throughout our conversation, it became abundantly clear that not only was she a leader in healthcare for over 40 years, she is also a relentless pioneer and advocate of healthcare rights and accessibility to migrants and women in the United States. She always is persistent in her efforts to provide accessibility for care to all, regardless of the challenges and lack of support she experienced at times.
Bruce was born and raised in Michigan. She received her undergraduate degree in English and French from Western Michigan University and a master's degree in administration with a focus in healthcare from Notre Dame University. Bruce's career as a CEO began at the age of 29. She was the both the youngest and the first woman appointed CEO at Berrien General Hospital in Berrien Center, Michigan. Bruce believes that she was also the first laywoman CEO in the state of Michigan at that time, and that she was one of only two women CEOs in over 200 hospitals in the state of Michigan.
Most recently, Bruce was the president and CEO of Presence Health in Chicago. Presence Health is the largest Catholic healthcare system in Illinois. It was formed in a 2011 merger of Provena Health and Resurrection Health Care. Bruce had served as president and CEO of Resurrection Health Care.
When I spoke with Bruce on a Friday morning, she was thrilled to be at home in her pajamas drinking a cup of coffee. Although she is no longer president and CEO of Presence Health, she still has a "little base" there, and goes into the office about once a week.
All of us here at QLK are delighted to showcase Sandra Bruce as our fascinating person. We wish her the absolute best in all of her future endeavors. May she continue to advocate for accessibility to healthcare both nationally and internationally. Most importantly, we wish her safe travels.
What inspired you to pursue a career in healthcare?
I spent a summer doing an annual report for Berrien General Hospital [Michigan]. At the beginning of that process, I knew nothing about healthcare. By the end of that summer, I had visited every department. I had talked to the leaders. I had photographed patients and staff. I knew that healthcare was a field that deeply resonated with me. I could see the value to human beings of what was being provided, and the diminishing of suffering is such a wonderful thing. I knew nothing about healthcare. Having gotten out of college, I spent a year working, but not in healthcare. The inspiration to me came from being able to see upfront, close, and personal the impact on people's lives, and I wanted to be part of that.
What are some of the significant changes you have seen in healthcare during your tenure as CEO?
One of the more significant changes over the years has been the changing reimbursement systems and coverage systems. For instance, when I began in 1968, Medicare and Medicaid had just entered the scene, in American healthcare. Suddenly, everyone over 65 was walking around with a red, white, and blue card that gave them access to pretty much any hospital in the country merely because of their age.
A year after Medicare came Medicaid which provided health insurance coverage for low income and disabled citizens. One of the big changes earlier on in my career was not only the expansion of coverage but a very different way of being paid. You didn't negotiate with the federal government for a rate: they set it. In those days, it was cost plus two percent. It was really a wonderful time–spend a lot of money and have a two percent margin, and lots of people were covered with insurance. Those were the good old days.
Over the next 40 some years, the payment mechanism moved from cost plus two percent on the federal side to DRG (diagnosis related groups) fixed payments. That caused the health care industry to begin to look at efficiencies and process improvement because it could no longer drive up the cost and still have a profit.
Finally, in this last decade, we have the Affordable Care Act, which again has the federal government expanding coverage for Americans, particularly at the lower-income levels and for the middle class worker who can obtain significant premium support. But, it's also changing the care delivery system one more time: in a capitated environment the insurer or provider receives a fixed amount of money for an individual, often for a year, and all the components of care must be paid for out of that fixed sum of money. This will require the healthcare industry to shift its focus from one of sickness and being rewarded for the number of sick people treated to a focus on keeping people healthy and well. This is often called population health.
What would you consider the biggest challenge(s) you have faced over the years as CEO?
One of the challenges has always been how to create access for people who still don't have coverage, and to successfully do so within the economic constraints that we have. If you look at the United States today, we still have many people not eligible for either the products on the exchanges (ACA) because they have too much income to qualify and they make too much to qualify for Medicaid. More importantly, the U.S. is not letting illegal immigrants in this country have access to any of these programs, so it's tough financially as health systems focus on providing care to everyone regardless of ability to pay. A big challenge is how to do that and remain economically viable.
The overriding issue for me every single day has been the importance of the people issues: relationships with the medical staff, (and that whole model has morphed over 40 years as well), the management team and the workforce. It is just so critically important to be focused on those relationships every single day, having all of those constituencies of employees, management team, physicians, and governing board be partnered in the delivery of care and how services are organized to deliver a high-quality product that is affordable. A healthcare organization's success depends on its ability to align everyone toward the common goal.
What do you believe has been your biggest accomplishment as CEO?
In a broad sense, I have been successful in building coalitions and partnerships either with other organizations or with key individuals toward a goal of improving healthcare in the community. One example would be the merger that we put together here in Illinois between Provena Health and Resurrection Healthcare. I've been good at gaining trust so that others will join in creating a more dynamic and broader organization.
I did that in Muskegon, Michigan with an osteopathic hospital we brought into our Catholic system there. In Idaho, I was able to build a coalition of small rural hospitals connected in a vibrant and meaningful way with the trauma hospital that I ran. In a broad sense, my accomplishments are about bringing together disparate organizations and people into something that is better, bigger and more powerful at the end of the day.
There are also smaller accomplishments. I started one of the first migrant health programs in the country back in the early 70s. I'm very proud of that. I've had one of the second centers for women's health in the country. I tended to focus on populations that could benefit from increased access to care. In the case of migrants, how do we get them access to care? Today we call them Federally Qualified Health Clinics. In those days, I think they were called Community Health Centers. You had to have a board that was predominantly not providers, not the paid staff of the hospitals, but community representatives. It was a beautiful governing structure that insured that the voices of the community and the patient were heard.
At Berrien General Hospital, we created the second center for women's health in the country. It was modeled after a program in Chicago started by Sally Rynne. The concept was that women wanted and preferred a different relationship with their providers. So we gave them access to their medical records. We gave them longer appointments. We gave them a library so they could look up words and diagnoses that the doctors were spouting. We gave them access to research on pharmaceuticals that were being prescribed. In the early 70s, we were learning that drugs being prescribed for women were based on research that was done largely on men. However, women's bodies metabolize drugs differently. Women wanted to understand the potential risk, as well as the data and research behind what they were being prescribed. It was a wonderful program. I bought an old farmhouse and converted it into a successful health center for women.
When and how did you decide that it was time for you to retire?
I'm not sure exactly when I began to think about something new to do. I tend to plan in calendar years, and knowing that I would turn 70 in 2015, it seemed like the right time to make the transition. I wanted to be young enough to be able to explore other things. I wanted to be able to travel with my husband for longer than a week at a time. Mostly it was just, 'Okay, when you are 70 maybe you don't have that much time left. You should see what else there is out there to do and enjoy in life.'
On the other hand, I just loved what I was doing. I had committed to the board of Presence Health that as the CEO post the merger, I would accomplish certain milestones. When those milestones were completed–I thought it could take three to five years–it ended up taking four. In November 2015 it will be four years into the merger and 95 percent of the heavy lifting of the integration of systems, boards, governing structures, and management is done. Having accomplished those things, I felt I had honored my commitments and could move on to other things.
Did you provide any advice or words of wisdom to Presence Health's new President and CEO Michael Englehart?
We spent about a week together as I did handoffs on major issues and projects. I don't know if I would say it was advice, but I gave him my insights into people issues and potential roadblocks. He is a very bright, well-educated leader who knows a lot about the next era of American healthcare, which will requires health systems to take financial risk for a population of people.
Mike is Catholic. Catholic roots, heritage and values are a very important part of how we run and manage the organization, and those items determine the criteria for evaluating people, projects, and organizational success. I also reviewed the Presence Health sponsorship and governance structure with him.
What are your plans now that you have retired?
My plans are to try to continue to do meaningful work that touches the lives of people, but to do it from a different position–perhaps a governance or board seat, so I'm not in the day-to-day line of fire. I believe that American healthcare has got to shift its focus from sickness to wellness and from volume to value. The more we understand about how to keep people healthy and well, the more we understand that it has to do with social determinants. It has to do with poverty and safe streets, education, the right food, exercise, and access to a less stressful life. I want to help support organizations that are trying to improve the social determinants of health.
One organization I have chosen is Catholic Charities; I will serve on their board. They serve about 1.2 million people every year here in the city of Chicago. They are focused on everything from homelessness to pre-school, and food programs–some of those social determinants that impact health.
Also, I am concerned about how we are educating the healthcare workforce. We have had too much focus on acute care and sick care and not enough focus on community-based care and how to deliver care at home and schools. We must take healthcare to where people live, work, and play and use different models to deliver that care. I agreed to go on the board of the Rosalind Franklin Medical School in North Chicago. I think I can help them evaluate new models of care, and how we have to train our students differently–from a curriculum perspective, from a site perspective, and from what we're looking for in the students, particularly in the area of emotional IQ.
I've been invited to sit on a couple of health system boards across the country. I haven't chosen one yet, but I think that it will be interesting to use what I've learned to help guide another system.
I may do some work overseas. I have a colleague Patty Williams, who runs Global Health Services Network. I've known her for about 20 years. She builds hospitals, builds programs, and supports healthcare internationally. She asked if I would go to Beirut to look at a hospital that Notre Dame University has built and now needs assistance in opening it. It's not the Notre Dame of the U.S., but it's a Catholic University, and the priest there built the hospital, and I am considering assisting him. There is another opportunity in Vietnam. However, I don't want to spend my whole time overseas, but if I could make a difference in creating access to high quality healthcare, I would go.
What inspired to become involved with global health?
Early on in my career when I was running the county hospital, a group of doctors, about 30 or 40 of them at the time, were very involved in international healthcare overseas. In fact, to join that medical group, the doctor had to commit to spending a certain amount of time overseas, and had to agree that 10 percent of the earnings of that physician group would go to support that endeavor. They were committing to going to Africa, Haiti and various other developing countries. My husband, who worked for them, and I would get to go on some of these mission trips. So from early on in my career, I had exposure to third world countries that were operating healthcare on a shoestring and were benefitting from American trained physicians coming over, or even people like myself. Sometimes my jobs entailed sorting medication samples from pharmaceutical companies into boxes or sewing baby blankets. We were all helping with whatever skills we had. We would run clinics that started at seven in the morning and ended at eight or nine at night, where people would walk for dozens of miles to get care. These experiences allowed me to see early on in my career how good healthcare could be delivered with far fewer resources than we deployed in the United States.
Do you have any retirement plans outside the realm of healthcare?
We are going to travel. My family has planned my retirement party in Jamaica the day after Christmas. There are 48 of my family members gathering in three villas on a compound in Jamaica for five days of celebrating retirement and the next phase. We have a trip to Ireland and Wales planned. I have a foster brother who grew up with my family and now lives in Thailand, and we will travel to Thailand and spend some time with him. Travel is on the agenda.
We have a home in Michigan, and I joined a board there, too. It's not really healthcare; it's a not-for-profit organization that works with disadvantaged junior high and high school kids using music and art to help them gain self-esteem.
I'm going to be writing a little. I'm doing research on the women in my family. My grandmother was one of six sisters. They grew up in northern Michigan. All of them, pretty much, came to Chicago to find their fortunes, if you will, the minute after they graduated high school. Several of them became very successful and entrepreneurial in their own rights. One of them, who remained here in Chicago, my aunt Grace, was one of the first women on a TV cooking show, Mr. Pope's Cooking School. I'm going to be down at the Siskel Center going through the archives, trying to see if I can find some of the old tapes. One my aunts had a child out of wedlock, when it was absolutely a very, very bad thing to have been pregnant, unmarried and to have a child. She kept the child. I want to write about her, and what I can learn about what that must've been like [for] her. Another one of my aunts built her own hotel and ran a kind of bed and breakfast with great food that was periodically written up in gourmet food magazines. These were my great aunts; so they were way ahead of their time. They came out of a little rural northern Michigan community. What made them so successful, and not afraid to do what they wanted to do? I'm impressed. I'm writing it for my family, but if anything really good comes up, maybe I'll make it into a real book.
Everyone here at QLK would like to extend a huge thank you to Sandra Bruce for allowing us to share her story. Her longevity as a healthcare leader, and her passion to help others obtain accessibility to healthcare and wellness is inspirational.