Loma Linda CEO Fike on China partnership, community outreach; her gun in Vietnam
The healthcare industry isn't for the faint of heart.
So says hospital system chief executive Ruthita Fike. She coordinates with physicians, implements government regulations and balances mind-boggling cost structures. It keeps her and many of her colleagues working only slightly fewer hours than the Emergency Department interns' 80-hour workweeks.
Fike oversees the Seventh-day Adventist Church's flagship medical facility -- Loma Linda University Medical Center in southern California, the United States state with the most regulation and lowest reimbursement in the healthcare industry.
Despite tough economic times, the center is pushing ahead with expansion plans. Its fifth hospital campus opened earlier this year and an additional outpatient center will be complete in April. It's another step away from a central model of care to a "hub and spoke" model to better serve its surrounding community.
Known for its care and regional outreach, the medical center is also known as a preferred place of employment. Even before the economic downturn the line to work for the system as a support staffer was as crowded as an ER waiting room.
During an interview in her office, Fike spoke about challenges in the healthcare industry, serving the church as a female CEO and Loma Linda's partnership with Sir Run Run Shaw Hospital in the eastern China province of Zhejiang. The government-owned hospital, run by Loma Linda, was founded by Shaw, now a 101-year-old Hong Kong media mogul and philanthropist. His ongoing relationship with Loma Linda is rooted in a childhood experience of receiving great care from an Adventist missionary doctor.
Fike, 60, holds a master's degree in education and is finishing a Ph.D. at Claremont University. Excerpts follow:
Adventist News Network: Where is the fine line between the hospital's mission and staying in business?
Ruthita Fike: We work hard to fine that line. When the state requires you to do things that aren't part of your faith, you have to accommodate without violating your beliefs. I think most of us believe that as we get closer to the end of time, the world is more stressed, more violent and more in need of Christian healthcare that we're going to have to find a way through those challenges so that we can continue to provide a faith-based option.
ANN: What is this hospital known for?
Fike: Cardiac, cancer (especially with our proton beam), prostate cancer, pediatric -- we serve one quarter of the state with our children's hospital. We're a Level I trauma for children and we have an 82-bed neo-natal intensive care unit. That's one of the largest in the country.
ANN: How does the health care industry compare to the business model of other industries? Is there a business model?
Fike: There is a business model. We're a billion dollar business, these five hospitals. Loma Linda as a whole is $1.4 billion. We're also one of the most complex businesses. We have physicians making orders, who in many cases are not employed by you. Administrators can influence those behaviors but you don't have direct control like other industries.
ANN: How has the process of third party payment affected health care?
Fike: The shift from personal accountability for payment to a primarily third party payment system for healthcare services is positive in that it provided a shared pool for insurance costs, making sure that those primarily impacted by health issues are not disproportionately disadvantaged financially. The counterpoint to that argument is that we have also created a "moral hazard" where access to healthcare is over-utilized since there are few financial constraints on use. An example would be if auto insurance included gasoline -- everyone would drive as much as they wanted since there was no personal cost constraint. That kind of reduced personal responsibility may have served to raise the cost of healthcare as well as contributed to a healthcare shortage.
ANN: What's one of your main challenges now?
Fike: It's a growing challenge to recruit physicians here to southern California. People have options and because of the state regulations, cost of living, it's harder to recruit physicians.
ANN: So how are you able to recruit in spite of the cost of living and sometimes burdensome state regulations?
Fike: We focus on the mission. Loma Linda's reputation and legacy also help us recruit. We have so many directors that [have been here for] 35 or 40 years -- people who have committed their lives to this ministry and we appeal to that. We also have physicians who choose [to work here] because they want to teach and they embrace our mission. If people don't want to do ministry in their work they won't be happy at Loma Linda.
ANN: What's the waiting time like in your Emergency Room?
Fike: Well... it's not what I want. But it's getting better. Wait times for our children's [emergency department] are shorter than for adults. We have a new director and a new medical director in place. I'm anticipating a significant improvement in the next several months. Currently, we're on the outside of average for academic medical centers as well as community hospitals.
ANN: You've said you have to limit applications to work here to about 60,000 a year. Could it be that it's just easier to fill out applications online nowadays?
Fike: Our market research says we're the preferred place to work in the region. I've talked to other CEOs and they're not having nearly the numbers of applicants that we have.
ANN: How long do administrators from [Sir Run Run Shaw] work at Loma Linda for training?
Fike: It can be a few weeks or several months, depending on what they're training for.
ANN: What do people in China know about Loma Linda?
Fike: There's definitely an awareness of Loma Linda in China for what we've accomplished over 15 years. [Sir Run Run Shaw was] the first public hospital there to receive joint commission accreditation and they received a lot of national publicity as a result.
ANN: What are your goals there now?
Fike: What we're trying to do now is to expand, build upon that as the site where other people in the country would come and see how to do healthcare. We're partnering particularly with the children's hospital but they have nine hospitals and it's part of Zhejiang University. I think it's the number three university in that country.
ANN: What sets that system apart in China?
Fike: Values. They openly talk about compassion and love. You don't hear a lot about that in other Chinese hospitals. We've seen some other healthcare organizations work in China and they've struggled. What worked is that Loma Linda supported them for altruistic reasons. We didn't go in there trying to make money; we were trying to contribute to the elevation of healthcare in a country with need.
ANN: What's it like to be a woman in a field dominated by men?
Fike: There are more women hospital CEOs than there used to be. There aren't many [managing] a system of hospitals like we have at Loma Linda, however. I think positions like these are always stressful and I think for women it's even a little more challenging because there aren't as many natural mentorships. I think women in church leadership have a little more of a lonely journey than their male counterparts.
ANN: Why did you choose to go to Vietnam in 1970, when some people were burning their draft cards in the street?
Fike: It was the first time in my life I felt a calling. I looked at the list of opportunities for student missionaries and I truly felt called there. As it has turned out, it was a life-changing experience and it veered me toward health care as a career.
ANN: How were you able to vaccinate 175,000 people from diphtheria in a year there?
Fike: With a vaccination gun. You can vaccinate hundreds in a day. The gun is air pressurized to hold against the person's arm. The vaccinations can go very rapidly. I haven't seen that kind of vaccination gun in years.