One of These Docs Is Doing Her Own Thing

And it’s working. Dr. Patricia Gabow’s remarkable turnaround of Denver Health has made it a national model for public hospitals. And it just may be a blueprint for health care in the United States.

So, this staff meeting: It starts off looking like what you’d expect a super unexciting hospital staff meeting might look like. The mothership of Denver Health Medical Center is a 477-bed hospital that sits prominently on the corner of Speer Boulevard and Bannock Street. It’s comprised of several buildings spread over several blocks. On this day, in the basement of the hospital, in a large classroomlike room, some 80 doctors, nurses, and administrators are gathered. As Gabow’s staff mills about, filling all of the available seats and standing along the walls, she enters virtually unnoticed. She’s so small that in a crowd—a crowd of people who are tall enough for the big-kid rides at Elitch Gardens anyhow—she’s difficult to spot.

Where, where…. Oh, there she is.

She steps onto a raised platform and pops up behind the podium’s microphone—all creamy and smiley—and begins as if she’s picking up in the midst of an ongoing conversation. Still effortlessly harnessing that power of projection on display in the elevator moments earlier, she says, “I think some of you heard I was a secret shopper this week. I was in the ER.” Gabow explains that she’d been playing tennis with her husband. She almost never beats him. On that particular day, though, she was up 30–love, rushed the net, injured her knee, and fell to the ground. Gabow tells the room that as she lay on the court, her husband uttered what could have been a “marriage-ending comment: ‘See, I told you winning isn’t everything.’ ”

The room cracks up. Gabow’s delivery, and the audience’s reaction—the knowing glances with raised eyebrows shared among her employees—makes clear that what made her anecdote so funny is that everyone who knows her knows that while her husband of 40 years was joking, good old, soft-spoken Hal Gabow was not entirely kidding. The humor was in the extreme understatement. Gabow is always rushing the net to win.

Why, she’s barely taken a breath after her opening ice-breaker when, stat-like, she starts talking about “Black Belts”—not the break-a-board-with-your-forehead kind of Black Belts, but rather cost-chopping Black Belts—and “Value Streams” and “Rapid Improvement Events” and “Lean” and the “Shingo Prize,” which, evidently, is some kind of prize awarded to especially efficient manufacturing operations. Gabow thinks Denver Health can be the first-ever hospital not only to enter, but also to win. None of this is the sort of talk you were expecting to hear in a hospital, let alone a public hospital.

Public hospitals are operated and funded by governments, and serve as communities’ safety-net health-care providers. These hospitals are the polar opposite of private, for-profit hospitals, where the policy is essentially no shirt, no shoes, no feeling in your extremities—no problem—we’ll make you better, provided, of course, you’ve got coverage or can otherwise pay up. According to the Colorado Hospital Association, 63 percent of Denver Health’s patients are on Medicare or Medicaid, and only 9 percent of the hospital’s patients have commercial health insurance. As Gabow puts it, “Not exactly the best business model.”

Of the nation’s nearly 5,000 hospitals, a full one-fifth of them are public, and many are so in debt they’re cutting services, closing, or their municipal owners are selling the hospitals to for-profit companies. The ever-increasing health-care costs, the rising number of uninsured patients (especially with the record number of unemployed), along with cuts in Medicare and Medicaid, have had a devastating effect. According to the American Hospital Association, between 2003 and 2008 the country lost 16 government-owned hospitals. Yet, despite the national trends, everything at Denver Health is relatively spectacular.

As Tom Nash, vice president of financial policy at the Colorado Hospital Association, told me, “Denver Health has national recognition for the things they do. The fact that they can turn a margin is a testament to the fact they are working as efficiently as possible. They are nationally renowned.” In fact, as Gabow points out to her staff in this morning’s meeting, there’s a reporter from SuperImportantHospital magazine roaming the halls to find out how they’ve been doing it. The answer has everything to do with Gabow and a whole lot to do with these Black Belts, Value Streams, and Rapid Improvement Events she’s talking about.