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.

Dr. Frank Judson was one staff member not thrilled by the hire. Judson had attended medical school with Gabow at Penn, and he’d worked with her for more than two decades at the hospital. He thought she was an unlikely candidate for head of medicine. Because her research, and her career, had been so specific, Judson says, unlike an interdisciplinary area of medicine—such as his specialty, infectious disease—he believed she lacked a broad understanding of medical and hospital operations. “There was nothing,” Judson says, “about her at the time that would have foretold her rise.”

Naturally, Gabow didn’t see it that way. Like Sister Marie Scott, she felt quite comfortable wading into these waters. “I think being on the research side is important,” Gabow says. “It means I like to innovate. I like to find new ways of doing things. I like to ask questions: ‘Now, why are we doing this?’ ” As director of medical services, she began reviewing the hospital’s operations, which she knew were not going well.

During 1991, that first year of the Webb administration, it seemed like every time the nearly seven-foot-tall mayor turned around, there she was, with that smile that conveyed, Hey, remember that thing we talked about—you giving me Denver General? There was a precedent: In 1989, University of Colorado Hospital left the state system and became a self-managing not-for-profit. Gabow made her case to Webb, repeatedly, until one day he asked her, “Are you ever going to get off this?” And she replied, “As soon as you say ‘Yes.’ ”

Webb was looking at that $38.9 million deficit, and although he was personally committed to the hospital, the politician in him might have considered Gabow for other reasons. If her plan worked, Webb would be remembered as a civic hero. If it tanked, well, hey, he’d tried something bold and new. In 1992, he appointed Gabow the manager of Denver Health and Hospitals, which meant she was now both the director of medicine and the hospital’s chief executive officer. If Webb had been looking for a way to give Gabow and her ways a trial run, this was a pretty smooth approach.

Gabow and her husband, Hal, have two children, and at the time of her appointment to CEO, her then teenage son asked his mom, “How are you taking a job for which you have absolutely no training?” Gabow gave her son the answer she’s given everyone who’s ever asked that question: “I looked at this job like I looked at patient care: You get problems, you need a diagnosis. Then you need a treatment plan. Then you need to monitor the treatment plan. And if the outcome isn’t what you want, you have to go back and change the diagnosis and change the treatment.”

Over the next two years, Gabow, working with her co-manager of business operations, Tom Moe, did some amazing institutional triage. By 1994, the hospital was operating with a $60 million surplus—a two-year turnaround of almost $100 million. Moe, now deceased, and Gabow streamlined the billing system, reducing the amount of time before a bill was paid from 150 days to half that; encouraged physicians to buy less expensive equipment; and generally held down expenses.

In 1994, Webb began supporting the idea of making the city hospital an independent “authority,” and that created the political momentum that helped persuade the Colorado Legislature to authorize independent status for Denver General. In 1996, the mayor took center stage at a press conference in which he announced Denver General was changing its name. Denver Health, he said, was more than a name change: It reflected the hospital’s new, clean bill of health.

It was toward the end of the second of Webb’s three terms as mayor, in 1997, that Gabow got her wish and Denver Health was officially recognized as an autonomous authority. It defined itself as a “public safety-net hospital for the city and county of Denver,” meaning its mission was still a city hospital mission, supported by government funds, and the mayor still had sway over the hospital board. But the hospital was now unfettered by the city’s civil service regulations and so much of the bureaucratic red tape. Where it mattered, the hospital honchos now made the decisions—which meant, in essence, that Gabow made the decisions.

The longer she was there, the better the hospital performed, financially and medically—yet with each year, Gabow felt like there was much more that could and should be done. “Even though we had new drugs, new technology, new buildings, all that stuff,” she says, “the core of the way we did things really was not different. This began to frustrate me. Try to think of almost anything else that’s really good that hasn’t changed in 40 years.” By 2003, Gabow decided that she really wanted “to blow this up and start up again.”