Many quality improvement professionals would like to move into a C-suite position one day, but the path from quality to hospital executive is not always clear. A quality professional in Kansas has made that transition successfully, noting her background in quality, safety, and compliance will serve her well in the new position.
Melanie Urban, RN, BSN, HACP, recently was named administrator of the University of Kansas Health System Pawnee Valley Campus in Larned after serving as director of patient quality services at HaysMed, another hospital in the university system, for 10 years. During her 26-year career, Urban has served as a director of quality, accreditation, and infection prevention, as well as a risk manager, case manager, and acute care nurse. She also has worked in utilization review and discharge planning.
“I built my career and got a lot of department experience underneath me. Then, about five years ago, our focus in the organization really started moving to a higher level of safety, quality, and patient experience,” Urban says. “I started shedding some of the departments underneath me to start building up the quality program.” Urban says her background in quality improvement helped position her well for the administrator role when it became available, but she says it was no accident. Urban always saw quality as the vital link to all aspects of healthcare and worked to gain the experience that she thought would lead to an executive position.
“I always tell people I worked in quality when quality wasn’t cool. Fifteen years ago, a lot of people didn’t even know what it was, thought it was just a lot of measuring and checking boxes,” Urban recalls. “I think it’s come to the forefront now, and it absolutely is the focus of the system now.”
The University of Kansas Health System acquired HaysMed in 2017, and that is when Urban saw an opportunity to move up. The university health system wanted to provide all Kansans with the same kind of care they provide their own patients, and they were a little further along with that quality approach than HaysMed, Urban says.
“As we transitioned into the system, I started focusing mainly on quality, accreditation, and patient safety,” Urban says. “I lost some of the other departments that had reported to me because we needed to devote more time to quality if we were going to fit into the University of Kansas Health System’s approach to quality of care. We developed score cards that were very transparent on patient harm and associated score cards just to set the bar and get people motivated.”
Urban led HaysMed in changing its entire mindset about quality improvement and patient safety. Previously, the hospital had focused on rates. However, with Urban’s direction and support from the health system, the hospital started adhering more to the idea that one incident of a patient fall or other harm is too many. “We started motivating people to know when their last fall was, to the day, so that we could encourage and celebrate when we go 30 days, 60 days, 90 days without a particular form of harm happening,” Urban says.
Urban says she had her eyes on a leadership role for some time before the opportunity arose. HaysMed had begun working with the Pawnee Valley campus of the health system in 2009, and Urban frequently visited the campus in a quality and risk management role.
The University of Kansas Health System Pawnee Valley Campus, formerly Pawnee Valley Community Hospital, is a 22-bed critical access hospital. “I fell in love with the organization and thought that was the size of an organization I could be an administrator for. It was something that fit my skill set and what I enjoyed doing,” Urban says. “I started trying to help as much as I could here on the Pawnee Valley campus and become someone they could depend on.”
Urban started working on her master’s degree in healthcare administration two years ago and is about halfway through her program. She also joined the American College of Healthcare Executives (ACHE), which helps healthcare directors who want to move on to CEO, administrator, and similar roles. Urban participated in several of the group’s webinars and other activities as she prepared herself for leadership.
“I wish I had finished my master’s degree before this position became available ... I always encourage people to get a master’s degree in something that would lead to an executive position if that is their eventual goal,” Urban says. “I also made sure I spent a lot of time with the vice presidents at HaysMed to learn and watch.”
Reaching a top leadership position is not something that typically happens without the person striving for it in a purposeful way. It is rare that someone in quality will be cruising along with no particular effort to advance and then be tapped out of the blue to take a role like hospital administrator, Urban notes.
“You have to have a target and create a plan for getting yourself there. I let people know that I was interested,” Urban says. “The administrator at HaysMed and our vice presidents knew, which is helpful because they can start grooming you for the position you want. They start seeing you in that role because they know you’re interested.”
Other hospital leaders may be surprisingly helpful once you voice your desires to take on a similar role, Urban says. They probably will provide more useful feedback and direct you to career advancement opportunities that eventually could lead to your desired position. “Even during my evaluations, they would provide feedback on my current position but then also add advice about how to proceed if I want to reach a senior leadership role,” Urban says. “It’s important to let people know what you’re interested in. You might receive more assistance and encouragement than you anticipated.”
One benefit for Urban was the location of Pawnee Valley Campus, about an hour south of HaysMed. Urban’s husband farms in the HaysMed community, so taking a leadership role in any hospital farther away would have been a family hardship. But even living an hour away was a hurdle in the beginning.
The health system originally wanted an administrator for Pawnee Valley Campus who lived closer to the hospital, but they relented after losing a few administrators who fit that criteria but did not last long because they viewed the position as a stepping stone or because they just didn’t fit with the organization. “Five years ago, I had conversations with them about this position, but they were wanting me to move here, so I had to just let it go,” Urban says. “I think they realized that it was more important to find the right person vs. the person who was willing to live there.”
When the position became available again, Urban applied and did so without relying solely on the groundwork she had laid over the years. Rather than working only through her connections and assuming the relationships she had cultivated would win her the role, Urban applied for the position as if she were an outside person.
Urban used the ACHE résumé assistance toolkit, studied, and participated in practice interviews, even though the interviewers would be people with whom she already had close working relationships. “I decided I was going to lay out all my cards and do everything I could to go after this position,” Urban says. “I formally applied, with cover letters and treating everyone as if I were applying from outside the health system and not acting as if I had some inside line to this because of the people I knew. I wanted them to take me seriously and not just keep me in their side pocket as someone they could hire if the other person they hired didn’t work out.”
She was interviewed nine times, including a whole day of interviews with leaders at Pawnee Valley Campus, community member interviews with her and her husband, and an interview with the health system CEO. “I feel like I earned the position. You want to come in here knowing that you are the one [leaders] wanted in this position so you feel supported,” Urban says. “I feel extremely supported throughout the system and here in this facility. I was in a position at HaysMed where I could build relationships here. Now, I try to capitalize on that.”
Urban says her background in quality will shape her role as administrator at Pawnee Valley Campus. Such a background clarifies what is important as an administrator. “Some administrators think it is all about business and financials. They spend a lot of time in their office. That’s not how I see it or how the health system sees it,” Urban says. “I’ve made patient care the priority. My focus is on seeing what’s going on in the organization and measuring it. I’m all about looking at patient outcomes and measures because that tells you the true north of how your organization is doing.”
The focus on quality helps Urban make decisions for the organization that will put the patient first. “Historically, we have seen administrators in organizations who were accounting- or business-driven and maybe don’t see that aspect as clearly as I do,” Urban says. “I wanted to come down here and spend more time making sure that we were meeting all our goals for sepsis bundles, stroke, chest pain, [and] patient outcomes ... they just needed someone to keep that quality focus at the forefront because that is what is going to make this facility successful.”
Urban also wants to improve employee engagement, which she says is vital to improving quality and safety and measuring the right patient safety and quality factors. Further, she wants to emphasize communication about those quality measures with the facility staff as well as within the health system.
“Communication has not always been a strong point here but it is important. If people know the purpose behind things and are included in the decision-making, then your outcomes are better,” she says. “We want to keep the medical staff, the hospital staff, and myself all in line as an organization and moving toward the same goals. You set goals with your strategic plan but also with your quality measures.”
Urban encourages quality professionals interested in leadership positions to set a goal and stick with it. Landing an administrator or similar role may take time. However, Urban recommends using that time wisely so as to be prepared when the opportunity arises.
“Stick with it,” Urban says. “I’m probably more prepared now than I ever imagined I could be. Even if you’re not in an administrator position now, you can be confident that you will be that much better prepared when the time comes.”
- Melanie Urban, RN, BSN, HACP, Administrator, University of Kansas Health System Pawnee Valley Campus, Larned. Phone: (620) 265-8663. Email: firstname.lastname@example.org.