CEO in Charge

Few careers demonstrate upward mobility more than Kim Milstein’s. She started as a volunteer at Simi Valley Hospital 17 years ago; today she runs the institution, which has 188 beds and revenue of nearly $28 million. It is owned by Adventist Health in Roseville, a non-profit founded on the health principles of the Seventh-day Adventist Church. Since becoming chief executive last year, Milstein has overseen the opening of the hospital’s new cardiac catheter lab, banned smoking on hospital property and started distributing fruit bowls to employees to encourage healthy snacking. She met with the Business Journal in her office to talk about the economic forces behind hospital consolidation, the need for the Affordable Care Act and her surprise trip to the White House. Question: How has the hospital industry changed during your career? Answer: We are more focused on quality and outcomes. When everyone practices (medicine) in different ways, you can’t always predict the outcome. By following national best practices, you can make it much more predictable. The last 10 to 15 years have focused on systematizing care. How has that affected day-to-day work at hospitals? We are on a journey from what I call volume to value. Traditionally, doctors and hospitals have been about volume. How many patients are we seeing? How many surgeries? The idea was that from repetition, you get better outcomes. Now we are on a transition to value, well-person care. How are we preventing disease and interacting earlier? What is the hardest part of your job? Right now, it’s the unknown. We are on a journey as a country that is incredibly important. How we are going to get through the next three or four years is still undecided. We think we have a vehicle to get to a more affordable health care system, but this is the time of most intense change that health care has ever seen in this country. Getting through that requires a special kind of energy. I’m glad I have a front seat for a time like this, but it is challenging. Is this why so many hospitals are consolidating into larger groups? The Affordable Care Act is a huge driver for change. But frankly, the act is the result of the growing realization that our system is broken and unaffordable. (Health care) is 17 percent of GDP; it’s not something we can afford as a country. We as health care providers are looking to the future, and we realize we will be stronger together. Has the trend affected your hospital? No. I’m fortunate. Adventist Health has 19 hospitals and is A-rated by Standard & Poor’s. We have a strong system, so I’m not looking for that kind of integration. Still, is Adventist Health looking to get more hospitals? Absolutely. We strongly believe in our mission, and if you truly believe in a mission you want to spread it further. Adventist Health acquired a hospital as recently as last year in the Central Valley of California. We are open to partners that share our mission. What is the biggest news about your operation? We’ve worked hard to open the community’s first heart program (in March). Previously, when we had a patient in cardiac distress, we had to ship them out of town to get treatment. Where? Thousand Oaks is the closest. Why did you build your own? There is a lot of clinical literature about how delay in treatment increases damage to the heart muscle. Time is muscle, so we need to get people to treatment as soon as possible. That’s why we decided to invest. Heart disease is the number one killer of both men and women. How much did you invest? Totally, Adventist has invested more than $130 million in this community. (The cardiac catheter lab was part of a $41 million investment.) How does religion fit into your job? Adventist Health in unique, even in the field of faith-based health care. It started about 150 years ago, based on the premise of making people well, not treating sickness. That really appeals to me. At a past time in our medical history when we were prescribing cigarettes to asthmatics and using leeches, Adventist Healthcare was focusing on rest, exercise, nutrition, time with God, time with family – all things that we know are core parts of a healthy lifestyle today. And nowadays? We deliver a big bowl of fruit or vegetables to every department every week. Our employees do hard work, and we need to take care of them like they were our own family. We had a “Walk-tober” in October with competitions to encourage walking. What do you like most about your job? Health care is a sacred responsibility. We have the opportunity to intersect with people at the times of highest vulnerability. So the environment of health care is magic. There’s something special about one person taking care of another. How did you get into this industry? I fell into health care. My husband and I moved to Simi Valley in 1996. I was pursuing my immigration – it’s not automatic like in the movie “Green Card” – and knew I had to wait awhile for my green card. I wanted to do something meaningful, so I came to the hospital to volunteer. This particular hospital, actually. How did that turn into a job? The CEO asked me why I was volunteering. Eventually the hospital sponsored my immigration and offered me a job. I did a four-year “residency,” as I call it, right here in Simi Valley. From there I went to the corporate office. Where? Roseville, outside Sacramento. Then I moved to Glendale Adventist in 2001. I got increasingly progressive jobs. I was in business development for the last six years. Then in July I came here. Was there a culture switch between Glendale Adventist and Simi Valley? The health care itself is the same. The communities are very different. Simi is a multi-generational community. You don’t typically see that in L.A. People live here for generations, call this home and don’t want to leave. Glendale has a lot more diversity – a lot of Armenians, for example. How does the community affect your work? The culture of a hospital reflects the culture of the community. From the selection of restaurants to the signage in the hospital, the Glendale hospital reflects diversity. This hospital is reflective of the family orientation. What is your favorite memory from your career? The most notable day wasn’t in a hospital. At Glendale, we received some appropriations for a rebuilding project. My boss and I flew to Washington, D.C. with a doctor who had a cousin who worked in the White House. We got a behind-the-scenes tour of the White House, in between meetings with legislators. He took us into the press room and I got to stand behind the podium. Who was president? George W. Bush. He did an impromptu press conference on the lawn while we were there. I stood beside the CNN camera and watched him take off in Marine One. It was an inside view of the highest level of our government at work. I never thought I would stand behind the podium in the White House. Finally, what aspect of your personality makes you good at this job? I love people. I love their stories. I can think of no better way to create meaning in a community than to take care of people at their most vulnerable and help people to be healthier. This interview has been edited for clarity and space reasons.