Dr. Susan Turney is CEO of Marshfield Clinic Health System in Wisconsin. She served as a clinician at Marshfield Clinic for 25 years, then left for a decade before returning as CEO in 2014 to lead the organization through a massive integration process.

The core of the organization’s mission to enrich lives and care for the community has remained consistent throughout the decades, even as the operations and organizational structure have changed.

We spoke with Dr. Turney about developing a vision for Marshfield’s future and then implementing it in projects ranging from employee engagement to purchasing Saint Joseph’s Hospital in Marshfield, WI from Ascension.                                                                                                                                        

Quotes have been lightly edited for clarity 

How do you define “visionary?”

Turney: It’s really about the personal qualities one needs and the skillsets that one has. It’s also about board management and organizational characteristics. It’s thinking about and planning the future using one’s wisdom – but also imagination – and creating an opportunity for growth. Some of the attributes that are important are being bold, seizing opportunities and always aspiring to improve. Personally, it’s having thick skin. You also need to build a team you can trust and to delegate effectively. And you must be a good listener.

Talk about what it meant for Marshfield Clinic Health System to be bold. 

As I started off on this journey nearly five years ago, we had to develop a new mission, vision and values. We were changing as an organization. We had not owned hospitals, and we were becoming a fully integrated health system, going from a 100-year-old ambulatory care practice with hundreds of providers to a hospital-based system with a health plan and our wonderful clinicians.

So it was really about bringing people with us. It wasn’t either grassroots or top down, it was both. It was a collaboration. If you don’t have the infrastructure of trust and listening, and if you haven’t sought feedback and collaboration on your mission/vision/values from your entire staff, it’s really hard to be bold and successful.”

Did the vision come first and then the business model, or was it the other way around?

Healthcare is changing. The models of care delivery are changing. And the payment mechanisms for providing services are changing.  Health is so much more than the care that we provide within the four walls of our institutions. It’s more about our patients, families, communities than it is only managing acute and chronic illnesses.

When we looked at where we were as an organization, we realized first that we had very little ability to control the cost of care if we didn’t have acute care. We had good partnerships with the hospitals where our physicians admitted patients. But those were pretty expensive sites of service. Having the health plan and having a defined patient population, we knew that if we could take care of our patients throughout the entire continuum and were responsible for managing the costs, then we could better serve our communities and go beyond the sick-care model.

So it was it was a little bit of both business model and vision, kind of looking at what’s going on inside and outside and try to figure out the best pathway.

Did you work to align the new organization with the broader community as you cast the new vision?

Marshfield Clinic Health System has a clinic, a research institution, a foundation, an educational division, a health plan and some other small for-profit businesses. That was the internal view. The external view meant going to some of our business partners, vendors, other relationships that we have, as well as community members in over 60 communities. Healthcare is often a big employer in those communities, and when things change, or if people see the potential that things might change, they see it as very critical to understand where we’re going, what we’re doing and how they can be part of our future. The main center is in Marshfield, Wisconsin. We have nearly 6,000 employees in a town of about 18,000. Everyone is connected to the clinic.

We were looking to build a hospital in Marshfield because at that time Ascension was not willing to let us acquire the 500-bed teaching facility in the community. We knew there was risk in a launch strategy where we did not have that hospital because it was tied to graduate medical education, to a lot of our research and nursing training. It was a very important part of who we were as an organization, as well as a part of the community. But ultimately, Ascension gave us the opportunity to acquire the hospital. And I would say that it had a huge positive impact on the community.

What did you bring back after your time away from Marshfield Clinic?

When I was at the Wisconsin Medical Society, I got a much broader and deeper understanding of the Wisconsin landscape, certainly large integrated health systems and the unique opportunities that they bring to provide full spectrum of care and engage deeply in the health and wellness of our communities. When I served as CEO of the Medical Group Management Association (MGMA), it became the whole national landscape. MGMA has about 33,000 groups in the organization. I had an opportunity to visit every state and practices within every state, from very small rural to very large, urban, single, multi-specialty facilities. It helped me formulate a lot of the ideas around what one would need to come in and lead a very rural healthcare system with a population that is older, sicker and poorer than most other areas of the country across a wide geography over 40,000 square miles. So, that 10 years away gave me so much insight and awareness, both at the state and national levels, to really mobilize the resources and opportunity to forge the changes that are necessary to position us for the next 100 years.

You mentioned that people stay at Marshfield Clinic Health System for years, their whole career. How do you keep people inspired and engaged towards the vision?

We wanted our vision to be ambitious and to be inspiring, and we wanted to compel the organization to really reach high and move forward in a very clear direction. But buy-in is essential. If the people aren’t with you on the ground floor, you can’t expect them to be with you a year or two or five down the road. Understanding that piece is critical. And it’s hard to buy into a vision if you don’t understand the ‘why’ behind it. That really needs to be established early in the process. And then it’s an ongoing process. You have to talk about your vision, but if you don’t tie it to the strategic steps that you’re taking so that people can correlate the vision to the direction of the organization, it’s a big challenge to succeed. A vision has to be embedded in the culture, the culture is created through conversation, and we have to constantly talk about it, revisit it.  So, it’s kind of simple. It makes sense as a business strategy. But it’s an immense challenge and it’s a grind. To have that vision demands a lot of tenacity, a lot of zeal, a lot of resilience.