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HR veteran Trummell Valdera is passionate about making the Jackson Health System best-in-class.
"I like challenges,” says Trummell Valdera, SPHR, senior vice president and chief human resources officer at the Jackson Health System in Miami. And she found plenty of those when she came to Miami in January 2004 to help CEO Marvin O’Quinn “transition this health system to a world-class center of medical excellence.”
O’Quinn had been hired six months earlier to turn around the large public institution, which was suffering from serious financial problems. When he arrived, the HR department was in “disrepair” and he wanted the function—which had not been valued in the past—to be a strategic partner in the change effort ahead.
As he began searching for a new HR leader, O’Quinn was looking for someone with extensive HR experience, including experience with unions. (“Without [union experience] you’d be eaten alive here,” he says.) He also wanted “a builder,” someone who could repair the health system’s fragmented HR function. In addition, O’Quinn was looking for someone with a national reputation.
He soon realized that Valdera filled the bill on all counts. “She was all business when I interviewed her,” he says, “and I liked that. She told me what she would do, and she asked me some tough questions.” She had headed HR departments at top-ranked hospitals—The Johns Hopkins Hospital in Baltimore and The Children’s Hospital of Philadelphia—and had handled labor strikes and numerous contract negotiations.
He was particularly interested in Valdera’s labor union experience. “We could be the most beloved managers,” he says, “and I don’t think it will make a bit of difference. [Unions are] part of the political and cultural landscape here.”
In addition to having the skills and experience he was looking for, Valdera had another essential qualification: “It also comes down to personalities—who you can work with,” says O’Quinn, “and we were on the same wavelength.”
From Social Work to HR
Valdera thought she was on track to become a clinical or industrial psychologist when she graduated from Pennsylvania State College with a psychology degree. However, her first job, as a social worker in Philadelphia working with delinquent adolescent girls in a group home, soon convinced her that this “very depressing” work was not for her. When she was hired to recruit female minorities for a health consortium in Philadelphia, Valdera discovered a “passion” for HR, and her career path was set.
After HR jobs in the banking and retail industries, she began an eight-year stint at The Johns Hopkins Hospital in 1978. There, Valdera began to learn about labor unions and became involved in contract negotiations for the hospital. Although not a lawyer, she says she was fortunate to be mentored by an attorney at a top Baltimore law firm.
In 1987, Valdera, who says she “inherited an entrepreneurial spirit” from her father, decided the time was right to strike out on her own as an HR consultant. “I was one of the first to be certified as an SPHR” in the mid-1980s, she says—a step she took because she thought it would improve her credibility.
While she enjoyed consulting, she found she didn’t enjoy the marketing effort it required. In 1989, she accepted the job of director of human resources at the Group Health Association of Washington, D.C. (now Kaiser Permanente), because “I thought it would be a good opportunity to learn another side of the [health care] business,” she says.
The health maintenance organization ran into financial difficulties, however, and Valdera moved back to her hometown in 1991 to become vice president of human resources at The Children’s Hospital of Philadelphia. At Children’s—as at Hopkins—Valdera found herself dealing with labor strikes that drew national attention.
When her mother became seriously ill in 2001, Valdera left Children’s to care for her. Although she did some part-time consulting work during that period, most of her time was devoted to caring for her mother until her death in 2003. “I feel good about that decision,” she says. “I feel blessed that I had her a year longer than we expected.”
When Jackson Memorial recruited Valdera, the timing was right. She was ready to return to full-time work, and she was attracted by the opportunities and challenges of the job.
Turning the Ship of State
“It’s a huge undertaking [Valdera] walked into,” says Jane Mass, senior vice president and chief nursing officer. “You’re turning a huge ship of state here.”
Jackson Memorial Hospital, the flagship facility of the huge health care complex, is the public “safety net” hospital for half a million Miami-Dade County residents (a quarter of the population) who have no health insurance and nowhere else to go. As the only public hospital in the area, the system’s 37 health care delivery sites provide half a million dollars in charity care annually—almost half of the tax revenue the hospital receives.
Jackson is also an academic teaching hospital for the University of Miami School of Medicine and a regional tertiary care referral hospital with the only Level 1 trauma center in South Florida. In addition to serving Miami-Dade County, the Ryder Trauma Center trains U.S. military personnel being deployed to Iraq and other war zones.
Because it receives public funds, Jackson is heavily scrutinized under Florida’s so-called “sunshine laws.” Beset with bureaucratic red tape, the institution has been “hemorrhaging” financially for several years, says Valdera. Labor unions are firmly entrenched, “probably because of poor decisions in the past,” she says. In addition, Miami-Dade County commissioners have oversight for the institution and must sign off on all labor contracts, so every decision has political ramifications.
With only 20 percent of its revenue coming from tax dollars, says Valdera, the hospital must find the other 80 percent from the same kinds of private funding sources available to the private hospitals with which it competes. “We need to learn to think and operate differently,” she says, “to function more like a private institution.”
Change in Action
Before Valdera’s arrival, the HR department had long been in a “reactive mode” under a series of interim leaders, says Sandy Sears, senior vice president for ambulatory services and community health. Sears credits Valdera with making significant improvements. “She increased productivity tenfold and more,” she says. “She turned around the HR department, which shows what good leadership can do.”
One of Valdera’s many changes was to reorganize the recruiting function into a single entity that handles recruitment for all positions, including doctors and nurses. Previously, says Mass, the nursing department handled its own recruitment.
In addition, Valdera laid the groundwork for contract negotiations with the organization’s six labor unions, which represent 92 percent of the staff—including doctors. In the past, the relationship between labor and management had been adversarial. In promoting a partnership between the two, says Mass, Valdera helped set the stage for “what I think is a more sound way to proceed.”
Mass also praises Valdera’s “great communication skills,” which are critical given the diverse employee population. Because the employees are so diverse, the hospital routinely uses translators. For example, when Valdera installed an employee hotline during recent labor contract negotiations, she made certain it was available in English, Spanish and Haitian patois.
Perhaps most impressively, Valdera rapidly implemented change with existing staff. “She did it quickly,” says Mass, “and she did it with the same people. She didn’t come in and fire everyone.” Instead, says Mass, Valdera was able to motivate current employees to better serve their customers, both internal and external.
Uncovering Hidden Talent
Valdera began by assessing the current staff and was “delighted to find skills that hadn’t been used. I did a lot of restructuring and reassigning of staff,” she says, as she set about changing a very hierarchical structure into a flatter operation.
Rosa Ruiz, who reports to Valdera, is an example of an employee with untapped skills. Her lengthy title—director of human resource management systems, compensation and records, and human resource capital management—illustrates the increasing responsibilities she has assumed under Valdera.
Ruiz, who has worked in HR for 24 years, has been at Jackson Memorial for 13 years in various systems analyst roles. “Some of us knew we could play a good role for the hospital,” Ruiz says, “but we didn’t have the support in HR until Trummell came. We didn’t know how to sell [our ideas], but Trummell did.”
Ruiz, who has a degree in computer science, says the hospital’s HR management systems were outdated and the bureaucracy and “politics of being tied to the government” made it difficult to make the improvements she knew they needed.
“Trummell defended the HR function to the institution,” says Ruiz. “She has the knowledge and the energy, and she also has the power [to get things done].” What is even more encouraging, she says, is that Valdera has, in turn, given her employees power. “She brings us to meetings and keeps us informed about what is going on at the hospital. And she knows about everything. She even knows about [HR] systems and what is needed,” which many HR leaders delegate to others, Ruiz says.
Working at a busy hospital like Jackson, says Valdera, is like living in a soap opera. “Two out of three soap operas and TV dramas are built around health care,” she says, because the high stress and “craziness” of the environment attract viewers and health care workers alike. “Walls between staff and patients are broken down in such an intense, 24/7 environment,” she says.
As Ruiz puts it, “You are always dealing with crisis in a hospital. [Staff] thrive on it—or you leave.”
The dramas that play out daily in the emergency room and the trauma center are reflected in the executive committee meetings at Jackson Memorial as the institution grapples with the complexities of running a large public hospital.
“It’s increasingly difficult to make ends meet,” O’Quinn says. Although only 20 percent of the organization’s funding comes from tax dollars, the hospital must accept all Miami-Dade County residents, regardless of their ability to pay. In addition, it has had a tradition of accepting indigent patients from anywhere—including some from as far away as Latin America and the countries of the Caribbean Basin.
Compounding the hospital’s problems, says O’Quinn, are the “extraordinarily onerous labor contracts with high salaries that are at least 20 percent to 30 percent above marketplace. That’s not a proper use of our tax dollars,” he believes.
O’Quinn says the hospital can’t afford to continue the open-door policy of the past. “That is no longer our vision. Our vision is to be a first-class medical center that provides a single standard of care for all residents of Miami-Dade County.”
To do that, he says, they need to take on more private patients and operate more like their competitors, which are the private hospitals in the area. O’Quinn, Valdera and others on the executive team expect the struggle to change an “entitlement” culture to a performance-based culture to take at least five more years of intensive effort.
Jackson Memorial staff share a strong sense of mission about this effort. In spite of the hospital’s serious problems, longtime employees like Mass, who has been there more than 25 years, and Sears, a 30-year veteran, say they’ve never considered leaving.
Valdera, who has worked at two nationally ranked private institutions, knows what it takes to be best-in-class, and she’s determined to help Jackson reach this level.
Everyone at Jackson Memorial realizes that the stakes are high. “If this hospital fails,” says O’Quinn, “so many will be denied health care.” In addition, he adds, the hospital generates more than $2 billion worth of economic activity in the form of jobs that would be lost to the county. “We provide careers to many in the community who wouldn’t otherwise have the opportunity [to build a career],” O’Quinn says.
To take Jackson to a new level of excellence, continue to provide high-quality care for the indigent and attract more private patients to improve its fiscal health requires teamwork, says O’Quinn, and Valdera is an important member of that team.
“We can’t get the job done without her,” he says.
Ann Pomeroy is senior writer for HR Magazine.
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