Crunching numbers, building consensus

HEALTHY OUTLOOK: Mary T. Wakefield, chief financial officer at Lifespan, joined the health care provider in 1997 and became its CFO in 2002. She has helped produce operating gains during her entire tenure in the position. / PBN PHOTO/RUPERT WHITELEY
HEALTHY OUTLOOK: Mary T. Wakefield, chief financial officer at Lifespan, joined the health care provider in 1997 and became its CFO in 2002. She has helped produce operating gains during her entire tenure in the position. / PBN PHOTO/RUPERT WHITELEY

Ever since Mary T. “Mamie” Wakefield was 16, when she first cashed out the day’s receipts on the register at the gas station where she worked and was thrilled to get everything balanced to the last penny, she knew that she wanted to pursue a career in accounting and finance.
Now, as senior vice president and chief financial officer at Lifespan, Rhode Island’s largest hospital system – and with a much more difficult challenge in balancing the bottom line than at the gas station – she still loves crunching numbers.
“This is my ideal job. I love being CFO,” Wakefield said. She spent the first 17 years of her career as an accountant working with KPMG. She joined Lifespan in 1997, and has served as CFO since 2002.
Her impact on the hospital’s finances has been impressive. When Wakefield arrived in 1997, the system was reeling from a $50 million loss. Under her guidance, the system’s financial underpinnings were stabilized. During the last 10 consecutive years, from 2001 through 2011, Lifespan has realized operating gains.
Over this same period, Standard & Poor’s and Moody’s ratings for Lifespan’s bonds for Rhode Island Hospital, The Miriam Hospital and Bradley Hospital have improved from BBB and Baa2 to A- and A3. As of March 6, Moody’s downgraded its ratings for Lifespan to Baa1 from A3.
Lifespan’s return to financial stability enabled the system to invest in nearly 2,000 additional employees and to make more than $500 million in capital improvements, as well as upgrades in new equipment and technology to facilitate better, safer patient care and an enhanced work environment.
One of the secrets of her success, Wakefield said, is her ability to translate the numbers into a compelling story. “When I came to Lifespan, there was a whole world of people who didn’t like numbers,” she said. “They didn’t enjoy working with them.” Part of her job, Wakefield continued, was to illustrate the numbers so that people could understand what the numbers meant. It proved to be a successful strategy in sharing the financial facts and getting them onboard, she said.
Another successful management strategy employed by Wakefield was to bring together all the different affiliates and discuss – as a team, rather than as competitors – the priorities for capital improvements from a system perspective.
“At the beginning of the process, we identify how much we think we can afford, looking at our budget,” Wakefield said. “Clearly the CEO weighs in and narrows down that range. Then we bring all the affiliates together and look at not only what needs to happen next year, but what the needs are over the next five years.” The result, according to Wakefield, was that through the cooperation of all the affiliates, by listening to the needs of each hospital, the priorities of the projects were determined.
As an example, Wakefield cited the way the group agreed that focusing on the deferred maintenance at the power plant at Rhode Island Hospital was an immediate priority, taking precedence over the need to replace patient beds at The Miriam Hospital.
In creating a uniform information technology platform across numerous hospitals, Wakefield adopted a similar strategy of building buy-in through consensus from clinicians as well as administrators.
“We wanted to become as efficient as we could, and from an administration perspective, that made sense, to have everyone working from the same platform,” she said. “From a clinical perspective, because clinicians have the care of patients foremost in their minds, we went to them and explained how it would be better for patients, and safer,” she said. As a result, physicians and nurses were all glad to make the changes. Now, she continued, “it’s all so comfortable and common, everyone has probably forgotten the bad old days when there was lots of paper.” As hospitals adapt their business models to reflect the change in reimbursement strategies that are moving away from volume to value, Wakefield is realistic that there may be some tough years down the road. “From the patient-care perspective,” she said, “it’s always about value and patient outcomes. Our clinicians practice medicine in the best way they know how.” However, she continued, now that hospitals and providers will be paid differently, it will require a few difficult years for hospitals.
Wakefield’s forthright approach to the coming financial challenges reflects her successful leadership qualities in addressing the issues with honesty and directness.
“We are taking on risk for patient populations. We’ll get paid a certain amount for that patient’s well-being,” she said. “From our perspective, we need to make sure we understand the needs of patients when they are not in the hospital. I think it’s going to be tough on cash flow, and we’re going to have to be very careful.”
Mentoring played a very important role for Wakefield in her career, and she believes it is important to share the thinking behind the numbers with future CFOs of the world.
“I had some wonderful mentors in my career, and it has meant a lot to me,” she said. It’s important to me to repay the favor for the upcoming generation, people who are just coming out of school and learning the profession.”
What Wakefield stresses about her profession is that it’s not just about the decision, “but how you came to that decision.” Finances determine how much you can afford, she said, and it’s not about being arbitrary, it’s about being thoughtful. •

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