Robert Earley’s office on the main campus of JPS Health network in Fort Worth is surprisingly small for the chief executive of a $650 million, tax-supported hospital system with 4,500 employees.

One arm of the L-shaped configuration at John Peter Smith Hospital features what Earley calls a workstation. There’s a basic table in front of an average-looking office chair. Papers and a few personal items cover the table. A small, hand-drawn sign reads, “Bryce’s dad.” (Bryce is Earley’s daughter.)

A sitting area occupies the other part of the office. A well-maintained but obviously old rocking chair stands out near three cloth-covered wingbacks. Earley says he finds comfort in the rocker, which has been in his family for many years.

When he’s seated there, an antique mantel clock—wound every Friday morning—is in Earley’s line of sight. If he’s uneasy for some reason or other, he sits and looks at the clock, often recalling a summer internship he had with a South Texas judge. The same clock sat behind the judge’s desk.

The clock’s deep chime—it sounds every 15 minutes—strikes people in one of two ways. It startles those who can’t forget they’re in Earley’s office. On the other hand, visitors who have sunk into the easiness of the sitting area take the chime as a natural element of the surroundings.

It’s that ease and comfort that Earley wants for everyone who enters his office—and his health system’s 44 facilities. “We realize that when you come into a healthcare organization, this one or any other one, you’re not going to the day spa,” Earley says. “You’re not going to take the half-day off and go fishing and relax. You’re going to be in a situation that, oftentimes, just by its nature, is going to make you feel uncomfortable.”

JPS, which has been guided by Earley since he was appointed its interim CEO in 2008, has three rules for everyone who works in the health network—including vendors and physicians who work at, but not for, the system:

No. 1: You own it. No. 2: You must seek joy. No. 3: Don’t be a jerk.

Each rule is equally weighted, but No. 2 has an infectious, physical manifestation. Earley smiles easily. So does his head of operations, the staff at the information desk, and Raymond Tucker, who helps maintain the main campus’ facilities.

“If you work in healthcare and you can’t smile, go to another profession; don’t work here,” says Earley, who dropped the interim title in 2009. “We had 1.1 million ‘patient encounters’ last year. Of those 1.1 million people, I venture to say very few of them wanted to be here. We’re not the Hyatt Regency; we’re not the Omni Hotel; we’re not the day spa. Nobody is getting out of their car in our parking lot, going, ‘Oh man, I’ve waited for this day.’

“It’s a tough time,” Earley continues. “Even sometimes in the greatest of situations—of bringing life into the world—there is trepidation to that. So we need to make sure that when people come in that front door, we smile.

“We don’t have to be hokey. We don’t have to be singing songs. We don’t have to have jazz hands. But I want them to smile because I want our patients to feel better even walking in that door.”

Earley acknowledges that rules No. 2 and No. 3 haven’t always been the law of the land at JPS. Not long ago, critics say, there was a get-them-in, get-them-out approach to patient service. Earley and his team set out to change that.

“We want to create a level of pride in the people who come here, and we want to create a level of pride in this community,” he says. “I want to create a pride in people that don’t even use our services. I want them to say, ‘You know what, I’m really proud that we have a public hospital in Tarrant County that has this reputation.’ ”

Prior to Earley’s appointment as interim CEO, the Fort Worth Star-Telegram reported on a consultant’s findings, based on visits to JPS in 2007, that were critical of the hospital under then-CEO David Cecero, who would announce his retirement the following year. According to the newspaper, the consultant cited “filth, ineptitude, and callousness” at JPS, including delays in treatment, broken or missing equipment and medical records, and a dehumanizing environment in general.

Scott Fisher, chairman of the network’s appointed board of managers, says that there was poor communication and distrust between Cecero’s administration and hospital physicians, and between that administration and elected officials in Tarrant County.

“Pre-Robert, there was a sense taken that we’re providing healthcare for the poor and indigent, [that] they should be content with the services they received because they were getting it for free or highly discounted,” Fisher says. “Our approach since Robert took over as CEO has been that every person that walks in the door should be treated with respect and dignity and compassion and genuine care, so when they leave our hospital or one of our clinics, they feel that they have really been cared for.”

Earley notes that in addition to its role as a public hospital—it’s the sixth-largest hospital facility in North Texas, with 537 licensed beds—JPS is Tarrant County’s Level 1 trauma center. That means that even people with more healthcare choices could end up at JPS if they’re involved in a serious wreck or some other emergency.

Earley says the pride that his team is building goes along with the trust that the network must continually earn and maintain as it spends taxpayer dollars.

During the recent tough economic times, JPS has operated at a very thin margin of positive revenue, negating the need for tax increases, Fisher says.

“It has built a sense of confidence in the community that we are a very efficient operation. I went through the loss of confidence and now
have been here for the regaining of confidence. [Community and civic leaders] attribute that to Robert. I certainly attribute that to Robert.”

Making the Rounds
If it’s Thursday morning, don’t bother going down the long, nondescript hall at John Peter Smith Hospital toward Earley’s office. He won’t be there. The system’s VPs, CFO, COO, and general counsel also won’t be in their offices or in the modest administrative suite.
Instead, you’ll find them somewhere in the hospital doing rounds. The best bet will be to look where you would not expect them.
As part of rule No. 1, Earley and his administrative team do weekly rounds outside of their core areas of responsibility and expertise. Earley says it’s important for everyone to take an interest in all areas of the system, and for employees to see the CEO. He also says rounding outside of one’s reporting areas creates ties across the system, allows administrators to see how their departments touch others, and makes open questions about processes and services a normal part of the environment.

“Not having the background that some others might have is an advantage,” says Earley, who earned a B.A. in political science from the University of North Texas and a master’s in healthcare administration from the University of Texas at Arlington. “It allows me to ask questions [that people with medical training] might be embarrassed to ask.”

Dr. Ron Anderson, who served as CEO of Parkland Health and Hospital System in Dallas for 30 years, recalls talking with Earley before Earley took over as JPS’ chief executive.

“He was concerned with not being a hospital administrator or a physician,” says Anderson, who recently became senior adviser to the CEO at Dallas’ public health system. “He and I talked about the characteristics and the qualities you have to have. I encouraged him to take the job.”

Anderson, who grappled with his own thorny, high-profile problems at the Parkland system, says Earley’s personal and listening skills—as well as his ability to surround himself with smart people—made him a good fit for the CEO position at JPS. Anderson has since recommended Earley for several industry leadership roles, including the Health Industry Council and Teaching Hospitals of Texas, where Earley now serves as chairman.Anderson also credits Earley with improving JPS’ standing in Tarrant County, and for expanding access and services within existing resources. Among other things, JPS now operates 19 school-based health centers that serve about 59,000 students.

In addition to their weekly rounds, Earley and the executive team make weekly discharge follow-up phone calls to some of the thousands of patients who have received services. Says Earley: “I always start each one of my discharge calls the same way. I say, ‘Hi, I’m Robert Earley; I’m the president of John Peter Smith. Did we treat you right?’ ”

Earley says he’s proud and grateful when he hears about good experiences.

“When I hear those patients and they say, ‘No, you let me down,’ I don’t like it. But then I am able to talk to folks and ask, ‘Why did we do that?’ and that’s the only way we are going to change.”

Inconsistency weighs on Earley. “What hurts me is when a patient tells me, ‘You guys are great. Thank you.’ Then I’ll call five minutes later to the next patient and they’ll say, ‘I used this service’—it’s the same service—‘and I didn’t get a good experience.’ If we can do it once, we should be able to do it every single time. We shouldn’t have disparity.

“That means your system is not hardwired. We’re not where we want to be. We want to be consistent, and we’re not at that level of consistency. It’s a change that takes constant effort, and you can’t stop.”

No Dropped Balls
As this issue of D CEO went to press, Earley and his team were anticipating an inspection visit from federal regulators—a regularly scheduled, three-year review. Earley said consistency and focus across the board would be key to a good report.

“Where we really need to make certain is the 360-level of care,” he says. “That when that patient comes in the front door, nothing is a dropped ball; nothing is a fumble at any point—that we’ve got them registered properly, that we’ve got them receiving care at a clinical level, we’ve got them receiving care in an emergency level, in an urgent-care setting. Then we have that follow-up. We’re getting them in our clinics. We’re getting them in that full gamut of healthcare.”

Earley understands government oversight and politics. He worked as a legislative assistant to former U.S. Rep. Tom Vandergriff from 1983 to 1984. Earley then served as a Democratic member of the Texas House from 1984 to 1995, after setting a goal for himself of serving 10 years in the state Legislature. 

“I think being in the Legislature was a great undergraduate school to attend. I think it was wonderful place, and the lessons I learned there have been incorporated in my life,” Earley says. “The greatest thing about the Legislature is you’re constantly in a world where you don’t have agreement. The question is … what is the ultimate, ‘Here is what we concluded.’ And I think you have to have patience for that, and that’s what helps me here, because here, too, the answers are not always apparent.”

With administrative rules still pending for the sweeping 2010 federal healthcare regulations—and the possibility that courts and a new Congress will take action forcing more changes or reversing the policies—Earley says the nation’s healthcare industry will enjoy a strong voice in the process. He worries, however, whether that voice will be carefully used and clearly heard.

“I think one of the challenges that we face in healthcare is when healthcare becomes a political issue rather than a policy issue,” he says. “When it becomes political, when we get out of the realm of healthcare and decisions are made to keep or not keep somebody in office, it becomes far more challenging.”

Earley says his approach is to be very clear about how various proposals will affect JPS’ patient base. Industry groups and officials need to maintain that absolute honesty, he adds.

“They don’t need to inflate the impact or deflate the impact based on the fact that they are going to get more money,” he says. “I really think that we do need to have a level of accountability with the money we spend. And I don’t think the federal government is this faucet of money and we don’t have to be conscientious about how we spend it.”

smile_02 Earley knows about government oversight... He served as a Democratic member of the Texas House. photography by Elizabeth Lavin

Without taking a position on the 2010 healthcare changes, Earley says that if faced with the choice, he would take policies with which he does not agree rather than drawn-out debate.

“I think the inconsistency is the hardest thing to deal with, because you have to make budget decisions,” he says. “I think you can deal with a policy you don’t like and you can conform to it easier than you can bounce from a policy that you have in October that changes in September that changes in February.”

Scott Fisher, the network’s board chairman, calls Earley’s government experience important, but says it was not the key factor in hiring him as chief executive. “It was really more his relational style that kind of sealed the deal,” Fisher says. “The change that we felt we needed to go through was a major cultural shift that had to be a total systemic change in the way we approach our employees, the way we approach patients and families, the way we approach the community at large.”

Fisher says Earley has a self-effacing, sometimes humorous approach to building and maintaining relationships. “Robert has been very proactive in connecting with all of the cities in the county—the mayors, the city council members, the school districts, the business community, the rotary clubs,” Fisher says.

Keeping a Balance
If it’s the weekend, odds are that Earley is on a tractor or tending to one of the Clydesdale horses he raises on his family land in Gordon, in southern Erath County. If the approaching week is certain to bring tough decisions, he’s chopping wood. Tricia, Earley’s wife of 13 years, can measure the next week’s challenges by the height of the split-wood pile.

Earley emphasizes balance between work and personal life—seriousness and fun. Taking cues from Southwest Airlines Chairman Emeritus Herb Kelleher, Earley has filmed silly internal videos to help employees keep important issues in mind. He’s ridden in 100-mile bike races and taken his turn in a dunking booth to raise money for an internal fund benefiting employees facing personal financial strains. His four-digit internal extension is very easy to remember, and anyone is allowed to schedule a meeting with him.

“I try to have a balance between my mind and my heart,” Earley says. “At times, with a $650 million budget, you have to lead with your mind. It’s key to keep that balance.”

Earley says he strives for balance by taking inspiration from a variety of sources. For example, Tricia, a veterinarian, shows her concern for her patients in part by working at the animals’ eye level; Kelleher illustrated the business value of consistency and fun. Even the giant Clydesdales’ gentleness, and their endless willingness to work, inspire Earley.

Raymond Tucker, the maintenance man, provides a special inspiration every day. Earley says Tucker greets him and visitors with a smile every morning, sweeping leaves and trash from the main entrance. The next day, seemingly sweeping the same leaves and trash, Tucker is still smiling.

“He has the greatest attitude,” Earley says. “Every morning he puts me in the best frame of mind because I think, ‘My job is not as hard as that guy’s.’ He has it tough, and he does it with a smile every day.”