If you have a healthcare emergency, need immediate surgery, or give birth in Broward County, chances are you will spend time at a hospital in one of the two major public health systems.
Your hospital experience — for better or worse — will be shaped by the new top leadership, at both the Broward Health and Memorial Healthcare systems.
In the north part of Broward County, Shane Strum, former chief of staff to Gov. Ron DeSantis, took over two years ago as CEO at Broward Health, also known as the North Broward Hospital District. Strum brought his hospital background and political connections to the CEO job overseeing Broward Health Medical Center, Broward Health North, Broward Health Imperial Point, Broward Health Coral Springs, and Salah Foundation Children’s Hospital
In the south part of Broward County, Scott Wester took over a year ago as CEO of Memorial Healthcare System, also known as the South Broward Hospital District. Wester brought his man-of-the-people style and hospital leadership experience to the CEO job overseeing Memorial Regional Hospital, Memorial Regional Hospital South, Memorial Hospital West, Memorial Hospital Miramar, Memorial Hospital Pembroke, and Joe DiMaggio Children’s Hospital.
As taxpayer-funded health systems, Broward Health and Memorial must treat everyone, regardless of whether they can pay. But they also need to provide services that will attract those with insurance who want good care. The vision of these CEOs needs to strike that balance, and their strategies will determine patients’ healthcare experiences in South Florida for years to come.
Both men control millions of dollars in expenditures, oversee thousands of employees, have a say in negotiations with insurers, and make strategic decisions on recruiting, expansion and new initiatives. With those responsibilities comes scrutiny.
“You are under a microscope in terms of services and quality, meeting care standards, meeting the needs of your professionals, and running a 24/7 operation,” said Steven Ullmann, University of Miami professor and chair of the Department of Health Management and Policy. “There are definitely CEOs who do it well and others who run into more difficulties. I have watched CEOs make mistakes that they should have seen before they occur.”
Leadership styles
Strum and Wester both answer to boards appointed by the governor, and differ in how they approach the job, each using their strengths to steer their large health systems that employ more than 24,000 people combined. Strum relies on political savvy and his relationship-building know-how. Wester draws on his many years of healthcare leadership experience.
At Broward Health, Strum, spent the last two years forging relations with academic institutions. The payoff has been a partnership with the University of Florida that will put the health system at the forefront of Alzheimer’s disease research. He also struck a deal with Florida Atlantic University to become an academic medical center for its medical students.
Along with those partnerships, Strum, a Broward native and former chief of staff to DeSantis and former Gov. Charlie Crist, used his political savvy to benefit Broward Health by obtaining funds from state agencies.
Since he became CEO, Strum said Broward Health secured state money for Healthpoint, a mobile unit that goes into the community and eliminates transportation barriers for underserved populations. The district also received funds for 300-person PACE adult daycare program, and for a 30-bed mobile MASH unit to help triage patients after a storm or hurricane. And it lobbied and received money for the Cora E. Braynon Family Health Center in Fort Lauderdale, as well as for a memory disorder clinic at Broward Health North. Broward Health also will operate a new maternal health location in Lauderdale Lakes that will open in early 2024 and it has received a federal grant to renovate Pompano Care Center.
“We are identifying things that Broward County needs, and we are actually going after the money for it,” Strum said. “I could name 10 things that the Legislature and governor have been generous to make sure that Broward Health has gotten, and we didn’t receive these things in the past because we didn’t tell our story.”
Strum also points out that at his invitation, DeSantis and multiple heads of key state agencies have visited Broward Health since he took the helm, more so than in prior years.
“Relationships matter, and because we have those great strong relationships, we’re reaching out to our friends in Tallahassee. We’re telling the Broward Health story,” he said.
Wester at Memorial comes from outside of Florida and doesn’t have the relationships Strum has built over a lifetime. But Wester comes from a background in healthcare management, most recently as Executive Vice President of Strategic Partnerships and Advocacy for Franciscan Missionaries of Our Lady Health System in Baton Rouge, La.
For the last year, Wester says he has been on a listening tour at Memorial, meeting with patients, doctors, nurses, new hires and even cooks at the hospitals to learn about how the system operates, its culture, and where improvements can be made. UM professor Ullman says that’s critical for a CEO new to the area who will need to approach the South Florida market differently than a health system in another state..
A big focus for Wester has been cutting the wait times in Memorial’s emergency departments, a community-wide complaint. He’s hired more doctors and relied more on technology to help with discharging patients to home or rehab in order to open hospital beds faster to new patients.
“It’s not a perfect science, but it’s over an hour less wait time than before,” he said.
Wester also has spent time exploring ways the Memorial Healthcare System can run more efficiently, whether it is scheduling appointments or managing patient electronic health records.
“We are actually putting together more analytics to make sure we are able to measure the difference we are providing for the communities we are serving and figure out needs,” he said.
Wester begins his second year as CEO of Memorial with an aggressive expansion plan: An $88 million upgrade for Memorial Regional Hospital’s birthing center, trauma center and emergency department. Also, Memorial recently bought land for a project at the corner of Hollywood Boulevard and State Road 7 with an eye to creating a mixed-use health and wellness hub. Along with fees from property taxes, the hospital systems get government grants and private donations.
Longtime Memorial board member Doug Harrison said Wester took the helm of the Memorial system with a financial advantage: “He’s been able to deploy resources without having to worry about the bottom line, because we have a robust bottom line,” Harrison said.
Healthcare closer to your home
When it comes to health, Broward residents and visitors have plenty of care options and continue to get more. As costs rise, public health system CEOs must convince paying customers to choose them over competitors, especially for more lucrative services.
For residents of Broward County and the cities just north or south of the county lines, both CEOs’ strategies envision urgent cares, free-standing emergency rooms, and primary care centers closer to your homes; robots and technological devices that make your surgeries less invasive; better access to your electronic medical records; and better communication with your doctors.
Wael Barsoum, former CEO of Cleveland Clinic Florida and president of HOPCo, said Strum and Wester must be forward-thinking. “As CEOs, they will be judged on the value they are bringing to the community, but also on whether they have a sense of what’s coming.”
Wester is leading Memorial across county lines for patients and profits. In mid-September, Memorial announced a new primary care center in northwest Miami-Dade County, and it will open an urgent care center in the same location in the coming months. Memorial opened a primary care center earlier this year in Weston and has one planned for Plantation in 2024. And it has expanded its mobile care clinic into more underserved pockets of South Florida.
In its own home turf, Memorial is building a large free-standing cancer care center in Pembroke Pines with the newest equipment for ultrasound, radiation and surgery. The health system recently finished an expansion of Joe DiMaggio Children’s Hospital, nearly doubling its space and adding operating rooms, a simulation lab and a play zone.
“Our big focus is how do we improve the level of access for people that need services at Memorial,” Wester said.
Strum says his vision is a focus on growing Broward Health’s reach and finances, and rebuilding its reputation after mismanagement, leadership turnover, and the resignation of doctors about five years ago. Over the last few months, he says he has dismissed executives and doctors at the individual hospitals who don’t buy into his vision. Strum has been scouting Broward County for more locations to build free-standing Emergency Departments.
“In the coming weeks and months, Broward Health is going to enter a dynamic time,” Strum said. “You are going to see more strategic growth.”
Memorial board member Harrison says Strum’s expansion vision may take longer to accomplish than Memorial’s: “He found himself in district that has historically had issues. It takes a long time to get people out of a wreck,” Harrison said. “That places needs a good five- to 10-year turn-around time to get it right.”
The hospital districts can’t afford to get complacent. Broward County has become a highly competitive healthcare market, particularly in Strum’s backyard north of Interstate 595 where Cleveland Clinic, Holy Cross, HCA Florida and Tenet have hospitals. Baptist Health South Florida and UHealth Miami have crossed the Miami-Dade county line to bring more of their healthcare services to the Broward suburbs.
Broward Health and Memorial not only compete with the for-profits, but also with each other for executives, doctors and nurses, corporate donations and insured patients.
“I’m a big believer that competition in healthcare is a good thing,” Barsoum said.
For the first time ever, the South and North Hospital districts will partner on a project, a new free-standing Emergency Department in Sunrise. Broward Health will operate the adult emergency room and Memorial will run the children’s side. They are in the process of getting city approval.
Barsoum said collaborating or competing where appropriate will bring the greatest benefit to the community. “That’s the true north for these two health systems.”
But Harrison believes they need to collaborate and partner more, so whatever hospital you land in during a trauma, your records are available and medical treatment is seamless.
“They are two ships miles apart, going in the same direction. One might have more speed on it, but there are many ways to marry up,” he said.
Chris Day / South Florida Sun Sentinel
Broward Health Medical Center on Andrews Avenue in Fort Lauderdale is the flagship hospital for the North Broward Hospital District.
Old hospitals cost millions for upkeep
It will take more than expansion to bring these health systems into the future.
A big challenge for these CEOs is the drain on these two health systems from the upkeep for their flagship hospitals. Both were built more than 70 years ago in what since have become flood zones. Strum at Broward Health says his main hospital in Fort Lauderdale built in 1938, Broward Medical Center on Andrews Avenue, had been neglected for many years as the system struggled with management turnover and operational issues. The hospital has had an a/c breakdown and flooding issues. Since Strum arrived, the board has signed off on more than $60 million in infrastructure improvements and $10 million in repairs. The board just approved another $6 million to repair an employee parking garage that had been deteriorating, and there are more improvements needed.
“It’s just like an old home; it needs ongoing repairs,” Strum said. “We’ve had to spend 60, 70, 80 million dollars in deferred maintenance in the last of couple years.”
Memorial Regional Hospital, built in 1953 on Johnson Street in Hollywood, has benefitted from more stable management in recent decades. But the aged hospital does require millions of dollars a year in upkeep. Wester said Memorial is reinvesting $88 million in its maternity ward at its main hospital to bring it up to today’s standards and recently made millions of dollars in improvements to its heating, ventilation, and air conditioning systems.
“We do spend a lot of money every year reinvesting in our facilities and clinical equipment,” he said.
The future of Broward hospitals
Doug Wolfe, a South Florida healthcare attorney with Wolfe | Pincavage, said it’s a difficult time to operate hospitals.
“Costs are going up, inflation is higher than average, and reimbursements from insurers are not going up at the same rate as costs,” Wolfe said. “All of that is impacting hospitals, and they are having to get creative on how they are handling business operations.”
Unlike for-profit hospital chains like HCA and Tenet, public health systems like Broward Health and Memorial Healthcare must be more community-minded. They can’t shed unprofitable healthcare services like birthing wards or steer away from providing costly mental health services.
In addition, nursing care and new technologies are increasingly expensive, yet critical to hospitals’ future. The projected supply of physicians is forecast to fall short relative to demand, and insurers don’t want to increase how much they reimburse hospitals for patient care
“All hospitals are experiencing the same challenges, but how they handle those challenges differs for public health systems,” Wolfe said. “Hospitals are not a business you would want to invest in. They are not making tons of money, but if public hospitals have margins, they have to reinvest in new technology, new equipment and the higher cost of operations.”
Over the years, there has been buzz about merging the two public hospital districts as Broward’s population grows. Strum says that will never happen. “We are both very complex organizations.”
For now, both leaders must lure more doctors and nurses at a time when shortages exist both nationally and locally — and salaries reflect the demand.
At Memorial, Wester says he has made recruiting doctors a priority. “We have hired 70 physicians over the last 12 months, and we will probably repeat that same amount this current year,” he said.
Strum has addressed the challenge through more medical graduate programs that will produce a physician pipeline and by starting a nurse staffing company that hires contract workers for its hospitals.
Going forward, the health system of the future will include more doctors and nurses who work outside of the hospitals to provide medical care at urgent cares, outpatient centers, in patients’ homes, and through telehealth, experts say. Only the extremely ill will get care in a hospital.
That’s a trend Wester said Memorial is positioning itself to respond to.
“We already utilize different levels of sites for different levels of clinical care. And that’s going to continue to evolve,” he said. “You know, in our business, we got the baby boomer population. This age cohort will continue to consume more and more healthcare, so hospital beds will still be heavily utilized, but it’ll be for a much sicker type of pathology than what we’re currently used to.”
Barsoum said Wester and Strum’s performance will be judged by whether they help make healthcare in Broward better than it was when they arrived, and whether they fulfill the purpose of having public hospital systems.
“They were set up through the state Legislature very clearly to ensure every person who lives in Broward County has access to high-quality care that doesn’t bankrupt them or is potentially free if they can’t afford it,” Barsoum said. “That is first and foremost how you judge the success of the CEOs of these two systems.”
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.
Hospital systems at a glance
Broward Health
- Number of employees: 8,700 plus 2,400 physicians
- Annual operating budget: $1.6 billion
- Patients served from July 2022 to June 2023: 950,000
- System operations include: Five hospitals, 50 ambulatory locations, the Broward Health physicians group, Broward Healthpoint and Children’s Diagnostic & Treatment Center.
- Taxing district: Northern 2/3 of the county
Memorial Healthcare System
- Number of employees: 16,000
- Annual operating budget: $3 billion
- Patients served from July 2022 to June 2023: 1 million
- System operations include: Five hospitals, one children’s hospital, one children’s health center in Wellington, free standing ER, primary care centers, urgent cares, and a skilled nursing and rehabilitation center
- Taxing district: Southern one-third of the county