‘Inside UVA’: Learn How COVID Tested This UVA Health Chief’s Leadership Skills

Jim Ryan, president of the University of Virginia: And did you think about, from an early stage, that you might eventually want to be on the administrative side of health care? Or was it more evolutionary?

Wendy Horton, chief executive officer of UVA Health University Medical Center: It was really just various taps on the shoulder, “Hey, can you help with this project? Can you help with this?” And then you know, the projects kept getting a little bit bigger and a little bit more complex. So I never had planned or even dreamed of going into administration.

Ryan: I know that feeling. 

Hello, everyone. I’m Jim Ryan, president of the University of Virginia, and I’d like to welcome all of you to another episode of “Inside UVA.” This podcast is a chance for me to speak with some of the amazing people at the University, and to learn more about what they do and who they are. My hope is that listeners will ultimately have a better understanding of how UVA works and a deeper appreciation of the remarkably talented and dedicated people who make UVA the institution it is. 

I’m joined today by Wendy Horton, the chief executive officer of the University of Virginia Medical Center. In her nearly four years at UVA, Wendy has stewarded the medical center through the unprecedented coronavirus pandemic, in collaboration with Dr. Craig Kent and his leadership team, she helped craft the first 10-year strategic plan in the history of the health system, and is well into the hard work of executing on that plan. 

Wendy earned a Doctor of Pharmacy from the University of Utah and a Master of Business Administration from the University of Wisconsin in Madison. She’s a fellow with the American College of Healthcare Executives, and last year was named to Modern Healthcare’s list of Top 25 Women Leaders in Health Care. Wendy is a trailblazer and a dedicated leader – indeed one of the most important leaders at UVA today, and we are incredibly fortunate to have her on the podcast. 

Wendy, thank you for being here.

Horton: Well, thank you.

Ryan: So like Dr. Kent, you started at UVA Health right around the same time COVID hit, in March of 2020. And you came here as chief operating officer. I’m assuming that made your start simple, and I wonder if you could just, I wonder if you could walk through what was your first month like,

Horton: Sure, totally seamless, textbook, the first 90 days (laughs). I remember I came to UVA a month before I was supposed to start. So I was supposed to start in April. And I actually started in March, because I was calling and kind of making arrangements of starting. And I learned that we had two days of PPE on hand at the hospital, and that was a little bit frightening. I thought, “Oh, maybe I just need to get there and get started early.” So started a month early. 

When I came, there wasn’t traditional meet-and-greets, but it was, you know, hand sanitizer, and “What are we going to do for the students?” and all kinds of fun things. It was a great time, actually, because I got to know so many parts of the University and to call people. And I just remember, we were very united as a university as well.

Ryan: And what was the biggest challenge that you faced early on?

Horton: You know, I think early on, it was a lot of fear. So we didn’t know a lot of information. So we were helping people and taking care of people the best way that we knew how, but, you know, what I remember most is talking to the community and trying to make plans for not only the academic medical center, but you know, how we were going to vaccinate and how we were going to, you know, take care of students and you know, what plans that we were going to do communitywide.

Ryan: Yeah, I mean, it drove home the fact that the University and the community are inextricably linked, for sure. When you look back on that time period, not just your first month, but dealing with COVID generally, what stands out? What are you most proud of?

Horton: You know, I’m most proud of – I remember the day that I met with some community members, and you know, we were talking about vaccination then, and how many people were available to vaccinate the community, and it was this moment that I came back to the office and I thought, “Wow, UVA is going to have to find a way to help partner to vaccinate the community.” It was, at that moment, a really important way for people to stay safe and, you know, the next thing that we can do, and I just remember that moment of that partnership. “How are we going to work together? What are we going to do? Where are we going to do it?” All these logistic things. But the moment of, you know, being a large employer, being really a big piece of the community, and then being that good neighbor was so important in COVID.

Ryan: Yeah, I remember going up to the old Big Lots store for one of the vaccination clinics and was incredibly impressed by how quickly it was set up and how well it was operating. And someone said – this was an incredible compliment – “This place runs more efficiently than Chick-fil-A.” 

Horton: That is the best compliment. 

Ryan: All right, so let’s step back a little bit. You grew up in California, right? 

Horton: Yeah, Southern California. 

Ryan: OK, where exactly? And tell us a little bit about your childhood.

Horton: Sure. I grew up in a small town in Southern California called Banning. It’s next to Palm Springs. It’s, you know, towards the desert, so very different than, than Charlottesville. About the same size, though. And it’s a community where my whole family was born and raised. So my grandparents, both sets of my grandparents, my parents, my brother lives there, and so no one has ever left except for me.

Ryan: So I remember the moment that I decided I didn’t want to be a pharmacist. I was watching “It’s a Wonderful Life,” and there’s a scene where George Bailey prevents the pharmacist from basically giving poison to someone – the pharmacist had been drinking, because he was mourning the loss of his wife. And I thought, “I really do not want to be a pharmacist.” I’m wondering if you remember the moment when you decided you did want to be a pharmacist? 

Horton: Yeah, it was a moment. I was a exchange student – I was an exchange student in Australia. Part of going to school – I was in the 10th grade, 15 years old – and part of going school there was deciding if you were going to do an apprenticeship model, or if you were going to go on to what they called “uni.” 

So you had to do all these job shadows. And so one of them was in a corner drugstore, where at the time, you could not buy ibuprofen or anything; there was a butcher and a bakery and a pharmacy. So I rotated through the pharmacy and was absolutely enamored by the leadership of the pharmacist and what they did in the community. I think it was that moment, I knew I wanted to be a pharmacist. 

Ryan: No kidding. As a 10th-grader.

Horton: Yeah! I never looked back.

Ryan: And what was it, exactly, about being a pharmacist that was so attractive?

Horton: You know at the time, I think it was the leadership qualities of that pharmacist that really showed me what an important role they played in the community, from everything from counseling to blood pressure regulation, to really saving people and the drug interactions, and that’s part of it. But most importantly, how respected they were within the community, and how many people came to ask for advice, which was just really wonderful.

Ryan: Oh, interesting. So you went off to college, and you got a Bachelor of Science in pharmacy, if I’m remembering correctly. What led you to go on to get a doctorate in pharmacy? 

Horton: You know, that’s a good question. It was kind of right in the midst of things changing for pharmacy. So, you know, the bachelor’s was phasing out or would be in the years to come, so I thought it was really important. And I didn’t have a lot of upbringing in health care, so no other family members in health care, and really wanted to strengthen my education. So, you know, I was working, but also wanted to really further my education in that space and, and really become a little bit more sub-specialized in certain areas. 

Ryan: And did you think about, from an early stage, that you might eventually want to be on the administrative side of health care? I mean, are you one of these people who had a life plan? So you would be a practicing pharmacist, you’d get your doctorate and then you’d eventually move into health care administration? Or was it more evolutionary?

Horton: Totally evolutionary. You know, I was really happy as a pharmacist, very clinically strong. You know, loved it, love working with patients, the mission of health care really rang true to me. I loved helping patients as board-certified, doing all the things in the societies. 

And it was really just various taps on the shoulder – “Hey, can you help with this project? Can you help with this?” And then, you know, the projects kept getting a little bit bigger and a little bit more complex. And it was, you know, a little bit at a time, so I never had planned or even dreamed of going into administration.

Ryan: I know that feeling. So what brought you to UVA? 

Horton: You know, I was not honestly planning to come to UVA. I had never been to Virginia. I knew I wanted to be a chief operating officer, and so I had interviewed a couple places. But I will tell you, it was the people that is the reason why I came to UVA. You know, I think really incredibly talented people all throughout UVA, but especially within UVA Health in the medical center and world-renowned people that are just very humble. You come here, and you know, they want to help other people and each other, and it’s a really special place. 

Ryan: Yeah, I agree. So you came here as chief operating officer. What does that entail? 

Horton: So chief operating officer, at the time, you know, during COVID, was really helping – and if you remember – every day protocols were changing, we were figuring it out. And so it was operationalizing and implementing all of that. 

In addition, you know, it was a time where throughout the state, different services were being shuttered. So at that point in time, our elective surgeries were shut down. And so constantly learning how to pivot, you know, what was needed in the organization, and really just serving the most acute needs of the institution at the time.

Ryan: Then not too long after you arrived, you went from being COO to CEO, meaning you’re in charge of the medical center. Was that an enormous leap? Or was it just a slightly bigger job?

Horton: It was enormous at the time, because I had come early, and that first week, the CEO had stepped down. And so you know, that was a big change coming into the institution. At the time, you know, people were not traveling, people were not visiting, there was no way to backfill my role. And so a whole team of us pulled together, and we really worked hard to cover all the bases during that time. 

It was an incredible journey. But I would say almost the best of times because we were focused, and I really got to work with the very front lines, getting to know the institution, the University, and it was, in some ways, magical times because you roll up your sleeves, you work together, and you’re doing the task at hand for the day. And so, in many, many ways, I loved the teamwork. I loved getting to know people in a very authentic way. And so many ways I cherish those times.

Ryan: You and your team, and all the doctors and nurses and other team members are just an incredible inspiration throughout. I’m wondering if you can walk us through a day in the life of the CEO of an academic medical center? 

Horton: Well, typically, it’s an early morning, and you start with an assessment of how things went the night before. I think that’s one thing that maybe not everyone thinks about is, you know, we’re a 24/7 business, and so a lot can happen overnight. And so you know, you’re assessing, or sometimes you get called in the middle of the night of if something’s happening or going on. And so “How are you doing? Are we on task? You know, how’s the operating room? How’s the emergency department? And how many beds do we have, how much staff do we have?” You know, all the things that could change or pivot your plan for the day. And so kind of just making sure that everything’s in order, everybody has what they need to really have a successful day. 

What I love is, as a leadership team and all throughout the institution, we come together at 10 o’clock every day. So, we get the morning started, and then we check in with each other and go through our biggest vitals and make sure everyone has what they need for the day, and then we continue. I love my day – I have a full calendar. But I would say that oftentimes my calendar gets blown up. So you have to be a person that is very nimble, very willing to go with the flow, because every day is so unique. 

The needs are different. Patients and families have unique needs, things happen, and so you’re constantly pivoting, adjusting to meet the needs of patient care and that demand, but also planning for the future at the same time, which is a lot of fun. 

Ryan: Right. It seems like a lot.

Horton: It is a lot. I think your job is a lot!

Ryan: What part of your job do you love the most and which part is the most challenging?

Horton: I love the mission of health care. I love seeing patients and families. You know, sometimes they’re at their most vulnerable, and you get to see miracles happen. You walk with them in their shoes, they entrust you with their care, and it’s really special moments. It can be very stressful for patients and families and you’re with them and part of their family for this unique time in their life. So I love that piece of it – the connection and it really makes a difference in people’s lives. So that’s very, very rewarding. 

I would say the most challenging is sometimes miracles are happening, sometimes people are dying, the hours are long, you know, so I think it’s really keeping yourself well in check, the stress under key, because you’re setting the tone and the pace for a large workforce and making sure people have what they need to be successful. 

Ryan: What are some things that you now know about running a hospital or working in a hospital, that people who don’t have your experience or aren’t privy to what you see day in and day out. What should the rest of us know?

Horton: Sometimes it can be little things. Like we’re kind of a mini city, if you think about it. So if there’s a snowstorm, and we don’t get a delivery truck at 4:30, we know that’s going to be a problem. Or if our trash doesn’t get taken out, or if we don’t have water, these are major components to running a hospital. So it’s all these little things that you never really think of as big things, but if something goes wrong with key infrastructure, you know, it could be really important. 

Or, you know, how the ORs work and the ventilation and, and so there’s a lot of facility components, there’s a lot of infrastructure, and then there’s a lot of just the way that a patient flows through the system. So if we have a backlog in an area, or our emergency department isn’t optimized, you know, all of this is going to clog up various areas, and the throughput of the institution. And so that that’s really important to make sure that we’re getting all the different teams working together, communicating together, and helping one another out. That’s key to us having various touch points throughout the day to make sure everyone has what they need to care for patients.

Ryan: Do you have mentors that you rely on? I’m sure that you have – I know, you have, in your short time become a role model for many, and I know that you mentor many other people. Who are your mentors?

Horton: You know, my mentors are, you know, a lot of different people. I would say, I have like an advisory council of mentors, if you will. You know, I’m going to a cadre of people asking for advice and, and helping people, you know, “We have this situation. What have you tried?” to other CEOs across the country, to other people within the University, seeking counsel with a variety of individuals. Sometimes you can get too close to things and having people help you think through or ask questions, you know, from a broader perspective is so helpful. 

So I would say that I have a lot of CEO colleagues that we’re texting and emailing and spending time together. It’s amazing – sometimes our situations are very similar and sometimes unique to the institution.

Ryan: So thinking more broadly, what are some of the biggest challenges for health care in general? Or what are some of the most promising things to come that are on the horizon for health care? 

Horton: Yeah, I would say coming out of the pandemic, you know, workforce was a major issue and making sure that people were really well. And so we’ve spent a lot of time at UVA, and I think we’ve done a great job of, making sure that we’ve prioritized wellness, and that we’re building for the future, so inspiring the next generation to go into health care, to make sure that we have pipeline programs and services that we’re going to have health care workers is really key. 

I would say, lately, within the last couple of years, inflation, compensation, finances were also a big theme. 

I think UVA has done an extraordinary job in both of these areas. I would say that we’re really strong as a health system, and I think it’s because we’ve really invested and thought a lot about these two areas, which have really well positioned us throughout the commonwealth.

Ryan: Can you talk a little bit about what is special about an academic medical center as opposed to a hospital that is freestanding?

Horton: Yes, and I think this is key – this is the piece that I love. I just love the innovation. You know, most – if you’re working in a community medical center, you know, the research, the teaching component may not be there. But at an academic medical center, you have all four missions, really thinking about the clinical care, the research, the education, and then also our community. And together, these really make such a big difference. 

Today, the innovations and the discoveries and the research is really fueling the advanced treatments that we can provide. So just in the short time that I’ve been at UVA, I remember CAR T-cells, we could only give it in an inpatient setting. And just this last couple of weeks, through technology advancements, we’re now able to give some of that therapy on an outpatient basis. Likewise, some of the orthopedic surgery that used to take days and days of recovery now are being done at our new orthopedic facility and going home the very same day, so it’s just incredible to see the innovation.

Ryan: Yeah. So last question. I understand you’re involved in the American College of Healthcare Executives, which is the largest executive association in health care. Can you talk a little bit about this organization and your role in it? That seems like a big deal to me.

Horton: Well, the American College of Healthcare Executives is an organization of about 48,000 individuals across the nation in the world and a lot of military as well. They are really the premier organization for health care executives. And, you know, I’m just so honored because recently I was selected to be on the Board of Regents, the Board of Governors, and the Board of Governors is what stewards the organization. So it’s quite an honor for me as an individual, and I think for UVA as well to be represented as a Board of Governors for the American College of Healthcare Executives. 

Ryan: Well, congratulations on that and they are very lucky to have you. 

Horton: Well, thank you.

Ryan: Wendy. This has been terrific to get a chance to talk with you. Thanks for everything you do for UVA and in particular for the patients who are lucky enough to cross your path.

Horton: Thank you so very much.

Aaryan Balu, co-producer of “Inside UVA”: “Inside UVA” is a production of WTJU 91.1. FM and the Office of the President at the University of Virginia. “Inside UVA” is produced by Jaden Evans, Aaryan Balu, Mary Garner McGehee and Matt Weber. Special thanks to Maria Jones and McGregor McCance. 

Our music is “Turning to You” from Blue Dot Sessions. 

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