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Nancy Agee (center) with Patrice Weiss and Steve Arner a few years ago. Arner was being groomed to replace Nancy. |
Here's Nancy Agee in a NutshellSeveral years ago, I was contracted by Carilion to write its history and the following is from that book-length effort. It gives you a good idea of who Nancy is, though much of what she has accomplished recently is missing.
Nancy Agee: Carilion Lifer
Nancy Howell Agee, President/CEO Carilion Clinic, was
described by one healthcare executive as “a Carilion lifer,” and indeed she
is. Quite literally. She was born in April of 1952 at Crippled Children’s
Hospital, which later became Roanoke Memorial and now houses her Carilion office
on the first floor. Her son was born at a Carilion facility and her father died
in one. She earned a nursing diploma at Roanoke Memorial Hospital.
Over the years, Agee has risen to the top echelons of
healthcare administration in the United States, recognized widely as one of
the most influential women in the field. By all accounts, she has earned every
accolade, every promotion. She is the CEO many admire for her humanity, her
humility, her honesty, her quick mind, her ability to rapidly evaluate the most
complex challenges, and for her fearless decisiveness. Carilion employees adore her; competitors
admire her; colleagues seek her counsel.
As a child who had frequent contact with health care
professionals because of knee surgeries (she spent nearly two years in a wheelchair or on crutches), “I saw mostly the good in nurses and doctors who cared
so much.” But there was a flip side, especially “with the lack of transparency,
the lack of communication with a teen [her], fear of certain types of cancer. I
wanted to fix that.”
Her early years
were spent in a four-room house in the working-class Virginia Heights section
of Roanoke with her mother and father (JoAnn and
Billy Howell) and two siblings. Billy worked at the grocery store Mick or Mack,
as did Nancy Agee’s beloved grandmother, Reyna Howell.
The family later moved to the more upscale Cave Spring area.
Agee’s
grandmother, Reyna Howell, was her touchstone. “She worked all her life [as a
manager at Mick or Mack grocery stores], but she was always doing something
fun. When I look back on it, it was a series of small adventures: getting
milkshakes at 10 p.m., chewing ice …” Reyna Howell was the only female manager
at Mick or Mack and she owned her own home, which was unusual for a woman at
the time. Nancy Agee lived with her grandmother for a while as a child. “We
were very close,” she says. “She was my go-to person.”
***
Her career with
Carilion began when she was a teen, working as a candy striper. About 40 years
ago, Agee was hired as a nurse at Roanoke Memorial and advanced through
administration. She was named VP of medical education in 1996 and Chief Operating
Officer in 2001, reporting to CEO/President Ed Murphy, who would groom her for
his position. In 1985, the Jaycees of Roanoke saw her as a bright light and
named her Outstanding Young Woman of the Year. Most recently, recognition for
her work has been impressive: beckershospitalreview.com selected her among the
24 leading women in the health care world. She was included among Virginia
Business magazine’s Big Book Most Influential Virginians. Virginia Lawyers
Weekly selected her one of the 40 Most Influential Women of Virginia, 2015.
She has degrees from the University of Virginia and Emory
University; postgraduate studies at Northwestern University's Kellogg School of
Management and she went to nursing school at Carilion. She was “first in my
family to graduate high school,” not to mention college, she says.
Husband Steve Agee, was a Republican Virginia State Delegate
from Salem. He now sits on the U.S. Court of Appeals, 4th Circuit in Richmond.
Son Zach is a clerk for an appellate judge in Virginia Beach. The family is
close, despite physical distances of their jobs. “We love each other and we like
each other. The family is a priority,” she says. Zach and Steve “respect that I
have my own thing. Each of us has our own interest. At home, we don’t always
talk about work.”
Agee is a healthy eater and works out regularly, but she
drinks Diet Dr. Pepper throughout the day. It is a drink that is something of a
family tradition. “We used to stop on the way to the beach—on those few trips
we made to the beach—or to see our family in Tennessee, and get Dr. Peppers.”
***
Her profession, she says, “is a passion. It started a
long time ago. All my life, I’ve wanted to make a difference in health care.”
“I never did” aspire to high management, Agee insists. “I
moved into it out of a sense of frustration, getting things done for patients
that needed to be done. I gravitated to it more than planned for it.”
Replacing Ed Murphy, an MD and PhD with clinical
experience, as president/CEO “was a bit of a surprise. I was flattered and
grateful, but I anticipated being an interim CEO until a search was completed.”
When Agee was selected by the board of directors, “I said, ‘Are you sure?’”
Murphy says he moved Agee into the COO position when he
took over the reins from Tom Robertson at Carilion because she had “the skills
to run a complex organization.” He saw “a three-legged stool” in her skill set:
the “ability to handle and manage a [large, complicated] health care
organization; the ability to manage people and keep the trains running on time;
and a good dose of strategic vision. She was a very good fit.”
It wasn’t difficult to convince the board to slide Agee
into the boss’ chair upon Murphy’s resignation, he says. “You look at the
people all over the country [in that position] and Nancy has elements of all of
the [successful ones]. She is a rare individual with an equally strong set of
skills [across the spectrum]. She is a rare find.”
Board member Warner Dalhouse, a retired banker who has
been on the boards of Carilion and Community Hospital before the merger with
Roanoke Memorial, says he and a few others pushed hard for Agee when the
vacancy at the top occurred.
Says Dalhouse, “When Ed let it be known he was leaving for
New York [to join TowerBrook Capital Partners LP], I was one pushing hard for
us not to do a search, to just go ahead and hire Nancy. It was a gusty thing
for the board of a large enterprise to do. We had a fiduciary responsibility.”
The vote was lopsided. “I was at a funeral with [former
Carilion CEO Tom Robertson] a few days after we appointed Nancy and we were
talking about it. I said, ‘Can she run it?’ and he said, ‘She’s been running it
for a long time.’”
Robertson says Agee “has a lot of credibility, a clinical
background and excellent interpersonal skills. She understands the culture [at
Carilion].” It was a matter, he says, “of the right time, right place, right
person.”
Murphy, says Dalhouse, “was a visionary, but Nancy ran [the
corporation] on a day to day basis. Boy did she ever! We had been losing a good
bit of money for several years when Nancy took over and it took her four years
[to push Carilion into the black]. Now [in 2015] we are making money.”
***
As Chief Operating Officer, “I followed [Murphy’s
direction] and made it work,” says Agee. “The COO can disagree,” she says, “but
you have to believe. The CEO has to be vigilant and understand what’s going on.
You work differently in a $1.7 billion company.”
Murphy was a
difficult act to follow, even though finances were in a bind when he left. In 2010, shortly before Agee took over, Carilion reported an
operating loss of $45.9 million on revenues of $1.24 billion. The loss
continued for a while before Agee righted the ship (the net having fallen 40
percent in the previous two fiscal years). During that difficult financial
period, charity
care increased by 31 percent at the region’s non-profit health care center, the
one that was described by Valley Business FRONT magazine as “the health care
organization with big shoulders.”
Murphy began a long transition from a hospital to a patient-focused
clinic during his tenure; helped institute a partnership with Virginia Tech and
also founded a med school and research institute. Agee calls Murphy “a
visionary,” “a wonderful mentor,” “a good teacher” and a man who “dreams big
dreams.” She told Virginia Business, “His footprint will be different than mine
...” shortly after she was elevated to CEO.
***
Carilion met strong, loud and persistent resistance to its
conversion from a hospital-based operation—which is traditional—to the newer
clinic system. That system focuses on outpatient care. Murphy instituted the
change but Agee has been all-in. Those opposed to the change—primarily
physicians—say it creates a monopoly and drives up costs.
For a period during the change, Carilion was losing
physicians in trauma care specialties at such a rate that it had to alert the Commonwealth
that it wasn’t meeting its requirements as a Level I center. The change in
leadership seemed to ease that conflict. Vista Eye Center managing partner John
Brisley, M.D., was quoted in The Roanoke Times at the time as saying, "Our
sense is with Nancy Agee heading things up now, there really is a new tone and
it's a new approach." She moved quickly upon appointment to fill the
trauma leadership void, promoting Paul Davenport to VP of Emergency Services.
Dalhouse says, “When she took over, Carilion was in terrible
shape regarding the area’s independent physicians [because of the move to the
clinic model] and there were a lot of sharp feelings. Ed didn’t really tend to
that. She smoothed it over and now some of the physicians who opposed [the
clinic change] have joined in. Ed made no real effort to do that.”
The sheer size of the company obviates some of what Agee
would like to do. “People say, ‘I wish you would make rounds every day like Mr.
[ex-CEO Ham Flanagan] did.’ I do, but we have seven hospitals and 1,000
physicians. Every day I am somewhere, but we have a bigger footprint.”
Early in her tenure, says Agee, she received some
valuable advice from a close friend: “Make this your own. You’re not following
anybody else’s footsteps.”
The board wanted immediately to “refresh and review our
mission. First, how do we get out of the hole? We were deep in the red at the
time. I got permission with expectation.” She did not “have a traditional
honeymoon. It was time to roll up my sleeves and get to work.” She says Carilion
has “a very engaged board,” and has had for a long time.”
The challenge was impressive, but, says Agee, “I love to
work and I work hard.” Her days are often 12 to 15 hours long.
***
Education has
always been at the center of Agee’s interest. “Jefferson College is an enormous
asset. It has, what, 1,100, 1,200 students with masters and baccalaureate
degrees.” PhDs are on the horizon and that will “be a huge asset.”
She was instrumental in bringing the new doctorate of
physical therapy program from Radford University to Roanoke. She established
the research-based Innovation Center at Carilion, as well.
Education and health care “are a dual passion” of hers.
Centering STEM(H) education in Roanoke is a goal. She directs a nonprofit
organization that includes Jefferson College of Health Sciences and the
Virginia Tech/Carilion Medical School. She stresses that “we have educated a
lot of people who work at the other hospitals.”
The vigorous relationship with Virginia Tech, which
accelerated during Ed Murphy’s tenure, presents “the opportunity to do exciting
things. You’re just seeing the beginnings.” What Carilion has accomplished, Agee
says, “is extraordinary for a region our size. You can get anything here except
transplants. That’s a WOW!”
Her work with the Joint Commission board and the American
Hospital Association have put her smack in the middle of the conversation on
health care reform with the people who can make it happen. Cost and quality are
her laser-focus issues. She is especially interested in how cuts would affect
Medicare and Medicaid.
Agee stresses that “60-90 percent of our payer source
[the government] doesn’t pay the cost” of treatment. “We need a vibrant
business community to support the kind of health care we want. We need to grow
this community better, to grow services. I’m really serious about that.”
As big as Carilion is, “We’re small compared to others.
We’re a big fish in a small pond. I wish the pond was much larger.”
***
Colleagues and
business leaders have been consistently impressed with Agee.
John Williamson, former CEO of RGC Resources in Roanoke,
served on the Foundation for Roanoke Valley, Roanoke Economic Development
Partnership and RGC Resources Boards with her. He says, “I always found
her to be well prepared, incisive in her questions, thoughtful and poised in
her comments, and deliberate and prompt in her decisions. She tends to inspire
confidence. "
Laurens Sartoris, former President/CEO of the Virginia
Hospital & Healthcare Association, has been quoted as saying Agee’s strong
relationships make it “a more comfortable exercise in communication when people
get along." Sartoris’ successor, Sean Connaughton, calls Agee a “nationally
recognized leader and trailblazer who has helped build Carilion Clinic into a
renowned provider of exceptional healthcare services.
“She is a Carilion Clinic lifer … overseeing one of
Virginia's largest non-profit integrated health care organizations. … Nancy is
a tireless advocate for Carilion Clinic, for health care, and for patients. I
consider myself fortunate to have ... a chance to know her and work with her.”
Warner Dalhouse says
Agee “is an excellent administrator. She is good with the board. Nancy decides
the strategy, gets approval and delegates. The people who work with her love
that. … Carilion runs like a well-oiled machine. She doesn’t even have to be
there.”
Agee, says Dalhouse with emphasis, “tends to the store.”
In a magazine story, Becker’s Hospital Review quoted Agee as
saying, “At
the end of the day, it's about paying attention. The most important thing is
taking care of patients, followed by making sure our staff has a great
environment.”
In brief
Nancy Howell Agee
Born: Roanoke Children’s Hospital, April, 1952
Married To: G. Steven Agee, judge U.S. Court of Appeals,
4th Circuit. Son, Zachary S. Agee, court clerk.
Education: Northwestern University (Kellogg School of
Management); Emory University, magna cum laude; University of Virginia, with
honors; Roanoke Memorial Hospital, nursing diploma.
Title: President and CEO, Carilion Clinic since 2011. Has been COO/Executive VP; senior VP Carilion
Health System/Carilion Medical Center and VP medical education. Various
management positions at Carilion Roanoke Memorial Hospital.
Professional Affiliations: American Hospital Association
board of trustees, board of directors, committees; Coalition to Protect
America’s Healthcare Association board; Virginia Hospital & Healthcare
Association board member and chairwoman; The Joint Commission board; Virginia
Tech Carilion School of Medicine board; Virginia Foundation for Independent
Colleges, board; Virginia Tech Foundation board; Virginia Business Council,
vice chairwoman; Virginia Business Higher Education Council; Virginia Western
Community College Education Foundation board; RGC Resources board; Hometown
Bank & Hometown Bankshares Corporation board; Governor’s Advisory Council
on Revenue Estimates; Center for Medical Interoperability board; Rockingham Group board; Association of
Community Cancer Centers board; Hospice Association of America board; American
Cancer Society—National advisory group; ACS Virginia Division board; ACS
Roanoke Valley Unit honorary board.
Community Involvement: Taubman Museum of Fine Arts board;
Western Virginia Foundation for the Arts and Sciences board; Radford University
board of visitors; Foundation for the Roanoke Valley, board; Mill Mountain
Theatre board; Roanoke Regional Chamber of Commerce board.
Awards (selected): University of Virginia Outstanding Alumni;
Roanoke College – Doctor of Humane Letters; The Taubman Museum of Art – Ann
Fralin Award (Community leadership and support of the arts); Palladium Award
(Carilion’s highest award for quality); March of Dimes Hall of Fame; Silver Hope Award
– Multiple Sclerosis Society, Blue Ridge Chapter; Meritorious Service, American
Cancer Society, Virginia Division’s Highest Award; Outstanding Young Woman of the Year, Jaycees
of Roanoke Valley; Outstanding Nurse, Virginia Nurses’ Association, District 2;
Miss Hope of Virginia, American Cancer Society.