Inside Columbia's CEO Summer 2011

LET THE SUN SHINE

an mu PRoFessoR amPs uP solaR PoWeR Page 19

HAL WILLIAMSON & DAN ROTHERY on THe busIness oF HealTH CaRe Page 50

ArE WE fEELING BEttEr yEt? Taking The Temperature of Columbia’s economy

summer 2011 www.ColumbiaCeo.com

Small Business Of The Year Owner Mel Toellner Shares His Secrets For Success Page 23

CONtENts

Inside Columbia’s ceo • www.ColumbiaCEO.com • Volume 2, Issue 4

23

10

10

opening Bell: The Buzz on Como Biz

12

The Columbia/Boone County economic Index

14

regional roundup

19

Invention: The power of sunshine

23

mel Toellner shares His success secrets

44

Are we feeling Better yet?

Taking The Temperature of Columbia’s economy

50

Healthy Competition: Dan rothery And Hal williamson on The Business of Health Care

59

shopping: great grills

61

networking

65

publisher’s note

66

Closing Quotes

19

59

summer 2011

I

InsIde ColumbIa’s CEO

I

7

INsIdE COLUmBIA’s CEO

stAff Publisher Fred Parry fred@insidecolumbia.net associate Publisher Melody Parry melody@insidecolumbia.net

meeT our eDITorIAl ADVIsory BoArD

editor-in-chief Sandy Selby sandy@insidecolumbia.net copy editor Kathy Casteel kathy@insidecolumbia.net editorial assistant Haley Adams haley@insidecolumbia.net Photo editor L.G. Patterson design consultant Katie S. Brooks

tom atKins Chairman and CEO, Atkins Companies

randy coil President, Coil Construction

gary dreWing President, Joe Machens Dealerships

bob gerding Partner, Gerding, Korte & Chitwood CPAs

creative director Carolyn Preul design@insidecolumbia.net graphic designer Casey Loring casey@insidecolumbia.net digital and new media Projects designer Jill Hamilton jill@insidecolumbia.net

Paul land Principal/Owner Plaza Commercial Realty

byron hill President & CEO, ABC Laboratories

dianne lynch President, Stephens College

george PFenenger President & CEO, Socket

director of marketing & business development Bill Bales bill@insidecolumbia.net director of sales Linda Cleveland linda@insidecolumbia.net marketing representative Ken Brodersen ken@insidecolumbia.net marketing representative Kyle Gross kyle@insidecolumbia.net

bob Pugh CEO, MBS Textbook Exchange

miKe staloch Vice President of Operations, State Farm Insurance

greg steinhoFF President of Strategic Operations, VA Mortgage Center

Jerry taylor President, MFA Oil Co.

marketing representative Eric Steege eric@insidecolumbia.net special Projects manager Elliott Usher elliott@insidecolumbia.net business development specialist Quinn Leon quinn@insidecolumbia.net

Please Recycle This Magazine.

Inside Columbia’s CEO magazine 301 W. Broadway • Columbia, MO 65203 • Office: 573-442-1430 • Web: www.ColumbiaCEO.com Inside Columbia’s CEO is published quarterly by OutFront Communications LLC, 301 W. Broadway, Columbia, Mo. 65203, 573-442-1430. Copyright OutFront Communications, 2011. All rights reserved. Reproduction or use of any editorial or graphic content without the express written permission of the publisher is prohibited.

Postage paid at Columbia, Mo. The annual subscription rate is $19.95 for four issues.

8

I

InsIde ColumbIa’s CEO

I

summer 2011

office manager Brenda Brooks brenda@insidecolumbia.net distribution manager John Lapsley contributing Writers Anita Neal Harrison, Jessica Perkins, Ed Robb contributing Photographer Dan Brenner

summer 2011

I

Inside Columbia’s CEO

I

9

OPENING BELL

the buzz on como biz

Vacations Unplugged

R

Can you make it through a vacation without touching base with your office?

We dare you to try.

10

I

InsIde ColumbIa’s CEO

I

summer 2011

emember the good ol’ days when your vacation was uninterrupted by emails and text messages? When you didn’t pack your iPad next to your swimsuit or tuck your smartphone into your beach bag next to your sunscreen?

A new survey by CareerBuilder finds that 3 out of every 10 workers take their jobs with them on vacation. The good news is that the economic recovery has made people more comfortable taking time off this year, according to the survey, and 25 percent of them plan to take a vacation of seven to 10 days. About the same number plan to take their vacations in smaller chunks — long weekends and midweek breaks.

Rosemary Haefner, vice president of CareerBuilder, has these tips to help you make the most of your summer vacation.

■ GIVE PLENty Of NOtICE. Coordinate your schedule with your family and your co-workers as early as possible so you won’t be caught trying to vacation while juggling major work projects and events.

■ dON’t tAKE A GUILt trIP. Twelve percent of workers reported they feel guilty that they’re not at work while they’re on vacation. But Haefner says you should take the opportunity to relax and restore your creativity. The work will still be there when you return.

■ mAKE sUrE yOU’rE COVErEd. Buddy up with other co-workers to cross-train one another on responsibilities, upcoming deadlines, key contacts, where information is stored, etc. If your company may need to contact you for something while on vacation, make sure to set parameters on when you’ll be available and stick to them.

OPENING BELL

The Inside Columbia’s CEO

Economic Index Boone County/Columbia Business Conditions First Quarter 2011

94 —

101.6

100.4

100.2 97.2 95.7

95.4

-

96.5

97.5

97.5

96 —

98.2

2 0 0 7 Q 4

99.5

2 0 0 7 Q 3

99.1

101.2

102.9

104.9 101.6

103.0

103.6

98 —

101.1

108.1 106.1 104.3

104.6 101.7

100 —

102.7

102 —

105.0

104 —

106.8

106 —

100.0

108 —

109.5

110 —

92 — 90 — 2 0 0 4 Q 1

2 0 0 4 Q 3

2 0 0 4 Q 2

2 0 0 4 Q 4

2 0 0 5 Q 1

2 0 0 5 Q 2

2 0 0 5 Q 3

2 0 0 5 Q 4

2 0 0 6 Q 1

2 0 0 6 Q 2

2 0 0 6 Q 3

2 0 0 6 Q 4

2 0 0 7 Q 1

2 0 0 7 Q 2

DATE

I

nside Columbia’s CEO Economic Index is a quarterly snapshot of how Columbia’s economy is doing compared to where it was five years ago.

Edward H. Robb and Associates, an economic and governmental consulting firm, prepared this index for Columbia and Boone County by collecting data from the past 18 years for 10 key economic indicators: hotel taxes; deplanements at the Columbia Regional Airport; Boone County total sales tax receipts; Columbia total sales tax receipts; Boone County sales tax receipts

2 0 0 8 Q 1

2 0 0 8 Q 2

2 0 0 8 Q 3

2 0 0 8 Q 4

2 0 0 9 Q 1

2 0 0 9 Q 2

2 0 0 9 Q 3

2 0 0 9 Q 4

2 0 1 0 Q 1

2 0 1 0 Q 2

2 0 1 0 Q 3

DATE excluding Columbia; total Boone County building permits; total Boone County single-unit building permits; total Boone County employment; total Columbia employment; and Boone County employment excluding Columbia. After analyzing the data, Robb went a step further and seasonally adjusted the figures to create the most accurate index possible.

The result is a single number that indicates how robust our Columbia/Boone County economy was for a given quarter.

Prepared By E.H. Robb & Associates *The base year for all of the indices is 2000. All indices will average 100 for the 12 months of 2000. **Based on one month of analysis

12

I

Inside Columbia’s CEO

I

summer 2011

2 0 1 0 Q 4

2 0 1 1 Q 1 **

summer 2011

I

Inside Columbia’s CEO

I

13

OPENING BELL

regional roundup

Columbia’s VA Mortgage Center.com Announces Plans To Add 300 Jobs

G

ov. Jay Nixon came to Columbia on June 2 to announce that VA Mortgage Center.com, a company that specializes in providing home financing to military veterans, will significantly expand its operations in Columbia, creating 300 new jobs over the next five years while further investing in the local economy.

The governor made the announcement at VA Mortgage Center.com’s main facility in Columbia, where it currently houses about 400 of its 500 employees.

The company’s planned expansion is aimed at increasing its offerings, hiring more employees, and consolidating its three Columbia facilities into a single headquarters in Columbia.

“This investment in job creation is a significant step forward for Boone County and all of central Missouri,” Nixon said.

“VA Mortgage Center.com has been wildly successful since its founding nine years ago, helping to ensure that our nation’s military veterans, who have sacrificed so much for our freedom and security,

have access to affordable home loans. This company’s plans to create 300 new jobs while investing significantly into the local economy is great news for our state, and just the latest sign that our economy is clearly headed in the right direction.”

Since its founding, VA Mortgage Center.com has helped more than 500,000 military families, making available more than $1 billion in home financing in the last year alone. Since May 2008, VA Mortgage Center.com has grown from 136 employees to 505 currently, an increase of 268 percent in just three years.

To help VA Mortgage Center.com move ahead with its plans, the state of Missouri authorized an economic incentive package worth $6.1 million to the company, which can be redeemed by the company over the next five years, provided it meets the requirements of each incentive program.

VA Mortgage Center.com Names Gary Lee As Chief Technology Officer VA Mortgage Center.com has named former Carfax executive Gary Lee as its first chief technology officer. Lee will work with the VA Mortgage Center.com executive team to develop and implement company strategy and vision for the future. He will also help determine how to best utilize technological advances to better serve the company’s short- and long-term goals.

“Gary’s experience with a wellrespected technology company will be extremely valuable,” says CEO Nate Long. “His skills and knowledge will help us leverage evolving technologies to increase our position as an industry leader. That ultimately translates to providing even better service to veterans and military families.”

Since its inception, VA Mortgage Center.com has developed proprietary software that has given it a competitive advantage within the industry. Lee will oversee advances to that software and take the lead in recruiting one of the most advanced teams of technology professionals in the country.

Moberly’s Mamtek Recognized With Site Selection Award

M

amtek International’s decision to locate in Moberly has earned the sweetener manufacturer a CiCi Award from Trade & Industry Development, the leading magazine dedicated to site selection. The magazine recently announced its sixth annual Corporate Investment & Community Impact Awards.

“Despite a slowly rebounding economy, the 2011 CiCi Awards showcase 30 impressive projects indicating positive economic growth across the country,” says Scott D. Swoger, Trade & Industry Development publisher and president of Due North Consulting Inc. “From foreign direct investment to innovative new domestic companies to blue-chip corporations recognized worldwide, we have seen significant developments throughout a broad range of industries. Each of these projects has a unique story to tell.”

14

I

Inside Columbia’s CEO

I

summer 2011

Mamtek International Inc., a new manufacturer in the Moberly area that produces a no-calorie, no-carbohydrate sweetener, was selected for honors in the Community Impact category. According to the magazine’s editors, hundreds of submissions were considered, concluding with 30 winners for the two categories — Corporate Investment and Community Impact. Mamtek was the only Missouri business on the list.

The CiCi Awards are unique in that it is a dual-awards program that not only highlights the largest corporate investment projects, but also recognizes those projects that may not involve large investments but made the most notable impact on communities. Several criteria are considered for the Community Impact division, including number of new jobs created, number of current jobs retained, unemployment figures, income level of the region and plant closings.

18

I

Inside Columbia’s CEO

I

summer 2011

inventions

The Power Of Sunshine Patrick Pinhero And His Team Are Developing A More Effective Way To Harness Solar Energy by JESSICA PERKINS photos by L.G. PATTERSON

Patrick Pinhero

S

olar power is heralded as a sustainable energy option, but its limitations make it an unrealistic choice for many American businesses and homes. Current methods of generating electricity from sunlight max out at a theoretical 30 percent efficiency, with real-life models bordering on only 20 percent efficiency. This, combined with the relative costliness of installing solar materials, leaves solar power with some pretty dismal options for marketability.

Some wavelengths of light are felt as heat.

But Patrick Pinhero and his team are developing a new way of harnessing the sun’s power. The University of Missouri associate professor of chemical engineering and his collaborators are creating a thin, flexible material that could harness solar energy with about 90 percent efficiency. They envision its lowcost incorporation into advanced building

materials, including siding and perhaps even auto bodies.

Unlike traditional mechanisms, Pinhero’s solar technology doesn’t rely upon the photoelectric effect. While most solar devices use sunlight to excite electrons in a semiconductor, thereby creating an electrical current, Pinhero’s models “capture” the sun’s power directly. summer 2011

I

Inside Columbia’s CEO

I

19

inventions Tiny nanoantennas — or “nantennas,” as the researchers have dubbed them— allow photons to resonate in the structure, kick-starting a process that generates an electrical current. Pinhero and his colleagues have fabricated nantennas into flexible polymer films, making their device much more versatile than bulky solar panels.

Today’s solar devices function only within a small sliver of the visible light spectrum, leaving other energies untapped. But Pinhero’s team has already had success at the infrared level and expects to tackle a fuller range of the visible frequencies next, outperforming previous solar devices.

Although they can’t be seen, some wavelengths of light are felt as heat.

Pinhero says the nantennas can be used to convert heat from infrared light into electricity, if temperatures are greater than 750 degrees. Possible industrial settings include power plants and aluminum smelters. This new technology

20

I

Inside Columbia’s CEO

I

summer 2011

could be utilized to fabricate a wall covering, for example, that could harvest waste heat to power secondary operations such as a plant’s HVAC control systems.

Now that Pinhero and his colleagues have succeeded at collecting energy with the nantenna, the next big step is to develop higher-speed diodes that will actually convert the energy into usable electricity.

“We can collect with 90 percent efficiency, but we can’t do anything with it,” Pinhero says. Experts at the Idaho National Laboratory and the University of Colorado at Boulder are working on this aspect of the project.

Pinhero and his team also have their sights set on reducing the dimensions of the devices in order to collect visible solar light.

“Within some of the mid-infrared frequencies, we are extremely confident that we have the technology,” he says. “It’s when we move toward the visible where we will be on the frontiers of engineering.”

When Pinhero and some colleagues first realized they’d hit upon a more efficient way to collect solar energy, it was an unexpected discovery. They were working on another project at the Idaho National Laboratory, where Pinhero was employed as a materials scientist until he accepted his current position at MU in 2007. As he and his team were working, they noted that energy collection efficiencies were much higher than anticipated.

“We knew we had something pretty novel,” he says.

By the time Pinhero began working at MU, the solar energy project had slowed down considerably. Once the group brought the University of Colorado’s Garret Moddel on board to couple his high-speed diodes with the nantenna, the researchers began to seek funding from the U.S. Department of Energy, the U.S. Department of Defense and private investors.

Without adequate funding, Pinhero fears the team’s research will become trapped in what he calls the “valley of death” — a no-man’s land between fundamental science and commercialready products. With funding, Pinhero expects to have prototypes for the waste heat devices ready in about three years, and visible frequency prototypes in five years. A group at MicroContinuum Inc. in Massachusetts is charged with using cost-effective processes to create these prototypes on a large scale.

Pinhero’s pride in his colleagues is evident. “This is a true integration of design, science and manufacturing, all on one team,” he says. “To me, this is nothing short of amazing.”

The implications of their developments are profound. The international problem of how to get enough energy is among the most important issues the world faces, Pinhero says. With inexpensive nantenna devices, he envisions bringing energy to remote places such as villages in Africa, or having ready backup power in the aftermath of natural disasters.

It will serve as a complement to other energy sources, including traditional solar mechanisms.

The technology could also prove useful in a number of other fields.

a crosscountry collaboration Experts from across the United States are pooling their knowledge and resources to realize a new kind of solar technology.

Columbia, Mo. Patrick Pinhero University of Missouri Idaho Falls, Idaho Dale Kotter Idaho National Laboratory Idaho Falls, Idaho Steven Novack Idaho National Laboratory Boulder, Colo.

Garret Moddel University of Colorado at Boulder Cambridge, Mass.

Dennis Slafer MicroContinuum Inc. Glen Ellyn, Ill. Pat Brady RedWave Energy Inc.

Within infrared frequencies, Pinhero says the nantenna could possibly be used as dual transmitter/receivers in new communication bands. They could also be used for security applications such as airport or border patrol monitors.

Within visible frequencies, the possibilities are nearly endless. Pinhero says the nantenna could be integrated into various materials in order to collect solar energy, including vehicle surfaces, tent fabrics, clothing and military supplies.

“One of the key elements about energy security is to be able to diversify your energy supply portfolio and have similar economic options,” Pinhero says. “It’s not about making trillions of dollars. The real objective is to make this technology widely available.” summer 2011

I

Inside Columbia’s CEO

I

21

22

I

Inside Columbia’s CEO

I

summer 2011

ENTREPRENEURIAL SPIRIT <<< Store manager Holly Seaver (left) and Songbird Station founder/co-owner Mel Toellner

THIS BUSINESS IS FOR THE BIRDS

Songbird Station Owner Shares His Success Secrets

by KATHY CASTEEL photos by L.G. PATTERSON

Mel Toellner learned his lessons well as a Boy Scout. The classic credo, “Always Be Prepared,” was his byword when Toellner was scouting the area for a small-business opportunity in the early 1990s.

“We studied the market and charted the industry in Columbia for three years before we opened Songbird Station,” he says.

Toellner’s homework has paid off in spades since he and his wife, Bev, opened the retail shop that caters to backyard birding and nature enthusiasts in 1995. In May, the Columbia Chamber of Commerce named Songbird Station Small Business of the Year.

“We’ve been blessed,” says the 57-year-old entrepreneur. “But I don’t think it’s an accident.” >>>

Toellner traces his passion for birding to his Boy Scout days. In 1972, the Bunceton teenager won a scholarship to an Audubon Society camp in Wisconsin.

“Everything happens for a reason,” he says. “There was a seed planted then.”

He filed away the camp experience, along with lessons learned growing up and working in his father’s 49-year family business in Bunceton — Toellner’s Tire Supply — and headed to Columbia that fall to study agricultural economics at the University of Missouri. His first Columbia business, Mel’s Plants, paid his way through college and opened networking connections he still treasures nearly four decades later.

Toellner spent 23 years with Purina as a manager of dealer development and distribution for eastern Missouri and parts of Illinois and Iowa. The corporate career was satisfying but the entrepreneur bug is a hard one to shake. He opened Songbird Station in a 900-square-foot space across from Chris McD’s in Forum Shopping Center 16 years ago.

“The first year we broke even, and the second year we made money,” Toellner says.

Annual sales in 2010 topped $500,000.

The Toellners were soon looking for ways to buy inventory at a better price and expand their sales potential. They launched their warehouse division, Gold Crest Distributing, in 1996, stockpiling items for shipment in their garage. Two warehouse moves later, Gold Crest today is the largest distributor of wild bird and backyard nature products in North America, shipping to all 50 U.S. states and Canada from its 75,000-square-foot facility in Mexico, Mo. In 2002, Inc. magazine named Gold Crest to the Inc. 500, ranking it No. 168 on its list of the nation’s fastestgrowing private companies in the United States. Gold Crest made the Inc. 500 again in 2003, coming in at No. 287.

Toellner retired from Purina in 2000 to devote attention full time to his business and manage its growth.

“You have to be there,” he says. “Only planes fly on autopilot — businesses don’t.”

It is a family business; he has worked side-by-side with wife Bev, benefiting summer 2011

I

Inside Columbia’s CEO

I

23

ENTREPRENEURIAL SPIRIT from her “woman’s touch” in choosing many of the store’s products.

“She has signed every check and entered every payable,” he adds.

Son Grant and daughter Becky grew up with their parents’ business; Becky has gone on to a career as a special education teacher in Harrisonville but still helps out in the summer while Grant joined the store’s staff as sales and marketing manager after graduating from MU in 2010.

In 2007, Songbird Station moved a few blocks south to 2010 Chapel Plaza Court, filling the 3,600-square-foot space with a mind-boggling array of nature products — feeders, seed and accessories, birdhouses, birdbaths, toys, books, DVDs, pet products, native plants, wind chimes, home and patio décor, outdoor furniture, shade-grown “bird-friendly” coffee, even apparel — in a soothing oasis of backyard calm punctuated by the merry sounds of chirping birds and water gardens. The broad-ranging inventory reflects Toellner’s new tagline he coined after the move

24

I

Inside Columbia’s CEO

I

summer 2011

to describe Songbird Station as “MidMissouri’s Best Wild Bird Store & So Much More.”

“It’s truly a destination store,” says store manager Holly Seaver. “We have people who stop in every time they come

Nature, not the business of nature, is Toellner’s passion. to Columbia, and local folks who bring in visitors when they have company — one of the stops on their personal tour of Columbia.”

The store’s loyal customer base is intense, says Seaver, who has worked at Songbird Station for 2½ years. “I’ve never worked in a place where I’ve gotten so many hugs,” she says with a laugh.

Already the owner of several patents for products such as the All Weather Feeder and the Nectar Protector ™, Toellner launched his own brand of products,

Songbird Essentials, in 2008, which he sells in the Columbia retail store as well as nationwide through Gold Crest Distributing. Songbird Essentials is the fastest-growing line of wild bird products in North America for three years running.

“The retail store is our concepts testing ground,” Toellner says. “We test all our products here.”

Successful test products that have recently joined the Songbird Station inventory include Summer Classics, a line of American handcrafted outdoor furniture, and Organic Lawn Care, a line of products launched in conjunction with Columbian Jeff Zimmerman’s The Lawn Company.

Songbird Station has become a showcase for the backyard nature industry, hosting an annual open house and tour every October for other Gold Crest client stores, as Toellner shares his formula for success with fellow entrepreneurs. It is that same spirit of sharing he offered local entrepreneurs

when he addressed chamber members after winning this year’s Small Business of the Year award.

Toellner’s “secrets to success” are centered on seven principles he follows in his business dealings.

1. Study your market and your competition. Toellner likes to quote a favorite movie line from George C. Scott in “Patton”: “Rommel, you magnificent bastard! I read your book!” Understand the strengths and weaknesses of your competition, he says.

“The business plan has got to be right,” he says. “Then it boils down to execution — ID key actions, put the right people in place, and put a checklist in place.”

2. Listen, listen, listen to your customers. The best product ideas, service issues and referrals come from your customers, he says.

“Don’t wait for them to come to you, though,” Toellner advises. “We get out and mingle with our customer base at home shows, do the talk circuit at Kiwanis, Rotary and garden clubs, host Sip & Shop events and offer seminars.”

3. Know who’s walking through your door. Get to know your customers, he says. Collect their contact information, likes and dislikes at the point of sale. Soon after that first visit, customers receive a personalized thank-you note with a gift: a magnetic bookmark featuring a favorite bird or pet breed.

“People remember it,” he says. “It makes an impression. I’ve had people tell me they still have their bookmark from 15 years ago.”

Toellner utilizes a newsletter (email or postal) and a rewards system to capitalize on his database.

“I check reports every morning, and I know what sold yesterday and who bought it,” he says. Songbird Station’s rewards system offers coupons and special sales to repeat customers; coupons for the house brand are doubled.

“We always include a call to action with our sales and coupons,” he adds.

“There’s always an expiration date to get them back in the store soon.” summer 2011

I

Inside Columbia’s CEO

I

25

ENTREPRENEURIAL SPIRIT 4. Share knowledge — don’t just sell products. An educated customer is a loyal customer, Toellner believes, and his staff ’s product knowledge sets Songbird Station apart from other retailers and chain stores. The store opened in August 1995 and Toellner offered his first birding seminar just a few months later, in October. Over the past 16 years, he estimates he has conducted more than 100 seminars in the store.

Newsletters, seminars and outreach talks provide interesting information to feed his customers’ passion for nature.

From 2008 to 2010, Toellner wrote, filmed and hosted 2-minute “In Your Backyard” segments as Birdman Mel on the RFD-TV cable show “Making Better Animals.”

“Outreach is how you attract new people to your business,” he says.

Seaver’s passion is involving youth in birding and nature. “We’ve built birdhouses in the parks, brought in puppeteers and authors, and taken bus

trips up to Clarksville for Eagle Days,” she says. The store recently partnered with the Audubon Society to help Grant Elementary School’s fourth-grade science class purchase binoculars for birding.

5. Change, change, change the look of your store. Toellner follows the “20 percent rule” for retail inventory: a minimum of 20 percent changeover in products every year.

“You have to do new,” he says. “Know what the most common question retailers hear when customers walk in the door? ‘What’s new?’ So we change up our inventory and the look of our displays often.”

Seaver puts a pragmatic spin on it: “In this economy, you have to give your customers what they want.”

And what they want — if Songbird Station’s newest offerings are any indication — is custom patio furniture, unique dog and cat products (“My wife’s passion is her dogs,” Toellner says), garden

gifts and décor, organic lawn care and outdoor fashion. The apparel lines have been tremendously successful; Lindsay Phillips shoes, with their interchangeable straps and toppers, have provided the highest gross profits per square foot for the store, and local dermatologists have pointed their patients to Songbird Station’s sunwear and the SunDay Afternoon line of protective hats.

The store’s plethora of products led The Callaway Bank’s Ellen Dent to nominate Songbird Station for the chamber’s small-business award. The bank branch operations manager works right next door and visits the store frequently.

“I love to take my three grandchildren in and shop there and get gifts for my family members. The kids always love looking at everything in the shop and it is child friendly!” she says.

“Songbird Station offers a very unique place for the Columbia community. It appeals to the bird-loving folks, pet owners, everyone! It would take a couple days to look at everything!”

Yet despite the success of the evolving inventory, Toellner never loses sight of “the big thing,” he says. “You can’t worry about ants in the petunias while the elephants are stomping on the watermelons,” he says with an affable smile that quickly turns serious. “We never forget that the wild bird sector is our primary business.”

6. Work with neighboring and fellow business owners. It is important, he says, to cooperate with other businesses in the area, buy local whenever possible, and support the community.

“Our neighbors — Clover’s Natural Market, Kilgore’s Pharmacy, Jazz and D. Rowe’s — have been very gracious in letting us place hummingbird baskets outside their businesses,” Toellner says.

“And when we need to purchase services, or offer refreshments at a seminar, guess who are the first businesses we turn to.”

Toellner has always sought out like-minded vendors committed to the independent business owner. “If they don’t exist, create them,” he says. “That is how our wholesale division came about.”

26

I

Inside Columbia’s CEO

I

summer 2011

7. Get involved in the community and give back. Toellner is a man of faith, he says, and “thankful to the Lord for this and the many blessings I’ve received.

My greatest joy now is helping folks like Mel West with PET [Personal Energy Transportation, a network of volunteers building and distributing hand-cranked wheelchairs].” Songbird Station buys boxes for PET, and contributes to projects for the Audubon Society, Second Chance animal shelter and Coyote Hill Children’s Home.

“I don’t want to be known just for how many bird feeders I sold,” he says.

“I am truly humbled by the award we received and I view it as a reward for the entire Songbird Station team. I hope we can be an encouragement to Columbia’s independent retailers. We can survive and flourish in central Missouri — even in the ever-exploding expansion of big box national retailers.”

Nature, not the business of nature, is Toellner’s passion.

“I want to help families enjoy nature together,” he says, always adding his signature pet phrase: “Nature is God’s stress reliever — take time today to listen to the birds sing.” summer 2011

I

Inside Columbia’s CEO

I

27

special advertising section

[ HEALTH CARE ]

by ANITA NEAL HARRISON

Health Care Nurses Missouri’s Economy A New MU Report Sheds Light On Economic Impact Of Hospital Construction In Columbia

A

new University of Missouri report shows that health care is Missouri’s No. 1 employer.

Health care ascended to the top spot during the Great Recession; as all other top five employment sectors lost positions, the health care sector continued to grow.* “That finding really underscores how the health care sector cushions the economy,” says the report’s lead author, Thomas G. Johnson, director of MU’s Community Policy Analysis Center, which prepared the report for the Missouri Hospital Association.

Growth in the health care industry did more than provide jobs for doctors and nurses; it also provided vital injections of jobs and wages into other sectors of the economy. For example, between 2002 and 2009, Missouri hospitals created almost as many jobs through construction and capital improvements — 21,703 jobs created — as through adding full-time hospital staff — 23,000 jobs created. And in 2009, hospital construction alone added $1.23 billion to Missouri’s economy.

That total captures more than just the price tag of hospital construction projects. While project costs cover the direct effects of construction, there are also indirect economic effects, such as expenditures on raw materials, that aren’t billed to the hospital, as well as induced effects, such as increased sales at local businesses as construction workers look to spend their wages.

“Imagine a hospital spends $1 million to renovate a wing,” Johnson says. “In the end, that million gets spent more than once.”

28

I

Inside Columbia’s CEO

I

summer 2011

For each dollar spent on hospital construction in Columbia, the state’s central region will realize 61 cents in new gross domestic product Or imagine instead, two hospitals in one city spend a total of $391 million on new construction projects within just a few years’ time.

That’s the situation in Columbia, where Boone Hospital Center just opened a new patient tower in June that, along with related projects such as a new pedestrian bridge, cost $124 million, and where University of Missouri Health Care is implementing a Master Facility Plan with three projects — the $52.5 million Missouri Orthopaedic Institute; the $12 million Women’s and Children’s Hospital; and the $203 million new patient care tower — for a total projected cost of $267.5 million.

Of course, not all of the $391 million being spent by Boone Hospital and University Hospital will stay right here in Columbia. Some of the money will go toward building materials, labor and other inputs purchased from outside the region.

Still, Johnson estimates that for each dollar spent on hospital construction in Columbia, the state’s central region will realize 61 cents in new gross domestic product and .0000137 job-years (a job-year is one year of one job; for example, 2,000 jobyears could equal 2,000 jobs finished in one year or 1,000 jobs lasting two years). Applied to the $391 million, those multipliers translate to $239 million in new gross domestic product and 5,359 job-years for the central region.

Broaden the effect to look outside of the central region and total sales generated from the construction projects, and the estimated impact jumps to $1.43 per dollar spent, or $559 million from the new construction projects.

Whichever calculation is used, Thomas points out, the result captures just the first of the economic impact of hospital construction.

“You also get a long-term benefit that we don’t measure,” he says. “[The hospitals] now have more capacity, and the new facilities increase the attractiveness of your sector. It reduces the number of local people going out of the area to get health services, and it increases the number coming in. You might think, ‘We spent that much, and that’s it,’ but it’s not because there’s this trade [of health care services between regions and states] that goes on as well.”

*Sectors analyzed by the MU study did not include the combined public sector of federal, state and local governments.

Both private and public hospitals were included in the health care sector.

summer 2011

I

Inside Columbiaâ&#x20AC;&#x2122;s CEO

I

29

special advertising section

[ HEALTH CARE ]

by ANITA NEAL HARRISON • photos by L.G. PATTERSON & courtesy of university hospital

boone hospital patient tower Timeline: Master plan completed: March 2006 Construction began: Nov. 3, 2008 Final steel beam placed: March 2010 New pedestrian bridge finished over Broadway: June 2010 William Street remodel completed: January 2011 Grand opening: June 26, 2011 Vital Stats: Area: 244,000 square feet Levels: 8 Patient rooms: 128, all private (40 ICU rooms and 88 medical surgery patient rooms) Conference room: Maximum capacity, 250 (area can be split into three rooms) Breakdown of floors: Ground: Lab 1: Registration, gift shop, conference center, main entrance 2: ICU waiting, ICU patient rooms 3: Cardiac surgery patient rooms 4: Cardiology patient rooms 5: Surgical specialties patient rooms 6: Shell space for future use 7: Shell space for future use 8: Mechanical penthouse Key Players: Architects: HKS Architects, Northville, Mich.

Construction management: Reinhardt/Wilson, Columbia/St. Louis Related Projects: New patient tower: $89.2 million William Street parking garage: $15 million William Street improvements: $5.2 million William Street pedestrian bridge: $1.3 million Oxygen farm: $1.1 million Boone Hospital Center also will relocate its lab for $5.9 million; in addition, the patient tower construction required the creation of a new labor and delivery unit for $6 million.

30

I

Inside Columbia’s CEO

I

summer 2011

university hospital patient care tower Timeline: Design work began: Mid-2006 Site preparation began: August 2009 Construction began: Early 2010 Projected construction completion date: Early 2013 Vital Stats: Cost: $203 million Area: 300,000 square feet Levels: 7 Inpatient rooms: 90, all private Operating rooms: 6, with “shelled” space for 6 more Pre- and post-procedure rooms: 25, with “shelled” space for 25 more Breakdown of floors: 1 & 2: New home of Ellis Fischel Cancer Center 3 & 4: Surgical services 5, 6, & 7: Inpatient rooms Key Players: Architects: Hellmuth, Obata & Kassabaum (HOK), St. Louis Construction management: JE Dunn Construction Company, Kansas City Related Projects: 1. UMHC’s new Children’s Hospital,moved in September 2010 2. UMHC’s new Missouri Orthopaedic Institute, opened in June 2010

special advertising section

[ HEALTH CARE ]

by ANITA NEAL HARRISON • photo courtesy of university hospital

Q&A With The HOSPITALS the consultants found that University Hospital was undersized by today’s standards, approaching the maximum capacity in key areas, and that it should be scheduled for long-term replacement.

How are the tower projects being funded?

University Hospital: The funding is coming from health system operating revenues, bonded indebtedness and philanthropy.

Boone Hospital: $100 million bond by the Boone Hospital Center Board of Trustees and $25 million in trustee funds.

How did the hospital determine the need for this expansion?

University Hospital: The expansion projects at University of Missouri Health Care are based on strategic financial and facilities plans developed in 2005 by health system leadership and approved by the University of Missouri Board of Curators in 2006. The integrated strategic, financial and facility plans are designed to guide the operations and expansion of the system through 2017.

Cannon Design of St. Louis conducted a facility review in 2005– 2006. To no one’s surprise, 32

I

Inside Columbia’s CEO

I

summer 2011

Boone Hospital: The most compelling immediate benefits of the new patient tower are the advances in privacy, safety and technology … The tower was also built to help accommodate the future growth of our community and our service area. Boone Hospital conducted a demographic study of our 26-county service area as well as analyzed our capacity for the next 20 years and researched a multiyear model as a road map for our hospital.

How has the hospital marketed the expansions?

University Hospital: Our marketing has been a mix of traditional advertising such as radio, TV commercials and newspaper as well as nontraditional communication through our social media channels, Facebook, Twitter and YouTube. In addition, we have held open houses.

Boone Hospital: The central message in our marketing of the tower is community ownership.

The tagline is, “This is your new patient tower.” We are hoping to show every person in this community that they are co-owners of this tower and they can feel pride in having Boone Hospital Center as their community hospital.

Both patient tower projects are seeking LEED certification. How does committing to green building impact construction costs?

University Hospital: In many cases, such as with most interior finishes, there was no premium for choosing a high recycled-content or a locally manufactured material. In other areas such as mechanical and plumbing systems, there was less than a 3 percent upfront investment that will be recaptured through reduced utility costs in less than five years.

Ultimately, the biggest savings should be in water and energy consumption over the life of the building. Engineering calculations indicate an estimated 37 percent water savings and 17 percent energy cost savings over a similar building without the high performance mechanical, electrical and plumbing systems. These two categories are especially critical in hospital buildings, which typically tend to have very high water and energy demands, long operating hours and long life spans.

Boone Hospital: Committing to green building practices resulted in a 1 to 2 percent markup of total project costs, or about $1 million. That investment will be recouped within three to five years through energy savings alone.

summer 2011

I

Inside Columbiaâ&#x20AC;&#x2122;s CEO

I

33

special advertising section

[ HEALTH CARE ]

Browning Accepted To National Public Health Leadership Institute

Medical notes

Health Care News From Around The Region

Unveiling Event Provides First Glimpse Of St. Mary’s Future Community members and leaders joined the project team, hospital staff and physicians on May 18 for the unveiling of designs for the new St. Mary’s Hospital in Jefferson City. President Brent VanConia heralded the project as “the most modern health care facility in our state.”

St. Mary’s project manager and chief operating officer, Cathy Abrams, described some of the unique clinical features of the new design.

“It’s all about the patient,” she said at the event. “We’ve taken years and years of input from our patients … and we’ve spent the past two years trying to figure out how to put all of that input into our new hospital.”

VanConia said the Missouri Department of Transportation plans to begin construction of the Highway 179 interchange at the new hospital site in July.

Completion for the new hospital facility is targeted for 2015.

Boone County Public Health and Human Services Director Stephanie Browning was recently accepted into the National Public Health Leadership Institute. According to the NPHLI, the one-year leadership development program is geared toward “high-potential leaders with a commitment to leading in their own organizations and communities, but also leading system change on the national scene.” NPHLI works to recruit high-potential leaders, foster individual development, build a network of committed leaders and combine learning methods.

Springfield Health Director Kevin Gipson recommended the program to Browning.

“I felt it was an opportunity for extensive interaction over a period of time with other public health officials that would give me greater insight and help me improve what I do here,” Browning says.

The program launched March 10. The group includes weekly conference calls, webinars, readings and assignments. Two on-site sessions that will include training in systems change, leadership assessment, developing others and individual coaching, will be held at the University of North Carolina Gillings School of Global Public Health at the North Carolina Institute for Public Health, where the program is based. Leadership assessments are conducted by the Center for Creative Leadership, a top-ranked, global provider of executive education that develops better leaders through its exclusive focus on leadership education and research.

The NPHLI’s mission is “to strengthen the leadership competencies of senior public health leaders and to build a network of senior leaders who can work together and share knowledge on how to address public health challenges.”

The NPHLI is sponsored by the U.S. Centers for Disease Control and Prevention.

Moberly Regional Medical Center Wins Award For Patient Safety Moberly Regional Medical Center has earned a Primaris recognition trophy celebrating the hospital’s success in quality of care improvements.

Primaris, Missouri’s quality improvement organization, partnered with Moberly Regional Medical Center and assisted on two fronts: preventing pressure ulcers and improving the medication reconciliation process at the hospital. The tailored approach has had a significant effect on patient safety and improved the quality of care for patients.

Moberly Regional Medical Center used a variety of quality improvement methods to determine areas for improvement, 34

I

Inside Columbia’s CEO

I

summer 2011

developed and implemented strategic tactics to address these areas, and utilized best-practice methodology to make dramatic improvements on both focus areas.

“By keeping an eye on these measures, we can celebrate our successes or, when we see a drop, we can work to address it. It keeps us on our toes and it keeps our patients healthy,” says Jennifer Dunkin, MRMC’s quality director.

“One of the strategies implemented to make improvements included an increase of pharmacy staff involvement in confirming a patient’s home medication lists. This helped tremendously with patients’ medication reconciliation.”

S pecial Promotional S ection

Note From Dan

Our Past And Our Future – Commitment to Caring Is At The Heart Of Our Mission Dear Neighbor,

L

ong ago, there was little here but a very steep hill. And up the hill, there was a path for wagons.

It was part of a trail used by early Missouri settlers as they traveled west.

While passage up the hill was always difficult, it became especially complicated during rain or when snow was melting. Wagons would begin to slide and wheels would spin. As they slipped and struggled on the soggy hillside, some travelers became stuck. But before long, locals would arrive and help pull the wagons to the top.

Once out of the mud, and before moving on, the travelers and locals would often stop to rest at the top of the hill.

This story is part of a book we published back in 1996: The History of Boone Hospital Center. That hill where they rested is where Boone Hospital Center sits today. The trail, which was called the Boone’s Lick Trail, is now Broadway.

It’s fascinating to imagine what one of those early travelers might say if they were to see our hill today. Certainly, much has changed. I imagine they would be amazed by the beautiful, brick hospital campus, with our community’s new patient tower rising high against horizon.

The people who rested under the shade trees atop our hill long ago most likely could not envision that such a structure would one day be built here. They would probably also be astounded that the once-remote location is now home to one of the nation’s 100 Top Hospitals.

However, they would also likely notice that one thing remained the same — this is still a place where people reach out to help others in need, whether they are stuck travelers or patients needing care. The spirit of giving is so ingrained in our culture it is not surprising to learn that it is part of the very ground this hospital was built upon.

This spring, as we prepare to welcome patients to the new tower, we will be writing the next chapter of our history. Building this new tower is a major accomplishment for this community and I hope you will join us to celebrate the occasion.

Serving others is our shared history — and our future.

Dan Rothery President Boone Hospital Center

Daniel J. Rothery

36

I

Inside Columbia’s CEO

I

summer 2011

S pecial Promotional S ection

Boone Hospital Center N ew Patient Tower

Healing By Design

June 26 - Grand Opening Celebration

Safety Is Built Into Every Aspect Of Boone’s New Patient Tower

W

hen you walk down the hall, past the rooms inside Boone Hospital Center’s new patient tower, one of the first things that will stand out is how the entryway to each room is slightly angled from the wall.

It’s an unusual sight.

In comparison to a traditional hallway, with the entries flat along the corridor, these doors are gently staggered, angled toward the patient’s bed.

As it turns out, the design choice goes beyond aesthetics. Hospital leaders chose to angle the doors so doctors, nurses and caregivers could see the patient as they pass each room.

That way, a nurse just walking down the hall for another purpose can informally check the status of a dozen patients as he or she passes. More eyes on each patient mean any problems are spotted sooner and care is provided more quickly.

This attention to detail and focus on safety is everywhere inside the new patient tower.

“We’ve really focused on evidencebased practice, and how we can make our patients safer,” said Monica Smith, Boone Hospital director of patient care services.

“We have put a lot of thought into working safety into our design.”

For example, when hospital leaders were deciding where to place the restrooms inside each patient room, they looked to the research. They found that most hospital falls happen while patients are using the restroom or moving to and from the restroom. The answer was to move the restrooms closer to the patient beds and ensure they are more accessible from the bed. It’s a simple change but one that will make a meaningful difference in helping reduce dangerous falls.

Every patient room is also structured and organized for same-handedness, meaning all the equipment and supplies are located in the same location in each room.

“If you are a nurse who goes from one floor to another, you will know where everything is,” Smith said. “You don’t have to go hunting for supplies; you are more efficient and it doesn’t take any time away from caring for the patient.”

Another time-saving safety feature is the new tower’s decentralized nursing stations. Traditionally, the caregivers in each hospital unit are based around a central nursing station. This new design places smaller stations nearer to the patient rooms, allowing nurses to be more responsive and pay closer attention to patient needs.

The new rooms were also created with a focus on ensuring patients have a comforting healing environment that goes well beyond the traditional hospital setting.

Each room is set up in invisible “zones” that help establish a natural flow to the room and set aside space for caregivers and patients. The room design also recognizes the importance of family members to the healing process.

Each room comes equipped with a pullout couch for family members. Current research shows that there are better outcomes when patients and their families are active participants in the healing process.

Another easily-overlooked feature of the new rooms are the windows. The large windows and their position in the rooms are designed to maximize natural light inside the rooms. This can help preserve natural day and night body rhythms for patients facing multi-day stays in the hospital.

For Myrl Frevert, Boone Hospital’s director of Support Services, watching the tower project come together from the early plans has been “almost like a dream.”

“At every decision point, we asked, ‘What’s the right thing for the patient?’”

Frevert said. “As it’s coming in to reality, I know we’re doing the best thing for our patients. This is a true healing environment for them.” summer 2011

I

Inside Columbia’s CEO

I

37

S P EC I AL PROMOTIONAL SECTION

A Healthy Community Needs A These panes aren’t a pain for the environment. All of the windows are triple-insulated to minimize energy loss. The large windows also help light patient rooms with the most efficient bulb around — the sun.

There is nothing greener than plants — and Boone Hospital has added a lot of them. The new native Missouri shade trees and grasses look beautiful and also provide a natural storm water filtering and control system.

Boone Hospital has joined the rain barrel movement — big time. With a 30,000-gallon rainwater harvesting tank and a 4,000-gallon filtering system buried underground, the hospital now uses natural rainwater to water its plants and trees.

Recycling was a major focus of the project. More than 10 percent of the tower was built from recycled materials. Half of the construction waste was also recycled.

14

May 2011 BOONE HOSPITAL CENTER

S P EC I AL PROMOTIONAL SECTION

Boone Hospital Center

Healthy Environment Solar panels on the roof help heat water for the new tower’s hot water system. Meanwhile, the gleaming white roof reflects rays.

N E W PAT I E N T TO W E R June 26 - Grand Opening Celebration

Health Care Goes Green With New Patient Tower

G

This big green wheel is part of a local SEMCO air handling unit in the tower’s mechanical penthouse.

The new energy-efficient heating, air conditioning and ventilation systems will help reduce energy use by 14 percent. Occupancy sensors in staff areas make sure lights are only used when needed.

The tower conserves H2O by using ultra low flow toilets, urinals, showers and faucets.

reen ideas are everywhere at the new patient tower.

They range from the very big, like the 30,000 gallon rainwater harvesting tank, to the very small, such as the environmentally-friendly glue.

Some of the design features even help lower automotive carbon emissions. For example, 10 percent of the building’s materials were produced and manufactured in this region.

Using regional materials means fewer trucks on the highway and thus fewer emissions. The plan even added new bike racks and widened sidewalks, making it easier for hospital staff members to leave their cars at home.

With green ideas, the new patient tower will be one of Missouri’s first health care facilities to gain LEED certification from the U.S. Green Building Council.

S pecial Promotional S ection

Textbook Care

Boone Nurses Look To Evidence To Enhance Care

I

n some respects, it was a forgotten practice.

Decades ago, hospital patients were encouraged to get out of bed each day for a little exercise. Even some of the sickest patients, on the intensive care units, were walked slowly down the hall or just moved to a chair for a period during the day.

But over the years, many hospitals stopped these daily routines with the intensive care patients and those on ventilators.

As a 33-year nursing veteran, intensive care nurse Melissa Clarke remembered the earlier days when it was common for ventilated patients to get out of bed. One day, Clarke wondered why the practice was phased out.

To answer her question, she turned to the academic literature — finding many studies reporting that getting intensive care patients out of bed was once again a preferred practice.

“There is a lot of information out there about how beneficial it is in terms of decreasing the time spent on a ventilator as well as the length of stay in the hospital when you get your patients up,” Clarke said.

With this knowledge, she set out to make a change.

Like Clarke, caregivers all over Boone Hospital Center are encouraged to ask questions and continually refine the hospital’s best care practices.

In 2008, Boone Hospital formalized an Evidence Based Practice program to empower staff members to make researchsupported changes to improve patient care.

With the program, a Boone caregiver can bring forward an idea and have a peer mentor help them research the academic literature. If the idea is supported in the research, the caregiver can then create a plan to make the change a reality.

“We’ve been trying to stimulate our nurses to ask the question ‘why?’” said Monica Smith, director of Patient Care Services. “We’ve been doing things a 40

I

Inside Columbia’s CEO

I

summer 2011

certain way for 20 years and we have to stop and ask whether there might be a better way to do this.”

Michelle Crumby, a patient safety and clinical quality coordinator, was one of the first evidence based practice mentors at Boone Hospital. In 2009, the Boone Hospital Foundation sent her to a week-long

immersion training session on evidencebased practice at Arizona State University.

Crumby said the program empowers caregivers to take even better care of their patients. It also offers an opportunity for personal and professional growth — the experience inspired Crumby to pursue her doctorate.

S P EC I AL PROMOTIONAL SECTION

“It’s a fantastic program,” Crumby said. “If I wasn’t working at someplace that provided these opportunities and was open to allowing change based on literature, I’d feel stifled.”

In addition to Clarke, a number of Boone Hospital caregivers have already begun using Evidence Based Practice principals to initiate change in their areas.

Last year, the Boone Family Birthplace began using SleepSacks instead of traditional swaddles after a nurse identified research showing that the SleepSacks can help reduce the occurrence of Sudden Infant Death Syndrome. The Boone Hospital Foundation also began purchasing SleepSacks for every new Boone Baby to use at home after they leave the hospital.

Ongoing projects in the Boone Family Birthplace Intensive Care Nursery are

there is a process in place to seeking to improve the way “We’ve made help you answer that question,” neonatal babies are fed and a lot of Smith said. how often their IVs are As for Clarke, she reports changed. progress in just that on a few occasions Caregiver-initiated research a few years, but patients have been helped to has also helped improve nurse their feet for a short walk. rounding on Boone’s surgery we want to It’s progress. Still, she looks unit, reduce urine sample do more.” forward to the day when the contamination and improve practice is widespread. surgical site dressings.

As an owner in the care she provides, “We’ve made a lot of progress in just a she continues to work toward that goal. few years, but we want to do more,” Smith She said she has spent many hours doing said. research after work and helping to educate To get the word out and encourage her co-workers about the benefits of the more projects, the hospital has 45 nurses practice. who have been through special training She has also spoken with the doctors in to be Champions for the Evidence-Based her area about the change. She said it was Practice program. an easy sell.

“We’ve been trying to establish “When they see the evidence, they throughout the hospital that when staff want their patients to do it,” she said. members have that burning question, summer 2011

I

InsIde ColumbIa’s CEO

I

41

summer 2011

I

Inside Columbiaâ&#x20AC;&#x2122;s CEO

I

43

are We Feeling better yet? taking the temperature of columbiaâ&#x20AC;&#x2122;s economy

by K At h y C A st E E L

44

I

InsIde ColumbIaâ&#x20AC;&#x2122;s CEO

I

summer 2011

The Columbia economy took to its sickbed during the economic downturn of the past few years, along with almost every other local economy. The National Bureau of Economic Research says the Great Recession officially ended in June 2009, about 18 months after it began in December 2007, and we’ve been hanging out in the recovery room ever since. Although a peek at our bedside chart shows Columbia’s economy isn’t exactly the picture of health yet, the numbers give reason to hope that this local economy is on the road to recovery.

Some numbers have the power to coax a smile from even the frailest of patients. It’s ratings season again and Columbia rebounded onto some pretty impressive lists this spring, including a couple of top 10 rankings in national magazines. Forbes ranks Columbia No. 8 on its 2011 list of Best Small Places for Business and Careers. Columbia’s affordable housing market earned a nod from U.S. News & World Report in March, when the magazine pegged it at No. 8 among places where buyers can purchase a home for less than $600 a month.

Columbia’s recovery has also impressed The Milken Institute.

The Southern California think tank ranked Columbia 22nd in its 2010 index of the best-performing small cities, up from No. 51 in 2009. The 2010 Milken Institute Best-Performing Cities Index ranks U.S. metropolitan areas by how well they are creating and sustaining jobs and economic growth. The components include job, wage and salary, and technology growth. Columbia’s rise in the Milken Index is the sixth best of 2010.

In May, the St. Louis Post-Dispatch went so far as to call Columbia a “boomtown.” So how are we living up to all these kudos?

Let’s take a look at some vital statistics.

summer 2011

I

InsIde ColumbIa’s CEO

I

45

Columbia’s Unemployment Rate 2008–2011 9 8 7

Percentage

6 5 4

Source: U.S. Bureau of Labor Statistics

3 2

apr ‘11

mar ‘11

Feb ‘11

Jan ‘11

dec ‘10

nov ‘10

oct ‘10

sep ‘10

aug ‘10

Jul ‘10

Jun ‘10

may ‘10

apr ‘10

mar ‘10

Feb ‘10

Jan ‘10

dec ‘09

nov ‘09

oct ‘09

sep ‘09

aug ‘09

Jul ‘09

Jun ‘09

may ‘09

apr ‘09

mar ‘09

Feb ‘09

Jan ‘09

dec ‘08

nov ‘08

1

tAKE thIs JOB ANd…

C

olumbia’s employment picture has long been the envy of other regions.

Insulated by such stable industries as education, health care and government payrolls, the unemployment rate here has been historically low — just 1 percent in 2000— until recession struck. From 3.3 percent in November 2007, the Columbia metropolitan area’s jobless rate slowly climbed in 2008, according to the Bureau of Labor Statistics. By November it had risen to 3.9 percent; in December it was 4.2 percent.

A sharp jump to 6.2 percent unemployment in January 2009 foreshadowed a dismal year in local job losses that reached a high of 7.4 percent that June. The bleak summer figures moderated a bit in the fall, and 2009 ended

46

I

InsIde ColumbIa’s CEO

I

summer 2011

with 6 percent of Columbians unemployed. But 2010 was no happy new year for many; the end of seasonal holiday jobs pushed the unemployment rate back up to 6.9 percent.

The rate peaked again in the summer months, reaching a high of 7 percent before gradually declining the rest of the year.

Again this year, January’s unemployment rate was 6.9 percent; it has dropped steadily each month of 2011. The Columbia metropolitan area unemployment rate in April 2011, the latest month for which data is available, was 5.6 percent.

We are faring better than our fellow Show-Me Staters, though.

The Bureau of Labor Statistics lists Missouri’s jobless rate in April 2011 as 8.9 percent.

Job Fair Job creation has picked up in Columbia with a string of high-profile corporate locations and expansion in the past year. The five biggest job announcements include: IBM opened a service delivery center that will employ up to 800 by the end of 2012.

Linen King, an Oklahoma-based linen service catering to the health care industry, chose to locate its fourth facility in Columbia with plans to create up to 100 jobs.

3M’s production of Ultra Barrier Solar Film and additional products will add 120 jobs to the Paris Road plant over the next three years.

Carfax, a data repository for used-car buyers, is expanding its Columbia facility and will add 50 positions within the next five years.

VA Mortgage Center, a Columbia-based online loan processor for veterans, is expanding its staff to add 300 jobs in the next five years.

Build It And They Will Come

C

ommercial construction dipped in Columbia over the past three years. In 2008, the city issued 291 commercial construction permits; that dropped to 253 in 2009 and 251 in 2010. For the first five months of 2011, the city has issued 87 commercial construction permits.

Residential construction slowed in 2008 and 2009 as the city issued 944 and 945 construction permits in those years. That number jumped to 1,245 residential construction permits in 2010. In the first five months of 2011, the city has issued 404 residential construction permits.

4849

licensed businesses in Columbia in 2011

Taking Care Of Business According to the city’s Business License Office, 257 Columbia businesses have closed since July 2008. Startups declined in the same period: 422 new businesses opened in fiscal year 2009; 387 opened in FY2010.

The number of startups has begun to climb, though — for the nearly completed fiscal year 2011, the city has issued licenses to 465 new businesses.

Show Me The Money Columbians’ per capita personal income has risen steadily despite the economic downturn, albeit at a reduced pace, outperforming national and state income growth. According to the Bureau of Economic Analysis, personal income in the Columbia metropolitan area in 2007 was $35,396, which was 90 percent of the national per capita personal income. In 2008, Columbians’ personal income was $36, 424, still 90 percent of the national figure. In 2009, the latest year for available figures, personal income in Columbia was $36,568 per capita and 92 percent of U.S. personal income, which declined that year.

The per capita personal income of all Missourians in 2009 was $36,181. Boone County ranks eighth in the state in personal income.

Where to stash that money? Deposits at Columbia market banks have grown as well. According to the Federal Deposit Insurance Corp., 33 institutions were holding $2.89 billion in deposits at the end of fiscal year 2010. That’s up from $2.7 billion among 31 institutions in FY2009 and $2.487 billion among 23 in FY2007.

Home, Sweet Home

T

he Columbia real estate market has outperformed national and Missouri markets, according to a report by R.H. Lawler Appraisals for the Columbia Board of Realtors. From April 1, 2010, through March 31, 2011, Columbia real estate sales totaled 954. Of those, 768 were existing homes and 186 were newly constructed.

Total home sales in the Columbia market for first quarter 2011 numbered 302, compared to 340 sales in first quarter 2010. The median sale price of homes sold increased this year — $149,950 in first quarter 2011, compared to $135,250 in the same period of 2010.

As of April 16, there were 498 existing homes listed in the Columbia Board of Realtors MLS database; another 75 newly constructed homes are also listed.

There were 59 construction permits issued for single-family homes in the first quarter of 2011, compared to 79 in the first quarter of 2010; just 40 permits were issued in first quarter 2009. Single-home construction permit activity in 2009 was up 18 percent over 2008, Lawler says. summer 2011

I

Inside Columbia’s CEO

I

47

Shop ‘Til You Drop Shoppers hung back from purchases during the recession, delivering a double whammy of depressed sales for retailers and declining sales tax revenue for city coffers. After climbing to a 21st-century apex of $19,992,671 in sales tax receipts in 2007, Columbia’s collections began to fall, dropping to $19,818,754 in 2008 and $19,380,878 in 2009.

Shoppers regained their confidence in 2010 and hit the stores with gusto, shelling out $20,137,219 in city sales taxes. Preliminary figures for the first quarter of 2011 show receipts of city sales taxes at $4,035,366.

LEAVIN’ ON A JEt PLANE

d

espite the sour economy, Columbia Regional Airport is enjoying sweet success. Business has been booming since Mesaba (now part of regional service provided by Delta Air Lines) took over air service in August 2008, offering three daily round-trip flights to Memphis.

In 2008, the airport saw 10,918 departures and 10,890 arrivals, with most of that traffic coming in the last four months of the year (there were zero flights in July 2008). Traffic more than doubled in 2009 with 24,843 departures and 24,830 arrivals. Passenger numbers jumped again in 2010 with 35,429 departures and 35,372 arrivals.

If the first four months of 2011 are an indication, airport traffic is on track for another big year. Enplanements through April were 11,402; deplanements were 11,247.

the road to recovery

by sA N dy s E L By

Missouri CORE Executive Director Gary Laffoon Offers His Assessment Of The Region’s Economic Health

G

ary Laffoon has been executive director of Missouri CORE (Connecting Our Regional Economy) since March 1, 2010. CORE is a not-for-profit economic development agency that represents 12 mid-Missouri counties: Audrain, Boone, Callaway, Camden, Cole, Cooper, Howard, Miller, Moniteau, Morgan, Osage and Randolph.

The consortium works to attract companies to the region as well as retain and grow existing industry. Laffoon recently shared his thoughts on Columbia’s emergence from the Great Recession with Inside Columbia’s CEO magazine.

From your vantage point, where do you think mid-Missouri is on the road to economic recovery?

Mid-Missouri is fortunate to be anchored by the city of Columbia. The city has continued to grow while keeping the unemployment

48

I

InsIde ColumbIa’s CEO

I

summer 2011

rate down compared to most other regions.

With that said, we still have a ways to go as a region. Improvements are being made around the area but certainly not as fast as we would like. The Lake of the Ozarks for example, which relies heavily on tourist traffic, has seen moderate activity but not to the level of years past. They are hoping for a great summer season. The city of Fulton has been hit with the downsizing of the state hospital, which has a significant impact on the community. These and many other local factors have impacted the region’s ability to rise out of this economic slump. I feel we will get there; however, it will simply take a little longer and require us to work together better than ever before.

Columbia has attracted some big employers and expansion projects recently. Is the rest of the region faring as well?

So far Columbia has led the recruitment

charge coming out of the economic downturn. We have seen a few companies locate in our more rural areas but nothing to the level of Columbia. Bonneybrook Steel, a Canadian company, located in Glasgow and will create 109 jobs in the coming months. That was a tremendous win for Howard County.

Many of the new jobs being created in Columbia are high-paying, high-tech jobs. That’s exciting, of course, but not everyone is cut out to be a computer engineer. Are we creating enough opportunity in this city, and in the larger Missouri CORE region, for the segment of the workforce that is more inclined to seek manufacturing jobs?

While you hear a lot about the big success stories in the area such as IBM, you may not be aware of the several other projects that have successfully located in the region.

These projects do not require such a highly skilled workforce; Bonneybrook Steel in Glasgow; Mamtek US and Vest fiber in Moberly; the Keiper expansion in Eldon; and landing Linen King, the industrial laundry facility located in Columbia’s LeMone Industrial Park.

Columbia is fortunate to have an ample supply of student labor to fill the many service-related positions; however, more effort can be made to better prepare fulltime citizens for the many other positions needed.

CORE continues to work with universities, colleges and tech schools in the region to make sure that we are training individuals for all types of jobs from entry level to highly skilled positions.

All the regional schools and training centers have been working together to accomplish that task.

What do you perceive as this region’s greatest strengths when it comes to attracting new business?

Location, location, location. Missouri has long been known for its central location in the United States. Logistics is a big part of every company out there. Whether it is retail distribution, manufacturing components for OEM’s or assembly of finished projects, all companies would prefer to locate in an area where they can maximize their reach to their end customers. Being right on a major interstate and being able to reach a large percentage of the U.S. population within a one-day drive is extremely valuable to companies.

What are our biggest weaknesses?

Current challenges really lie around air service and being able to secure a dependable long-term energy supply.

The Columbia Regional Airport, while continuing to improve, still lacks the “regional” support necessary to move us forward. Improvements to the terminal, airfield and infrastructure around it are still major factors holding back our growth.

To a lot of companies and consultants, the airport is the first impression they have of a community. I don’t believe the current condition conveys an accurate description

said, there are a lot of communities in the United States and even overseas that are competing for these few precious projects.

When a company is faced with more than one comparable site, that’s when the incentives come into play. If you do not have a competitive incentive program, one of the other competing communities will.

Keep in mind that you want companies that will be long-term partners with the community. Sure, you may give up some tax dollars initially but those are minuscule compared to what you can get for your residents immediately. The

“We still have a ways to go as a region … we will get there; however, it will take a little longer and require us to work together better than ever before.” of our community. CORE is working with several groups in an effort to find ways to make these needed improvements.

As for energy needs, Columbia is doing a great job of diversifying its energy creation. However, as a state we must look to the future. Coal-fired power plants are getting very old and the federal Environmental Protection Agency will most likely not allow the creation of new coal plants in the future. We must plan for long-term base load production. The addition of a second nuclear power plant in Callaway County will help keep our rates down in the long term as well as give us the supply we need to attract companies in the future.

In your opinion, how important are incentives to local governments in attracting big employers?

When talking about recruitment or retention of companies, the conversation always goes toward the use of incentives.

The rule of thumb when talking about incentives is … “incentives will not get you a project; they will win the project in the end.” Meaning, most companies do not think about incentives up front. They are usually driven by either where their end customers are located or perhaps making sure they are close to resources in the production of their products. Depending on the project and the company, they might overlook most factors in order to be close to the uniquely skilled workforce necessary for their business. Now with that

community as a whole will benefit from the job creation and increase in personal income. You will see the increased tax revenue in a few short years.

When Missouri CORE was formed three years ago, there was some skepticism that communities used to competing for new businesses would be able to band together for the good of the entire region.

Are communities cooperating in the way you had hoped, or are there still some turf wars?

There will always be some level of competition between communities. That’s human nature. Fortunately for us in central Missouri, we have a very professional group of economic developers. Most of these economic development professionals have known each other for many years and fully grasp the idea of “regionalism.” They know that if a project comes to Fulton then Columbia, Jefferson City and the Lake will benefit from increased sales and activities.

Additionally, we are a very mobile society. People may live in Columbia but work in Jefferson City, Fulton, and the Lake or vice versa. They may earn their paycheck in one community but spend the bulk of it in another. I continually emphasize to people that the days of brutal competition between neighboring communities are over.

With improvements in technology and transportation, our competition is worldwide. We need to pool our resources in order to compete globally. summer 2011

I

Inside Columbia’s CEO

I

49

50

I

InsIde ColumbIaâ&#x20AC;&#x2122;s CEO

I

summer 2011

healthy CompeTITIon DAn roTHery a n d H A l w I l l I A m so n t a c k l e the BusIness o f h e a l t h c a re i n Co lum B I A

[

by K AT H Y C A STEEL • photos by L .G. PAT TERSON

]

summer 2011

I

InsIde ColumbIa’s CEO

I

51

Last summer, a shift in Columbia’s workforce dynamics altered the occupational portrait of Collegetown, USA. By a thin margin, health care has officially knocked education off its throne as the dominant industry in Columbia. U.S. Census Bureau figures for the second quarter of 2010 show 14,778 Columbians working in health care; 14,101 work in educational services. Health care is big business in this town. The men who lead Columbia’s two unique health care delivery systems must contend with competition, rising costs and market forces against an ever-changing backdrop of technical innovation and scientific breakthroughs. As their expansion plans rise up to alter the Columbia skyline, the business reach of Boone Hospital Center and University of Missouri Health System is altering the city’s economic landscape.

52

I

Inside Columbia’s CEO

I

summer 2011

Dan Rothery

S

Expanding Boone Hospital’s Comfort Zone Some folks might think Dan Rothery is an adrenaline junkie … or maybe he just enjoys a challenge.

Rothery has made a career of stressful occupations, first as an air traffic controller — until he was fired by President Ronald Reagan — and later as president of Boone Hospital Center, arriving just as the hospital’s trustees were mulling over the possibility of “firing” the firm that operates it.

“It’s all in how you define ‘stress,’ ” Rothery says. “Pressure can have a negative manifestation. Air traffic control is a high-pressure job, but it didn’t get to me. I enjoyed it. There was a day-to-day sense of accomplishment; I knew precisely what I had done each day. Here, it’s a different type of pressure and a different way of measuring accomplishments — not in days but in months, and sometimes years as I’ve watched our new patient tower go up.”

The new patient tower will open June 26, a sparkling symbol for Rothery and his management team of their confidence in measuring those long-term accomplishments for mid-Missouri health care. Staffing levels are back up after a round of layoffs and budget cuts 2½ years ago, and the hospital recently celebrated its second consecutive appearance on the Thomson Reuters 100 Top Hospitals list. This past year, Boone Hospital Center was the top performing hospital in the portfolio of BJC HealthCare, the St. Louis firm that manages the facility.

“We strive for the top decile in performance,” Rothery says.

“And we have a history of achieving that success. My role is to demonstrate value to Boone County’s citizens. I think we’re doing just that.”

The onus to show value comes with the territory at Boone Hospital Center. The 90-year-old county hospital has been privately managed since 1988 by the firm that eventually became BJC HealthCare. Shortly after Rothery took over as president in 2006, the hospital’s Board of Trustees sought to renegotiate the terms of the 15-year lease with BJC, Rothery’s employer.

Uncertainty permeated the hospital environment until the protracted and public dealings ended at the end of the year with a revised operating agreement that retained BJC as manager.

“It was stressful and distracting while trying to run a hospital of this size and magnitude,” Rothery says. “I actually began to worry about the effect on the hospital’s reputation.

But the trustees hired BJC to run this hospital because they found value in that relationship. The renewal process in 2006 revalidated that process.”

“We have a history of achieving

success .

My role is to

demonstrate value to Boone County’s citizens.”

Less than two years later, Rothery found himself managing yet another stressful situation.

“We could see we were headed for an economic downturn in 2007,” he says. “Patient volume began to slow, in an inexplicable contraction. It was almost like the canary in the coal mines — a sentry warning of what was to come.”

As the country sunk deeper into recession, the health care business was foundering in mid-Missouri. Bed occupancy dropped from an average daily census of 222 in 2007 to 205 in 2008. With fewer patients seeking care, layoffs began in late 2008. About 80 full-time equivalent positions were eliminated through layoffs and attrition. The timing of the layoffs was unfortunate, though, as construction was already under way on a $120 million expansion plan that included the new patient tower.

“We were dealing with perceptions,” Rothery says. “There was a cognitive dissonance where perception became reality for some who criticized us. We believed that the economic downturn would be short — that it would last about a year to 18 months. For this construction project, we were looking at an investment with a life cycle of 30 to 50 years. It would have been short-sighted not to look to the future to build.”

Rothery credits prudent management in the down cycle for the

hospital’s recovery. Cutbacks were focused on managerial fixed costs in administration to preserve a bias toward patient care. “The majority of the FTEs eliminated during the layoffs were not frontline patient-care positions,” he says. “As we have grown back, the greatest growth has been in those patient-care areas. For example, if you look at nursing FTEs, there were 405 nursing FTEs in 2007 and 415 nursing FTEs this year.”

Boone Hospital has refilled most of the positions lost in the layoffs, but not all, a result of efficiency efforts and Lean management techniques that focus expenditure of resources on the creation of value for the end customer. The average daily census of occupied beds has bounced back to 221, a return to pre-recessionary levels. “As patient volume has risen, we have ramped up our hiring to support that volume,” Rothery says.

Rothery’s path to a career in health care management has been an unusual journey. The St. Louis native attended Quincy University in Illinois on a soccer scholarship. The son of an air traffic controller and a nurse, Rothery followed in his father’s footsteps and eventually landed at Lambert-St. Louis International Airport directing air traffic.

The illegal strike by the air traffic controllers union and subsequent firing by the president in 1981 brought that career to a screeching halt.

Casting about for a new skill set with which to support his young family, Rothery took a job as a delivery truck driver for a medical equipment company. He later became part-owner of the company, Health Consultants Inc., and when he sold the company to St. John’s Mercy Hospital, he joined the staff there as vice president of home health care. He has been in the health care business ever since, earning a master’s degree in hospital administration from St. Louis University and working stints at BJC HealthCare and the Cleveland Clinic before returning to his hometown to lead the Rehabilitation Institute of St. Louis. summer 2011

I

Inside Columbia’s CEO

I

53

Rothery arrived in Columbia to little fanfare in September 2005 to direct Rusk Rehabilitation Center.

“I just showed up,” he says.

He got to know Jim Ross, CEO of MU Health Care, when attending director’s meetings at the University of Missouri, which is a part-owner of Rusk. When the opening for president of Boone Hospital Center came up, Rothery called Ross to tell him of his interest and his decision to stop attending Ross’ meetings until Boone made its hiring decision. He started work at Boone in June 2006.

Rothery has begun rolling out a dashboard of sorts, department by department, that tracks progress on hospital processes. “It’s a tool for the highest-performing hospitals,” he explains. “Anyone can look at this and get a snapshot of where we are in a project or a task.”

Every day at 1:05 p.m., Rothery or one of his management team members “walks the gemba.” “Gemba is Japanese for ‘walk where the work is being done,’ ” he says. He has led the initiative on these afternoon walks along designed corridors, exploring the work going on in the hospital, listening as problems are aired — what isn’t working, what they’ve learned from their mistakes — and guiding employees in determining their own solutions. He plans to deploy regular gemba walks to 50 sites within the hospital.

“It’s a process of discovery that comes from the freedom of autonomy and respect for the staff ’s skills,” he says. “When employees come up with their own solutions, they have a sense of ownership and they’re more likely to actually use the solution.”

His management journey may have been nontraditional, but 60-year-old Rothery has embraced his task and set about creating a culture of efficiency and pride, focusing on dual goals of customer satisfaction and employee satisfaction.

“We have a tremendous work ethic here,” he says. “When you have a 20-inch snowfall and 300 staffers volunteer to spend the night … it’s palpable.”

Rothery describes his management style as a cross between inclusiveness and teaching.

Longtime employee Angy Littrell has witnessed Boone Hospital “I’m trying to empower people to have control over their own administration efforts for 20 years from her ringside seat destiny,” he says. as director of business development, physician services and Every new employee spends the first hour on planning. She appreciates the job getting to know the hospital president. the fresh direction of Boone Beginnings convenes every Monday management initiatives and the morning, when Rothery educates new hires on encouragement to go outside her what it takes to succeed at Boone Hospital. comfort zone.

“It’s the most important thing I do,” he says.

“Dan focuses on attracting “I’m trying to plant seeds. I get juiced up about it. the right people who are Boone HospITAl CenTer They don’t expect to hear the things I tell them in knowledgeable and can think Hospital buildings and land are that first meeting.” critically … problem-solvers who owned by the citizens of Boone Most new employees don’t expect to meet the can help us as an organization get County, administered by a Board company CEO their first day on the job, let alone to where we need to be,” she says. of Trustees. BJC HealthCare of talk to him.

“He consistently challenges us to St. Louis employs the staff and “As a new employee at Boone Hospital, I was seek out knowledge beyond what contracts with the trustees to not expecting to meet the hospital president on we are comfortable with. If you operate the hospital. the first day, nor was I expecting him to be so work on the clinical side, he may funny and approachable,” says Communications have you learn about finances.

Employees: 1,471 FTEs Coordinator Shannon Whitney, who started And if you are a financial person, working at Boone on June 6. “He told stories — he may want you to learn about Facilities: 394 beds some funny and others more serious — about his the expectations from the clinical Hospital (579,000 sq. ft.) life experiences as he shared words of wisdom side.”

Patient Tower (250,000 sq. ft.) with the 27 newest hires. I was impressed.”

It’s a lesson in leadership that Broadway Medical Plaza, a Those with longer tenure at the hospital have Rothery learned the hard way collection of four buildings housing come to expect his passion. when he made the leap from affiliated health care services on “Every Monday morning, Dan Rothery is at aviation to health care. And now the 24-acre North Campus across his pure best,” says five-year employee Brian 30 years later, that old comfort Broadway, plus additional office Whorley, manager of the hospital’s surgical zone he left so unwillingly space in several smaller buildings services business and supply chain. “That’s may seem to have been a bit nearby when he’s welcoming new staff during Boone constraining.

––––––– Beginnings. No script, no podium, no mic. It’s “I love my job,” he says. “I just Dan doing what he loves — making sure have to pinch myself sometimes BJC HeAlTHCAre you’re certain you want to work with or for Boone to make sure I’m not dreaming.

Hospital. He’s the first person you meet when you I can’t imagine a better gig than Employees: 23,105 FTEs join our world. For some, it’s a reality check; for president of Boone Hospital Facilities: 13 hospitals; Boone others, it’s a sign that we’re finally home.”

Center.”

Hospital Center is the only leased 54 I InsIde ColumbIa’s CEO I summer 2011 property in the group

W

Hal Williamson bui ldi ng synergy with the academ ic health cen ter

When the University of Missouri moved to revamp its health care operations in 2008, former system President Gary Forsee knew just who to tap to lead the venture.

Forsee was looking for context, he said when he and MU Chancellor Brady Deaton announced the restructuring, “to provide the kind of support our hospital structure has needed for some time.”

That context would come from Dr. Hal Williamson, a longtime member of the university’s Family and Community Medicine faculty.

In the newly created position of vice chancellor for health sciences, Williamson was charged with integrating MU Health Care’s clinical and business operations with the academic and research activities of the schools of medicine, nursing and health professions into a synergistic enterprise. Forsee wanted advice — strategic, policy and regulatory advice, plus a general health care perspective that doesn’t come from a curator’s or a CEO’s perspective. Williamson was up for the challenge.

“I saw an opportunity,” he says, “where we could be a lot better than we were.” summer 2011

I

Inside Columbia’s CEO

I

55

Nearly three years later, Williamson is presiding over a massive health system that has seen exponential growth over the past decade. Based in Columbia but with a statewide outreach, University of Missouri Health System is riding the wave of change washing over health care delivery in this country. No longer satisfied with simply turning out health care professionals, academic health centers have adopted a new organizational model that has reshaped medical education, research and service, toppling the old “ivory tower” world and setting them aright in a competitive business world.

It is a notion replete with management and leadership challenges, says Steven Wartman, president and CEO of the Association of Academic Health Centers. Writing in the September 2008 Journal of Academic Medicine, Wartman hailed the changes that capture what he called “the power of a virtuous cycle, whereby clinical revenue and academic performance support each other by being strategically and tactically aligned.

The ‘virtue’ is that each makes the other better.”

Williamson has a simpler way of putting it: synergy.

“One of the most exciting parts of health care is at the edges,” Williamson says, “where business meets academics and research.”

The 61-year-old physician leads an executive team of deans from medical, nursing and health professions schools and the CEO of MU’s hospitals and clinics. “My job is to get them in the same room with their most productive hats on,” he says. He elicits that effort through consensus building and visioning.

“The idea in an academic health center is to use the expertise,” he says. “We use research for the best treatments; we use people for the best delivery. We all benefit from this expertise.”

Melding the business side with the academic side of health care has infused the organization with synergy, Williamson says.

It permeates the operation through better strategic planning, strategic hiring, and the direction of programs and buildings with a business sense of “Where’s the biggest pop,” he says.

“The advantage of building a culture like this — where doctors and executives are working together, making decisions in the same room — is the buy-in. When people are involved in the decisionmaking, they buy into it.”

Williamson bought into a life in medicine a long time ago. The son of a general practitioner and a nurse, the Minnesota native grew up in the small town of Fairmont. It was a place he likens to Lake Woebegon, the fictional town of Garrison Keillor’s “Prairie Home Companion” (where all the women are strong, all the men are good-looking, and all the children are above average).

Williamson studied biology at St. Olaf College in Northfield, Minn., and earned his medical degree from Case Western Reserve University in Cleveland. After a residency in family medicine at the University of Minnesota, he and his wife, Mary, set out on a once-in-a-lifetime adventure to drive the Pan-American Highway all the way to Tierra del Fuego at the southern tip of South America.

56

I

InsIde ColumbIa’s CEO

I

summer 2011

unIVersITy of mIssourI HeAlTH sysTem Total faculty and staff: 8,334 employees Expenditures for health system: $851.3 million Economic impact: $2 billion Facilities: 562 beds University Hospital and Clinics Ellis Fischel Cancer Center Missouri Orthopaedic Institute Missouri Psychiatric Center (formerly Mid-Missouri Mental Health Center) Women’s and Children’s Hospital (formerly Columbia Regional Hospital) Missouri Rehabilitation Center (Mount Vernon, Mo.) In addition, the system is closely aligned with Capital Region Medical Center in Jefferson City, co-owns Rusk Rehabilitation Center with HealthSouth Corp., provides clinical outreach services to other Missouri hospitals such as in Callaway, Cooper and Audrain counties, and operates 50 clinics around the state.

“It was partly adventure and partly work in mission clinics,” he says.

Williamson came to Columbia on a fellowship when Mary began a Ph.D. program in counseling psychology at MU. He earned a master’s degree in public health and joined the faculty as residency director in MU’s Department of Family Medicine. Aside from a sabbatical to study rural health services, Williamson has remained at MU, rising to associate chair and then chair of Family and Community Medicine before taking the reins of the health system.

His background is invaluable in helping to harness the collective strengths of the divisions under his purview, says University of Missouri Health Care CEO Jim Ross.

“A significant impact of his leadership has included strategic planning to align the health sciences schools and clinical enterprise around a common mission and vision,” Ross says.

“Under Dr. Williamson’s leadership, the University of Missouri Health System has emphasized exemplary care for patients and exemplary learning for health professionals.”

Deliberate and patient … inclusive … relaxed and confident … visionary. The adjectives roll off the tongues of Williamson’s leadership team when describing their boss’s management style.

Williamson calls himself a consensus builder. “I can’t always get it — sometimes I have to make the hard decisions — but I believe we get better decisions and better buy-in when we have consensus.”

“He is not a ‘ready-shoot-aim’ type of person,” says School of Health Professions Dean Richard Oliver. “He likes to get input from all key stakeholders and then use this information to develop appropriate strategies. The inclusive nature of his leadership style has helped him garner solid support from those who serve under him.”

Humor always helps, says Oliver. “He has a Garrison Keillorlike sense of humor that not only brightens the mood of most administrative meetings but makes him more relatable as a leader and as a person.”

A good laugh can be a powerful leadership tool, says Sinclair School of Nursing Dean Judith Miller. “His use of humor helps us tackle tough issues,” she says. “This engenders a sense of good will and trust as we problem solve.”

Williamson believes an important part of leadership is vision, keeping an eye on the big picture. “He has a clear, well-thoughtout vision for our health system,” says School of Medicine Dean Robert Churchill. “We know what his expectations are for each of the three colleges and University of Missouri Health Care.”

Williamson’s vision and expectations are focused on three areas now: patient satisfaction, quality improvement and measuring results.

“I’m proud of our quality of care,” he says, “but we are not where we should be in patient satisfaction. We quantified it, called attention to it and made changes.” An employee incentive program tied to patient satisfaction is now in place. “We’ve set the bar high, though, so those bonuses aren’t easy to come by,” he says.

Quality improvement must be measured, Williamson says, a goal the hospitals have accomplished and is spreading out to the

clinics. “We now have excellent quality that is unmeasured,” he says. “We need to quantify it.”

Measuring operations on the business side of the system is well in hand. “We can measure the in-patient side of the business with a micrometer — Jim Ross is that good,” he says. “We’re moving it to the ambulatory side now; when that’s up and running, look out!”

Improvements in electronic medical records are a source of pride. “EMRs were the No. 1 source of dissatisfaction among the staff,” he says. “Since our agreement with Cerner Corp., our EMRs have improved from a level 3 to a level 6 on the HIMSS [Healthcare Information and Management Systems Society] scale in just 18 months.”

He is expecting more good things to come from the system’s other improvement plans. The medical school and University of Missouri Health Care have begun the Baldrige process, a national quality program. The Office of Clinical Effectiveness embodies improvement, he says, through Six Sigma quality management methods.

“It is a complex and challenging business to be in,” points out Teresa Maledy, central region president of Commerce Bank and a member of the advisory board that offers input on strategies and policies for the health system. “I value and appreciate Dr. Williamson’s engagement in our community where he does a great job of representing University of Missouri Health Care to a broader audience. He has a very strong understanding of the different business, clinical and academic facets and is able to lead at this level with transparency and accountability.”

The University of Missouri Health System’s transformation into an academic health center meets the mission of the university in education, research, service and economic development.

“There is opportunity for growth,” Williamson says. “The stronger the health enterprise, the more growth.”

Growth has been the byword for the expanding health system.

Construction is humming along this summer as the first phase of a 6-year-old master facility plan nears fruition — two new hospitals opened last year and work began on a $203 million patient care tower slated for completion in 2013. Additional phases in the plan call for the eventual replacement of University Hospital and other new facilities, dependent on funding.

Paying for all this expansion comes from a combination of bonds, patient revenues and philanthropy, but no taxpayer support.

“There’s a misperception that we are running on public money from the state,” Williamson says. “That’s not true. The only state support we are receiving in fiscal year 2012 is $10 million for our long-term care facility, Missouri Rehabilitation Center, in Mount Vernon. MU Health Care functions as if it were a private entity, and has for some time.”

Regardless of where its support comes from, the system has an obligation to support Missourians through its mission. One of only two “safety net” hospitals in Missouri, MU Health care absorbed $44 million in uncompensated care last year.

“What it comes down to,” Williamson says, “is priorities and the value the state places on the health of its people.” summer 2011

I

InsIde ColumbIa’s CEO

I

57

58

I

Inside Columbiaâ&#x20AC;&#x2122;s CEO

I

summer 2011

dIVIdENds

after hours

Great Grills

Big Green Egg grill, large model with nest and wings, available at River Mist Spas ($1,079)

spice up Your outdoor Cuisine

by HALEY ADAMS photos by DAN BRENNER

You may not feel like grilling a big meal right when you get home from work, but we think these grills and accessories will change your mind. Add some sizzle to your family dinner, Fourth of July plans or neighborhood barbecue with these outdoor cookers and supplies.

Outset BBQ Grill Grid, available at Tallulah’s ($27.50)

Epicurean BBQ Board, available at Tallulah’s ($66)

Grill tongs ($18.95), grill spatula ($18.95), grill fork ($18.95) and basting brush ($9.95) by Big Green Egg, available at River Mist Spas

Holland Epic Grill, available at Downtown Appliance Home Center (price available upon request)

Outset BBQ Grill Apron ($43) and Outset Grill gloves ($22), available at Tallulah’s GE Monogram 54” Outdoor Cooking Center, available at Downtown Appliance Home Center (price available upon request) summer 2011

I

InsIde ColumbIa’s CEO

I

59

60

I

Inside Columbiaâ&#x20AC;&#x2122;s CEO

I

summer 2011

DIVIDENDS 1

networking

2

3

spring into action

The Bank of Missouri presented the 10th annual Voluntary Action Centerâ&#x20AC;&#x2122;s Spring Into Action on May 24 at the University Club. The evening honored Harlan, Harlan & Still, Brent Beshore, and Mike and Rockie Alden for their community service. Raising nearly $40,000 the Voluntary Action Center can continue helping low-income citizens of Boone County get out and stay out of poverty. The VAC, a not-for-profit social service agency formed in 1969 by Hazel Riback, is the Heart of Service in Boone County.

(Photos by Logan Park) 1. Rose and Mike Porter 2. Brent Beshore 3. John and Ryanne DeSpain 4. Jason Becking, Ron Schmidt, Shawn Barnes and Courtney Barr 5. Alison, Alex and Julian George 6. Russell Still, Tim Harlan and Vicky Riback Wilson 7. Mike, Rockie and Jake Alden

4

6

5

7

summer 2011

I

Inside Columbiaâ&#x20AC;&#x2122;s CEO

I

61

62

I

Inside Columbiaâ&#x20AC;&#x2122;s CEO

I

summer 2011

DIVIDENDS

networking

1

2

HARD HAT TOWER TOUR

3

Boone Hospital Center hosted a Hard Hat Tower Tour for CEOs that included a lunch on the new pedestrian bridge between the Boone Hospital William Street Parking Garage and a tour of the new patient tower. Boone Hospital President Dan Rothery and Board of Trustees Chairman Fred Parry spoke at the lunch. Mary Beck, vice president of patient care services, and Jerry Kennett, chief medical officer, gave business leaders a tour of the new patient tower construction. Boone Hospital Center is hosting a public grand opening for the new tower on June 26 from noon to 3 p.m.

(Photos by Dave Hoffmaster) 1. Guests dine on the pedestrian bridge. 2. A tour of the conference center 3. Dan Rothery addresses the crowd during the luncheon. 4. Jerry Kennett points out features in a patient room. 5. Mary Beck leads the tour.

4

5

summer 2011

I

Inside Columbiaâ&#x20AC;&#x2122;s CEO

I

63

ADVERTISING INDEX Atkins...........................................................13 Beckett & Taylor Insurance....................25 Bleu Restaurant & Wine Bar..................33 Boone County National Bank.................. 3 Central Trust..............................................58 City of Columbia Water & Light...........43 Coil Construction.....................................62 Columbia Regional Airport.................... 18 Columbia Turf........................................... 60 CORE............................................................15 Creative Surroundings.............................58 D&M Sound.................................................4 Gary B. Robinson Jewelers..................... 18 Hawthorn Bank........................................ 68 Handyman Solutions.............................. 64 Image Technologies................................... 2 Inside Columbia’s CEO Best Places To Work ..........................29 Kliethermes Homes.................................24 Landmark Bank.......................................... 11 Les Bourgeois Vineyards........................62 Manor Metal Roofing..............................22 MayeCreate...............................................27 Moresource.................................................21 MU Health Care........................................67 Rusk Rehabilitation Center....................33 Sandler Training.......................................... 9 Schuster Financial Services....................33 Shelter Office Plaza.................................... 5 Smart Business Products....................... 20 Steve Twitchell Productions.................. 60 Stifel Nicholaus.........................................43 Suit Yourself................................................. 9 Tiger Court Reporting.............................. 18 UMB Bank.................................................... 6 University Club..........................................26 VA Mortgage Center......................... 16–17 Vicky Shy Realty.......................................27 Waddell & Reed....................................... 64 Wilkerson & Reynolds.............................43 William Woods University.....................22 Williams Keepers......................................13 Women’s Health Associates..................31 64

I

Inside Columbia’s CEO

I

summer 2011

PUBLISHER’S NOTE

A Comprehensive Plan For Columbia’s Health Care Industry

A

bird in the hand is worth two A Billion-Dollar Building Boom in the bush. This 17th-century If you have any doubt about the vitality proverb is a saying I’ve heard of Columbia’s health care industry, throughout my life without all you have to do is study the skyline giving much thought to its meaning. As I of our city, dotted with construction understand it now, the adage implies that cranes working on any number of it’s better to focus on the real advantage health-related building projects. A we have today versus new $125 million patient wasting valuable energy tower at Boone Hospital wishing for the things that Center has just opened. may be unattainable.

Construction is under I think this theory way for a $250 million describes our community’s project on the University approach toward one of of Missouri campus that the driving forces in our will provide a new patient local economy. It’s no tower for MU Health Care secret that Columbia is and a new Ellis Fischel blessed with a thriving Cancer Center. Major health care community. projects have recently been With five hospitals, a dozen completed at Columbia “It’s no secret freestanding outpatient Orthopedic Group, Harry that Columbia is clinics and hundreds S. Truman Memorial blessed with a of private practice Veterans’ Hospital and physician offices, health thriving health MU Health Care’s new care surpasses education Women’s and Children’s care community.” in terms of jobs in this Hospital. These projects – Fred Parry community. Health care is alone have created a bird in Columbia’s hand. thousands of construction Given that reality, I often wonder why jobs and a total economic impact in the city leaders don’t invest more of their billions of dollars for Columbia. energies into making Columbia a “super regional hub” for health care. By building Need For Collaboration a network of health-related businesses Despite the recent growth spurt in that complement our current health health care projects, Columbia will care industry, leaders could position always take second place to cities Columbia as the health care mecca of the such as Rochester until there is more Midwest. Rochester, Minn., home of the collaboration among the major players Mayo Clinic, is an excellent example of a in local health care. In what might be city where collaboration among multiple best compared to a Cold War-era arms disciplines, and even competitors, has race, we have witnessed an unnecessary resulted in great success. Economic duplication in services and technology. developers could learn a lot from As with any industry, the population of Rochester. prospective patients needing a certain

type of surgery is not an infinite number.

Perhaps this is best illustrated in the area of orthopedic surgery, where the number of surgeons and related facilities in Columbia has nearly doubled in the last six or seven years. There also have been missed opportunities for collaboration in mental health, home health care and other traditionally lean areas. There is considerable lip service expended on the concept of exploring collaboration, but the competitive nature of the business seems to prevent any real progress.

The Impact Of Reform With health care reform looming on the horizon, there is a great deal of uncertainty ahead for those working in the industry. The full impact of reform is still largely unknown and the industry is bracing for an insurgence of millions of previously uninsured patients that will likely test the system in untold ways. Also at play are reimbursement rates paid for Medicare patients which, in a town like Columbia, could have a dramatic impact on the take-home pay of hundreds of local physicians. When the ultimate goal of reform is to make America’s health care system more efficient and accessible, you can expect an adverse impact on a community like Columbia where health care drives the local economy.

I am awestruck by the tremendous potential for growth in the health care industry that exists for this city. The foundation is already established. While nothing is ever guaranteed, we have a better than fighting chance of building upon our current success. Who could argue with that?

summer 2011

I

Inside Columbia’s CEO

I

65

CLOSING QUOTES

What Columbia’s Business People And Community Leaders Are Saying “We don’t have ‘casual Fridays’ here.

There’s nothing casual about what we do in health care.”

— Boone Hospital President Dan Rothery

“Columbia is a city that has firmly established itself as a national leader in forwardthinking public policies.”

— Timothy Shaughnessy, IBM senior vice president of services delivery during a recent ribbon-cutting ceremony at IBM’s Columbia facility

“I never retreat — I only attack.

You can’t stay even in this business; you’re either going forward or backward.”

— Songbird Station owner Mel Toellner, winner of the Columbia Chamber of Commerce’s Small Business of the Year award

“I fear that having flags on the top of the parking garage will call more attention to the tallness.”

— City Councilwoman Barbara Hoppe sharing one of the reasons she voted against the installation of a $13,000 flagpole on top of the new downtown parking garage

“Leadership is about managing attention and managing meaning.

We have sick people here all the time — it’s easy to see why we’re here.”

— Dr. Hal Williamson, vice chancellor of University of Missouri Health System, on looking at the big picture

“The batch just flew out of here. No pun intended.”

— Sparky’s Homemade Ice Cream owner Scott Southwick on the popularity of the store’s one and only batch of cicada ice cream 66

I

Inside Columbia’s CEO

I

summer 2011

Inside Columbiaâ&#x20AC;&#x2122;s ceo OutFront Communications, LLC 301 W. Broadway Columbia, MO 65203

PRSRT STD U.S. Postage

PAID

Columbia, MO Permit 286