Becker's CEO + CFO Roundtable 2019: 3 Questions with Maria Ryan, Chief Executive Officer at Cottage Hospital

Maria Ryan, PhD, serves as Chief Executive Officer at Cottage Hospital. 

On November 11th, Maria will give a presentation on "New Ideas in Healthcare Reform" at Becker's 8th Annual CEO + CFO Roundtable. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place November 11-13, 2019 in Chicago.

To learn more about the conference and Maria's session, click here.

Question: What is going on right now?

Maria Ryan: I have been giving the status of our health in America a critical look and in doing so have broadened my definition of health. We typically look at healthcare as providing preventive care and episodic care. However, preventive care falls short for many reasons, including social determinants. We cannot wait until someone is an adult to start teaching them health strategies. This is where I think school systems can make a difference. I propose lengthening the school year and providing a comprehensive health curriculum. For example, in grade school, we should be providing nutrition information and providing a nutritious breakfast, lunch and afternoon snack to all children. Toothbrushes and toothpaste will be provided and ensure the children brush their teeth after breakfast and after lunch. We know from the Harvard studies that poor dentition leads to overall poor health; especially cardiovascular health. Another example would be that if a child is not involved in organized sports then the school can provide an after school exercise program. Given the rise in mental health diagnosis (especially anxiety), it is important to start promoting various forms of exercise starting at a young age. Mindfulness and yoga are a few strategies that could be introduced and practiced at school daily. Teaching the children about American history and how much ‘we’ have done for other countries offers a sense of pride and belonging. Financial health is also important to overall wellbeing and having a financial literacy program can only positively impact children’s lives. If we begin to implement these strategies, our children will grow to be healthier adults and experience less chronic illnesses. Just imagine in just a decade how much we will begin to bend the health and the cost curve!

Q: What is the single most important thing you need to do in your role?

MR: Lead. As the CEO, you have a unique feel of the entire internal mechanisms and external opportunities influencing your organization. A strategic leader will surround themselves with the best and brightest. Your direct reports will be busy doing process improvement in their area of expertise and offering new strategies. A thoughtful and forward-thinking leader will allow others to make their own decisions. You can lead and guide your organization through the tough times by being nimble and by using common sense. Too many times I see people who are unable to make decisions or move through a transition because of irrational emotions. Do you remember when guided imagery first came out to help patients with anxiety and for relaxation? Use a similar technique when meeting with your staff! Help them envision a perfect scenario of success. Once you articulate the vision in a way that is compelling your experts will figure out a way to get it done.

Q: Healthcare leaders today need skills and talents that span…..

MR: The skills needed today to lead a dynamic and innovative organization are different than yesteryear. Today’s CEO must think more like an entrepreneur… In an urban market, there shouldn’t be a need to repeat many of the same services. You need to take a critical look at your strengths and build upon them. You may let go of a service if it means you can dedicate additional resources to a cutting edge service that no one else has.

Cottage Hospital in Woodsville, NH provides services to 26 towns between NH and Vermont. A 35-bed hospital with a critical access designation is an example of a vibrant ‘fresh’ hospital. A designated trauma center for adults and pediatrics, multi-specialty clinic, Medical/Surgical and Intensive Care Unit, Physical and Occupational Departments are just an example of the services offered. Despite being a cash-poor hospital with an economically depressed service area, Cottage Hospital is referred to as “The Little Engine that Could”. At every turn, I want to increase access while maintaining a lower cost structure. This defies economics. Typically a low volume hospital needs to have higher charges to cover the cost of running a small business. You see this in a Mom and Pop hardware store. The prices will be somewhat higher than a national chain store because the Mom and Pop store does not have economies of scale.


Cottage Hospital provides the same services as other hospitals in the area but produces lower charges. This is done strategically. There is such charge variation amongst hospitals for the same service. If a business is self-insured for their health insurance, they will want their employees to have high-quality healthcare at a reasonable price. The business can then steer their employees to utilize your services and can even make this more attractive to employees by having a tier system. For instance, the business could emphasize; If you go to Cottage Hospital to have your total knee or hip done then you pay nothing out of pocket. But if you choose X facility you will have to pay a high copayment.


Nationally, we are in a mental health crisis. Cottage saw this need and developed an acute psychiatric inpatient (short stay) unit for seniors. The intent of this unit was to provide a necessary service to a region; not just the immediate community. The referrals come in from Southern New Hampshire, Vermont, Massachusetts, and Maine. Cottage Hospital is also a designated trauma center which therefore has 24/7 surgical coverage. Other rural hospitals have stopped doing emergency surgeries because the numbers were low and it is expensive to cover 24/7 with a surgeon and an operating staff. We recognized a need and thus started a referral in the center. The idea initially was for surgery patients but the referral center is often used to transfer medical or ICU patients to Cottage as well. These are just a few examples of the kind of entrepreneurial thinking done here at Cottage Hospital.

Hospital leaders face increasing demands on their time and must continually prioritize where to
focus their efforts and energy. As I partner with hospital leaders, it’s important to assess the impact
and benefits of projects to help prioritize initiatives.
For example, everyone is paying attention to the rise in specialty drug costs. Yet often there is little a
hospital can do to lower their specialty drug spend. However, there are substantial cost savings
possible through an improved reimbursement strategy and medication utilization-based projects.
Not only would prioritizing these initiatives drive meaningful results, they also are within the
hospital’s span of control.
In addition, I find that hospital leaders can overlook the pharmacy in performance improvement
initiatives, so it is an ongoing education and advocacy about the pharmacy’s potential impact. The
pharmacy should be a center of innovation for a hospital – and innovation is key to expanding
services and improving care.

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