Michael Tarwater, Michael Dowling, Wayne Smith: 3 of the most interesting health system CEOs, part II

In the second part of a two-part installment, we examine the unique backgrounds, work ethics, interests and leadership styles of three of the nation's most powerful health system CEOs.

Michael Tarwater, CEO of Carolinas HealthCare System (Charlotte, N.C.). Mr. Tarwater has commanded the wheel as CEO of Carolinas HealthCare System since 2002, but he has been a leader for the system for more than 30 years. As CEO, he manages more than 60,000 employees in more than 900 care locations throughout the Carolinas and Georgia. Prior to joining Carolinas, Mr. Tarwater served as assistant administrator at the University of Alabama Hospitals in Birmingham.

Throughout his tenure, Mr. Tarwater has led CHS through tremendous growth in both size and complexity. His emphasis on the importance of a "single unified enterprise" strategy has been achieved by sharing best practices, recruiting premier medical staff for the system's urban and rural community facilities, as well as serving as a proponent of local policy guidance and decision-making.

Recently, Mr. Tarwater made headlines for his decision to eliminate CHS' president and COO position, meaning Joe Piemont, who has been with the system for 18 years, will leave his post at the end of May.

"After careful thought and evaluation, I have determined that the position of chief operating officer is no longer necessary and will be eliminated," Mr. Tarwater wrote in an email to CHS employees. "This latest change follows our restructuring last fall that helped to streamline the management structure, allowing us to become more nimble and enabling our system to better respond to the challenges and opportunities in front of us."

Mr. Tarwater is an accomplished pilot and holds an Airline Transport Pilot rating. He considers one of his greatest achievements to be piloting a transatlantic crossing from Nottingham, England, to North Carolina. In 2013, Mr. Tarwater raised eyebrows when it was disclosed that he took at least 29 personal flights on the system's patient and organ transport planes in a four-year period, often co-piloting. However, a spokesperson for the health system said his flights were counted as part of his compensation.

Michael J. Dowling, president and CEO of North Shore-LIJ Health System (Great Neck, N.Y.). Mr. Dowling has led New York's largest integrated healthcare system since 2002. North Shore-LIJ is also one of the nation's largest health systems, with $7.8 billion in annual revenue. With 19 hospitals, 400 outpatient physician practices, more than 6,400 beds and a workforce of about 54,000 employees, North Shore-LIJ is also the state's largest private employer.

Mr. Dowling grew up in Limerick, Ireland, and first arrived in the U.S. in the 1960s. In a period of nationwide poverty in Ireland, he came from a very modest home, describing it as an "old-fashioned thatched house with mud floors and mud walls, no running water, no heat, no anything." His success today as leader of one of the largest and most successful healthcare systems in the country illustrates his belief in the advice his mother gave him as a child: "Never let your circumstances limit your potential."

He spent a short period of time working in steel factories in England, then moved to New York where he took jobs in the docks, in construction, plumbing and as a janitor. Eventually, Mr. Dowling came into public service, serving in the New York State government for 12 years, including seven years as state director of health, education and human services and deputy secretary to the governor. He also served as commissioner of the New York State Department of Social Services.

Chuck Lauer, former published of Modern Healthcare, says of Mr. Dowling, "He is one of those individuals who converses with the future every day. He is probably one of the brightest individuals I ever had the pleasure to know in my 45-year career as a healthcare leader, journalist and observer of the healthcare industry. He is simply very special and when he speaks I listen very intently because I always learn something new. He comprehends what the true intent of healthcare has to be, which is the uncompromising devotion to the patients and their care."

Wayne T. Smith, chairman of the board, president and CEO of Community Health Systems (Franklin, Tenn.). Mr. Smith has served as president and CEO of CHS since 1997, and was additionally named chairman of the board in 2001. As chief, Mr. Smith oversees one of the nation's leading operators of general acute-care hospitals. CHS' affiliates own, operate or lease more than 200 hospitals in 29 states with approximately 31,100 licensed beds.

Prior to joining CHS, Mr. Smith served as president and COO of Louisville, Ky.-based insurance company Humana, where he spent 23 years in various management positions. Before joining Humana, Mr. Smith spent four years as a captain in the U.S. Army Medical Services Corps.

During his tenure at CHS, Mr. Smith has led the system through a series of acquisitions that have drastically expanded its reach, particularly the large-scale acquisition of Plano, Texas-based Triad Hospitals in 2007 and the January 2014 acquisition of Naples, Fla.-based Health Management Associates. The acquisition of Triad Hospitals nearly doubled the size of CHS at the time with the addition of 50 hospitals, while CHS added 70 more hospitals to its count after the HMA acquisition. CHS' expansion over the last several years has led the company to dethrone Nashville, Tenn.-based Hospital Corporation of America as the largest hospital operator in the U.S. by number of facilities.

Mr. Smith is described as a soft-spoken man with a gentle demeanor, but his leadership style is characterized as bold, confident and laser-specific — Mr. Smith makes every decision based on what is best for the company's strategic interests.

"These decisions aren't personal to me," Mr. Smith said at the Nashville Health Care Council's annual Wall Street Panel in April 2014 in response to a question regarding his personal satisfaction in the closing of the HMA acquisition. "They are around the opportunity to create jobs and if they're the right strategy for this company."

Under Mr. Smith's leadership, CHS has achieved one of the industry's strongest records of annual compound growth, raising net revenue from $742 million in 1997 to more than $13 billion in 2010, according to Auburn.

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