The No. 1 issue UofL Health leaders face each day is improving access to care, according to CEO Tom Miller.
The Louisville, Ky.-based health system’s mission — even during the COVID-19 pandemic — has been to never turn away someone in need and to improve the health of the communities it serves.
“Divert is a word I hear too often,” Mr. Miller told Becker’s. “I feel that’s an obligation I have: to never be in that position for our community.”
Health systems across the U.S. have long grappled with declining resources and rising patient volumes. Mr. Miller recalled calls from rural hospital CEOs facing urgent needs.
“I would get a call saying, ‘I have a patient who is going to die in my hospital because I have no pulmonologist, I have no cardiologist. Please take this patient,'” he said. “I feel an obligation to do our best to take care of those individuals.”
One way UofL Health — which includes nine hospitals and four medical centers — has expanded access is by bringing care closer to patients in underserved areas. In March 2024, the system opened UofL Health-South Hospital in Shepherdsville, bringing vital services to Kentucky’s largest county without an inpatient hospital.
Clinician recruitment in rural areas has been key to expansions, Mr. Miller said.
“Workforce is the one component I get the most concerned about,” he said. “Twenty years ago, we used to create our own workforce. We used to teach our technicians. We had nursing schools that were within the health systems.”
Today, the industry relies more heavily on community colleges and universities — a shift that is prompting UofL Health to rebuild internal pipelines.
“We’ve started our own radiology program again, our surgical tech program, our CNA programs,” Mr. Miller said. “The reality is that we are going to need the ability to create our own workforce.”
While nursing shortages amid an aging U.S. population have received widespread attention, Mr. Miller emphasized the industry is not talking enough about other gaps.
“I’ve got to have radiology techs, I’ve got to have respiratory techs, I’ve got to have lab techs,” he said. “I believe the industry is going to find itself back into a situation where we can’t rely on the community colleges to build our workforce.”
He also reflected on how CEO-physician relationships have evolved.
“I’m a firm believer that physicians have to be our partners for us to do things well together,” he said. “That has been my mantra all along: Let’s find the wins for our doctors and our health system. They’re there to help us, and we need to work together.”
Competition among leaders
With more than 30 years of healthcare experience, Mr. Miller has navigated staffing shortages, potential Medicaid cuts and rising pharmaceutical prices.
“The ability to juggle 100 different things at one time is a challenge for anybody in this role,” he said. “The reality is, you can’t do it all.”
Hiring the best people, he added, is essential.
Within UofL Health’s nine hospitals, Mr. Miller said he hires the smartest CEOs he can find — leaders who, in his words, practice “co-opetition.”
“They compete against each other to some extent, but they also cooperate with each other,” he said. “Sometimes you get into a situation where they compete — that’s a positive, not a negative. It makes everybody better.”
Looking back on his career, Mr. Miller measures his success by a personal benchmark inspired by his first day of graduate school. During his first class in a master’s program for hospital and health administration, a professor asked students: “What is your tombstone going to say?”
“I ended up writing down, ‘I improved the health of every community I serve,'” Mr. Miller said. “That has been a part of every mission statement at every organization I’ve led. That’s what I hope I’ve done.”
