Harry Nurkin didn't particularly want to come to Charlotte. In the spring of 1981, though, out of courtesy to a headhunter, he took a weekend off from his job as chief financial officer at the University of Alabama at Birmingham (UAB) Hospital to meet with the Board of Commissioners of Charlotte Memorial Hospital.
Although it had a decent medical staff, Charlotte Memorial lacked adequate facilities, was low on morale and was barely getting by financially.
Nurkin, a 36-year-old Durham native and Duke University graduate, shared his vision of transforming the moribund hospital into a first class healthcare facility with a distinguished board, which would include such rising business stars as Hugh McColl and Ed Crutchfield. They liked what they heard, and today, nearly twenty years later, Nurkin's vision is finally being fully realized in the form of Carolinas HealthCare System (CHS), a diversified $2 billion enterprise with nearly 5,000 hospital beds and a reputation as a top healthcare provider in the U.S.
"It sounded like an interesting opportunity," says Nurkin. "But my wife Jarleth and our boys and I had planted roots and didn't want to leave Birmingham." Before he left for the interview in Charlotte, he asked the dean at UAB what he knew about Charlotte. "He said the medical community may be the best in America for a region that doesn't have a medical school," recalls Nurkin. "They were pretty strong words from a guy who didn't brag too much."
Nurkin took the job. "The deciding factor was that, for all their wonderful parts, universities are impossible to manage. There are so many layers of interests that getting something accomplished takes months," he explains. "Selecting people can take years. In Charlotte, there were teaching programs for physicians and nurses, but decisions could be made quickly; therefore we could be more competitive and really see if our decisions were efficacious in the short term. What I saw was the best combination of a community hospital and a university hospital."
At the time, Charlotte Memorial was the number three hospital in a three hospital town, languishing well behind Presbyterian and Mercy hospitals. Because it was losing money, the hospital had to rely on general obligation bonds from Mecklenburg County just to make capital improvements. Nurkin knew this going in, but he had a few aces up his sleeves.
"We had an up-and-coming city in Charlotte, a very good medical staff, and a board that, person for person, was - and still is - unsurpassed in their understanding of business, their understanding of the need to care for human beings and their willingness to serve," he points out. Nurkin credits former chairman R. Stuart Dickson for much of the progress made by the hospital over the past two decades. "No single individual has had as much impact on our healthcare system as Stuart. He pioneered the transformation of Charlotte Memorial Hospital from a lethargic, suffering facility into Carolinas Medical Center - the dynamic cornerstone of Carolinas HealthCare System," wrote Nurkin in the CHS annual report.
Board members are quick to return the compliment. "Harry Nurkin was the best thing that ever happened to the Carolinas HealthCare System, or as I used to think of it, Charlotte Memorial Hospital," says board treasurer and Bank of America ceo Hugh McColl. "When the board brought Harry to Charlotte, we had high hopes he could improve the results of our hospital. He transformed it from a much-maligned public facility into the preferred medical provider, not only for this county but for dozens of others. He brought administration which produced profits, something unheard of before. He provided more and better medical attention to the public at a lower cost. In short, he has been a phenomenal success.
"What he did was bring a vision to the board. We embraced it - he executed it."
Nurkin's plan to revive the hospital was a fairly simple one that involved improving both the facilities and the morale. "I felt that if we could pump a little intellectual and emotional juice into the place and give the employees a vision of what it could be, we could decide if we could get there in a short period of time or not," he relates. "We wanted to draw more talented people and improve the facilities so when people went home from our hospital they would say, 'The people were really attentive; they were compassionate and competent, and it was a nice environment.' "
A complete overhaul of the hospital's facilities was essential. "This building we are in now [the Rush S. Dixon Tower] was the cornerstone for our organization," he says proudly.
During the 1960s and '70s, patients were placed in different sections of the hospital based on socioeconomic status. "I thought that if we were ever to become competitive we had to have a wonderful environment where nobody could tell if a patient had heavy insurance or no insurance," says Nurkin.
"So we built a building with all private rooms. When we opened this building, it enabled us to treat all God's children in exactly the same way without any concern for age, race, sex or socio-economic status. It was a powerful statement that says this organization treats everybody in the same fashion."
The building was also designed to appear decidedly non-institutional. When patients and visitors enter through the front lobby, for example, they encounter a two-story atrium full of light and space that resembles an upscale office lobby more than a hospital. Says Nurkin, "When people step through the door, you can see them relax just a little because the environment is designed to be soothing and reassuring, not intimidating or clinical."
The building is also quite efficient. For example, nurses' stations are circular hubs with hallway "spokes" that lead to patient rooms "so the nurse has something like 39 steps maximum to any patient," reveals Nurkin. "It's better for the nurses and allows for better patient care."
In addition to the facilities upgrade, Nurkin had to change the management culture at the hospital. He started with some underlying tenets. "We believe that there is a value system in almost every human being that is positive if you can tap into it," he says. "We also believe that people like to work but do not work at full capacity. So if you provide a pleasant environment and give employees the opportunity to learn more and grow, they feel very positive.
"We want them to have that positive feeling when their feet hit the floor in the morning. How do you do that? You listen to them - what makes their life miserable at work, what makes it fun. It boils down to open and honest communication. If you work here, we're not going to communicate with you by memo, and you're not going to find out things in your paycheck. We're going to listen to you and you're going to become part of the organization."
All managers and administrators are required to spend considerable time on the hospital floor. "Basically we are saying, 'You're going to have a nice work environment and we're going to do everything we can to make your life pleasant, understanding that you have a very critical, difficult and at times scary job.' It sounds rather simple, but not everybody does it. We do.
"Some companies issue pink slips around Thanksgiving and Christmas when they see their end of year numbers not looking so good. We just don't do that. The emotional downturn reverberates throughout the entire organization so the next time somebody's treating a patient in the emergency room, in the back of his or her mind is 'Am I going to be laid off next?' I don't want people thinking about that. I want people thinking about the person on the stretcher."
It has taken longer to create the kind of organization Nurkin envisioned 20 years ago. "The process that I thought was going to take five years was really a 20-year process," he admits. "I was a young guy - just 36 years old - and thought we could do this in a heartbeat. I learned that it takes longer to take people's hearts and minds and move them in a new direction. Even if they are enthusiastic, they still have to change."
The Road to Charlotte
Harry Nurkin did not plan to be a hospital administrator. Growing up, he wanted to be Mickey Mantle. When it became clear that wasn't going to happen, "I wanted to go to Vanderbilt and become a sports journalist, but our family couldn't afford that." Nurkin's father had died of diphtheria when Harry was just four years old. "As a senior in high school, I got a job at the Veterans Hospital in the summer, and got to see the environment in a heart research lab." Later, while at Duke studying political science, he went to work as a ward clerk at Duke Hospital to earn some additional money. He happened to meet Ray Brown, a pioneer in the field of healthcare management, who turned Nurkin on to the field of hospital administration.
Upon receiving his graduate degree in health administration, Nurkin headed to Baptist Memorial Hospital in Memphis, Tenn. After about three years he went to work for Memorial Mission, a smaller hospital in Asheville, N.C. Then in early 1980, Nurkin came to a conference in Charlotte and met a manby the name of Rush Jordan. "He offered me a job with the Baptist Hospital in Birmingham," says Nurkin. "I went for a visit and met with the head of the 800-bed university hospital at UAB.
We struck up a friendship and I became chief operating officer at age 27." Nurkin was nearly finished with his doctorate from the University of Alabama in Tuscaloosa when he took the job in Charlotte. He completed it in 1983.
While Nurkin loves his work, he admits, "I do worry about the fact that I have been ceo for 20 years. I don't want my style to become stale. I'm 56 so I've got a few years, but we will be looking at a succession plan on an ongoing basis."
When that time comes, Nurkin does not have any grandiose plans. "We're homebodies," he says. "I like to spend time with my family" which includes five boys, two of whom are still at home at ages 12 and 14. Together the family enjoys spending time boating at Lake Norman and going to the beach.
Until he does retire, Nurkin will continue to face the challenges of modern healthcare management. He does not need any external motivation, though, and tells this story to illustrate why.
"There was an 18-year old girl who was brought to the emergency room one day, unconscious with no symptoms. At the time it seemed pretty clear that she was going to die, and the family was told as much. But one of the physicians in our emergency medicine training program figured out the problem and talked to the family's attending physician. After some awfully difficult surgery, we moved the patient back to the intensive care unit to try to keep her alive. She was on dialysis, extra corporeal membrane oxygenation, a ventilator to breathe, and multiple IVs just to maintain blood pressure.
"She was here for over a month. After going through rehab, she left our institution with a couple of scars, but alive and with a long life ahead of her.
"I know who received that person, who diagnosed her, and who cared for her in the ICU. I know the surgeon who was called in the middle of the night to do an awfully difficult surgery. And I know the people in rehab who sent her home.
"The knowledge that we can do those kinds of things on a routine basis would get anybody out of bed to participate. My participation is vicarious, but it's exciting to know that people who I know are doing this stuff every day. We fail sometimes, but the process of using technology and science and people's minds and hearts is extremely invigorating.
"My job is to give them the environment to do that and to recruit the right people and make them happy. And to make sure that when they turn for something in the heat of battle with a patient that the right supplies are there, the right nurse is there, the right operating room is available. To me, I am assisting the physicians and the nurses and that feels pretty good."
It also feels pretty good to have someone like Dr. Harry Nurkin around, too. As Hugh McColl puts it, "All of the citizens of this county and this region should be thankful that Harry Nurkin chose to come here to carry out his life's work."